{"title":"Dose-Escalated Upadacitinib for Refractory Myositis in Anti-Jo-1-Positive Antisynthetase Syndrome: A Case Report.","authors":"Yuji Kukida, Hironori Inoue","doi":"10.1155/crrh/5972090","DOIUrl":null,"url":null,"abstract":"<p><p>Anti-Jo-1-positive antisynthetase syndrome (ASS) can follow a relapsing course during glucocorticoid tapering, and evidence for refractory myositis remains limited. We report a 33-year-old woman with anti-Jo-1-positive ASS with a dermatomyositis phenotype and recurrent myositis despite multiple immunosuppressants, biologics, and Janus kinase (JAK) inhibitors. Upadacitinib was increased from 15 to 30 mg/day during a flare, together with intravenous immunoglobulin and temporary prednisolone escalation. During follow-up, upadacitinib was withdrawn twice for fertility treatment; both withdrawals were followed by disease flares, and disease control was restored after reintroduction. Prednisolone was ultimately discontinued. This repeated withdrawal-rechallenge pattern suggests that dose-escalated upadacitinib may have contributed to sustained disease control.</p>","PeriodicalId":9622,"journal":{"name":"Case Reports in Rheumatology","volume":"2026 ","pages":"5972090"},"PeriodicalIF":0.0000,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584330/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Case Reports in Rheumatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1155/crrh/5972090","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Anti-Jo-1-positive antisynthetase syndrome (ASS) can follow a relapsing course during glucocorticoid tapering, and evidence for refractory myositis remains limited. We report a 33-year-old woman with anti-Jo-1-positive ASS with a dermatomyositis phenotype and recurrent myositis despite multiple immunosuppressants, biologics, and Janus kinase (JAK) inhibitors. Upadacitinib was increased from 15 to 30 mg/day during a flare, together with intravenous immunoglobulin and temporary prednisolone escalation. During follow-up, upadacitinib was withdrawn twice for fertility treatment; both withdrawals were followed by disease flares, and disease control was restored after reintroduction. Prednisolone was ultimately discontinued. This repeated withdrawal-rechallenge pattern suggests that dose-escalated upadacitinib may have contributed to sustained disease control.
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