No 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.

No abstract

Due to its anti-inflammatory and antioxidant capacity and, by inference, its involvement in the myelin stealth attainment, oral nutrient supplementation (ONS) with saffron has recently been investigated as a complementary treatment in multiple sclerosis (MS). The purpose of the present study was to systematically review the literature for randomized controlled trials (RCTs) comparing saffron supplementation to placebo, or other interventions, in patients with an MS diagnosis. PubMed, CENTRAL, and clinicaltrials.gov were searched for relevant completed or ongoing RCTs. The Cochrane’s RoB tool 2.0 was used, and a qualitative synthesis without meta-analysis (SWiM) was performed. In total, five parallel, double-, or triple-blind RCTs were identified, fulfilling the study’s criteria, and were included in the SWiM. Intervention duration ranged from four weeks to a year. The summary RoB revealed some concerns, or even high risk for overall bias. The included RCTs failed to report particularities of their interventions (exact composition, active compound, safety assays, etc.) and adverse events. The SWiM revealed that according to the results of single trials, inflammation markers (TNF-a and IL-17) were reduced, and MS-specific biomarkers (MMP-9 and TIMP-1) and cognition were improved after saffron ONS, although definite conclusions regarding saffron efficacy with regard to these outcomes cannot be drawn. Two RCTs reported improvement in the redox status of patients receiving saffron, whereas, with regard to depression, the findings were conflicting. Overall, ONS with saffron compounds may prove beneficial in improving antioxidant defense and oxidative stress in patients with MS; however, the evidence appears scattered, heterogenous, and inadequate in terms of making any suggestions regarding the direction of effect of other outcomes. Trials of better design and MS-specific outcomes are required.