Cutaneous manifestations are frequent and diverse among patients with rheumatoid arthritis and impact their quality of life: a cross-sectional study in a cohort of patients with recent-onset disease

Understanding the role of ethosomes in rheumatoid arthritis: innovative solutions to challenges in transdermal delivery of synthetic drugs and phytoconstituents

Rheumatoid Arthritis (RA), an autoimmune disease, is a chronic inflammatory disorder affecting the joints leading to severe damage and cartilage destruction. Current therapies for RA such as DMARDs, NSAIDs, glucocorticoids and phytoconstituents often face challenges related to solubility and transdermal permeability. Considering the barriers posed by the stratum corneum in transdermal drug delivery, ethosomes have shown promising results in overcoming these hurdles. The presence of ethanol in ethosomes imparts flexibility and disrupts the skin's lipid bilayer, allowing for transdermal penetration. Researchers have explored the potential of ethosomal drug delivery systems loaded with various synthetic drugs and phytoconstituents for the management of RA. Despite promising preclinical findings, these systems have yet to transition from the bench to the bedside, and there is a lack of comprehensive review papers highlighting the potential of ethosomes in RA treatment. Considering the commercial challenges in scaling up such nano systems, this review aims to analyse the current state of the art and advancements in ethosomal formulations loaded with synthetic agents and phytoconstituents. Further, it explores the impact of excipients and processing parameters, on the preparation of ethosomes and their efficacy in overcoming skin barriers, to enhance the permeability of therapeutic agents.

CLIC1 Expression in Skin Biopsies from Patients With Rheumatoid and Psoriatic Arthritis as a Potential Tool to Predict Therapy Response

BACKGROUND/AIM

Chloride intracellular channel protein 1 (CLIC1) activates inflammasomes in rheumatoid (RA) and psoriatic (PsA) arthritis. We studied CLIC1 expression in RA and PsA patients' skin with vasculitis and its variability depending on the therapy used.

MATERIALS AND METHODS

CLIC1 immunoexpression was evaluated in the vascular (CLIC1-V) and stromal (CLIC1-S) compartments of the RA and PsA skin biopsies of patients treated with methotrexate (MTX), leflunomid (LFN), corticotherapy (CT), or biological therapies.

RESULTS

MTX significantly reduced CLIC1-S expression (p=0.016), whereas LFN decreased CLIC1-V (p<0.001). LFN therapy duration also correlated with CLIC1-V (p<0.001). CT decreased CLIC1-S expression (p=0.006). CLIC1-S expression persisted in skin biopsies despite of erythrocyte sedimentation rate (ESR, p=0.018) and C reactive protein (CRP, p=0.0026) normalisation. For PsA, CLIC1-S expression significantly related to MTX (p<0.022). Both CLIC1-S (p<0.001) and CLIC1-V (p=0.007) decreased by biological therapies in RA.

CONCLUSION

CLIC1 expression is strongly influenced by the therapy used. Our data strongly support the extensive evaluation of CLIC1 in RA as a potential marker of inflammation and tool to predict therapy response.