{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T04:28:14Z","timestamp":1785644894382,"version":"3.56.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T00:00:00Z","timestamp":1750032000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Palindromic Rheumatism (PR) is a rare form of arthritis characterized by recurrent episodes of joint and periarticular inflammation. Given the paucity of established treatment guidelines due to its rarity and complex pathogenesis, we aimed to analyze the efficacy and safety of iguratimod (IGU) in the treatment of refractory PR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included patients with PR who attended the First People\u2019s Hospital of Wenling between January 2019 and September 2023. 32 patients with poor response to methotrexate (MTX) and hydroxychloroquine (HCQ) were enrolled and were switched to IGU 25 mg twice daily alone or in combination with MTX 10 mg weekly. The primary outcomes measured included the frequency and duration of disease attacks over a three-month period. Complete remission was defined as no attacks within three months, partial remission as a reduction of at least 50% in attack frequency, and no remission as less than a 50% reduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median treatment duration with IGU was 11.3 months. The results demonstrated a significant reduction in the number of attacks over a three-month period (1.3 \u00b1 1.4 vs. 5.8 \u00b1 2.0, P &amp;lt; 0.0001). Furthermore, patients experienced a decrease in attack frequency and an increase in remission duration (78.0(33.8,99.0) days vs. 15.0(13.0,22.0) days, P &amp;lt; 0.0001). The duration of each attack was also shortened (2.1 \u00b1 0.7 days vs. 2.5 \u00b1 0.8 days, P=0.0042). Only one patient discontinued IGU due to gastric upset.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Iguratimod has demonstrated favorable efficacy and safety in the treatment of patients with PR who have not responded adequately to MTX and HCQ, which needs to be further confirmed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1613129","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T04:10:35Z","timestamp":1750047035000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Efficacy of iguratimod in the treatment of patients with palindromic rheumatism ineffective to methotrexate or hydroxychloroquine"],"prefix":"10.3389","volume":"16","author":[{"given":"Mengjie","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongjun","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiyao","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuren","family":"Tu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chuanfu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenlong","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1038\/s41584-019-0308-5","article-title":"Palindromic rheumatism as part of the rheumatoid arthritis continuum","volume":"15","author":"Mankia","year":"2019","journal-title":"Nat Rev Rheumatol"},{"key":"B2","article-title":"The role of anti-cyclic citrullinated peptide antibodies in predicting progression of palindromic rheumatism to rheumatoid arthritis","volume":"33","author":"Russell","year":"2006","journal-title":"J Rheumatol"},{"key":"B3","article-title":"HLA and cytokine gene polymorphisms in relation to occurrence of palindromic rheumatism and its progression to rheumatoid arthritis","volume":"29","author":"Maksymowych","year":"2002","journal-title":"J Rheumatol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-014-2569-3","article-title":"In palindromic rheumatism, hand joint involvement and positive anti-CCP antibodies predict RA development after 1 year of follow-up","volume":"33","author":"Emad","year":"2014","journal-title":"Clin Rheumatol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.090025","article-title":"Palindromic rheumatism: longterm outcomes of 60 patients diagnosed in 1967-84","volume":"36","author":"Koskinen","year":"2009","journal-title":"J Rheumatol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.berh.2017.09.014","article-title":"What can palindromic rheumatism tell us","volume":"31","author":"Mankia","year":"2017","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1136\/annrheumdis-2018-214175","article-title":"Identification of a distinct imaging phenotype may improve the management of palindromic rheumatism","volume":"78","author":"Mankia","year":"2019","journal-title":"Ann Rheum Dis"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1002\/art.42614","article-title":"Identification of distinct genetic profiles of palindromic rheumatism using whole-exome sequencing","volume":"75","author":"Zheng","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2020.11.008","article-title":"How should we treat palindromic rheumatism? 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