TNF and Insulin resistance: Previous published study had demonstrated the significant association diabetic patients with raise liver enzymes when compare to healthy person.20,21 Disturbances in liver function tests are commonly observed in diabetic patients, as increased liver enzyme activity has been linked to insulin resistance and type 2 DM.22 DM is one of the most common comorbidities for PsA patients.23 Although the link between PsA and DM is not yet fully understood, TNF-α and adipokines such as adiponectin are thought to be among the principal mediators.24