TNF-alpha inhibitors: Treatment for inflammatory diseases

For people with inflammatory conditions, such as rheumatoid arthritis and Crohn's disease, who have tried other medications with little success, tumor necrosis factor-alpha (TNF-alpha) inhibitors may provide some relief. These drugs block TNF-alpha — a protein that's present in larger quantities in your body if you have certain inflammatory conditions. Along with the possible benefits, TNF-alpha inhibitors may cause side effects, including some that could be life-threatening. As with all medications you take, you and your doctor must balance the risks and financial cost with the potential benefits.

Available TNF-alpha inhibitors

Three TNF-alpha inhibitors are available by prescription.

Adalimumab (Humira)
Adalimumab is used alone or in combination with other drugs to treat:

• Rheumatoid arthritis
• Psoriatic arthritis
• Moderate to severe Crohn's disease

You inject adalimumab under the skin on your thighs or abdomen every other week, or sometimes weekly.

Etanercept (Enbrel)
Etanercept can be used alone or in combination with other medications for conditions such as:

• Rheumatoid arthritis
• Juvenile rheumatoid arthritis
• Psoriatic arthritis
• Psoriasis
• Ankylosing spondylitis

You inject etanercept once or twice a week under the skin of your thigh, abdomen or upper arm.

Infliximab (Remicade)
Infliximab is given as an intravenous (IV) infusion over two or three hours. You might receive two or three IV infusions over several weeks or months. For rheumatoid arthritis, the usual dosage schedule is three infusions over the first six weeks, then once every eight weeks after that.

Your doctor might prescribe infliximab if you have:

• Moderate to severe Crohn's disease
• Rheumatoid arthritis
• Psoriatic arthritis
• Ankylosing spondylitis
• Ulcerative colitis

Common side effects of TNF-alpha inhibitors

TNF-alpha inhibitors, like many medications, carry a risk of side effects — some more serious than others. Because TNF-alpha inhibitors are infused or injected into your body, you might notice a reaction at the injection site. Some common signs and symptoms of injection reactions include:

• Redness
• Itching
• Pain
• Swelling
• Bleeding
• Bruising

TNF-alpha inhibitors also may cause other side effects, including runny nose, sneezing, headache and dizziness. Tell your doctor if any of these signs and symptoms persist or are bothersome.

Each TNF-alpha inhibitor may cause different side effects. Read the information that comes with your medication carefully so that you know what to expect and when to seek medical attention. Talk to your doctor or pharmacist if you have any questions.

TNF-alpha inhibitors in the future

Clinical trials are under way to investigate the use of the three currently available TNF-alpha inhibitors, as well as others, in several other diseases. Look for possible new developments in the future. For now, talk to your doctor if you think TNF-alpha inhibitors may be of benefit to you.

Symptoms

The most obvious sign of a subconjunctival hemorrhage is a bright red patch on the white (sclera) of the eye. Despite its bloody appearance, a subconjunctival hemorrhage should cause no change in your vision and no discharge from your eye. Your only discomfort may be a scratchy feeling on the surface of your eye.

When a small blood vessel breaks leading to bleeding under the conjunctiva, blood accumulates in this blotchy fashion. It may look scary, but this condition is harmless and usually disappears in a few days.

Causes

The cause of subconjunctival hemorrhage is usually unknown. However, the following actions may be enough to cause a small blood vessel to rupture in your eye:

• Violent coughing
• Powerful sneezing
• Heavy lifting
• Vomiting

When to seek medical advice

If a bright red patch appears on your eye or on the eye of your child, contact your doctor to be sure that the problem is not more serious than a subconjunctival hemorrhage.

Complications

While you may feel self-conscious about the appearance of your eye, health complications from a subconjunctival hemorrhage are rare.

Prevention

There's no known way to prevent subconjunctival hemorrhage unless there is a clearly identifiable cause for the bleeding, such as might occur if you're taking more blood-thinning medications than you should be.

Symptoms

Retinal detachment is painless, but visual symptoms almost always appear before it occurs. Warning signs of retinal detachment include:

• The sudden appearance of many floaters — small bits of debris in your field of vision that look like spots, hairs or strings and seem to float before your eyes
• Sudden flashes of light in one or both eyes
• A shadow or curtain over a portion of your visual field
• A sudden blur in your vision

If you experience any of these signs or symptoms, seek urgent evaluation by an ophthalmologist. In most cases, these signs and symptoms don't indicate a serious problem. However, if you do have a retinal tear or retinal detachment, prompt treatment is necessary to preserve your vision.

Risk factors

Your risk of developing a detached retina generally increases with age simply because the vitreous changes as you grow older. The condition tends to affect more whites than blacks. The following factors also increase your risk of retinal detachment:

• Previous retinal detachment in one eye
• A family history of retinal detachment
• Extreme nearsightedness (myopia)
• Previous eye surgery, such as cataract removal
• Previous severe eye injury or trauma
• Weak areas in the periphery of your retina

When to seek medical advice

If you experience any of the warning signs of retinal detachment, see your ophthalmologist right away. Prompt medical attention is necessary to save your vision.

Unfortunately, many people don't appreciate the urgency of the warning signs of retinal detachment, and they tend to put off seeing a doctor in the hope that symptoms will disappear. In some cases, symptoms temporarily diminish only to be followed by a loss of vision over the next few days or weeks, caused by advanced retinal detachment. This condition can't always be successfully repaired with surgery, and vision loss may be permanent. So it's best to see your doctor at the earliest signs of retinal detachment.

Coping and support

Unless you undergo prompt surgery, retinal detachment will cause you to lose vision in the portion of your field of vision that corresponds to the detached part of the retina. Losing part of your vision can greatly change your lifestyle — affecting your ability to drive, read and do many other things you're accustomed to doing. Yet there are ways to cope with impaired vision:

• Check into transportation. Investigate vans and shuttles, volunteer driving networks, or rideshares available in your area for people with impaired vision.
• Get special glasses. Optimize the vision you have with glasses that are specifically prescribed for the effects of retinal detachment and keep an extra pair in the car.
• Brighten your home. Have proper light in your home for reading and other activities.
• Make your home safer. Eliminate throw rugs and other tripping hazards within your home.
• Enlist the help of others. Tell friends and family members about your vision problems so that they can help you perform certain tasks and help you recognize people.
• Talk to others with impaired vision. Take advantage of online networks, support groups and resources for people with impaired vision.