Skin disease in PsA is not a side note to joint management — specific phenotypes (nail, scalp, palmoplantar, inverse) carry their own diagnostic and prognostic weight, and discordant skin/joint responses are a leading driver of complex-to-manage PsA. This review maps the phenotypes, the shared IL-23/IL-17/TNF pathogenesis, and how drug-class selection should follow the cutaneous pattern in front of you, not just the joint count.
IgA vasculitis and IgA nephropathy share HLA susceptibility, 21 GWAS risk loci, elevated Gd-IgA1 and renal biopsies that cannot be told apart — yet IgAN now has five approved therapies and IgAV has none, because IgAV patients were excluded from every trial that delivered them. What changes today: KDIGO 2025 lowers the treatment threshold to 0.5 g/day of proteinuria, and it explicitly covers IgA vasculitis.
Population-based data from Olmsted County finally give a usable number for how often a seronegative RA diagnosis turns out to be something else: about 13% over ten years, front-loaded into the first five, and most often spondyloarthritis. A quarter achieve sustained drug-free remission lasting a median of 6.3 years, one in five needs a biologic — and nothing measured at baseline predicts which.
Relapsing polychondritis is not one disease with variable severity. A French cohort splits it into three clusters whose mortality runs 4%, 13% and 58% — and the worst cluster is almost certainly VEXAS, which this review argues should be treated as a disease mimic rather than a subtype. Chondritis is absent at presentation in 40%, there is no confirmatory test, and no randomised trial has ever been conducted.
Secukinumab doubled sustained remission at 52 weeks in relapsed polymyalgia rheumatica — 41% versus 20% on a prednisone taper alone — and halved the need for escape steroid. But 150 mg worked as well as 300 mg, the component data show the drug maintains remission rather than inducing it, and roughly six in ten treated patients still did not reach the endpoint.
A 2026 review of cutaneous lupus therapeutics, now organised almost entirely around the type I interferon axis — from TLR7/8 and pDCs through IFNAR to TYK2 — alongside the practical foundation of photoprotection, early hydroxychloroquine and smoking cessation. No therapy is yet FDA-approved specifically for CLE, and almost all evidence is borrowed from SLE trials where skin was a secondary endpoint.
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.
Final 24-month data from APPLAUSE-IgAN: the oral factor B inhibitor iptacopan roughly halved the rate of eGFR decline in high-risk IgA nephropathy (−3.10 vs −6.12 ml/min/1.73 m²/year) and cut hard kidney-failure events from 33.5% to 21.4%, converting an accelerated approval based on proteinuria into evidence on preserved kidney function — with serious infection the trade-off to manage.
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.
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.