Artemisinins in autoimmune diseases: effects and mechanisms in systemic lupus erythematosus and rheumatoid arthritis.

Autoimmune diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) result from immune self-tolerance loss, causing tissue damage. Standard treatments targeting late-stage inflammation often have serious side effects. Artemisinin, known for its antimalarial properties, shows potential immunomodulatory effects. This review examines artemisinin's application in SLE and RA, emphasizing its therapeutic potential and mechanism insights. From 2014 to 2024, we searched PubMed, Web of Science, and Google Scholar using keywords 'artemisinins', 'SLE', and 'RA'. Artemisinins modulate immune pathways (PI3K/Akt, HIF-1α/NF-κB, Nrf2/HO-1, p62/Nrf2), balance Th17/Treg cells and M1/M2 macrophages, inhibit ROS production, and suppress B-cells, fibroblast-like synoviocytes, and osteoclasts, affecting SLE/RA progression. Structure-activity relationship analysis indicates that the effects of artemisinin are mainly due to their endoperoxide bridge and sesquiterpene lactone structures. This review highlights artemisinin's potential for treating various autoimmune diseases and aiding drug development.