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Certolizumab pegol was effective for treating residual synovitis after total knee arthroplasty in a patient with rheumatoid arthritis: therapeutic monitoring by ultrasound

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We present the case of a 59-year-old female who developed rheumatoid arthritis in 2007. Right total knee arthroplasty (TKA) was performed in 2008. Although she was treated with methotrexate (MTX) after the operation, this treatment was insufficient. Infliximab (IFX) was introduced in 2001, and she achieved clinical remission. Left TKA was performed in October 2014. Because active synovitis was not detected by ultrasound after the operation, IFX was discontinued. She had been treated with MTX 8 mg weekly. However, arthralgia of the bilateral knees developed in March 2015. Ultrasound showed synovial hypertrophy with vascular signals representing postoperative residual synovitis. She was given certolizumab pegol. According to ultrasound, the synovitis had improved after 3 months.

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Computed tomography


Certolizumab pegol


Disease activity score


Erythrocyte sedimentation rate




Total knee arthroplasty


Magnetic resonance imaging






Rheumatoid arthritis


  1. Niki Y, Matsumoto H, Otani T, et al. Five types of inflammatory arthritis following total knee arthroplasty. J Biomed Mater Res A. 2007;81:1005–10.

    Article  PubMed  Google Scholar 

  2. Shinomiya F, Okada M, Hamada Y, et al. Indications of total ankle arthroplasty for rheumatoid arthritis: evaluation at 5 years or more after the operation. Mod Rheumatol. 2003;13:153–9.

    Article  PubMed  Google Scholar 

  3. Boldt JG, Munzinger UK, Zanetti M, et al. Arthrofibrosis associated with total knee arthroplasty: gray-scale and power Doppler sonographic findings. AJR Am J Roentgenol. 2004;182:337–40.

    Article  PubMed  Google Scholar 

  4. Roger P, Michael A, Moore A, et al. Use of biofluorescence imaging to compare the distribution of certolizumab pegol, adalimumab, and infliximab in the inflamed paws of mice with collagen-induced arthritis. J Immunol Methods. 2009;348:36–41.

    Article  Google Scholar 

  5. Ma Y, Li G, Li J, et al. The diagnostic value of superb microvascular imaging (SMI) in detecting blood flow signals of breast lesions: a preliminary study comparing SMI to color doppler flow imaging. Med (Baltim). 2015;94:e1502.

    Article  Google Scholar 

  6. Kawashiri SY, Suzuki T, Nakashima Y, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatol (Oxf). 2014;53:562–9.

    Article  Google Scholar 

  7. Kawashiri SY, Kawakami A, Iwamoto N, et al. The power Doppler ultrasonography score from 24 synovial sites or 6 simplified synovial sites, including the metacarpophalangeal joints, reflects the clinical disease activity and level of serum biomarkers in patients with rheumatoid arthritis. Rheumatol (Oxf). 2011;50:962–5.

    Article  CAS  Google Scholar 

  8. Okamoto T, Futani H, Atsui K, et al. Sonographic appearance of fibrous nodules in patellar clunk syndrome: a case report. J Orthop Sci. 2002;7:590–3.

    Article  PubMed  Google Scholar 

  9. Jacobson JA, van Holsbeeck MT. Musculoskeletal ultrasonography. Orthop Clin North Am. 1998;29:135–67.

    Article  CAS  PubMed  Google Scholar 

  10. Takase K, Ohno S, Takeno M, et al. Simultaneous evaluation of long-lasting knee synovitis in patients undergoing arthroplasty by power Doppler ultrasonography and contrast-enhanced MRI in comparison with histopathology. Clin Exp Rheumatol. 2012;30:85–92.

    CAS  PubMed  Google Scholar 

  11. Gaigneux E, Cormier G, Varin S, et al. Ultrasound abnormalities in septic arthritis are associated with functional outcomes. Joint Bone Spine. 2017.

  12. Emery P, Bingham CO 3rd, Burmester GR, et al. Certolizumab pegol in combination with dose-optimised methotrexate in DMARD-naïve patients with early, active rheumatoid arthritis with poor prognostic factors: 1-year results from C-EARLY, a randomised, double-blind, placebo-controlled phase III study. Ann Rheum Dis. 2017;76:96–104.

    Article  CAS  PubMed  Google Scholar 

  13. Koarada S, Tsuboi M, Komine M, et al. Effectiveness of certolizumab pegol in treating rheumatoid arthritis patients with persistent inflamed residual mono- or oligosynovitis resistant to prior TNF-α inhibitors. Case Rep Rheumatol. 2015:348614.

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Correspondence to Shin-ya Kawashiri.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Informed consent was obtained from the patient for this report.

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The authors have no conflicts of interest to report.

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Kawashiri, Sy., Michitsuji, T. & Kawakami, A. Certolizumab pegol was effective for treating residual synovitis after total knee arthroplasty in a patient with rheumatoid arthritis: therapeutic monitoring by ultrasound. J Med Ultrasonics 45, 371–374 (2018).

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