Evidence Based Targeting of Cytokines for Conventional and the Potential Phytotherapies in Management of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease that leads to chronic, systemic inflammatory reaction that primarily affects synovial joints. Current cytokine based therapies are effective and safe. However, they have a challenge of having short plasma half-life and even higher doses are required to manage the conditions. The processes involved in production using phage and viral technologies are expensive. Herbal medicines have been used for long and are considered safe and effective as medicines for many inflammatory related diseases. Many plants also posit as a potent anti-inflammatory agents. Evidence for use of herbal plants in both human and animal trials in studies suggest significant potential of application in herbal formulation in management of rheumatoid arthritis. Specifically, many studies suggest the direct effect of managing the agents of inflammation as a way of managing rheumatoid arthritis. Most evidence links the involvement of pro-inflammatory cytokines (interleukin-1, TNF-α, IFN-α, and NF-ÐoB) to the long term. It has also been suggested that the use of protective cytokines such as (Interleukin-4, Interleukin-6, Interleukin-8). Key pathways involve cyclooxygenase 1 and 2, 5-Lipooxygenase, formations of metalloproteinases, and inhibition of formation of prostaglandin E2. Use of herbal medicines has potential of improving joint conditions in rheumatoid arthritis. Use of herbal extracts offers better, cheap and affordable solution for long term management of rheumatoid arthritis in patients. They also show potential of offering multifunctional approaches to the management of the conditions through their anti-oxidative and anti-inflammatory mechanisms. Further studies are required to demonstrate the mechanisms involved in activation of protective cytokines in the management of rheumatoid arthritis.