A new study has evaluated the efficacy of etanercept in patients with juvenile dermatomyositis (JDM) who are refractory to standard therapy. Nine patients, who received 0.4 mg/kg twice weekly alongside baseline medication for 12 weeks, were evaluated using measures including a validated disease activity score, serum muscle enzymes, childhood myositis assessment scale and nailfold capillaroscopy. The authors report that although the majority of patients did have a mild improvement in disease activity, two patients worsened while on etanercept—interestingly both of these patients had the same polymorphism in the TNF gene (308G>A). However, the effects of this genetic polymorphism on TNF blockade in patients with JDM are currently not well understood. The authors conclude that caution should be taken when recommending TNF receptor inhibitors and patients should be followed up closely.