Presence of ultrasound subclinical synovitis and increment of serum vascular endothelial growth factor in a patient with rheumatoid arthritis achieved in sustained clinical remission by treatment with adalimumab and methotrexate.

A 63-year-old male Japanese rheumatoid arthritis (RA) patient, in whom treatment with infliximab and methotrexate (MTX) had once led to drug-free remission, experienced a disease flare in July 2010. He was retreated with a combination of adalimumab and MTX, and clinical remission was achieved in 3 months. In contrast, power Doppler signals by ultrasonography with increased serum vascular endothelial growth factor still remained after he achieved sustained clinical remission, whereas no radiographic progression has been found.