The renin-angiotensin system (RAS) and arthritic diseases: therapeutic potential for RAS inhibitors.

The renin-angiotensin system (RAS) is a pivotal hormonal regulator of cardiovascular and renal homeostasis, recently implicated in the etiology and progression of inflammatory arthritis, including rheumatoid arthritis (RA) and osteoarthritis (OA). This review explores the dual nature of RAS, highlighting its classical axis (ACE/Ang II/AT1R), which promotes inflammation and tissue damage, and its counter-regulatory axis (ACE2/Ang-(1-7)/MasR), which exhibits anti-inflammatory and protective effects. Elevated levels of RAS components in synovial fluid of arthritis patients emphasize its role in local joint pathology. The potential of RAS inhibitors, including angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs), is discussed, demonstrating their efficacy in reducing inflammatory cytokines, oxidative stress, and immune dysregulation. Emerging research also underscores the protective effects of the counter-regulatory axis in mitigating inflammation, oxidative stress, and angiogenesis, which are crucial in arthritis progression. The review further explores innovative therapeutic strategies, such as AI-powered personalized and tailored medicine, to optimize RAS-targeted therapies for enhanced efficacy and patient-specific outcomes. This evolving field highlights the promise of integrating RAS modulation with advanced diagnostic and therapeutic technologies to revolutionize arthritis treatment, offering hope for better disease management and improved quality of life.