Immunostimulatory Herbal Supplements and Their Hidden Impact on Connective Tissue Diseases: a scoping review

Background: Immunostimulatory dietary supplements are widely used and increasingly marketed to patients, including those with autoimmune and connective tissue diseases. However, the scope and characteristics of the existing literature examining their potential associations with disease onset, flares, or cutaneous manifestations remain unclear. Objective: The objective of this scoping review is to map and characterize the existing literature evaluating immunostimulatory supplements in relation to connective tissue diseases, including implicated supplements, reported clinical outcomes, patient populations, and study designs. Methods: This scoping review will be conducted in accordance with established scoping review methodology and reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We will search multiple electronic databases and relevant gray literature sources for studies published in English from inception to the date of search. A single reviewer will conduct title/abstract and full-text screening using predefined eligibility criteria, with uncertainties resolved through consultation with a senior author. Data will be extracted using a standardized and piloted charting form. Findings will be synthesized using descriptive statistics and narrative methods to summarize the breadth of evidence and identify gaps in the literature.