Fewer than a quarter of lupus patients reached major response a year after escalation

The edition in brief

In the UK BILAG Biologics Register, 422 people with active moderate-to-severe lupus who started rituximab, belimumab or standard immunosuppression were followed for a year. Only 23% met major clinical response criteria at 12 months: 42% of East Asian, 30% of South Asian, 24% of White and 10% of Black patients. Black patients began with more activity, damage and comorbidity, and after adjustment had markedly lower odds of response (OR 0.13, 95% CI 0.02–0.88). A EULAR inception cohort of 373 people found arthropathy meeting haemochromatosis arthropathy criteria in 43% of those carrying other HFE genotypes, including H63D, and 22% of C282Y homozygotes without iron overload, compared with 7% of osteoarthritis or CPPD controls; ferritin and transferrin saturation did not predict it. A Bayesian network meta-analysis of 35 trials (3,808 patients) in knee osteoarthritis found that combined aerobic and resistance exercise over 12 weeks or less had the largest effect on pain (SMD −0.94), function and quality of life, though certainty was low. The pearl is about second and third metacarpophalangeal joint arthritis as a clue to look beyond ferritin.