The anti-tumor necrosis factor agents are a major advance in the treatment of rheumatoid arthritis.

Despite optimization of the use of the traditional disease modifying antirheumatic drugs (DMARD) as mono- or combination therapy, between 25% and 50% of patients with rheumatoid arthritis (RA) still have clinically active synovitis with progressive structural articular damage. Several clinical trials with the anti-tumor necrosis factor (TNF) agents etanercept, infliximab, and adalimumab, used alone or in combination with methotrexate, in patients with early or established RA have shown consistent improvement in signs and symptoms as well as function, with a dramatic slowing of radiographic damage. The anti-TNF agents combined with optimal doses of MTX currently constitute the best therapeutic regimen for the management of patients with RA failing to adequately respond to traditional DMARD.