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In this adverse microenvironment, synovial cells adapt to generate energy and switch their cellular metabolism from a resting regulatory state to a highly metabolically active state, enabling them to produce essential building blocks to support their proliferation

doi: 10.1097/00003246-200106000-00024

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Patients were to be excluded after enrollment if they were non-adherent to the treatment (using the medication for less than 80% of study period) or refused or decided to withdraw from the study

Oxidative stress itself can actually increase inflammation