Sir, A 50‐yr‐old male patient who had had seropositive [rheumatoid factor (RF) and antiperinuclear factor] and erosive rheumatoid arthritis (RA) for 12 yr was seen in September 1999. He fulfilled all seven of the 1987 American College of Rheumatology (ACR) criteria for this disease, including rheumatoid nodules, but no other extra‐articular features (no sign suggestive of rheumatoid vasculitis). RA had remained active since its onset, despite treatment with a combination of low‐dose steroids (8–15 mg/day of prednisone) and most disease‐modifying anti‐rheumatic drugs: injectable gold salts, d‐penicillamine, tiopronin, sulphasalazine, methotrexate, hydroxychloroquine, azathioprine, cyclosporin and even a short (3 months) trial of chlorambucil. In September 1999, RA was still very active, with a disease activity score (DAS‐28) of up to 6.8 (15 out of 28 joints painful, 12 out of 28 swollen, erythrocyte sedimentation rate 74 mm in 1st h). The haemoglobin level was 111 g/l, white blood count 10.4×109/l (including 8.1×109 polymorphonuclear leucocytes/l) and platelet count 452×109/l. The patient had not been tested for antineutrophil cytoplasmic antibodies (ANCA). The latest RF titres available were 160 IU/ml in the latex test (normal range 0–25) and 128 IU/ml in the Waaler–Rose test (normal range 0–12). On 1 September 1999, the patient gave informed consent to treatment with subcutaneous injections of etanercept (Enbrel; 25 mg twice weekly) [1]. At that time, and during the 4 months of treatment with etanercept, he was free of fever or other extra‐articular signs (including features suggestive of rheumatoid vasculitis). There were no reactions to these injections, whether local or systemic. Unfortunately, improvement of RA was only modest (DAS‐28 values after 1, 2, 3 and 4 months of treatment were 5.6, 5.4, 6.05 and 5.8 respectively). In December 1999, the patient considered that improvement was very slight and his condition more painful despite the replacement of fentanyl with hydromorphone. Both patient and physician decided to stop etanercept, but to continue steroids at the same dose. As before, the patient was still free of fever or other extra‐articular symptoms, except chronic fatigue and a discrete sore throat. His muscles were not tender or weak, and neurological examination was normal. A short course of minocycline (Minolis‐Gé; 100 mg/day) was administered on the basis of the favourable response of some RA patients to this treatment [2–4].