Two diseases called Sjögren's, and a bone risk that hides behind a normal DXA

The edition in brief

Single-cell RNA sequencing with surface protein profiling of 1.5 million peripheral blood mononuclear cells from 333 participants identified two immunological endotypes of Sjögren's disease. Anti-SSA-positive participants carried a dominant, persistent type I interferon signature with altered immune cell composition, most marked in transitional B cells - reduced B-cell receptor diversity, shorter CDR3 regions and altered developmental states consistent with disturbed early B-cell selection. Anti-SSA-negative participants differed little from symptomatic non-Sjögren's controls. In 370 patients with rheumatoid arthritis, 284 of whom reported an acceptable symptom state, a patient-reported residual symptom sheet identified thresholds of 3 overall and 2 among the 213 in Simplified Disease Activity Index remission, with areas under the curve of 0.824 and 0.838; the proportion reporting an acceptable state fell from 95.2% to 46.8% across rising symptom categories. A systematic review of 21 trials found interactive digital rehabilitation may improve pain-related functioning in knee osteoarthritis (pooled standardised mean difference -0.59, 95% CI -1.11 to -0.06) and after total knee arthroplasty, at low certainty, with adverse events rarely reported. A single-centre assessor-blinded trial in 66 adults found high-intensity laser therapy as an exercise adjunct reduced WOMAC scores more than ultrasound (adjusted difference -27.7 points, 95% CI -39.0 to -16.5). And three Taiwanese societies have issued joint consensus statements on osteoporosis in diabetes, advising earlier screening, adjusted fracture risk calculation, and attention to the skeletal effects of antihyperglycaemic choice.