A recent paper showed, in patients with early RA treated with TNFi (certolizumab pegol), that bone turnover markers and Wnt/B-catenin pathway inhibitors may change quickly after starting therapy, with a decrease in carboxy -terminal telopeptide of type 1 collagen (CTX-I), an increase in PINP and the decrease in DKK-1 and sclerostin, already evident from the first week of therapy (92). The gene discussed is DKK1; the disease is rheumatoid arthritis.