Anti-tumor necrosis factor therapy can help manage inflammation and limit joint damage in moderate to severe RA. Here's what you need to know.

Phoenix resident Anna Lee Speer knows a thing or two about rheumatoid arthritis pain. She was diagnosed with the condition 30 years ago, at the age of 36. For decades, miserable flares prevented her from leading an active lifestyle.

That all changed when she began taking an anti-tumor necrosis factor (anti-TNF) therapy medication. Since then, Speer has hiked the Grand Canyon, taken two kayaking trips in British Columbia, and toured Holland by bicycle. “Those activities would have been unthinkable in my forties,” Speer said. “[Anti-TNF] therapy has made a huge difference for me.”

Anti-Tumor Necrosis Factor Therapy

If you have RA, your immune system is producing excess amounts of TNF, a naturally occurring protein. These excess levels of TNF lead to the signature symptoms of RA, like inflammation, joint pain and damage.

Anti-TNF drugs are biologics – medications made with live organisms – that specifically target the TNF protein. They are classified under the umbrella of DMARDs, or disease-modifying anti-rheumatic drugs. Some of the more well-known anti-TNF drugs are infliximab (Remicade), etanercept (Enbrel), and adalimumab (Humira).

Anti-tumor necrosis factor drugs have been used to treat RA since the late 1990s, said Scott Zashin, MD, a rheumatologist in Dallas. This class of drugs also treats conditions like psoriatic arthritis, Crohn's colitis, ankylosing spondylitis, and psoriasis. When the drugs are used effectively, they can reduce symptoms and prevent joint damage, Dr. Zashin added.

Anti-TNF drugs need to be injected or infused directly into the bloodstream, said Nortin M. Hadler, MD, a rheumatologist at the University of North Carolina at Chapel Hill. Some people learn how to administer the injections on their own; others get infusions at their doctor's office. You might need treatment as often as once a month or as infrequently as twice a year, Zashin said.

Typically, you'll only go on an anti-TNF drug after oral DMARDs, like methotrexate, fail to help. You might get anti-tumor necrosis factor therapy alone or in combination with an oral DMARD, particularly if you have moderate to severe RA, as Speer does.

Anti-Tumor Necrosis Factor Therapy Side Effects and Effectiveness

The most common side effect of this type of RA therapy is irritation or infection at the site of the injection, which can very rarely turn into a life-threatening problem, Zashin said. Some studies have shown that adalimumab, etanercept, and infliximab carry an increased risk of heart failure compared with oral RA drugs, according to a U.S. Agency for Healthcare Research and Quality report.

Speer said she doesn't notice any major side effects, although she does feel tired after an infusion. She usually allows herself to rest for the following 24 hours. Sometimes lab tests show a change in her liver function due to her use of methotrexate and then she'll temporarily stop its use. That is part of the challenge of using both medications at the same time, she added.

Anti-tumor necrosis factor therapy is expensive, costing $10,000 a year or more. However, it is often covered by insurance, or you may be able to access pharmaceutical-company-based payment assistance programs, Zashin said.