TNF and interstitial lung disease: Although there is no consensual therapeutic strategy for such patients in ASS, in RA patients, it is recommended to start biologic DMARDs, and current practice would be to start a TNF inhibitor.39 However, it has recently been reported that anti-TNF agents may not be effective in ASS patients and may even trigger myositis and/or ILD in ASS.17,18 Indeed, among 6 anti-TNF courses in our series, 1 led to the development of myositis and ILD, whereas another led to worsening myositis.