Role of food-based antioxidants in autoimmune disorders: A comprehensive systematic review with integrated clinical data

Abstract

Oxidative stress and chronic inflammation are central to the pathogenesis of autoimmune disorders, affecting nearly 90 million individuals worldwide. This systematic review evaluates evidence on food-based antioxidants in major autoimmune diseases, including rheumatoid arthritis (RA), systemic lupus erythematosus, multiple sclerosis (MS), type 1 diabetes, and inflammatory bowel disease. A literature search (2010–2026) across PubMed, PMC, Web of Science, and Cochrane identified 37 high-quality randomized trials, meta-analyses, and mechanistic studies. Curcumin showed the strongest clinical efficacy, significantly reducing RA disease activity (DAS-28) and inflammatory markers. Resveratrol modulated immune responses via SIRT1 activation, while EGCG reduced Th17 cells and enhanced regulatory T cell differentiation. Coenzyme Q10 improved fatigue and disability in MS, and anthocyanin-rich interventions enhanced remission rates in ulcerative colitis. Mechanistically, antioxidants inhibited NF-κB and NLRP3 while activating Nrf2 and SIRT1 pathways. Gut microbiota modulation emerged as a key determinant of efficacy. Despite promising safety and efficacy, standardized dosing and large-scale trials are needed.