Decoding cellular crosstalk to inhibit angiogenesis in rheumatoid arthritis: integrated approaches for targeted intervention and vascular imaging

Rheumatoid arthritis (RA) is a chronic autoimmune disease pathologically defined by the formation of pannus, a highly vascularized tissue with pronounced proliferative, invasive, and destructive properties. With the molecular mechanisms of angiogenesis becoming increasingly elucidated, targeted interventions are now being developed to disrupt the pro-angiogenic cellular network within the pannus, which is orchestrated by activated endothelial cells, invasive fibroblasts, and infiltrating immune cells. From the perspective of early detection, sensitive non-invasive imaging techniques, including photoacoustic, ultrasound, and nuclear imaging, enable visualization of angiogenesis in RA joints, providing a critical window for timely diagnosis and antiangiogenic treatment. This review synthesizes recent advances in RA angiogenesis research, particularly focusing on molecular mechanisms, novel targeted therapeutic strategies, and advanced imaging techniques for in vivo assessment. Collectively, these developments highlight the paradigm of image-guided antiangiogenic theranostics, which integrates real-time visualization of neovascularization with nanomaterial-based targeted therapeutic intervention to offer a refined approach for early RA management.