Several studies have shown an increased risk of tuberculosis infection in SpA patients treated with infliximab, adalimumab, or etanercept, with 3- to 4- fold increase of tuberculosis recurrence for patients treated with infliximab or adalimumab over etanercept.[81] The Expert Group on Tuberculosis Prevention and Management in China recommended that patients with latent tuberculosis infection and previous history of tuberculosis infection should receive prophylactic anti-tuberculosis treatment for at least 4 weeks before starting TNF inhibitors. This evidence concerns the gene TNF and tuberculosis.