TNF and endothelial dysfunction: One of the cardiac manifestations of rheumatoid arthritis is premature atherosclerosis, which is not necessarily correlated with traditional cardiovascular risk factors (gender, cigarette smoking, high body mass index, hypercholesterolemia, diabetes, hypertension, hypothyroidism and hyperhomocysteinemia).There are many proposed mechanisms to explain accelerated atherosclerosis in rheumatic patients: proinflammatory pathways (TNF-alpha, IL-6), adhesion molecules and cellular infiltrates, and also endothelial dysfunction, which is the first step in atherosclerosis development [3].