Is there place for TNF-alpha inhibitors in the treatment of connective tissue diseases?

Tumour necrosis factor alpha (TNF-α) plays a crucial role in the inflammatory and immune responses. While TNF-α inhibitors (TNFi) have demonstrated efficacy in inflammatory diseases like rheumatoid arthritis, their use in connective tissue diseases remains controversial. Various studies highlight inconsistent benefits, particularly in systemic lupus erythematosus where limited evidence supports TNFi therapies despite some positive outcomes in resistant cases. In antiphospholipid syndrome, TNFi therapy has shown promise in specific refractory cases, increasing live birth rates. Conversely, the effectiveness of TNFi in systemic sclerosis, Sjögren's syndrome and idiopathic inflammatory myopathies is less well established, with reports of exacerbated symptoms and severe adverse effects. Existing literature suggests that while TNFi may provide some benefits, particularly in refractory cases, their overall safety and efficacy remain uncertain. This underscores the necessity for further clinical trials to elucidate the therapeutic role of TNFi and ensure patient safety in these complex autoimmune conditions. The aim of this review was to collect and evaluate the current scientific evidence on the efficacy and safety of TNF-α inhibitors in the treatment of connective tissue diseases.