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Rheumatoid Factor Levels Are Associated With Arthritis Exacerbation After Bucillamine Discontinuation.

Yusuke Ogata1, Masumi Bamba1, Koichi Bamba1

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International Journal of Rheumatic Diseases
|January 23, 2026
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Summary

High rheumatoid factor levels (≥28 U/mL) predict arthritis exacerbation after discontinuing bucillamine, a methotrexate alternative. Rheumatoid factor may identify patients benefiting from continued bucillamine therapy for rheumatoid arthritis.

Keywords:
Japanarthritis exacerbationbucillamineconventional synthetic disease‐modifying antirheumatic drugsrheumatoid arthritisrheumatoid factortreatment discontinuation

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Area of Science:

  • Rheumatology
  • Immunology
  • Pharmacology

Background:

  • Bucillamine is a disease-modifying antirheumatic drug (DMARD) used as a methotrexate alternative for rheumatoid arthritis (RA).
  • Identifying patients who benefit from bucillamine treatment is crucial for optimizing RA management.
  • A nationwide bucillamine supply shortage in 2021 necessitated treatment discontinuation for some RA patients.

Purpose of the Study:

  • To determine which rheumatoid arthritis patients benefit from continued bucillamine therapy.
  • To investigate the predictive value of baseline clinical characteristics for arthritis exacerbation after bucillamine discontinuation.

Main Methods:

  • Retrospective follow-up study of RA patients who discontinued bucillamine in 2021.
  • Comparison of baseline characteristics between patients who experienced arthritis exacerbation and those who did not.
  • Analysis of rheumatoid factor (RF) levels as a potential predictor of exacerbation using ROC and Kaplan-Meier analyses.

Main Results:

  • Thirteen of 18 patients (72%) experienced arthritis exacerbation after bucillamine discontinuation.
  • Patients who experienced exacerbation had significantly higher baseline RF levels (49 U/mL) compared to those who did not (6 U/mL).
  • Baseline RF levels ≥28 U/mL predicted arthritis exacerbation with 76.2% sensitivity and 80.0% specificity.

Conclusions:

  • Arthritis exacerbations are common following bucillamine discontinuation, particularly in patients with higher baseline RF levels.
  • Elevated baseline RF levels (≥28 U/mL) serve as a biomarker for predicting exacerbation in RA patients after stopping bucillamine.
  • RF levels can help identify RA patients who may benefit from continued bucillamine therapy to prevent disease flares.