Anti-TNFα therapy in systemic autoimmune and/or inflammatory diseases

TNF alpha plays a crucial role in the physiopathology of a large number of auto-immune and/or inflammatory systemic diseases. In addition to authorized indications including rheumatoid arthritis, ankylosing spondylitis, Crohn disease, ulcerative colitis, psoriatic arthritis and plaque psoriasis, TNF alpha blockers hove been tested in a wide range of auto-immune and/or inflammatory diseases. TNF alpha blockers might be an option in refractory ANCA-associated vasculitis, sarcoidosis, adult onset Still disease, Behcet disease, AA amyloidosis and TRAPS. However, pertaining to the limited number of prospective randomized trails available, the small number of patients included and the poor methodology, it is difficult to define their place in the therapeutic strategy in these conditions. The therapeutic effect of TNF alpha blockers is often suspensive and disease flares are frequently observed during sustained treatment, as in the case of Behcet's disease. Published data do not support the use of TNF alpha blockers in connective tissue diseases.