The use of Tumor Necrosis Factor alpha (TNF–α) antagonists has profoundly improved clinical management of psoriasis and other inflammatory diseases, but acute and chronic adverse reactions, including demyelination, are becoming increasingly recognized. We reported a case of multiple sclerosis in a 48–year–old Italian man with plaque psoriasis treated with etanercept. Through a literature review, we found a total of 35 psoriatic patients, including our case, in whom a demyelinating disease developed in course of TNF–α antagonists therapy. Since neurological disorders are rarely associated with the use of anti–TNF–α therapy in psoriatic patients, but have severe side effects, physicians should screen patients before starting therapy, excluding a positive anamnesis for demyelinating disease;; if patients receiving anti–TNF–α drugs develop new or unusual neurological symptoms, the anti–TNF–α drug should be stopped and patient should be properly examined. Furthermore, therapies for demyelinating diseases that could exacerbate psoriasis manifestations should be carefully avoided.
Tumor necrosis factor is a central mediator in inhibiting arthritis but if you inhibit TNF in MS it can make MS worse. In other conditions it can give you MS as shown in this study.
However in animals the jury is out and blocking TNF can do good things and it can do unwanted things,it depends on the context.
In animal studies mechanism of action is all important an in yesteryear (before they did the studies in MS) it was said TNF is bad so block it and there are a number of drugs that were claimed to inhibit TNF. However now this idea has been questioned and blockade of TNF can make MS worse so should we be using them in MS?
What do you think and what would you think if I said they are being tested in MS?