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Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic systemic inflammation causing progressive joint damage that can lead to lifelong disability. The pathogenesis of RA involves a complex network of various cytokines and cells that trigger synovial cell proliferation and cause damage to both cartilage and bone. Involvement of the cytokines tumor necrosis factor (TNF)-α and interleukin (IL)-6 is central to the pathogenesis of RA, but recent research has revealed that other cytokines such as IL-7, IL-17, IL-21, IL-23, granulocyte macrophage colony-stimulating factor (GM-CSF), IL-1β, IL-18, IL-33, and IL-2 also play a role. Clarification of RA pathology has led to the development of therapeutic agents such as biological disease-modifying anti-rheumatic drugs (DMARDs) and Janus kinase (JAK) inhibitors, and further details of the immunological background to RA are emerging. This review covers existing knowledge regarding the roles of cytokines, related immune cells and the immune system in RA, manipulation of which may offer the potential for even safer and more effective treatments in the future.

DOI： 10.3390/ijms222010922

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DOI： 10.1620/tjem.2025.J160

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Factors affecting bone strength have not been elucidated in patients with rheumatoid arthritis (RA) undergoing silicone implant arthroplasty. In this observational study, we aimed to investigate factors affecting bone strength. We measured toughness in terms of bone strength, bone mineral density, and bone quality of 105 resected metacarpal heads (I:32, II:36, III:33, IV:2, V:2) obtained during silicone implant arthroplasty at the metacarpophalangeal (MP) joint in patients with RA. Bone strength was associated with all parameters in micro-computed tomography (µCT) and all parameters in bone histomorphometry, other than osteoid volume and osteoid surface. Clinical factors associated with bone strength included prednisolone (PSL) dose at the time of surgery, % young adult mean, T-score and the Rooney score. Bone volume fraction by µCT only influenced bone strength per multiple linear regression analysis. Compared to joints with higher bone strength, those with lower bone strength had a higher magnitude of implant subsidence, which assumed to the risk of reduced mobility and implant fracture after the operation. Suppressing the degradation of subchondral bone structures by continuously ameliorating disease activity without the use of PSL appeared to be crucial to maintain the radiological appearance of silicone implant arthroplasty at the MP joint.

DOI： 10.1038/s41598-025-31762-z

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Patellar tendon rupture is a severe complication following total knee arthroplasty (TKA). We encountered a case of rheumatoid arthritis with an incomplete rupture of the patellar tendon post-TKA. An 84-year-old woman was diagnosed with an incomplete rupture of the right patellar tendon 3 months post-TKA of her right knee. The patient exhibited a 45° extension lag 6 months post-TKA, necessitating reconstruction surgery. Intraoperative findings revealed incomplete rupture of the patellar tendon that was stretched out, diagnosed as incomplete patellar tendon rupture. Due to knee valgus instability (passive knee valgus showed 20°), the thickness of the tibial insert was adjusted from 11 to 15 mm, resulting in improved valgus instability. The scarring region of the patellar tendon was resected to 10 mm in length, and the tendon was repaired using an ultra-high molecular weight polyethylene cable (Nesplon cable) and Krackow suture. The repair was secured by making an 8-figure pattern with the cable. After the reconstruction surgery, the knee was immobilised at 0° extension for 3 weeks, followed by the initiation of range-of-motion exercises. Three months later, the extension lag was reduced to -15°, and the patient could walk without orthosis and reported neither instability nor surgical site infection at 8 months after the surgery. In conclusion, this case is notable due to the rarity of incomplete (stretched out) patellar tendon rupture post-TKA and demonstrates the effectiveness of Nesplon cable with Krackow suture in reconstruction surgery.

DOI： 10.1093/mrcr/rxae074

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A retrograde ankle nail combined with corrected talar osteotomy is indicated for severe ankle joint deformities owing to rheumatoid arthritis. However, the usefulness of this procedure in improving gait function remains unclear. We treated a 78-year-old woman with rheumatoid arthritis (RA) who experienced significant gait pain owing to a severe varus deformity of the ankle. She underwent corrected closed-wedge talus osteotomy and retrograde intramedullary ankle nail insertion. Preoperative analysis showed Japanese Society for Surgery of the Foot RA foot ankle scale of 44, with limited range of motion and impaired gait. Six months postoperatively, her scale improved to 69, indicating enhanced functional outcomes. Gait analysis at 6 months revealed a notable increase in stride length, gait speed, and cadence, along with a reduction in stance phase and double support duration. In addition, the swing phase increased. The painful lateral callosity of the foot disappeared postoperatively. This report emphasises the effectiveness of surgical intervention in improving gait function in patients with severe ankle deformities owing to RA. However, limitations include the absence of clubfoot correction and a relatively short follow-up period. Overall, these findings suggest that the surgical approach is beneficial for restoring mobility and alleviating pain in patients with complex ankle conditions.

DOI： 10.1093/mrcr/rxaf081

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BACKGROUND: Although surgical treatment is the standard of care for most hip fractures, the post-fracture management of osteoporosis remains challenging. This study aimed to elucidate the status of osteoporosis treatment, subsequent fracture rates, mortality rates, and changes in residential status and care levels among hip fracture patients in Japan, and to explore strategies for fracture prevention and extension of healthy life expectancy. METHODS: This study included patients with hip fractures treated at approximately 3000 orthopaedic facilities nationwide during July 2020. Data was collected via web-based surveys at the time of injury and 6 and 12 months post-injury. RESULTS: A total of 6705 patients were registered from 1309 facilities (mean age: 82.9 ± 0.7 years; 86.4 % were female). The surgery rate was 94.8 %, with 62.1 % undergoing osteosynthesis and 37.9 % receiving hemiarthroplasty or total hip arthroplasty. Osteoporosis treatment rates gradually increased from 23.0 % at the time of injury to 44.8 % at 6 months and 47.3 % at 12 months, although the rates remained suboptimal. Active vitamin D3-based medications were the most commonly used medications, accounting for approximately 60 % of cases. The cumulative 12-month mortality rate was 10.0 %, and the incidence of new fractures was 11.0 %. The main fracture sites were the contralateral proximal femur, vertebral, and proximal humerus. The most common reason for non-treatment was "patient's decision." Among patients who were not enrolled in long-term care insurance at the time of injury, 66.1 % had newly obtained care level certification by 12 months after injury. The proportion of patients who returned home among those living at home at the time of injury was 80.7 % at 6 months and 96.8 % at 12 months, respectively. CONCLUSIONS: Osteoporosis treatment rates after hip fractures remain low, indicating the need for more proactive intervention, including secondary fracture prevention. This study also highlights the importance of early rehabilitation and continuous support.

DOI： 10.1016/j.jos.2025.05.014

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INTRODUCTION: Rheumatoid arthritis (RA) is a systemic autoimmune disease that primarily affects the synovial membrane, leading to progressive joint destruction. Among RA-related deformities, forefoot deformities are particularly common, causing severe pain, gait disturbances, and a significant decline in patient quality of life. Typical forefoot deformities observed in patients with RA include hallux valgus (HV), hammer toe deformities, and plantar callosities, all of which require appropriate therapeutic intervention. We aimed to evaluate the clinical outcomes of modified Mitchell's osteotomy with shortening oblique osteotomy (SOO) for forefoot deformities in patients with RA. METHODS: Twenty-four patients (31 feet) underwent surgery between 2005 and 2023. The cohort included 22 women (29 feet) and two men (2 feet) with a mean age of 59 ± 12 years and disease duration of 20.3 ± 8.7 years. Clinical outcomes were assessed using the Japanese Society for Surgery of the Foot (JSSF) RA Foot and Ankle Scale and radiographic evaluations. RESULTS: At a mean follow-up of 10.1 years, the JSSF scale score improved significantly from 57.9 to 77.1 points; HV angle (HVA) significantly improved from 31.7° to 17.1°; and the 1st to 5th intermetatarsal angles (M1M5A) significantly improved from 29.3° to 20.6°. The 28 joint-Disease activity score with erythrocyte sedimentation rate significantly improved from 2.75 to 2.20. Complications included recurrence of callosities in six feet (16.1%), metatarsal phalangeal joint subluxation in 13 feet (8.4%), appearance of HV deformity in 10 feet (32.3%), and infections in two feet (6.5%). No non-union was observed. CONCLUSIONS: Modified Mitchell's osteotomy with SOO significantly reduced pain and improved walking ability in patients with RA. The procedure also achieved a remarkable degree of radiographic correction, particularly a reduction in HVA and M1M5A, contributing to improved forefoot alignment. These findings suggest that the procedure provides clear benefits. Careful attention should be paid to potential postoperative complications such as the appearance of HV deformity and infection.

DOI： 10.1186/s13018-025-05965-z

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A 67-year-old woman with rheumatoid arthritis presented with an untriggered hematoma in the right shoulder joint. Radiographic findings showed humeral head collapse and destruction of the glenoid fossa with ectopic calcification. Calcium pyrophosphate deposition (CPPD) in the synovial fluid was observed using a polarizing microscope. Histopathological findings revealed chronic inflammatory cell infiltration and giant cells surrounded by CPPD. The patient was diagnosed with rapid destructive arthropathy (RDA). Endoscopic shoulder joint debridement was performed. Postoperatively, active flexion improved from 40 to 75 degrees. This case highlights that CPPD can cause RDA in the shoulder, detectable with detailed histopathology.

DOI： 10.18926/AMO/68727

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Atypical femoral fracture (AFF) is generally a rare complication of long-term use of bisphosphonate (BP); glucocorticoid (GC) use and Asian race are also risk factors. Femoral localized periosteal thickening (LPT, also termed "beaking") of the lateral cortex often precedes AFF. This cohort study investigated the incidence of LPT and AFF and their clinical courses over 10 yr in patients with autoimmune inflammatory rheumatic diseases (AIRDs) treated with BP and GC. The study population consisted of 121 patients with AIRDs taking BP and GC. LPT was screened by X-ray, and the LPT shape was evaluated. Prednisolone (PSL) dose was 10 (8-12) mg/d at enrollment and 9 (6-10) mg/d at the last observation. LPT was evident in 10 patients at enrollment and increased linearly to 31 patients (26%) at the last observation. AFF occurred in 9 femurs of 5 patients with LPT. All patients with AFF had bilateral LPT, and the prevalence of pointed type and LPT height were higher in the AFF-positive group than in the AFF-negative group. AFF occurred before BP discontinuation in 2 patients, 1 yr after BP discontinuation in 1, after BP discontinuation followed by 7 yr of alfacalcidol use in 1, and after switching from alfacalcidol to denosumab in 1. The prevalence rates of AFF and LPT associated with long-term BP use with concomitant use of GC (mostly PSL ≥ 6 mg/d) in Japanese patients with AIRD increased over time. The selection of long-term osteoporosis treatment for LPT-positive patients is difficult in some cases.

DOI： 10.1093/jbmrpl/ziae090

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A 15-year-old girl had experienced hip pain at 11 years of age. At 15 years of age, the patient complained of persistent generalised pain. Her rheumatoid factor and serum matrix metalloproteinase-3 levels were below standard values; there were no inflammatory responses, and the human leukocyte antigen test was negative for B27 and positive for B52 and B62. The bath ankylosing spondylitis disease activity index (BASDAI) value was 8.0 at the time of induction and 3.1 at 6 months after the introduction of adalimumab (at a dose of 40 mg). The BASDAI value improved with an increase in the dose of adalimumab to 80 mg at 8 months after the initial introduction of adalimumab (at 40 mg), although it remained at 4.8 at 16 months after the dose increase. The BASDAI value was 2.6 at 6 months, 2.7 at 1 year, and 1.8 at 1.5 years after the introduction of infliximab, indicating that the patient had progressed well without any adverse events. Based on this case, juvenile ankylosing spondylitis is a differential diagnosis for low back pain and generalised pain since childhood. Tumour necrosis factor (TNF) inhibitors were promptly introduced in this case, although it took 4 years from the initial presentation. TNF inhibitors were effective in treating juvenile ankylosing spondylitis in the present case without any adverse events. This case is notable because juvenile onset ankylosing spondylitis is one of the reasons for severe lumbago since childhood and because TNF inhibitors were administered promptly after diagnosis.

DOI： 10.1093/mrcr/rxae006

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OBJECTIVES: The incidence of femoral localized periosteal thickening (LPT), which can precede atypical femoral fracture (AFF), is not low (1-10%) in Japanese patients with autoimmune inflammatory rheumatic diseases (AIRDs). We explored the associations between underlying AIRDs and the prevalence of LPT. METHODS: We conducted post hoc analyses of two cohorts that included a total of 280 Japanese women, 105 of whom had AIRDs and had been taking bisphosphonate (BP) and prednisolone (PSL) and 175 of whom had rheumatoid arthritis (RA). RESULTS: LPT was detected in a total of 18 patients (6.4%) and 3 (1.1%) developed AFFs. RA was negatively correlated with LPT. A disease other than RA requiring glucocorticoid treatment, BP use ≥5 years, PSL use ≥7 years, and a PSL dose ≥5.5 mg/day were positively correlated with LPT. After adjusting for age, diabetes mellitus, and BP duration or daily PSL dose, RA was no longer associated with LPT. CONCLUSIONS: LPT in Japanese patients with AIRDs was associated with BP and glucocorticoid treatment rather than underlying AIRDs. When PSL dose ≥5.5 mg/day is required long-term [typically combined with long-term BP treatment (≥5 years)], clinicians need to pay particular attention in cases LPT and AFF as well as glucocorticoid-induced osteoporosis.

DOI： 10.1093/mr/roac062

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Multiple subcutaneous extensor tendon ruptures in more than the ulnar three fingers sometimes occur in patients with rheumatoid arthritis accompanied by wrist deformity. In these situations, the flexor digitorum superficialis tendon of the middle finger (the FDS3 tendon) and that of the ring finger (the FDS4 tendon) are used for the transferred tendon (modified Boyes' procedure). Here, we treated two patients with rheumatoid arthritis, whose extensor tendons of more than three fingers were ruptured, using the modified Boyes' procedure. Case 1 had ruptures in four fingers (index through little), and Case 2 had ruptures in three fingers (middle through little). The FDS3 and FDS4 tendons were passed subcutaneously around the radial side of the wrist to the extensor sides and interlaced with the distal stump of the ruptured tendons. Switching of the finger movement was achieved smoothly in both cases. The post-operative evaluation showed an extension lag of -15° for the index finger 0° for the middle through the little fingers in Case 1, and 0° for the middle finger and -5° for the ring and little fingers in Case 2. The average post-operative extension lag was -3.5°. However, median nerve palsy occurred in both cases, and it gradually recovered. Stretching of the nerve by the correction of the wrist deformity and increased pressure in the carpal tunnel were supposed to be causes of this palsy. Modified Boyes' procedure is a useful method for more than three ulnar finger extensor tendon ruptures; however, post-operative median nerve palsy should be considered.

DOI： 10.1093/mrcr/rxac050

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A 74-year-old Japanese woman who underwent Mann's procedure with fibular sesamoidectomy for left hallux valgus 21 years ago complained of left hallucis pain. She was diagnosed with iatrogenic hallux varus and hammer toe deformities. Metatarsophalangeal joint arthrodesis and shortening oblique osteotomy were performed. After surgery, the hallux valgus angle improved from -28° to 0°, and the intermetatarsal angle between the first and the second metatarsus improved from 0° to 6°. The Japanese Society for Surgery of the Foot RA foot and ankle scale improved from 73 to 81 points. She could walk without pain and sustained no deformity at 4 years after the surgery.

DOI： 10.12688/f1000research.131495.2

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DOI： 10.21037/atm-22-4734

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OBJECTIVES: To investigate the outcomes of the modified Thompson-Littler (m-TL) method, a corrective surgical method utilising a dynamic tenodesis, in patients with rheumatoid swan-neck deformity. METHODS: Twenty-seven fingers in 10 patients with rheumatoid arthritis (RA) underwent surgical correction. The mean age at the time of surgery was 60.3 (45-77) years, the mean duration of RA was 19.3 (4-34) years, and the mean postoperative follow-up period was 2.4 (0.5-6) years. RESULTS: The deformity was corrected and the proximal interphalangeal (PIP) joint pain disappeared in all operated fingers. The mean pinch power between the thumb and the operated finger increased. The active extension decreased, the active flexion increased, and the total arc of motion decreased. Comparing the range of motion by Nalebuff's type classification, the postoperative arc of motion decreased as the type advanced. CONCLUSIONS: The m-TL method provided a favourable outcome in cases of Type ≤III rheumatoid swan-neck deformity without severe joint deterioration at the PIP joint. Aesthetic and functional improvements were observed and the patients were satisfied with the operation.

DOI： 10.1093/mr/roab015

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Herein, we present two cases of older adult patients with highly destructive changes in ankle joints (Larsen grade IV) who underwent retrograde intramedullary ankle nail fixation with fins. In both patients, bony union was achieved, and full weight-bearing was attained at 3 months after surgery.

DOI： 10.1002/ccr3.5348

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