Rheumatoid arthritis: Pathophysiology, treatment and improved efficacy of targeted treatment using novel herbal therapeutics formulations

Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease that leads to synovial inflammation, destruction of articular cartilage, bone erosion, deformities, accompanied by pain, swelling, and stiffness, most commonly in limbs. The pathophysiology elaborates on the role of T-helper (Th1) cells secreted in response to interleukin-1 (IL-1) and 12, thus producing pro-inflammatory ILs whereas Th2 cells activated by IL-4 secretes anti-inflammatory cytokines (IL-4, 5, 10 and 13). A neutralization of endogenous anti-inflammatory cytokines mainly IL-10 by the production of anti-IL-10 monoclonal antibodies, results in the downregulation of antiinflammatory cytokines which lead to more severe collagen-induced arthritis. Conventional treatment for RA includes non-steroidal anti-inflammatory drugs, glucocorticoids, non-biologics, and biological disease-modifying anti-rheumatic drugs, a conjugate of the humanized monoclonal antibody, dendritic cells, etc. Although, conventional therapy and newer treatments are effective but suffer from several limitations like serious adverse effects, high cost, and invasive intervention. The information regarding disease, pathophysiology, treatment, and novel interventions was collected through vigorous literature search from authentic search engines, books and journals using relevant keywords. Novel herbal therapies using phytochemicals of Curcuma longa, Zingiber officinale, Glycyrrhiza glabra, Withania somnifera, Tripterygium wilfordii, Boswellia serrata, Camellia sinensis, Tanacetum parthenium, Commiphora wightii, Mukul, Plumbago zeylanica through their promising novel drug delivery systems like microspheres, transdermal patches, ethosomes, liposomes, and phytosomes. have shown promising response and efficacy via well-defined immune mechanism along with their easy accessibility, mild or negligible adverse effects, thus gaining the edge over conventional and invasive therapies for RA. This review indicates that there is a need to study these novel formulations, extensively on preclinical and clinical levels and develop these herbal therapies as a promising alternative to conventional therapies for the treatment of RA.