To report a VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome patient presenting with muscular manifestations, at diagnosis, and to review the literature on this rare involvement.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a frequently relapsing systemic autoimmune disorder characterized by inflammation and destruction of small- to medium-sized blood vessels resulting in potentially life-threatening organ damage. Of the three AAV subtypes, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are the most common. The aims of treatment are to rapidly control active disease with induction therapy [typically rituximab (RTX) (the new standard-of-care) or cyclophosphamide alongside glucocorticoids (GC) and avacopan], followed by less aggressive maintenance strategies to reduce the risk of relapse. International and national guidelines for the treatment of GPA/MPA are generally aligned, with all guidelines highlighting a need to reduce treatment-related adverse events through rapid GC tapering and the use of GC-sparing avacopan treatment. Guidelines will continue to evolve as ongoing studies provide new insights into alternative (GC-sparing) treatment options and optimal RTX-based treatment regimens.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of frequently relapsing systemic autoimmune disorders characterized by vasculitis-related organ damage and multiple comorbidities related to chronic inflammation. Advances in immunosuppression-based therapies for AAV have considerably improved remission rates, reduced the risk of relapse, and improved survival in patients with AAV. However, mortality remains high compared with the general population and the benefits of treatment are often offset by treatment-related comorbidities, organ damage and adverse effects, particularly infections. The aim of this review is to investigate the key contributors to disease burden in patients with AAV and to describe strategies for improving health-related quality of life.

Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life years (ASDR) of rheumatoid arthritis (RA) and their trends at the global, regional, and national levels were determined using data from the Global Burden of Disease (GBD) 2021 study.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a dangerous autoimmune condition that usually requires high-dose glucocorticoids with immunosuppressive agents. Although effective, long-term glucocorticoid use is associated with significant toxicity. Avacopan, a selective inhibitor of C5a receptors, has emerged as a possible glucocorticoid-sparing drug for AAV, potentially offering a safer, more specific approach to treat the disease. This systematic review and meta-analysis aimed to compare the efficacy and safety of avacopan and conventional glucocorticoid-containing regimens for the treatment of AAV.

Knee osteoarthritis is a highly prevalent whole-joint disease that is associated with substantial morbidity. If step changes are to be made in the management of knee osteoarthritis, novel patient stratification approaches are needed to identify the most effective treatment for individual patients. Numerous methods for stratifying patients with knee osteoarthritis can be employed; clinical presentation, including co-morbidity and pain phenotype, can influence treatment decisions, and there is a rich history of imaging biomarker use, both from conventional radiographs and, since its development, via MRI, in identifying patients at risk of disease progression, and the latter facilitates the detection of synovitis. The development of novel biochemical biomarkers and the rapid growth of '-omics' technologies provide fresh opportunities to deploy these advances in the stratification of patients with knee osteoarthritis. The health economic landscape in this area is developing, and scoping work has highlighted the need for further studies.

Although psoriatic arthritis and rheumatoid arthritis are both common types of inflammatory arthritis characterised by synovial inflammation, there are distinct molecular and cellular landscapes between these conditions. Recent advances in synovial research in psoriatic arthritis have begun to unlock important insights into disease pathogenesis and potential clinical applications. For example, studies using high-dimensional technologies have identified psoriatic arthritis-specific macrophage, fibroblast, and mast cell subsets, as well as specific cytokines, such as IL-36 and IL-41, that drive pathogenesis. This Review explores how research of the synovium has advanced the understanding of psoriatic arthritis, the potential of identified cell types and cytokines as biomarkers and novel therapeutic targets, how limited sample sizes in high-dimensional studies are hindering clinical translation, and the future directions for synovial research in psoriatic arthritis.

Sedentary behaviour (SB) is receiving increasing attention as a potential target for behavioural change interventions in people with Rheumatoid Arthritis (RA), to improve RA outcomes. The primary aim of this review was to describe the design and content of existing SB interventions in RA with a focus on the use of digital technology and Behaviour Change Techniques (BCTs). Secondary aims were to understand how SB is conceptualised in intervention studies, and report data on participants' perceptions of acceptable and/or engaging components, adherence, and intervention efficacy.

The classification of Sjögren's disease partly relies on focus score grading from a minor salivary gland biopsy. Expert regrading of the focus score leads to disease reclassification in half of cases. This study aimed to leverage machine learning to automatically classify the focus score and Sjögren's disease to identify new histological disease subtypes based on minor salivary gland biopsy.

Immune checkpoint inhibitors (ICIs) have been associated with immune-related adverse events (irAEs), including ICI associated vasculitis (ICI-vasculitis) and ICI associated PMR (ICI-polymyalgia rheumatica (PMR)-like syndromes). We sought to describe the characteristics of ICI-vasculitis and ICI-PMR in individuals treated with ICIs through a systematic review and local case series.

Chronic inflammatory arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA), poses unique challenges during pregnancy due to potential maternal and fetal complications. This study aimed to compare pregnancy outcomes among women with these conditions in Qatar.

In this Viewpoint article, six patients and patient advocates discuss the role of the patient in rheumatology, the current unmet needs of patients and promising advances. By reflecting on their own lived experiences, the authors emphasize the integral role of patients for progress in the field.

Obesity affects nearly one in six adults worldwide. Excess adiposity is a pro-inflammatory state associated with increased risk of several types of arthritis, increased arthritis disease activity and/or severity, and poorer response to certain treatments. Obesity is a major risk factor for cardiovascular disease, the leading cause of death in people with common arthritides such as osteoarthritis (OA), gout, rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a promising therapeutic option for people with arthritis and obesity or type 2 diabetes mellitus owing to their pleiotropic effects, including weight loss, improved survival and reduced risk of major cardiovascular and renal events. In vitro and preclinical in vivo experiments in arthritis have uncovered weight-loss-independent anti-inflammatory and chondroprotective properties of GLP-1RAs. In knee OA, clinical data suggest that GLP-1RAs improve pain and function and reduce the risk of surgical intervention; however, their effects on OA incidence remain incompletely understood. Evidence suggests that GLP-1RAs do not directly prevent gout attacks, but are effective in managing cardiometabolic conditions commonly associated with gout and other arthritides. More research is needed to clarify the effects of GLP-1RAs on incidence, disease activity, and progression of rheumatoid arthritis, psoriatic arthritis and axial spondyloarthritis.

Lyme disease is a tick-borne illness that can result in a spectrum of musculoskeletal complications, ranging from infection-related arthritis to post-infectious, immune-mediated conditions. Although prior reports have linked Lyme disease to systemic autoimmune diseases, such as rheumatoid arthritis and psoriatic arthritis, non-radiographic axial spondyloarthritis (nr-axSpA) has not previously been described following Lyme disease.

Recent attempts to understand the pathophysiology and characteristics of osteoarthritis (OA) have led to the stratification of samples and data. An important part of this process is the use of specific terminology, although the lack of clear definitions for these terms can lead to misinterpretation across different disciplines. In this study, we aimed to assess the frequency of use and chronological appearance of key scientific terminology of four prevalent terms in the field of OA research: PHENOTYPE, SUBTYPE, SUBGROUP and ENDOTYPE. These terms were analysed in conjunction with tissues and fluids associated with OA research, specifically plasma/serum, synovial fluid, synovial membrane, cartilage, meniscus and bone. The method for screening the published literature focused on publications from January 2010 to September 2024, with priority given to studies that reported results from unmanipulated human tissues and applying unbiased analytical methods. Excluded from the analysis were reviews, clinical trials, animal studies, in vitro data, and analyses of pre-existing datasets. The data revealed that the most frequently used term was PHENOTYPE, followed by SUBGROUP and SUBTYPE, with ENDOTYPE being the most recently introduced term in 2019. These terms were rarely defined and often used interchangeably within a single paper, particularly in studies involving cartilage and serum. Notably, the use of these terms has tripled in total over the last 14 years, with an increase in the past decade, reflecting a growing interest in OA stratification, as well as the utility of advanced unbiased analytical methods including microarray and RNA sequencing. The term PHENOTYPE was broadly used and often when describing clinical features, whilst the term ENDOTYPE is used when describing molecular mechanisms related to OA pathogenesis. To improve communication of findings associated with OA stratification, we propose a harmonised application in the use of these stratification terms to prevent misinterpretation and support better communication of OA-related research findings. Building on published terminology, PHENOTYPE could be used to describe clinical features, while ENDOTYPE could be used to describe molecular mechanisms.