Objective: Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in children, with an unknown cause and prolonged disease course. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) have improved outcomes in severe or refractory cases, but challenges remain due to disease heterogeneity and long-term management needs. Understanding treatment patterns of novel therapies is essential for optimizing care. This study aimed to investigate bDMARD treatment patterns in JIA patients using a real-world database. Methods: A retrospective analysis was conducted using Health Insurance Review and Assessment (HIRA) national claims data from 2007 to 2019. JIA patients were classified into bDMARDs and non-bDMARDs groups, with treatment patterns compared. Results: Among 1,728 JIA patients, 31.3% (n=541) received bDMARDs, with 15.5% (n=84) discontinuing treatment. The median time from diagnosis to first bDMARD was 36.7 (9.7~58.1) months, with a median treatment duration of 28.1 (11.5~54.4) months and follow-up of 24.3 (7.7~43.7) months post-discontinuation. In the non-bDMARDs group (68.7%, n=1,187), 68.7% (n=815) used conventional synthetic DMARDs (csDMARDs), with a 46.6% (n=380) discontinuation rate. Methotrexate, sulfasalazine, and hydroxychloroquine were the most prescribed csDMARDs. Etanercept (69.7%) was the most common first bDMARD, followed by adalimumab (19.0%) and tocilizumab (7.6%), with 14.8% switching to a second biologic. Discontinuation rates of csDMARDs were higher in the non-bDMARDs group (p<0.001). Conclusion This is the first comprehensive study profiling the treatment patterns of Korean patients with JIA using populationbased claims data. The findings enhance understanding of real-world treatment trends, aiding clinical decision-making.

Objective: This study aims to compare the incidence of active tuberculosis (TB) among Korean patients with rheumatoid arthritis (RA) initiating treatment with tumor necrosis factor inhibitors (TNFi) or tofacitinib. Methods: Using the Korean National Health Insurance database, we conducted a nationwide, retrospective cohort study of RA patients who started TNFi or tofacitinib therapy between 2015 and 2018. We calculated the incidence rates of active TB based on the treatment type and results from latent tuberculosis infection (LTBI) screening tests. A multivariable Cox proportional hazards model was employed to evaluate the risk of active TB in RA patients beginning TNFi or tofacitinib treatment. Results: Among 3,382 RA patients (596 on tofacitinib and 2,786 on TNFi), LTBI screening was predominantly conducted using the IGRA (interferon-gamma release assays) test. Of these patients, 624 (18.5%) with a positive LTBI test received prophylactic treatment. No cases of active TB occurred in tofacitinib users, while 32 cases were observed in TNFi users. The adjusted hazard ratio for active TB in LTBI-positive patients was 5.47 (95% confidence interval 2.74 to 10.92) compared to LTBI-negative patients.In subgroup analyses, TB incidence was significantly higher among individuals aged over 65 years. Conclusion Despite LTBI treatment, active TB remains prevalent among RA patients on TNFi therapy and in those with positive LTBI tests.

Objective: In this study, we aimed to investigate the incidence and risk factors for interstitial nephritis in patients with ankylosing spondylitis (AS). Methods: We retrospectively analyzed the claims records of patients diagnosed with AS in Korea’s Health Insurance Review and Assessment Service Database between 2016 and 2019. The Assessment of Spondyloarthritis International Society nonsteroidal anti-inflammatory drugs (NSAIDs) intake score was used to calculate the NSAID dosage over 1 year after AS diagnosis. The incidence rate of interstitial kidney disease was calculated as the number of events per 1,000 person-years. The risks associated with sex, age, Charlson Comorbidity Index, comorbidities, and concomitant medications were assessed using the Cox proportional hazards model, with results presented as hazard ratios (HRs) and 95% confidence intervals (CIs). Results: In total, 11,749 patients with AS were included in this study. Of these, 79 patients had interstitial nephritis, with an incidence rate of 2.50 per 1,000 person-years. In multivariable analysis, female sex (HR, 2.44; 95% CI, 1.56~3.83), hypertension (HR, 2.08; 95% CI, 1.15~3.76), and renal failure (HR, 3.70; 95% CI, 1.30~10.55) showed significant associations. However, NSAID use in the first year after AS diagnosis was not associated with interstitial nephritis occurrence. Conclusion The incidence of interstitial nephritis in patients with AS was 2.50 per 1,000 person-years, with female sex and comorbidities identified as significant risk factors. However, NSAID use during the first year after AS diagnosis was not associated with interstitial nephritis development.

Objective: Janus kinase (JAK) inhibitors are widely used to treat rheumatoid arthritis (RA); however, comparative analyses regarding their adverse events remain limited. This study aimed to compare the effects of different JAK inhibitors (tofacitinib, baricitinib, and upadacitinib) on hematological parameters in patients with RA in a real-world setting. Methods: This retrospective analysis included 552 patients with RA treated with JAK inhibitors between August 2015 and February 2024. Hematological parameters, including absolute neutrophil count (ANC) and platelet count, were assessed at baseline and after 6 months of treatment. Statistical analysis was performed to evaluate changes over time, and logistic regression analysis identified factors associated with hematologic alterations. Results: The 552 patients were divided into three groups: tofacitinib (n=264), baricitinib (n=143), and upadacitinib (n=145). No significant differences in baseline hematological parameters were observed across the groups. After 6 months, ANC decreased in all groups without significant differences among them (p=0.465). Patients receiving baricitinib had significantly higher platelet counts than those receiving tofacitinib (Pillai’s trace value of 0.063, p<0.001) or upadacitinib (Pillai’s trace value of 0.029, p<0.001).Multivariate analysis revealed that baricitinib was significantly associated with increased platelet counts (odds ratio, 2.009; 95% confidence interval, 1.212~3.331; p=0.007). Conclusion Although all three JAK inhibitors reduced ANC, baricitinib was associated with a substantial increase in platelet counts. These findings highlight the differences in adverse effect profiles among JAK inhibitors, emphasizing the importance of tailored monitoring in RA management.

Anti-neutrophil cytoplasmic antibody-associated vasculitides (AAV) are rare autoimmune disorders typically involving the lungs and kidneys. A few case reports have described an association with hematopoietic stem cell transplant (HSCT). We present a case of myeloperoxidase-positive AAV with predominant renal involvement in a 49-year-old male with a history of acute myeloid leukemia treated with allogenic HSCT and complicated by chronic graft-versus-host disease (GVHD). He presented with rapidly progressive glomerulonephritis, and kidney biopsy revealed pauci-immune necrotizing crescentic glomerulonephritis. Treatment with methylprednisolone pulses followed by oral prednisolone, rituximab, and plasmapheresis led to improved kidney function and a tailored rituximab maintenance regimen was followed. However, a renal-limited relapse occurred at 15 months, requiring repeat induction therapy. Dialysis was avoided, but renal function only partially recovered. This case suggests that AAV can develop after HSCT and GVHD and highlights the importance of long-term follow-up and further research into underlying mechanisms.

Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease of clinical importance in the Philippines. While its actual prevalence in the Philippines is unknown due to a lack of organized cohorts and community-level screening, Filipino females in the second and third decades of life are primarily affected, commonly presenting with mucocutaneous, musculoskeletal, hematologic, and renal involvements. Several risk factors have been described as influencing the development of SLE in Filipinos, including molecular/genetic, clinical, lifestyle, and environmental factors. The diagnosis of SLE in the Philippines still relies on international standards, such as the Systemic Lupus International Collaborating Clinics 2012 and the European League Against Rheumatism/American College of Rheumatology 2019 classification criteria. Similarly, the lack of published local guidelines for SLE requires Filipino practitioners to rely on international management guidelines, which now include the Asia-Pacific League of Associations for Rheumatology recommendations for the Asia-Pacific region, with management goals including the achievement of a low disease activity state, the prevention of organ damage, the prevention of flares, and the promotion of quality of life. Structural barriers still impede comprehensive lupus care in the country, manifesting as poor access to essential drugs and rheumatologists, low capacity for community-level surveillance, lacking research and guidelines in Philippine-specific nuances (i.e., common presentations and comorbidities such as tuberculosis), and education. The medical community in the country must be mobilized to ensure holistic care for SLE patients, as it is one of the most important rheumatologic conditions in the Philippines.

Objective: We aimed to identify predictors of short- and long-term sustained remission in early rheumatoid arthritis (eRA) and very early rheumatoid arthritis (veRA), and to assess their relevance within the joint accumulation model paradigm. Methods: This retrospective real-world cohort study included adult Colombian RA patients. Based on symptom onset, patients were classified as eRA (≤12 months) or veRA (≤3 months). Sustained remission was defined using Clinical Disease Activity Index (CDAI) thresholds maintained for ≥6 months (short-term) and ≥24 months (long-term). Predictors were identified using robust Poisson regression. Results: In eRA, short-term remission was more likely in antinuclear antibodies (ANA)-positive patients (risk ratio [RR]: 3.29, 95% confidence intervals [CI]: 1.38~7.83) and less likely in those with higher baseline Health Assessment Questionnaire (HAQ) (RR: 0.48, 95% CI: 0.29~0.78). Long-term remission was more frequent in males (RR: 2.67, 95% CI: 1.11~6.46) and in patients with lower baseline Simple Disease Activity Index (SDAI) (RR: 0.92, 95% CI: 0.85~0.99). In veRA, short-term remission was negatively associated with anti-citrullinated protein antibodies (ACPA) (RR: 0.74, 95% CI: 0.58~0.93), swollen joint count (RR: 0.52, 95% CI: 0.27~1.00), and patient global assessment (RR: 0.61, 95% CI: 0.40~0.93). Long-term remission was associated with higher rheumatoid factor levels (RR: 1.76, 95% CI: 1.20~2.56), lower tender joint counts (RR: 0.71, 95% CI: 0.55~0.92), and slower joint accumulation rates (RR: 0.51, 95% CI: 0.29~0.90). These findings were consistent among disease-modifying anti-rheumatic drug (DMARD)-naïve patients. Conclusion Distinct predictors of remission in eRA and veRA underscore the need for stage-specific treatment strategies. Our findings provide real-world evidence supporting the joint accumulation model and highlight the potential to optimize outcomes through tailored time-sensitive interventions.

Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological disorder primarily affecting the posterior circulation of the brain. It manifests with a spectrum of symptoms, typically accompanied by hypertension, headache, seizures, and blurred vision. The etiology of PRES remains uncertain, but it is believed to be associated with vasogenic edema. The underlying conditions can range from sepsis to drug-induced states, autoimmune diseases, systemic lupus erythematosus (SLE), which is the most prevalent connective tissue disease associated with PRES. SLE is a multisystemic disorder that impacts various organs in the body, with musculoskeletal and skin systems being the most affected. The morbidity and mortality associated with SLE stem from its potential involvement of life-threatening organs, including the central nervous system, kidneys, and respiratory system. This article will focus on the neurological impact of PRES, including its manifestations. The association between PRES and SLE will be discussed in detail, accompanied by a literature review that explores the variability of presentation, reversibility, and prognosis.