Anti-MDA5 antibody testing takes two to eight weeks and fails to detect 17% of cases — so in rapidly progressive ILD, the skin exam is the faster test. This review covers the pathognomonic and characteristic DM rashes, the specific findings that flag anti-MDA5, TIF1γ and NXP2, why DM-specific rashes appear in antisynthetase and overlap myositis, presentations in skin of colour, and the treatments for refractory cutaneous disease.
Hair loss in rheumatic disease is rarely just cosmetic — it can mark active inflammation, a drug effect, or an irreversible scarring process. This review walks through the mechanisms behind alopecia in lupus, RA, sarcoidosis, scleroderma and dermatomyositis, the DMARDs that cause shedding, the scarring alopecias that mimic systemic disease, and a stepwise bedside approach for the non-dermatologist.
Sex differences in rheumatic disease are usually pinned on oestrogen, but this review argues the picture is far more tangled. Oestradiol drives disease in SLE while appearing protective in Sjögren’s and RA; X chromosome dosage raises risk independently of hormones — triple X carries a 2.9-fold higher Sjögren’s prevalence; and gut bacteria reactivate oestrogen through β-glucuronidase, closing a loop between all three mechanisms.
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.
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 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 review of renal involvement in systemic sclerosis — a spectrum well beyond scleroderma renal crisis (SRC), covering the diagnostic constellation, five converging mechanisms, risk factors (anti-RNA polymerase III, early dcSSc, steroids), and the management essentials: immediate ACE inhibition, never stopped for a rising creatinine.
CD19 CAR-T cellular therapy delivers drug-free remission in 80–85% of refractory SLE patients in early-phase trials, with similar signals in IIM and SSc — the first credible attempt at true immunological reset in autoimmune rheumatic disease.