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They also reported a more significant improvement of the arthritis score with combination treatment than with MTX alone

doi: 10.1002/cphg.38

Acetyl-L-carnitine crosses the blood-brain barrier where it supports the synthesization of acetylcholine"a primary neurotransmitter that allows communication between nerve cells

doi:10.1007/s00421-021-04774-6 Addicott MA, Yang LL, Peiffer AM, Burnett LR, Burdette JH, Chen MY, Hayasaka S, Kraft RA, Maldjian JA, Laurienti PJ

Medications such as semaglutide, liraglutide, and tirzepatide mimic this hormone and have been FDA-approved for the treatment of type 2 diabetes and chronic weight management