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Gerald Krueger, MD; Kristina Callis, MD

Arch Dermatol. 2004;140:218-225.

Objectives  To summarize the role of tumor necrosis factor (TNF) in the pathogenesis of psoriasis and psoriatic arthritis (PsA) and to present the latest data on the efficacy of TNF inhibitors in these diseases.

Data Sources  PubMed was used with the following indexing terms: TNF, TNF inhibitor, psoriasis, psoriatic arthritis, etanercept, infliximab, and/or T cell. Abstract booklets and manufacturer's package inserts were also used. When possible, only sources published after the year 2000 were incorporated.

Study Selection  Sources that described a role for TNF in the pathogenesis of psoriasis and PsA were selected based on relevance. Clinical trials that examined the efficacy of the TNF inhibitors etanercept and infliximab in psoriasis and PsA were selected.

Data Extraction  Data were extracted if they represented safety information, the American College of Rheumatology criteria for improvement, the Health Assessment Questionnaire, or the PsA response criteria. These data were abstracted independently by the authors.

Data Synthesis  Aberrant regulation of TNF is involved in the development of psoriasis and PsA. Therefore, recent intervention strategies for psoriasis and PsA have incorporated biologic agents that specifically target TNF. Etanercept and infliximab are effective at reducing disease activity and are generally well tolerated in the treatment of psoriasis and PsA.

Conclusion  Tumor necrosis factor plays a major role in the pathogenesis of psoriasis and PsA, and TNF antagonists provide clinicians with a worthy alternative to traditional therapies, which are associated with toxic effects and poor compliance.

From the University of Utah School of Medicine, Department of Dermatology, Salt Lake City. Dr Krueger is a consultant for Amgen Inc, Centocor Inc, and Serono Inc. Dr Callis has been a consultant for Amgen Inc and Centocor Inc.

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