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The complex nature of RA and the incomplete understanding of its pathogenesis contribute to the lack of specific therapeutic measures in clinical practice, with drug therapy remaining the primary approach to managing disease progression and increasing patients quality of life [20]

On the other hand, synthetic ingredients such as hydroquinone and retinoids are commonly found in chemical-based treatments

Peripheral and cochlear mechanisms include N-methyl-D-aspartate receptor activation, 62 altered operating points of outer hair cells, 63 stereociliary detachment, 64 and elevated intracochlear potentials

Horm Metab Res 51(5):296301