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Randomised controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s), meta\u2010analyses of <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s, Cochrane reviews, national registry articles and case reports were identified using PubMed\/<jats:styled-content style=\"fixed-case\">MEDLINE<\/jats:styled-content>, The Cochrane Library and Google Scholar. The medical subject heading \u201crheumatoid arthritis\u201d was combined with \u201cserious infection\u201d or \u201cinfection\u201d or \u201cadverse drug events\u201d with each of the three reference biological therapies separately: etanercept, infliximab and adalimumab. These electronic searches were limited to human studies, adult studies, those published in the last 10\u00a0years (2004\u201314) and in the English language. Studies which involved the tumor necrosis factor\u2010\u03b1 inhibitors certolizumab pegol or golimumab were excluded. The background risk of serious infection appears to be approximately two\u2010fold more than non\u2010<jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patients before any treatment with biological therapy. The national registries, which may represent the typical <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patient more accurately than clinical trials, suggest a small but significantly increased incidence of serious infection ranging 1.2\u20132.78 times that of control (treatment with methotrexate). <jats:italic>Mycobacteria<\/jats:italic> spp., <jats:italic>Staphyloccus aureus<\/jats:italic>,<jats:italic> Listeria monocytogenes,<\/jats:italic> Varicella zoster virus and Leishmania species (spp.) repeatedly appear in the case report literature and should be in the mind of the clinician faced with a serious infection in a <jats:styled-content style=\"fixed-case\">RA<\/jats:styled-content> patient with an unknown pathogen who is being treated with either etanercept, infliximab or 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