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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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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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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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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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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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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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/YmS2dRolL1
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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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Cross-sectional study of 180 PMR pts compared dz activity by PMR-AS to Systemic Immune-Inflammation Index (SII = Plts × PMNs/Lymphs) using CBC.48% had mod-hi dz (PMR-AS >=7). SII had moderate correlation with PMR-AS (r = 0.47), possibly useful in monitoring PMR https://t.co/vG1alSdVRU
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Is BMI a risk factor for Palindromic rheumatism (PR)? Study of 147 PR patients and 294 matched HCs. No significant difference was observed in mean BMI between PR patients and HCs and overweight or obesity was not associated with an increased risk of PR. https://t.co/W7XehFVCTR https://t.co/YRPOeqR04j
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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
A multi-center, retrospective chart review of 82 Still's disease pts (63% female; mean Dx age 6.4 ± 4 yrs; F/U ~2.8 yrs). When analyzing Dz course, 34% were monophasic, 46% polyphasic (higher-than-expected), 19.5% persistent Dz. non-monophasic predicted by active 3 mos from Dx https://t.co/qtONtpeA22
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2025 Update: EULAR Recommendations on Rheumatoid Arthritis Management
The European Alliance of Associations for Rheumatology (EULAR) has updated their rheumatoid arthritis (RA) management recommendations, notably with fewer recommendations (total of 9, down from 11 in 2022 version), by merging and removing previous recommendations.
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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.
A current review focuses commonly used serologies and autoimmune tests to identify
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Worldwide Trends in Hyperuricemia
A Lancet Rheumatology systematic review shows the prevalence of hyperuricaemia has risen markedly over the past two decades in both men and women, owing to population growth, aging, and increasing age-specific rates
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Managing Gout in CKD Patients
A current review article addressed the management of gout patients with chronic kidney disease (CKD). This full read review addresses the epidemiology, challenges, treatment decisions, and outcomes.
https://t.co/ND0cspcmDd https://t.co/HI55D5koZj
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Rheumatic Immune-related Adverse Effects with Checkpoint Inhibitor Therapy
A retrospective study of patients who developed rheumatic immune-related adverse events (R-irAEs) after receiving immune checkpoint inhibitors (ICIs) at two oncology centers in Spain suggests that early recognition can lead to effective management that allows continuation of cancer therapy.
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Managing Gout in CKD Patients
A current review article addressed the management of gout patients with chronic kidney disease (CKD). This full read review addresses the epidemiology, challenges, treatment decisions and outcomes.
The prevalence of gout rises with each stage of CKD; from 4%, 6% to 10%, 11%
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Prebiotic fibre improves knee OA. Study of 117 older adults w/ KOA Rx w/ 6wks of inulin (fibre) or Physiotherapy exercise (PSE) or both vs PBO. Both Inulin & PSE signif improved pain & PSE vs PBO ( −1.11 to -2.5; p <0.045); inulin also improved pain sensitivity & grip strength https://t.co/Efic4mru1i
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b/ts-DMARDs Do Not Arrest Bone Loss in RA
In RA, the goal is to control or arrest inflammation such that articular and bony damage is halted. While we have many effective therapies, it is not clear that biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) can prevent or improve osteoporosis outcomes in RA. A
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Swiss study of 1st TNFi efficacy in 3324 axial spondy (axSpA) (≤1 yr=very early Dz,441; 1-2 yrs =early axSpA, 218; >2 yrs=establi axSpA, 2575). After adjusting for age/sex, B27, etc, no signif. difference seen when TNFi started regarding later outcomes: TNFi retention, or ASDAS https://t.co/1EaP8UOsVt
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Recent Blogs
Nearly 25 years ago, while lecturing on best therapies for rheumatoid arthritis (RA), I loudly stated that hydroxychloroquine was “useless” and, deservedly, I was “boo-ed” off stage. My point then was that rheumatologists needed to be aggressive, if not overly aggressive, in treating all RA patients. And my view was that HCQ was representative of under-treatment. I have reconsidered the use of HCQ in RA substantially in the last few years, based on its merit.
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I recently overheard a very good practicing rheumatologist complain, “why do I need yet another drug for psoriatic arthritis? I have more treatment choices than I have actual PsA patients who need a new or better drug”.
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