Background: rheumatoid arthritis (RA) is a chronic inflammatory arthropathic with multiorgan involvement. Increased prevalence of insulin resistance (IR) has been observed in patients with RA. High-grade systemic inflammation is implicated in the development of IR in these patients. Tumor necrosis factor- alpha (TNF-α) is a potent proinflammatory cytokine that plays a role in initiation and progression of inflammation and the mechanisms associated with accelerated atherosclerosis in RA. Aim of the work: this study aimedto investigate the relation between TNF-α and IR in RA patients and its relation to disease activity. Patients and methods: 40 RA patients were included as the patient group and 40 healthy subjects as the control group. Both groups were subjected to full history, clinical examination including body mass index (BMI) and lab investigation, fasting blood glucose, fasting insulin and TNF-α. Results: the sex distribution was the same in patients and the control groups, 82.5% females and 17.5% males. The disease activity (DAS score) was 4.57 ± 1.35. TNF-α median was 240 with IQR 190-510. RA patients had significantly higher serum TNF-α than controls (p value = 0.001). BMI and Waist Circumference among RA patients and controls showed no significant difference. TNF-α has significantly positive correlations with fasting serum insulin, HOMA-IR and disease activity in RA patient group (p value < 0.001). Conclusion: serum TNF-α level was significantly higher in RA patients than the control groups with positive correlation in fasting serum insulin, HOMA score and disease activity.