TNF blockers have been studied in patients for years and have been on the market since 1998. Two major concerns with these drugs include the risk of serious infection or lymphoma. Even without taking TNF blockers, rheumatoid arthritis patients have an increased risk of developing these two problems (infection or lymphoma) compared to the general population. In fact, patients who have the most severe cases of rheumatoid arthritis are more likely to develop lymphoma than those with milder disease.
There is evidence that the biologic drugs increase the risk of developing unusual infections like tuberculosis. Therefore, it is recommended that all patients be screened with a skin test and chest x-ray to check for prior exposure to TB before beginning therapy with a TNF blocker.
Be extra cautious about taking these medications if you are an insulin dependent diabetic or have another reason to be at increased risk for infection, recurring infections or open wounds/sores. Many rheumatoid patients may do very well on the traditional DMARDS such as Plaquenil (hydroxychloroquine), Azulfidine (sulfasalazine) or Rheumatrex (methotrexate) and may never need to take a TNF blocker. In patients who have significant disease and have reasons they should not take methotrexate (e.g., liver disease), TNF blockers can be used as a first line treatment.
Dr. Zashin is clinical assistant professor at University of Texas Southwestern Medical School and an attending physician at Presbyterian Hospitals of Dallas and Plano. Dr. Zashin is author of Arthritis Without Pain - The Miracle Of TNF Blockers. The book is useful for anyone on one of the biologic drugs or considering the biologic drugs.