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The tumor necrosis factor (TNF-alpha) is a multifaceted polypeptide cytokine known as a mediator of inflammation and immunity.1 It may mediate some of the significant changes in cellular homeostasis which accompany the invasion of the mammalian host by viruses, bacteria, and parasites.2 TNF-α is an acute phase protein which initiates a cascade of cytokines and increases vascular permeability, thereby recruiting macrophage and neutrophils to a site of infection. TNF-α secreted by the macrophage causes blood clotting which serves to contain the infection. TNF-α has been detected in synovial fluid of patients with rheumatoid arthritis.