BACKGROUND: The management of reproductive health in individuals with autoimmune rheumatic diseases (AIRDs) has evolved into a primary clinical priority. Wide variations in clinical practice and drug availability in the...BACKGROUND: The management of reproductive health in individuals with autoimmune rheumatic diseases (AIRDs) has evolved into a primary clinical priority. Wide variations in clinical practice and drug availability in the Asia-Pacific regions necessitate localized frameworks. These consensus statements, developed by the Asia Pacific League of Associations for Rheumatology (APLAR) Special Interest Group for Women's Health & Reproductive Issues in Rheumatic and Musculoskeletal Diseases, aim to bridge the gaps within the region, foster multidisciplinary collaboration, and address regional knowledge deficits. METHODS: An expert panel comprising 16 members of the 13 APLAR member nation organizations formulated 23 research questions using the PICO framework. A systematic review of English-language literature up to July 2025 was conducted across the MEDLINE, Scopus, Google Scholar, and Cochrane Library databases, supplemented by a manual search of journals from the APLAR regions. Evidence from the APLAR region was appraised using the GRADE system. A modified Delphi online voting process was employed to reach consensus, pre-defined as ≥ 75% agreement. RESULTS: The panel approved four overarching principles and 86 statements, organized into 16 broad categories. These statements cover all three phases of pregnancy in AIRDs, the safety of medications during pregnancy and lactation, contraception, assisted reproductive techniques, fertility preservation, and hormonal replacement therapy, covering both female and male aspects as relevant. CONCLUSION: In a field often lacking high-quality data, these consensus statements from APLAR provide expert opinion-based guidance to support clinical decision-making. It is envisaged that it will assist in educational and training purposes and help shape future research priorities.
OBJECTIVE: To examine factors associated with a higher long-term frailty status in patients with rheumatoid arthritis (RA). METHODS: We analyzed 313 patients who had complete annual Japanese version of the Cardiovascular...OBJECTIVE: To examine factors associated with a higher long-term frailty status in patients with rheumatoid arthritis (RA). METHODS: We analyzed 313 patients who had complete annual Japanese version of the Cardiovascular Health Study (J-CHS) assessments from 2020 to 2025. Frailty status was evaluated using the mean J-CHS score across the study period, and patients were classified into two groups: mean J-CHS ≤ 2 (n = 236) and mean J-CHS > 2 (n = 77). Factors associated with mean J-CHS > 2 were examined using logistic regression analysis. RESULTS: Compared to patients with mean J-CHS ≤ 2, those with mean J-CHS > 2 were older (63.9 vs. 68.2 years) and had a longer disease duration (9.8 vs. 15.1 years), higher disease activity (mean DAS28-ESR: 2.44 vs. 3.17), higher rate of glucocorticoid use (23.3% vs. 36.4%), and worse physical function (mean HAQ-DI: 0.21 vs. 0.77). Logistic regression analysis identified longer disease duration (OR 1.06), higher DAS28-ESR (OR 2.38), and glucocorticoid use (OR 2.90) as independent factors associated with mean J-CHS > 2. In longitudinal analyses, patients with higher frailty status consistently exhibited higher glucocorticoid use over time. Among patients who achieved baseline remission, disease activity remained comparable between groups, whereas glucocorticoid use remained consistently higher in patients with mean J-CHS > 2. CONCLUSIONS: Long-term frailty status in RA was associated with disease duration and treatment patterns, particularly continued glucocorticoid exposure. Even among patients in remission, those with mean J-CHS > 2 showed persistently higher glucocorticoid use despite comparable disease activity, without corresponding DMARD intensification, which may reflect differences in treatment patterns in this subgroup.
Int J Rheum Dis
· 2026 Jul · PMID 42363030
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AIM: Biologic agents play a pivotal role in controlling both articular and cutaneous manifestations of psoriatic arthritis (PsA). Although international guidelines emphasize the appropriate use of biologics, Korea lacks...AIM: Biologic agents play a pivotal role in controlling both articular and cutaneous manifestations of psoriatic arthritis (PsA). Although international guidelines emphasize the appropriate use of biologics, Korea lacks standardized treatment protocols tailored for PsA across specialties. We therefore aimed to examine specialty-specific prescription patterns and treatment retention using nationwide claims data. METHODS: Health Insurance Review and Assessment (HIRA) claims data from 2011 to 2022 were analyzed, including patients with PsA who initiated treatment with their first biologic agent. Patients with concurrent autoimmune diseases were excluded. Trends in diagnosis, prescription patterns, and retention were analyzed according to medical specialty. RESULTS: Of the 2406 patients with PsA, 63.0% were diagnosed in dermatology departments and 32.8% in internal medicine departments. Most biologics were prescribed in the dermatology department (80.2%), while 17.8% were prescribed in the internal medicine department. Since 2016, dermatology has exhibited a marked increase in both PsA diagnoses and biologic prescriptions. Interleukin-23 (IL-23) inhibitors were the most frequently prescribed class (62.0%), followed by IL-17 inhibitors (21.9%) and tumor necrosis factor inhibitors (TNFi) (16.1%). Drug retention analysis revealed that dermatology was associated with a significantly higher risk of biologic discontinuation than internal medicine (hazard ratio = 1.40, 95% confidence interval 1.11-1.78). CONCLUSION: The predominance of PsA diagnosis and biologic initiation in dermatology indicates substantial specialty-specific differences in practice. This pattern warrants careful evaluation and supports the development of standardized, evidence-based guidelines across specialties to promote appropriate care.
Yamaoka K, Li Z, Aung KTZM
… +20 more, Bird P, Bhochhibhoya M, Choudhury MR, Danda D, Darisuren T, Hidayat R, Hung NV, Kaneko Y, Katchamart W, Lahiri M, Ng CT, Salim B, Sigdel KR, Suyin SC, Takeuchi T, Togizbayev G, Vista E, Wijeweera S, Xu C, Lau CS
Int J Rheum Dis
· 2026 Jul · PMID 42362943
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AIM: To update the Asia-Pacific League of Associations for Rheumatology (APLAR) treatment recommendations for rheumatoid arthritis (RA) by incorporating new evidence and reassessing the validity of previous guidance: MET...AIM: To update the Asia-Pacific League of Associations for Rheumatology (APLAR) treatment recommendations for rheumatoid arthritis (RA) by incorporating new evidence and reassessing the validity of previous guidance: METHODS: A literature search for relevant publications from January 2018 to August 2023 was conducted, supplemented by earlier studies where relevant. Recommendations were formulated based on this evidence and refined through a modified-Delphi process during a series of online meetings. The quality of evidence and strength of recommendations were assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. RESULTS: This update comprises 14 statements that achieved consensus during the meetings. Topics covered include measurement of disease activity and treatment response, the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs), the use of targeted therapies, vaccination and screening for infections and the use of DMARDs during pregnancy. The recommendations address the selection of disease activity scores, initiation and intensification of therapy using csDMARDs and targeted therapies, and management of RA in patients at risk of reactivation of infectious diseases. These recommendations are discussed in the context of the clinical landscape encountered in the Asia-Pacific region. CONCLUSION: These updated recommendations complement previous APLAR guidelines and aim to support best practice management of RA across the Asia-Pacific region. They provide a practical framework for national rheumatology associations to develop local guidelines adapted to their specific needs and clinical practice.
INTRODUCTION: To compare the retention rate, hazard ratio of treatment discontinuation, and effectiveness of tumor necrosis factor inhibitor (TNFi), interleukin-6 inhibitor (IL-6i), and cytotoxic T lymphocyte-associated...INTRODUCTION: To compare the retention rate, hazard ratio of treatment discontinuation, and effectiveness of tumor necrosis factor inhibitor (TNFi), interleukin-6 inhibitor (IL-6i), and cytotoxic T lymphocyte-associated antigen-4-Ig (CTLA4-Ig) in patients with rheumatoid arthritis (RA) and reduced kidney function. METHODS: We analyzed data from patients with RA and reduced kidney function included in the large-scale, real-world observational cohort study in Japan. Patients who initiated treatment with biological disease-modifying antirheumatic drugs (bDMARDs) between 2003 and 2018 were selected. Reduced kidney function was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m. Drug retention, disease activity, and physical function were compared during the observational period using inverse probability of treatment weighting (IPTW). RESULTS: The study included 154 patients with 237 treatment courses. The overall drug retention rate was 54.6% at 3 years, while the individual rates of TNFi, IL-6i, and CTLA4-Ig were 54.9%, 61.1%, and 44.3%, respectively. Retention rates due to ineffectiveness were 72.4%, 67.7%, and 49.3%, and due to adverse drug reactions were 76.2%, 90.3%, and 89.9%, respectively. Adjusted hazard ratios of discontinuation were 0.85 (95% confidence interval [CI], 0.37-1.96) for IL-6i and 1.31 (95% CI, 0.63-2.73) for CTLA4-Ig compared to TNFi. After IPTW, mean scores for the clinical disease activity index and the Japanese version of the health assessment questionnaire at 3 years were similar across the three groups. CONCLUSION: The drug retention rates and effectiveness of bDMARDs with different modes of action were comparable in patients with RA and reduced kidney function.
Chen H, Si L, Zhang L
… +10 more, Hunter DJ, Duong V, Wang X, Cao P, Cen H, Tang S, Chen T, He Y, Ding C, Zhu Z
Int J Rheum Dis
· 2026 Jun · PMID 42317017
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AIM: This study aimed to assess the long-term trends in cross-country inequalities related to the burden of osteoarthritis from 1990 to 2021. METHODS: Data on osteoarthritis incidence, prevalence, years lived with disabi...AIM: This study aimed to assess the long-term trends in cross-country inequalities related to the burden of osteoarthritis from 1990 to 2021. METHODS: Data on osteoarthritis incidence, prevalence, years lived with disability, and sociodemographic index (SDI) were extracted from the Global Burden of Diseases Study 2021. Slope index of inequality and concentration index were calculated to quantify the absolute and relative cross-country inequalities in osteoarthritis burden. Joinpoint regression was used to measure the average annual percentage change. Decomposition analysis was applied to quantify the contributions of population growth, population aging, and epidemiological changes to changes in osteoarthritis burden. RESULTS: Globally, more than 600 million people had osteoarthritis in 2021, with an increase of 137.03% since 1990. Significant absolute and relative SDI-related inequalities in osteoarthritis burden were observed across 204 countries/territories, with the burden disproportionately concentrated among countries/territories with higher SDI rankings. The slope index of inequality for all-age osteoarthritis prevalence rose from 5759.73 to 11151.93, while the concentration index increased from 0.26 to 0.28 from 1990 to 2021. Sensitivity analyses using age-standardized rates showed that the direction of inequality remained unchanged, whereas the increasing trend was attenuated for total osteoarthritis and persisted for knee osteoarthritis and other types of osteoarthritis. Population growth was the largest contributor to the increase in osteoarthritis burden, and population aging became the second-largest contributor globally after 2011. CONCLUSIONS: Osteoarthritis is a growing health problem with widening cross-country inequalities, suggesting an urgent need to adopt specific measures according to different levels of sociodemographic development.
Xiang L, Yeo SI, Low AHL
… +6 more, Leung YY, Fong W, Gan WH, Graves N, Gandhi M, Thumboo J
Int J Rheum Dis
· 2026 Jun · PMID 42316976
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AIM: Existing cost-of-illness studies on inflammatory arthritis (IA) and osteoarthritis (OA) often are cross-sectional, include patients with various disease durations, and rely primarily on claims data, which might not...AIM: Existing cost-of-illness studies on inflammatory arthritis (IA) and osteoarthritis (OA) often are cross-sectional, include patients with various disease durations, and rely primarily on claims data, which might not provide an accurate estimation of the associated costs. To address these limitations, we aimed to (1) quantify direct medical costs of an inception cohort of patients with IA and OA incurred from six months before to one year after diagnosis using hospital billing data and (2) identify cost drivers among these patients. METHODS: All costs incurred in the hospital during the six months before diagnosis (Study Period 1), the 1st to 6th month after diagnosis (Study Period 2), and the 7th to 12th month after diagnosis (Study Period 3) were extracted from hospital billing records and assessed for inclusion in the cost estimation. RESULTS: A total of 85 rheumatoid arthritis (RA), 45 spondyloarthritis (SpA), 38 psoriatic arthritis (PsA), and 280 OA patients were included in this study. The highest direct medical costs were observed among patients with SpA in Study Period (1) and among patients with RA in Study Periods (2) and (3), while the lowest direct medical costs were observed among patients with OA in all three study periods. The largest cost drivers varied across study periods and among patients with different conditions. CONCLUSION: High direct medical costs were observed among patients with IA and OA both before and after diagnosis. The varying cost drivers over time and across different arthritis could provide a foundation for future healthcare resource planning.
Dhanasekaran P, Yeo SI, Ng YX
… +7 more, Lim R, Wong S, Angkodjojo S, Khor AYK, Koh LW, Lahiri M, Ma M
Int J Rheum Dis
· 2026 Jun · PMID 42298801
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PURPOSE: To determine the association of body mass index (BMI) with incident COVID-19 infection in patients with inflammatory arthritis (IA) using biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted sy...PURPOSE: To determine the association of body mass index (BMI) with incident COVID-19 infection in patients with inflammatory arthritis (IA) using biologic disease-modifying anti-rheumatic drugs (bDMARDs) and targeted synthetic DMARDs (tsDMARDs) and to describe characteristics of patients with severe COVID-19 infection. METHODS: This prospective inception cohort study included IA patients ≥ 21 years old initiating a bDMARD after July 2016 across five public hospitals in Singapore. Data were collected via questionnaires and electronic medical records. Baseline characteristics were compared between patients who developed COVID-19 and those who did not. The association between BMI and time to incident COVID-19 infection was assessed using Cox proportional hazards regression, adjusting for demographic and clinical factors. RESULTS: Five hundred sixty-one patients (60.1% female, 69.0% Chinese; median age 49.0 years) were included. Diagnoses included rheumatoid arthritis (39.6%), psoriatic arthritis (26.6%), and spondyloarthritides (33.9%). Most (63.8%) were on tumor necrosis factor (TNF) inhibitors. SARS-CoV-2 infection occurred in 140 (25.0%) patients. Those infected had higher BMI (27.0 vs. 25.0 kg/m, p = 0.005). BMI ≥ 23 kg/m was independently associated with increased risk of infection (HR 1.63 [95% CI 1.05, 2.53]; p = 0.029). Severe COVID-19 infection occurred in five patients. All were male, and four had underlying comorbidities. The underlying rheumatic diagnoses included rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis. These patients were receiving b/tsDMARDs including golimumab, tofacitinib, adalimumab biosimilar (Amgevita), and infliximab biosimilar (Remsima). Importantly, no deaths were reported. CONCLUSION: Being overweight or obese (BMI ≥ 23 kg/m) was independently associated with higher COVID-19 infection risk. Severe infections were rare.
Pradhan A, Chouni A, Sengupta R
… +2 more, Paul S, Chatterjee M
Int J Rheum Dis
· 2026 Jun · PMID 42298798
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INTRODUCTION: This study aimed to evaluate the anti-arthritic role of Garcinia cowa bark extract (GC) in a murine collagen-induced model of arthritis (CIA), as it mimics the clinical symptoms and pathological features of...INTRODUCTION: This study aimed to evaluate the anti-arthritic role of Garcinia cowa bark extract (GC) in a murine collagen-induced model of arthritis (CIA), as it mimics the clinical symptoms and pathological features of synovitis observed in human rheumatoid arthritis (RA). METHODS: Rats were administered GC (1.25-5 mg/kg body weight, p.o.) from days 11 to 27, during which paw edema and arthritis score were regularly monitored. Following sacrifice on the 28th day, bone architecture was evaluated by radiography and histopathology, while the redox status was measured in the paw tissue in terms of myeloperoxidase (MPO) activity, protein carbonylation, lipid peroxidation, total antioxidant capacity by ferric ion reducing antioxidant power (FRAP) and 1,1-diphenyl-2-picrylhydrazyl (DPPH) assays, along with estimation of IL-6 and IL-10 by ELISA. RESULTS: In the CIA model, there was joint damage, enhanced oxidative stress, along with raised levels of IL-6 and IL-10. The pre-treatment with GC (5 mg/kg b.w.) prevented the progression of arthritis, evident from the reduction in paw edema, arthritic score, and attenuation of bony and cartilaginous damage. Additionally, GC improved the splenic and thymic indices, reduced levels of IL-6 and IL-10, and restored the redox balance as evidenced by reduction of MPO, protein carbonylation, and lipid peroxidation along with raised anti-oxidant capacity. CONCLUSION: Taken together, GC ameliorated oxidative stress and inflammation in an animal model of arthritis and therefore holds promise as an adjunct in the improved management of RA.