Previously well controlled RA on Humira and Hydroxychloroquine. Methotrexate was discontinued because of side effects. Switched to Enbrel x3 months. Patient keeps having flare in different joint but persistent in knees and ankles. High dose prednisone did not help significantly. Knee joint was aspirated which was negative for crystal and infection but did show inflammatory fluid. Knee joint was injected with steroid most recently.