Therefore, the justification for starting another target therapy in a RA patient, before having tried adalimumab, can only be justified if a personalized analysis recognizes some peculiar patient circumstances (such as fear of needles, need to travel or difficulty in keeping the drug at a low temperature, etc.), or some condition that can predict anti-TNF agents’ failure (such as use in monotherapy). This evidence concerns the gene TNF and rheumatoid arthritis.