TNF and rheumatoid arthritis: Studies have shown that the efficacy of Tripterygium wilfordii Hook II monotherapy is not inferior to MTX monotherapy in the treatment of RA, and Tripterygium wilfordii Hook II in combination with MTX or tumor necrosis factor α (TNFα) inhibitor also has good efficacy and safety.[101,102] Tripterygium wilfordii Hook II can be used as csDMARD in addition to MTX, sulfasalazine, and leflunomide, but they are contraindicated in patients who are preparing for pregnancy, in pregnancy, in lactation, or with fertility requirements because of their genital toxicity.