A 47-Year-Old Woman Comes to the Physician with Progressive Joint

A 47-year-old woman comes to the physician with progressive joint pain and swelling in her hands for the past several months.  She also has easy fatigability that has gradually worsened over the same period.  Morning activities are especially difficult due to stiffness lasting 1 to 2 hours after waking.  Examination shows warmth, swelling, and tenderness involving the proximal interphalangeal joints, metacarpophalangeal joints, and wrists bilaterally.   Plain radiographs of the symptomatic joints show joint space narrowing and marginal erosions.  Which of the following cytokines are primarily involved in the pathogenesis of this patient's joint destruction?

A) IL-1 and tumor necrosis factor-alpha
B) IL-2 and interferon gamma
C) IL-4 and IL-5
D) IL-10 and transforming growth factor-beta
E) IL-12 and IL-23

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