2024 Update of the Japan College of Rheumatology Clinical Practice Guidelines for the Management of Rheumatoid Arthritis: Secondary publication.

The article presents the 2024 update of the Japan College of Rheumatology (JCR) Clinical Practice Guidelines for the Management of Rheumatoid Arthritis (CPG for RA), incorporating evidence published up to June 2022. Key updates include 21 new or revised recommendations addressing drug therapies such as subcutaneous methotrexate, biological disease-modifying antirheumatic drugs (bDMARDs), rituximab (RTX), Janus kinase (JAK) inhibitors, biosimilars, treatment considerations for older patients, and pregnancy and lactation. The guidelines maintain the 2020 treatment goals and drug algorithms with modifications to footnotes reflecting new evidence, notably conditionally recommending oral methotrexate as first-line due to cost despite superior efficacy of subcutaneous forms, and providing cautious guidance on JAK inhibitors given safety concerns from recent trials. Recommendations for RTX were included despite its pending approval in Japan, reflecting its clinical relevance. The update emphasizes shared decision-making between patients and rheumatologists and aims to standardize RA management in Japan while considering patient values, safety profiles, and healthcare economics.