Ankylosing Spondylitis

Suhas Balakrishna et al. (2026) · Journal of lifestyle medicine

This systematic review and meta-analysis pooled 33 controlled studies with 2,651 adults to ask whether pelotherapy, the application of mineral-rich mud, peat or clay as packs, wraps or full baths, eases musculoskeletal disorders. These include osteoarthritis (joint cartilage wear), rheumatoid arthritis (an autoimmune joint disease), fibromyalgia (widespread pain) and chronic low back pain. Pelotherapy is a traditional naturopathic practice used in spas, balneological centres and clinics in at least 40 countries, and the authors set out to test it against modern standards: pre-registration, risk-of-bias rating and GRADE certainty scoring. The team searched eight databases and trial registers up to April 2026. Included trials enrolled adults with a confirmed musculoskeletal diagnosis, applied mud as the main treatment for 10 to 21 sessions over two to three weeks, and compared it with sham treatment, usual care, waiting lists or nothing. Pain was mostly rated on a 0-100 mm visual analogue scale or a 0-10 numeric scale, and function on questionnaires such as the WOMAC. Two reviewers worked independently and combined results with random-effects statistics. Pain dropped clearly after mud treatment (standardised mean difference -0.74, a moderate-to-large effect, roughly 18.5 mm on the 100 mm scale and above the 15 mm threshold for a meaningful change). The effect was still present at 3 months (-0.61) and at 6 months (-0.49, low certainty). Physical function (-0.69) and quality of life (+0.58 on SF-36) improved as well, with osteoarthritis trials using the WOMAC at -0.82 and rheumatoid arthritis trials using the HAQ at -0.58. Morning stiffness (-0.52) and C-reactive protein, a blood marker of inflammation (-0.44), fell modestly, while the erythrocyte sedimentation rate did not change significantly. Knee osteoarthritis showed the biggest benefit (-0.86), and Dead Sea mud the strongest peloid effect (-0.84). Serious adverse events were no more common than in controls (relative risk 0.98); about 6.5% of mud recipients had mild, short-lived skin redness, largely from heat. The authors note several limits: participants cannot be blinded to mud, peloid type, temperature and protocol varied widely, results differed between trials (I2 = 62% for pain), a correction for possible publication bias lowered the pain estimate to -0.66, most trials came from European spa settings, and safety beyond 12 months is unknown. They call for larger blinded trials with standardised peloids and longer follow-up, and frame pelotherapy as an adjunct to, not a replacement for, drug and physiotherapy care.

Tatiana Leite Müller et al. (2026) · International journal of biometeorology

This systematic review of nine studies with 465 adults looked at climatotherapy, the therapeutic use of climate and natural settings, for musculoskeletal and rheumatologic disorders such as osteoarthritis, rheumatoid arthritis, fibromyalgia and ankylosing spondylitis. The settings were the Dead Sea (very salty water, low humidity, distinctive solar radiation and air pressure about 5% above sea level) and coastal sites using thalassotherapy, which means bathing and exercising in seawater, sometimes with marine mud, sun exposure and sea air. Because these programs vary widely, the authors wanted to gather what trials say about pain, physical function, quality of life and safety. The reviewers searched three databases through September 2025 and included eight randomized trials and one non-randomized study from 1995 to 2011, mostly in Israel. Participants were aged 18 to 65 and stayed at a spa or coast for 10 days up to 12 weeks. Comparison groups used freshwater pools, usual care, pool exercise or the same program in Norway. Pain was usually rated on a 0 to 100 visual analog scale, and quality of life was measured with questionnaires such as the SF-36. Most studies reported short-term improvements in pain, stiffness, function and quality of life, mainly within groups. Only two studies could be pooled for pain, giving an inconclusive overall result (SMD -0.47, 95% CI -5.47 to 4.53; an interval too wide to show benefit or no benefit). Split by condition, osteoarthritis showed a large effect (SMD -1.01, meaning pain fell by roughly one standard deviation more than with comparison) while fibromyalgia showed a small non-significant one (SMD -0.18, p = 0.158). In fibromyalgia, single-study estimates showed fewer tender points (SMD -0.50, p = 0.0047) and better physical quality of life (SF-36 physical score 0.36, p = 0.0391), but mood scores (p = 0.5968) and overall fibromyalgia impact (p = 0.0612) did not change significantly. No serious adverse events were reported, though only one study recorded adverse events explicitly. The evidence has important limits: trials were small and published between 1995 and 2011, participants and therapists could not be blinded, safety was inconsistently recorded, and several programs combined many components, so the effect of the climate itself is hard to separate. Only one trial analyzed all participants as randomized, and the pooled estimate rests on two studies. Certainty was judged low. The authors suggest climatotherapy may be a complementary option, particularly for osteoarthritis, and call for multicenter randomized trials with standard outcome sets and systematic safety reporting.

Liuting Zeng et al. (2022) · Frontiers in immunology

This systematic review and meta-analysis pooled 31 randomized controlled trials (34 study records, roughly 1,583 participants) exploring curcumin and Curcuma longa (turmeric) extract across 10 autoimmune diseases — conditions where the immune system mistakenly attacks the body's own tissue. Autoimmune disease covers more than 120 named conditions; this review focused on ankylosing spondylitis, Behçet's disease, Crohn's disease, multiple sclerosis, oral lichen planus, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, Takayasu arteritis, and ulcerative colitis. Curcumin is the main active compound in turmeric, long used in Chinese medicine, and is studied here for its ability to regulate immune cells and reduce inflammation. Researchers searched English and Chinese databases plus the Cochrane Library and ClinicalTrials.gov through February 2022, screening 2,991 records down to 31 RCTs that tested curcumin or Curcuma longa extract against placebo or usual care. Trial count per disease varied widely: 9 RCTs for ulcerative colitis and 6 for oral lichen planus, but only 1 each for ankylosing spondylitis, Behçet's disease, and Takayasu arteritis. Doses ranged from 60 mg to 6,000 mg daily, taken orally, or in some trials applied as a gel, mouthwash, or enema, for 2 to 96 weeks. Disease activity was tracked with condition-specific scales (PASI for psoriasis, DAS28 for rheumatoid arthritis, EDSS for multiple sclerosis, and others) alongside blood markers like ESR and CRP. Where enough trials existed to combine statistically, curcumin performed well. In psoriasis, it roughly tripled the rate of major skin-clearance (PASI75: RR=3.01, p=0.008—meaning patients getting curcumin were about three times as likely to see substantial improvement). In ulcerative colitis, it raised clinical remission more than twofold (RR=2.28, p=0.0005) and lowered inflammatory markers ESR and CRP. In rheumatoid arthritis, it reduced the DAS28 disease-activity score (WMD=-1.10, p=0.0002—a clinically noticeable drop in joint disease activity), though results varied considerably between the five trials. Oral lichen planus, despite being studied in six trials, did not show a significant benefit on its pooled lesion-severity score (p=0.17). None of the pooled analyses found more side effects with curcumin than with placebo. The other six diseases each had just one or two small trials reporting improvement, too few to combine or confirm. These findings support curcumin as a reasonably safe adjunct for psoriasis, ulcerative colitis, and rheumatoid arthritis specifically, where the evidence is strongest and most consistent; for the seven other diseases, results are preliminary and should not yet guide treatment decisions. Curcumin's poor absorption from the gut remains a practical obstacle to reliable dosing. The authors call for larger, multi-center trials, especially for the thinly studied conditions, before broader clinical recommendations can be made.

Zeng L et al. (2022) · Frontiers in Immunology

This systematic review and meta-analysis evaluates the efficacy and safety of curcumin and Curcuma longa extract across five types of arthritis: rheumatoid arthritis (RA), osteoarthritis (OA), ankylosing spondylitis (AS), juvenile idiopathic arthritis (JIA), and gout/hyperuricemia. Twenty-nine randomized controlled trials involving 2,396 participants were included, drawn from 11 countries. For RA (6 RCTs), curcumin significantly reduced disease activity (DAS28), ESR, CRP, and rheumatoid factor compared to controls. For OA (20 RCTs), curcumin reduced pain (VAS and WOMAC-pain), improved physical function, and decreased stiffness compared to placebo. Notably, curcumin showed comparable efficacy to NSAIDs (ibuprofen, diclofenac) with significantly fewer adverse events. For AS, a single RCT of nanocurcumin showed increased regulatory T cells and decreased IL-6. Two JIA trials found curcumin improved disease activity scores in children. Doses ranged from 120 to 1,500 mg daily for 4-36 weeks. The mechanisms of action include inhibition of NF-kB signaling, COX-2 suppression, NLRP3 inflammasome inhibition, and modulation of the RANK/RANKL/OPG system. Safety was favorable across all studies, with no serious adverse events attributed to curcumin. However, the evidence is limited by small sample sizes, short follow-up periods, high heterogeneity, and potential industry funding bias.