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Review Open Access

Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review)

  • Authors:
    • So Yeon Park
    • Min Seok Kwon
    • Sunju So
    • La Yoon Choi
    • Dae Yong Kim
    • Mi Hye Kim
  • View Affiliations / Copyright

    Affiliations: Department of Korean Medicine, College of Korean Medicine, Woosuk University, Jeonju, Jeollabuk-do 54986, Republic of Korea
    Copyright: © Park et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 4
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    Published online on: October 29, 2025
       https://doi.org/10.3892/br.2025.2077
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Abstract

Ankylosing spondylitis (AS) is an autoimmune disease characterized by chronic inflammation in the sacroiliac joints and cartilage, resulting in symptoms such as back pain, morning stiffness, sacroiliitis, and extra-articular manifestations. Several drugs reduce the inflammatory response, such as nonsteroidal anti-inflammatory drugs, and disease-modifying antirheumatic drugs. However, the adverse effects and high costs associated with drug therapy highlight the need for complementary treatments. In the present review, significant alternative and complementary remedies for the treatment of AS are examined to provide broader insight. PubMed and Google Scholar were searched for alternative and complementary treatments for AS, using the keywords ‘ankylosing spondylitis’, ‘spondyloarthropathy’, ‘oriental medicine’, ‘herbs’, and ‘therapy’. The symptoms and underlying pathogenesis were described based on diagnostic methods, including principal criteria and radiographic findings. In addition, current remedies for AS, including exercise and pharmacological treatments, were reviewed alongside evidence indicating that alternative therapies, such as moxibustion, decoctions, herbal medicines, and plant-derived compounds, may regulate inflammation, oxidative stress, and abnormal osteogenesis in AS. Given the risks associated with drug use, herbal remedies, including decoctions, formulations, individual herbal extracts, and compounds isolated from herbs, may represent promising therapeutic options for managing the progression of AS. Further large-scale studies, building on cell- and animal-level research, are required to validate the efficacy of herbal medicines.
View Figures

Figure 1

Diagram of possible pathogenesis of
ankylosing spondylitis. The four hypotheses of HLA-related
pathogenesis: The arthritogenic peptide theory, the misfolding
theory, the homodimer theory, and the mimicry theory. The
arthritogenic peptide theory suggests that presentation of abnormal
or self-like peptides by HLA-B27 activates autoreactive
CD8+ T cells. The misfolding theory emphasizes that
ERAP1 variants generate aberrant peptides that fail to stabilize
HLA molecules, resulting in misfolded HLA accumulation in the ER.
This induces ER stress and the UPR, subsequently activating
autophagy and promoting IL-23 production. The homodimer theory
suggests that dissociation of the β2-microglobulin light
chain allows HLA-B27 heavy chains to form homodimers, which
strongly interact with KIRs on NK and Th17 cells. Th17 activation
by IL-23 and homodimer signaling promotes release of IL-17 and
IL-22, leading to inflammation, bone erosion, and new bone
formation. The mimicry theory proposes that microbial peptides
structurally resemble self-peptides, leading to cross-reactive
immune responses when presented by HLA-B27. The interplay of bone
erosion and aberrant new bone formation ultimately contributes to
pathological bone fusion. HLA, human leukocyte antigen, ERAP1,
endoplasmic reticulum aminopeptidase 1; ER, endoplasmic reticulum;
UPR, unfolded protein response; IL, interleukin; KIRs, killer
immunoglobulin-like receptors; NK, natural killer.
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Copy and paste a formatted citation
Spandidos Publications style
Park SY, Kwon MS, So S, Choi LY, Kim DY and Kim MH: Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review). Biomed Rep 24: 4, 2026.
APA
Park, S.Y., Kwon, M.S., So, S., Choi, L.Y., Kim, D.Y., & Kim, M.H. (2026). Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review). Biomedical Reports, 24, 4. https://doi.org/10.3892/br.2025.2077
MLA
Park, S. Y., Kwon, M. S., So, S., Choi, L. Y., Kim, D. Y., Kim, M. H."Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review)". Biomedical Reports 24.1 (2026): 4.
Chicago
Park, S. Y., Kwon, M. S., So, S., Choi, L. Y., Kim, D. Y., Kim, M. H."Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review)". Biomedical Reports 24, no. 1 (2026): 4. https://doi.org/10.3892/br.2025.2077
Copy and paste a formatted citation
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Spandidos Publications style
Park SY, Kwon MS, So S, Choi LY, Kim DY and Kim MH: Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review). Biomed Rep 24: 4, 2026.
APA
Park, S.Y., Kwon, M.S., So, S., Choi, L.Y., Kim, D.Y., & Kim, M.H. (2026). Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review). Biomedical Reports, 24, 4. https://doi.org/10.3892/br.2025.2077
MLA
Park, S. Y., Kwon, M. S., So, S., Choi, L. Y., Kim, D. Y., Kim, M. H."Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review)". Biomedical Reports 24.1 (2026): 4.
Chicago
Park, S. Y., Kwon, M. S., So, S., Choi, L. Y., Kim, D. Y., Kim, M. H."Comprehensive overview of alternative medicine in the treatment of ankylosing spondylitis: Symptoms, pathogenesis, diagnosis and treatments (Review)". Biomedical Reports 24, no. 1 (2026): 4. https://doi.org/10.3892/br.2025.2077
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