A prospective, multicentre, randomized, open study assessed the safety of methotrexate (MTX), etanercept, or both, in patients with active RA and mild hepatitis C virus (HCV) infection (n = 29). None of the treatments resulted in increased HCV viral load or increased levels of liver enzymes. The authors conclude that a combination of MTX and etanercept can be safely used to treat RA in patients with chronic HCV infection without risking hepatotoxicity or HCV replication.