According to the authors, this suggests a feedback loop between sleep maintenance, slow-wave sleep, and cellular inflammation.44 Treatment of RA patients with anti TNF- alpha therapy has been shown to improve sleep quality.35Another study reported improvement in insomnia scores in RA patients treated with Upadacitinib.45 Similar improvements in sleep quality after treatment with anti-TNF agents have been seen in patients with inflammatory bowel diseases and ankylosing spondylitis.37,46 This suggests the role of inflammatory cytokines and disease activity on sleep quality. The gene discussed is TNF; the disease is ankylosing spondylitis.