Advancements in Rheumatoid Arthritis Therapy: Journey from Conventional Therapy to Precision Medicine via Nanoparticles Targeting Immune Cells

Abstract

Rheumatoid arthritis (RA) is a progressive autoimmune disease mainly affecting the inner lining of the synovial joints and leading to chronic inflammation. While RA is not known as lethal, recent research indicates that it may be a silent killer because of its strong association with increased risk of chronic lung and heart diseases. Patients develop these systemic consequences due to the regular uptake of heavy drugs used such as Disease-modifying antirheumatic medications (DMARDs), glucocorticoids (GC), nonsteroidal anti-inflammatory medicines (NSAIDs), etc. Nevertheless, a number of these medications have off-target effects, which might cause adverse toxicity, and have started to become resistant in patients as well. Therefore, alternative and promising therapeutic techniques must be explored and adopted like post-translational modification inhibitors (like Protein Arginine Deiminase inhibitors), RNA interference by siRNA, epigenetic drugs, peptide therapy, etc., specifically in macrophages, neutrophils, Treg cells and dendritic cells (DCs). As the target cells are specific, ensuring targeted delivery is also equally important, which can be achieved with the advent of nanotechnology. Furthermore, these nanocarriers have fewer off-site side effects, enable drug combination, and allow for lower drug dosages. Among the nanoparticles that can be used for targeting, there are both inorganic and organic nanomaterials like solid-lipid nanoparticles, liposomes, hydrogels, dendrimers, and biomimetics that have been discussed. This review highlights contemporary therapy options targeting macrophages, neutrophils, Treg cells, and DCs and explores the application of diverse nanotechnological techniques to enhance precision RA therapies.