With the paradigm shift in rheumatology medicine, the role of rheumatology nurses has also undergone significant changes. In 2012, the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis were proposed. Subsequently, the 2018 updated version was published with three overarching principles:（1）team care,（2）evidence-based care, and（3）shared decision-making（SDM）.

  The eight recommendations call for holistic person-centered care, including not only an active role in comprehensive disease management, but also self-management support to improve self-efficacy, timely needs-based patient care, increased patient satisfaction, and psychosocial support, among other aspects. Continuing professional education for nurses is also required.

  To fulfill these diverse roles, there are many issues that need to be addressed. Along with insufficient time, manpower, and knowledge, the educational support systems for nurses, communication and collaboration with rheumatologists, and context-related issues are lacking. The issue of incentives, specifically, is a barrier to utilizing the expertise of rheumatology nurses.

  Moreover, if nurses and doctors cannot understand that patients are often reluctant to convey their feelings and wishes to those around them, it is difficult to elicit their intentions, making SDM challenging. This reluctance is also a form of self-stigma（negative perceptions of the disease）, and patients may withdraw socially to maintain their identity. The role of nurses in understanding and supporting patients in cultivating resilience against self-stigma is significant.

  In practicing these roles, the cooperation and support of the relevant others for continuing professional education for nurses, the promotion of team-based medicine, the establishment of conducive environments and systems are crucial.

  Rheumatoid arthritis（RA）has become possible to achieve remission through proactive treatment interventions from an early stage using the treatment strategy known as Treat to Target（T2T）. The medicinal treatment for RA has seen a dramatic increase in options due to breakthroughs in conventional disease-modifying antirheumatic drugs centred around methotrexate（MTX）, as well as biological agents and targeted molecular therapies such as JAK inhibitors. While the advanced drug therapies show a high efficacy in suppressing joint destruction, they can also necessitate treatment changes due to relapses from reduced efficacy and side effects such as infections. Additionally, insufficient patient understanding of the disease and treatment, anxiety regarding medication side effects, and financial issues can lead to decreased adherence to medication and self-injection rates, as well as treatment interruptions. To continue treatment and maximise its benefits, it is crucial for patients and healthcare providers to collaboratively engage in shared decision-making（SDM）, determining treatment goals tailored to each patient and advancing optimal treatment. Nurses play a role that connects various disciplines in RA care. Sharing various information obtained through good communication with patients with multiple professions is essential for the practice of SDM. Moreover, for patients to safely continue their treatment, it is important for nurses to thoroughly understand RA treatment and the characteristics of individual medications, by acquiring specialized knowledge and skills, enabling them to respond quickly to issues or side effects associated with self-injection. Furthermore, enhancing patients’ self-management abilities is indispensable for the continuation of treatment, and nurses must contribute to patient education based on sufficient knowledge and experience.

  Rheumatoid arthritis（RA）causes pain, swelling, cartilage and bone destruction, joint deformation, and functional disability owing to joint inflammation. In recent years, a paradigm shift in treatment has allowed patients to achieve remission and maintain good health-related quality of life. In addition, treat-to-target（T2T）, based on the principle of shared decision-making between patients and physicians, is recommended. In other words, patients are now expected to participate in treatment with correct knowledge and information, and to have the ability to continue self-care. RA patients are at high risk of infection due to the use of immunosuppressive medications and measures against infectious diseases, such as hand washing, hygiene, recommended vaccinations, and early detection and treatment of infectious diseases. The incidence of periodontal diseases in patients with RA is higher than that in the general population, and a poor oral environment worsens periodontal diseases and RA disease activity; therefore, oral care, including oral observation, awareness, and tools, is necessary. Furthermore, the prevalence of osteoporosis in patients with RA is reported to be two times higher than that in the general population; therefore, prevention of osteoporosis through diet, sun exposure, and exercise is necessary. However, evidence is insufficient to provide evidence-based, individualized patient support for patients with RA. Nursing research on nursing support is required in the future.

The number of rheumatoid arthritis（RA）-related surgeries has been reported to decline according to Japanese cohort studies. Although the number of total joint replacements has decreased, the number of wrist and foot arthroplasties and the number of artificial finger arthroplasties has gradually increased in recent years. With the advancement of the disease-modifying medications, the surgical treatment of wrist and forefoot deformities in RA patients has shifted from joint-sacrificing to joint-preserving surgery. RA patients treated with biologic or targeting synthetic disease-modifying anti-rheumatic drugs require joint surgery to improve physical function and quality of life, partially due to the increased expectations of these patients, even when disease activity is in remission. Despite treatment according to the current management recommendations, a number of patients with difficult-to-treat RA remain symptomatic, and surgical procedures play an important role in the treatment of joint deformity.

The increasing demand for RA surgery has led to a greater reliance on non-physician healthcare professionals in the perioperative practice setting. Rheumatology nurses play an important role in the total care management, and need to be familiar with the characteristics of medications and share optimal treatment plans with orthopaedic surgeons and therapists. In addition, as an orthopaedic nurse, it is necessary to educate RA patients about perioperative precautions and the risk of surgical complications.

Preconception care（PCC）involves providing women and couples with appropriate knowledge and information at the right time to support their health in preparation for future pregnancy. In Japan, the Preconception Check Sheet（Figure 1）on the website of the National Center for Child Health and Development includes items such as diet, exercise, personal habits, and regular lifestyle patterns, allowing individuals to assess their current health status from various perspectives. However, since this sheet is not specific to any particular disease and serves as a basic tool for PCC, it is necessary to consider patient education for RA based on these checklist items. In the case of RA, especially when initiating treatment with MTX, it is considered beneficial to provide PCC along with contraception guidance. Additionally, repeated counseling is crucial during the course of treatment, such as when considering marriage or pregnancy, or when planning subsequent pregnancies after the birth of the first child. In Japan, there is a trend toward later marriage and childbirth, and when individuals of so-called “advanced maternal age” wish to conceive, infertility treatment may also need to be considered. For RA patients in the WoCBA generation, it is important to provide PCC at appropriate timings, ensuring sufficient communication and building a trusting relationship while aligning with the patient’s life stages and significant events.

Due to the aging population in Japan, the patients with late-onset rheumatoid arthritis（LORA）are increasing. In our hospital, we treat many patients with LORA, and the patients of chronic inflammatory arthritis including rheumatoid arthritis（RA）are aging. Because of societal changes in which older people are increasingly living alone, many older patients with RA need to provide their own medical treatment. It is important that we medical workers grasp the patient’s background and whether they understand their illness with informed consent. Further, multidisciplinary care and cooperation between medical workers and the patient’s family are important for alleviating the symptoms of the patient to help them maintain their quality of life. To take care of older RA patients, it is important to grasp the change of the patient’s functions, mental state, and lifestyle, as well as the characteristics of their RA and LORA. Individual care is vital.

Objective: The factors involved in the increase in antibody titers in rheumatoid arthritis（RA）patients who receive multiple doses of COVID-19 vaccines, as in Japan, are not fully understood. Therefore, we compared the antibody titers of RA patients with those of age- and sex-matched controls, and investigated the influence of various factors on antibody titers. In addition, people who have already been infected with COVID-19 and those who have not received the COVID-19 vaccine were excluded from the analysis.

Subjects and methods: We measured nucleotide（N）and spike protein（S）antibody titers in 446 RA patients and 30 control subjects, and investigated the number of vaccinations, vaccination date and time, and medication used. We also compared the two groups and examined the influence of medication used in the RA group. Finally we performed a multiple regression analysis with S antibody titers as the dependent variable. Patients with a history of COVID-19 infection and those who had not received the COVID-19 vaccine were excluded from the analysis.

Results: No significant difference in S antibody titers was observed between the RA group（median 8.58［interquartile range 7.56, 9.35］U/ml（natural logarithm transformed））and the control group（8.83, ［7.98, 9.49］）（p=0.472）. In RA patients, S antibody titers increased with age（Spearman rank correlation, ρ=0.158, P=0.004）, and elderly patients tended to receive more vaccinations. S antibody titers increased significantly with increasing number of vaccinations, but reached a plateau at four doses. S antibody titers were significantly lower in prednisolone users compared to non-users（P=0.023）, and among users of molecular targeted drugs, anti-TNF（tumor necrosis factor）agent users showed significantly lower S antibody titers compared to non-users（P < 0.001）. Multiple regression analysis showed that female gender, number of days since the last vaccination, and use of bDMARDs and prednisone were significant factors influencing S antibody titers. However, no effect was observed with the use of methotrexate（MTX）.

Conclusion: In RA patients using bDMARDs（anti-TNF agents）and prednisolone, the rise in S antibody titers after vaccination was suppressed, but there was no effect from the use of MTX.