TNF and rheumatoid arthritis: What at first sight seems like a negative effect of anti-TNF treatment on joint destruction, in our opinion reflects the characteristics of the patient population receiving biologic DMARDs: Its usually insufficient control of clinical activity or radiographic progress that leads rheumatologists to the escalation of treatment with a biologic, in our cohort usually a TNF antagonist, results in a selection of patients suffering from a more aggressive form of RA.