Vascular risk in ANCA-associated vasculitis is front-loaded

The edition in brief

A nationwide Swedish matched cohort of 4,317 people with granulomatosis with polyangiitis or microscopic polyangiitis found roughly twice the rate of cardiovascular and thromboembolic events compared with matched controls, with the risk concentrated in the first three months after diagnosis (HR 7.69). Siblings carried no excess risk, which points at the vasculitis itself rather than shared family background. A retrospective European series of 47 patients with lupus and cytopenias reported complete normalisation of every affected lineage in about a third within six months of starting anifrolumab, with responses less likely in those with higher inflammatory activity at baseline. The LAMDA instrument, derived against hand and wrist ultrasound in the USEFUL cohort and externally validated in Leeds, reduces lupus arthritis assessment to four items and was responsive to glucocorticoid treatment where swollen joint counts alone were not. Serial dual-energy CT in gout showed urate deposits losing density evenly throughout the lesion rather than shrinking from the outside in, with most of the change in the first six months of urate-lowering therapy and no sign of calcification. A real-world cohort of 393 people with psoriasis on biologics found psoriatic arthritis diagnosed in 22% over follow-up, with lower adjusted hazards on interleukin-17, interleukin-23 and interleukin-12/23 inhibitors than on TNF inhibitors, though the association weakened when analysed by first biologic received. All five are observational or measurement studies; none establishes causation, and the biologic class finding in particular is open to channelling by baseline joint symptoms.