TNF and rheumatoid arthritis: In a randomized controlled trial, compared to methotrexate and leflunomide, treatment with “Niuxi” and other TCMs combined with methotrexate and leflunomide in patients with RA obviously decreased CRP levels, ESR, tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-17, RF, matrix metalloproteinase-3 (MMP-3) and transforming growth factor-β (TGF-β) (Chen et al., 2024).