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Objective The objective of this study was to assess the effectiveness of tofacitinib vs TNF inhibitors (TNFis) in Korean patients with RA. Methods The study used data from a single academic referral hospital's registries of biologic DMARDs (bDMARDs) and tofacitinib and examined remission rates based on the DAS28-ESR after 12 months. Multivariable logistic regression analysis was used to estimate the odds ratio (OR) for achieving remission with tofacitinib compared with TNFi, adjusting for potential confounders. Results This analysis included 665 patients (200 on tofacitinib and 455 on TNFis) who were followed up for at least 12 months. Of these, 96 patients in the tofacitinib group (48.0%) and 409 patients in the TNFi group (89.9%) were treatment-naïve to bDMARDs. Intention-to-treat analysis revealed no significant difference in the remission rates between the two groups (18.0% vs 19.6%, P  = 0.640). Multivariable analysis demonstrated comparable remission rates with tofacitinib and TNFi (OR 1.204, 95% CI 0.720–2.013). In the subpopulation naïve to Janus kinase inhibitors (JAKis) and bDMARDs, tofacitinib showed better remission rates than TNFis (OR 1.867, 95% CI 1.033–3.377). Tofacitinib had more adverse events but similar rates of serious adverse events to TNFis. Conclusion In real-world settings, there was no significant difference in remission rates at 12 months between the tofacitinib and TNFi groups. In terms of safety, tofacitinib exhibited a higher incidence of adverse events compared with TNFis, while the occurrence of serious adverse events was comparable between the groups. Trial registration ClinicalTrials.gov, https://clinicaltrials.gov , NCT02602704. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the trends in immunomodulator use and pregnancy outcomes among pregnant women with systemic lupus erythematosus (SLE), a condition requiring medication to maintain disease activity. Methods: This descriptive study used data from the National Health Information Database in Korea from 2002 to 2018. We included 5,044 pregnancies initiated between 2005 and 2017 in 3,120 SLE patients. Annual trends in SLE therapy, drug utilisation patterns during the preconception and pregnancy periods, and pregnancy outcomes were analysed. Results: Pregnancy compatible immunosuppressant (PC-IS) and hydroxychloroquine use during the first trimester were 10.7% and 41.4%, respectively. Most SLE medications exhibited a decline in usage from the preconception period to the first trimester. A prescription rate of 0.9% for pregnancy incompatible immunosuppressants (PIC-IS) was observed during the first trimester, and the incidence of live births, stillbirths, and abortions remained consistent from 2005 to 2017. Conclusions: Insufficient usage of hydroxychloroquine and PC-IS, along with a reduction in PIC-IS usage primarily during early pregnancy rather than before conception, highlights the unmet need for preconceptional family planning with appropriate medication management strategies in SLE pregnancies. [ABSTRACT FROM AUTHOR]

To evaluate the incidence and risk of cardiovascular disease (CVD) among Korean patients with systemic lupus erythematosus (SLE) comparing them to diabetes patients and the general population. This nationwide cohort study focused on incident SLE patients aged over 40 years, matched with diabetes patients and the general population (1:4:4 ratio). CVD was defined as ischaemic heart disease, ischaemic stroke, and cardiac arrest. Incidence rate and incidence rate ratio (IRR) of CVD were calculated using generalised estimating equation models. The Fine-Gray model assessed risk factors for CVD in both SLE and diabetes patients. The study included 4272 incident SLE patients, 17,003 diabetes patients, and 17,088 from the general population. SLE patients had higher CVD risk compared to the general population, with adjusted IRRs of 1.99 for overall CVD. Diabetes patients showed increased CVD risk, but to a lesser extent, with an IRR of 1.39. SLE patients aged 40–59 years displayed a significantly elevated CVD risk. Advanced age, male gender, and current use of glucocorticoids, immunosuppressive, and anti-platelet agents were associated with increased CVD risk in SLE patients. SLE patients have a higher risk of CVD compared to the general population, more so than diabetes patients. [ABSTRACT FROM AUTHOR]

Objectives To estimate the direct healthcare cost progression from before to after systemic lupus erythematosus (SLE) diagnosis and to compare healthcare costs by disease severity. Methods Patients with incident SLE diagnosed between 2008 and 2018 were identified from the Korean National Health Insurance database. Annual direct healthcare costs for 5 years before and after SLE were estimated and compared with those of age-, sex- and calendar month-matched (1:4) controls, without SLE. Direct healthcare costs were compared by disease severity of SLE using regression analysis. Results Among 11 173 patients with SLE and 45 500 subjects without SLE, annual direct healthcare costs per person increased in the year before SLE diagnosis and peaked in the first year after diagnosis. They were 7.7-fold greater in the SLE patients than in the subjects without SLE ($5871 vs $759). Severe SLE was associated with 3.284-fold (95% CI: 3.075, 3.507) higher annual costs than mild SLE during the year after diagnosis. Older age (age 60–79 years), lupus nephritis, interstitial lung diseases, and comorbidities such as avascular necrosis and chronic kidney disease were associated with higher annual direct healthcare costs (times [95% CI]) in the first year after diagnosis: age 60–69: 1.119 (1.034, 1.211); age 70–79: 1.470 (1.342, 1.611); lupus nephritis: 1.794 (1.711, 1.881); interstitial lung diseases: 1.435 (1.258, 1.638); avascular necrosis: 6.208 (4.541, 8.487); and chronic kidney disease: 1.858 (1.673, 2.064). Conclusion Patients with SLE incurred significantly higher direct healthcare costs than subjects without SLE during the first year after diagnosis. Disease severity, older age, major organ involvements and comorbidities were associated with increased healthcare costs. [ABSTRACT FROM AUTHOR]

Ankylosing spondylitis (AS) is a chronic inflammatory disease affecting the axial skeleton, resulting in severe pain, decreased mobility, and irreversible structural damage. This study explores the evolving prevalence, patient demographics, and treatment trends for AS in the Korean population from 2010 to 2023, alongside advancements in targeted therapies. This population-based study utilized data from the National Health Insurance Database covering 2010 to 2023. AS cases were identified using at least two ICD-10 (International Classification of Diseases, 10th Revision) codes and rare intractable disease registration codes, excluding diagnoses of rheumatoid arthritis and systemic lupus erythematosus. The annual prevalence of AS was calculated and standardized to the 2017 population. Patient characteristics, comorbidities, and treatment patterns were assessed. The prevalence of AS increased from 26.76 per 100,000 individuals in 2010 to 81.87 per 100,000 in 2023. The proportion of patients over 50 years rose from 19.5 to 32.5%, and female representation increased from 17.9 to 24.0%. Comorbidities such as metabolic syndrome and musculoskeletal complications became more prevalent. Tumor necrosis factor-alpha inhibitor prescriptions rose from 29.7 to 41.6%, while the use of conventional synthetic disease-modifying antirheumatic drugs declined. The introduction of interleukin-17 and Janus kinase (JAK) inhibitors, particularly as second- and third-line therapies, marked a significant development. The prevalence of AS has surged between 2010 and 2023, particularly among older and female patients. The concurrent rise in comorbidities underscores the need for integrated care. Future research should focus on optimizing therapeutic sequences and evaluating long-term outcomes in this changing patient population., Competing Interests: Declarations. Consent for publication: The use of secondary claims data permitted the study to obtain a waiver of informed consent. Competing interests: The authors declare no competing interests. Ethical approval and consent to participate: The study protocol received an exemption from review by the Institutional Review Board at Hanyang University due to its use of anonymized secondary data (IRB No: HYUH202401047-HE001), and informed consent requirements were waived. Ethical statement: The study protocol was exempted from review by the Institutional Review Board of Hanyang University, as it involved the use of anonymized secondary data (IRB No: HYUH202401047-HE001). The requirement for informed consent was also waived., (© 2025. The Author(s).)

Analysis of healthcare utilization, such as hospitalization duration and medical costs, is crucial for policymakers and doctors in experimental and epidemiological investigations. Herein, we examine the healthcare utilization data of patients with systemic lupus erythematosus (SLE). The characteristics of the SLE data were measured over a 10-year period with outliers. Multivariate linear models with multivariate normal error distributions are commonly used to evaluate long series of multivariate longitudinal data. However, when there are outliers or heavy tails in the data, such as those based on healthcare utilization, the assumption of multivariate normality may be too strong, resulting in biased estimates. To address this, we propose multivariate t-linear models (MTLMs) with an autoregressive moving-average (ARMA) covariance matrix. Modeling the covariance matrix for multivariate longitudinal data is difficult since the covariance matrix is high dimensional and must be positive-definite. To address these, we employ a modified ARMA Cholesky decomposition and hypersphere decomposition. Several simulation studies are conducted to demonstrate the performance, robustness, and flexibility of the proposed models. The proposed MTLMs with ARMA structured covariance matrix are applied to analyze the healthcare utilization data of patients with SLE., (© 2024 John Wiley & Sons Ltd.)

Background: This study aimed to identify key priorities for the development of guidelines for information and communication technology (ICT)-based patient education tailored to the needs of patients with rheumatic diseases (RDs) in the Republic of Korea, based on expert consensus., Methods: A two-round modified Delphi study was conducted with 20 rheumatology, patient education, and digital health literacy experts. A total of 35 items covering 7 domains and 18 subdomains were evaluated. Each item was evaluated for its level of importance, and the responses were rated on a 4-point Likert scale. Consensus levels were defined as "high" (interquartile range [IQR] ≤ 1, agreement ≥ 80%, content validity ratio [CVR] ≥ 0.7), "Moderate" (IQR ≥ 1, agreement 50-79%, CVR 0.5-0.7), and "Low" (IQR > 1, agreement < 50%, CVR < 0.5)., Results: Strong consensus was reached for key priorities for developing guidelines in areas such as health literacy, digital health literacy, medical terminology, user interface, and user experience design for mobile apps. Chatbot use and video (e.g., YouTube) also achieved high consensus, whereas AI-powered platforms such as ChatGPT showed moderate-to-high agreement. Telemedicine was excluded because of insufficient consensus., Conclusion: The key priorities identified in this study provide a foundation for the development of ICT-based patient education guidelines for RDs in the Republic of Korea. Future efforts should focus on integrating digital tools into clinical practice to enhance patient engagement and improve clinical outcomes., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2025 The Korean Academy of Medical Sciences.)