**8. Conclusion**

*Genetic Variation*

flares of PR [47].

to treat PR [41].

**7. Treatment options for PR**

There is no specific treatment for PR for several reasons described earlier. Research has reported Non- Steroidal anti-inflammatory drugs appeared to delay flares of PR. In recent years Gold therapy is emerging as a promising treatment option for relieving joint pain and swelling. According to a study, about 60% of patients showed an improved result of gold salt. However, other studies have reported a high mucocutaneous side effect of gold therapy [8, 46]. The use of sulfasalazine also proves to be good for treating episodic flares of PR. In another study use of Chloroquine marked good results in the severity of an attack of PR where 41 patients out of 51 showed improvement [47]. Another study also focused on the delay effect of antimalarial drugs in PR flares [48]. Antimalarial drugs prove to be good in treating PR by their inhibitory effect on TNFα and IL-1. The case of the application of antimalarial in 71 patients mostly showed good results by decreasing

According to recent research PR patients who did not respond well to drugs mostly use in PR showed a very good response to Rituximab [49]. Biological DMARDs (Abatacept) affect the immune system by inhibiting T-cells stimulation and prove to be good for patients who poorly respond to methotrexate. Tofacitinib is also used in patients of PR who poorly or intolerantly respond to DMARDS [50].

According to research in Japan successful use of Kampo therapy (a Chinese herbal medicine) in three patients with Rheumatoid reveal its pharmaceutical potential in treating rheumatism although it needs a deep study of these findings to uncover its biological potential [51]. According to research in Iran yarrow, oat, colchicum, dill, fennel, wild rue, bitter melon, willow, garlic, and burdock help treat rheumatoid although their use in PR is still not reported [52]. Heat therapy is a medication-free way to relieve muscle pain and stiffness and is also recommended

The possible treatment options are shown in **Figure 3**.

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**Figure 3.**

*Possible treatment options for PR.*

Several risk factors such as genetic and environmental factors favor PR development. Most exposable genes are HLA-DRBI, PTPN22, TNFα, and PYCARD which mutate because of unbalancing in environmental factors. This study updates the information that Non- Steroidal anti-inflammatory drugs, Heat therapy, Chloroquine, and sulfasalazine show good results in the treatment of PR. Although many studies have validated these emerging therapies, still there is a need for further research to figure out their efficacy and precision. Side effects of these drugs and therapies must be considered before clinical applications for achieving stunning gains in the future. Additionally, these summarized genes might be capable of improving the therapeutic inventions for PR hence will serve as a significant pioneer for researchers who wants to identify the associative pathways involve in the pathogenesis of PR.
