Tumour necrosis factor α (TNFα) is a proinflammatory cytokine that is involved in the pathogenesis of rheumatoid arthritis (RA).1 Anti-TNFα has been shown to have a significant effect in delaying the joint destruction associated with this condition, and is being used with increasing frequency. The side effects are well documented, but further information continues to emerge and advice regarding how to proceed thereafter remains limited.2

We report on a 46-year-old woman with a 6-year history of seropositive erosive RA. Despite combination disease-modifying antirheumatic drugs (DMARDs) she remained symptomatic and had a 28-joint Disease Activity Score (DAS28) …