TNF inhibitors were first approved for treatment of active rheumatoid arthritis (RA) in 1998. Since that time, a series of multicentre, randomized controlled trials have been evaluated in early and established RA, in patients who had not been treated with methotrexate (Mtx) as well as in those who had an inadequate response to traditional disease modifying antirheumatic drugs (DMARD), including Mtx. In these trials approximately 6000 RA patients have participated. Clinical response to treatment and adverse effects of anti-TNF agents are discussed. The relative expense of TNF inhibitors makes their universal use impractical. The use of TNF inhibitors in the treatment of active RA should be considered when traditional DMARD, including combination therapy of DMARD, are not effective.