Tumor necrosis factor
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Tumor necrosis factor (TNF) is a chemical messenger produced by immunoregulatory cells responsible for the normal inflammatory response.
In certain disease states such as rheumatoid arthritis there is overproduction of TNF with a consequent destructive effect on joints as well as other organ structures.
The tumor necrosis factor inhibitors have revolutionized the treatment of rheumatoid arthritis and have become a mainstay in the modern approach to rheumatoid arthritis.
Here's a review from Australia...
Tumor necrosis factor inhibitors: risks and benefits in patients with rheumatoid arthritis.
Roberts L, McColl GJ.
Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis and can, if left untreated, result in significant disability and early death. It is also associated with large direct and indirect costs to the individual and to society. Early and aggressive disease modifying anti-rheumatic drug (DMARD) treatment of patients at risk of erosive disease has improved the outcome in the majority, but not all, RA patients.
Tumor necrosis factor (TNF) appears to be a key mediator of the inflammatory and destructive process in RA, and consequently inhibitors of TNF action have been tested in randomized controlled trials in patients with RA. The results of these studies have suggested that TNF inhibitors are potent DMARD particularly when combined with methotrexate. They appear well tolerated with the commonest adverse events related to their parenteral route of administration, and the serious but rare side-effects being various infections, notably tuberculosis, multiple sclerosis, and worsening of cardiac failure. Treatment costs are high and range from $15 000 to $25 000 per patient per year. Etanercept, adalimumab and infliximab have been approved for the treatment of rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis by the FDA. The availability of TNF inhibitors in RA represents a significant advance in the treatment of patients with severe RA.
Intern Med J. 2004 Dec;34(12):687-93.
There are currently five tumor necrosis factor inhibitors approved in the United States for treatment of rheumatoid arthritis. They are Enbrel, Remicade, Humira, Cimzia, and Simponi.
All five drugs are excellent although certain side effects must be looked out for.
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