Lupus arthritis is the most common manifestation of systemic lupus erythematosus (SLE), affecting up to 95
Rheumatoid arthritis (RA) is a systemic rheumatic disease that often impacts women of childbearing age. Women and men with RA experience higher rates of subfertility compared to the general population. Disease activity, treatment, psychosocial concerns, and sexual dysfunction contribute to subfertility, delayed childbearing, and reduced family size in the RA population. Assisted reproductive technology (ART) procedures are safe and effective options for patients who experience subfertility or are interested in preserving future fertility while continuing pregnancy-incompatible medications. Women with RA also experience increased risk of various adverse pregnancy outcomes compared to the general population, including preterm delivery and having small-for-gestational-age infants. Achieving well-controlled disease on pregnancy-compatible medications prior to conception optimizes maternal and neonatal outcomes. For patients with childbearing potential taking teratogenic medication, contraception is important; there are no RA-specific contraindications to the use of hormonal birth control. Sexual and reproductive health care for women and men with RA requires a multidisciplinary, patient-centered approach. Future studies are needed to elucidate mechanisms of impaired fertility and adverse pregnancy outcomes in RA, to investigate the safety of non-tumor necrosis factor inhibitor biologic disease‑modifying antirheumatic drugs (non-TNFi bDMARDs) during pregnancy and lactation, and to illuminate patient perspectives and priorities regarding their reproductive health across the lifespan.
This study assessed pharmacokinetics and safety of subcutaneous (SC) belimumab in Chinese paediatric patients with systemic lupus erythematosus (cSLE) who previously received intravenous (IV) belimumab; only the IV form is approved for cSLE in China. This single-arm, open-label, 12-week bridging study (GSK Study 217091) characterised belimumab 200 mg SC exposure in Chinese paediatric patients (5–17 years) with cSLE who completed the 48-week IV belimumab Phase 4 trial (GSK Study 213560). Safety and tolerability of SC belimumab on-treatment and in a 16-week follow-up period were also assessed. Patients were categorised based on weight; data were summarised using descriptive statistics. Overall, 16 patients were enrolled (≥ 15– < 30 kg, n = 1; ≥ 30– < 50 kg, n = 5; ≥ 50 kg, n = 10) with a mean age of 12.9 years. The geometric mean approximate Cmax (3 days post-administration) after the first and last dose were 92.44, 63.41 and 68.87 μg/mL, and 28.01, 85.11 and 88.61 μg/mL for the three weight groups, respectively. The geometric mean Ctrough at steady state were, 20.44, 71.57 and 85.55 μg/mL for the ≥ 15– < 30 kg, ≥ 30– < 50 kg and ≥ 50 kg weight groups, respectively. Thirteen patients (81
FILOSOPHY (NCT04871919) and PARROTFISH (NCT05323591) are ongoing, prospective observational European phase 4 studies of filgotinib in patients with rheumatoid arthritis (RA) in a real-world setting. We report the study design, baseline characteristics, and interim results for disease activity measures, patient-reported outcomes (PROs), and treatment persistence up to 6 months and safety up to 24 months. Eligible patients had moderate to severe RA and were prescribed filgotinib for the first time in daily practice. In this interim analysis, measures include the proportion of patients achieving low disease activity (LDA), according to Disease Activity Score for 28 joint count using C-reactive protein (DAS28-CRP) or Clinical Disease Activity Index (CDAI), and the proportion achieving a clinically meaningful change from baseline in visual analog scale (VAS) pain (≥ 10 mm reduction) and in Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue score (≥ 4.0 increase). Treatment persistence was estimated using the Kaplan–Meier method. Treatment-emergent adverse events (TEAEs) are reported. From May 2021 to April 2025, 1431 patients initiated filgotinib treatment; 93.0
Minimal disease activity (MDA) is a composite tool used to measure disease state in psoriatic arthritis (PsA), but its longitudinal stability across individual domains remains insufficiently understood. We aimed to investigate domain-specific instability of MDA components over time in patients with fluctuating disease states. This post hoc analysis of a real-world longitudinal cohort included patients with PsA treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (bDMARDs or tsDMARDs) who exhibited fluctuating trajectories over 24 months. MDA was assessed at 6-month intervals across seven domains. For each domain, an instability score (IS) was calculated as the number of transitions across the MDA cutoff between consecutive visits. Domains were also grouped into objective, tenderness-based, and subjective categories. Longitudinal instability patterns were analyzed and compared across domains. Among 289 patients in the parent cohort, 107 (37.0
Persistence to therapy to treat rheumatoid arthritis (RA) is an indirect measure of tolerability and effectiveness in the real-world setting. Previous clinical trials suggested that seropositive patients with RA may particularly benefit from abatacept. The risk of non-persistence after initiating abatacept, tumor necrosis factor inhibitors (TNFi), and Janus kinase inhibitors (JAKi) as first-line biologic or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) was examined. We utilized the 100
Patients with rheumatoid arthritis (RA) often fail to achieve treatment targets with first-line treatment because of poor efficacy or tolerability. However, comparative long-term adherence and switching data among patients initiating a second-line therapy after a first-line tumor necrosis factor inhibitor (TNFi) remain limited. Retrospective data were from the Merative MarketScan® claims database, August 2018–October 2024. Eligible patients were aged ≥ 18 years; diagnosed with RA; initiated upadacitinib (UPA), tofacitinib (TOF), adalimumab (ADA), etanercept (ETA), abatacept (ABA), or tocilizumab (TOC); and had discontinued a first-line TNFi within 12 months prior to index. Treatment adherence and switching outcomes were reported at 1- and 3-year follow-up. Overall, 3782 and 1182 patients were included for the 1- and 3-year analyses, respectively. The proportion of patients with adherence ≥ 80
The indications, dosage, and duration of systemic corticosteroid treatment may vary among pediatric rheumatologists (PRs) and adult rheumatologists (ARs) in daily clinical practice. This study aims to evaluate and compare practices, perceptions, and attitudes of PRs and ARs regarding the use of systemic corticosteroids. An online survey was administered to rheumatologists in Türkiye to assess their use of systemic corticosteroids in the management of rheumatic diseases. The questionnaire addressed preferred corticosteroid formulations, dosing and tapering strategies, monitoring and preventive measures for adverse effects, and vaccination practices. Sixty PRs and 40 ARs participated in the study. Prednisolone was most commonly preferred by PRs while almost all ARs used methylprednisolone. Weight-based dosing was favored by PRs whereas ARs preferred fixed-dose regimens. PRs more frequently preferred longer pulse corticosteroid therapy, whereas ARs most commonly used a 3-day pulse regimen. In contrast, ARs reported significantly longer durations of bridging and maintenance therapy. Delirium was reported significantly more often by ARs as a complication (p = 0.026). In pre-treatment evaluation, PRs more commonly assessed peripheral blood smear (p < 0.001) whereas ARs more frequently screened for hepatitis serology (p = 0.014). As preventive strategies, PRs were significantly more likely to request ophthalmologic examination (p = 0.005). Immunization assessment for meningococcal, measles—mumps—rubella, and varicella vaccines was significantly more common among PRs (p > 0.005, for all). Significant heterogeneity exists between PRs and ARs in systemic corticosteroids practices, highlighting the need for age-specific standardized protocols for dosing, preventive strategies, and complication monitoring. Graphical abstract available for this article.
Rheumatic diseases (RDs) significantly impact patients’ physical, psychological, and social well-being, yet psychological dimensions remain inadequately addressed in routine clinical practice. In this commentary, we examine psychological manifestations and mental health comorbidities in RDs, such as systemic lupus erythematosus, systemic sclerosis, Sjögren’s disease, vasculitis, rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, axial spondyloarthritis, osteoarthritis, and fibromyalgia. Patients demonstrate high rates of depression (up to 90
IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition that can cause irreversible organ dysfunction and life-threatening complications. Although glucocorticoids are the standard first-line therapy, frequent flares necessitate prolonged use, which is in turn associated with toxicity. Inebilizumab, a CD19-targeted antibody approved in Japan in November 2025, demonstrated efficacy in the phase 3 MITIGATE trial. However, the trial’s eligibility criteria and controlled environment may not reflect the heterogeneity of the routine clinical setting or the long-term profile in the Japanese population. This study (4SigHT Study) aims to evaluate the long-term effectiveness and safety of inebilizumab in Japan. This multicenter, prospective, observational study plans to enroll 100 patients with definite or probable IgG4-RD who are initiating inebilizumab at up to 40 sites in Japan. The study runs from March 1, 2026 to March 31, 2032. It includes up to 14 scheduled visits over a maximum duration of 312 weeks and reflects real-world decisions without mandated interventions. Comprehensive baseline assessments capture disease characteristics, comorbidities, vaccination history, and clinical history, including the frequency and nature of flares over the preceding 52 weeks. Longitudinal data are collected via an electronic data capture system. To ensure data robustness, the study employs a rigorous adjudication process. Suspected flares treated by investigators are adjudicated by an independent data and safety monitoring board using standardized organ-specific flare criteria. The primary outcome is the proportion of participants with an adjudicated clinical flare through week 52. Secondary outcomes include treatment-free complete remission, glucocorticoid-free complete remission, time to clinical flare, annual clinical flare rate, proportion of patients who initiate additional treatment, time to treatment initiation for new or worsening symptoms, and cumulative glucocorticoid dose. Furthermore, the study evaluates the long-term safety of inebilizumab over 6 years. The study is registered with the Japan Registry of Clinical Trials (jRCT1031250749).
This study aimed to evaluate the diagnostic performance of optical spectral transmission (OST) in patients with hand osteoarthritis (OA) and to assess its associations with clinical findings, joint ultrasound (US) markers of active OA, and patient- and disease-related characteristics. In this exploratory pilot study, consecutive patients with OA and healthy controls underwent OST measurements using the HandScan® device. Clinical examinations and inflammatory markers (C-reactive protein, erythrocyte sedimentation rate) were obtained. A subset of patients underwent standardized joint US [greyscale (GSUS)/power Doppler (PDUS)]. Correlations between OST and clinical, anthropometric and US parameters were examined, and receiver operating characteristics (ROC) assessed discriminative ability. Linear regression was used to evaluate confounding effects. A total of 2910 joints of 97 patients with OA were examined via OST and compared to 3300 joints of 100 control subjects. OST values were significantly higher in patients with OA than in controls (10.39 ± 1.82 vs. 7.51 ± 3.80; p < 0.001), and this difference remained significant after adjustment for potential confounders (β = 1.698; 95
We conducted a systematic review on the epidemiology, clinical presentation, pathophysiology, treatment, and prognosis of clinically amyopathic dermatomyositis (CADM). A qualitative systematic review was performed from October 1988 to January 2026 according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines, using seven electronic databases: PubMed, Web of Science, EMBASE, Virtual Health Library, PsycInfo, Scopus, and the Cochrane Library. Studies were eligible if at least one combination of search terms appeared in the title, were written in English, Portuguese, or Spanish, and addressed the epidemiology, pathogenesis, diagnosis, or treatment of CADM. Systematic reviews, theses, dissertations, letters, editorials, studies with unclear methodology, and articles addressing classic or paraneoplastic dermatomyositis were excluded. A total of 106 studies comprising 816 patients were included. CADM is more frequent among females and most prevalent in the fifth and sixth decades of life. The most common cutaneous findings were Gottron’s signs, heliotrope rash, and the V-neck sign. Interstitial lung disease (ILD) was the most frequent extracutaneous, extramuscular manifestation. Elevated ferritin, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels were common. The most frequent autoantibodies were anti-MDA-5 (Anti-Melanoma Differentiation-Associated gene 5) and anti-Ro-52. Treatment most often combined pulse glucocorticoids with human immunoglobulin, cyclophosphamide, rituximab, or cyclosporine. Poorer prognosis was associated with higher ferritin, CRP, and LDH levels, and with the presence of ILD. CADM is a serious, complex disease with a distinct clinical and serological profile, requiring further conceptual refinement and multicenter studies to better characterize this DM phenotype.
Interstitial lung disease (ILD) is a progressive fibrotic condition that markedly reduces survival and increases mortality in patients with rheumatoid arthritis (RA). Dysregulated lipid metabolism is associated with the progression of both RA and ILD. However, its relationship with the risk of ILD in the RA population remains uncertain. This study aimed to determine the association between lipid traits and incident ILD in an RA population, as well as the mediating role of systemic inflammation. This prospective cohort study included 4229 UK Biobank participants with RA and no baseline ILD. Cox proportional-hazards models were used to investigate the association between six lipid traits and ILD risk. Systemic inflammation was estimated using the INFLA-score. Generalized structural equation modeling was employed to investigate the mediating effect of the INFLA-score on the relationship between lipid traits and ILD incidence. After a mean follow-up of 14.736 years, 152 incident ILD cases were recorded. High serum levels of apolipoprotein A (ApoA) and high-density lipoprotein cholesterol (HDL-C) were independent protective factors against incident all-cause ILD in RA, associated with a 61.5
Health-related quality of life (HRQoL) is a critical patient-reported outcome in systemic lupus erythematosus (SLE). We aimed to evaluate longitudinal trajectories of HRQoL and identify associated clinical and demographic determinants. This longitudinal cohort study included 1005 patients with SLE from the Asia Pacific Lupus Collaboration. HRQoL was assessed using the Short Form-36 (SF-36) at baseline, 12, and 24 months. Disease activity and organ damage were recorded using validated composite indices (SLEDAI-2 K and SLICC damage index). Generalized estimating equations (GEE) analyzed longitudinal trajectories of Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. Among 915 women (91.0
Fatigue is a prevalent and disabling symptom in Sjögren’s disease (SjD), yet its pathogenesis remains poorly understood and inadequately managed. This narrative review addresses a critical gap in knowledge by conceptualizing SjD-related fatigue as a bidimensional phenomenon driven by both biomedical and psychosocial mechanisms, and framed within the model of persistent somatic symptoms (PSS). In this narrative review, findings from immunology, neuroendocrinology, psychology, and clinical research were synthesized to examine predisposing, triggering, and maintaining factors contributing to SjD-related fatigue. Particular attention was given to studies exploring immune dysregulation, neuroimmune signaling, autonomic imbalance, and psychological traits. Findings indicate that biomedical contributors—such as pro-inflammatory cytokine (e.g., interleukin [IL]-1β, IL-36α), neuroendocrine dysfunction, dysbiosis, and genetic predispositions—interact with psychosocial vulnerabilities, including early-life adversity, personality profiles, maladaptive coping strategies, and mood disorders. These interactions foster self-reinforcing loops of symptom persistence. Notably, current treatments targeting isolated domains yield limited success. Nonetheless, integrated strategies—ranging from biologics and cytokine modulators to exercise, cognitive behavioral therapy, and neuro-modulatory interventions—have demonstrated promise, particularly when aligned with the PSS framework. This narrative review underscores the need for a paradigm shift in fatigue management, advocating for multidimensional assessment and personalized, multimodal interventions. By illuminating the duality of SjD-related fatigue, this narrative review provides a roadmap for more effective diagnosis, research, and patient-centered care.
C-reactive protein (CRP) predicts radiographic progression in radiographic axial spondyloarthritis (r-axSpA). Normal CRP levels have been associated with reduced response to tumor necrosis factor inhibitor treatment. Ixekizumab (IXE) has demonstrated effectiveness in smaller patient groups stratified by CRP at baseline. This pooled analysis aims to demonstrate efficacy stratified by CRP across a broader population. This post hoc analysis pooled biologic-naïve patients with r-axSpA from two phase III trials: COAST-V (N = 168) and NCT04285229 (N = 130), with participants receiving IXE 80 mg every 4 weeks or placebo for up to 52 weeks. Analyses evaluated outcomes in patients stratified by CRP at baseline (≤ 5 mg/L or > 5 mg/L). A second analysis subgrouped patients based on magnetic resonance imaging (MRI)-detected inflammation in the spine or sacroiliac joints (SIJ). Baseline characteristics were comparable between normal (N = 105 [35.2
Obesity and knee osteoarthritis (KOA) are prevalent conditions that significantly impact public health and healthcare costs. We aimed to quantify the economic burden and explore the relationship between obesity and KOA pain. This study used Optum’s de-identified Market Clarity Data from October 1, 2015, to March 31, 2024. Adults (≥ 45 years) with moderate-to-severe osteoarthritis (MTS-OA) knee pain (index date: first-observed claim with a KOA diagnosis between October 1, 2016, and March 31, 2023), with continuous enrollment in commercial, Medicare, or Medicaid healthcare plans for 1 year before and after post index, were included. The presence of KOA pain was identified using a previously validated algorithm. Adjusted annualized all-cause and KOA-related healthcare resource utilization and costs were assessed in the first year after index date, stratified by body mass index (BMI) categories: normal (≥ 18.5 to < 25 kg/m2), overweight (≥ 25 to < 30 kg/m2), Class 1 obesity (≥ 30 to < 35 kg/m2), Class 2 obesity (≥ 35 to < 40 kg/m2), and Class 3 obesity (≥ 40 kg/m2). Models were adjusted for age, race, sex, payor type, baseline Charlson Comorbidity Index score, and baseline cost. Adjusted costs were winsorized at 1
Rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) impact quality of life. Medication persistence is a key determinant of long-term effectiveness in chronic inflammatory diseases. This study evaluated treatment persistence, function, and program satisfaction among Canadian patients with RA, PsA, and axSpA receiving upadacitinib enrolled in the AbbVie Care patient support program (PSP). Data were collected from adults with RA, PsA, or axSpA enrolled in the Canadian PSP between January 2020 and July 2025. Demographic characteristics, first prescription fill rates, medication persistence, Health Assessment Questionnaire Disability Index (HAQ-DI) scores, and patient satisfaction with the PSP (subset of RA patients) were assessed. A total of 16,075 patients enrolled in the PSP were assessed (RA: N = 11,449; PsA: N = 2751; axSpA N = 1875). Over 90
Cutaneous disease is a central component of psoriatic arthritis (PsA), contributing substantially to patient disease burden and influencing therapeutic choices. Beyond plaque psoriasis, specific phenotypes, including nail, scalp, palmoplantar, and inverse involvement, are relatively common in PsA and are frequently associated with greater functional limitation, impaired quality of life, and discordant responses to systemic therapy. Accurate identification of these manifestations is critical for diagnosis, risk stratification, and treatment optimization. This review provides a clinically oriented overview of the dermatologic spectrum of PsA, outlining epidemiology, pathogenic mechanisms linking the skin–joint axis, and the impact of skin disease on outcomes. We summarize evidence for topical therapies, conventional systemic agents, biologics targeting tumour necrosis factor alpha (TNFα), interleukin-17 (IL-17), and interleukin-23 (IL-23), targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs), and emerging treatments, with attention to phenotype-specific considerations and multidisciplinary management. The implications of persistent skin activity in complex-to-manage PsA are also discussed. A domain-based, integrated approach to skin and joint care is required to achieve effective control both of musculoskeletal and cutaneous symptoms. Systematic evaluation and treatment of skin involvement should be considered a core component of PsA management rather than an ancillary concern.
