The purpose of this study was to investigate the ability of outpatient nurses to conduct telephone consultations from patients with rheumatoid arthritis（RA）, and the current education and support systems for nurses to appropriately address these consultations.

  An online survey was conducted for outpatient rheumatology nurses, asking to what extent they can explain the 15 topics extracted from previously reported telephone consultations. Furthermore, the information sharing and cooperation between doctors and nurses, and the establishment of education and support systems for nurses were rated on a 7-point numerical scale.

  142 nurses completed the questionnaire. 82 were certified rheumatology nurses. Of the 15 topics, the most common that nurses could confidently explain were “changing appointments” and “devices and techniques for self-injection.” Moreover, divided using propensity score patching, a comparison between certified（n=27）and uncertified（n=27）rheumatology nurses showed that the former group had a greater ability to explain all 14 topics, except “change of appointment”（p = 0.073）. Although the nurses were able to cooperate and share information with other nurses and doctors to some extent, the levels of support systems, including a system for educating nurses to address telephone consultations, as well as securing time and preparing nursing manuals for them, were low.

  This survey revealed the challenges outpatient rheumatology nurses faced with telephone consultation for RA patients, alongside the need for more comprehensive nurse education and improved support systems. Telephone consultation support should be addressed in the medical field, as it remains an accessible and valuable resource for patients.

［Objective］ To investigate the effectiveness and safety of ipragliflozin in glucocorticoid-induced hyperglycemia in patients with autoimmune diseases. ［Methods］ We retrospectively examined HbA1c levels and adverse events after initiation of ipragliflozin treatment for glucocorticoid-induced hyperglycemia in patients with autoimmune diseases who were followed up for 24 weeks at our hospital between 2015 and 2021. ［Results］ Among the 39 patients on ipragliflozin, 8 discontinued it because of insufficient effects and adverse events. The remaining 31 patients（rheumatoid arthritis 22, systemic lupus erythematosus 4, others 6; 21females and 10 males, median age 68.0 years old）were followed up for 24 weeks on ipragliflozin. At 24 weeks, the HbA1c value was significantly reduced（7.6［7.3, 8.3］to 7.2［6.5, 8.0］, p=0.008）, even though the prednisolone（PSL）dose was significantly reduced（6.0［2.3, 7.9］mg/day to 5.0［2.3, 6.3］mg/day, p<0.001）. In 11 patients receiving a fixed or increased dose of PSL and fixed antidiabetic drugs, HbA1c values were also significantly reduced（7.5［7.3, 7.9］to 7.2［6.8, 7.7］, p=0.024）. No serious adverse effects were observed. ［Conclusions］ In the short term, ipragliflozin is an effective and safe treatment for glucocorticoid-induced hyperglycemia in patients with autoimmune diseases.

Objective:

To clarify the effect of a caution alert to rheumatologists using high-dose methotrexate（MTX）for the treatment of elderly patients with rheumatoid arthritis（RA）.

Patients and methods:

The Department of Pharmacy issued a caution alert to rheumatologists using MTX at doses of > 8mg/week for RA patients of > 75 years of age（n=80, at July 2022）to reduce the dose of MTX. We investigated the change in the dose of MTX at 9 months, added other antirheumatic drugs, and changes in disease activity score 28-erythrocyte sedimentation rate（DAS28-ESR）.

Results:

The MTX dose was significantly reduced（from 9.0 ± 1.5mg/week to 7.7 ± 2.2mg/week, p<0.001）. MTX was increased in 1 patient, unchanged in 45 patients, and reduced in 34 patients. The DAS28-ESR remained unchanged in 24 patients who had been recorded.

Conclusion:

The dose of MTX was significantly reduced by the caution alert, but the disease activity of RA did not change, possibly due to unnoticed renal dysfunction. The caution alert appeared to be effective in preventing the side effects of MTX in elderly patients with RA.

Aim: This retrospective observational study of adults in Japan investigated the impact of rheumatoid arthritis（RA）diagnosis, risk factors of interest and antirheumatic drugs on changes in renal function.

Methods: Medical records were extracted from the Real-World Data database between 1 July 2011 and 3 March 2023. Patients were categorized into RA/non-RA groups and matched using exact and propensity score matching. The primary endpoint was difference in slope of estimated glomerular filtration rate（eGFR）over time between RA and non-RA patients, both overall and by subgroups of interest. Other endpoints included differences in eGFR slope between RA patients with/without the use of pre-defined medications, and in RA patients diagnosed prior to index date and previously treated with methotrexate（MTX）.

Results: After matching, 29,062 patients were included（n=14,531 for RA/non-RA groups）. Minimal difference in eGFR slope was observed between RA/non-RA patients（−0.05mL/min/1.73m²/year）; no trends emerged following subgroup analyses. MTX and tacrolimus use was negatively associated with changes in eGFR in RA patients. Patients diagnosed with RA before enrolment and who received MTX monotherapy had a steeper negative eGFR slope versus both overall groups（RA/non-RA）.

Conclusion: Our findings highlight the need for monitoring renal function in RA patients prescribed antirheumatic drugs.

We present two cases of patients with rheumatoid arthritis（RA）complicated with nontuberculous mycobacterium（NTM）. Case 1 was an 82-year-old woman who developed RA in 1994. Adalimumab was introduced in 2010, but it was ineffective. Etanercept（ETN, 25mg/week）was then introduced, but infections were frequent. In 2013, ETN was switched to abatacept（ABT）500mg（IV）. However, due to Mycobacterium（M）. avium infection, it was discontinued according to the pre-revised treatment guideline. Currently, intraarticular steroid injections are being administered into the knee joint.

Case 2 was a 68-year-old woman with RA. She was treated with methotrexate（MTX, 8mg/week）, but multiple abnormal shadows were detected by CT scan, so MTX was switched to iguratimod. In 2022, RA relapsed, and M. intracellulare was detected in gastric fluid. She was treated with ethambutol, clarithromycin, glucocorticoid and ABT（125mg/week）, and the disease activity was controlled, so steroid was discontinued. Until 2014, the use of biological disease-modifying antirheumatic drugs（bDMARDs）was contraindicated in patients with RA with NTM. But, in the revised version of the treatment guide 2014, it was permitted to use bDMARDs under certain conditions. The favorable outcome in case 2 was likely due to this revision.

【Objective】 In 2022, American College of Rheumatology and European Alliance of Associations for Rheumatology released new classification criteria（2022 ACR/EULAR classification criteria）for anti-neutrophil cytoplasmic antibody（ANCA）associated vasculitis. Microscopic polyangiitis（MPA）and granulomatosis with polyangiitis（GPA）are known to exhibit significant ethnic differences. This study was performed to evaluate the validity of the 2022 ACR/EULAR classification criteria in Japan.

【Methods】 A retrospective review was conducted on patients diagnosed with MPA or GPA at the University of Tokyo Hospital from April 2003 to September 2022.

【Results】 Concordance between the two criteria was 38/67 patients（56.7%）. Of 19 MPO-ANCA positive patients classified as GPA by the EMA algorithm, the 2022 ACR/EULAR classification criteria classified 14 patients（73.7%）as MPA and 3 patients（15.8%）as GPA, while 2 patients（10.5%）met the criteria for both MPA and GPA. Including classification changes, relapse rates did not differ significantly by classification criteria.

【Conclusion】 There was a significant number of patients whose classification differed between the EMA algorithm and the 2022 ACR/EULAR criteria. Additionally, there were patients who met the criteria for both MPA and GPA, highlighting issues that need to be addressed in the future.

Objective: This study aimed to investigate skeletal muscle mass and quality in patients with rheumatoid arthritis（RA）and locomotive syndrome（LS）.

Methods: A total of 160 patients with RA attending rheumatology outpatient clinics were included in this study. LS was defined by a scoring ≥ 16 points on the 25-question Geriatric Locomotive Function Scale. Skeletal muscle mass index（SMI）and phase angle（PhA）were measured using bioelectrical impedance analysis（Inbody-S10;Tanita Corp, Tokyo, Japan）to assess skeletal muscle mass and quality.

Results: The median whole body PhA was 4.0（3.6-4.8）° in LS group and 4.7（4.3-5.3）° in non-LS group. PhA was significantly lower in LS group compared to non-LS group. Among individuals with normal SMI, 19% of men and 18% of women had LS, and those with LS exhibited a lower PhA than their non-LS.

Conclusions: In patients with RA, LS with normal SMI had low PhA, suggesting reduced skeletal muscle quality. As the quality of skeletal muscles declines with age, affecting muscle strength and walking ability, a decline in quality may lead to locomotion. Assessment of skeletal muscle quality is therefore also considered important.