Climatotherapy in marine and dead sea environments for musculoskeletal and rheumatologic conditions: a systematic review of effectiveness and safety.

Climatotherapy (including thalassotherapy, sun exposure, and marine mud therapy) has long been used as a complementary intervention for musculoskeletal and rheumatologic disorders (MSRDs), yet its evidence base remains fragmented and methodologically heterogeneous. To synthesize the effectiveness and safety of climatotherapy in marine or Dead Sea environments for MSRDs, focusing on pain, physical function, and health-related quality of life. Following Joanna Briggs Institute methodology and PRISMA 2020, PubMed, PEDro, and the Cochrane Library were searched (May 2024; updated September 2025) for randomized and non-randomized trials of climatotherapy in marine or Dead Sea settings. Methodological quality was assessed with the PEDro scale. A structured narrative synthesis was complemented by a limited meta-analysis of pain; given the few trials and substantial heterogeneity, pooled estimates are exploratory. Ten articles representing nine studies (n = 465) were included. Interventions consistently produced short-term improvements in pain, physical function, and quality of life. Pooling was feasible only for pain (k = 2) and was statistically inconclusive, but condition-specific analysis showed a large, significant effect in osteoarthritis and a smaller, non-significant effect in fibromyalgia. Single-study estimates indicated benefits for tender point count and physical quality of life. No serious adverse events were reported, though safety was inconsistently assessed. Climatotherapy shows consistent short-term benefits, particularly for pain and physical function in osteoarthritis. Methodological limitations preclude firm pooled conclusions; rigorous multicenter trials with standardized outcomes and safety reporting are needed. Trial RegistrationPROSPERO CRD42024534694 (registered May 2024).