Pantothenic acid (vitamin B5) supplementation in rheumatological diseases: a review

Background: Pantothenic acid (PA), the dietary precursor of coenzyme A, plays a central role in mitochondrial metabolism, lipid regulation, and the synthesis of steroid hormones and neurotransmitters. Although PA has been traditionally applied in areas such as wound healing and immunomodulation, its potential therapeutic relevance in rheumatology has not been well characterized. Objective: To provide an updated overview of the clinical effectiveness, safety, and research gaps related to PA supplementation in rheumatic diseases. Methods: A structured search was performed across PubMed/MEDLINE, Web of Science, SciELO, and LILACS for human studies published up to July 2024. Eligible articles investigated PA supplementation in patients with rheumatic diseases and reported clinical outcomes. Key data relating to population characteristics, dosage, treatment duration, outcomes, and adverse effects were extracted. Results: Seven studies involving 183 participants were included: two focused on osteoarthritis (OA), one on fibromyalgia (FM), and four addressing systemic lupus erythematosus (SLE). PA was administered using heterogeneous regimens, generally in combination with other micronutrients, at doses ranging from 12.5 mg to 12 g/day and over variable follow-up durations. Clinical improvement was reported in most studies, especially in cutaneous lupus, in which substantial resolution of lesions was frequently observed. Benefits in fatigue in SLE and pain reduction in OA and FM were also noted. Adverse events were rare and predominantly mild. Conclusions: Available clinical evidence suggests that PA supplementation may provide symptomatic benefit in selected rheumatic diseases, with a favorable safety profile. However, current data remain limited by small sample sizes, lack of standardized protocols, and frequent co-supplementation. Well-designed randomized clinical trials—especially in SLE and OA—are required to determine therapeutic efficacy, optimal dosing, and mechanistic pathways.