{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T21:20:39Z","timestamp":1789852839299,"version":"4.0.1"},"reference-count":20,"publisher":"The Journal of Rheumatology","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"accepted":{"date-parts":[[2025,5,8]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Cutaneous polyarteritis nodosa (cPAN) is a rare necrotizing vasculitis that affects primarily small- to medium-sized arteries in subcutaneous tissue. cPAN is often characterized by a chronic and relapsing disease that presents with skin ulcers, livedo, and painful erythema. In this study, we evaluated the efficacy of tumor necrosis factor inhibitor (TNFi) treatment for cPAN-associated refractory leg ulcers.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This retrospective study was conducted between 2016 and 2023 at 3 medical institutions in Japan and targeted patients with cPAN presenting with refractory leg ulcers who were treated with TNFi. The diagnosis of cPAN was histologically confirmed, and patients with secondary PAN were excluded. Data on the clinical background, treatment, ulcer status, and glucocorticoid (GC) dosage were collected, and the therapeutic efficacy of the treatment was evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Ten patients were included, with a mean age of 51 years, and 9 were female. All patients presented with recurrent leg ulcers. TNFi included adalimumab (5 cases), etanercept (4 cases), and infliximab (1 case). Complete epithelialization of the leg ulcers was achieved in all patients, and the average GC dose was successfully reduced from 20 mg\/day to 3.5 mg\/day. Additionally, 5 patients achieved a GC-free status. No serious adverse events were observed in any of the patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>TNFi showed therapeutic efficacy for cPAN-associated refractory leg ulcers and enabled ulcer epithelialization and significant GC dose reduction. These findings support the utility of TNFi in the management of refractory leg ulcers in cPAN, highlighting the need for further large-scale studies to validate the results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.3899\/jrheum.2025-0140","type":"journal-article","created":{"date-parts":[[2025,5,15]],"date-time":"2025-05-15T08:20:17Z","timestamp":1747297217000},"page":"909-913","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy of Tumor Necrosis Factor Inhibitors for Refractory Leg Ulcers in Cutaneous Polyarteritis Nodosa: A Case Series"],"prefix":"10.3899","volume":"52","author":[{"given":"Kimie","family":"Harama","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takao","family":"Sugiyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chisaki","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toyohiko","family":"Sugimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soichiro","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Ito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-2855","authenticated-orcid":false,"given":"Yoshiaki","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8964-8513","authenticated-orcid":false,"given":"Shunichiro","family":"Hanai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1682-9799","authenticated-orcid":false,"given":"Daiki","family":"Nakagomi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2025,5,15]]},"reference":[{"key":"2025090105350881000_52.9.909.1","first-page":"135","article-title":"Polyarteritis nodosa revisited: a review of historical approaches, subphenotypes and a research agenda","volume":"36","author":"Karadag","year":"2018","journal-title":"Clin Exp Rheumatol"},{"key":"2025090105350881000_52.9.909.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.37715"},{"key":"2025090105350881000_52.9.909.3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1346-8138.2009.00752.x","article-title":"Cutaneous polyarteritis nodosa: a report of 16 cases with clinical and histopathological analysis and a review of the published work","volume":"37","author":"Ishiguro","year":"2010","journal-title":"J Dermatol"},{"key":"2025090105350881000_52.9.909.4","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.1997.6601645.x"},{"key":"2025090105350881000_52.9.909.5","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/j.1651-2227.1998.tb01453.x","article-title":"Cutaneous polyarteritis nodosa in a child and a review of the literature","volume":"87","author":"Mocan","year":"1998","journal-title":"Acta Paediatr"},{"key":"2025090105350881000_52.9.909.6","doi-asserted-by":"crossref","first-page":"884","DOI":"10.1002\/acr.23007","article-title":"Clinical spectrum of medium-sized vessel vasculitis","volume":"69","author":"Alibaz-Oner","year":"2017","journal-title":"Arthritis Care Res"},{"key":"2025090105350881000_52.9.909.7","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1111\/ddg.14271","article-title":"Manifestations, clinical course and prognostic markers in cutaneous polyarteritis nodosa","volume":"18","author":"Munera-Campos","year":"2020","journal-title":"J Dtsch Dermatol Ges"},{"key":"2025090105350881000_52.9.909.8","doi-asserted-by":"crossref","first-page":"4039","DOI":"10.1093\/rheumatology\/keab402","article-title":"Therapeutic options for cutaneous polyarteritis nodosa: a systematic review","volume":"60","author":"Papachristodoulou","year":"2021","journal-title":"Rheumatology"},{"key":"2025090105350881000_52.9.909.9","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/rheumatology\/keac332","article-title":"Use of biologics to treat relapsing and\/or refractory polyarteritis nodosa: data from a European collaborative study","volume":"62","author":"Hadjadj","year":"2022","journal-title":"Rheumatology"},{"key":"2025090105350881000_52.9.909.10","doi-asserted-by":"publisher","DOI":"10.1002\/art.10461"},{"key":"2025090105350881000_52.9.909.11","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1007\/s10067-005-0015-2","article-title":"High-dose intravenous immunoglobulin infusion in polyarteritis nodosa: report on one case and review of the literature","volume":"25","author":"Asano","year":"2006","journal-title":"Clin Rheumatol"},{"key":"2025090105350881000_52.9.909.12","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/j.1346-8138.2001.tb00066.x","article-title":"Cutaneous polyarteritis nodosa: therapy and clinical course in four cases","volume":"28","author":"Misago","year":"2001","journal-title":"J Dermatol"},{"key":"2025090105350881000_52.9.909.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2013.11.009"},{"key":"2025090105350881000_52.9.909.14","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1111\/pde.14005","article-title":"Cutaneous polyarteritis nodosa in pediatric patients successfully treated with TNF-\u03b1 inhibitor and methotrexate: case series and literature review","volume":"36","author":"Do","year":"2019","journal-title":"Pediatr Dermatol"},{"key":"2025090105350881000_52.9.909.15","doi-asserted-by":"crossref","first-page":"102784","DOI":"10.1016\/j.autrev.2021.102784","article-title":"Biologic drugs in the treatment of polyarteritis nodosa and deficit of adenosine deaminase 2: a narrative review","volume":"20","author":"Conticini","year":"2021","journal-title":"Autoimmun Rev"},{"key":"2025090105350881000_52.9.909.16","doi-asserted-by":"crossref","first-page":"2825","DOI":"10.1007\/s10067-019-04474-9","article-title":"Infliximab for the treatment of refractory polyarteritis nodosa","volume":"38","author":"Ginsberg","year":"2019","journal-title":"Clin Rheumatol"},{"key":"2025090105350881000_52.9.909.17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/BF00196711","article-title":"Mechanisms of endothelial cell injury in vasculitis","volume":"16","author":"Pall","year":"1994","journal-title":"Springer Semin Immunopathol"},{"key":"2025090105350881000_52.9.909.18","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1365-2249.1990.tb03336.x","article-title":"Enhanced expression of the tumour necrosis factor\/cachectin gene in peripheral blood mononuclear cells from patients with systemic vasculitis","volume":"81","author":"Deguchi","year":"1990","journal-title":"Clin Exp Immunol"},{"key":"2025090105350881000_52.9.909.19","doi-asserted-by":"publisher","DOI":"10.1136\/ard.58.3.189"},{"key":"2025090105350881000_52.9.909.20","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200005)43:5<1041::AID-ANR12>3.0.CO;2-7"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.2025-0140","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T12:35:35Z","timestamp":1756730135000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.2025-0140"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,15]]},"references-count":20,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,1]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.3899\/jrheum.2025-0140"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.2025-0140","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,15]]}}}