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20 Moreover, at 7 days, the Kyoto Encyclopedia of Genes and Genomes analysis of the proteomics data revealed that SPPEPS activated insulin signaling pathways through a gene crucial for cartilage development, namely GSK-3

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First-line treatment typically involves: Methotrexate the most commonly prescribed conventional synthetic DMARD Sulfasalazine or hydroxychloroquine alternative or combination options Leflunomide for patients who cannot tolerate methotrexate These medications are usually combined with short-term corticosteroids (such as prednisolone) to provide rapid symptom relief whilst DMARDs take effect, which can take several weeks to months