A 12-month randomized double blind clinical trial in 60 patients with active erosive hand osteoarthritis compared TNF blockade using adalimumab (40 mg fortnightly subcutaneous administration) with placebo. Whereas no benefit could be attributed to adalimumab overall, the drug significantly slowed erosive evolution in a subpopulation of patients with palpable soft tissue swelling at baseline (P = 0.009).