Treatment with biologicals leads to more pronounced changes in disease activity and sleep improvement.30–32 Similar effect of improvement in sleep quality with anti-TNF-α treatment was seen in a group of ankylosing spondylitis patients.39 It appears that sleep quality in RA patients is a reflection of multiple factors such as disease duration, disease activity, pain, anxiety, depression, and disability. The gene discussed is TNF; the disease is major depressive disorder.