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Other PAEs may be qualified as borderline and include uveitis, scleritis, sarcoidosis and other granulomatous diseases (granuloma annulare, interstitial granulomatous dermatitis), vasculitis, vitiligo and alopecia areata. Proposed hypotheses to explain these PAEs include an imbalance in cytokine production, the differential immunological properties between the monoclonal antibodies and TNF-\u03b1 soluble receptor, an unopposed type I interferon production and a shift towards a Th1\/Th2 profile. Data from registries suggest that the risk for paradoxical psoriasis is low and non-significant. We discuss management of these PAEs, which depends on the type and severity of the adverse events, pre-existing treated conditions and the possibility of alternative therapeutic options for the underlying disease. Paradoxical adverse events are not restricted to anti-TNF-\u03b1 agents and close surveillance of new available biological drugs (anti-interleukin-17\/23, anti-integrin) is warranted in order to detect the occurrence of new or as yet undescribed events.<\/jats:p>","DOI":"10.1136\/rmdopen-2015-000239","type":"journal-article","created":{"date-parts":[[2016,7,15]],"date-time":"2016-07-15T23:33:29Z","timestamp":1468625609000},"page":"e000239","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":190,"title":["Paradoxical reactions under TNF-\u03b1 blocking agents and other biological agents given for chronic immune-mediated diseases: an analytical and comprehensive overview"],"prefix":"10.1136","volume":"2","author":[{"given":"\u00c9ric","family":"Toussirot","sequence":"first","affiliation":[{"name":"Clinical Investigation Center in Biotherapy, INSERM CIC-1431, University Hospital of Besan\u00e7on, Besan\u00e7on, France"},{"name":"FHU 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