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.
A 2026 NEJM Clinical Practice review reframing fibromyalgia as nociplastic pain — CNS sensitisation to painful and non-painful stimuli — so therapy aims to calm the CNS rather than repair peripheral tissue. Covers the positive (non-exclusion) diagnosis, the chronic overlapping pain conditions, and management where non-pharmacologic treatment outperforms drugs, amitriptyline at night leads the drugs, and opioids are harmful.
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.
A 2026 narrative review of T-cell engagers (TCEs) in autoimmune rheumatic disease — off-the-shelf bispecific antibodies that redirect a patient’s own T cells against autoreactive B/plasma cells, pitched as a repeatable, dose-adjustable alternative to CAR-T. Early efficacy across SLE, SSc, RA, myositis and Sjögren’s is real but preliminary, and the review’s headline problem is under-dosing relative to oncology, which likely drives frequent relapse.
A 2026 narrative review arguing that B cells are the single through-line of Sjögren disease — connecting autoantibodies, glandular pathology, the highest lymphoma risk of any autoimmune disease, and the emerging drug pipeline. Endotyping by B-cell activity may identify who develops lymphoma and who responds to B-cell-targeted therapy, as newer BAFF/APRIL, CD40L, BTK and FcRn agents succeed where rituximab failed.
The 2026 Sjögren’s Foundation clinical practice guideline for peripheral nervous system involvement in Sjögren’s disease — an aligned neuro-rheumatology nomenclature, 31 evaluation good-practice statements, and 20 treatment recommendations (6 strong), covering mononeuropathies, polyneuropathies, and autonomic disease. Evidence is very low certainty, so most guidance rests on expert consensus.
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.
RepurpSS-II is a phase 2b, placebo-controlled RCT of leflunomide plus hydroxychloroquine in active systemic Sjögren’s disease, given without any background immunomodulatory therapy. The combination met its primary endpoint — a clinically meaningful ESSDAI improvement (−4.14) at 24 weeks, replicating RepurpSS-I — but dryness and patient-reported symptoms (ESSPRI) did not separate from placebo.