Clinical questions to be addressed: 1. What is the best approach for diagnosis? 2. What other diseases mimic rheumatoid arthritis? 3. Should anti-TFN medications be a first-line medication (DMARD)? 4. What are the most common complications of rheumatoid arthritis in the era of DMARDs? 5. What are internal medicine consequences of using TNF-alpha agents? a. Vaccinations for flu, pneumonia, etc. b. Dealing with infections in patients who are taking TNF agents. c. Planning for elective surgery or dealing with managing surgery.