Rheumatoid Arthritis - Anti-TNF

•TNF inhibitor therapy in early RA is useful in patients with very active RA.•The role of anti-drug antibodies in secondary failure of TNFi therapy is reviewed.•Lowering TNFi doses will be increasingly adopted in practice reducing drug exposure and generating significant cost benefits.

This review will focus on the recent information and strategies now informing best use of TNF inhibitor therapy in RA. These issues include the role of TNFi therapy in early RA management, anti-drug antibodies in TNFi therapy, updates on safety and optimal dosage regimens in long term management.