Although it is recommended to screen and treat infections prior to starting therapy, anti-tumor necrotic factors (anti-TNF) carry a risk for infection, especially in the first 6-12 months of initiation.1 Rheumatoid arthritis patients per se were 4 times more likely to have tuberculosis compared to the general population.2 Nevertheless, anti-TNF use is associated with even higher risk.1 This evidence concerns the gene TNF and neoplasm.