She had active systemic disease, MAS, and progressive polyarthritis refractory to conventional (corticosteroids, methotrexate, cyclosporine, leflunomide) and biological DMARDs, both TNF-α (infliximab, etanercept) and IL-1 (anakinra) inhibitors (JADAS-10 score over the years 22–35). This evidence concerns the gene TNF and macrophage activation syndrome.