{
  "abstract": "Objectives Subcutaneous methotrexate (SC MTX) provides more reliable bioavailability than oral MTX; however, longitudinal real-world data incorporating musculoskeletal ultrasound (MSUS) remain limited. We aimed to evaluate longitudinal changes in clinical disease activity and ultrasound-detected synovitis, particularly power Doppler (PD) activity, after switching from oral to SC MTX in patients with rheumatoid arthritis (RA). Methods This two-center retrospective cohort study included 57 patients with RA who switched from oral to SC MTX in routine clinical practice. Clinical disease activity measures (DAS28-CRP, SDAI, and CDAI) were assessed at baseline and at 1, 3, and 6 months. In patients with available longitudinal MSUS follow-up, semiquantitative gray-scale (GS) and PD scores of the representative joint were evaluated at the same time points. Longitudinal changes were analyzed using linear mixed-effects models with Dunnett-adjusted comparisons versus baseline. Baseline characteristics of patients with and without 6-month ultrasound follow-up were compared using standardized mean differences. Results Clinical disease activity improved over time following the switch to SC MTX. Significant reductions from baseline were observed for SDAI, CDAI, and DAS28-CRP at all follow-up visits. Representative-joint PD scores showed a significant overall longitudinal reduction, with adjusted mean decreases of 0.64 points at 1 month and 0.95 points at 3 months compared with baseline. Although representative-joint PD scores also showed a numerical reduction at 6 months, statistical significance was not maintained after adjustment for multiple comparisons. In contrast, representative-joint GS scores showed numerical improvement but no statistically significant overall longitudinal change. DAS28-CRP remission (<2.6) was achieved in 30/56 (53.6%) patients at 1 month, 38/55 (69.1%) at 3 months, and 34/52 (65.4%) at 6 months. MSUS follow-up was available in 40 patients at baseline, 29 at 1 month, 20 at 3 months, and 17 at 6 months. Most missing 6-month ultrasound assessments were attributable to clinical remission or low disease activity. Conclusions In this real-world observational study, switching from oral to SC MTX was associated with early reductions in representative-joint PD-detected synovitis, with statistically significant improvement observed at 1 and 3 months, together with improvements in clinical disease activity over six months. Because of the retrospective design, absence of a comparator group, and incomplete ultrasound follow-up, residual confounding and selection bias cannot be excluded. These findings should therefore be considered hypothesis-generating but suggest that MSUS, particularly PD assessment, may provide a useful objective tool for monitoring inflammatory activity after switching to SC MTX in routine clinical practice. Clinical trial number Not applicable.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine",
    "Komagamine Rheumatology and Orthopedic Clinic"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Masatsugu Komagamine"
    },
    {
      "affs": [
        1
      ],
      "name": "Sari Taguchi"
    },
    {
      "affs": [
        0
      ],
      "name": "Tetsuji Naka"
    },
    {
      "affs": [
        0
      ],
      "name": "Minoru Fujimoto"
    },
    {
      "affs": [
        0
      ],
      "name": "Masataka Komagamine"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ffs86b9y4va3f.bib",
  "cited_by": 0,
  "doi": "10.1186/s41927-026-00678-0",
  "fulltext_url": "https://doi.org/10.1186/s41927-026-00678-0",
  "id": "ffs86b9y4va3f",
  "issns": [
    "2520-1026"
  ],
  "landing_url": "https://doi.org/10.1186/s41927-026-00678-0",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "lcc",
      "RC925-935"
    ],
    [
      "openalex",
      "2745|Rheumatoid Arthritis Research and Therapies"
    ]
  ],
  "openalex": "W7171420329",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-01",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/ffs86b9y4va3f.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T13:46:35Z",
      "native_id": "b472233183474288af21a90efa30bc61",
      "source": "doaj",
      "url": "https://doi.org/10.1186/s41927-026-00678-0"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2745|Rheumatoid Arthritis Research and Therapies",
      "subfield": "general"
    }
  ],
  "title": "Longitudinal clinical and musculoskeletal ultrasound assessment after switching from oral to subcutaneous methotrexate in rheumatoid arthritis: a two-center real-world study",
  "title_text": "Longitudinal clinical and musculoskeletal ultrasound assessment after switching from oral to subcutaneous methotrexate in rheumatoid arthritis: a two-center real-world study",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:35Z",
  "url": "https://research.draconitic.com/paper/ffs86b9y4va3f",
  "venue": "BMC Rheumatology",
  "versions": []
}