Paradoxical Inflammation in IBD Patients Treated with Anti-Tumor Necrosis Factor Alpha Therapy

The development of tumor necrosis factor (TNF) antagonists has revolutionized the treatment of inflammatory bowel disease (IBD). Paradoxically, TNF antagonists can also induce inflammation, such as psoriasis induced by TNF antagonists. The mechanisms by which TNF antagonists induce paradoxical inflammation, has remained largely unresolved. In this review we will focus on the immunologic effects of the therapy with TNF antagonists and give an overview of TNF antagonist-induced immunologically mediated diseases.