TNF Blockers—Should Arthritis Patients Fear Side Effects?

TNF (tumor necrosis factor) blockers are a type of biologic approved by the FDA for treating inflammatory types of arthritis. Most people experience significant improvement with these drugs, and serious side effects are not common. However, there is a small risk of serious side effects associated with TNF blockers, such as severe infections and lymphoma.

Three vials of medication and a syringe
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Traditional disease-modifying antirheumatic drugs (DMARDs) include Plaquenil (hydroxychloroquine), Azulfidine (sulfasalazine), or Rheumatrex (methotrexate). Many people with inflammatory arthritis experience improvement with these medications and may never need to take a TNF blocker.

TNF blockers, which are considered biologic DMARDs, include Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), and Cimzia (certolizumab pegol). These medications are often considered when traditional DMARDs are not effective in controlling symptoms.

If you have severe inflammatory arthritic disease and can't take a traditional DMARD, like methotrexate (such as due to underlying liver disease), TNF blockers can be used as a first-line treatment.

Warnings and Precautions

There are several risks of taking TNF blockers, and some underlying conditions increase these risks.

These drugs include the risk of lymphoma. Even without taking TNF blockers, people with rheumatoid arthritis have an increased risk of developing lymphoma compared to the general population. In fact, people who have severe rheumatoid arthritis are more likely to develop lymphoma than those with milder disease.

Research also suggests those with rheumatoid arthritis who take TNF blockers may have a higher risk for skin cancer, especially non-melanoma skin cancers such as squamous cell carcinoma. However, more research is needed.

There is evidence that biologic drugs increase the risk of infections that usually affect people who have a compromised immune system. Tuberculosis (TB) is one of these infections. It is recommended that all patients be screened for prior exposure to TB before beginning therapy with a TNF blocker because a past infection can become severe when exposed to biologics.

You should be extra cautious about taking TNF blockers if you are an insulin-dependent diabetic or have another reason to be at increased risk of infections or open wounds or sores.

The Bottom Line

If you are prescribed a TNF blocker, remember to:

  • Know the potential side effects associated with TNF blockers
  • Use your medication as prescribed
  • Pay attention to the new symptoms which may have developed after starting the TNF blocker and report these issues to your healthcare provider
  • Be sure to check with your healthcare provider and pharmacist before starting any new medications, supplements, or herbs to avoid drug interactions
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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  4. Wang J lin, Yin W jun, Zhou L yun, et al. Risk of non-melanoma skin cancer for rheumatoid arthritis patients receiving TNF antagonist: a systematic review and meta-analysisClin Rheumatol. 2020;39(3):769-778. doi:10.1007/s10067-019-04865-y

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Additional Reading
  • Answer provided, in part, by Scott J. Zashin, M.D.  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 and co-author of Natural Arthritis Treatment.