{
  "abstract": "Pemafibrate is a selective peroxisome proliferator-activated receptor α (PPARα) modulator (SPPARMα) used for hypertriglyceridemia. PPARα activation also suppresses nuclear factor-κB (NF-κB) signaling, a pathway central to synovial inflammation and joint destruction in rheumatoid arthritis (RA). Whether pemafibrate affects RA-related biomarkers in humans is unknown. A 51-year-old woman (height: 164 cm, body weight: 71 kg, body mass index: 26.4 kg/m²) with RA treated with methotrexate, bucillamine, iguratimod, and low-dose prednisolone (0.7 mg/day) had hypertriglyceridemia with coexisting metabolic dysfunction-associated steatotic liver disease (MASLD). Pemafibrate was started at 0.2 mg/day and increased to 0.4 mg/day after 12 weeks, while the disease-modifying antirheumatic drug (DMARD) regimen was kept unchanged throughout. Over the 20 months following the initiation of pemafibrate, rheumatoid factor (RF) and matrix metalloproteinase-3 (MMP-3) declined, and C-reactive protein (CRP) showed an overall decrease with a transient rise at month 6; prednisolone was tapered and discontinued after 17 months. The 28-joint Disease Activity Score based on C-reactive protein (CRP; DAS28-CRP), already in the remission range at baseline (1.9), remained below the remission threshold throughout. Serum triglycerides fell from 184 mg/dL to 88 mg/dL, and hepatic transaminases (aspartate aminotransferase (AST) and alanine aminotransferase (ALT)) showed a transient early increase followed by a return toward baseline, without meeting criteria for drug-induced liver injury. No adverse events attributable to pemafibrate were observed. In this patient, the introduction of pemafibrate was temporally associated with reductions in RA-related biomarkers and with successful glucocorticoid withdrawal, without any intensification of DMARD therapy. Because the baseline prednisolone dose was already low (0.7 mg/day), this withdrawal should be interpreted cautiously and should not be regarded as strong evidence of a glucocorticoid-sparing effect. Causality cannot be established from a single case; nevertheless, together with earlier clinical reports on fenofibrate, animal studies showing anti-arthritic effects of fenofibrate and bezafibrate, and preclinical evidence of PPARα-mediated NF-κB inhibition, this observation suggests that PPARα agonists merit further investigation as adjunctive agents in RA, particularly in patients with coexisting dyslipidemia or steatotic liver disease.",
  "abstract_shown": true,
  "affiliations": [
    "Rheumatology, Suzuhiro Clinic, Saitama, JPN."
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 1,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kimihiro Suzuki"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1e4ckrhrjp8rc.bib",
  "cited_by": 0,
  "doi": "10.7759/cureus.116509",
  "fulltext_url": "https://europepmc.org/articles/PMC13677156",
  "id": "1e4ckrhrjp8rc",
  "issns": [
    "2168-8184"
  ],
  "landing_url": "https://europepmc.org/article/MED/42894855",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2745|Rheumatoid Arthritis Research and Therapies"
    ]
  ],
  "openalex": "W7213596942",
  "pdf_url": "https://europepmc.org/articles/PMC13677156?pdf=render",
  "pmcid": "PMC13677156",
  "pmid": "42894855",
  "published": "2026-09-18",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/1e4ckrhrjp8rc.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:41Z",
      "native_id": "MED:42894855",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42894855"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Rheumatoid Arthritis Research and Therapies",
      "subfield": "general"
    }
  ],
  "title": "Reduction in Rheumatoid Factor and Matrix Metalloproteinase-3 With Successful Glucocorticoid Withdrawal After Initiation of Pemafibrate in a Patient With Rheumatoid Arthritis and Hypertriglyceridemia: A Case Report.",
  "title_text": "Reduction in Rheumatoid Factor and Matrix Metalloproteinase-3 With Successful Glucocorticoid Withdrawal After Initiation of Pemafibrate in a Patient With Rheumatoid Arthritis and Hypertriglyceridemia: A Case Report.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:41Z",
  "url": "https://research.draconitic.com/paper/1e4ckrhrjp8rc",
  "venue": "Cureus",
  "versions": []
}