Rheumatology

Early RA patients usually discontinue glucocorticoids after a 7-week prednisolone bridge

In the ARCTIC tight-control trial, 227 DMARD-naïve recent-onset RA patients received methotrexate plus a 7-week tapering prednisolone bridge. By 7 weeks, 84% had stopped prednisolone; 89% by 3 months and 95% within 24 months. Among those off prednisolone at 7 weeks, 80% never restarted over 2 years, with a median exposure of 55 days. Only 5% used prednisolone at every visit and 22% had continuous use for at least 3 months. 1

Checkpoint inhibitors cause frequent but usually manageable flares of pre-existing rheumatic disease

This meta-analysis pooled 31 studies including over 700 patients with pre-existing rheumatic disease treated with immune checkpoint inhibitors for solid tumors. The pooled incidence of any-grade flare was 33.8%, typically beginning about 5–8 weeks after therapy initiation. Severe flares were less common at 4.2%, yet 17% of flare cases led to permanent checkpoint inhibitor discontinuation. Flare risk varied by disease, highest in psoriatic arthritis and rheumatoid arthritis, lowest in systemic sclerosis and lupus. 2

Daratumumab yields universal early clinical responses but frequent hypogammaglobulinemia in refractory SLE

In this single-arm phase 2 trial, 10 women with active SLE refractory to at least two immunosuppressants received weekly subcutaneous daratumumab for eight weeks. By week 12, anti-dsDNA levels fell substantially and all patients achieved SRI-4 response, with improvements across organ domains. Daratumumab depleted antibody-secreting cells, reduced type I interferon activity, and markedly altered T cell responses, indicating deep immune modulation. Hypogammaglobulinemia occurred in 5 of 10 patients and required immunoglobulin replacement, underscoring infection risk. 3

Anti-CD19 CAR T (IM19) improves systemic lupus activity with variable renal responses

This open-label pilot evaluated IM19 autologous anti-CD19 CAR T cells after lymphodepletion in six patients with refractory SLE and lupus nephritis. Systemic disease activity improved substantially, with median SLEDAI-2K decreasing from 12 at baseline to 4 at day 90 and 5 at day 180. Renal responses were heterogeneous: two complete responses, two partial responses, and two non-responders, despite absent B cell infiltration on repeat biopsies. Biopsies showed dominant chronic changes and podocytopathy, suggesting irreversible damage limited renal recovery after CAR T therapy. 4