Effect of Communicative and Critical Health Literacy on Trust in Physicians Among Patients With Systemic Lupus Erythematosus (SLE): The TRUMP2-SLE Project

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.

This study was supported by the Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research (KAKENHI; grant number: JP 19KT0021). The funder had no role in the study design, analyses, or interpretation of the data; writing of the manuscript; or the decision to submit it for publication. N. Oguro, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, and Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima. N. Yajima, MD, PhD, Division of Rheumatology, Department of Medicine, Showa University School of Medicine, Tokyo, Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine Kyoto University, Kyoto and Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima. Y. Miyawaki, MD, PhD, K. Hayashi, MD, PhD, K. Shidahara, MD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,Okayama. R. Yoshimi, MD, PhD, N. Sakurai, MD, Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama. Y. Shimojima, MD, PhD, D. Kishida, MD, PhD, T. Ichikawa, MD, PhD, Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto. K. Sada, MD, PhD, Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, and Department of Clinical Epidemiology, Kochi Medical School, Kochi University, Nankoku. C. Hidekawa, MD, Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama. Y. Ishikawa, MD, The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu. N. Kurita, MD, PhD, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, and Department of Innovative Research and Education for Clinicians and Trainees (DiRECT), Fukushima Medical University Hospital, Fukishima, Japan. NK is a member of the Committee on Clinical Research, Japan College of Rheumatology, and has received grants from the Japan Society for the Promotion of Science, consulting fees from GSK KK, and payment for speaking and educational events from Chugai Pharmaceutical Co Ltd, Sanofi KK, Mitsubishi Tanabe, and the Japan College of Rheumatology. KS has received a research grant from Pfizer and payment for speaking and educational events from GSK KK. The remaining authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. N. Kurita, Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan. Email: kuritanoriaki@gmail.com. Accepted for publication October 31, 2022.