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TNF antagonists revolutionized the treatment of several high-needs inflammatory conditions including plaque psoriasis and hidradenitis suppurativa. After an initial, sputtering start in MS, septic shock, and congestive heart failure, clinical trials in rheumatoid arthritis established a development path in chronic inflammatory diseases. Plaque psoriasis was a serendipitous passenger on the psoriatic arthritis train. Over many years of development, dozens of clinical trials, and thousands of patients in registries, we know TNF to be a central cytokine mediating many chronic inflammatory diseases. We also know that therapeutic blockade of TNF is remarkably safe. Yet to be established are collateral benefits of treatment with TNF antagonists.