Introduction

Rheumatoid arthritis (RA) is a chronic autoimmune disease of joints, in which the immune system will attack the tissues lining the joints, most commonly the fingers, wrists and ankles, though it may affect other joints too.

 The condition involves an inflammatory process, where the immune system releases substances that attack cartilage, which acts as a shock absorber. With time this might lead to joint deformity and eventually bone erosion.

Although it mainly affects the joints, RA can affect other parts of the body too, like the skin, lungs and eyes.¹

Risk factors

Although anyone develop RA, some people are more at risk:²

• Female gender
• Age - people between 30 and 60 years old have a higher risk
• Family history and genetic factors
• Weight/obesity
• Smoking
• Lung diseases

Symptoms of RA

Symptoms of RA are usually symmetrical and can include:³

• Joint pain
• Joint swelling
• Tenderness and stiffness of the joints
• FeverFatigue 

Diagnosis of rheumatoid arthritis

One of these tests could be performed to help diagnose RA:³

• ESR (erythrocyte sedimentation rate) blood test - to confirm inflammation of the joints
• CRP(C-reactive protein) blood test - again a marker of inflammation
• X-ray
• Ultrasound scan
• MRI (magnetic resonance imaging) 

Treatment of RA

Although there is no cure for the disease, the goal of treatment of RA is to prevent the progression of the disease and deformity of the joints, and to decrease pain and inflammation.⁴

Treatment can be categorised into three sections

• Agents to decrease pain and inflammation, such as painkillers and steroids.
• Disease-modifying antirheumatic drugs (DMARDs) - this class of drugs acts by blocking the inflammatory cascades produced by your immune system that can lead to the inflammation of the joints. The medications from this class include methotrexate, leflunomide, hydroxychloroquine and sulfasalazine.

Methotrexate is the most commonly used medication of this group, and is usually used in combination withsteroids.

• Biological agents - this class of drugs acts by blocking some agents in the blood from activating your immune system. It includes adalimumab, etanercept and infliximab. They are only used in combination with DMARDs when DMARDs are not effective alone.

Interferon Therapy for rheumatoid arthritis

What are interferons?

Interferons are a group of signaling proteins that help your body fight certain diseases like cancer, infection and autoimmune diseases.⁵ They are naturally produced by the body and recently have been produced in laboratories to be used as medications.

Interferons are released by inflammatory cells like white blood cells in response to the disease. They stimulate cells to release cytokines, which help to fight the disease.

According to the cell releasing them, interferons are divided into three groups:

• Interferon alpha
• Interferon beta
• Interferon gamma

Interferons produce their effects by binding to cell receptors, called interferon receptor INFAR, and while both interferon alpha and beta act through the same receptors, their activation has different results.

Interferon alpha increases the production and activation of the inflammatory cells in the lining of the joints in RA.

Interferon beta launches a cascade of responses that lead to a decrease in inflammation. Interferon beta acts by inhibiting the inflammatory cells and tumor necrosis factor that lead to rheumatoid arthritis. It also activates anti-inflammatory cells and fibroblasts in synovial fluid (the fluid found inside the joints).

Despite all these findings, there’s no study to support the use of interferons in treatment of RA and hence more data and studies are needed.⁶

Adverse effects of interferon beta

These are some of the adverse effects that can be caused by subcutaneous interferon beta:⁷

• Nausea, vomiting and stomach pain
• Fever and chills
• Muscle pain and aches
• Fatigue
• Green/blue discoloration of skin
• Sore throat
• Runny nose and/or cough
• Decreased sexual drive in men
• Trouble sleeping
• Psychological adverse effects

Summary

Rheumatoid arthritis is an autoimmune disease that affects the joints causing erosion of cartilage and, eventually if not treated, joint deformity and bone erosion. Early detection and treatment of rheumatoid arthritis can prevent this deformity and prevent pain.

Interferon alpha has been found in the synovial fluid in patients with RA and is thought to increase inflammation and the autoimmune response.Interferon beta, however, has an anti-inflammatory effect and inhibits tumour necrosis factor and inflammatory cells that are involved in RA.More studies are, however, needed to prove the effectiveness of interferon beta as a medication to treat rheumatoid arthritis.