The major treatment of systemic vasculitis, such as Wegener's granulomatosis and polyarteritis nodosa, is based on the combination of corticosteroids and immunosuppressive drugs, such as cyclophosphamide. This therapy has been successful in improving the survival rate, but relapses and treatment failure are not infrequent. Anti-tumor necrosis factor-alpha (TNF-alpha) treatment offers the potential to open new era in treatment of inflammatory diseases, such as rheumatoid arthritis, by blocking the major pro-inflammatory mediator TNF-alpha. Clinical trials in these diseases and others, such as ankylosing spondylitis and Crohn's disease, demonstrate clinical benefit associated with significant improvement in patients with severe active joint and intestinal disease. To date, the indication of anti-TNF-alpha therapy has been widening and shows a favorable clinical benefit in some cases of systemic vasculitis. This review will cover the nature of this therapy and current evidence of its clinical benefit and adverse effects.