Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease with synovitis and extra-articular systemic involvement. Chronic RA treatment is challenging and represents a major health burden worldwide. Recent insights regarding RA pathogenesis have led to novel therapeutic agents, especially biologics. Furthermore, accumulating experience and new clinical studies have helped to inform updated recommendations for treatment of RA. Recently, treatment guidelines from the American College of Rheumatology were released. Here, we review these guidelines and their application to daily practice.

Background/Aims: The aim of this study was to compare the short- and long-term retention rates of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in Korean patients with seropositive rheumatoid arthritis. Methods: This study was conducted with 1,538 treatment courses of 1,063 patients, including adalimumab (n = 332), etanercept (n = 369), infliximab (n = 146), abatacept (n = 152), tocilizumab (n = 299), tofacitinib (n = 136), and baricitinib (n = 104), in patients with seropositive rheumatoid arthritis who started b/tsDMARD treatment between 2008 and 2020 at Seoul St. Mary’s Hospital. Discontinuation 1 and 3 years after the first prescription of each drug was investigated. Kaplan– Meier estimates of time to discontinuation were calculated to compare the difference in drug retention rate for each drug. Patient-level predictors of drug discontinuation were evaluated using a Cox proportional hazards model. Results: The overall 1-year drug retention rate was from 60.1% for adalimumab to 90.0% for tofacitinib in the b/tsDMARD-naïve group, and from 55.2% for infliximab to 84.8% for tofacitinib in the b/tsDMARD-experienced group. The 3-year drug retention rate was from 36.9% for infliximab to 86.5% for tofacitinib in the b/tsDMARD-naïve group, and from 31.0% for infliximab to 65.4% for tocilizumab in the b/tsDMARD-experienced group. Drug discontinuation appeared to be affected by specific types of b/tsDMARDs. Conclusions Tocilizumab and tofacitinib are less commonly discontinued compared to tumor necrosis factor-α inhibitors at 1 and 3 years. Specifically, tofacitinib in the b/tsDMARD-naïve group and tocilizumab in the b/tsDMARD-experienced group showed the highest 3-year retention rates.

Background/Aims: The aim of this study was to compare the short- and long-term retention rates of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in Korean patients with seropositive rheumatoid arthritis. Methods: This study was conducted with 1,538 treatment courses of 1,063 patients, including adalimumab (n = 332), etanercept (n = 369), infliximab (n = 146), abatacept (n = 152), tocilizumab (n = 299), tofacitinib (n = 136), and baricitinib (n = 104), in patients with seropositive rheumatoid arthritis who started b/tsDMARD treatment between 2008 and 2020 at Seoul St. Mary’s Hospital. Discontinuation 1 and 3 years after the first prescription of each drug was investigated. Kaplan– Meier estimates of time to discontinuation were calculated to compare the difference in drug retention rate for each drug. Patient-level predictors of drug discontinuation were evaluated using a Cox proportional hazards model. Results: The overall 1-year drug retention rate was from 60.1% for adalimumab to 90.0% for tofacitinib in the b/tsDMARD-naïve group, and from 55.2% for infliximab to 84.8% for tofacitinib in the b/tsDMARD-experienced group. The 3-year drug retention rate was from 36.9% for infliximab to 86.5% for tofacitinib in the b/tsDMARD-naïve group, and from 31.0% for infliximab to 65.4% for tocilizumab in the b/tsDMARD-experienced group. Drug discontinuation appeared to be affected by specific types of b/tsDMARDs. Conclusions Tocilizumab and tofacitinib are less commonly discontinued compared to tumor necrosis factor-α inhibitors at 1 and 3 years. Specifically, tofacitinib in the b/tsDMARD-naïve group and tocilizumab in the b/tsDMARD-experienced group showed the highest 3-year retention rates.

Background/Aims: The aim of this study was to compare the short- and long-term retention rates of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in Korean patients with seropositive rheumatoid arthritis. Methods: This study was conducted with 1,538 treatment courses of 1,063 patients, including adalimumab (n = 332), etanercept (n = 369), infliximab (n = 146), abatacept (n = 152), tocilizumab (n = 299), tofacitinib (n = 136), and baricitinib (n = 104), in patients with seropositive rheumatoid arthritis who started b/tsDMARD treatment between 2008 and 2020 at Seoul St. Mary’s Hospital. Discontinuation 1 and 3 years after the first prescription of each drug was investigated. Kaplan– Meier estimates of time to discontinuation were calculated to compare the difference in drug retention rate for each drug. Patient-level predictors of drug discontinuation were evaluated using a Cox proportional hazards model. Results: The overall 1-year drug retention rate was from 60.1% for adalimumab to 90.0% for tofacitinib in the b/tsDMARD-naïve group, and from 55.2% for infliximab to 84.8% for tofacitinib in the b/tsDMARD-experienced group. The 3-year drug retention rate was from 36.9% for infliximab to 86.5% for tofacitinib in the b/tsDMARD-naïve group, and from 31.0% for infliximab to 65.4% for tocilizumab in the b/tsDMARD-experienced group. Drug discontinuation appeared to be affected by specific types of b/tsDMARDs. Conclusions Tocilizumab and tofacitinib are less commonly discontinued compared to tumor necrosis factor-α inhibitors at 1 and 3 years. Specifically, tofacitinib in the b/tsDMARD-naïve group and tocilizumab in the b/tsDMARD-experienced group showed the highest 3-year retention rates.

Background/Aims: The aim of this study was to compare the short- and long-term retention rates of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in Korean patients with seropositive rheumatoid arthritis. Methods: This study was conducted with 1,538 treatment courses of 1,063 patients, including adalimumab (n = 332), etanercept (n = 369), infliximab (n = 146), abatacept (n = 152), tocilizumab (n = 299), tofacitinib (n = 136), and baricitinib (n = 104), in patients with seropositive rheumatoid arthritis who started b/tsDMARD treatment between 2008 and 2020 at Seoul St. Mary’s Hospital. Discontinuation 1 and 3 years after the first prescription of each drug was investigated. Kaplan– Meier estimates of time to discontinuation were calculated to compare the difference in drug retention rate for each drug. Patient-level predictors of drug discontinuation were evaluated using a Cox proportional hazards model. Results: The overall 1-year drug retention rate was from 60.1% for adalimumab to 90.0% for tofacitinib in the b/tsDMARD-naïve group, and from 55.2% for infliximab to 84.8% for tofacitinib in the b/tsDMARD-experienced group. The 3-year drug retention rate was from 36.9% for infliximab to 86.5% for tofacitinib in the b/tsDMARD-naïve group, and from 31.0% for infliximab to 65.4% for tocilizumab in the b/tsDMARD-experienced group. Drug discontinuation appeared to be affected by specific types of b/tsDMARDs. Conclusions Tocilizumab and tofacitinib are less commonly discontinued compared to tumor necrosis factor-α inhibitors at 1 and 3 years. Specifically, tofacitinib in the b/tsDMARD-naïve group and tocilizumab in the b/tsDMARD-experienced group showed the highest 3-year retention rates.

This new classification system redefines the current paradigm of rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ankylosing spondylitis (AS), by focusing on the features of the disease at earlier stages. The new classification criteria of RA was devised to facilitate early diagnosis. They include the use of positive anti-cyclic citrullinated peptide antibody test and the presence of the increased level of acute phase reactants such as erythrocyte sedimentation rate and c-reactive protein. As compared to the old criteria in which only plain radiography was used to determine the joint damage, ultrasound can be regarded as a valuable tool for examining the extent of synovitis in the new criteria. In terms of SLE, immunologic criteria were intensified in the new classification criteria. They include hypocomplementemia as a single criterion and the presence of anti beta2GPI antibody is considered to meet the antiphopholipid antibody criterion. The new concept of neuropsychiatric lupus is applied as well. The most recent classification criteria for AS were provided by Assessment of Spondyloarthritis International Society. They cover the whole spectrum of axial spondyloarthritis (SpA) and peripheral SpA and use magnetic resonance imaging as an important tool to assess early sacroiliac changes. In addition, they emphasize the presence of HLA-B27 gene as an important criterion. In order to prevent the undesirable organ damages, it is crucial to diagnose rheumatic diseases at early stages according to these new classification criteria and to start an early aggressive treatment. The accurate diagnosis and early targeted therapies will contribute to the improved quality of life and increased overall survival of the patients with rheumatic diseases.
Acute-Phase Proteins ; Arthritis, Rheumatoid ; Blood Sedimentation ; C-Reactive Protein ; Early Diagnosis ; HLA-B27 Antigen ; Humans ; Joints ; Korea ; Lupus Erythematosus, Systemic ; Magnetic Resonance Imaging ; Quality of Life ; Rare Diseases ; Rheumatic Diseases ; Spondylitis, Ankylosing ; Synovitis

Human parvovirus B19 (HPV-B19) usually infects children. We report a case of an adult with HPV-B19 infection mimicking systemic lupus erythematosus (SLE). A previously healthy 46-year-old woman presented with an acute illness of cough, fever, chilling, polyarthritis, and skin rash. Laboratory findings showed pancytopenia, increased creatinine level, proteinuria and hypocomplementemia. Anti-double stranded DNA antibody (anti-dsDNA Ab) and antinuclear antibody were positive. Highly suspected of SLE based on clinical and laboratory findings, the patient was initially treated with corticosteroids. Meanwhile, the result of HPV-B19 polymerase chain reaction, which was done initially with other viral tests to exclude infection, turned out to be positive. Steroid was tapered, and pancytopenia, proteinuria, hypocomplementemia gradually improved. On the seventh day, anti-dsDNA Ab was found to be negatively converted. HPV-B19 infections are mostly self-limited and occur rarely in adults, but if a patient presents lupus-like syndrome with transient autoantibody positivity, lupus mimickers including HPV-B19 should be considered.

Systemic sclerosis as a connective tissue disease could affect all internal organs of the body and could also manifest as a cutaneous lesion. Cardiac involvement leading to cardiac manifestations in systemic sclerosis patients is not rare. However, cardiac amyloidosis combined with systemic sclerosis is extremely rare. Although there were no definite treatment options in this case, symptomatic treatment is the cornerstone of the management plan. In this case report, we described a correct diagnosis and symptomatic medical care of early reactive cardiac amyloidosis with systemic sclerosis and summarize the current state of the relevant literature.
Amyloidosis* ; Cardiomyopathy, Restrictive ; Connective Tissue Diseases ; Diagnosis* ; Humans ; Scleroderma, Systemic*

Axial spondyloarthritis and sarcoidosis are both inflammatory multi-system diseases. Having different pathophysiologies, they develop different typical lesions. The co-occurrence of both diseases is rare and nature of the association between the entities is unknown.
Female ; Humans ; Sarcoidosis*

Background/Aims: We aimed to clarify the clinical characteristics of psoriatic arthritis (PsA) in Korean patients focusing on PsA with axial involvement. Methods: A retrospective medical chart review was performed to identify PsA patients at a single tertiary center. Cases of AS patients with psoriasis were recruited from a prospective AS registry of the same center. Demographics, laboratory findings, and radiologic characteristics were assessed. Results: A total of 69 PsA patients were identified. In PsA patients, spondylitis (46.4%) was the most common form. Compared to AS patients with psoriasis, PsA patients with radiographic axial involvement were older (50.9 vs. 32.4 years; p < 0.001) and showed greater peripheral disease activity (peripheral arthritis 78.1 vs. 12.5%, p < 0.001; enthesitis 50.0 vs. 6.3%, p = 0.003). AS patients with psoriasis presented a higher rate of HLA-B*27 positivity (81.3 vs. 17.2%; p < 0.001) and a more frequent history of inflammatory back pain (100.0 vs. 75.0%; p = 0.039) than PsA patients with radiographic axial involvement. Significant proportions of PsA patients with radiographic axial involvement had cervical spine involvement (10/18, 55.6%) and spondylitis without sacroiliitis (10/23, 43.5%). Conclusions We demonstrate that axial involvement is common in Korean PsA patients, and its characteristics can be distinct from those of AS.