Few will argue that the availability of tumor necrosis factor α (TNF-α) blocking agents has significantly altered the way dermatologists manage disease in patients with moderate to severe psoriasis. Even for physicians who do not use these agents in their practice, the finding that TNF-α inhibitors uniquely arrest destructive joint progression is something that must be considered for patients with significant psoriatic joint disease.
The utility of these agents, however, goes beyond improving the clinical care of our patients. With specifically targeted agents in clinical practice, we now have the ability to observe human “knockouts” on a large scale for the first time in history. It is often by observing the side effects or nonresponders that we are able to increase our understanding of a disease process.
Model of psoriasis (adapted from Nestle and Gilliet9 with permission). IFN indicates interferon; MDC, myeloid dendritic cell; PDC plasmacytoid dendritic cell; T, T cell; TH1, type 1 helper T cell; and TNF, tumor necrosis factor.
Modifications of Figure 1 based on concepts detailed by Dutz and de Gannes.11 A, Model for homeostasis in prepsoriatic skin due to inhibition of interferon α (IFN-α) by locally produced tumor necrosis factor α (TNF-α). B, Derepression by TNF-α inhibitor and initiation of psoriasis. MDC indicates myeloid dendritic cell; PDC plasmacytoid dendritic cell; T, T cell; and TH1, type 1 helper T cell. The circled minus signs indicate inhibition.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Dermatology editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 26
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.