The edition · Rheumatology
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.
The edition in brief
Today's rheumatology desk leads with cardiometabolic risk in lupus: a meta-analysis of observational studies puts the pooled prevalence of metabolic syndrome in systemic lupus erythematosus at 27 per cent (95% CI 24 to 30), higher in men at 36 per cent and highest in Africa at 36 per cent, with Asia at 27 per cent. Hydroxychloroquine was associated with lower odds (OR 0.66, 0.52 to 0.83), while cyclophosphamide, azathioprine and mycophenolate were associated with higher odds, and corticosteroids showed no significant association. The PERMAJI trial randomised 44 children with oligoarticular or RF-negative polyarticular juvenile idiopathic arthritis to VSL#3 or placebo for three months: ACR Pedi 30 response was 47 versus 63 per cent (P=0.33), a worst-case missing-data analysis favoured placebo (36 versus 68 per cent, P=0.03), and the probiotic raised faecal Toll-like receptor 4 agonist activity without changing microbial diversity, permeability or systemic cytokines. On the regulatory side, the FDA approved a supplement to BLA 761498 for AVTOZMA (tocilizumab-anoh, Celltrion) on 2 September 2026 — a licence change to an existing tocilizumab biosimilar, not a new molecule or indication. The practice-changer is the 10-year follow-up of CRESPA, in which patients with peripheral spondyloarthritis treated with golimumab within 12 weeks of symptom onset were reassessed at a mean 10.5 years: 81.6 per cent were in clinical remission and 30.6 per cent in longstanding drug-free remission, rising to 48.1 per cent among those without psoriasis (OR 9.1, 95% CI 1.8 to 50).
One in four lupus patients meets metabolic syndrome criteria
Screen for metabolic syndrome annually in lupus clinic — roughly one in four patients has it, and more in men.
A probiotic in juvenile arthritis that moved the wrong marker
Do not recommend probiotic supplementation in juvenile idiopathic arthritis — it did not help, and it increased pro-inflammatory microbial signalling.
FDA clears a supplement to the AVTOZMA tocilizumab biosimilar licence
This is a licence supplement to an already-approved tocilizumab biosimilar — nothing to change in prescribing today.
Date the symptom, not the referral
Record the month and year symptoms began, anchored to an event the patient remembers, in a structured field.
CRESPA at ten years: treating within 12 weeks, and stopping
In peripheral spondyloarthritis treated within 12 weeks of onset, discuss eventual drug-free remission as a realistic goal — particularly for patients without psoriasis.
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