Box 1: BSR guideline for the use of anti-TNF therapy in rheumatoid arthritis 1. Persistent RA activity: Disease Activity Score-28 (DAS28) of >5.1 at 2 time points 1 month apart 2. Failure of >2standard DMARDs of which one must be methotrexate (methotrexate, intramuscular gold, hydroxychloroquine, sulphasalazine, azathioprine, leflunomide, penicillamine)   An adequate therapeutic trial:     - Treatment >6months, with >2months at standard dose (unless significant toxicity)     - Treatment < 6 months, where treatment was withdrawn because of drug intolerance or toxicity 3. Exclusion Criteria:   Pregnant or breast feeding   Active infection or at high risks of infection   Septic arthritis of native joints in last 12 months   Septic arthritis of prosthetic joint in last 12 months or indefinitely if the joint remains in situ   Tuberculosis if not adequately treated   Multiple sclerosis   Malignancies excluding skin cancer & cancers >10 years 4. Withdrawal of treatment:   Adverse event: cancer, severe toxicity, infection   Lack of effect:     - DAS28 remains >3.2 or     - Reduction in DAS28 by <1.2