Notably, in three patients with difficult-to-treat RA, fourth-generation CD19-targeted CAR T-cells (CD19/aIL-6/aTNFα) improved symptoms, reduced effusion, synovitis, osteitis, and tendinitis (via ultrasound and MRI), and induced seroconversion of rheumatoid factor and anti-CCP antibodies (130). This evidence concerns the gene CD19 and synovitis.