TNF and systemic lupus erythematosus: High TNF-A levels also play a role in the pathogenesis of SLE as it has a pro-apoptotic effect, causing increased auto antigen exposure that leads in increased auto antibodies and ultimately development of an auto immune process [17]. TNF inhibitors should theoretically be an excellent candidate in the treatment of SLE-psoriasis overlap, data has shown that although it has an excellent response in treatment of psoriasis, there are reports of worsening SLE cutaneous and systemic manifestations.