Rheumatoid arthritis increases the risk of generalised muscle wasting, with chronic inflammation contributing to the loss of muscle mass and strength. Tofacitinib, a Janus kinase (JAK) inhibitor used to treat rheumatoid arthritis, increases serum creatinine concentrations without conclusive evidence of nephrotoxicity. In the Rheumatoid Arthritis and Muscle (RAMUS) study, we investigated whether tofacitinib affects muscle volume, strength, and function.

Idiopathic inflammatory myopathies are a heterogeneous group of chronic autoimmune diseases characterized by inflammation and muscle weakness. In Colombia, these conditions have been poorly studied. Therefore, an analysis of the prevalence and demographic characteristics of the main reported inflammatory myopathies in the country (dermatomyositis and polymyositis) was carried out, based on data from the Ministry of Health.

Axial spondyloarthritis (axSpA) exhibits notable sex-related differences, particularly in Asian populations, influenced by genetic, cultural, and healthcare factors. This systematic review and meta-analysis assess sex-specific disparities in axSpA among Asian patients.

Synovial tissue is widely considered to be a strong candidate for contributing to the development of individualised therapeutic strategies for the treatment and management of rheumatoid arthritis. Recently, several factors have enabled major developments in synovial tissue analysis: (1) improvement in synovial tissue biopsy techniques; (2) availability of powerful biotechnologies with increasing granularity; (3) recruitment of larger cohorts of patients; (4) development of recommendations to standardise synovial tissue analysis; and (5) an expanded therapeutic armamentarium of targeted therapies. Although recent studies have suggested the existence of rheumatoid arthritis subtypes based on the synovial tissue inflammatory profile, with potential therapeutic implications, other studies have yielded different results. In this Viewpoint we discuss and contextualise the findings of recent major studies in the field of synovial tissue. We highlight how disease activity, synovial tissue inflammatory burden, and response to therapy are interdependent features in rheumatoid arthritis, both earlier and later in the disease course. From there, we discuss how this multidirectional relationship has impacted (and potentially influenced the interpretation of) the findings of synovial tissue-based studies. Finally, we discuss the different hypotheses explaining the link between synovial tissue, clinical features, and therapeutic response.

Immune-mediated vascular endothelial injury is considered one of the earliest pathological features in systemic sclerosis and is thought to occur simultaneously within a broad range of organs, although typically clinically manifesting only as Raynaud's phenomenon in the early stages. Overt vascular systemic sclerosis manifestations include Raynaud's phenomenon, abnormal nailfold capillary morphology, digital ulcers, pulmonary arterial hypertension, cardiovascular disease (primary and coronary), telangiectasia, renal crisis, and gastric antral vascular ectasia. Tissue ischaemia might also contribute to aberrant tissue remodelling, resulting in calcinosis and fibrosis. Recognition of the substantial inter-relationship between these vascular complications is growing; examples of vascular treatment interventions targeting digital vasculopathy having off-target vascular benefits in other organs have been reported. In general, treatment of life-threatening vascular complications, such as pulmonary arterial hypertension, is not commenced until classifiable organ disease has occurred; however, the identification of robust prognostic biomarkers might allow such complications to be averted with preventative disease modification. In this Personal View, we describe the inter-relationship between vascular features of systemic sclerosis. We consider how these features might be exploited to establish a unified vascular conceptual framework that can inform the development of both predictive composite indices to guide preventative intervention, and a unified vascular composite endpoint model that can effectively capture clinically meaningful disease modification in future clinical trials of vasoactive treatments in systemic sclerosis.

Evaluation of risk factors and screening strategies for rheumatoid arthritis-associated interstitial lung disease (ILD) in patients with early rheumatoid arthritis has been scarce. We investigated the prevalence of rheumatoid arthritis-associated ILD, risk factors, and the performance of proposed screening methods for rheumatoid arthritis-associated ILD in patients with early rheumatoid arthritis.

Socioeconomic deprivation as a fracture risk factor remains underexplored. We evaluated associations between deprivation indices and bone health outcomes in a UK clinical population.

This study aimed to establish the role of myositis-specific antibodies (MSAs) in the association between type I interferon (IFN-I) plasma levels and disease activity in juvenile dermatomyositis (JDM).

Biologic therapies for skin psoriasis (PsO) have been linked to a lower risk of developing psoriatic arthritis (PsA), but their efficacy across different mechanisms of action remains to be fully explored. This study aimed to compare PsA risk in PsO patients prescribed interleukin-23 inhibitors (IL23i) vs interleukin-17 inhibitors (IL17i).

Despite significant vascular inflammation, the relationship between Behçet's syndrome (BS) and atherosclerotic cardiovascular (CV) disease remains unclear. This study aimed to evaluate coronary artery involvement in asymptomatic male BS patients and matched controls using coronary computed tomography angiography (CCTA).

Ixekizumab, an interleukin 17A inhibitor, has demonstrated efficacy in improving clinical and patient-reported outcomes in axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA). However, objective data regarding its effects on peripheral inflammation in joints and entheses, inflammation of the posterolateral spinal segments, and structural progression in the spine are lacking. In this study, we aim to address the abovementioned gaps by conducting a longitudinal investigation of the effects of ixekizumab on peripheral and axial inflammation and structural damage in patients with axSpA and PsA. Through comprehensive assessment using advanced imaging techniques such as whole-body magnetic resonance (WB-MRI) and detailed MRI evaluation of the spine, including MRI-based synthetic computed tomography (synthetic CT), and low-dose CT, we seek to investigate the therapeutic effectiveness of ixekizumab across different disease domains.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) encompasses three rare yet interrelated diseases: granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangiitis (EGPA). Despite increasing recognition, the diagnosis of AAV remains challenging, even in specialized medical centres, owing to its clinical heterogeneity, overlap with mimicking conditions, and the variable performance of ANCA testing. The assessment of a patient suspected of AAV requires a timely synthesis of symptoms, physical examination, laboratory tests, histopathology and imaging data to substantiate the diagnosis, exclude alternative diagnoses, assess disease activity and extent, and enable rapid initiation of appropriate therapies. Classification is similarly complex, and evolving classification systems are based on clinical phenotype, ANCA specificity or a combination of both, each with implications for disease monitoring, therapeutic decisions and trial design. Assessing disease severity and predicting prognosis are fundamental but complicated by the diverse patterns of organ involvement, relapsing-remitting course and co-morbidities. Although validated tools exist for measuring disease activity, organ damage and prognosis, many limitations remain, particularly in identifying smouldering disease, irreversible damage and risk of relapse. Emerging therapies have improved outcomes, with recovery of kidney function, better overall survival and improved glucocorticoid-related toxicity, but patients with AAV continue to experience high risks of chronic morbidity and early mortality. This Review explores current challenges and opportunities in the diagnosis, classification and prognostic assessment of AAV, and outlines a structured framework to support personalized and outcome-focused care.

Patients with immune-mediated inflammatory diseases (IMIDs) treated with immunosuppressive therapies are at higher risk for infections, including those preventable by vaccines. Among these therapies, Janus kinase inhibitors (JAK-is) are increasingly used, though their association with varicella zoster virus (VZV) reactivation raises concerns. The recombinant zoster vaccine (Shingrix™) is recommended for immunocompromised individuals and has shown strong safety and efficacy; however, data on its immunogenicity in IMID patients-especially those receiving JAK-is, anti-TNF agents, or methotrexate-remain limited. In the present study, we aimed to evaluate both humoral and cellular immune responses to the recombinant herpes zoster vaccine in IMID patients treated with different JAK-inhibitors in comparison with IMID patients treated with "conventional" therapies i.e. anti-TNF and/or MTX. We also sought to assess whether immune responses differ between patients receiving pan-JAK inhibitors vs selective JAK1 inhibitors, and to identify clinical factors associated with reduced vaccine-induced immunity.

The effects of sodium-glucose transporter 2 inhibitors (SGTL2i) in patients with lupus nephritis (LN) remain poorly studied. This study aimed to assess the SGLT2i effects in patients with LN and residual proteinuria through a retrospective before-and-after study.