Sudden painless visual loss over 50: the question is arteritic or not

The edition in brief

A joint position statement from the Spanish Society of Internal Medicine's vascular risk and systemic autoimmune disease groups and the Spanish Retina and Vitreous Society addresses anterior ischaemic optic neuropathy, a leading cause of sudden painless monocular visual loss after 50. It separates the arteritic form, usually driven by giant cell arteritis and a same-day emergency, from the far commoner non-arteritic form, which has no specific effective treatment, and argues that care pathways and aetiological work-up are too variable. The recommendations are expert consensus, not trial evidence, and the authors say so. The FDA has acted on a supplement to the biologics licence for AVTOZMA (tocilizumab-anoh, Celltrion); the record identifies the application and sponsor but not what the supplement covers, so it is a change to an existing licence rather than a new approval. An Italian multicentre retrospective series of 51 patients with systemic sclerosis-associated pulmonary arterial hypertension on selexipag reported 88% survival at three years and 70% at five, with right ventricular function the main determinant and starting within a year of diagnosis associated with a better one-year mortality risk profile. A meta-analysis of three studies and 97 patients found FDG PET positive in a pooled 94% of relapsing polychondritis, including asymptomatic cartilage in more than a quarter. A Markov model estimated recombinant zoster vaccination in rheumatoid arthritis at EUR 11,205 per quality-adjusted life year, below the threshold used. Everything here is observational, modelled or consensus; none of it is randomised.