title: Targeting tumor necrosis factor alpha in psoriasis and psoriatic arthritis.
abstract: BACKGROUND
  Psoriasis is an immune-mediated chronic inflammatory disease triggered and maintained by inflammatory mediators, including TNF-alpha.
  
  
  OBJECTIVE
  To summarize the role of anti-TNF-alpha agents psoriasis therapy, focusing on the mechanisms and biological pathways involved, by reviewing relevant literature.
  
  
  CONCLUSIONS
  The three TNF-alpha antagonists currently available (etanercept, infliximab and adalimumab) are effective in the therapy of psoriasis and psoriatic arthritis. Certolizumab pegol and golimumab are TNF-alpha inhibitors not approved for therapy of psoriasis yet. In addition to neutralizing soluble TNF-alpha, TNF-alpha blockers bind to membrane TNF-alpha and change the behavior of TNF-alpha-expressing cells, resulting in hastened cell cycle arrest and apoptosis, and suppression of cytokine production. TNF-alpha blockers may also affect adaptive immune responses by reducing T helper cell (Th)1 and Th17 responses, and favoring the development of T-regulatory cells. TNF-alpha antagonists can regulate differentiation and activation of osteoclasts, thus reducing bone destruction in psoriatic arthritis. Anti-TNF-alpha agents differ in their pharmacokinetics and pharmacodinamic properties, which is reflected in their therapeutic and safety profiles. The safety of TNF-alpha antagonists has been established, and patient selection and monitoring allow risk minimization.
authors.affiliation: University of Verona, Department of Biomedical and Surgical Sciences, Section of Dermatology and Venereology, Piazzale A. Stefani 1, 37126 Verona, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Fantuzzi
authors.forename: Micol
authors.initials: M
authors.lastname: Del Giglio
authors.forename: Paolo
authors.initials: P
authors.lastname: Gisondi
authors.forename: Giampiero
authors.initials: G
authors.lastname: Girolomoni
mesh_terms: D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000378:metabolism; D003879:Dermatologic Agents / Q000494:pharmacology; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy* / Q000378:metabolism; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha