TNF and tuberculosis: The change in treatment guidelines to include rituximab as a first-line biologic is particularly relevant to patients with relative or absolute contraindications to TNF inhibitors, such as those with a personal or family history of lymphoma, history of previous active tuberculosis (TB), or latent TB with contraindications to the use of chemoprophylaxis, those living in a TB- or fungal-endemic region, previous history of demyelinating disease, or those with congestive heart disease [40, 41].