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Labs/Biomarkers

VA/DoD 2025 Obesity Guidelines

Annals of Internal Medicine has published the updated 2025 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guidelines on adult Overweight and Obesity management. Here is a review of the guidelines, including five key takeaways for rheumatologists.

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Rheumatology Pay Up (9.25.2026)

Dr. Jack Cush reviews the news and journal reports from this past week on RheumNow.com.

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Systematic review 14 studies assessed Lung ultrasound (LUS) (vs HRCT) to detect RA-ILD (using threshold of ≥ 5 B-lines) found sensitivity was 86.8% (95% CI 80.1–91.4), specificity 75.4% (95% CI 62.3–85.1), and AUC 0.890 https://t.co/GlNpsPBwtS https://t.co/FJ6B5E5CWy
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FORWARD is a Phase 4, OL trial in 51 refractory uncontrolled gout pts Rx w/ MTX plus higher doses pegloticase (16 or 30mg) IV q4wk. At 24-wk Responses similar 68% or 73%. ~31% of responders later had SUA >6. Confusing anti-Drug Ab results in this trial?? https://t.co/udjE7sXDm5 https://t.co/F8VGDAyJzb
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Scleroderma-Specific Autoantibodies in Early Systemic Sclerosis

Prognostication is tenous in early scleroderma, especially in those with diffuse cutaneous systemic sclerosis (dcSSc). dcSSc has associated with substantial morbidity and disease-specific mortality. Analysis of an early SSc registry shows that anti-RNA

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Steroid Delusions in Giant Cell Arteritis

A real world analysis of drug use in giant cell arteritis (GCA) patients shows that despite intending to taper patients off glucocorticoids (GC) by 24 months, 75% remained on GCs for ≥ 48 months.

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Phenotypic cluster analysis of 134 CPPD pts from COLCHICORT & CHRONIC-CPPD European cohorts ID 4 Grps: 1) C1 monoarticular recurrent flares, older, W, ^CRP; 2) C2 monoarticular w persistent arthritis; 3) C3 polyarthritis lower CRP; 4) C4 polyarticular (spine/shoulder( & recurrent https://t.co/ghMCmDLCki
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CLOAK study: 3 mos DBRPCT of Colchicine vs PBO (no NSAID) in 120 symptomatic KOA (KL gr 2/3) shows no benefit in VAS pain index knee after 3 mos. (but COL pts had signif change in some biomarkers hsCRP, β-NGF (p < 0.05); PGE2, IL-1ra, IL-8, and VEGF (p < 0.16). https://t.co/MPgLpr7LPP
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Review of HLA-B27

HLA-B27 remains the dominant genetic link to spondyloarthritis (SpA) across the age spectrum, but B27 related clinical expression diverges between children and adults. New mechanistic data on autoreactive T cells, HLA-B27 misfolding, and gut-joint trafficking point to new plausible, targetable

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Early RA Referral Clinics Work!

An outcomes study from the Leiden Early Arthritis Clinic (EAC) has shown substantially less diagnostic delay and better long-term outcomes when patients are referred to EAC compared to usual referrals.

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Leeds study of 44 patients idiopathic inflamm myopathy (IIM) pts Rx w/ rituximab showed a 70% response 4-6 mos post RTX. Responders had higher TIS (50·0 vs 17·5). Using highly sensitive flow cytometry, @ 2 wks responders had lower #s memory B cells & Plasmablasts. Is there a role https://t.co/JDvVZ1KEIY
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True or False: In a Leeds study of idiopathic inflammatory myopathy patients treated with rituximab, responders had lower memory B cells and plasmablasts at 2 weeks. See if you got it right in this week's RheumIQ quiz at https://t.co/UaXqHKWizt. https://t.co/zRJOMeLn8M
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Dutch single center study of ANCA tests (n 5518) betw 2012-2023; 286 (5.2%) were positive: 63% did not have AAV. ANCA+ Non-AAV pts had other CTD, neoplasia, infxn, or used specific drugs. IIF and ELISA 1st test - good negative predictive values. Performing a second test increased https://t.co/0oAhOg10VL
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A Day of Infamy (9.11.2026)

Dr. Jack Cush reviews the news and journal reports from this past week on Rheumnow.com - including obesity, disappointing durability with GLP-1 drugs, AI diagnoses and worries about CV risk in ANCA-associated vasculitis. And take this week's RheumIQ quiz

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Difficult PsA is called ‘difficult-to-manage’ (D2M) or ‘treatment-refractory’ dz (TRD). Data from 5 Nordic PsA registries 14,362 ps, D/Cs of ≥2/≥3/≥4 b/tsDMARDs in 36%/18%/10%. Freq of D2M low 2%/3%/3%, & TRD was 1.2%/1.2%/0.8%. Female #s, depression, & opioids incr w/ # of https://t.co/FkQU5BVRn2
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JAMA: Review of Adult Rheumatoid Arthritis

Smolen, Kerschbaumer, Aletaha, and Robinson have published a comprehensive review article of rheumatoid arthritis (RA) in JAMA, noting significant changes to our understanding and treatment guidelines.

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Leeds study of 44 patients idiopathic inflamm myopathy (IIM) pts Rx w/ rituximab showed a 70% response 4-6 mos post RTX. Responders had higher TIS (50·0 vs 17·5). Using highly sensitive flow cytometry, @ 2 wks responders had lower #s memory B cells & Plasmablasts. Is there a role https://t.co/HTxOIxkezs
Dr. John Cush @RheumNow( View Tweet )
Metanalysis looked at neutrophil to Lymph ration (NLR) in SLE - 31 studies, 4,006 SLE pts. NLR signif incr in SLE worldwide. NLR was higher in Active vs inactive SLE, and showed a significant but moderate correlation w/ SLEDAI (CC=0.354, p < 0.001). https://t.co/tA6UBb1wVo https://t.co/XoXrf6HlKL
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Ro52 Abs in idiopathic inflammatory myopathies (IIM). From 2,126 IIM China/Japan pts, Ro52 positivity was common (46%), esp in MDA5+ DM & anti-synthetase syndr (ASyS) & was assoc w/ high freq of ILD, rapidly progressive ILD, and poor prognosis. https://t.co/TA4gSnZax1 https://t.co/riYs5YJwQV
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Treating Obesity is Disease-Modifying (9.4.2026)

Dr. Jack Cush reviews the news and journal articles from the past week on RheumNow.com.  New drugs approved, new drugs halted and some drugs out of control. Ready to test your knowlege? Take this week's quiz!

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Metanalysis looked at neutrophil to Lymph ration (NLR) in SLE - 31 studies, 4,006 SLE pts. NLR signif incr in SLE worldwide. NLR was higher in Active vs inactive SLE, and showed a significant but moderate correlation w/ SLEDAI (CC=0.354, p < 0.001). https://t.co/ROG5L4nfo2 https://t.co/9mqqId45lG
Dr. John Cush @RheumNow( View Tweet )
Ro52 Abs in idiopathic inflammatory myopathies (IIM). From 2,126 IIM China/Japan pts, Ro52 positivity was common (46%), esp in MDA5+ DM & anti-synthetase syndr (ASyS) & was assoc w/ high freq of ILD, rapidly progressive ILD, and poor prognosis. https://t.co/may6ZTJkvt https://t.co/EuinNbZUm7
Dr. John Cush @RheumNow( View Tweet )

EUSTAR Registry - Cancer in Systemic Sclerosis

Cancer is a major cause of mortality in systemic sclerosis (SSc).  A nested case-control study within EUSTAR registry shows distinct patterns of cancer related temporally to SSc, serologic profiles and traditional cancer risk factors.

Cancers were

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JAK inhibitors work & have a dose dependent effect in severe alopecia areata (AA). Metanalysis of 10 Rxs, 3866 AA pts (used the SALT20 endpoint) showed the best efficacy was deuruxolitinib_12 mg, and baricitinib_4 mg (OR: 2.59, 95% CI: 1.98–3.38). https://t.co/k86f2RvCEJ https://t.co/N1fsrbbmDw
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Per adult-onset IgA vasculitis guidelines, which agent is now preferred for refractory or relapsing disease? Test your knowledge in this week's RheumIQ at https://t.co/TBlB4pmnKa. https://t.co/7tMcDkoCKH
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