Dear Editor, We read, with interest, the paper of Corrao et al. [1] reporting six various surgical procedures in five long-standing rheumatoid arthritis (RA) patients under etanercept therapy without interruption of the TNF blocker before and after surgery. No complications, particularly infectious, were noted, with 6 to 12 months of follow-up. According to the authors’ advice, we would like to share our experience and additional data of the literature. We reported [2] a retrospective study of 50 surgical procedures in 35 RA patients under anti-TNF therapy (26 infliximab, 13 etanercept, 11 adalimumab), with a mean anti-TNF exposition of 12.1 months (1 to 42), associated with disease-modifying antirheumatic drugs (methotrexate in 33 cases) and general steroid therapy in 41 of 50 cases (mean dosage 8.2 mg/day of prednisone). Discontinuation of anti-TNF therapy before surgery was noted in 18 of 50 cases, with a mean follow-up after surgery of 14 months (1 to 42). Thirty-nine cases were orthopedic surgery (extremities 24 cases, total joint replacement in 12 cases). No infectious complications were recorded whether the anti-TNF agent was held or not. Three cases (6%) of delay of wound healing were observed, as well as six cases (12%) of moderate and short-lasting RA flares, significantly associated with anti-TNF interruption before surgery. Other reports conclude to the absence of increased infectious events after surgery under anti-TNF treatment. The paper by Bibbo and Goldberg [3] compared foot and ankle surgery in 16 RA patients under anti-TNF agents compared with 15 matched anti-TNF naive patients and found similar rates of complications in both groups. Similar results were reported by Joven et al. [4] in seven patients (no complication and two cases of RA reactivation associated with interruption or delay of anti-TNF treatment), and by Den Broeder et al. [5], comparing surgery in RA patients without anti-TNF (n=575), stopping anti-TNF preoperatively (n=72), and not stopping anti-TNF preoperatively (n=49). Infection rates did not significantly differ between the three groups (3.5, 8.3, and 4.0%, respectively). Shergy et al. [6] analyzed 76 procedures under infliximab and failed to show significant differences in surgical outcomes for RA patients receiving infliximab. The same conclusion was drawn from the study of Talwalker et al. [7] about 16 patients. On the other hand, Giles et al. [8] reported increased risk of infection (odds ratio 4.4) in orthopedic surgery under anti-TNF (35 patients under anti-TNF among 91 patients analyzed). In the Cochin Hospital experience [9], among 770 patients treated by TNF blockers, 92 (12%) underwent 127 various surgical procedures; postoperative complications occurred in 19% of the cases, more often (although not significant), in patients not discontinuing anti-TNF therapy. Taken together, all these data bring no clear evidence that discontinuation of anti-TNF blockers before surgery reduces the risk of infection and other postoperative complications, and in some studies, the global incidence of complications may be higher in patients under anti-TNF therapy. Nevertheless, these results should be interpreted in the light of possible bias related to the retrospective character of these studies (often published as abstract only) and the frequency of infectious and postoperative complications up to 10% in global RA population [10]. The debate is not closed, prospective case-control studies are needed to Clin Rheumatol (2007) 26:1396–1397 DOI 10.1007/s10067-007-0585-2