A 47-year-old patient was referred to our rheumatology department due to treatment refractory rheumatoid arthritis, characterized by polyarthralgia, progressive joint destruction, and impaired functionality despite treatment with multiple disease modifying antirheumatic drugs (DMARDs). Notably, the patient had previously undergone bilateral ankle joint replacement believed to be due to postarthritic osteoarthritis. Clinical and ultrasound examination showed persistent active arthritis in the left carpus, left elbow, and knees despite DMARD combination therapy.
