TNF and rheumatoid arthritis: These findings suggest that TNFα might be a key player forming a positive feedback circuit in maintaining the pathology of corticosteroid-refractory systemic flare of AOSD in this patient and higher-dose etanercept might be required to suppress the disease activity of refractory AOSD patients with partial response to etanercept at its approved dose for the treatment of rheumatoid arthritis.