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Rheumatology
2nd Dec, 2025
The Lancet
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.
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.
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.
Pediatrics
18th Nov, 2025
Journal of the American Medical Association
Over the past 150 years, US government leaders have slowly but surely expanded access to health insurance and medical care for children. The Medicaid program represents federal and state governments’ largest commitment to financing health care for children from low-income families and children with chronic medical conditions. In 2025, we took a big step, potentially backward. The recent One Big Beautiful Bill Act (OBBBA) will challenge states to maintain coverage for vulnerable children and families and stretch health systems to their limits. The legislation may also create the conditions for greater experimentation and ultimately a more comprehensive system of care for children’s health in the US.
Psychiatry and Behavioral Health
In March 2025, the National Institutes of Health (NIH) announced that it would be terminating $1.8 billion in grant funding unaligned with the agency’s priorities. The proportion of grant funding that was terminated varied substantially across institutes, with 0.5% of grant funds terminated at the National Heart, Lung, and Blood Institute, 2.3% of funds at the National Cancer Institute, and approximately 6% at the Institutes focusing on alcohol, mental health, and infectious disease. The NIH supports a broad array of research programs and funding mechanisms, and these prior analyses provided an important high-level view. However, clinical trials deserve close scrutiny, in that they expose patients to risks and are essential to generating high-quality evidence. In this issue of JAMA Internal Medicine, Patel et al address a key knowledge gap by characterizing NIH terminations of grants that supported ongoing clinical trials. They found that in the first half of 2025, the NIH terminated grants supporting 383 unique clinical trials, affecting 74 311 individuals.
General Medicine
Community-acquired pneumonia is a major global health challenge that disproportionately affects vulnerable populations, including older people, immunocompromised people, those with chronic conditions, and young children. Once considered solely an acute illness, community-acquired pneumonia is now recognised as a disease with long-term complications, including cardiovascular events, respiratory impairment, and cognitive decline. Advances, such as nucleic acid amplification tests (NAATs) and the broader availability of point-of-care lung ultrasound, allow for rapid pathogen detection and personalised treatment.
STELLAR-303 is the first phase 3 trial to show a significant improvement in overall survival with an immunotherapy-based regimen, zanzalintinib–atezolizumab, in patients with relapsed or refractory metastatic colorectal cancer that is not MSI-H or dMMR. This combination represents a chemotherapy-free treatment option with a novel mechanism of action for heavily pretreated patients in need of improved therapies.
The VENUSCANCER project provides the first global picture of patterns of care for three of the most common cancers in women. These findings offer crucial real-world evidence to support the implementation and monitoring of global initiatives on cancer control such as WHO's Global Breast Cancer Initiative and Cervical Cancer Elimination Initiative. Although guideline-consistent treatment has become more accessible for women diagnosed with early-stage tumours in LMICs, the proportion of these women diagnosed early remains far too low.
Patel PD, Liang Y, Meiring JE, et al. Efficacy of typhoid conjugate vaccine: final analysis of a 4-year, phase 3, randomised controlled trial in Malawian children. Lancet 2024; 403: 459–68—In this Article, in table 3, the third year Vi-TT incidence rate should have been 21·4 (95% CI 6·9–66·3). This correction has been made to the online version as of Nov 13, 2025.
Alcorn T. In Timor-Leste, even modest cuts in US foreign aid add up. Lancet 2025; 406: 1937–38—In this World Report, the name of the president of World Neighbors should have been given as Kate Schecter, and their project is operating in Timor-Leste and Indonesia. This change has been made to the online version as of Nov 4, 2025.
We wish to point out some major issues with Abdel-Fattah and colleagues’ FUTURE study.1 Surprisingly, substantial key information is not found in the main text, but in the supplementary appendix of the study.1 Based on previous reports, sample size analysis assumed a 60% success rate in the control group, but the actual success rate of the primary outcome in the trial was below 25% in both arms. This finding suggests that the selection mechanisms for trial enrolment identified a sample that was less likely to respond to treatment.
We read with interest the FUTURE study by Mohamed Abdel-Fattah and colleagues, which reported on the role and cost-effectiveness of urodynamic testing in women with refractory overactive bladder compared with comprehensive clinical assessment without urodynamics.1 We commend the authors for diligently performing a robust randomised controlled trial on 1099 patients, with a high-quality control for the urodynamic traces. However, although this study is of considerable relevance in changing clinical practice, we do not believe that this study will mark the end of urodynamic testing in the evaluation of patients with refractory overactive bladder symptoms.
We appreciate the comments raised by Shirin Heidari and colleagues about the need for better reporting of sex and gender considerations in randomised trials. We agree that these participant characteristics can have important implications for the planning, execution, analysis, and reporting of trials. We also thank Shirin Heidari and colleagues for the invitation to collaborate and agree that it would be useful to explore the development of supplements to the Sex and Gender Equity in Research (SAGER) and Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2025 reporting guidelines, particularly with regard to promoting trial representativeness across key sociodemographic variables1 and facilitating reliable secondary analysis of data.
We welcome the revised Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2025 guidelines published in The Lancet and commend the efforts to enhance transparency and rigour in clinical trial protocols.1,2 Accurate and transparent reporting is fundamental to ensuring the validity of clinical trial findings, enhancing reproducibility and clarifying the generalisability of results across diverse populations.3 The updated SPIRIT guidelines introduce several important improvements, including clearer definitions of protocol contributors and strengthened guidance on data sharing and trial registration, which move us towards greater transparency and accountability in clinical research.
Undiagnosed and uncontrolled hypertension remains one of the most important preventable causes of heart attack, stroke, chronic kidney disease, and dementia. In 2024, an estimated 1·4 billion people aged 30–79 years were living with hypertension worldwide, yet fewer than one in five had the condition adequately controlled.1,2 The economic toll is severe and increasing with demographic changes, with cardiovascular diseases projected to cost low-income and middle-income countries US$3·7 trillion between 2011 and 2025—around 2% of the gross domestic product of these countries.
Medical News
15th Jan, 2026
phys.org
Regional Health – Americas
Medical Journal
Wiley
