OBJECTIVES: To determine rheumatologists' current prescribing practices, laboratory monitoring protocols, and perceived barriers to prescribing Tumor Necrosis Factor (TNF) inhibitors (adalimumab, etanercept, and infliximab) in patients with rheumatoid arthritis (RA). METHODS: A survey questionnaire was mailed to 1970 rheumatologists who were randomly selected from a national sample of 3007 rheumatologists. A one-page nonresponse questionnaire was mailed to about 200 randomly selected nonresponding rheumatologists to assess nonresponse bias. RESULTS: Two mailings yielded a response rate of 22.2% (428 completed, usable surveys out of 1925 deliverable surveys). Rheumatologists reported using all three agents in patients with moderate RA (82-87%) and severe RA (94-96%). Also, some rheumatologists (10-18%) reported using these agents in newly diagnosed and mild RA patients. Sixty eight percent preferred etanercept as first choice TNF inhibitor while 28.5% and 20.3% preferred adalimumab and infliximab as first choice TNF inhibitors, respectively. In patients with severe RA and an inadequate response to methotrexate, 91% rheumatologists reported using TNF inhibitor with one other disease modifying anti-rheumatic drug (DMARD) and 27.9% reported using TNF inhibitor with two other DMARDs. Over 94% rheumatologists stated switching patients from one TNF inhibitor to a different TNF inhibitor due to inadequate response or side effects. Most rheumatologists ordered purified protein derivative test (96%) when administering these agents with almost 82% conducting this test at baseline. Other tests ordered were complete blood count, chest radiography, antinuclear antibody, and creatinine during baseline and follow-up of patients. Costs to the patients and insurance coverage were perceived as major barriers to prescribing these agents although the perception was a little lower with infliximab than with adalimumab or etanercept. CONCLUSIONS: Rheumatologists are fairly similar in their use of the three different TNF inhibitors although some variation exists in terms of laboratory monitoring protocols and perceived barriers regarding the use of these drugs.