Paradoxical immune-mediated inflammation in inflammatory bowel disease patients receiving anti-TNF-alpha agents

Reports of autoimmune diseases, including psoriasis- and dermatitis-like skin reactions with anti-tumor necrosis factor-alpha (TNF-alpha), are increasing, likely a reflection of the growing use of these agents. This paradoxical phenomenon can no longer be considered rare, with some studies providing incidence estimates of greater than 10%. This paradoxical inflammation has been reported in patients receiving treatment with anti-TNF-alpha agents for a variety of inflammatory conditions, including inflammatory bowel disease, psoriasis and rheumatoid arthritis and appears to be a class effect. Moreover, there have recently been reports of autoimmune arthralgia occurring in patients receiving anti-TNF-alpha agents. Further studies are necessary to determine the true incidence of this phenomenon and to identify those patients most likely to be at risk. (C) 2013 Elsevier B.V. All rights reserved.