From the Guidelines
Elevated Tumor Necrosis Factor (TNF) alpha levels are associated with increased risk of infections, inflammatory conditions, and potentially life-threatening complications, and therefore, require careful monitoring and management to minimize morbidity, mortality, and improve quality of life.
Significance of Elevated TNF-alpha Levels
Elevated TNF-alpha levels are associated with various inflammatory conditions, including rheumatoid arthritis, inflammatory bowel disease, psoriasis, and certain infections 1. TNF-alpha is a cytokine produced primarily by activated macrophages and is involved in systemic inflammation, immune cell regulation, and can induce cell death.
Risks Associated with Elevated TNF-alpha Levels
The use of TNF inhibitors, such as infliximab and adalimumab, can increase the risk of infections, including bacterial, viral, and mycobacterial infections, as well as opportunistic infections like histoplasmosis, listeriosis, and coccidioidomycosis 1. Additionally, elevated TNF-alpha levels have been linked to an increased risk of hepatitis B reactivation in patients receiving immunosuppressive therapy, particularly those with high-risk conditions like hematologic disorders or solid tumors 1.
Management of Elevated TNF-alpha Levels
To minimize the risks associated with elevated TNF-alpha levels, careful monitoring and management are essential. This includes regular screening for infections, monitoring of liver function and hepatitis B status, and adjustment of immunosuppressive therapy as needed 1. The use of TNF inhibitors should be avoided in patients with chronic, serious, or recurring infections, and patients at increased risk for TB or other opportunistic infections should be carefully screened and monitored.
Key Considerations
- Elevated TNF-alpha levels are associated with increased risk of infections and inflammatory conditions
- Careful monitoring and management are essential to minimize morbidity, mortality, and improve quality of life
- TNF inhibitors should be used with caution, particularly in patients with high-risk conditions or those receiving immunosuppressive therapy
- Regular screening for infections and monitoring of liver function and hepatitis B status are crucial in patients with elevated TNF-alpha levels 1.
From the Research
Significance of Elevated Tumor Necrosis Factor (TNF) Alpha Levels
Elevated TNF alpha levels play a significant role in various systemic and dermatologic diseases, including:
- Rheumatoid arthritis
- Crohn's disease
- Ankylosing spondylitis
- Psoriatic arthritis
- Sarcoidosis
- Hidradenitis suppurativa
- Cicatricial pemphigoid
- Behçet's disease
- Pyoderma gangrenosum
- Multicentric reticulohistiocytosis
- Aphthous stomatitis
- Sneddon-Wilkinson disease
- SAPHO syndrome
- Pityriasis rubra pilaris
- Eosinophilic fasciitis
- Panniculitis
- Necrobiosis lipoidica diabeticorum
- Dermatomyositis
- Scleroderma 2
Role of TNF Alpha in Disease Pathogenesis
TNF alpha is a proinflammatory cytokine that plays a key role in the pathogenesis of many chronic inflammatory and rheumatic diseases 3. It is involved in the initial host response to infection and in the pathogenesis of various immune-mediated diseases, such as rheumatoid arthritis, ankylosing spondylitis, psoriasis, and Crohn's disease 4.
Treatment of TNF Alpha-Related Diseases
Several TNF alpha inhibitors are available for the treatment of these diseases, including infliximab, etanercept, adalimumab, golimumab, and certolizumab pegol 3, 5, 4, 6. These drugs have been shown to be effective in reducing symptoms and signs, improving function and quality of life, and reducing radiologically evident damage in patients with rheumatoid diseases 3, 6.
Adverse Effects of TNF Alpha Inhibitors
The use of TNF alpha inhibitors is associated with several adverse effects, including injection site and intravenous reactions, increased risk of infection, and increased risk of lymphoproliferative disease 3, 6. The risk of malignancies, especially lymphoma, remains controversial 6.