In 1999, Czech Society for Rheumatology published standard protocols for the treatment of rheumatoid arthritis (RA), which were modified due to initiation of biological agents in 2002. Extensive use of biological agents during the last 2 years increased our knowledge, especially in the prevention of the toxicity of these agents, and compelled another amendment of the standard protocols. The indications for the treatment of RA with TNF blockers and instructions for their use are reviewed. The safety of anti-TNF therapy with regard to the risk of tuberculosis is discussed. Every patient with latent tuberculosis has to use preventive antituberculosis treatment 1 month before initiation of TNF blocking agents. The emphasis is put on a need of long term observations of all TNF blockers-treated patients and the use of patients’ registry to reliably evaluate safety and socioeconomic data of the treatment is recommended.

        Key words: rheumatoid arthritis (RA), TNF blocking agents, standard protocol, tuberculosis