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[Personal View] Exploiting a unified vascular framework to predict organ-specific complications and accomplish disease modification in systemic sclerosis

Immune-mediated vascular endothelial injury is considered one of the earliest pathological features in systemic sclerosis and is thought to occur simultaneously within a broad range of organs, although typically clinically manifesting only as Raynaud's phenomenon in the early stages. Overt vascular systemic sclerosis manifestations include Raynaud's phenomenon, abnormal nailfold capillary morphology, digital ulcers, pulmonary arterial hypertension, cardiovascular disease (primary and coronary), telangiectasia, renal crisis, and gastric antral vascular ectasia.

[Articles] Risk factors for interstitial lung disease in early rheumatoid arthritis and external validation of screening strategies: a cross-sectional analysis of the prospective SAIL-RA cohort in the USA

In this population with early rheumatoid arthritis, 11% had rheumatoid arthritis-associated ILD. Moderate or high disease activity and age of 60 years or older were strongly associated with rheumatoid arthritis-associated ILD in early rheumatoid arthritis. Several proposed screening strategies using factors routinely available at the point of care showed promise for detecting rheumatoid arthritis-associated ILD in early rheumatoid arthritis.

[News] The Nobel celebrates tolerance

On Oct 6, 2025, the Nobel Prize in Physiology or Medicine was awarded to Mary Brunkow, Fred Ramsdale, and Shimon Sakaguchi for their discoveries around the mechanisms governing peripheral immune tolerance. Not only did their work uncover a fundamental facet of human health, it also solved a decades-old genetic mystery and breathed new life into a long-abandoned immunological concept. Whether these discoveries are now poised to transform treatment for patients with autoimmune rheumatic diseases remains to be seen.

[News] Research in Brief

Ghaith Noaiseh and colleagues assessed the safety and efficacy of nipocalimab, a neonatal Fc receptor blocker that reduces circulating IgG, in patients with Sjögren's disease in a phase 2 trial. 163 patients were randomly assigned (1:1:1) to receive intravenous nipocalimab 5 mg/kg (n=53), intravenous nipocalimab 15 mg/kg (n=54), or placebo (n=56), every 2 weeks for 22 weeks. At week 24, the change in Clinical EULAR Sjögren's Syndrome Disease Activity Index score from baseline (primary outcome) was –3·74 (90% CI –4·74 to –2·75) in the placebo group versus –6·40 (–7·43 to –5·36) in the nipocalimab 15 mg/kg group (least squares mean difference –2·65 [–4·03 to –1·28]; p=0·0018) and –4·08 (–5·10 to –3·07) in the nipocalimab 5 mg/kg group (least squares mean difference from placebo –0·34 [–1·71 to 1·03]; p=0·68).

[Corrections] Correction to Lancet Rheumatol 2025; 7: e747

The Lancet Rheumatology. Psoriatic arthritis: strategy shaping treatment. Lancet Rheumatol 2025; 7: e747—In this Editorial, in the third sentence of the third paragraph and in the margin link, the trial name should have read “TICOPA”. Additionally, the final sentence of the fifth paragraph should have read “While GRAPPA distinguishes between complex-to-manage and treatment-refractory disease, EULAR defines difficult-to-manage psoriatic arthritis as persistent disease despite optimal therapy and problematic disease burden by the patient or clinician.” These corrections have been made as of Oct 29, 2025.

[Correspondence] Anti-BCMA CAR-T for the treatment of IgG4-related disease: clinical assessment and single-cell transcriptomic analysis

IgG4-related disease is an autoimmune disease entity with high relapse rate during and after glucocorticoid tapering, in which B cells and their deriving antibody-secreting cells exert important pathogenic effects.1 Despite several attempts of conventional immunosuppressants and B cell-targeting biologics to help reduce the risk of disease flares, there are still a number of individuals with disease relapse even within the first 6 months after treatment initiation.2,3 The successful application of chimeric antigen receptor (CAR)-T-cell therapy in treating several autoimmune diseases in those who have completely stopped immunosuppressant and glucocorticoid use implies its potential in managing IgG4-related disease.

[Comment] Revisiting safety and refining benefit of rituximab–belimumab combination for refractory SLE

B-cell depletion using rituximab is used to treat systemic lupus erythematosus (SLE), particularly for patients whose disease is refractory to conventional immunosuppressants (eg, mycophenolate), and is included in guidelines for the management of SLE, including lupus nephritis.1 In one study, SLE was the most common diagnosis for off-label use of rituximab.2 Rituximab is now off patent, and acquisition costs are lower than other advanced therapies for SLE, facilitating its availability for patients.

[Comment] Can AI be used to classify the focus score in Sjögren's disease?

Sjögren's disease is a rheumatic disorder evidenced predominantly by exocrine gland-impairment that disproportionally affects women. The gold-standard diagnostic tool includes a microscopic evaluation of the minor salivary gland biopsy. Characteristically, a biopsy is considered positive for Sjögren's disease if the number of lymphocytic aggregates comprising at least 50 mononuclear inflammatory cells per 4 mm2 of glandular tissue (focus score) exceeds one. However, interpreting the focus score accurately requires expertise found in a limited number of diagnostic laboratories.

[Comment] ILD risk prediction in routine care for rheumatoid arthritis

Rheumatoid arthritis-associated interstitial lung disease (ILD) is one of the most serious extra-articular manifestations of rheumatoid arthritis, being strongly associated with increased morbidity, mortality, and health-care costs. The possibility of ILD should be systematically considered both at initial evaluation and throughout longitudinal follow-up of patients with rheumatoid arthritis. Rheumatologists play a key role in screening for rheumatoid arthritis-associated-ILD, as early recognition and assessment are essential to ensure timely treatment and limit disease progression.

[Comment] Modelling allopurinol-induced severe adverse cutaneous reactions

Severe adverse cutaneous reactions, including Stevens–Johnson syndrome, drug rash with eosinophilia and systemic symptoms, and toxic epidermal necrolysis, are serious and life-threatening but fortunately rare adverse events associated with allopurinol. Although the incidence of allopurinol-induced severe adverse cutaneous reactions is low (estimated 0·69 cases per 1000 person-years),1 the resulting substantial morbidity and mortality mean any reasonable steps to prevent occurrence of severe adverse cutaneous reactions should be implemented.

[Editorial] The stark reality of living with arthritis in the UK

Arthritis takes a substantial toll, affecting every aspect of daily life. This is the message of Left Waiting, Left Behind: The Reality of Living with Arthritis, a survey from Arthritis UK (formally Versus Arthritis), capturing the lived experience of almost 8000 people with arthritis in the UK. Two-thirds live with persistent pain; a third report severe interference with daily life. The psychological impact of arthritis is striking; in the past 12 months, three-quarters of respondents felt low or anxious some or all of the time.

Mediterranean Diet May Offer Psoriasis Benefits

Extra virgin olive oil, plant-based foods, and moderate meat consumption may help with psoriasis, according to a recent study published in JAMA Dermatology. The randomized clinical trial found that a 16-week Mediterranean diet reduced psoriasis severity, possibly due to anti-inflammatory benefits. Current psoriasis dietary advice focuses on weight loss for patients who are overweight, but these findings suggest an option for all patients.

[Clinical Picture] Coronary polyarteritis nodosa

A 36-year-old woman had dyspnoea on exertion with intermittent chest tightness that occurred during and outside of exertion. She did not disclose any systemic diseases and there was no family history of cardiovascular or pulmonary conditions. An electrocardiogram done during a treadmill test showed ST segment depression without atypical serum concentrations of creatinine kinase or troponin I. A coronary CT angiography showed a so-called rosary-bead appearance and luminal irregularity with ectatic changes over the coronary arteries (figure A–C).

[Review] Synovial immunopathology in psoriatic arthritis: cellular and molecular insights

Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis.

[Articles] Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial

Treatment sessions of CFT produced sustained effects at 3 years for people with chronic disabling low back pain. These long-term effects are novel and provide the opportunity to markedly reduce the effect of chronic back pain if the intervention can be widely implemented. Implementation requires scaling up of clinician training to increase accessibility and replication studies in diverse health-care systems.