Tumor necrosis factor-a inhibition and palmoplantar pustulosis: Janus-faced therapy?

Dutz JP.

BACKGROUND: Janus was the Roman god of beginnings and endings; he was thus represented as a double-faced head, the 2 faces gazing in opposing directions. Consequently, the term Janus-faced denotes a person or object that has 2 contrasting aspects.

INTRODUCTION: Tumor necrosis factor-a (TNF-a) is a cytokine that may have such contrasting roles. It is well known that TNF-a is an early coordinator of the cytokine response to injury and is elevated in inflammatory diseases such as rheumatoid arthritis (RA)1. However, chronic TNF-a stimulation has the paradoxical consequences of both acting as an antiinflammatory and downregulating T cell responses2. Ablation of TNF-a signaling by genetic TNF-a receptor deletion accelerates autoimmunity in lupus-prone NZB mice3. This dichotomy is also reflected in the clinical response to TNF- a inhibition.

J Rheumatol. 2007 Feb;34(2):247-9.

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