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NAD + can be generated de novo in the kynurenine pathway, where Trp is oxygenated to N-formylkynurenine by tryptophan 2,3-dioxygenase (TDO) or indoleamine 2,3-dioxygenase (IDO) 31

CXC chemokines, including CXCL1, CXCL2, CXCL5, CXCL6, CXCL8, CXCL9, CXCL10, CXCL12, CXCL13, and CXCL16, have been identified with abnormal expression levels in synovial fluids, synovial tissues, fibroblasts, and endothelial cells of RA patients (94, 95)

Dietary Modifications Adjusting your diet can substantially reduce digestive discomfort: Eat smaller, more frequent meals rather than large portions, which accommodates the delayed gastric emptying Reduce dietary fat intake , particularly saturated fats, as these are more difficult to digest when stomach emptying is slowed Avoid spicy, heavily seasoned, or fried foods that may exacerbate nausea or diarrhoea Increase soluble fibre gradually (oats, psyllium, fruits) if experiencing diarrhoea, as this helps bulk stools Stay well hydrated , consuming at least 1.5-2 litres of water daily, especially if experiencing loose stools (note: adjust fluid targets if you have heart failure or chronic kidney diseaseconsult your healthcare provider for personalised advice) Limit alcohol and caffeine , both of which can irritate the digestive system Timing and Dose Escalation According to the BNF and SmPC, Ozempic is initiated at a low dose (0.25 mg weekly) specifically to minimise gastrointestinal side effects

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