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Rheumatology Pitfalls (3.20.2026)
Dr. Jack Cush reviews the regulatory actions, news and journal reports from this past week on RheumNow.com.
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Predictors of Response in Lupus
A systematic review suggests that traditional measures (serologies and disease activity) are superior to biomarkers in predicting response to biologics in systemic lupus erythematosus (SLE) patients.
Long-Term Bimekizumab Safety Data
MedPage Today
Adverse effects from bimekizumab through 2 years or more of treatment for psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) were about as expected from shorter-term data, results from long-term extension studies indicated.
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FDA Approves Icotrokinra for Plaque Psoriasis
Today the FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older (who weigh at least 40 kg) who are candidates for systemic therapy or phototherapy.
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REVEAL, a 5-yr real-world study of 236 SLE pts initiating anifrolumab (basekbube SLEDAI-2K 7 for mucocutaneous (67%) & MSK (49%) dz. At 6 months, 26% achieved remission, 66% reached LLDAS, and 57% achieved LLDAS5. Authors claim rapid onset of action https://t.co/16OQatOcPj https://t.co/mU9aciCNcH
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Pitfalls of autoimmune serologic testing
Misuse of laboratory testing may lead to misdiagnoses and mismanagement; this is particulary prevalent when clinicians consider the use of the diagnostic use of serological autoimmune markers.
https://t.co/QDWTRgdlOh https://t.co/3hvM1OBcMC
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NEJM: Obinutuzumab in Active Systemic Lupus Erythematosus
A phase 3 trial of obinutuzumab, an anti-CD20 monoclonal antibody, showed potent B-cell depletion and clinical efficacy active systemic lupus erythematosus without evidence of nephritis.
https://t.co/OEuNAZlgzp https://t.co/yjUmJITAmQ
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FDA has accepted the supplemental biologics license application for use of interleukin-23 inhibitor tildrakizumab (Ilumya; Sun Pharma) in active psoriatic arthritis (PsA) in adults. https://t.co/cwqz9DoWsL https://t.co/ut0A4MwqW7
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FDA Approves Icotrokinra for Plaque Psoriasis
The FDA approved an oral IL-23 inhibitor, icotrokinra (Icotyde), for use in moderate-to-severe plaque psoriasis in adults and children 12 years of age and older who are candidates for systemic therapy or phototherapy, according to a https://t.co/q5b3TceFHx
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Retrospective Japanese study of 544 pts w/ GPA or microscopic polyangiitis (MPA) followed > 48 wks; only 29 (5.3%) achieved steroid free remission (GFCR) at wk 48. Predictors of GFCR: rituximab induction (OR 3.9) & avacopan use (OR 24.3). MP pulse RX had lower likelihood of GFCR https://t.co/EMRqA5oHJQ
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New Dyslipidemia (Cholesterol) Guidelines from AHA/ACC: A) Check during childhood; B) Lower Targets: if 10-year ASCVD risk =10%, aim for LDL <70; if you have ASCVD/MI/CV, aim for 55; C) chk lipoprotein(a) once; D) supplements dont lower cholesterol - statins do. https://t.co/tRwdg6GHm8
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Prospective multinational cohort of 1180 lupus pts, followed ~2.7 yrs. 37% had renal biopsies (Class III/IV 56%). They achieved mCRR 46%, mPERR 53%, LLDAS 60%, & REMission 46% at least once. renal response highest @ 2 yrs. New organ damage 11% @ 1yr; 33% by 5yr. https://t.co/ugh60M08Xf
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Outcomes of 87 VEXAS pts in the AutoInflammatory Disease Alliance (AIDA) - 75% had recurrent fever episodes. Fever episodes assoc w/ mortality, organ involvement (CV, GI, Lung), but not with complete response to biologics. https://t.co/j9vzBJNMj0 https://t.co/YGsE7LH3ml
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Hydralazine and the Rare Risk of Vasculitis
Since the 1980s, hydralazine has been a notable cause of drug-induced lupus, and inferred to cause vasculitis as well. A retrospective cohort study from Canada has shown that vasculitis resulting from hydralazine is possible, but https://t.co/ewqCesatbm
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2025 Update: EULAR Recommendations on Rheumatoid Arthritis Management
EULAR has updated its RA management recommendations, notably with fewer recommendations (a total of 9, down from 11 in the 2022 version), by merging and removing previous recommendations. https://t.co/7SCIL2Prjw
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Urinary biomarkers improve w/ anifrolumab in TULIP-LN (lupus nephritis) trial; 112 pts, 197 uriniary proteins assessed. Urinary CD163 and MCP-1 signif improved as early as wk 12. Anifrolumab reduced the proteomic inflammatory signature, regardless of responder status https://t.co/n6fIJVDCN1
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SOLSTICE: phase 3b RCT of IL-23i, guselkumab vs PBO in 451 active PsA pts (GUS q4wk vs q8wk vs PBO). @wk 24 GUS signif better than PBO-ACR20 (59%/62% vs 35%), ACR50 (31%/32% vs 12%), ACR70 (17%/17% vs 2%), PASI 90 (49%/45% vs 12%), MDA (19%/24% vs 5%) ction) https://t.co/QDMCnGdN6J
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Pilot phase I open-label trial of the PPARγ agonist pioglitazone (ACTOS; 45 mg/d) in 13 pts w/ inclusion body myositis (IBM) showed promise. After 32 weeks, no clinical improvement but proteomic muscle metabalomics & PPARGC1A expression improved. https://t.co/MtiTnwRfaE https://t.co/jUthouMSnP
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Single center prospective cohort study of 137 Takayasu’s arteritis (TAK) pts found the prevalence of coronary arteritis was 13 (9%). TAK coronary arteritis pts were not distinguished by demographics, angiographic patterns. 50% had complications from vascular grafts or stents https://t.co/xRR7TSi5FW
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JAMA Patient Education Page on JAMA Eosinophilic Fasciitis (EF). EF is rare, but begins with swelling and redness of the arms and/or legs. Later the skin thickens and develops the peau d' orange appearance. EF does not involve fingers or toes, & doesnt have Raynauds https://t.co/azH9bMRsOb
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