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.
Glucocorticoids remain the leading cause of secondary osteoporosis, and oral steroid use in rheumatic disease has risen over the last twenty years despite steroid-sparing agents. This review covers how quickly bone is lost, why DXA systematically underestimates fracture risk on steroids, how much the underlying rheumatic disease contributes, the steroid-sparing evidence in SLE, GCA, PMR and ANCA vasculitis, and what the trial data actually support.
A full map of EGPA therapy — why reduced-dose steroid regimens validated in GPA and MPA may not transfer, what REOVAS and MAINRITSEG actually showed about rituximab (no superiority in either), and how anti-IL-5 therapy has made complete glucocorticoid withdrawal a realistic trial endpoint. Also carries a development many will have missed: avacopan’s marketing approval is being withdrawn after ADVOCATE’s primary endpoint data were found to have been manipulated.
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.
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 2026 narrative review of the IL-5/eosinophil axis in eosinophilic granulomatosis with polyangiitis (EGPA) and the two approved IL-5 pathway inhibitors — mepolizumab and benralizumab — covering their mechanisms, MIRRA and MANDARA trial evidence, real-world data, guideline positioning, and the remaining unmet needs.
The 2025 EULAR update to the Behçet’s syndrome recommendations moves monoclonal TNF-alpha inhibitors (especially infliximab) to first-line induction and maintenance for eye, vascular and parenchymal-CNS disease, displacing cyclophosphamide and the azathioprine-first strategy, and broadens treatment targets to angiographic and endoscopic remission.
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.