Since proinflammatory cytokines, and particularly TNF-α, are important inducers of RC,13,63 it is logical to expect that a reduction in inflammation (including TNF-α), would attenuate RC.5 However, a treat-to-target therapeutic approach with tight control in RA failed to attenuate RC.5 According to Lemmey, 5 a possible explanation is that RC occurs early in the course of RA, probably even during the preclinical phase. Here, TNF is linked to rheumatoid arthritis.