Psoriasis, inflammatory bowel disease, and uveitis as paradoxical adverse effects induced by TNF inhibitors in patients with immune-inflammatory rheumatic conditions

Abstract

Despite their known benefits, tumor necrosis factor alpha inhibitors (TNFi) may cause certain unexpected side effects, such as the aggravation of pre-existing autoimmune conditions or inducing the onset of new inflammatory conditions, these reactions being called “paradoxical adverse effects’’ (PAEs). The spectrum of TNFi-induced PAEs is vast and may include dermatological disease (frequently - psoriasiform skin reactions), gastroenterological disease (inflammatory bowel disease), ophthalmological disease (uveitis) and other autoimmune conditions (lupus-like reactions, vasculitis). PAEs are characterized by complex physio-pathological mechanisms which remain a matter of further research and may significantly impact the patients’ evolution and quality of life. Importantly, a large number of patients require the cessation of TNFi treatment, as well as other types of therapeutic interventions. The present review aimed to analyze recent findings regarding certain paradoxical adverse effects (psoriasis, inflammatory bowel disease, and uveitis) in patients with RA, ankylosing spondylitis (AS), and PsA treated with TNFi.