A 2026 Personal View arguing that ‘seronegative’ usually describes the assay rather than the patient — and that separating genuinely seronegative disease (myeloid/CD8-driven, MHC class I-associated, rituximab-unresponsive) from merely undetected seropositivity is the field’s necessary next step. Includes a disease-by-disease audit of seronegativity rates and why classification criteria naming the antibody but not the method matters.
A 2026 overview of drug- and vaccine-induced ANCA-associated vasculitis — clinically near-indistinguishable from idiopathic AAV, but with a recognisable serological fingerprint (dual MPO/PR3 positivity, elastase-ANCA, high IgM MPO-ANCA, low C4, neutropenia), a milder course, and one intervention no immunosuppressant can substitute for: stopping the drug. Antithyroid drugs, hydralazine and levamisole-adulterated cocaine dominate practice.
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.
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.
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.
A 2026 practical review of morphea (localized scleroderma) across age groups — an organ-sparing autoimmune skin disease distinct from systemic sclerosis. Covers classification, the high-stakes subtypes (pansclerotic, facial linear), activity-vs-damage assessment, and management anchored on long-course methotrexate plus a steroid bridge, where depth and site dictate aggressiveness.
A 2026 practical distillation of the 2023 ACR/CHEST guidelines on SSc-ILD — the single leading cause of death in systemic sclerosis. Covers proper screening (full PFTs + non-contrast HRCT), monitoring schedules, the first-line drug evidence (mycophenolate, tocilizumab, rituximab, nintedanib), and the strong recommendation against glucocorticoids.
A 2026 pictorial review of the conditions that mimic sacroiliitis on SIJ MRI — bone marrow oedema is sensitive but the least specific sign, and overcalling it risks committing patients to lifelong biologic therapy. Erosion, lesion combinations, topographic location, semi-axial imaging and clinical context are the defences against false-positive reads.
Work through a previously healthy 7-year-old girl with six weeks of progressive bilateral leg pain and a limp — one finding at a time. Twelve multiple-choice checkpoints test how you reshape a broad differential as imaging, labs and, crucially, a dietary history land on a diagnosis that is easy to miss.
Step through a 76-year-old woman’s diagnostic journey — palpable purpura, falling kidney function, a stroke, a new murmur — one finding at a time. Fourteen multiple-choice checkpoints test how you reshape the differential as each piece of data lands.