How Does TNF Cause Inflammation?

If you have an immune system disease like rheumatoid arthritis (RA), you may have heard your doctor use the term TNF. It's shorthand for tumor necrosis factor, a protein in your body that causes inflammation and helps coordinate the process.

It may surprise you to learn that inflammation can be a good thing. It happens when your immune system -- your body's natural defense force -- is fighting a possible threat. For example, when you have a cold, your sinuses swell. When you get a cut, your finger turns warm and red. These things don't feel good, but they show your immune system is doing its job.

Sometimes, inflammation isn't good for the body. If you have a disease like RA or psoriatic arthritis, your immune system is confused about what to attack. It goes after healthy body parts, like your joints, by mistake. Your system gets flooded with inflammation, which often means you have too much tumor necrosis factor -- specifically, a type called TNF alpha.

Inflammation Is a Chain Reaction

When you have an infection, certain white blood cells release chemicals that tell other cells to cause inflammation. Your doctor might call them signaling chemicals. TNF is a major player when it comes to inflammation.

Think of the white blood cells that make tumor necrosis factor as the army. TNF is the signal that tells the rest of the defense units where to go and what to do.

What do these defense units do? Some white blood cells fight infection. TNF also tells other cells to make other chemicals, like the hormones that cause you to lose your appetite when you're sick. It's all part of the inflammatory process.

Signs of High TNF

If you have a severe bacterial infection like pneumonia, high levels of tumor necrosis factor are a sign of inflammation that's helping you heal. But high TNF levels can also trigger some unpleasant symptoms:

• Low blood pressure
• Fever
• Muscle aches
• Loss of appetite
• Redness and swelling (if you have an infected wound)

If you have a lot of TNF but no infection, your immune system may not be working properly. Symptoms are usually different from when you have an infection. If you have psoriasis, high levels of TNF play a role in the raised, red skin plaques that come with the disease. For people with RA, they play a role in joint swelling and redness, aka joint inflammation.

There's also a link between TNF and insulin resistance, a condition that leads to type 2 diabetes. Your pancreas makes the hormone insulin to help cells turn blood sugar into energy. If your cells don't respond to the insulin, you have insulin resistance. If you're overweight, your body makes more TNF, which also leads to insulin resistance.

Drugs That Block Excess TNF

Having the right amount of tumor necrosis factor in your body is important. If you're healthy, your body naturally takes care of this: It blocks any extra TNF you might have. That doesn't always happen in diseases like RA, so you end up with too much TNF in your blood. That leads to inflammation and painful symptoms.

Fortunately, there are drugs that block excess tumor necrosis factor. They're part of a group called biologics, and you might hear your doctor call them one of these names:

• TNF inhibitors
• Anti-TNF agents
• Anti-TNF drugs
• TNF blockers

The drugs are:

• Adalimumab (Humira), adalimumab-atto (Amjevita)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel), etanercept-szzs (Erelzi)
• Golimumab (Simponi, Simponi Aria)
• Infliximab (Remicade), infliximab-dyyb (Inflectra)

These drugs stop TNF's “create inflammation now” message before it can get to other cells. The result is less inflammation in your joints, digestive tract, or skin, depending on what disease you have. These medications can be used to treat:

• Rheumatoid arthritis
• Psoriatic arthritis
• Juvenile arthritis
• Crohn's disease
• Ulcerative colitis
• Ankylosing spondylitis
• Psoriasis

Rheumatoid arthritis patients who have not responded sufficiently to TNF inhibitors may be prescribed baricitinib (Olumiant) or tofacitinib (Xeljanz). They are a class of drugs known as Janus Kinase Inhibitors. JAKs work by interrupting the signal pathway from inside the cell involved in the inflammation.

Doctors are studying the effects of a TNF inhibitor on type 2 diabetes, but there are no conclusive results. Some studies show it improves insulin resistance, others don't. More work is needed.

Can You Lower TNF Naturally?

Yes. Get moving. Exercise will help get rid of fat, where TNF lives. And it can help reverse metabolic syndrome, which leads to insulin resistance and type 2 diabetes. The U.S. Department of Health and Human Services suggests that adults get 150 minutes of moderate exercise each week. That's 30 minutes a day, 5 days a week. Take a walk or ride a bike. If you can't do half an hour, do short bursts of at least 10 minutes. Add muscle-strengthening activities at least 2 days a week. Push-ups, sit-ups, and weight lifting are options.

Though there isn't a specific diet that fights inflammation, you can add these foods to your list:

• Green, leafy vegetables
• Fatty fish, like salmon, tuna, sardines, and mackerel
• Fiber
• Fruits, like strawberries, blueberries, cherries, and oranges
Nuts
• Olive oil
• Tomatoes

And avoid these foods

• Fats like margarine, shortening, and lard
• Fried foods
• Red meat and processed meat
• Refined carbs, like white bread and pasta
• Soda and sugary drinks

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