Children with moderate to severe uveitis can be refractory to methotrexate.4, 5, 6, 7, 8 In such patients, monoclonal TNF inhibitors, including adalimumab, are often effective.9, 10, 11, 12 However, 30–40%13 of patients are refractory to both methotrexate and TNF inhibitors and are therefore at great risk of significant ocular complications and blindness. Here, TNF is linked to uveitis.