The efficacy of complementary and alternative medicine non-pharmacological interventions in improving disease activity and inflammation in ankylosing spondylitis: a network meta-analysis.

Objective: Ankylosing spondylitis (AS), a chronic progressive autoimmune disease primarily affecting the axial joints, frequently causes symptoms such as pain, stiffness, and functional limitations. In recent years, complementary and alternative medicine (CAM) non-pharmacological therapies have gained increasing recognition within the academic community for their potential efficacy in alleviating AS symptoms. This study aims to evaluate the effectiveness of CAM therapies in relieving AS symptoms. Methods: This systematic review was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD420261323792). A comprehensive search of English and Chinese databases was conducted from their inception until 1 January 2026. Search criteria focused on prospective controlled trials of CAM therapies for AS patients. Statistical analysis employed mean values and standard deviations. Additionally, study quality and potential bias were assessed. Results: Thirty-one randomized controlled trials involving 2,459 patients with ankylosing spondylitis and 15 complementary and alternative medicine interventions were included. The network meta-analysis (NMA) revealed that, compared with conventional therapy, AI (MD = -1.81, 95% CI [-2.90, -0.73]), Acu (MD = -1.63, 95% CI [-2.85, -0.41]), Moxibustion (MD = -1.51, 95% CI [-2.58, -0.44]), and Moxibustion + Cupping (MD = -1.05, 95% CI [-2.07, -0.03]) demonstrated statistically significant improvements in BASDAI scores. Regarding functional status (BASFI), several CAM interventions showed favorable trends, although further evaluation is required. For pain relief (VAS), IH (MD = -1.75, 95% CI [-2.98, -0.52]), AA (MD = -1.37, 95% CI [-2.46, -0.28]), Acu (MD = -1.05, 95% CI [-2.03, -0.07]), and Moxibustion (MD = -0.76, 95% CI [-1.46, -0.06]) demonstrated statistically significant improvements compared with conventional therapy. Regarding inflammatory markers, Moxibustion (CRP: MD = -40.69, 95% CI [-76.83, -4.55]) showed a statistically significant reduction in C-reactive protein levels compared with conventional therapy. SUCRA probability ranking suggested that some CAM interventions had higher probabilities of achieving favorable outcomes; however, these rankings should be interpreted cautiously because they represent relative probabilities rather than definitive evidence of clinical superiority. The observed differences among interventions should primarily be considered together with effect estimates, confidence intervals, and clinical relevance to determine their true clinical effectiveness and safety. Conclusion: Moxibustion combined with cupping showed a favorable probability of improving pain outcomes; however, this finding requires confirmation due to limited certainty of evidence. Several CAM interventions demonstrated potential benefits in improving disease-related outcomes, including disease activity, pain, and inflammatory markers. However, the safety profile of CAM interventions should be interpreted cautiously because adverse events were incompletely reported among the included studies. Overall, the available evidence does not allow definitive conclusions regarding the safety of CAM therapies in patients with ankylosing spondylitis. Systematic review registration: CRD420261323792; https://doi.org/10.37766/inplasy2025.12.0043.