Modern Rheumatology最新文献

{"title":"Rituximab versus intravenous cyclophosphamide for anti-neutrophil cytoplasmic antibody-associated vasculitis with severe renal impairment: A multicentre REVEAL cohort study.","authors":"Hirofumi Miyake, Ayana Okazaki, Shogo Matsuda, Yuichi Masuda, Takuya Kotani, Muneyuki Hatta, Mayu Shiomi, Ryu Watanabe, Motomu Hashimoto, Hideki Oka, Shuji Sumitomo, Kaho Jo, Yohei Fujiki, Wataru Yamamoto, Tomoki Taniguchi, Mikihito Shoji, Atsushi Manabe, Ryosuke Hiwa","doi":"10.1093/mr/roaf124","DOIUrl":"10.1093/mr/roaf124","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the efficacy and safety of rituximab (RTX) to those of intravenous cyclophosphamide (IVCY) as remission induction therapy in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and severe renal impairment.</p><p><strong>Methods: </strong>Using the REVEAL cohort, this retrospective multicentre study enrolled 96 newly diagnosed patients with AAV and an estimated glomerular filtration rate of < 30 ml/min/1.73 m2. The patients were divided into RTX and IVCY groups. Matching weights were used to adjust for baseline characteristics. The primary outcome was a 2-year composite of all-cause mortality or end-stage kidney disease (ESKD). Secondary outcomes included all-cause mortality, ESKD, relapse, and hospitalisation-requiring infections. Outcomes were assessed using multivariable Cox proportional hazards models.</p><p><strong>Results: </strong>In the weighted population, the hazard ratio for RTX versus IVCY was 0.73 (95% confidence interval: 0.31-1.72) for the primary composite outcome, with no significant intergroup difference. Similarly, intergroup differences in the hazard ratios for all-cause mortality, ESKD, relapses, and hospitalisation-requiring infections were not significant.</p><p><strong>Conclusions: </strong>RTX and IVCY demonstrated comparable efficacy in preventing mortality and ESKD in this high-risk population. RTX is a viable option for patients with AAV and severe renal impairment.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"610-618"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743436","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":"Treatment outcomes of periprosthetic fracture following unlinked total elbow arthroplasty: A case series study.","authors":"Yuhei Horiguchi, Masashi Naito, Mitsuyasu Iwasawa, Tetsuro Yasui, Atsushi Teramoto, Sakae Tanaka","doi":"10.1093/mr/roag009","DOIUrl":"10.1093/mr/roag009","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate periprosthetic fracture management following unlinked total elbow arthroplasty (TEA) based on a retrospective case series analysis.</p><p><strong>Methods: </strong>The medical records of 13 patients with periprosthetic fractures who underwent unlinked Kudo TEA at our institution between 2013 and 2022 were retrospectively reviewed. Postoperative assessment included elbow range of motion, radiographic evaluation, and the Mayo elbow performance score.</p><p><strong>Results: </strong>Among the 13 patients, 11 were managed surgically, and two received conservative treatment. Seven patients with component loosening and insufficient bone stock underwent revision to a linked TEA. Three patients with isolated ulnar loosening but preserved bone stock underwent revision with a long-stemmed unlinked ulnar component. One patient was treated with internal fixation. At the latest follow-up, the mean total arc of elbow motion was 91°. The mean Mayo elbow performance score was 85. All cases of aseptic loosening were treated without using strut bone allografts.</p><p><strong>Conclusions: </strong>Unlinked Kudo TEA is an effective option for primary TEA, considering the possibility of future periprosthetic fractures, as revision procedures are more straightforward than those for linked TEA. When loosening is observed, early intervention is advised to reduce the risk of periprosthetic fractures.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"657-663"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157743","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":"Long-term safety and efficacy of filgotinib in patients with idiopathic multicentric Castleman disease: 52-week results from a Phase Ib clinical trial.","authors":"Shoichi Fukui, Remi Sumiyoshi, Tomohiro Koga, Naoki Hosogaya, Sawana Narita, Shimpei Morimoto, Osamu Kamisawa, Rieko Kiya, Atsushi Katsube, Shingo Yano, Kazuko Matsuyama, Naoki Kato, Atsuhiko Kawamoto, Atsushi Kawakami","doi":"10.1093/mr/roag011","DOIUrl":"10.1093/mr/roag011","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term safety and exploratory efficacy of filgotinib, a JAK1-preferential inhibitor, in patients with idiopathic multicentric Castleman disease (iMCD) over 52 weeks in a small, single-arm extension study.</p><p><strong>Methods: </strong>This Phase Ib single-arm extension study enroled five patients with iMCD who completed an initial 8 weeks' treatment with filgotinib. Patients received filgotinib 200 mg once daily for an additional 44 weeks (total 52 weeks). The primary endpoints assessed the comprehensive safety parameters. The secondary endpoints were efficacy.</p><p><strong>Results: </strong>All five patients completed the full 52-week treatment period without permanent discontinuation. No serious adverse events or deaths were observed. All adverse events were mild-to-moderate (Grade 1-2), with upper respiratory infections in four patients and headache in three of five patients. Herpes zoster occurred in one patient. At Week 52, three of five patients had ≥1-point CHAP score reduction (one additional patient compared with Week 8). Median changes from baseline included: C-reactive protein -1.85 mg/dl, haemoglobin +0.50 g/dl, albumin +0.30 g/dl, and ECOG-PS zero points.</p><p><strong>Conclusion: </strong>Filgotinib was well-tolerated over 52 weeks with no serious adverse events reported. Numerical changes in disease activity markers were observed over time, providing preliminary support for the therapeutic concept of JAK inhibition in iMCD.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"627-634"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146220446","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":"Developments in clinical practice treating systemic lupus erythematosus-A single-centre retrospective longitudinal study in Japan.","authors":"Kentaro Minowa, Yusuke Yanagimoto, Eitaro Yoshida, Ayako Makiyama, Makio Kusaoi, Masakazu Matsushita, Hirofumi Amano, Ken Yamaji, Naoto Tamura","doi":"10.1093/mr/roag001","DOIUrl":"10.1093/mr/roag001","url":null,"abstract":"<p><strong>Objectives: </strong>To assess treatment patterns for systemic lupus erythematosus from 2012 to 2024 and evaluate corresponding changes in serological activity and relapse rates.</p><p><strong>Methods: </strong>We retrospectively reviewed medical records of 1705 patients with systemic lupus erythematosus treated at a single centre between 2012 and 2024. Temporal trends in therapeutic approaches, glucocorticoid (GC) use, and clinical outcomes were analysed.</p><p><strong>Results: </strong>Use of GC monotherapy declined from 58.3% in 2012 to 22.4% in 2024. Combination therapies (GC and hydroxychloroquine, with or without immunosuppressants) increased from 1.0% in 2015 to 41.6% in 2024, while biologics use rose from 0.9% in 2018 to 12.5% in 2024. Quadruple therapy (GC, hydroxychloroquine, immunosuppressants, and biologics) also expanded from 0.4% in 2018 to 6.2% in 2024. The mean GC dose decreased from 7.7 mg/day in 2012 to 4.6 mg/day in 2024, and the median dose, stable at 5 mg/day for many years, declined to 4.6 mg in 2023 and 4.2 mg in 2024. The proportion of patients with elevated serological activity steadily decreased. Flare rates peaked at 8.1% in 2016 but stabilised at ~4% after 2020.</p><p><strong>Conclusions: </strong>These findings suggest that improved disease control can increasingly be achieved in real-world practice while reducing long-term GC dependence.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"566-573"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146018910","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":"A proposal for the implementation of telemedicine in Japan for rheumatoid arthritis, juvenile idiopathic arthritis, and systemic lupus erythematosus: Review article.","authors":"Shin-Ya Kawashiri, Atsushi Kawakami, Takako Miyamae","doi":"10.1093/mr/roag023","DOIUrl":"10.1093/mr/roag023","url":null,"abstract":"<p><p>Telemedicine is a promising solution for addressing regional disparities, and for improving access to specialized care for patients with rheumatic diseases in Japan. This review provides a comprehensive overview of the current challenges, proposed clinical models, and future directions for implementing telemedicine for these conditions. Drawing from the European Alliance of Associations for Rheumatology points to consider and national surveys, we highlight the potential of hybrid care models, the importance of digital literacy, and the need for interdisciplinary collaboration in this field. We introduce innovative remote care systems currently being piloted in island regions to deliver high-quality care in underserved settings. Additionally, we discuss the outcomes of a health economic simulation, revealing the benefits and financial concerns regarding the current reimbursement structures. Key barriers - technical, clinical, patient-related, organizational, and legal - are analysed alongside proposed countermeasures. Finally, we outline a research agenda to evaluate the effectiveness, safety, and sustainability of telemedicine. With appropriate policy support and system development, telemedicine could play a pivotal role in enhancing the quality and equity of rheumatologic care in Japan.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"504-515"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147499324","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":"Impact of disease activity on the long-term progression of wrist joint deterioration over 10 years in patients with rheumatoid arthritis.","authors":"Hiroyuki Wada, Hajime Ishikawa, Asami Abe, Masanori Sudo, Sayuri Takamura, Satoshi Ito, Kiyoshi Nakazono, Akira Murasawa","doi":"10.1093/mr/roaf120","DOIUrl":"10.1093/mr/roaf120","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the relationship between wrist deterioration and each of disease activity and physical function in patients with rheumatoid arthritis (RA).</p><p><strong>Methods: </strong>We analyzed 434 wrists in patients with RA who initiated treatment within the first year of disease onset. The annual mean Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), the annual mean Health Assessment Questionnaire Disability Index (HAQ-DI), and the biennial decrease in the carpo: metacarpal ratio (c/MC) on plain radiographs were assessed. At year 10, wrists were classified into three groups according to Larsen grade (LG): LG 0, LG I-II, and LG ≥ III.</p><p><strong>Results: </strong>In LG ≥ III, the annual mean DAS28-ESR at year 1 was particularly high, and both the annual mean HAQ-DI and the decrease in c/MC remained the highest throughout the study. The decrease in c/MC for 10 years had a weak positive correlation with the annual mean DAS28-ESR for 10 years (r = 0.301, P < .001). The mean DAS28-ESR cut-off value indicating progression to LG ≥ III at year 10 was 3.59 during the first 2 years.</p><p><strong>Conclusion: </strong>Control of disease activity in the early stage is crucial to prevent wrist joint deterioration and preserve physical function in patients with RA.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"537-542"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701095","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":"Histological subtypes of rheumatoid arthritis-associated lymphoproliferative disorders: Serological and Epstein-Barr virus findings.","authors":"Keiichiro Kinoshita, Hirofumi Miyake, Ryuichi Minoda Sada, Hiroyuki Akebo, Shinji Sumiyoshi, Kazuhiro Hatta","doi":"10.1093/mr/roaf125","DOIUrl":"10.1093/mr/roaf125","url":null,"abstract":"<p><strong>Objectives: </strong>Lymphoproliferative disorders (LPDs) in patients with rheumatoid arthritis (RA) are thought to develop through two major mechanisms: chronic inflammation and immunosuppression. This study aimed to investigate the relationship between histological subtypes and two representative biomarkers, rheumatoid factor (RF) and Epstein-Barr virus-encoded RNA in situ hybridisation (EBER-ISH), in RA-associated LPD (RA-LPD).</p><p><strong>Methods: </strong>We retrospectively analysed patients with clinically diagnosed RA-LPD who underwent tissue biopsy at a single institution. Histological subtypes were classified as classic Hodgkin lymphoma (CHL), monomorphic LPD (Mono-LPD), polymorphic LPD (Poly-LPD), or reactive lymphoid hyperplasia/normal variant (RLH/NV). RF levels and EBER-ISH results were compared across groups.</p><p><strong>Results: </strong>A total of 69 RA-LPD patients were included in the analysis. RF levels differed significantly across the four histological subtypes (P = .024), with the highest median level observed in the Mono-LPD group. EBER-ISH positivity differed significantly among the subtypes (P < .001), with a significantly higher rate in Poly-LPD compared to Mono-LPD and RLH/NV. Mono-LPD tended to show high RF titres and EBER-ISH negativity, whereas Poly-LPD and CHL were characterised by low RF titres and high EBER-ISH positivity.</p><p><strong>Conclusions: </strong>RF and EBER-ISH status differed among histological subtypes of RA-LPD, and their combined assessment may help explain its histological diversity.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"543-549"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145743423","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 of enzyme-linked immunosorbent assays for the detection of myositis-specific autoantibodies against signal recognition particle, nuclear matrix protein 2, and small ubiquitin-like modifier activating enzyme.","authors":"Akihiro Murakami, Hiroki Abe, Tetsuya Kikuchi, Shunsuke Kidani, Yukihiro Nishikawa, Takuya Isayama, Shun Matsuzawa, Shinji Sato, Ran Nakashima, Naoko Okiyama, Manabu Fujimoto, Ichizo Nishino, Masataka Kuwana","doi":"10.1093/mr/roag003","DOIUrl":"10.1093/mr/roag003","url":null,"abstract":"<p><strong>Objectives: </strong>To develop and validate enzyme-linked immunosorbent assay (ELISA) systems for the detection of autoantibodies against the signal recognition particle (SRP), nuclear matrix protein 2 (NXP2), and small ubiquitin-like modifier activating enzyme (SAE).</p><p><strong>Methods: </strong>Serum samples from 288 individuals were analysed, including 183 patients with idiopathic inflammatory myopathies, 20 with other neuromuscular diseases, 35 with non-idiopathic inflammatory myopathies and other systemic autoimmune rheumatic diseases, and 50 healthy controls. ELISA systems were established using recombinant SRP, NXP2, and SAE proteins expressed in insect cells or Escherichia coli. The diagnostic performance of the ELISAs was assessed in comparison with the 'gold-standard' immunoprecipitation assays.</p><p><strong>Results: </strong>The ELISAs demonstrated high concordance with immunoprecipitation assays, with positive and negative percent agreements of 97.4% and 100% for anti-SRP, 100% and 99.6% for anti-NXP2, and 100% and 99.6% for anti-SAE antibodies, respectively.</p><p><strong>Conclusions: </strong>The newly developed ELISA systems showed excellent agreement with immunoprecipitation assays, supporting their applicability for routine clinical use in detecting anti-SRP, anti-NXP2, and anti-SAE autoantibodies.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"604-609"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146149695","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":"Can baseline features predict progression to defined connective tissue disease? Insights from a minimum 5-year follow-up study of 504 patients with undifferentiated connective tissue disease: A retrospective study.","authors":"Hakan Apaydin, Şerife Çoşkun Sağirkaya, Bünyamin Polat, Berkan Armağan, Ahmet Omma, Şükran Erten, Orhan Küçükşahin, Serdar Can Güven","doi":"10.1093/mr/roag006","DOIUrl":"10.1093/mr/roag006","url":null,"abstract":"<p><strong>Objectives: </strong>Undifferentiated connective tissue disease (UCTD) represents a systemic autoimmune condition characterized by clinical and serological features suggestive of defined connective tissue diseases (CTDs), yet it is insufficient to fulfil existing classification criteria. Despite increasing interest, long-term outcomes - particularly progression to defined CTDs - remain incompletely understood. This study aimed to evaluate the clinical outcomes of a UCTD cohort followed for at least 5 years and to identify baseline clinical and serological factors associated with an increased risk of evolution to a defined CTD.</p><p><strong>Methods: </strong>A total of 658 patients were screened for this retrospective cohort study. After applying predefined eligibility criteria, 504 patients who met established UCTD definitions were included. Baseline clinical, laboratory, and serological characteristics were analysed. Two patient outcome groups were defined at a 5-year follow-up: those who evolved to a defined CTD and those who remained stable. Given the limited number of cases evolving to defined CTDs, group comparisons were performed using Student's t-test or the Mann-Whitney U test rather than logistic regression. Autoantibodies were assessed using indirect immunofluorescence for antinuclear antibodies and validated immunoassays for anti-dsDNA, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Scl-70, anticentromere, anti-U1RNP, anti-Jo1, rheumatoid factor, anticyclic citrullinated peptide antibodies, antiphospholipid antibodies (anti-β2 glycoprotein I IgM/IgG and anticardiolipin IgM/IgG), and lupus anticoagulant.</p><p><strong>Results: </strong>After a mean follow-up of 82 months, 102 of the 504 UCTD patients (20.2%) developed a defined CTD (37 with Sjögren's disease, 35 with systemic lupus erythematosus, 12 with systemic sclerosis, 14 with rheumatoid arthritis, and 4 with mixed CTDs) within a follow-up period of at least 5 years. The most common clinical manifestations of UCTD included arthralgia, sicca symptoms, photosensitivity, oral aphthae, and Raynaud's phenomenon. Differentiation was significantly associated with features, such as a Schirmer test ≤5 mm (P = .007), anti-dsDNA (P = .001), anti-Ro/SS-A (P < .001), and hypocomplementemia (P = .004). Multivariate analysis identified several disease-specific predictors, including anti-Ro/SS-A for Sjögren's disease and anti-dsDNA and hypocomplementemia for systemic lupus erythematosus.</p><p><strong>Conclusions: </strong>Approximately one-fifth of UCTD patients progressed to a defined CTD during long-term follow-up, most frequently to Sjögren's disease or systemic lupus erythematosus. Anti-Ro/SS-A, anti-dsDNA, and a Schirmer test ≤5 mm were significant predictors of progression.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"619-626"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146157732","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":"Impact of deep remission on renal flare in pure class V lupus nephritis: results from KEIO-SLE cohort, a retrospective cohort study.","authors":"Masatoshi Kawai, Hironari Hanaoka, Hiroyuki Fukui, Koji Suzuki, Kazuoto Hiramoto, Hiroshi Takei, Jun Kikuchi, Yuko Kaneko","doi":"10.1093/mr/roaf129","DOIUrl":"10.1093/mr/roaf129","url":null,"abstract":"<p><strong>Objectives: </strong>To clarify long-term prognosis and its relevant factors in patients with pure class V lupus nephritis (LN).</p><p><strong>Methods: </strong>We reviewed consecutive patients with biopsy-proven pure class V LN from KEIO-SLE cohort. The treatment target and deep remission (DR) were defined as urine protein-to-creatinine ratio <0.7 g/gCr and <0.15 g/gCr, respectively. Patients were divided into two groups based on the occurrence of renal flare, and baseline clinical and pathological characteristics were compared.</p><p><strong>Results: </strong>Thirty patients with pure class V LN were included. All patients achieved the treatment target. Among them, seven patients (23.3%) experienced renal flare. In the Firth's penalized Cox regression analysis, univariate analysis showed that smoking history, glucocorticoid monotherapy throughout follow-up, anti-ribonucleoprotein antibody positivity, Chronicity index ≥3, and non-achievement of DR were associated with an increased risk of renal flare. Multivariable analysis revealed that only non-achievement of DR remained an independent risk factor. Kaplan-Meier analyses showed significantly lower flare-free survival in patients with these risk factors. No patients developed end-stage kidney disease during a median observation period of 85.6 months.</p><p><strong>Conclusion: </strong>Overall long-term prognosis of pure class V LN was favourable. However, approximately one-quarter of patients experienced renal flares. Failure to achieve DR, smoking history, throughout glucocorticoid monotherapy, and anti-ribonucleoprotein antibody positivity were associated with an increased risk of renal flare, with failure to achieve DR being the only independent risk factor.</p>","PeriodicalId":18705,"journal":{"name":"Modern Rheumatology","volume":" ","pages":"574-580"},"PeriodicalIF":2.1,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834440","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}