Certainly, the conclusions presented by this study and the resultant warning give clinicians pause when considering the order of applications, i.e., TNFi before tsDMARDs. It has long been my understanding that the increase in both cancers (particularly lymphomas) and MACE in RA correlates with uncontrolled inflammation. Does this data suggest indirectly that tsDMARD therapy is inferior to TNFi in the global control of inflammation in RA? Perhaps that is another conceptual reason to select a TNFi first, strategically.