Up to 40% of children with JIA don’t respond to methotrexate, and we currently have no way to know in advance. This three-centre study of 195 patients found that erythrocyte ITPA enzyme activity measured before the first dose separates responders from non-responders, and outperforms genotyping the ITPA variant. But the cutoffs run at 60% sensitivity and 63% specificity — enough to shift a prior, not enough to decide on its own.
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 combined individual-patient-data analysis of the NORD-STAR and BeSt trials shows that where early RA is distributed carries prognostic signal: hand-dominant disease (JIP-Hand) predicts better treatment response and polyarthritis (JIP-Poly) worse — independent of sex and serology, and equally across csDMARDs and bDMARDs, with ACPA/RF showing no association with short-term activity response.
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.
The 2025 EULAR update streamlines RA management to 5 overarching principles and 9 recommendations, abandons post-methotrexate prognostic risk stratification, and keeps JAK inhibitors co-equal with biologics after individual risk assessment.