TNF and infection: A randomized controlled meta-analysis involving patients with SpA and AS noted a 1.57-fold higher risk of serious infections among those using anti-TNF agents than among those in the placebo group, although this difference was not statistically significant.25 Conversely, a systematic review and meta-analysis including RA, AS, and PsA patients reported a significant increase in the risk of infections and serious infections among those using anti-TNF agents.26 These findings suggest that healthcare providers should recommend vaccination for all AIIRD patients, irrespective of subtype.