Clinical Rheumatology[JOURNAL]
Sun
200 papers
Disproportionality analysis of pyoderma gangrenosum reporting to the FDA Adverse Event Reporting System in association with antirheumatic biologics.
Woods RH
Clin Rheumatol · 2026 Jun · PMID 42310248 · Publisher ↗
BACKGROUND: Several cases of pyoderma gangrenosum, a rare neutrophilic dermatosis, have been reported in patients initiating biological therapies for rheumatic health conditions. Despite this, systematic analysis across...
BACKGROUND: Several cases of pyoderma gangrenosum, a rare neutrophilic dermatosis, have been reported in patients initiating biological therapies for rheumatic health conditions. Despite this, systematic analysis across available therapies is lacking. This study investigated pyoderma gangrenosum reporting in association with antirheumatic biologics to the US Food and Drug Administration Adverse Event Reporting System (FAERS). METHODS: Reports from FAERS (2016-second quarter of 2025) were complied, deduplicated, and standardized. Pyoderma gangrenosum cases were classified according to the Medical Dictionary for Regulatory Activities. Proportional reporting ratios (PRRs) and 95% confidence intervals (CIs) were calculated to estimate disproportionality for 20 individual antirheumatic biologics from nine pharmacologic classes. RESULTS: During the study period, 13,284,367 adverse events were reported to FAERS, including 1316 pyoderma gangrenosum cases; 868 (65.96%) cases identified an antirheumatic biologic as the primary suspect product. Positive disproportionality signals were detected for 11 study biologics belonging to six pharmacologic classes. All four interleukin (IL)-17 inhibitors exhibited disproportionate pyoderma gangrenosum reporting, with brodalumab (PRR 23.02; 95% CI 8.64-61.36) and bimekizumab (PRR 9.10; 95% CI 4.08-20.29) demonstrating the strongest signals. Positive disproportionality signals were also observed among biologics targeting tumor necrosis factor alpha, IL-6, IL-12/23, IL-23, and CD20. Similar results were obtained in sensitivity analyses. CONCLUSION: Despite its limitations, this hypothesis-generating analysis identified significantly disproportionate pyoderma gangrenosum reporting with several antirheumatic biologics. Clinicians should remain vigilant for these paradoxical reactions in patients undergoing biologic treatment for rheumatic conditions. Key points • Pyoderma gangrenosum has been reported in patients undergoing treatment with biologics for rheumatic indications. • This study analyzed spontaneous postmarketing pyoderma gangrenosum reporting in association with 20 antirheumatic biologics. • Pyoderma gangrenosum disproportionality signals were identified for 11 biologics targeting interleukin (IL)-6, IL-17, IL-12/23, IL-23, CD20, and tumor necrosis factor alpha.
Risk management plan adherence and clinical outcomes in patients receiving targeted therapies.
Wang LF, Li HL, Huang YH … +1 more , Yin CH
Clin Rheumatol · 2026 Jun · PMID 42303880 · Publisher ↗
BACKGROUND: The expanding use of biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) has substantially improved outcomes in autoimmune diseases but is accompanied by complex safet...
BACKGROUND: The expanding use of biologic and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs) has substantially improved outcomes in autoimmune diseases but is accompanied by complex safety concerns. Risk management plans (RMPs) have been introduced to mitigate treatment-related risks; however, real-world adherence to these strategies and their broader clinical impact remain incompletely characterized. METHODS: We conducted a retrospective observational cohort study of adult patients with autoimmune diseases who received bDMARDs, tsDMARDs, or biosimilars at a tertiary medical center in southern Taiwan between October 2014 and December 2023. Patients were classified into RMP and non-RMP groups based on completion of predefined pre-treatment safety assessments within 6 months prior to therapy initiation, including pulmonary and tuberculosis evaluation, viral hepatitis screening, and documentation of cardiovascular and malignancy risk factors. Clinical outcomes included Pneumocystis jirovecii pneumonia (PJP), major adverse cardiovascular events (MACE), treatment-related respiratory adverse events, and all-cause mortality. Multivariable logistic regression and time-to-event analyses were performed to evaluate associations between RMP implementation and clinical outcomes. RESULTS: Among 1,078 patients included, only 348 (32.3%) fulfilled the predefined RMP criteria prior to treatment initiation. Compared with the RMP group, patients without RMP exhibited significantly higher incidences of PJP (11.9% vs. 2.3%), MACE (8.5% vs. 2.6%), treatment-related respiratory adverse events (50.4% vs. 42.8%), and all-cause mortality (7.3% vs. 1.7%) (all p < 0.05). After multivariable adjustment, RMP implementation remained independently associated with lower risks of PJP (adjusted odds ratio [aOR] 0.18, 95% CI 0.15-0.84), MACE (aOR 0.30, 95% CI 0.13-0.71), and all-cause mortality (aOR 0.21, 95% CI 0.07-0.61). Subgroup and time-to-event analyses demonstrated that anti-CD20 therapy was associated with the highest risk of early-onset PJP, MACE, and mortality, with most events occurring within the first three to six months following treatment. DISCUSSION: In real-world clinical practice, adherence to predefined RMPs prior to targeted therapy initiation is suboptimal and is strongly associated with clinically meaningful differences in infectious, cardiovascular, and survival outcomes. These findings suggest that RMP implementation is associated with benefits extending beyond infection prevention and underscore the importance of standardized, consistently applied risk management strategies, particularly for high-risk targeted therapies such as anti-CD20 agents. Key Points • Adherence to predefined risk management plans (RMPs) before initiating biologic or targeted synthetic DMARDs remains suboptimal in real-world practice. • Implementation of RMPs is associated with lower risks of Pneumocystis jirovecii pneumonia, major adverse cardiovascular events, and all-cause mortality. • Lack of structured pre-treatment safety assessment may contribute to early severe complications after therapy initiation. • Anti-CD20 therapy is associated with a higher risk of early adverse outcomes, underscoring the need for careful risk stratification and monitoring.
Quantitative assessment of interstitial lung disease in rheumatoid arthritis.
Bertolazzi C, Silva M, Rojas-Serrano J … +6 more , Ramos-Martínez E, Carnevale A, Sverzellati N, Gutierrez M, Alfaro-Rodriguez A, Ariani A
Reumatol Clin (Engl Ed) · 2026 May · PMID 42303343 · Publisher ↗
BACKGROUND: Interstitial lung disease (ILD) is the most common pulmonary affection of rheumatoid arthritis (RA). Patients with a severe RA-ILD extent i.e. >20% according to chest Computed Tomography (CT) semiquantitative...
BACKGROUND: Interstitial lung disease (ILD) is the most common pulmonary affection of rheumatoid arthritis (RA). Patients with a severe RA-ILD extent i.e. >20% according to chest Computed Tomography (CT) semiquantitative (SQCT) scores, have poor prognosis. Quantitative CT (QCT) assessment with operator independent methods based on free software represents a reliable solution already tested in other ILD related to rheumatic diseases. OBJECTIVES: The main objective of this monocentric study is to verify if in RA-ILD there is a correlation between QCT and SQCT performed by experienced radiologists. Secondary aims are: (a) to explore if there is a difference of QTC indexes (QCTi) in RA-ILD patients with severe vs mild ILD extent; (b) to evaluate the discriminative ability of QCT in identifying severe RA-ILD patients. MATERIALS AND METHODS: The chest CTs of consecutive RA-ILD underwent to a SQCT assessment by two experienced chest radiologists. All CTs were also blindly post-processed by a rheumatologist in order to obtain the QCTi. QCTi correlations, distribution and discriminative ability were, respectively, verified using Spearman rank test, Mann-Whitney test and ROC curves. RESULTS: The majority of QCTi showed a moderate degree (0.40<r<0.59) with SQCT assessment (p-value<0.01). Patients with severe and mild ILD had dissimilar QCTi values (p=0.001). Almost all of QCTi had a good discriminative ability (AUC from 0.73 to 0.81, p-value=0.0001). CONCLUSIONS: These preliminary findings suggest that RA-ILD extent is related to QCTi. Moreover, QCTi can discriminate very well patients with a severe ILD. So, QCTi may become simple tools quickly estimate RA-ILD prognosis.
Smoking, inflammation and joint health: A toxicological perspective in knee osteoarthritis.
Fernández-Torres J, Martínez-Nava GA, Martínez-Villarreal AA … +9 more , Zamudio-Cuevas Y, Hernández-Valencia CG, Torre-Morales CM, Vargas-Sandoval B, Ilizaliturri-Sánchez V, Espinosa-Morales R, Cervantes-Meneses JF, López-Macay A, Martínez-Flores K
Reumatol Clin (Engl Ed) · 2026 May · PMID 42303342 · Publisher ↗
The impact of smoking on osteoarthritis (OA) remains controversial. This study aimed to evaluate the effect of smoking, adjusted for body mass index (BMI) and medication use, on systemic and joint inflammation in patient...
The impact of smoking on osteoarthritis (OA) remains controversial. This study aimed to evaluate the effect of smoking, adjusted for body mass index (BMI) and medication use, on systemic and joint inflammation in patients with knee OA. Peripheral blood (PB), synovial fluid (SF), and histological samples were analyzed from patients stratified by smoking status, pain level (VAS), tobacco index (TI), and use of DMARDs, NSAIDs, and analgesics. IL-1β, IL-6, and TNF-α levels were measured by ELISA. Histological evaluation of extracellular matrix (ECM) used Alcian blue and Safranin O staining. Statistical analyses included ANOVA, Dunn's test, Spearman's and Kendall's correlations, and linear regression adjusted for age and BMI. RESULTS: Smoking OA patients (OA-S) showed significantly higher plasma TNF-α levels compared to non-smokers (OA-NS) (P<0.01), and reduced proteoglycan content (47.15%) compared to former smokers (OA-ExS) (72.74%) (P<0.01). A moderate negative correlation was observed between SF IL-1β and proteoglycans in OA-ExS. In OA-S, plasma TNF-α strongly correlated with SF IL-6 (P<0.05). Plasma TNF-α correlated with pain in OA-S, while IL-1β did so in OA-ExS (P<0.01). BMI positively correlated with SF IL-6 in OA-S (P<0.01). Analgesic and NSAID use were associated with increased plasma TNF-α in OA-S and OA-ExS. Regression models showed that smoking was significantly associated with elevated plasma TNF-α and SF IL-6 levels, independent of BMI and age. CONCLUSION: Smoking, combined with excess weight and medication use, may enhance chronic inflammation and contribute to increased severity of knee OA.
Gender bias in guidelines and recommendations on rheumatology in Argentina: A bibliometric analysis.
Navarro B, Sequeira G, Kerzberg E
Reumatol Clin (Engl Ed) · 2026 May · PMID 42303341 · Publisher ↗
INTRODUCTION: Women constitute the majority in Argentine rheumatology research, but their participation in rheumatology guidelines and recommendations (RGRs) has not been evaluated. OBJECTIVE: To analyze women's represen...
INTRODUCTION: Women constitute the majority in Argentine rheumatology research, but their participation in rheumatology guidelines and recommendations (RGRs) has not been evaluated. OBJECTIVE: To analyze women's representation in RGRs published between 2010 and 2024 that included at least one Argentine rheumatologist. METHODS: Cross-sectional bibliometric study of rheumatology guidelines and recommendations published between January 1, 2010, and December 31, 2024, including at least one rheumatologist affiliated with an Argentine center. Publications were identified through searches in PubMed, the Revista Argentina de Reumatología, and Google Scholar using predefined affiliation-based keywords. The main study variables were author gender, first and corresponding authorship, guideline classification national (NAC) or international (INT), and declared conflicts of interest with the pharmaceutical industry. Descriptive analyses were performed, and group comparisons were conducted using the Mann-Whitney U test and chi-square test. RESULTS: Eighty-seven RGRs were analyzed (79% INT), with a median publication year of 2021. Of 526 authors, 274 (52%) were women. In NAC RGRs, 57% of authors were women versus 43% in INT (p=0.003). Among 25 first authors based in Argentina, 11 (44%) were women; among 12 corresponding authors, 5 (42%) were women. COIs were reported in 24 RGRs, totaling 59 declarations, 37 (63%) from men. CONCLUSIONS: Although women are the majority among Argentine rheumatology researchers, their representation decreases in international publications and leadership roles. Conflicts of interest show a gender bias favoring men.
Don't Miss Vasculitic Myopathy Without Elevated Creatine Phosphokinase.
Yamamoto H, Iwamoto Y
J Clin Rheumatol · 2026 Jun · PMID 42301618 · Publisher ↗
This report describes an 83-year-old woman who presented with subacute fever and lower limb pain and was ultimately diagnosed with vasculitic myopathy due to microscopic polyangiitis (MPA). Notably, the patient had norma...
This report describes an 83-year-old woman who presented with subacute fever and lower limb pain and was ultimately diagnosed with vasculitic myopathy due to microscopic polyangiitis (MPA). Notably, the patient had normal creatine phosphokinase levels despite active muscle involvement confirmed by magnetic resonance imaging and muscle biopsy. Histopathologic findings demonstrated small-vessel vasculitis with fibrinoid necrosis and disruption of the internal elastic lamina. Vasculitic myopathy remains underrecognized, particularly in patients with ANCA-associated vasculitis, as muscle symptoms may occur without creatine phosphokinase elevation.
Leukopenia and systemic features in Sjögren's disease: a retrospective hospitalized cohort study.
Zhu Y, Wang Y, Feng R … +2 more , Jin Y, He J
Clin Rheumatol · 2026 Jun · PMID 42301392 · Publisher ↗
OBJECTIVES: To evaluate the clinical characteristics of leukopenia in hospitalized patients with Sjögren's disease (SjD), particularly its association with systemic organ involvement, immunological activity, and disease...
OBJECTIVES: To evaluate the clinical characteristics of leukopenia in hospitalized patients with Sjögren's disease (SjD), particularly its association with systemic organ involvement, immunological activity, and disease duration. METHODS: This retrospective exploratory study of 200 hospitalized patients with SjD admitted to a tertiary medical center between 2017 and 2023. Patients were divided into leukopenia and normal white blood cell (WBC) groups according to WBC count. Demographic characteristics, hematologic parameters, inflammatory and immunological markers, and systemic organ involvement were compared between groups. Among patients with leukopenia, disease duration was further stratified into tertiles to explore duration-related patterns. Where data are available, multivariable logistic regression should be performed to explore whether leukopenia is associated with selected systemic manifestations after adjustment for disease duration and treatment exposure. RESULTS: Leukopenia occurred in 67 of 200 patients (33.5%). Compared with patients with normal WBC counts, patients with leukopenia had lower hemoglobin and platelet counts. The proportions of interstitial lung disease (ILD), pulmonary hypertension/suspected pulmonary arterial hypertension, peripheral nervous system involvement, and skin, joint, and muscle involvement were not significantly different between the leukopenia and normal WBC groups. In the leukopenia group, however, the prevalence of ILD increased across disease-duration quartiles, from 14.8% in Q1 (≤ 3 years) to 40.7% in Q4 (> 11 years). IgG and erythrocyte sedimentation rate were higher in early-duration leukopenic patients and lower in later-duration strata, suggesting a possible change in inflammatory activity rather than proven immune exhaustion. CONCLUSIONS: In this hospitalized SjD cohort, leukopenia was a common hematologic abnormality but was not significantly associated with most systemic manifestations in direct between-group comparisons. Within the leukopenic subgroup, a higher prevalence of ILD was observed across longer disease-duration strata, a hypothesis-generating finding rather than evidence of progression. These observations warrant validation in prospective longitudinal studies with standardized disease activity assessments, detailed treatment exposure records, and leukocyte subset analyses. Key Points • Leukopenia is common in Sjögren's disease, affecting approximately one-third of patients in this hospitalized cohort. • In leukopenic patients, longer disease duration is associated with a higher prevalence of ILD, an exploratory finding that warrants prospective validation rather than evidence of progression. • IgG and ESR levels decline across disease-duration strata in leukopenic patients, which may reflect duration- or treatment-related immune remodeling and not proven immune exhaustion.
Comments on the proposed diagnostic criteria for Hughes-Stovin syndrome: the role of Behçet syndrome.
Öğüt TS, Yazisiz V
Clin Rheumatol · 2026 Jun · PMID 42301391 · Publisher ↗
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Reply to: Vertebral fractures and b/tsDMARD use in rheumatoid arthritis remission: statistical imprecision and absent fracture history data limit the interpretability of the principal finding.
Yamashita Y, Maeda K, Zenitani A … +1 more , Saito M
Clin Rheumatol · 2026 Jun · PMID 42301390 · Publisher ↗
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Vertebral fractures and b/tsDMARD use in rheumatoid arthritis remission: statistical imprecision and absent fracture history data limit the interpretability of the principal finding.
Choudhuri B
Clin Rheumatol · 2026 Jun · PMID 42301389 · Publisher ↗
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When Rheumatoid Nodules Break the Rules.
Mylona D, Partalidou S
J Clin Rheumatol · 2026 Jun · PMID 42301319 · Publisher ↗
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Salivary Gland Ultrasounds Can be Read by General Radiologists: A Review of 4 Years of Reports From an Urban Academic Radiology Department.
Dhanaliwala AH, Direnzo DD
J Clin Rheumatol · 2026 Jun · PMID 42301269 · Publisher ↗
OBJECTIVES: Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, a...
OBJECTIVES: Salivary gland ultrasound (SGUS) plays a vital role in diagnosing and monitoring glandular disease activity, including the risk of lymphomagenesis in Sjogren's disease (SjD). Despite the importance of SGUS, access is often limited as rheumatologists do not always have the resources to perform these exams. Radiology, which specializes in image acquisition and interpretation at volume, has the potential to improve access to SGUS for patients undergoing SjD workup. The goal of this study was to evaluate the feasibility of radiology to perform and report SGUS exams. METHODS: A retrospective analysis of SGUS exams completed at a large urban academic radiology department was conducted. Evaluation was limited to SGUS examinations performed after the implementation of a standardized imaging protocol and reporting template for OMERACT (Outcome Measures in Rheumatology) scoring, developed through a collaborative initiative with rheumatology. Data were extracted from the ultrasound Digital Imaging and Communications in Medicine (DICOM) header, and a large language model (LLM) was used to evaluate the study reports. RESULTS: Over a 42-month period, a total of 811 SGUS exams specifically requesting OMERACT scoring of the salivary glands were completed by radiology. The radiology sonographers took an average of 17 minutes to acquire the images, and the exams were reported by 53 different radiologists. The majority of reports (64%) adhered to the template, and OMERACT scores and gland volumes were documented in 87% of reports. CONCLUSIONS: We describe the implementation of a standardized SGUS protocol at a large urban academic health system that includes a wide range of radiologists with diverse experience, demonstrating the ability of radiologists to efficiently and effectively perform SGUS for OMERACT scoring as part of routine care.
Artificial intelligence literacy in fibromyalgia: The inverse gap between informed patients and unprepared clinicians.
Therán-León JS, Otero-Rueda AF
Reumatol Clin (Engl Ed) · 2026 · PMID 42297680 · Publisher ↗
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Causes of biologic therapy withdrawal in patients with rheumatic diseases: An observational cohort study from Southeastern Mexico.
Castillo Ortiz AA, Barrera Rodriguez AA
Reumatol Clin (Engl Ed) · 2026 · PMID 42297679 · Publisher ↗
BACKGROUND AND OBJECTIVE: Biologic therapy withdrawal in inflammatory rheumatic diseases is a frequent event with direct consequences on disease control, safety, and care costs. Real-world data from southeastern Mexico r...
BACKGROUND AND OBJECTIVE: Biologic therapy withdrawal in inflammatory rheumatic diseases is a frequent event with direct consequences on disease control, safety, and care costs. Real-world data from southeastern Mexico remain scarce. The objective of this study was to describe the causes of biologic treatment withdrawal and to explore factors associated with drug survival in patients attending a referral rheumatology clinic in southeastern Mexico. PATIENTS AND METHODS: Observational, retrospective cohort study. The unit of analysis was the biologic treatment episode. After data cleaning, 583 episodes from 426 unique patients were included (mean 1.37 episodes/patient). Kaplan-Meier curves were constructed for treatment line and biologic class; comparisons used the log-rank test (presented descriptively given potential within-patient correlation). A multivariable Cox proportional hazards model was fitted with a cluster-robust sandwich variance estimator grouped by patient. Significance level: p < 0.05. RESULTS: 84.0% of patients were female; median age 51 years (IQR 41-58). Rheumatoid arthritis accounted for 76.7% of episodes and anti-TNF agents for 87.3% of biologic use. A total of 175 withdrawals (30.0%) were recorded. Among episodes with a documented reason, inefficacy was the most frequent cause (n = 134; 84.3%), followed by adverse events (n = 24; 15.1%) and non-medical causes (n = 1; 0.6%). No significant difference in drug survival by treatment line was observed (log-rank p = 0.40). Descriptive differences were observed across biologic classes (log-rank p < 0.001). In the adjusted Cox model, the anti-IL-6 class was associated with lower withdrawal risk (HR 0.14; 95% CI 0.06-0.37; p < 0.001) versus anti-TNF. DISCUSSION AND CONCLUSIONS: In this single-center cohort from southeastern Mexico, inefficacy was the most commonly identified medical cause of biologic withdrawal. Descriptive differences in drug survival were observed across biologic classes, with the most consistent signal in the anti-IL-6 class. These findings are hypothesis-generating and should be confirmed in larger, multicenter registries with more complete covariate adjustment.
Capillaroscopic alterations characterization in patients with primary systemic vasculitis.
Álvarez-Hernández E, Colli-Cortés MB
Reumatol Clin (Engl Ed) · 2026 · PMID 42297678 · Publisher ↗
BACKGROUND: Clinical manifestations in systemic vasculitis may be due to decreased arterial and venous flow because inflammation. There are few studies characterizing the changes in microcirculation in these diseases. Ca...
BACKGROUND: Clinical manifestations in systemic vasculitis may be due to decreased arterial and venous flow because inflammation. There are few studies characterizing the changes in microcirculation in these diseases. Capillaroscopy can help detect changes in the microvasculature. OBJECTIVE: Characterize capillaroscopy alterations in primary systemic vasculitis's patients and associated factors. PATIENTS: Cross-sectional, observational, and comparative study. Thirty-two patients with systemic vasculitis (PGA n = 17, PAM n = 4, AT n = 4, PHS n = 3, PAN n = 2, and others n = 2) and 32 controls matched for age and sex were included. All participants underwent capillaroscopy of eight fingers (2nd to 5th finger of each hand), obtaining at least two images of each finger studied for analysis. RESULTS: No characteristic pattern was found, only nonspecific changes. Avascular areas (84.4% vs. 59.4%, p = .026), microhemorrhages (34.4% vs. 6.3%, p < .005), and neoangiogenesis (34.4% vs. 0%, p < .001) were more frequent in the vasculitis group compared to the control group. The duration of the disease had moderate correlation with capillary density (r = -.31, p = .010) and avascular areas (r = .40, p = .001). VDI had moderate correlation (r = .50, p = .050) with capillary density. Capillary neoangiogenesis correlated with the diagnosis of vasculitis (r = -.40, p = .001) and ischemic lesions (r = .371, p = .003). The factors associated with capillaroscopic changes were: disease activity (BVAS3), cumulative damage (VDI) and presence of ischemic lesions. DISCUSSION AND CONCLUSIONS: The search for capillaroscopic abnormalities in patients with systemic vasculitis may be useful in patients with a history of ischemic lesions and longer disease duration.
Consultation time as a determinant of quality of care and patient safety in rheumatology.
Horta-Baas G
Reumatol Clin (Engl Ed) · 2026 · PMID 42297677 · Publisher ↗
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A pilot study on the efficacy and mechanism of telitacicept in systemic lupus erythematosus with antiphospholipid syndrome.
Gao H, Xing Q, Wang X … +4 more , Yang Q, Wang L, Feng H, Dong J
Clin Rheumatol · 2026 Jun · PMID 42295544 · Publisher ↗
INTRODUCTION: Antiphospholipid syndrome (APS) is a common complication of systemic lupus erythematosus (SLE). Current treatment mainly relies on anticoagulation. Whether telitacicept can reduce antiphospholipid antibodie...
INTRODUCTION: Antiphospholipid syndrome (APS) is a common complication of systemic lupus erythematosus (SLE). Current treatment mainly relies on anticoagulation. Whether telitacicept can reduce antiphospholipid antibodies (aPLs) and its mechanism remain understudied. This study aims to investigate the effect of telitacicept on reducing aPLs and its impact on B lymphocyte subsets in patients with APS secondary to SLE. METHOD: This exploratory, multicenter, prospective, single-arm, pre-post design study enrolled patients with APS secondary to SLE. Subcutaneous telitacicept 160 mg once weekly was added to stable standard therapy, with a 6-month follow-up. Standard treatment included glucocorticoids, hydroxychloroquine, immunosuppressants for SLE, and antiplatelet or anticoagulant therapy for APS. Medication types and doses had remained stable for at least 2 months within the 6 months prior to enrollment. Primary outcome measures included changes in aPLs, B lymphocyte subsets, and incidence of new thrombotic events and adverse reactions. RESULTS: This study enrolled 11 female patients. At 6 months of treatment, anticardiolipin antibodies (aCLs)-IgG/IgM and anti-β2-glycoprotein I antibodies (anti-β2GPI)-IgG/IgM were significantly reduced (P < 0.05). Lupus anticoagulant (LA) showed a decreasing trend but without statistical significance. Total B cells, transitional B cells, and naive B cells decreased significantly. Erythrocyte sedimentation rate (ESR) improved significantly at 6 months. No new thrombotic events or adverse reactions occurred during follow-up. CONCLUSIONS: Telitacicept is associated with a reduction in aPLs levels in patients with APS secondary to SLE, potentially by inhibiting total B cells, transitional B cells, and naive B cells, with a favorable safety profile. Key Points • Telitacicept is widely used for SLE in mainland China. Our study shows it is also effective in SLE patients with APS, filling an evidence gap. • Standard APS therapy does not lower autoantibody levels. Telitacicept reduces aPLs (including aCL and anti-β2GPI), offering a novel immunological strategy. • Our findings suggest telitacicept lowers aPLs by inhibiting B cell differentiation and maturation, providing mechanistic insights into its efficacy in APS secondary to SLE.
Usefulness of F-FDG PET/CT to distinguish polymyalgia rheumatica in elderly patients presenting with myalgia.
Wang J, Li Y, Wang Q … +1 more , He J
Clin Rheumatol · 2026 Jun · PMID 42295543 · Publisher ↗
OBJECTIVES: To describe imaging features of F-FDG positron emission tomography/computed tomography (PET/CT) of polymyalgia rheumatica (PMR) and evaluate their ability to distinguish PMR in elderly patients presenting wit...
OBJECTIVES: To describe imaging features of F-FDG positron emission tomography/computed tomography (PET/CT) of polymyalgia rheumatica (PMR) and evaluate their ability to distinguish PMR in elderly patients presenting with myalgia. METHODS: Ninety-three elderly patients (male 29, female 64, age 66.3 ± 8.7 years) with myalgia underwent F-FDG PET/CT for suspected PMR. Based on final clinical diagnosis, clinical data of PMR patients and other subjects were compared. Diagnostic efficacy of 2012 EULAR/ACR classification criteria was assessed. PET/CT findings were reviewed to define PMR-related metabolic patterns. An imaging score algorithm was developed to discriminate PMR from rheumatoid arthritis (RA), the most common alternative diagnosis. The score algorithm's diagnostic performance was validated in the cohort. RESULTS: Based on final clinical diagnosis, 44 (47.3%) patients were PMR and 49 (52.7%) were other rheumatic disorders. PMR often presented with fever and hip pain and was absent of other joint involvement. The EULAR/ACR classification criteria reached a maximum accuracy of 55.3%. PET/CT consistently demonstrated PMR-related uptake in the interspinous bursae, pubic tendon entheses, and ischial tuberosity bursae; some patients showed giant-cell arteritis (GCA) through abnormal vascular uptake. An 8-item PET/CT score (1 point per criterion) of ≥ 4 distinguished PMR from RA, with 95.5% sensitivity, 85.2% specificity, and 91.5% accuracy. For the entire cohort, a score ≥ 5 achieved 84.1% sensitivity, 94.8% specificity, and 88.2% accuracy. CONCLUSION: F-FDG PET/CT outperformed the EULAR/ACR criteria for early and accurate diagnosis of PMR in elderly individuals with myalgia. Key Points • FDG PET/CT assists in the diagnosis of PMR. • FDG PET/CT achieves higher diagnostic accuracy for PMR than the 2012 EULAR/ACR criteria. • Eight-item PET/CT score distinguishes PMR from RA with 91.5 % accuracy in elderly myalgia.
Upfront low-dose biosimilar rituximab as first biologic therapy after triple csDMARD failure in seropositive rheumatoid arthritis: a prospective real-world strategy study.
Parrey A, Lakshman A, Ismail M … +2 more , Ashraf M, Khan A
Clin Rheumatol · 2026 Jun · PMID 42287541 · Publisher ↗
INTRODUCTION: Limited access to biologic disease-modifying antirheumatic drugs (bDMARDs) in resource-constrained settings influences treatment sequencing after failure of conventional synthetic DMARDs (csDMARDs). Evidenc...
INTRODUCTION: Limited access to biologic disease-modifying antirheumatic drugs (bDMARDs) in resource-constrained settings influences treatment sequencing after failure of conventional synthetic DMARDs (csDMARDs). Evidence regarding upfront use of low-dose rituximab as first biologic therapy remains limited. This study aimed to evaluate the effectiveness and steroid-sparing potential of upfront low-dose biosimilar rituximab in biologic-naïve patients with seropositive rheumatoid arthritis refractory to maximally tolerated triple csDMARD therapy. METHODS: This prospective single-centre observational study included biologic-naïve anti-CCP-positive rheumatoid arthritis patients with inadequate response to ≥ 6 months of methotrexate, hydroxychloroquine, and sulfasalazine. Patients received two infusions of biosimilar rituximab (500 mg each) administered 2 weeks apart while continuing background csDMARDs. Disease activity was assessed using DAS28-ESR at baseline and weeks 2, 6, 12, and 24. Longitudinal changes were analyzed using Friedman and Wilcoxon signed-rank tests. RESULTS: Seventy-five patients (88% women) were included. Mean DAS28-ESR decreased from 5.57 at baseline to 2.78 at week 24 (p < 0.001), with a median reduction of 2.7 points. Remission rates increased from 0% to 50.7% at 24 weeks. Mean tender joint count declined from 9.43 to 1.33 and swollen joint count from 4.43 to 0.37. All patients discontinued corticosteroids during follow-up. Infusion reactions were mild, and no mortality occurred. CONCLUSIONS: Upfront low-dose biosimilar rituximab as first biologic therapy achieved significant and sustained disease activity reduction with high remission rates and successful steroid withdrawal, supporting a rituximab-first strategy in resource-limited public health settings. Key Points • Upfront low-dose biosimilar rituximab (500 mg × 2) significantly reduced disease activity in biologic-naïve, seropositive rheumatoid arthritis after triple csDMARD failure. • Mean DAS28-ESR decreased from 5.57 to 2.78 at 24 weeks, with 50.7% of patients achieving remission. • All patients discontinued corticosteroids, and 50% discontinued both sulfasalazine and hydroxychloroquine during follow-up.
Associations of cardiovascular health and genetic susceptibility with incident psoriatic arthritis: findings from two cohort studies.
Li P, Wang X, Tang B … +5 more , Gu P, Chen G, Mao X, Xiao T, Li H
Clin Rheumatol · 2026 Jun · PMID 42286265 · Publisher ↗
INTRODUCTION: Psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, may be influenced by cardiovascular health (CVH). This study aims to investigate the associations between three CVH score...
INTRODUCTION: Psoriatic arthritis (PsA), a chronic inflammatory disease associated with psoriasis, may be influenced by cardiovascular health (CVH). This study aims to investigate the associations between three CVH scores (Life's Simple 7 (LS7), Life's Essential 8 (LE8), and Life's Crucial 9 (LC9)) and a psychological health (PH) score with PsA risk and potential interactions with genetic susceptibility. METHODS: Using data from the UK Biobank and NHANES cohorts, we conducted prospective and cross-sectional analyses employing Cox proportional hazards and multivariable logistic regression models, respectively. Additionally, a polygenic risk score (PRS) was derived in the UK Biobank to quantify genetic susceptibility to PsA and examine its interactions with CVH and PH metrics. RESULTS: Higher scores in LE8, LC9, and PH showed consistent inverse associations with PsA, with the most pronounced association observed for LC9. Higher LC9 scores showed a strong inverse association with PsA (highest vs lowest group: OR = 0.25 (95% CI 0.05, 0.86), HR = 0.20 (95% CI 0.06, 0.65)). Each 10-point LC9 increase corresponded to lower PsA risk (OR = 0.76 (95% CI 0.58, 0.98), HR = 0.68 (95% CI 0.54, 0.86)). Genetic risk (assessed as the inverse of the PRS) showed significant antagonistic interactions with LE8, LC9, and PH scores. CONCLUSION: Inverse associations were observed between LE8, LC9, and PH scores and PsA risk, along with notable interactions with genetic predisposition. Key Points • Higher LE8, LC9, and PH scores showed inverse associations with PsA. • LC9 showed the strongest inverse association with PsA in both cohorts. • Genetic susceptibility showed antagonistic interactions with LE8, LC9 and PH scores.
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