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Pooled trial data indicates the following side effects and their incidences [20]: Injection site reactions 24.5% Joint pain 13.3% Peripheral edema and limb pain 6.1% Muscle pain 5.5% Tingling sensations 4.8% Worsened glycemic control (elevated glycated hemoglobin) 4.5% Hypersensitivity (allergic reactions such as skin rash) 3.6% Carpal tunnel syndrome 1.5% Injection site reactions were the most common adverse reaction and mainly included pain, redness, and itchiness

Ethical approval The experimental procedures were conducted under a collaborative agreement between the Animal Production Research Station (Karada, Kafr El-Sheikh Governorate, Egypt) and the Faculty of Agriculture, Tanta University, and were approved by the latter (Approval No.: AY2019-2020/S6/2020.01.13/UPDATE 10/2025)

Additionally, TNF- stimulation has been demonstrated to increase the expression of cGAS in FLSs, further supporting the involvement of TNF in RA progression through cGAS-STING signaling (41)

These factors are potential therapeutic targets for diseases with both autophagy dysfunction and oxidative stress

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