Modern Rheumatology最新文献

{"title":"Comment on: \"A narrative review of the diagnostic role of muscle biopsy in small- to medium-vessel vasculitis: Consideration of imaging-guided procedures\".","authors":"Shunichiro Hanai, Daiki Nakagomi","doi":"10.1093/mr/roag072","DOIUrl":"https://doi.org/10.1093/mr/roag072","url":null,"abstract":"","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Methotrexate Intolerance in Rheumatoid Arthritis: The Role of Oral-to-Subcutaneous Switching.","authors":"Shin-Ichiro Ohmura","doi":"10.1093/mr/roag070","DOIUrl":"https://doi.org/10.1093/mr/roag070","url":null,"abstract":"<p><p>Methotrexate (MTX) remains the anchor drug in the management of rheumatoid arthritis (RA). However, its clinical use is frequently limited by intolerance, leading to dose reduction or discontinuation. In addition, oral MTX exhibits pharmacokinetic limitations, including dose-dependent absorption and reduced bioavailability at higher doses, which may compromise therapeutic efficacy. Subcutaneous (SC) MTX has emerged as a strategy to overcome these limitations by providing more consistent bioavailability and potentially improved tolerability. Evidence suggests that switching from oral-to-SC MTX may improve gastrointestinal (GI) intolerance and support treatment persistence, whereas evidence for improved disease control or reduction of serious MTX-related toxicity remains limited. Recent Japanese studies suggest the potential utility of this approach at MTX doses commonly used in Japan, although evidence for the superiority of SC MTX over oral MTX in low-dose settings remains limited. This narrative review summarizes current evidence on MTX intolerance and oral-to-SC route switching in RA, with a focus on practical strategies for treatment optimization. Overall, oral-to-SC MTX switching may represent an important option to improve GI intolerance and support treatment persistence in patients with RA.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the comment on 'A narrative review of the diagnostic role of muscle biopsy in small- to medium-vessel vasculitis: Consideration of imaging-guided procedures'.","authors":"Shin-Ichiro Ohmura","doi":"10.1093/mr/roag073","DOIUrl":"https://doi.org/10.1093/mr/roag073","url":null,"abstract":"","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of intravenous and subcutaneous belimumab in Japanese patients with systemic lupus erythematosus: Final analysis of data from an all-case post-marketing surveillance study.","authors":"Nami Okamoto, Takao Fujii, Tatsuya Atsumi, Asami Abe, Nobunori Takahashi, Naoto Tamura, Atsuo Nakajima, Ayako Nakajima, Shingo Nakayamada, Keiichiro Nishida, Hiroaki Matsuno, Tomohiko Asamura, Megumi Koyano, Ai Hayashi, Mitsuhiro Yoshida, Daisuke Noda, Naoki Kaneko, Shuntaro Saito, Michiaki Takagi, Sakae Tanaka, Tsutomu Takeuchi, Yoshiya Tanaka, Masataka Kuwana","doi":"10.1093/mr/roag066","DOIUrl":"https://doi.org/10.1093/mr/roag066","url":null,"abstract":"<p><strong>Objectives: </strong>To assess safety of belimumab in Japanese patients with systemic lupus erythematosus (SLE) in real-world clinical practice.</p><p><strong>Methods: </strong>This all-case post-marketing surveillance study included patients initiating belimumab between December 2017 and October 2018. To evaluate safety, patients were observed for up to 52 weeks. In main population, baseline risk factors for serious infection were assessed by multivariate analysis. Exploratory risk factor analysis for depression/suicidal ideation/suicide attempt was conducted in expanded population.</p><p><strong>Results: </strong>Among 1177 patients (main population), incidence rates per 100 person-years of serious adverse events (SAEs) and AEs of special interest were: SAEs, 28.4; serious infection, 8.8; depression/suicidal ideation/suicide attempt, 1.3; malignant tumour, 0.7; serious hypersensitivity, 0.7. Male sex, any comorbidity and glucocorticoid dose at baseline were independent risk factors for serious infection. In exploratory analysis, comorbidity of depression/suicidal ideation/suicide attempt at belimumab initiation was an associated characteristic factor for the new occurrence/worsening depression/suicidal ideation/suicide attempt.</p><p><strong>Conclusions: </strong>No new safety concerns were identified compared with previously reported data and current belimumab labelling. Depression/suicidal ideation/suicide attempt incidence rate was similar to that previously reported for patients with SLE. Patients with risk factors for serious infection and depression/suicidal ideation/suicide attempt should be carefully monitored.Clinicaltrials.gov: NCT03370263.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Internal Validation of a Nomogram Model Based on Serum OPG and RANKL for Identifying Low Physical Health-Related Quality of Life Status in Patients with Rheumatoid Arthritis.","authors":"Chun Lu, Huan Liu, Hong Zhu","doi":"10.1093/mr/roag064","DOIUrl":"https://doi.org/10.1093/mr/roag064","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by progressive joint destruction and significant impairment of health-related quality of life (HRQoL). The receptor activator of nuclear factor-κB ligand (RANKL)/osteoprotegerin (OPG) pathway plays a pivotal role in bone metabolism and joint destruction in RA. However, the clinical value of serum OPG and RANKL levels for identifying low physical HRQoL status in RA patients remains unclear. This study aimed to develop and internally validate a nomogram model incorporating serum OPG and RANKL to estimate the probability of low physical HRQoL status in RA patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective cross-sectional study enrolled 324 RA patients from January 2022 to December 2025. Patients were randomly divided into training (n = 227) and internal validation (n = 97) cohorts at a 7:3 ratio. HRQoL was assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), with low physical HRQoL status defined as SF-36 Physical Component Summary (PCS) score &lt; 40 at the assessment time point. Serum OPG and RANKL levels were measured by enzyme-linked immunosorbent assay. Univariate and multivariate logistic regression analyses were performed to identify factors associated with low physical HRQoL status. Age and sex were included as clinically important adjustment variables, HAQ-DI was incorporated to account for functional disability, and the RANKL/OPG ratio was not entered into the primary multivariate model together with its components to avoid mathematical collinearity. A nomogram was constructed and internally validated using split-sample assessment, receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 324 patients, 138 (42.6%) had low physical HRQoL status. In the primary multivariate model, HAQ-DI (OR = 2.18, 95%CI: 1.48-3.22, P &lt; 0.001), serum RANKL (OR = 1.76, 95%CI: 1.25-2.48, P = 0.001), serum OPG (OR = 0.75, 95%CI: 0.59-0.96, P = 0.022), DAS28-ESR (OR = 1.48, 95%CI: 1.05-2.08, P = 0.025), disease duration (OR = 1.36, 95%CI: 1.04-1.78, P = 0.024), and CRP (OR = 1.24, 95%CI: 1.01-1.52, P = 0.042) were associated with low physical HRQoL status after adjustment for age and sex. The nomogram demonstrated excellent discrimination with an AUC of 0.881 (95%CI: 0.835-0.927) in the training cohort and 0.864 (95%CI: 0.792-0.936) in the internal validation cohort. Calibration curves showed good agreement between predicted and observed probabilities. DCA confirmed substantial clinical net benefit across clinically relevant threshold probabilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This study developed and internally validated a nomogram model integrating serum OPG and RANKL levels, functional disability, inflammatory activity, and disease duration for identifying low physical HRQoL status in RA patients. The model demonstrates robust dis","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Pharmacokinetic Analysis of Factors Affecting the Clearance of Methotrexate Polyglutamates in Red Blood Cells in Japanese Patients with Rheumatoid Arthritis.","authors":"Jun Hakamata, Yuko Kaneko, Mikiko Shimizu, Tsutomu Takeuchi, Masayuki Hashiguchi","doi":"10.1093/mr/roag063","DOIUrl":"https://doi.org/10.1093/mr/roag063","url":null,"abstract":"<p><strong>Objectives: </strong>To examine factors affecting the apparent clearance (CL/F) of total methotrexate polyglutamates (MTX-PGs) in red blood cells (RBCs) in Japanese patients with rheumatoid arthritis (RA) using population pharmacokinetic analysis.</p><p><strong>Methods: </strong>A total of 268 Japanese RA patients receiving low-dose MTX therapy were included. RBC MTX-PGs concentrations were measured using LC-MS/MS. Patient characteristics, including genetic polymorphisms in transporters (RFC1, ABCB1, ABCC2, ABCG2) and enzymes (FPGS, GGH) related to MTX metabolism, were evaluated as covariates. Population pharmacokinetic analysis was performed using Phoenix NLME software.</p><p><strong>Results: </strong>The final population pharmacokinetic model identified body weight (BW), estimated glomerular filtration rate (eGFR), and proton pump inhibitor (PPI) co-administration as covariates for CL/F of total RBC MTX-PGs. Lower BW, lower eGFR, and PPI use were associated with decreased CL/F. Genetic polymorphisms were not identified as significant covariates for CL/F in this study.</p><p><strong>Conclusions: </strong>BW, eGFR, and PPI co-administration may influence the CL/F of total RBC MTX-PGs in Japanese patients with RA. These findings may support model-informed interpretation of RBC MTX-PGs concentrations, although further studies are needed to confirm the clinical applicability of the model.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated with Glucocorticoid Withdrawal in Systemic Lupus Erythematosus: A Multicentre ANSWER-SLE Cohort.","authors":"Haruna Fujiki, Ryu Watanabe, Ryuhei Ishihara, Masao Katsushima, Yuhei Fujisawa, Akira Onishi, Hideaki Tsuji, Takuya Kotani, Yumiko Wada, Yuji Nozaki, Toshihiko Shiga, Shuji Sumitomo, Hideki Oka, Hirofumi Miyake, Takao Fujii, Shigeru Iwata, Yasuhiro Kato, Eri Itotagawa, Wataru Yamamoto, Yuya Fujita, Kazuo Fukumoto, Shinsuke Yamada, Motomu Hashimoto","doi":"10.1093/mr/roag065","DOIUrl":"https://doi.org/10.1093/mr/roag065","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the rate of glucocorticoid (GC) discontinuation and to identify factors associated with successful GC withdrawal in patients with systemic lupus erythematosus (SLE).</p><p><strong>Methods: </strong>This multicentre retrospective study used data from the ANSWER-SLE cohort. Patients fulfilling the 2019 ACR/EULAR classification criteria and registered between October 2023 and May 2025 were included. Patients were classified by GC status at enrolment as follows: discontinued GCs (Group 1), GC-naïve (Group 2), or continuing GC therapy (Group 3).</p><p><strong>Results: </strong>Among 1,689 patients, 107 (6.3%) were in Group 1, 130 (7.7%) in Group 2, and 1,452 (86.0%) in Group 3. Disease duration was longest in Group 3 (P<0.001). Group 2 had lower total 2019 classification scores (P=0.008), higher LLDAS attainment (P<0.001), and lower SLICC Damage Index scores (P<0.001). Group 1 had the highest concomitant use of hydroxychloroquine (HCQ) (P<0.001), mycophenolate mofetil (MMF) (P<0.001), and belimumab (P=0.001). In multivariable Cox regression analysis, older age at disease onset (HR=1.049, P<0.001), HCQ (HR=5.75, P<0.001), MMF (HR=1.82, P=0.009), and belimumab (HR=1.72, P=0.041) were independently associated with GC discontinuation.</p><p><strong>Conclusion: </strong>GC withdrawal may be achievable in selected patients with SLE, particularly those receiving HCQ, MMF, and belimumab, and in patients with an older age at disease onset.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical outcomes after switching from mepolizumab to benralizumab in eosinophilic granulomatosis with polyangiitis: A single-centre retrospective cohort study.","authors":"Daichi Umemoto, Eri Iwai-Kanai, Kazuhiro Hatta, Hirofumi Miyake","doi":"10.1093/mr/roag062","DOIUrl":"https://doi.org/10.1093/mr/roag062","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the impact of switching to benralizumab on flare risk in patients with eosinophilic granulomatosis with polyangiitis (EGPA) previously treated with mepolizumab.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study including 26 patients with EGPA who received mepolizumab. A landmark analysis was performed at 910 days after mepolizumab initiation (median time to switching), and patients were grouped according to treatment. The primary outcome was disease flares requiring treatment intensification. We used a Cox model with treatment switching as a time-dependent covariate.</p><p><strong>Results: </strong>In the landmark analysis, the benralizumab group (n=4) had a higher flare rate than the mepolizumab group (n=10) (log-rank test, P = 0.002). However, the Cox model did not converge and the time-dependent analysis yielded an imprecise estimate (hazard ratio 3.14, 95% confidence interval 0.31-32.02). The 1-year flare-free rate after switching to benralizumab (n=19) was 94.1%, and no severe flares occurred. Most patients had low disease activity at switching, and switching was primarily driven by patient preference.</p><p><strong>Conclusions: </strong>Short-term flare-free survival after switching to benralizumab was high despite a small number of minor flares. Further evidence is warranted to assess long-term outcomes.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148669844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential for Cartilage Restoration in Osteoarthritis Patients Through Intra-Articular Injection of Mesenchymal Stem Cells: An MRI-Based Morphological Evaluation of Repair Cartilage - A Narrative Review.","authors":"George Jacob, Kazunori Shimomura, Taro Akimori, Yu Moriguchi, Seiji Okada, Norimasa Nakamura","doi":"10.1093/mr/roag061","DOIUrl":"https://doi.org/10.1093/mr/roag061","url":null,"abstract":"<p><p>Knee osteoarthritis (OA) is a progressive joint disease associated with pain and disability, and current treatments do not restore damaged articular cartilage. Intra-articular mesenchymal stem/stromal cell (MSC) injection has emerged as a minimally invasive biologic therapy with potential chondroprotective and regenerative effects; however, its capacity for structural cartilage repair remains uncertain. This narrative review summarizes clinical outcomes, with a focus on MRI-based cartilage morphological findings after MSC injection for knee OA. A MEDLINE search through January 30, 2025 identified 53 eligible clinical studies evaluating intra-articular MSC injections for knee cartilage lesions or OA, including 20 studies with MRI-based cartilage assessments. Most studies demonstrated significant improvements in pain and function, with benefits observed within 3-6 months and maintained up to 12-24 months. MSC therapy was safe and well tolerated. MRI findings were heterogeneous: most studies showed no significant structural improvement, while a limited number of studies reported cartilage preservation or modest increases in cartilage thickness. Advanced MRI techniques, including T2 mapping, occasionally detected improvements in cartilage quality. Intra-articular MSC injection provides consistent clinical benefits for knee OA, but current MRI evidence suggests limited and variable morphological cartilage restoration. Further standardized studies are needed to clarify its regenerative potential.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148605393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcriptomic Profiling and Drug Repurposing Identify Fostamatinib as a Candidate Therapeutic Agent for IgG4-Related Sialadenitis.","authors":"Motohisa Yamamoto, Ryuta Kamekura, Masaaki Uehara, Yuta Ichii, Kenichi Takano","doi":"10.1093/mr/roag059","DOIUrl":"10.1093/mr/roag059","url":null,"abstract":"<p><strong>Objectives: </strong>To identify therapeutic candidates for IgG4-related sialadenitis, a manifestation of IgG4-related disease characterized by IgG4-positive plasma cell infiltration and limited treatment options beyond glucocorticoids, using transcriptomic profiling and in silico drug repurposing.</p><p><strong>Methods: </strong>Submandibular gland tissues from 49 patients with IgG4-related sialadenitis and 3 controls were analyzed by RNA sequencing. Differentially expressed genes were screened against DrugBank to identify druggable targets. Candidate drugs were prioritized based on their ability to modulate disease-associated gene signatures. Molecular docking was performed to evaluate binding affinities to key targets.</p><p><strong>Results: </strong>Transcriptomic analysis revealed upregulation of immune-related pathways. DrugBank integration identified fostamatinib as a top candidate targeting multiple kinases, including SYK, BTK, and JAK3. Docking analysis demonstrated favorable binding affinity, particularly to BTK.</p><p><strong>Conclusion: </strong>This integrative approach highlights fostamatinib as a promising therapeutic candidate and supports a role for the SYK-BTK axis in IgG4-RD pathogenesis, suggesting a potential alternative to glucocorticoids.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}