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Theres rarely a single cause

There are some differences in dopamine receptor expression across synovial layers, but all subtypes were expressed in the invasion zone, with higher levels of D1, D2, and D5 staining seen in this region than in other layers of synovial tissue in RA (van Nie et al., 2020)

15 The addition of methotrexate or another DMARD may also be considered for patients with an inadequate response, although as previously noted, there is little evidence to suggest that methotrexate provides synergistic efficacy in PsA as opposed to RA

hence, it is one of the most potent natural sources of these substances