Inflammatory or mechanical lower back pain along with dactylitis is associated with a poor response to MTX, while TNF inhibitors and IL-17 inhibitor agents are strongly recommended as a first-line treatment as they both showed a good response in all six key domains of PsA (axial, peripheral, enthesitis, dactylitis, skin and nail lesions), as recommended at the last GRAPPA annual meeting of 2022 [118]. The gene discussed is TNF; the disease is enthesitis.