Systematic Review of N-Acetylcysteine Supplementation in the Management of Rheumatic Diseases

Abstract

Introduction: N-acetyl cysteine (NAC) has been used to treat several rheumatological conditions. The study aimed to review the use of NAC in rheumatic diseases. Methods: PubMed/MEDLINE, EMBASE, and Scielo databases were screened for articles on NAC and rheumatic diseases until September 2023. Results: 23 articles were found with 13,603 patients. The investigated diseases were systemic sclerosis, systemic lupus erythematosus (SLE), rheumatoid arthritis, Sjogren syndrome, bone metabolism, and a national cohort. Age varied from 17 to 64 ± 7 years old, and female gender ranged from 45.0% to 100.0% in the included articles. Disease duration ranged from 2 months to 12.1 ± 8.36 years. The NAC dosage ranged from 600 to 4,800mg/day. Concerning outcomes, the SSc articles showed improvement in digital ulcers, reduction in frequency and severity of Raynaud phenomenon, improvement in modified Rodnan skin score, reduction in pain visual analog scale, and one of them saw improvement in lung capacities. Regarding RA, all but one showed improvements in visual analog scale (VAS), health assessment questionnaire (HAQ), disease activity score- 28 joints (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP). In SLE, a reduction in SLE disease activity index (SLEDAI) and British Isles Lupus Assessment Group (BILAG) scores, glucose, CRP, and anti-dsDNA antibody levels were observed. An increase in CH50 was also seen. Unexpectedly increased risk of osteoarthritis in whom was under NAC. The side effects were mild in all studies. Conclusion: NAC seems to be safe in treating some rheumatic conditions, especially lupus, rheumatoid arthritis, and Sjogren syndrome. Running title: NAC in rheumatic diseases.