A focused review of the risk of harms of anti-TNF inhibitors in adult rheumatic diseases was performed. An increased risk of serious infections, tuberculosis and other opportunistic infections has been reported across various studies, with etanercept appearing to have a modestly better safety profile in terms of tuberculosis and opportunistic infections, and infliximab posing a higher risk of serious infections. Evidence suggests no increase in risk of cancer with anti-TNF biologics, but there is an increased risk of non-melanoma skin cancer. Elderly patients appear to be at increased risk of incident or worsening heart failure with anti-TNF biologic use. © 2013 Future Medicine Ltd.