Background and Aim: The clinical tuberculosis infection risk increases with rheumatoid arthritis and its medication. Chronic systemic inflammation caused by rheumatoid arthritis is an autoimmune disease may affect various organs and tissues. The present study was aimed to assess the frequency of smear positive pulmonary tuberculosis in rheumatoid arthritis patients taking DMARDS at Khairpur Medical College/ Hospital Khairpur. Methodology: This cross-sectional study was conducted on 249 smear positive pulmonary tuberculosis in rheumatoid arthritis patients at the Department of Internal Medicine of Khairpur Medical College/Hospital Khairpur from March 2019 to July 2021. All the patients with cough for >3 weeks were enrolled by taking three sputum sample and risk assessment questionnaire. The Mycobacterium tuberculosis bacilli presence was identified based on acid fast staining technique. Tuberculosis incidence, medical records, and clinical manifestation were explored. SPSS version 24 was used for data analysis. Results: Of the total 249 patients, 226 (90.8%) were male and 23 (9.2%) were females. The overall mean age was 65.73±7.53 years. The incidence of tuberculosis with rheumatoid arthritis was 4-fold. The prevalence of pulmonary tuberculosis and disseminated tuberculosis was 59 (72.8%) and 22 (27.2%) respectively in rheumatoid disease patients. The incidence of tuberculosis with rheumatoid arthritis reduced from 47.6 to 28 per 100 000 with p<0.001. Conclusion: Our study found that pulmonary tuberculosis was more prevalent (72.7%) among adult tuberculosis patients with rheumatoid arthritis. Compared to general population, the tuberculosis incidence among rheumatoid arthritis patients was 4-fold. Keywords: Smear positive pulmonary tuberculosis, Rheumatoid arthritis, DMARDS