During "The Great Debate" at ACR Convergence 2020, the question: "Should JAK inhibitors be started before TNF inhibitors in people with rheumatoid arthritis who failed methotrexate?" was asked. However, in 2021, results from the oral surveillance trial showed an increased risk of major adverse cardiovascular events in cancers among patients with rheumatoid arthritis taking tofacitinib as compared to those on TNF inhibitors. These findings led to the FDA updating their black box warning on JAK inhibitors. Today, we've invited one of the speakers on the great debate, Dr. Vibeke Strand, to speak on her position on JAK inhibitors given these new results and shed some more light on the subject.