Clinical, Biochemical and Nrf2-Keap1-Related Outcomes of Silver Nanoparticle-Adjunct Therapy in Adults with Osteoarthritis or Rheumatoid Arthritis: A Prospective Comparative Study

Background: Osteoarthritis (OA) and Rheumatoid Arthritis (RA) are clinically distinct disorders in which inflammatory and oxidative processes may contribute to symptoms and tissue injury. The Nrf2-Keap1 system is an important regulator of cellular antioxidant responses but circulating biomarker changes do not by themselves establish pathway-mediated clinical effects. Objective: To compare clinical, biochemical, inflammatory and short-term radiological outcomes among adults with OA or RA receiving standard arthritis therapy alone versus standard therapy supplemented with silver nanoparticles (AgNPs) and to examine changes in biomarkers related to oxidative stress and Nrf2-associated signaling. Methods: This prospective comparative study included 255 adults with clinically confirmed OA or RA. Participants were consecutively recruited and categorized according to the therapeutic approach received: standard therapy alone (n = 128) or standard therapy supplemented with AgNPs (n = 127). No random allocation is described in the submitted study record. Clinical outcomes included VAS pain, WOMAC for OA and DAS-28 for RA. Oxidative-stress, antioxidant, inflammatory and Nrf2-related biomarkers were assessed using the reported laboratory methods. Radiological assessment was performed at baseline and after 12 weeks. Safety monitoring included routine hematological, hepatic and renal assessments. Results: In the submitted dataset, VAS pain decreased from 7.4±1.1 to 3.1±1.4 in the AgNP group and from 7.3±1.2 to 5.4±1.6 in the standard-therapy group (reported p<0.001). Among OA participants, the manuscript reports a 48.6% improvement in WOMAC with AgNP supplementation versus 22.3% with standard therapy. Among RA participants, the reported DAS-28 reduction was 2.1±0.6 versus 1.0±0.5, respectively (p<0.001). Nrf2, HO-1, SOD and catalase were reported to increase more in the AgNP group, while MDA, TNF-α, IL-6 and CRP decreased. Short-term radiological stabilization/improvement was reported in 39.5% versus 18.2%. These findings require confirmation with complete baseline/follow-up values, confidence intervals, disease-specific analyses and verification of the original statistical output. Conclusion: AgNP-augmented therapy was associated with greater short-term clinical and biochemical changes than standard therapy alone in this prospective comparative cohort. However, because treatment allocation was non-randomized, follow-up was limited to 12 weeks and important nanoparticle, molecular, imaging and statistical details require verification, the findings should be considered preliminary. The observed Nrf2-related biomarker changes support further mechanistic investigation but do not establish a causal Nrf2-Keap1 mechanism or long-term disease modification.