This Week in Rheumatology - 2025-06-15

# This Week in Rheumatology ## Ankylosing Spondylitis Recent research highlights advancements in both the assessment and management of axial spondyloarthritis (axSpA), particularly ankylosing spondylitis (AS). A UK-based study (Jones et al., *Arthritis Care & Research* 2025) demonstrated that NSAIDs can mask active sacroiliitis on MRI, with 20.2% of patients showing resolution of inflammation after resuming NSAIDs post-washout. Semi-quantitative and quantitative MRI methods corroborated these findings, prompting a recommendation for a 1-2 week NSAID washout prior to imaging for accurate diagnosis and monitoring. Meanwhile, Jamaludin et al. (*Rheumatology* 2025) validated machine learning (ML) models for automated detection of spinal bone marrow edema (BMO) in axSpA, achieving performance comparable to expert radiologists (AUC 0.94, accuracy 75.8%). The ML model, which bypassed manual segmentation, matched inter-reader reliability, offering a scalable solution to reduce variability and labor costs in clinical trials and practice. Together, these studies underscore the importance of refining imaging protocols (e.g., NSAID timing) while embracing AI-driven tools to enhance diagnostic precision in axSpA. ### References - Non-steroidal anti-inflammatory drugs reduce sacroiliac joint inflammation, as seen on MRI, in axial spondyloarthritis. by Jones GT, Bennett AN, Sengupta R, Machado PM, Marzo-Ortega H, Aucott L, Hall-Craggs MA, Bray TJ, Bainbridge A, Gollifer RM, Macfarlane GJ. Arthritis care & research. [PMID: 40511517](https://pubmed.ncbi.nlm.nih.gov/40511517/) - Automated detection of spinal bone marrow oedema in axial spondyloarthritis: training and validation using two large phase 3 trial datasets. by Jamaludin A, Windsor R, Ather S, Kadir T, Zisserman A, Braun J, Gensler LS, Ostergaard M, Poddubnyy D, Coroller T, Porter B, Ligozio G, Readie A, Machado PM. Rheumatology (Oxford, England). [PMID: 40489668](https://pubmed.ncbi.nlm.nih.gov/40489668/) ## Autoinflammatory Diseases Recent studies highlight advances in personalized treatment strategies for autoinflammatory diseases, particularly Still's disease and Familial Mediterranean Fever (FMF). In Still's disease, a subanalysis of a randomized trial (Suzuki et al., 2025) found that tocilizumab's efficacy was confined to IL-6 pathway inhibition, with non-responders exhibiting elevated baseline IFN-gamma and IL-1beta levels—suggesting an IFN-gamma-driven subtype. This underscores the potential for cytokine profiling to guide IL-6 inhibitor use. Meanwhile, research on heterozygous MEFV carriers (Cam et al., 2025) demonstrated that colchicine discontinuation was feasible in 85.7% of pediatric patients, particularly those with early attack resolution (≥70.8% frequency reduction in 6 months predicted success). Arthritis emerged as a red flag for treatment resumption. Together, these studies emphasize biomarker-driven decision-making: cytokine profiles may refine IL-6 inhibition in Still's disease, while attack patterns could optimize colchicine management in FMF heterozygotes. ### References - Serum cytokine levels towards precision medicine in Still's disease: a subanalysis of a randomized controlled trial of tocilizumab. by Suzuki K, Kameda H, Ikeda K, Ishii T, Murakami K, Takamatsu H, Tanaka Y, Abe T, Takeuchi T, Kaneko Y. Rheumatology (Oxford, England). [PMID: 40516928](https://pubmed.ncbi.nlm.nih.gov/40516928/) - Re-evaluation of MEFV carriers previously diagnosed with familial Mediterranean fever: a colchicine discontinuation study. by Cam V, Unal D, Sag E, Bayindir Y, Aliyev E, Emreol HE, Erkan MO, Banak ON, Dara Kar HD, Basaran O, Bilginer Y, Ozen S. Rheumatology (Oxford, England). [PMID: 40512183](https://pubmed.ncbi.nlm.nih.gov/40512183/) ## Drugs and Pharmacology Recent research highlights the underrecognized musculoskeletal toxicity of immune checkpoint inhibitors (ICIs), with a prospective imaging study using whole-body MRI revealing significant inflammation and erosions in patients with arthralgia or inflammatory arthritis post-ICI exposure. The study identified three distinct inflammatory patterns: peripheral inflammatory arthritis (37%), polymyalgia rheumatica (12%), and an overlapping phenotype (20%). Notably, synovitis was most frequent in acromioclavicular, glenohumeral, wrist, and metacarpophalangeal joints, with peripheral inflammatory arthritis patients more likely to require disease-modifying antirheumatic drugs (DMARDs). These findings underscore the need for heightened clinical vigilance and tailored management strategies for ICI-induced musculoskeletal adverse events. (PMID: 40513597) ### References - Whole-body MRI in patients with arthralgia or inflammatory arthritis after exposure to immune checkpoint inhibitors: a single-centre prospective imaging study. by Harnden K, Sidhu N, Rowbotham E, Duquenne L, Sharrack S, Howell K, Bertham D, Abacar K, Emery P, McGonagle D, Mankia K. The Lancet. Rheumatology. [PMID: 40513597](https://pubmed.ncbi.nlm.nih.gov/40513597/) ## Health Policy A recent multidisciplinary consensus by nine Mexican medical organizations established evidence-based guidelines for vitamin D management in adults, addressing widespread clinical variability. Key recommendations include measuring 25(OH)D levels only in high-risk individuals (deficiency <20 ng/mL, insufficiency 20-29 ng/mL), favoring cholecalciferol supplementation, and maintaining levels at 30-60 ng/mL for optimal outcomes. Developed via Delphi methodology, these standards aim to harmonize practice and inform public health strategies, particularly for skeletal and chronic disease prevention in Mexico. The guidelines emphasize targeted testing over routine screening and highlight calcifediol’s niche role in rapid correction scenarios, offering a pragmatic framework for equitable care. ### References - Joint position on vitamin D prescription in the adult Mexican population by AMMOM, AMEC, AMG, CMIM, CMO, CMR, CONAMEGER, FEMECOG, and FEMECOT. by Torres-Naranjo JF, Gutierrez-Hermosillo H, Garcia-Hernandez PA, Lopez Cervantes RE, Avila Armengol HE, Bedoya Torres R, Bremer Aztudillo AL, Medina Chavez JH, Morales Delgado R, Perusquia Frias EM, Rios Espinosa A, Vazquez Alanis A. Archives of osteoporosis. [PMID: 40512300](https://pubmed.ncbi.nlm.nih.gov/40512300/) ## Osteoarthritis Recent research on osteoarthritis highlights innovative care models and therapeutic approaches. A Norwegian randomized controlled trial (n=374) demonstrated that occupational therapist-led care for hand osteoarthritis is non-inferior to rheumatologist-led care, with comparable response rates (28.4% vs. 28.6%) at 6 months and potential cost savings, supporting task-shifting to allied health professionals (Polster et al., Lancet Rheumatol 2025). Meanwhile, a meta-analysis of 14 studies (n=507,696) revealed a dose-dependent relationship between physical activity and knee osteoarthritis risk, showing high-intensity activity increases risk by 26% compared to moderate activity, with no protective effect observed for any intensity versus low activity (Cui et al., J Glob Health 2025). In therapeutic interventions, a systematic review of PRP injections (n=868 knees) found that combining PRP with hyaluronic acid offered statistically significant but clinically marginal improvements in physical function scores versus PRP alone, with fewer adverse events (15.4% vs. 24.6%), suggesting limited added value for combination therapy (Yudtanahiran et al., Eur J Orthop Surg Traumatol 2025). These studies collectively emphasize the importance of care model optimization, activity intensity moderation, and nuanced evaluation of biologic therapies in osteoarthritis management. ### References - Occupational therapist-led versus rheumatologist-led care in people with hand osteoarthritis in Norway: an open-label, multicentre, randomised controlled, non-inferiority trial. by Polster A, Olsen U, Asphaug L, Bergsmark K, Christensen B, Haugen IK, Hennig T, Hermann-Eriksen M, Hove A, Sjovold T, Sexton J, Tveter AT, Kjeken I. The Lancet. Rheumatology. [PMID: 40513596](https://pubmed.ncbi.nlm.nih.gov/40513596/) - Association between physical activity and knee osteoarthritis: a comprehensive systematic review and meta-analysis. by Cui X, Xie F, Cui J, Tian Y, Bai X, Guo L, Liu J, Yao F. Journal of global health. [PMID: 40511516](https://pubmed.ncbi.nlm.nih.gov/40511516/) - Intra-articular injections of platelet-rich plasma combined with hyaluronic acid versus platelet-rich plasma alone in the treatment of knee osteoarthritis: a systematic review and meta-analysis. by Yudtanahiran N, Piyapanyamongkhon P, Rojpalakorn W, Itthipanichpong T, Limskul D, Tanpowpong T, Kuptniratsaikul S, Thamrongskulsiri N. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie. [PMID: 40498171](https://pubmed.ncbi.nlm.nih.gov/40498171/) ## Other Rheumatic Diseases Recent research highlights key advancements and challenges in managing rheumatic diseases beyond the most common conditions. In systemic lupus erythematosus (SLE), hydroxychloroquine continues to be a cornerstone therapy for pregnant women, offering protective benefits (Martin de Fremont et al., 2025). Meanwhile, Ruiz-Irastorza (2025) debates the feasibility of withdrawing glucocorticoids or immunosuppressants in SLE remission, underscoring the delicate balance between maintaining disease control and minimizing treatment toxicity. Ethnic disparities in anti-HMGCR myopathy, an immune-mediated necrotizing myopathy linked to statin use, were observed in New Zealand, with Polynesians presenting at a younger age and showing poorer CK normalization rates compared to Europeans (Anderson et al., 2025). The COVID-19 pandemic has also influenced rheumatic disease trends, with a study from Italy revealing a temporary dip in autoimmune inflammatory rheumatic disease (AIIRD) diagnoses in 2020, followed by a sustained rise—potentially tied to SARS-CoV-2 infection or vaccination (De Lorenzis et al., 2025). Juvenile idiopathic arthritis (JIA) research focused on treatment outcomes, with Brazilian studies showing improved clinimetric measures but low remission-off-medication rates (Terrazas et al., 2025), while Nordic data highlighted age-dependent remission patterns, with younger children faring better in oligoarthritis and older children in seronegative polyarthritis (Tuomi et al., 2025). DMARD withdrawal trials in JIA revealed high relapse rates across cycles, suggesting permanent discontinuation remains elusive for most patients (Bugeja et al., 2025). Finally, in IgG4-related disease, elevated eosinophil-to-lymphocyte ratio (ELR) emerged as a robust predictor of relapse, offering a potential biomarker for personalized management (Zhang et al., 2025). Together, these studies emphasize the need for tailored approaches across diverse rheumatic conditions, balancing efficacy, safety, and equitable care. ### References - Hydroxychloroquine use in pregnant women with systemic lupus erythematosus: the pill that shields. by Martin de Fremont G, Guettrot-Imbert G, Costedoat-Chalumeau N. The Lancet. Rheumatology. [PMID: 40516563](https://pubmed.ncbi.nlm.nih.gov/40516563/) - Glucocorticoid or immunosuppressives withdrawal in SLE in remission: that is the question... the only question? by Ruiz-Irastorza G. Rheumatology (Oxford, England). [PMID: 40515661](https://pubmed.ncbi.nlm.nih.gov/40515661/) - Anti-HMGCR myopathy: observed ethnic differences in disease and disease outcomes in New Zealand. by Anderson H, Chow KL, O'Donnell J. Rheumatology (Oxford, England). [PMID: 40515650](https://pubmed.ncbi.nlm.nih.gov/40515650/) - Rising incidence of systemic autoimmune inflammatory rheumatic diseases during the COVID-19 pandemic: a geographical cohort study. by De Lorenzis E, Parente P, Soldati S, Barbara A, Natalello G, Davoli M, Bosello SL, D'Agostino MA, Di Martino M. RMD open. [PMID: 40514058](https://pubmed.ncbi.nlm.nih.gov/40514058/) - Lupus serology: off target but still relevant to the treat-to-target strategy in systemic lupus erythematosus. by Piga M. Rheumatology (Oxford, England). [PMID: 40504026](https://pubmed.ncbi.nlm.nih.gov/40504026/) - A real-life study of juvenile idiopathic arthritis from two Brazilian referral centers for pediatric rheumatology. by Terrazas AML, Suarez RG, Campos RT, Len CA, Aikawa NE, Fernandez JD, Dantas ML, Silva CA, Clemente G, Terreri MT. Advances in rheumatology (London, England). [PMID: 40500805](https://pubmed.ncbi.nlm.nih.gov/40500805/) - Age at diagnosis as a prognostic factor in selected categories of juvenile idiopathic arthritis. by Tuomi AK, Rebane K, Arnstad E, Berntson L, Fasth A, Glerup M, Herlin T, Kautiainen H, Nordal EB, Peltoniemi S, Rygg M, Rypdal V, Zak M, Aalto K. RMD open. [PMID: 40499975](https://pubmed.ncbi.nlm.nih.gov/40499975/) - Executive summary: The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis. by Biddle K, Jade J, Wilson-Morkeh H, Adikari M, Al Yaghchi C, Anastasa Z, Basu N, Brogan P, Chanouzas D, Dass S, D'Cruz D, Martinez Del Pero M, Dhillon E, Ducker G, Griffin S, Hollick RJ, Jackson D, King C, Marlais M, Mason A, McAdoo S, Mewar D, Mooney J, Ntatsaki E, Pearce F, Rhodes B, Rupani H, Salama A, Siddiqui S, Smith R, Harper L. Rheumatology (Oxford, England). [PMID: 40499929](https://pubmed.ncbi.nlm.nih.gov/40499929/) - Disease modifying anti-rheumatic drug treatment cycles and rates of flare in juvenile idiopathic arthritis-a tale of Sisyphean endeavour? by Bugeja E, Tiller G, Renton W, Munro J, Gowdie P, Cox A, Allen R, Buckle J, Akikusa J. Rheumatology (Oxford, England). [PMID: 40489673](https://pubmed.ncbi.nlm.nih.gov/40489673/) - Elevated eosinophil-to-lymphocyte ratio (ELR) as a predictor of relapse for IgG4-related disease: a retrospective study across a decade. by Zhang N, Peng Y, Li R, Nie Y, Li J, Yang X, Zhang J, Wang Y, Luo Q, Zhou J, Fei Y, Li M, Peng L, Zhang W. Clinical and experimental medicine. [PMID: 40488799](https://pubmed.ncbi.nlm.nih.gov/40488799/) ## Rheumatoid Arthritis Recent research highlights promising advances in rheumatoid arthritis (RA) treatment and disease dynamics. A phase 2 trial of CPL'116, a novel dual JAK/ROCK inhibitor, demonstrated dose-dependent efficacy in RA patients with inadequate methotrexate response, with the 240 mg dose significantly improving DAS28-CRP at 12 weeks without the lipid abnormalities typical of JAK inhibitors (Wieczorek et al., *Lancet Rheumatol*). Meanwhile, post-hoc analysis of the SELECT-COMPARE trial revealed that rapid remission (DAS28-CRP <2.6 by 12 weeks) correlates with sustained improvements in pain, fatigue, and physical function over 5 years, emphasizing the value of early, aggressive treatment (Gossec et al., *Arthritis Res Ther*). A bidirectional link between RA and inflammatory bowel disease (IBD) was identified in a large cohort study, with each condition increasing the risk of the other by 44-65%, suggesting shared pathogenic mechanisms (Chen et al., *Rheumatology*). Environmental factors also play a role: air pollutants like NO₂ and O₃ were shown to exacerbate RA activity with 2-3 month lag effects, underscoring the need for air quality interventions (Alsaber et al., *Arthritis Care Res*). COVID-19 may further complicate RA risk, as meta-analysis and Mendelian randomization data linked infection to RA development via shared immune-inflammatory pathways, including elevated IL-13 and neutrophil dysregulation (Shao et al., *Biol Res*). Finally, real-world data on baricitinib in RA-ILD patients showed stabilization of lung function and joint symptoms, offering a dual therapeutic option for this challenging subgroup (Serrano-Combarro et al., *Rheumatology*). Together, these studies underscore the importance of precision therapeutics, early remission, and multidisciplinary management in RA. ### References - Dual JAK and ROCK inhibition with CPL'116 in patients with rheumatoid arthritis with inadequate response to methotrexate: a randomised, double-blind, placebo-controlled, phase 2 trial. by Wieczorek M, Kisiel B, Wlodarczyk D, Leszczynski P, Kurylchyk IV, Vyshnyvetskyy I, Kierzkowska I, Pankiewicz P, Kaza M, Banach M, Kogut J. The Lancet. Rheumatology. [PMID: 40516565](https://pubmed.ncbi.nlm.nih.gov/40516565/) - Association between rapid and sustained remission and clinician- and patient-reported outcomes in patients with rheumatoid arthritis: post hoc analysis of data from the SELECT-COMPARE study. by Gossec L, Patel J, Kadakia A, Fang S, Peng Y, Strengholt S, Taylor PC, Ostor A. Arthritis research & therapy. [PMID: 40514717](https://pubmed.ncbi.nlm.nih.gov/40514717/) - Bidirectional association of rheumatoid arthritis and inflammatory bowel diseases: a large-scale prospective cohort study. by Chen Y, Zhang Q, Liu S, Zhu S, Wu J, Zhang S, Li P, Wu S. Rheumatology (Oxford, England). [PMID: 40511997](https://pubmed.ncbi.nlm.nih.gov/40511997/) - Predicting the Impact of Air Quality Index on Rheumatoid Arthritis Disease Activity. by Alsaber A, Al-Herz A, Al-Mazedi M, Doush IA, Abdullah A, Alkandary D, Al-Sultan AT, Setiya P, Pan J. Arthritis care & research. [PMID: 40511561](https://pubmed.ncbi.nlm.nih.gov/40511561/) - Immunoinflammatory evidence of rheumatoid arthritis caused by COVID-19. by Shao Z, Xia D, Zhou L, Xu Z, Wang J. Biological research. [PMID: 40495223](https://pubmed.ncbi.nlm.nih.gov/40495223/) - Baricitinib in rheumatoid arthritis-interstitial lung disease: national multicenter study of 72 patients and literature review. by Serrano-Combarro A, Atienza-Mateo B, Martin-Gutierrez A, Loarce Martos J, Dubuc CAE, Pastor Mena M, Melero-Gonzalez RB, Martin Lopez M, Mena Vazquez N, Carrasco-Cubero C, Perez Garcia C, Valle AG, Bonilla G, Blanco Madrigal JM, Astigarraga-Urquia U, Vegas Revenga N, Albadalejo LP, Ortega Castro R, Sanchez DP, Fernandez Ortiz AM, Viejo PL, Lasanta ML, Garijo Bufort M, Casafont Sole I, Lamua-Riazuelo JR, Abascal IB, Ruiz-Esquide V, Perez EC, Flores Robles BJ, Martinez-Vidal MP, Moreno Morales J, Urruticoechea-Arana A, Rosas J, Fernandez Lozano D, Castro Corredor D, Ferraz-Amaro I, Castaneda S, Blanco R. Rheumatology (Oxford, England). [PMID: 40493905](https://pubmed.ncbi.nlm.nih.gov/40493905/) ## Scleroderma Recent research highlights advancements in assessing systemic sclerosis-associated interstitial lung disease (SSc-ILD), with a focus on overcoming traditional imaging limitations. A 2025 study (PMID: 40504021) compared quantitative lung ultrasound (LUS) scores—including B-lines count and a novel pleural line irregularity (PLI) score—against automated quantitative CT (qCT) in 82 SSc patients. Both LUS metrics strongly correlated with qCT-measured ILD extent, including deeper lung involvement (p<0.0001), particularly at the bases. The PLI score emerged as a promising tool to evaluate core parenchymal disease, challenging LUS’s historical superficial assessment constraints. These findings suggest LUS could complement or reduce reliance on CT for longitudinal ILD monitoring, though further validation is needed. ### References - Comparison of quantitative lung ultrasound scores with automated quantitative CT: to overcome the ultrasound limitations. by Mohammad Reza Beigi D, Pellegrino G, Landini N, Diana ME, Paone G, Bisconti I, Di Ciommo FR, Cadar M, Platania E, Landro J, Truglia S, Panebianco V, Conti F, Riccieri V. Rheumatology (Oxford, England). [PMID: 40504021](https://pubmed.ncbi.nlm.nih.gov/40504021/) ## Sjogren's Disease Recent research highlights key updates in Sjogren’s disease (SjD), including nomenclature shifts and clinical insights. A 2023 international consensus (Ramos-Casals et al.) advocates replacing 'Sjogren syndrome' with 'Sjogren disease' (SjD) to better reflect its distinct pathogenesis, while recommending 'associated' over 'secondary' for cases coexisting with other autoimmune diseases. This change aims to standardize terminology, though the primary/associated distinction remains valuable for research. Clinically, SjD frequently overlaps with fibromyalgia (FM), as shown by Mettler et al., who found no significant differences in FM features between patients with or without immune-mediated rheumatic diseases (IMRDs), including SjD (16% of IMRD cases). Notably, SjD-associated FM patients had higher enthesopathies and childhood pain but responded similarly to multimodal treatment, with the FiRST tool proving effective for FM diagnosis in IMRD contexts. Together, these studies underscore SjD’s complex interplay with comorbidities while advancing clarity in classification and management. ### References - Fibromyalgia with concomitant immune-mediated rheumatic diseases: an evaluation of clinical characteristics, diagnostic criteria and multimodal treatment outcomes. by Mettler J, Ming-Azevedo P, Hugle T. Advances in rheumatology (London, England). [PMID: 40506741](https://pubmed.ncbi.nlm.nih.gov/40506741/) - 2023 International Rome consensus for the nomenclature of Sjogren disease. by Ramos-Casals M, Baer AN, Brito-Zeron MDP, Hammitt KM, Bouillot C, Retamozo S, Mackey A, Yarowsky D, Turner B, Blanck J, Fisher BA, Akpek EK, Baldini C, Bootsma H, Bowman SJ, Dorner T, Laing L, Lieberman SM, Mariette X, Pflugfelder SC, Sankar V, Siso-Almirall A, Tzioufas AG, Anaya JM, Armagan B, Bombardieri M, Carsons S, de Vita S, Fox RI, Gerli R, Giacomelli R, Gottenberg JE, Hernandez-Molina G, Jonsson R, Kruize A, Kwok SK, Li X, McCoy SS, Ng WF, Olsson P, Rischmueller M, Saraux A, Scofield RH, Valim V, Vitali C, Vivino F, Wahren-Herlenius M, Moutsopoulos HM. Nature reviews. Rheumatology. [PMID: 40494962](https://pubmed.ncbi.nlm.nih.gov/40494962/) ## Systemic Lupus Erythematosus A recent nationwide Swedish cohort study (Nguyen et al., *Lancet Rheumatol* 2025) investigated hydroxychloroquine's (HCQ) impact on pregnancy outcomes in 959 SLE patients. HCQ exposure (≥2 dispensations from 3 months pre-pregnancy through first trimester) was associated with a 51% lower risk of pre-eclampsia (adjusted RR 0.49, 95% CI 0.31–0.79), with stronger effects in parous women (RR 0.44). No clear association was found for pre-term delivery (RR 0.95). Results were robust across subgroups (antiphospholipid syndrome, renal disease, hypertension), suggesting HCQ may be particularly valuable for pre-eclampsia prevention in SLE pregnancies, though its role in reducing pre-term birth remains uncertain. The study leveraged IPTW and modified Poisson models with comprehensive confounder adjustment, including lived experience input. ### References - Exposure to hydroxychloroquine in early pregnancy and incidence of pre-eclampsia and pre-term delivery in patients with systemic lupus erythematosus in Sweden: a nationwide population-based cohort study. by Nguyen NV, Sandstrom A, Svenungsson E, Dominicus A, Arkema EV, Simard JF. The Lancet. Rheumatology. [PMID: 40516564](https://pubmed.ncbi.nlm.nih.gov/40516564/) ## Vasculitis Recent research highlights advances in the management of various vasculitides, with a focus on reducing glucocorticoid dependence and optimizing long-term outcomes. In giant cell arteritis (GCA), upadacitinib shows promise in a clinical trial, offering a potential alternative to glucocorticoids, which are effective but plagued by relapses and side effects (Kermani & Warrington, 2025). Meanwhile, the British Society for Rheumatology has updated its guidelines for ANCA-associated vasculitis (AAV), incorporating new evidence to refine treatment strategies for granulomatosis with polyangiitis, microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis. The 26 recommendations emphasize tailored therapies, ENT manifestation management, and equitable care access (Biddle et al., 2025). Long-term outcomes in cryoglobulinemia vasculitis (CryoVas) reveal high relapse rates (71% at 5 years) post-rituximab induction, particularly in patients with purpura or prior flares, though maintenance therapy mitigates early relapses (Poggi et al., 2025). In Behçet’s syndrome, sleep disturbances and circadian rhythm disruptions are linked to active disease or fibromyalgia, while all patients exhibit elevated obstructive sleep apnea risk, warranting targeted screening (Colitta et al., 2025). Together, these studies underscore a shift toward precision medicine in vasculitis, balancing efficacy with reduced toxicity and addressing unmet needs in relapse prevention and comorbidity management. ### References - JAKing down glucocorticoids in giant cell arteritis. by Kermani TA, Warrington KJ. Med (New York, N.Y.). [PMID: 40516519](https://pubmed.ncbi.nlm.nih.gov/40516519/) - The 2025 British Society for Rheumatology management recommendations for ANCA-associated vasculitis. by Biddle K, Jade J, Wilson-Morkeh H, Adikari M, Yaghchi CA, Anastasa Z, Basu N, Brogan P, Chanouzas D, Dass S, D'Cruz D, Del Pero MM, Dhillon E, Ducker G, Griffin S, Hollick RJ, Jackson D, King C, Marlais M, Mason A, McAdoo S, Mewar D, Mooney J, Ntatsaki E, Pearce F, Rhodes B, Rupani H, Salama A, Siddiqui S, Smith R, Harper L. Rheumatology (Oxford, England). [PMID: 40499922](https://pubmed.ncbi.nlm.nih.gov/40499922/) - Prognosis of essential mixed cryoglobulinemia and connective tissue disease-related cryoglobulinemia after rituximab-induced remission. by Poggi C, Hachulla E, Karras A, Briantais A, Ravaiau C, Gobert P, Deroux A, Nicolas S, Belfeki N, Francois H, Groh M, London J, Campagne J, Allain JS, Dernis E, Durel CA, Le Gallou T, Curie A, Kerschen P, Gensous N, Reboux AH, Behal H, Terrier B, Quemeneur T. Rheumatology (Oxford, England). [PMID: 40493895](https://pubmed.ncbi.nlm.nih.gov/40493895/) - Sleep and circadian parameters in Behcet's syndrome: a comparative analysis using actigraphy and questionnaires. by Colitta A, Bruno S, Cruz-Sanabria F, Starace F, Bazzani A, Di Cianni F, Frumento P, Tassoni MM, Bonanni E, Mosca M, Talarico R, Faraguna U. Rheumatology (Oxford, England). [PMID: 40489669](https://pubmed.ncbi.nlm.nih.gov/40489669/)