Nicotinamide Phosphoribosyltransferase (Nampt) is a pleiotropic protein with multiple functions, including catalyzing a rate-limiting reaction of nicotinamide adenine dinucleotide (NAD) synthesis in a mammalian salvage pathway and mediating the innate immune system's inflammatory response. The enzymatic activity of Nampt has been well characterized; however, the mechanism(s) by which Nampt regulates cytokine signaling have not been fully elucidated. Rheumatoid arthritis (RA) a chronic, systemic autoimmune disorder in which the pathological roles of proinflammatory cytokines such as Tumor Necrosis Factor (TNF), interleukin (IL)-1β, and IL-6 have been clearly demonstrated. Recently, studies have shown that serum and synovial levels of Nampt are elevated in both RA patients and in mice with collagen induced arthritis (CIA), and that inhibition of Nampt activity decreases the expression of TNF, IL-1β, and IL-6. Thus, Nampt may represent a potential new therapeutic target in RA. This review will focus on Nampt's role in NAD metabolism and cytokine signaling in the context of the pathophysiology and therapeutic potential of RA.