A 58-year-old woman with a 2.5-year history of rheumatoid arthritis showed a pain, severe swelling, and a decreased range of motion of left knee joint. Medical therapy with 8 mg per week of oral methotrexate and 1 mg per day of tacrolimus in combination with 40 mg per 2 weeks of adalimumab failed to control the disease activity. Administration of tofacitinib achieved the successful disease control, and MRI taken 5 months after the initiation of tofacitinib showed the disappearance of synovial

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... ss within the knee joint and the bone marrow oedema and marked reduction of the popliteal cyst. The use of tofacitinib for inadequate response to the first TNF inhibitor as a third-line DMARD showed dramatic effect on severe synovitis, and the patient could avoid the surgical intervention. Rheumatology: Current Research Nishida et al., Rheumatology (Sunnyvale) 2016, 6:1 http://dx.