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. 2008 Aug 21;68(8):1316–1321. doi: 10.1136/ard.2007.086728

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Schematic view of the interaction between macrophage migration inhibitory factor (MIF) and tumour necrosis factor (TNF). Both macrophages and T cells as well as dendritic cells and fibroblast-like synoviocytes produce MIF and TNF. TNF induces the production of MIF, and vice versa. TNF production can be induced by MIF.⁸ ¹⁷ In rheumatoid arthritis increased levels of MIF and TNF have been found locally in the synovial fluid and synovial tissue, which perpetuate the inflammatory process not only by inducing further cytokine secretion, but also by enhancing leucocyte migration towards the site of inflammation.¹⁸ With anti-TNF antibody therapy available bioactive TNF is neutralised. Furthermore, infiltration of the inflamed synovium by macrophages (main producers of TNF and MIF) was shown to diminish early after treatment.¹⁹ Therefore, both the number of MIF-producing cells as well as the concentration of bioactive TNF decreases after anti-TNF therapy, potentially leading to a decrease in systemic MIF levels.