Abstract

OXIDATIVE STRESS–INFLAMMATION AXIS IN RHEUMATOID ARTHRITIS: MECHANISMS AND THERAPEUTIC IMPLICATIONS

Jay Nagdeve*, Ankit Kediya, Dr. B. R. Gandhare, Sandhya Jadhao, Rutuja Mind

ABSTRACT

Persistent synovial inflammation, increasing joint degeneration, and functional impairment are the hallmarks of rheumatoid arthritis (RA), a chronic systemic inflammatory disease. Oxidative stress has recently come to light as a crucial factor in the pathophysiology of RA, intimately interacting with inflammatory pathways to propel the disease's advancement. In the inflammatory synovial milieu, excessive formation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) causes oxidative damage to lipids, proteins, DNA, and extracellular matrix components, which intensifies tissue damage and immunological responses. Redox-sensitive signalling pathways, such as NF-κB, MAPK, and cytokine- mediated processes, are activated by this oxidative imbalance. These pathways further prolong inflammatory cascades and encourage osteoclast activation and cartilage breakdown. The main goal of current RA treatment approaches is to reduceinflammation with disease- modifying antirheumatic medications (DMARDs) and biologic medicines that target cytokines like TNF-α, IL-6, and IL-1. Targeting the oxidative stress–inflammation axis, however, may offer more therapeutic advantages, according to mounting data. Natural substances like curcumin, resveratrol, and N-acetylcysteine are examples of antioxidant-based strategies that show promise in regulating redox balance, blocking pro-inflammatory signalling pathways, and shielding joint tissues from oxidative damage. Superoxide dismutase mimetics, combination therapy with traditional medications like methotrexate, and nanotechnology-based antioxidant delivery systems are examples of emerging approaches that show promise for increasing therapeutic efficacy while lowering drug-related toxicity.The molecular pathways that connect oxidative stress and inflammation in RA are highlighted in this review, along with new and existing treatment approaches that target this pathogenic axis. Comprehending the relationship between immune dysregulation and redox imbalance may aid in the creation of more focused and efficient long-term treatments for rheumatoid arthritis.

Keywords: Rheumatoid arthritis; Oxidative stress; Reactive oxygen species; NF-?B signaling; Antioxidant therapy; Disease-modifying antirheumatic drugs.