Soo-Kyung Cho

Objective: Evidence supporting tapering of biologic or targeted synthetic disease‐modifying antirheumatic drugs (b/tsDMARDs) in patients with rheumatoid arthritis (RA) with sustained low disease activity (LDA) remains limited. We evaluated the efficacy and safety of a structured b/tsDMARD‐tapering strategy in patients with RA who had achieved sustained LDA. Methods: In this 24‐week, multicenter, randomized, open‐label, noninferiority trial, patients with RA receiving stable‐dose b/tsDMARDs and maintaining Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28‐ESR)–defined LDA for at least six months were randomized to either stepwise dose tapering or dose continuation. The primary endpoint was maintenance of DAS28‐ESR LDA at week 24. The noninferiority margin was prespecified as −10%. Secondary endpoints included disease activity measures, remission rates, patient‐reported outcomes, quality of life, and adverse events. Results: A total of 348 patients were randomized to the continuation group (n = 177) or tapering group (n = 171). In the per‐protocol population, LDA was maintained in 89.6% and 88.2% of patients, respectively, with a risk difference of −1.43% (95% confidence interval −8.09 to 5.23), meeting the prespecified criterion for noninferiority. Similar findings were observed in the full analysis set. Most patients experiencing disease worsening regained LDA after protocol‐guided treatment reescalation during follow‐up without permanent treatment discontinuation. Most secondary outcomes were comparable between groups, although some disease activity measures favored continuation, including DAS28 using the C‐reactive protein level at week 12 and DAS28‐ESR and Simplified Disease Activity Index at week 24. Adverse events were uncommon in both groups. Conclusion: In patients with RA with sustained LDA, structured b/tsDMARD tapering was noninferior to treatment continuation for maintaining disease control over 24 weeks. image

Jeong-Yeon Kim, M.S., Seung-Hun You, Ph.D., Yoon-Kyoung Sung, M.D., Ph.D., M.P.H., Sun-Young Jung, Ph.D., Soo-Kyung Cho, M.D., Ph.D.. J Rheum Dis -0001;0:. https://doi.org/10.4078/jrd.2025.0091C

Glucocorticoids are widely prescribed for inflammatory diseases, but their adverse skeletal effects, particularly osteoporosis and fracture, remain clinically important. Glucocorticoid-induced osteoporosis (GIOP) is characterized by rapid disruption of bone remodeling, with an early increase in bone resorption followed by suppression of bone formation. These changes substantially increase the risk of vertebral fracture. Fracture risk in GIOP cannot be explained by reductions in bone mineral density alone; it is also thought to reflect glucocorticoid-related deterioration in bone quality and microarchitecture. Current international guidelines recommend fracture risk assessment when glucocorticoid therapy is initiated and support a risk-stratified therapeutic approach. Oral bisphosphonates remain first-line therapy for individuals at low to moderate fracture risk. For patients at higher risk, more potent antiresorptive agents, including zoledronic acid and denosumab, have been shown to improve bone mineral density. In individuals at very high fracture risk, anabolic therapy followed by antiresorptive treatment is increasingly recommended. Careful attention to treatment sequencing is essential, particularly after denosumab discontinuation, for preventing rebound-associated vertebral fractures. Recent guideline updates and comparative clinical studies have placed greater emphasis on anabolic therapy and structured treatment sequencing in order to improve skeletal outcomes. This review summarizes evolving risk-based management strategies for GIOP, focusing on treatment selection by fracture risk category and planned transitions between osteoporosis therapies.

Background: Axial spondyloarthritis (axSpA) is a chronic inflammatory disease primarily affecting the axial skeleton, with tumor necrosis factor inhibitors (TNFi) as the standard first-line biologic disease-modifying antirheumatic drugs since the early 2000s. Interleukin-17 inhibitors (IL-17i) have emerged as effective alternatives, but the optimal sequencing after first-line TNFi discontinuation remains uncertain. Objectives: To compare real-world treatment persistence of IL-17i and TNFi as second-line therapies following initial TNFi discontinuation in patients with axSpA. Design: A nationwide retrospective cohort study using the Korean National Health Insurance Service-National Health Information Database (2010–2023). Methods: We included patients with axSpA who initiated TNFi as first-line targeted therapy and received IL-17i or TNFi as second-line therapy. The primary outcome was discontinuation of the second-line drug within 1 year. Drug retention was analyzed using Kaplan–Meier curves, and discontinuation risk was estimated using Cox proportional hazards models with multivariable adjustment, inverse probability of treatment weighting (IPTW), and IPTW with covariate adjustment. Subgroup analyses were conducted by type of prior treatment failure (primary or secondary). Results: Among 1,660 patients (IL-17i: 375; TNFi: 1285), overall treatment persistence and discontinuation risk were similar between groups. However, patients with primary treatment failure had significantly higher discontinuation risk with TNFi versus IL-17i, with adjusted hazard ratios ranging from 1.54 (95% CI, 1.14–2.07) to 2.11 (95% CI, 1.13–3.94). Results remained consistent across all analytic approaches. Conclusion: While overall persistence was comparable, IL-17i showed greater retention than TNFi among patients with primary treatment failure to initial TNFi therapy.

Choi SR, et al. J Korean Med Sci. 2026 Jul;41:e190. https://doi.org/10.3346/jkms.2026.41.e190

Choi SR, et al. J Korean Med Sci. 2026 Jan;41:e41. https://doi.org/10.3346/jkms.2026.41.e41

Jeong-Yeon Kim, M.S., Seung-Hun You, Ph.D., Yoon-Kyoung Sung, M.D., Ph.D., M.P.H., Sun-Young Jung, Ph.D., Soo-Kyung Cho, M.D., Ph.D.. J Rheum Dis -0001;0:. https://doi.org/10.4078/jrd.2025.0091

Objective: To validate the revised patient global assessment (PtGA) threshold of 2 cm in the Boolean 2.0 remission definition by assessing its agreement with index-based remission criteria and its predictive validity for quality of life (QoL) outcomes, compared with Boolean 1.0, in Korean patients with rheumatoid arthritis (RA) receiving targeted therapy. Methods: Data from a multicentre prospective cohort of patients with RA initiating treatment with Janus kinase inhibitors or biologic disease-modifying anti-rheumatic drugs were analysed. Remission was assessed using Boolean 1.0, Boolean 2.0, and index-based criteria including DAS in 28 joints calculated with ESR (DAS28-ESR), Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI). Agreement between Boolean definitions and index-based criteria was evaluated using Cohen’s kappa. Predictive validity was determined by comparing remission status at week 24 and patient-reported outcomes at week 48, specifically HAQ-Disability Index (HAQ-DI) ≤0.5 and EuroQoL-5 Dimension (EQ-5D) = 1. Results: Among 506 enrolled patients, 414 completed the 48-week follow-up. Boolean 2.0 showed stronger agreement with DAS28-ESR remission than Boolean 1.0 (κ = 0.50 vs. 0.39), but weaker agreement with CDAI (κ = 0.75 vs. 0.48) and SDAI (κ = 0.76 vs. 0.64). Boolean 1.0 demonstrated higher positive predictive values for HAQ-DI ≤0.5 (0.90 vs. 0.82) and EQ-5D = 1 (0.38 vs. 0.30) compared with Boolean 2.0. Conclusion: Although Boolean 2.0 improves concordance with DAS28-ESR, it does not enhance the prediction of long-term functional or QoL outcomes. Its broader definition of remission warrants cautious interpretation in clinical practice.

Purpose: Shared decision-making (SDM) plays a critical role in the clinical management of patients with rheumatic diseases, where long-term disease control, multiple therapeutic options, and variable patient responses require individualized and collaborative treatment planning. This review examines 3 representative SDM models—the 3-talk model, SHARE, and SEED—and evaluates their applicability to rheumatology, with particular emphasis on treatment decisions involving targeted therapies in rheumatoid arthritis and ankylosing spondylitis.Current Concepts: Several structured models have been developed to support the SDM process in clinical practice. These models highlight different aspects of physician–patient interaction, including recognition of decision points, information exchange, clarification of patient values, and achievement of consensus on treatment plans. Although growing international evidence demonstrates SDM’s benefits in improving adherence, satisfaction, and patient engagement, its application in Korean clinical practice remains limited. Structural and cultural barriers, such as time constraints, hierarchical communication, and insufficient system support, must be addressed before SDM can be widely implemented.Discussion and Conclusion: Effective SDM requires a multidisciplinary approach that combines physician communication training, patient education, and the integration of well-developed decision aids into routine practice. In parallel, institutional and policy-level measures are needed to ensure adequate consultation time and sufficient system capacity. Developing an SDM model contextualized for Korea and evaluating its effectiveness through clinical research will be essential. Ultimately, SDM should not be regarded merely as a communication technique, but as a strategic and practical framework to enhance quality of care in rheumatology and to promote patient-centered treatment decisions.