TNF and arthritic joint disease: Dengue virus-mediated activation of MDL-1/CLEC5A can trigger potent induction of TNF, IL-6 and IL-1β and NLRP3 inflammasome activation and shock.43 44 MDL-1/CLEC5A is also expressed in synovial tissue from RA patients and MDL-1/CLEC5A blockade reduced tissue inflammation and bone erosion in experimental arthritis models.27 Reduction of MDL-1/CLEC5A expression by TNFi may result in inhibition of bone erosion and inflammatory cytokine production in SpA.