Abstract
Rheumatic diseases (RDs) are often complicated by chronic symptoms and frequent side-effects associated with their treatment. Saffron, a spice derived from the Crocus sativus L. flower, is a popular complementary and alternative medicine among patients with RDs. The present systematic review aimed to summarize the available evidence regarding the efficacy of supplementation with saffron on disease outcomes and comorbidities in patients with RD diagnoses. PubMed, CENTRAL, clinicaltrials.gov and the grey literature were searched until October 2021, and relevant randomized controlled trials (RCTs) were screened for eligibility using Rayyan. Risk of bias was assessed using the Cochrane’s Risk of Bias-2.0 (RoB) tool. A synthesis without meta-analysis (SWiM) was performed by vote counting and an effect direction plot was created. Out of 125 reports, seven fulfilled the eligibility criteria belonging to five RCTs and were included in the SWiM. The RCTs involved patients with rheumatoid arthritis, osteoarthritis and fibromyalgia, and evaluated outcomes related to pain, disease activity, depression, immune response, inflammation, oxidative stress, health, fatigue and functional ability. The majority of trials demonstrated some concerns regarding overall bias. Moreover, the majority of trialists failed to adhere to the formula elaborations suggested by the CONSORT statement for RCTs incorporating herbal medicine interventions. Standardization of herbal medicine confirms its identity, purity and quality; however, the majority of trials failed to adhere to these guidelines. Due to the great heterogeneity and the lack of important information regarding the standardization and content of herbal interventions, it appears that the evidence is not enough to secure a direction of effect for any of the examined outcomes.
Highlights
Rheumatic and musculoskeletal diseases have the highest population impact across all adverse health outcomes, including greater disability-adjusted life years (DALY) [1,2].Due to the chronic nature of these conditions and the frequent side-effects associated with their treatment, patients often resort to complementary and alternative medicines (CAMs), in search of “less toxic” therapies [3,4].Garlic, ginger, curcumin, cinnamon, or saffron are a few of the most popular CAMs used in rheumatic diseases (RDs) [5,6,7]
The present synthesis without meta-analysis (SWiM) assessed the effects of supplementary Crocus sativus L. intake on disease-related outcomes among patients with a Rheumatic diseases (RDs) diagnosis
In the present SWiM, randomized controlled trials (RCTs) performed in patients with an OA diagnosis were included, as often, patients with rheumatoid arthritis (RA) are misdiagnosed with OA, and vice versa [22]
Summary
Ginger, curcumin, cinnamon, or saffron are a few of the most popular CAMs used in rheumatic diseases (RDs) [5,6,7]. The medicinal properties of saffron and its constituents (safranal, crocin, and crocetin) include anti-inflammatory, antioxidant, analgesic, antihypertensive, hypolipidemic, antitussive, anticonvulsant, antidepressant, anxiolytic, anticancer, and antinociceptive characteristics [9,10,11,12,13,14,15]. Saffron supplementation has been tested in patients with various RDs employing a randomized controlled trial (RCT) design, we have insufficient evidence regarding its efficacy, as no systematic reviews have attempted to synthetize these data in order to aid in the formulation of recommendations
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