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Arthritis or Cancer?

One of the treatments for severe psoriatic arthritis that has failed to respond to other treatments (e.g. methotrexate or sulfa) is a TNF inhibitor (Humira, Enberel or Remicade).  TNF stands for Tumour Necrosis Factor.  Necrosis is a type of cell death.  If you have any cancer cells in your body you want them to die. So, TNF is a “factor” (or thing) in your blood that tells tumour cells to die (in some cells, under some circumstances)

You would think TNF would be a good thing to have.  However having too much TNF is one of the reseasons people with inflammatory arthritis (like psoriatic arthritis, rheumatoid arthritis, or ankyolysing spondylitis) have joint damage.  If you reduce the amount of TNF in a person, you stop the joints (and possibly the tendons) from being damaged and destroyed.

The trouble is TNF inhibitors seem to cause cancer.  The experts argue, some people say it doesn’t cause cancer it just makes cancer you already have obvious.  As most cancer take 10 years or more to develop, it does seem logical that the TNF inhbitors could uncover cancers that people have but didn’t realise it.

Often people taking TNF inbitors also take other drugs that may also increase their cancer risk and even having rheumatoid arthritis alone, without treatment, increases your cancer risk so it is difficult and complicated to research this.

If is thought that the TNF inhibitors increase your risk of lymphomas.  If you have lymphoma you may  be fatigued (very tired) and lose weight, but these can also be signs of inflammatory arthritis.  There is more about this on the Arthritis Research Campaign website “Cancer Screening – should be offered to people on anti TNF drugs

In the US the warning labels on the TNF inbhitors are to be changed to say that these drugs can increase your risk of cancer and can cause, or worsen psoriasis. You can read more about this and read further links on the NHS Choices page “Immune Drug Linked to Cancer

Cancer can take decades 10-30 years to develop, TNF inhibitors have only been used for about 8 years.  I think if we studied people on TNF inhibitors for 30 odd years we will see an increase in cancer, in some (although not all) people who take these drugs. Which is worse, a life crippled by arthritis or cancer?  Some types of cancer can be treated very successfully.  Others can’t.

Could I chose to take a drug that could give me cancer?  How bad would my quality of life have to be before I would consider that? Which is better a short and productive life, or a long pain-filled one?  Is it ever that simple?

Could I live with my own decision either way?  Would I regret taking a TNF inhbitor and blame that if I developed cancer?  Plenty people get cancer without taking TNF inhibitors, I could develop it anyway. Would I regret NOT taking a TNF inhibitor and not being able to play with my kids and look after my family because I was so fatigued and in so much pain?

Who knows?  How can you know? I guess I’ll just have to cross that bridge IF I come to it.

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