ElaineD, you could discuss the option of having your serum levels of TNF tested with your immunologist.

TNF is an inflammatory cytokine, mainly made by activated macrophages, which are recruited to sites of tissue inflammation.

TNF is associated with the tissue damage in a number of diseases with an inflammatory component (rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel disease among others.

If your TNF levels are abnormally high, this can be treated with humanised monoclonal antibodies specific for it (infliximab is an example) or with what is in effect a soluble form of a TNF receptor (etanercept).

Depending on the results of the tests, your immunologist should be able to discuss these treatment options with you.