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

Autoimmun Rev. 2014 Jan;13(1):15-9. doi: 10.1016/j.autrev.2013.06.005. Epub 2013 Jun 15.


Reports of autoimmune diseases, including psoriasis- and dermatitis-like skin reactions with anti-tumor necrosis factor-α (TNF-α), 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-α 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-α agents. Further studies are necessary to determine the true incidence of this phenomenon and to identify those patients most likely to be at risk.

Keywords: Anti-TNF; Autoimmunity; IBD; Paradoxical reactions.

Publication types

  • Review

MeSH terms

  • Animals
  • Anti-Inflammatory Agents / adverse effects*
  • Anti-Inflammatory Agents / therapeutic use
  • Antibodies, Monoclonal / adverse effects*
  • Antibodies, Monoclonal / therapeutic use
  • Humans
  • Inflammation Mediators / immunology
  • Inflammatory Bowel Diseases / drug therapy*
  • Inflammatory Bowel Diseases / immunology
  • Psoriasis / chemically induced*
  • Tumor Necrosis Factor-alpha / immunology*


  • Anti-Inflammatory Agents
  • Antibodies, Monoclonal
  • Inflammation Mediators
  • Tumor Necrosis Factor-alpha