The edition · Rheumatology
Adding tirzepatide to ixekizumab improved joint response, not just weight, in psoriatic arthritis with obesity
A phase 3b trial lifted ACR50 from 20% to 34% when obesity was treated alongside the arthritis, myositis overlap in systemic sclerosis was linked to much more cardiac involvement, and ASAS sets a minimum assessment for every axial spondyloarthritis visit.
The edition in brief
In TOGETHER-PsA (Arthritis & Rheumatology, March 2026), 271 adults with active psoriatic arthritis and overweight or obesity were randomised to ixekizumab with or without tirzepatide; ACR50 at 36 weeks was 33.5% vs 20.4% (P = 0.02), and the composite of ACR50 plus 10% weight loss was 31.7% vs 0.8%, with function and fatigue also better and no new safety signals. In a single-centre matched cohort of systemic sclerosis (Rheumatology, 16 October 2026), overlapping myositis was associated with far more cardiac involvement (adjusted OR about 13-20, very wide CI), and cardiac involvement predicted death (aHR 8.09). ASAS has endorsed a clinical-practice core set for axial spondyloarthritis: five domains at every routine visit and four more at extended visits. A systematic review of 21 studies suggested Fc-free TNF inhibitors may perform as well or slightly better in high rheumatoid factor RA. Pearl: in diffuse systemic sclerosis, check blood pressure and creatinine, and avoid high-dose steroids.
Myositis overlap in systemic sclerosis was linked to markedly more cardiac involvement
Screen patients with systemic sclerosis and myositis for cardiac involvement, and repeat it over time.
ASAS endorses a minimum set of what to assess at every axial spondyloarthritis visit
Build the five ASAS routine domains into every axial spondyloarthritis follow-up, with the four extended domains periodically.
High rheumatoid factor and TNF inhibitors: Fc-free agents may hold up better
In high rheumatoid factor RA, an Fc-free TNF inhibitor is a reasonable first TNF choice, but the evidence is indirect.
In diffuse systemic sclerosis, check blood pressure and creatinine, and avoid high-dose steroids
Monitor blood pressure and creatinine closely in early diffuse systemic sclerosis and keep steroid doses low.
Treating obesity alongside psoriatic arthritis improved joint response, not just weight
In psoriatic arthritis with obesity, consider treating the weight alongside the biologic; joint response improved, not just weight.
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