The edition · Rheumatology
Pulmonary hypertension affected one in eleven with anti-synthetase syndrome and doubled mortality
A registry of 1,868 patients found pulmonary hypertension in 8.9%, independent of interstitial lung disease and associated with a hazard ratio of 2.52 for death. Plus a Boswellia trial in knee osteoarthritis with no published effect size, and methylation that separates gout from hyperuricaemia.
The edition in brief
A worldwide physician-reported registry of 1,868 patients with anti-synthetase syndrome and 2,043 controls from 103 centres found pulmonary hypertension in 8.9% — higher than in non-anti-synthetase myositis (3%), rheumatoid arthritis (4%) and interstitial pneumonia with autoimmune features (3%), but not different from systemic sclerosis (13%) or lupus (11%). Five-year survival fell from 94% to 88.3% where pulmonary hypertension was present, and the association with mortality held after adjustment for age, sex and interstitial lung disease (HR 2.52, 95% CI 1.41-4.53). A randomised, double-blind, placebo-controlled trial gave 60 adults aged 40 to 75 with mild to moderate knee osteoarthritis either 100 mg daily of a standardised Boswellia serrata extract or placebo for eight weeks. The abstract reports significant reductions in total and subscale osteoarthritis index scores, visual analogue pain and high-sensitivity C-reactive protein, with separation reported by day 7, but publishes no effect sizes. The FDA records a supplemental application dated 25 September 2026 on an adalimumab biosimilar, adalimumab-aqvh, without stating its scope. A two-stage epigenetic study of 124 patients with gout, 121 with asymptomatic hyperuricaemia and 124 normouricaemic controls found DNA methylation signatures mapping to 84 genes overlapping urate and gout risk loci. Adding methylation to clinical variables raised the area under the curve for separating gout from asymptomatic hyperuricaemia from 0.67 to 0.87. In 213 patients with axial spondyloarthritis or psoriatic arthritis, obesity by dual-energy absorptiometry was common and sarcopenia rare, with daily physical activity independently associated with grip strength and body composition.
A Boswellia trial in knee osteoarthritis that reports significance but not size
A small randomised trial reported benefit from one standardised Boswellia extract in knee osteoarthritis, but published no effect size — treat it as a reason to keep listening, not to recommend.
A supplemental application on an adalimumab biosimilar, with no stated scope
An FDA supplemental application on an adalimumab biosimilar is recorded with no stated scope; the practical point is knowing which product your patients receive and reteaching device technique on any switch.
Methylation separated gout from asymptomatic hyperuricaemia better than clinical variables
A blood methylation signature separated gout from asymptomatic hyperuricaemia far better than clinical variables, but it is a research finding and not a test.
In spondyloarthritis the body composition problem is fat, not muscle loss
In spondyloarthritis, assess adiposity and daily activity rather than screening for sarcopenia — obesity was common, sarcopenia rare, and activity tracked with performance.
A flare is not a reason to stop allopurinol, and a normal urate during one is not reassurance
Keep allopurinol running through a flare, ignore a urate measured during one, and titrate to a target rather than to the absence of attacks.
Evaluate for pulmonary hypertension in anti-synthetase syndrome, not just interstitial lung disease
Assess for pulmonary hypertension in anti-synthetase syndrome — it affected 8.9% and more than doubled mortality independent of interstitial lung disease.
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