A review of 16 clinical practice guidelines and 20 consensus statements on RA treatment revealed that while tumor necrosis factor (TNF)-α inhibitors were consistently recommended for patients with active RA and a history of inadequate response to synthetic DMARDs [5], the management of patients who stopped an initial TNF-α treatment because of lack of initial response, loss of initial response or side effects continues to be the subject of much debate, and guidelines for patient management are nearly absent. The gene discussed is TNF; the disease is rheumatoid arthritis.