Metabolic syndrome and chronic arthritis: effects of anti-TNF-α therapy

TNF-alpha plays a key role in the inflammatory cytokine cascade involved in the pathogenesis of chronic arthritis, including rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. Systemic inflammation and the increased production of pro-inflammatory cytokines in these patients may favor the onset of metabolic syndrome. In patients affected by chronic arthritis, TNF-alpha is considered as one of the factors responsible for favouring insulin resistance and dyslipidemia, which are important features of the metabolic syndrome. Even if TNF-alpha is a single player in the great molecular cauldron of inflammation, the use of TNF-alpha inhibitors may be an important approach for not only treating articular and cutaneous symptoms but also for ameliorating glucose and lipid metabolism. Nevertheless, further research and clinical trials are needed to better determine the effects of biologic therapies on metabolic components in chronic arthritis patients and to identify the most appropriate strategies on the basis of the comorbidities in these patients.