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Importantly, it does not significantly stimulate ACTH, cortisol, or prolactin release at physiological doses (PMID: 9849822)

Mild gastrointestinal side effects occur in 1015% of patients during the first two weeks and typically resolve as the body adapts

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Notably, Th17 cells can also enhance the expression of MMP-1, MMP-3, and MMP-13 in chondrocytes while reducing the expression of tissue inhibitors of metalloproteinases (TIMP-2), type II collagen, proteoglycans, and link proteins, all of which promote cartilage degradation and exacerbate cartilage damage (118) ( Figure 3 )