Nanotechnology-driven delivery of dexamethasone for arthritis: The role of liposomes

Arthritis is one of the most prevalent chronic musculoskeletal disorders worldwide, affecting more than 300 million individuals and representing a leading cause of pain, disability, and reduced quality of life. The global burden of osteoarthritis and rheumatoid arthritis continues to rise due to population aging, sedentary lifestyles, and increasing metabolic comorbidities. Liposomal drug carriers hold great promise in maximizing dexamethasone's therapeutic utility while minimizing its first-pass effect and systemic toxicity. Due to their biocompatibility, slow-release capability, and potential for target-specific delivery, liposomes enable localized drug sequestration within inflamed joints through both passive and active targeting mechanisms. This review aims to analyze the pharmacological action of dexamethasone in arthritis in conjunction with the advantages inherent to liposomal formulations, as well as recent advancements in liposome design, such as stimuli-responsive and theranostic liposomes. Despite their great promise, limitations, including drug leakage, immunogenicity, and regulatory hurdles, remain major impediments to their clinical use. Future directions indicate promise for personalized, image-directed liposomal therapies in a paradigm shift for arthritis treatment. Overall, liposomal dexamethasone represents a major breakthrough in the safe design of target-specific, effective anti-inflammatory therapies for arthritis. See also the graphical abstract(Fig. 1).