Despite the modulating/suppressive activity on the immune system, the use of DMARDs was not observed to contribute to PJI development; on the contrary, a prescription of DMARDs in the 3 months prior surgery was associated to a lower risk of PJI (Fig 2); these findings support the recommendation of the International Consensus Meeting on PJI to suspend DMARDs prior to an elective joint arthroplasty based on their half-life [55] and the non-significant role of TNF-α inhibitors prior to knee/hip replacement [43]. The gene discussed is TNF; the disease is juvenile polyposis syndrome.