Dr. Chandrashekara. S discussed the precautions before administration of tofacitinib. Jak inhibitors are Pan cytokines blocker that impairs the immune system functioning effectively. Incidence of the adverse events with tofacitinib is higher than the placebo and equivalent to the TNF inhibitors and other biological DMARDs. Major adverse events observed are serious infections, malignancies, MACE, DVT, and PE. Precautions need to be taken when prescribing to elderly patients above 60/65, uncontrolled diabetes, Recurrent infections in the past, previous thrombosis, high-risk of cardiovascular disease, previous MI or IHD, and low lymphocyte count (<500).