Would you have any concerns about starting an anti-TNF in RF and anti-CCP positive RA patients who also have high titer ANA?

No, I would not have any concerns. A patient with seropositive RA who demonstrates a positive ANA remains a patient with RA, not someone with an overlap connective tissue disease syndrome. Since a positive ANA can be seen in a sizable percentage of healthy people and among those treated with TNFi dr...

About 20% of patients with RA would have a positive ANA. Also, as mentioned in Dr. @Dr. First Last's comment, once the patient has received an anti-TNFi for a while, the ANA may turn positive just because of the treatment. This is not uncommon. However, true TNFi-induced clinical lupus is much rarer...