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Most patients with RA are in use of traditional disease modifying antirheumatic drugs (DMARDs) to control disease activity, and among the traditional, non-biological DMARDs (nbDMARDs), methotrexate (MTX) is a first line and an anchor drug for the treatment of RA. Currently introduced biologic agents, especially anti-tumor necrosis factor-alpha (TNFα) agents, have revolutionized the treatment of RA. TNF-α triggers the inflammatory cas‐ cade and stimulates the production of matrix degradable proteinases such as matrix metalloproteinases, which well known to play a major role in the proteolytic degradation of extracellular matrix macromolecules of cartilage and bone, which is a key step in joint de‐ struction in RA. Anti-TNF-α agents are now in routine use for RA patients who have failed to respond to nbDMARDs, and have been demonstrated to improve the clinical symptoms and delay joint destruction dramatically. Unfortunately, despite of the administration of nbDMARDs and/or biologic agents, complete prevention of the destruction of the affected joints is still not achieved. Over the course of their lifetime, many patients with RA may re‐

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Perioperative Surgical Site Infections and Complications in Elective Orthopedic Surgery in Patients with Rheumatoid Arthritis Treated with Anti-Tumor Necrosis Factor-Alpha Agents − Discontinue or Not, Clinical Dilemma