5-aminolaevulinic acid combined with sodium ferrous citrate ameliorated collagen-induced arthritis via anti-inflammatory effects and fibroblast-like synoviocytes-driven B cell immunomodulation

5-ALA/SFC exerted its therapeutic effects in RA by suppressing synovial inflammation via HO-1/IDO-mediated antioxidant pathways and restoring B cell homeostasis by modulating FLS-derived signals, including BAFF and VCAM-1 in mice. Potential translational limitations include inherent differences between murine CIA models and human RA pathophysiology, as well as the use of immortalized human synovial cell lines instead of primary patient-derived FLSs. These findings underscore the potential of 5-ALA/SFC as a multitarget therapeutic strategy, offering promising prospects for the development of novel RA treatments though clinical translation requires further investigation of long-term safety, optimal dosing, and side effects in humans.