Infection

Patients with autoimmune rheumatic diseases are at higher risk of vaccine-preventable infections, yet coverage for influenza and pneumococcal vaccines is still poor. This Nature Reviews Rheumatology article argues that commonly used vaccines are safe, that flares and new autoimmune disease after vaccination are uncommon, and that real-world data show protection even when antibody responses are blunted. The main problems are timing around methotrexate, rituximab and obinutuzumab, CAR T cells and bispecific T cell engagers, the avoidance of live vaccines, and the hesitancy that keeps uptake low.

Acute rheumatic fever and post-streptococcal reactive arthritis are both autoimmune responses to a group A streptococcal infection, but they differ in timing, joint pattern, heart involvement and what they mean for the next decades of care. This review sets out the Jones criteria, why echocardiography is now expected in every suspected case, how to treat arthritis, carditis and chorea, how long secondary prophylaxis should last, and how to separate PSRA from ARF before committing a patient to prophylaxis.

Musculoskeletal complaints affect roughly half to two-thirds of people living with HIV, at any stage and sometimes before the diagnosis is made. This review sorts the picture by mechanism and by tissue: the joint syndromes that mimic RA, spondyloarthritis without HLA-B27, myositis, vasculitis by vessel size, DILS and IRIS, and the infections that complicate advanced disease. The treatment advice is gated on CD4 count and viral control, and it rests mostly on case reports and small series.

There are no PJP prophylaxis guidelines for rheumatic disease, so practice varies widely between clinicians. This review assembles what the evidence supports: prophylaxis clearly works, the harms are real enough to matter, and the number needed to treat swings from about 4 in VEXAS to over 900 in rheumatoid arthritis — which is why the underlying disease, not the steroid dose alone, should drive the decision.