In the ACR/EULAR systemic scleroderma（SSc）classification criteria（2013）and Japanese SSc diagnostic criteria（2016）, clinical manifestations related to vascular lesions in SSc are regarded as an important finding in the diagnosis. The clinical presentation of vascular lesions varies from Raynaudʼs phenomenon, pitting scar, digital ulceration and gangrene, and is considered to vary with the severity of the vascular lesions. The symptoms wax and wane, and progress gradually. Ulcers occur in more than 70% of SSc, gangrene in about 10%, surgical digital amputation in about 5%, and lower limb amputation may occur in about 1% of SSc. To evaluate vascular lesions objectively, the same tests for other peripheral arterial diseases are used. These include ankle-brachial pressure index（ABI）, skin perfusion pressure（SPP）, thermography, doppler echocardiography, and angiography. Future treatment should be considered based on these imaging findings. Treatment is mainly conservative, including drugs to improve blood flow and topical ulcer treatments. Amputation is considered necessary if（1）infection cannot be controlled, （2）wound pain cannot be controlled, or（3）there is no prospect of improvement with blood flow improvement therapy. Easy amputation should be avoided.

Objective: This retrospective study compared the clinical efficacy and safety of baricitinib（BARI）and filgotinib（FIL）in Japanese patients with rheumatoid arthritis（RA）over a 24-week period．

Methods: We enrolled 98 RA patients who received either BARI or FIL therapy and could be followed for 24 weeks from two facilities between September 2017 and February 2023．Patients in the BARI group（n=67）and FIL group（n=31）were compared for outcomes including Disease activity score-28 for RA with CRP（DAS28-CRP），Simplified Disease Activity Index（SDAI），rheumatoid factor（RF），and matrix metalloproteinase-3（MMP-3）．Adverse events were also assessed for safety evaluation．

Results: In the BARI and FIL groups，average age at treatment initiation was 69.2 ± 13.0 years and 64.6 ± 13.9 years，and the mean disease duration was 163.6 ± 174.1 months and 144.5 ± 115.8 months，respectively．The number of pre-treatment b/tsDMARDs used varied．Both groups showed significant improvements in DAS28-CRP and SDAI at 24 weeks versus baseline，with no remarkable differences in change rate observed between the groups at any time point．RF and MMP-3 showed tendencies towards improvement at 24 weeks．Continuation rate was 77.7% in the BARI group and 74.2% in the FIL group．Adverse events included a 3.0% incidence of malignancy and 1.5% incidence of herpes zoster in the BARI group，with none recorded in the FIL group．

Conclusion: Comparable results were observed for the clinical efficacy and safety of BARI and FIL in RA patients over a 24-week treatment period．Larger studies are warranted to confirm our results．

Objective: This study aimed to investigate the association between locomotive syndrome（LS）and skeletal muscle mass index（SMI）in patients with rheumatoid arthritis（RA）.

Methods: A total of 160 RA patients attending rheumatology outpatient clinics were included in this study. LS was defined as a scoring ≥16 points on the 25-question Geriatric Locomotive Function Scale. SMI was measured using bioelectrical impedance analysis（Inbody-S10;Tanita Corp, Tokyo, Japan）. Low-SMI was defined as <7.0kg/m² in men and <5.7kg/m² in women.

Results: Among all the RA patients, the prevalence of LS was 38.0%, with a significantly higher occurrence in older individuals. The mean SMI was 7.2 ± 0.9kg/m² in men and 5.6 ± 0.9kg/m² in women. The proportion of individuals with low-SMI was 55%. There was no significant difference in SMI between the LS and non-LS groups, and the prevalence of LS was 39% in the normal-SMI groups. When comparing patients with and without LS, the following factors were found to be statistically significant: indoor activities, activities of daily living（ADL）, mental health status.

Conclusions: In RA patients, reduced participation in indoor activities, ADL and mental health status were associated with an increased risk of LS. Although SMI was not affected, dynapenia led to decreased motor function.

Objective: To elucidate the efficacy and safety of an adjuvanted herpes zoster-subunit vaccine（HZ/su）in RA patients treated with Janus kinase inhibitors（JAKis）in our institution.

Methods: We conducted a retrospective analysis of RA patients receiving treatment with JAKis, vaccinated with at least one dose of HZ/su in our hospital between April 2020 and December 2021.

Results: Sixty-nine RA patients treated with JAKis were enrolled（tofacitinib, n=3; baricitinib, n=27; peficitinib, n=6; upadacitinib, n=29; filgotinib, n=4）. The mean age was 67 years, 62 patients（89.9%）were aged ≥ 50 years, and 75.4% were female. Five patients（7.2%）had a history of HZ. Fifty-one patients（73.9%）had received two doses of HZ/su. Two patients（2.9%; 4.1/100 patient-years; nonmorbidity rate 97.1%; no disseminated HZ）had HZ reactivation after two doses of HZ/su. Both were aged >75 years. No severe adverse events or recurrence of RA disease activity after receiving HZ/su were reported.

Conclusions: HZ morbidity was lower in RA patients treated with JAKis receiving HZ/su in our institution compared with that previously reported in Asian RA patients treated with JAKis. Our results suggest that HZ/su could be safe and may be effective in preventing HZ reactivation in Asian RA patients receiving JAKi treatment. Extra attention should be paid to the possibility of HZ in elderly and immunosuppressed patients.

Aim: To evaluate the effect of the etanercept biosimilar Etanercept BS1 on the functional ability, disease activity and health-related quality of life（HR-QOL）in elderly patients with rheumatoid arthritis（RA）in Japan. Methods: Patients with RA aged 65 years and older participating in a seven-center Japanese prospective cohort study were enrolled（HAPPINESS）. Data were collected at baseline and at 26 and 52 weeks after treatment initiation with Etanercept BS1. Changes in the Geriatric Locomotive Function Scale 25（GLFS-25）score, Disease Activity Score（DAS28-CRP）, Simplified Disease Activity Index（SDAI）, and EuroQol 5 Dimensions 5 Level（EQ-5D-5L）were evaluated throughout the study period. Results: Forty-three patients were followed-up until week 52. The mean age of the patients was 74.2 years. The mean duration of RA was 6.9 years. Thirty-one patients（72.1%）were females. A significant improvement in the GLFS-25 score was confirmed at weeks 26 and 52 compared with the baseline（15.42, 17.60, and 26.37, respectively）. DAS28-CRP（3.72, 2.01, and 2.16, respectively）and SDAI（17.27, 5.18, and 6.08, respectively）improved significantly throughout the study period, as did the EQ-5D-5L scores（0.70, 0.83, and 0.83, respectively）. Conclusion: Etanercept BS1 significantly improved functional ability, disease activity, and HR-QOL in elderly patients with RA.

Objective: There are increasing opportunities to use biological disease-modifying antirheumatic drugs and Janus kinase inhibitors, even in elderly patients with rheumatoid arthritis（RA）. We evaluated the use of abatacept（ABT）, which is often used in elderly patients with RA. A comparative study was conducted with etanercept（ETN）, also for RA.

Methods: The clinical course data for 143 of 241 patients with RA treated with ABT at Niigata Rheumatic Center and Asahikawa Medical University from July 2010 to March 2018 and those aged 65 years or older were analyzed at 24 months. In addition, the clinical course data of 170 out of 463 patients with RA treated with ETN at the same hospital between May 2008 and March 2018 who were 65 years or older were analyzed and compared using the propensity score matching（PSM）method.

Results: The average age of 143 patients treated with ABT was 75.4 ± 6.2 years and disease activity scores improved significantly; the continuation rate at 24 months was 80.4%. The ABT group had significantly lower disease activity, more PSL reduction, and higher continuation rate compared with the ETN group using the PSM method.

Conclusion: ABT is an effective treatment for elderly patients with RA over 65 years old and is significantly better at improving disease activity than ETN.

［Objectives］We developed an activity classification of the joint index vector（JIV）for rheumatoid arthritis（RA）using monitoring data of RA cases at our institute and verified its validity.

［Methods］The cut-off index（COI）of the Vxy in the JIV was determined by Receiver Operating Characteristic analysis（ROC）in referring to the Clinical Disease Activity Index（CDAI）disease activity threshold and Health Assessment Questionnaire Disability Index（HAQ-DI）remission criteria, which was simultaneously calculated in RA patients. If there is no significant linear correlation between the CDAI score and the Vxy, ROC was performed based on the correlation between HAQ-DI and the Vxy or Vz within that range, and the activity was classified using the obtained COI. Using this classification method, we compared each activity with respect to indicators such as her CDAI and HAQ-DI.

［Results］A total of 617 patients were studied. There were defined as 0.1>Vxy as remission（REM）, 0.45>Vxy≥0.1 and 0.125≥Vz as low joint activity（LJA）, 1.0>Vxy≥0.45 and Vz>0.125 as moderate joint activity（MJA）, and Vxy≥1.0 was defined as high joint activity（HJA）. The concordance rate with CDAI disease activity criteria was 74.1% for REM, 66.7% for LJA, 49.3% for MJA, and 77.0% for HJA.

［Conclusions］It was suggested that treatment goals could be set based on JIV by classifying JIV as disease activity.

［Objectives］We evaluated the validity of the activity classification of Joint Index Vector（JIV）using a big data that already published.

［Methods］Classification criteria were created using the method used to create cJIV based on the processed NinJa 2015 data used to evaluate JIV for comparison with the existing classification（NcJIV）. The indicators on which the criteria are based are the disease activity indicator of the Simplified Disease Activity Index（SDAI）and the remission criteria of the Health Assessment Questionnaire Disability Index（HAQ-DI）. We compared NcJIV and cJIV, and also compared indicators such as SDAI and HAQ-DI.

［Results］We analyzed 11013 of NcJIV and 617 of cJIV datasets. There were defined as 0.05>Vxy as remission（REM）, 0.25>Vxy≥0.05 as low joint activity（LJA）, 0.7≥Vxy≥0.25 and 0.225≥Vz as low-middle joint activity（LMJA）, 0.7≥Vxy≥0.25 and Vz>0.225 as middle joint activity（MJA）, and Vxy>0.7 was defined as high joint activity（HJA）. The concordance rate（susceptibility）of cJIV to NcJIV was 100% for REM, 79.5% for LJA, 80.3% for MJA, and 93.0% for HJA.

［Conclusions］cJIV is highly sensitive even in big data, suggesting it is a highly versatile classification standard.