The edition · Rheumatology
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.
The edition in brief
A prospective cohort of 130 anti-CCP-positive people with musculoskeletal symptoms but no clinical synovitis found that over a median three years 37% progressed to inflammatory arthritis. MRI-detected hand tenosynovitis and ultrasound-detected bone erosions each independently predicted progression, and the combination carried the highest risk (hazard ratio 5.83); every participant had at least one minor MRI abnormality, so MRI 'positivity' alone did not discriminate. In 108 patients with autoimmune disease given CAR-T cells in Germany and China, 80% developed cytokine release syndrome, almost all grade 1, and higher baseline B-cell counts (OR 1.31) and IL-6 (OR 2.28) predicted it. A cohort of 289 patients with lupus found juvenile-onset disease relapsed in 87.5% against 24.7% in late-onset, while late-onset disease more often reached remission but carried higher mortality, mainly from infection. Statin-associated necrotising myopathy carried higher crude mortality than other myositis, but the excess attenuated and was no longer statistically significant after adjustment for age and cardiometabolic disease. A systematic review found RSV vaccines were 60–73% effective in immunocompromised adults but with no data by DMARD class. Today's pearl covers hydroxychloroquine dosing and retinal screening.
Baseline B cells and IL-6 predicted cytokine release after CAR-T in autoimmune disease
Check baseline B-cell count and IL-6 before CAR-T in autoimmune disease; higher values were associated with cytokine release (common but usually mild), but no validated cut-off exists, so every patient still needs standard CRS monitoring.
Juvenile-onset lupus relapsed far more often; late-onset reached remission but carried more deaths
Tailor lupus follow-up to age at onset: tighter flare surveillance in juvenile-onset, infection prevention and, as in all lupus, minimising glucocorticoid exposure in late-onset.
Statin-associated necrotising myopathy's excess mortality was no longer significant after adjustment for age and cardiometabolic disease
In statin-associated necrotising myopathy, treat the myositis and the cardiometabolic risk together; age and cardiometabolic disease mark a higher-risk group.
RSV vaccines protected immunocompromised adults, but no data exist by DMARD class
Offer RSV vaccination to eligible older patients with rheumatic disease, ideally before B-cell depletion, accepting that the evidence is indirect.
Hydroxychloroquine: 5 mg/kg of real weight, and screen the retina
Dose hydroxychloroquine at ≤5 mg/kg actual body weight and start annual retinal screening after five years.
Hand tenosynovitis on MRI plus erosions on ultrasound identified anti-CCP-positive people most likely to develop arthritis
In anti-CCP-positive arthralgia, ultrasound erosions and MRI hand tenosynovitis identify those most likely to progress; follow them closely.
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