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The possible reason for the inconsistent findings can be explained by various factors including cancer type, drug dosage, synergism, bioavailability, patients lifestyle, tendency to take supplements, and the duration of the studies with other variables incorporated (67) (Table 7)

The most frequently used treatment relies on the combination of several immunosuppressants such as corticosteroids, leflunomide, and standard disease-modifying antirheumatic drugs (DMARDs) like methotrexate (MTX) 11 to address joint inflammation

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The HPA activation is present but typically less pronounced in head-to-head studies