Conclusions
All the authors of CPG for rheumatoid arthritis developed by the Japan College of Rheumatology received personal payments from the pharmaceutical companies five years before its publication. The total amounts of personal payments were more than $3.6 million. Non-disclosure of financial COIs and the low quality of evidence supporting the majority of recommendations in the CPG raise significant ethical and clinical concerns. These findings call for immediate policy interventions to enhance the transparency, integrity, and reliability of clinical practice guidelines in rheumatology in Japan.