Pharmacological Research - Modern Chinese Medicine · Published 2026-07-01 · DOI 10.1016/j.prmcm.2026.100852
Tianjiao Zhang, Yuhua Wang, Jing Guo, Jun Hu, Meizi Wang, Linwan Li, Kailun Zhou, Wei Shang, Cheng Cheng
Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent synovial inflammation, cartilage destruction, and progressive bone erosion. Ferroptosis, an iron-dependent form of cell death driven by lipid peroxidation, contributes to RA pathogenesis by linking oxidative stress, inflammation, and immune dysregulation within the joint microenvironment. Owing to its multi-component and multi-target properties, traditional Chinese medicine (TCM) represents a promising strategy for modulating ferroptosis-related pathways. In TCM theory, RA is categorized as ''Bi syndrome'' and treated with herbs that dispel wind-dampness, promote blood circulation, and relieve pain. This review summarizes current evidence on ferroptosis mechanisms and the ferroptosis-modulating potential of TCM in RA. Methods: This review examines current evidence on ferroptosis-mediated mechanisms in RA and the regulatory effects of TCM interventions. Literature was retrieved from PubMed, Web of Science and CNKI up to December 2025. Eligible studies included cellular, animal, and clinical investigations addressing ferroptosis-related processes, including iron metabolism dysregulation, lipid peroxidation, oxidative stress imbalance, and antioxidant defense dysfunction, as well as TCM-based interventions in RA or related inflammatory diseases. Results: Accumulating evidence indicates that ferroptosis contributes to RA progression through dysregulation of iron metabolism, lipid peroxidation, and antioxidant defense systems. A variety of bioactive compounds from anti-rheumatic TCM herbs such as saikosaponins, icariin, baicalin, and sinomenine have demonstrated the ability to modulate ferroptosis-related pathways and alleviate joint inflammation and damage. In addition, classical TCM formulas and emerging nano-TCM delivery systems exhibit multi-component and multi-target properties that may enhance therapeutic efficacy by regulating ferroptosis and associated signaling pathways. Discussion: TCM interventions offer promising strategies for RA by targeting ferroptosis through multi-level mechanisms, consistent with their traditional use in treating “Bi syndrome.” However, further studies are required to clarify the synergistic effects of complex herbal formulas, identify reliable ferroptosis-related biomarkers, and evaluate the safety and clinical applicability of these interventions. Integrating traditional medicinal knowledge with modern pharmacological approaches may facilitate the development of novel ferroptosis-targeted therapies for RA.
Abstract from DOAJ. Public domain (CC0 1.0).
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Zhang, T., Wang, Y., Guo, J., et al. (2026). Ferroptosis and Chinese Medicine in Rheumatoid Arthritis: Mechanisms and Emerging Intervention Strategies. Pharmacological Research - Modern Chinese Medicine. https://doi.org/10.1016/j.prmcm.2026.100852