Population-based data from Olmsted County finally give a usable number for how often a seronegative RA diagnosis turns out to be something else: about 13% over ten years, front-loaded into the first five, and most often spondyloarthritis. A quarter achieve sustained drug-free remission lasting a median of 6.3 years, one in five needs a biologic — and nothing measured at baseline predicts which.
Secukinumab doubled sustained remission at 52 weeks in relapsed polymyalgia rheumatica — 41% versus 20% on a prednisone taper alone — and halved the need for escape steroid. But 150 mg worked as well as 300 mg, the component data show the drug maintains remission rather than inducing it, and roughly six in ten treated patients still did not reach the endpoint.
ACPA-positive and ACPA-negative RA take the same total time from first symptom to arthritis — but split it in mirror image. Seropositive patients reach the rheumatologist later and convert faster; seronegative patients arrive sooner and linger, leaving roughly twice as long an actionable window once they are in front of you. Each entity carries its own signature before arthritis exists.
ADVANCE OUTCOMES is a phase 3 trial of once-daily oral ralinepag, a prostacyclin IP receptor agonist, added to background therapy in pulmonary arterial hypertension. It cut first clinical worsening by 55% (HR 0.45) — but the effect was carried entirely by softer composite components, with death and hospitalisation unchanged, and 19% discontinued for adverse events. CTD-PAH made up 29% of the cohort as a prespecified stratum.
Final 24-month data from APPLAUSE-IgAN: the oral factor B inhibitor iptacopan roughly halved the rate of eGFR decline in high-risk IgA nephropathy (−3.10 vs −6.12 ml/min/1.73 m²/year) and cut hard kidney-failure events from 33.5% to 21.4%, converting an accelerated approval based on proteinuria into evidence on preserved kidney function — with serious infection the trade-off to manage.
Five-year data from the TREAT EARLIER trial show that a time-limited intervention (one glucocorticoid injection plus 12 months of methotrexate) in clinically suspect arthralgia produced durable benefit in ACPA-negative individuals at increased risk — RA in 9% vs 32%, NNT 4 — but nothing lasting in ACPA-positive individuals, splitting the at-risk phase into two diseases with two different answers.
A population-based MRI study of 11,163 German adults found sacroiliac joint bone marrow oedema in about one in three people — roughly 50 times the prevalence of axial spondyloarthritis. The signal tracked with BMI, occupational loading, age and, in women, pregnancy, while chronic back pain barely moved the rate, providing the missing denominator for interpreting a positive SIJ MRI.
RHO is a phase 2 proof-of-concept RCT of the FcRn antagonist efgartigimod in Sjögren’s disease, testing whether removing pathogenic IgG autoantibodies improves disease. It met its exploratory objective (CRESS response 45.5% vs 11.1% at week 24) with deep, selective IgG reduction — but systemic activity improved while patient-reported symptoms did not, and the tiny sample means this justifies phase 3, not practice change.
ALLEGORY is a phase 3 RCT of the type II anti-CD20 antibody obinutuzumab added to standard therapy in active non-renal SLE. It met its primary endpoint (SRI-4 76.7% vs 53.5% at week 52) and all five key secondary endpoints, achieving both steroid-sparing and a ~40% reduction in flare hazard — reinforcing that depth of B-cell depletion matters and that type II succeeds where rituximab failed.
WILLOW Cohort A is the first placebo-controlled RCT of a TLR7/8 inhibitor in lupus: the oral agent enpatoran met its primary endpoint with a dose-dependent reduction in cutaneous disease activity (CLASI-A) at 16 weeks, and — the headline — rapidly and reversibly switched off the skin type I interferon signature, pinning TLR7/8 as an upstream driver of cutaneous IFN activation. Steroid-sparing was not demonstrated.