Rheumatology

JAK inhibitors provide superior RA control versus csDMARDs and biologics but increase adverse events and serious infections

This systematic review and cumulative meta-analysis pooled 31 RCTs comparing JAK inhibitors with placebo, csDMARDs, or bDMARDs in adult RA. JAK inhibitors produced significantly greater DAS28-CRP and DAS28-ESR improvements than placebo, csDMARDs, and even bDMARDs, with parallel ACR and HAQ-DI benefits. Treatment with JAK inhibitors significantly increased overall adverse events, treatment-related adverse events, and serious infections versus comparators. The abstract reports assessment of MACE, VTE, and malignancy without quantifying excess risk, limiting current safety precision. These data support JAK inhibitors as highly effective options after csDMARD or bDMARD failure, requiring individualized infection-risk counselling. 1

JIA-associated uveitis retains high long-term cataract and visual impairment rates into adulthood

This meta-analysis synthesized 22 studies including 2,208 long-term cases of JIA-associated uveitis with at least five years’ follow-up. Severe visual impairment occurred in about 17% of adults at roughly 18 years, despite contemporary management. Cataract was the most frequent complication, affecting roughly 44%, followed by glaucoma, synechiae, band keratopathy, and hypotony. Complication rates were numerically lower in cohorts with greater biologic use, but high heterogeneity and reporting bias limit causal inference. The findings support tight rheumatology–ophthalmology collaboration, early escalation, and lifelong surveillance for patients with JIAU. 2

Photosynthetic nanothylakoids reprogram macrophages and improve arthritis in preclinical RA models

This preclinical study engineered folate-receptor-targeted photosynthetic nanothylakoids (FA-PEG-NTK) to modulate the inflammatory microenvironment in RA. Under light irradiation, FA-PEG-NTK generated oxygen and NADPH, alleviating hypoxia and reducing reactive oxygen species in M1 macrophages. This metabolic reprogramming promoted an anti-inflammatory M2 phenotype and remodeled the synovial inflammatory milieu. In collagen-induced arthritis rats, FA-PEG-NTK phototherapy reduced synovial hyperplasia and enhanced bone and cartilage regeneration, outperforming methotrexate. No apparent side effects were observed in these models, but translation to humans will require careful safety and feasibility evaluation. 3

UPsA ultrasound activity and damage scores standardize musculoskeletal assessment in psoriatic arthritis

This multicentre Italian study developed and internally validated composite ultrasound UPsA activity and damage scores in 312 PsA patients. The UPsA activity score (0–10) correlated moderately with DAPSA, tender joint count, and swollen joint count, supporting construct validity. The UPsA damage score correlated with modified Sharp–van der Heijde radiographic scores, reflecting structural damage burden. The activity score showed moderate overall responsiveness and high responsiveness in patients reaching minimal disease activity at six months. A simplified activity score (sUPsA) retained about 90% of information while improving feasibility for routine practice. 4