ANA at diagnosis flags the child with discoid lupus most likely to progress to SLE

The edition in brief

A retrospective cohort across 17 paediatric centres found that 14.4% of children with skin-limited discoid lupus met SLE classification criteria within a year. A positive antinuclear antibody at baseline was the strongest predictor (HR 3.71), with older age, antiphospholipid antibodies and cytopenias also contributing. Most who progressed had mild, mucocutaneous and laboratory disease; serious organ involvement was uncommon. Baseline ANA, blood count and antiphospholipid testing, with closer review in the first year, follows directly. The Spanish melanoma registry found that among 365 patients treated first-line for metastatic melanoma, those whose primary had been stage I relapsed later (median 52 months) but with more brain metastases and shorter survival (median 19.8 months) than those relapsing from stage II or III. That argues for keeping stage I patients in follow-up and taking new neurological symptoms seriously years later. A UK feasibility study gave upadacitinib to 20 adults with palmoplantar pustulosis; PP-PASI fell from 20.3 to 4.6 at 8 weeks, against historic placebo data — a signal for a proper trial, not a basis for routine use. A meta-analysis of 4516 patients with chronic urticaria found a median omalizumab drug survival of 3.1 years, with stopping driven mostly by good control rather than side effects. The pearl covers antihistamine updosing in chronic spontaneous urticaria.