TNF and autoimmune disease: Furthermore, TNF-α, IL-5, and IL-13 are involved in the development and exacerbation of RA.[46–48] Indeed, RA involves the formation of NETs, and NETs and related cytokines can exacerbate RA.[6,15,20,21] A study reported a vicious circle in which RA and NETs exacerbate each other.[14] Therefore, the present study supports the concept that autoimmune diseases increase NETs, which can then participate in the maintenance and exacerbation of the autoimmune condition.[44]