Rheumatology
Simple clinical scores helped predict relapse and serious infection after rituximab maintenance in ANCA vasculitis
Validation in the MAINRITSAN cohorts supports weighing both risks before extending rituximab beyond 18 months. Deucravacitinib improved psoriatic arthritis over placebo at 16 weeks, with safety data to 52, and PPI use in systemic sclerosis tracked disease severity more than benefit.
In anti-CCP-positive people with joint pain, hand tenosynovitis on MRI and erosions on ultrasound flagged who was most likely to develop arthritis
A prospective cohort found the two imaging features together carried nearly six times the risk; baseline B cells and IL-6 predicted cytokine release after CAR-T in autoimmune disease; and juvenile-onset lupus relapsed far more often than late-onset.
Starting early RA on a biologic or JAK inhibitor plus methotrexate raises 6-month remission by about 60%
A meta-analysis of 29 trials quantifies the gain from first-line advanced therapy against methotrexate alone; avacopan is linked to fewer severe infections in ANCA vasculitis; and axial SpA diagnosed within two years shows less spinal damage a decade on.
In lupus, infection risk tracks the steroid dose more than the immunosuppressant you choose
A 6,168-patient target trial emulation finds differences between azathioprine, methotrexate, mycophenolate and belimumab lose significance once glucocorticoid exposure is counted, and the FDA lists a Class I recall of a tocilizumab biosimilar for glass particles.
Lupus carries about two and a half times the risk of stroke; fracture-prevention evidence in men remains very uncertain
A meta-analysis of 25 cohorts puts stroke risk in SLE at 2.6 times the general population, a Cochrane review finds little reliable fracture data for osteoporosis drugs in men, bimekizumab reduces sacroiliac inflammation and erosion over two years, Nordic registries size difficult-to-manage psoriatic arthritis, and the FDA approves a supplement for the tocilizumab biosimilar Avtozma.
JAK inhibitors worked less well with every step up in BMI
Individual data from 16 trials show a graded loss of response with obesity and none on placebo; avacopan caused two highly probable liver injuries among 238 US patients; parenteral steroids in early RA were linked to less long-term steroid use than oral; and FDA records a supplement to an adalimumab biosimilar.
On a JAK inhibitor for RA, the CDAI at week 12 predicted the year ahead better than the rate of improvement — above 9.3, rethink
A Japanese registry sets week-4 and week-12 CDAI checkpoints for JAK inhibitors, EUSTAR finds no benefit from anticoagulation in scleroderma pulmonary hypertension, PEXIVAS yields a relapse model for ANCA vasculitis, and early mepolizumab in EGPA tracks with more remission.
Ten years on, half of non-psoriatic peripheral SpA is still drug-free
CRESPA followed 49 patients treated within 12 weeks of symptom onset: 81.6 per cent in clinical remission a decade later, and 48.1 per cent of those without psoriasis off all treatment. Plus a quarter of lupus patients meet metabolic syndrome criteria, and a probiotic trial in JIA that went the wrong way.
An oral TYK2 inhibitor holds its psoriatic arthritis response to a year
POETYK PsA-1 at 52 weeks in biologic-naive disease, consensus strategies for 22 more rare lupus manifestations, what proton pump inhibitors are and are not doing in scleroderma, and a Boswellia trial worth reading carefully.
Hand tenosynovitis on MRI plus erosions on ultrasound: a nearly sixfold risk of progressing to arthritis
In anti-CCP-positive people with symptoms but no synovitis, 37% progressed over three years — and two specific imaging features, one from each modality, identified those most likely to. Plus orbital inflammation in isolated polymyalgia, four reproducible ANCA vasculitis phenotypes, and where RSV vaccination stands for your immunosuppressed patients.
The cost of a late axSpA diagnosis shows up after ten years
A Swiss registry followed 376 patients for a mean of 11.5 years: those diagnosed within two years of symptom onset had nearly six mSASSS units less spinal damage, and the gap only opened at ten to fifteen years. Plus first-line biologics in early RA, avacopan and severe infection, and what maternal lupus does to the fetal heart.
Glass particles force a Class I recall of a tocilizumab biosimilar
Tyenne 400 mg vials are being recalled after glass was found in the product; and in 6,168 patients with non-renal lupus, the infection risk that looked like a drug effect turned out to track glucocorticoid dose.
People with lupus had about two and a half times the risk of stroke, ischaemic and haemorrhagic alike
A meta-analysis of stroke risk in SLE closes the edition. Before it: how little trial evidence supports fracture prevention drugs in men, MRI and radiographic outcomes with bimekizumab in axial spondyloarthritis, difficult-to-manage psoriatic arthritis in Nordic registries, and an FDA supplement for a tocilizumab biosimilar.
Severe liver injury on avacopan in US practice, and thrombotic risk in ANCA vasculitis peaks in the first three months
A US registry quantifies hepatotoxicity after the FDA asked for avacopan's withdrawal; a Swedish cohort shows cardiovascular and thromboembolic events cluster early; obesity blunts JAK inhibitor response in a dose-dependent way; and a bisphosphonate after denosumab was associated with 71% fewer vertebral fractures.
Half your patients are reading things in a group you have never seen
In 1,316 rheumatology patients, 85% found helpful information in online peer groups and 48% saw misinformation in the same spaces. Plus a case for treat-to-target in adult myositis, a new fibrotic axis in scleroderma, and a supplement on an adalimumab biosimilar.
Where the disease activity sits at week 12 tells you more than how fast it fell
A registry of 843 patients on JAK inhibitors gives a numerical threshold for the twelve-week decision; macrophage activation in lupus looks nothing like macrophage activation in Still's disease; and a probiotic trial in juvenile arthritis found more inflammatory signal, not less.
Sjögren is not a dry-eye disease
Over 25 years of linked Western Australian data, primary Sjögren disease carried 1.8 times the mortality of matched controls, and Sjögren with another connective tissue disease 3.1 times. The excess deaths were infection, ischaemic heart disease, lymphoid malignancy and interstitial lung disease - four things a review appointment can act on. Plus updated COVID vaccines, plasma exchange in childhood vasculitis, two numbers that stratify scleroderma, and a patch that works by day three.
Two diseases called Sjögren's, and a bone risk that hides behind a normal DXA
Single-cell profiling of 1.5 million cells splits Sjögren's disease at anti-SSA status; a patient-reported threshold defines what residual symptoms in remission are acceptable; digital rehabilitation earns a place in knee osteoarthritis; and three Taiwanese societies set out how to manage bone in diabetes.
Signals a decade before the diagnosis, and an oral TYK2 inhibitor at 52 weeks
Predictors of psoriatic arthritis are present the day psoriasis is diagnosed; Swedish registry data show healthcare patterns diverging ten years before rheumatoid arthritis; a masked Lancet trial finds no benefit from robotic knee replacement; and deucravacitinib reports a full year in psoriatic arthritis.
The febuxostat cardiovascular question turns out to be a question about time
A reconstructed individual-participant meta-analysis finds the risk relative to allopurinol changes direction across follow-up. Plus a Class I recall of a tocilizumab infusion vial, biologic choice in rheumatoid lung fibrosis, a deep-learning system that reads sacroiliac MRI as consistently as expert readers, and a stroke risk model built for rheumatoid arthritis rather than borrowed.
Sudden painless visual loss over 50: the question is arteritic or not
A joint internal medicine and retina consensus sets out how the two forms of anterior ischaemic optic neuropathy should be separated and managed. Plus an FDA action on a tocilizumab biosimilar, five-year survival on selexipag in scleroderma-associated pulmonary hypertension, FDG PET in relapsing polychondritis, and the economic case for shingles vaccination in rheumatoid arthritis.
Vascular risk in ANCA-associated vasculitis is front-loaded
Swedish register data put the highest cardiovascular and thromboembolic risk in the three months around diagnosis, not years later. Plus early haematologic response to anifrolumab, an ultrasound-anchored lupus arthritis score, how urate deposits actually dissolve, and biologic class as a possible brake on progression from psoriasis to psoriatic arthritis.
The steroid you inject is easier to stop than the one you prescribe
In early rheumatoid arthritis, patients given parenteral rather than oral glucocorticoid were half as likely to still be on steroids a year later. Also: only 12% of nearly 95,000 people with gout ever reach target urate, an FDA supplement on abrocitinib, and pooled evidence for the bisphosphonate that has to follow denosumab.
JAK inhibitors worked less well as BMI rose, across nearly 12,000 patients
An individual patient data meta-analysis of 16 phase 3 trials found a stepwise fall in ACR20 response with rising BMI, from a relative risk of 0.94 in overweight patients to 0.78 in class 3 obesity, with no equivalent gradient in the placebo arms.
Obesity blunts the response to JAK inhibitors in rheumatoid arthritis
An individual-patient meta-analysis of 11,883 patients shows JAK inhibitor benefit falling step by step as BMI rises, a dose-response meta-analysis pins down how much resistance exercise a knee actually needs, and deep-learning grading still fails the early knee.