TNF and rheumatoid arthritis: Guidelines issued by the American College of Rheumatology in 2015 for the treatment of RA recommend initial treatment with methotrexate (MTX) for patients with established RA, with the addition of another conventional or targeted synthetic or biologic (tumor necrosis factor inhibitors [TNFi] or non-TNFi) disease-modifying antirheumatic drug (DMARD) if symptoms persist at moderate or high disease activity [5].