Rheumatology

Pre-emptive immunosuppressive escalation for serologic lupus nephritis flares prevents clinical relapses

In clinically quiescent lupus nephritis with new asymptomatic serologic reactivation, pre-emptive treatment prevented all renal flares versus five in controls over 24 months. The regimen increased prednisone to 0.4–0.5 mg/kg/day and optimized mycophenolate or azathioprine, then tapered steroids back by 12 weeks. Pre-emptively treated patients had higher flare-free survival for renal, extra-renal, and overall disease, with better anti-dsDNA and C3 trajectories. Adverse events were few and similar, and kidney function remained stable in both arms, supporting this moderate, time-limited escalation strategy. 1

JAK inhibitors in RA: fewer osteoporosis outcomes but higher all-cause mortality than TNF inhibitors

In a large EHR-based, propensity-matched RA cohort, JAK inhibitor initiation was associated with fewer osteoporosis-related outcomes than TNF inhibitors. JAK inhibitors reduced the composite of any fracture or osteoporosis and osteoporosis alone, though fracture reduction alone was not clearly shown. However, JAK inhibitor use was associated with higher all-cause mortality compared with TNF inhibitors over follow-up up to five years. Given residual confounding and limited follow-up, these associations warrant cautious interpretation but inform individualized JAK versus TNF discussions. 2

Axial disease affects about a quarter of biologic-naïve PsA patients when centrally adjudicated

In the international AXIS study of 409 biologic-naïve PsA patients, axial involvement was confirmed in 27.4% after central imaging review. Investigators initially labeled 37.4% as having axial disease, but standardized review reduced this estimate, indicating frequent clinical over-calling. Axial PsA was associated with male sex, younger age, HLA-B*27 positivity, inflammatory back pain, and elevated CRP compared with non-axial disease. Active inflammatory and structural sacroiliac and spinal lesions strongly discriminated axial from non-axial PsA, underscoring the need for imaging confirmation. 3

Sustained low income substantially increases mortality in rheumatoid arthritis, especially in younger adults

In over 50,000 incident Korean RA patients, cumulative years of low income before diagnosis predicted higher all-cause mortality, especially under age 65. Younger patients showed a clear dose–response relationship independent of income at diagnosis, whereas trends were weaker in older adults. Sustained high income was associated with reduced mortality in both age groups, with stronger benefit in younger patients. Rural residence amplified the adverse impact of prolonged low income, emphasizing socioeconomic context in RA prognostication and policy planning. 4