December 2024 to March 2025
Authors: Clementina López-Medina and Rym Abida
Clinical factors associated with pneumocystis pneumonia despite its primary prophylaxis: When to stop prophylaxis?
Kim, JY et al. (doi:10.1002/art.43167/abs) aimed to identify risk factors for Pneumocystis jirovecii pneumonia (PJP) despite prophylaxis with trimethoprim-sulfamethoxazole (TMP-SMX). PJP occurred after discontinuation of TMP-SMX. Discontinuing TMP-SMX while on a glucocorticoid dose >12.5 mg/day of prednisone equivalent significantly increased the risk of PJP. They concluded that tapering glucocorticoids at 12.5 mg/day of prednisone equivalent could be a reasonable timepoint to initiate the withdrawal of PJP prophylaxis in patients with rheumatic diseases.
Recurrence risk in pediatric non-infectious uveitis during adalimumab tapering: an international multicenter retrospective study
Marino A, et al. (doi: 10.1002/art.43165) aimed to assess the risk of non-infectious uveitis (NIU) relapse in paediatric patients undergoing adalimumab (ADA) tapering. At ADA tapering, 46% experienced NIU recurrence. A slower ADA tapering schedule was associated with a lower recurrence rate during weaning (HR 0.40, 95% CI 0.21–0.74). This study highlights the clinical impact of ADA tapering on uveitis recurrence risk, recommending a gradual, slow tapering approach with close monitoring.
Pro-inflammatory dietary pattern and the risk of female gout: sex-specific findings from three prospective cohort studies
Rai S, et al. (doi:10.1002/art.43127) aimed to determine whether a proinflammatory dietary pattern is associated with incident female gout. Empirical dietary inflammatory pattern (EDIP) was positively associated with female gout risk, with HR 2.02 (95% CI 1.83-2.22) for the most vs least pro-inflammatory quintile. Reversing the EDIP score, women in the most anti-inflammatory EDIP quintile had the largest magnitude of protective association for gout (HR 0.58, 95% CI 0.53-0.65). These findings support a pivotal role of inflammation as a potential modulator between diet and gout onset, particularly among females.
Critical role for Transglutaminase 2 in scleroderma skin fibrosis and in the development of dermal sclerosis in a mouse model of scleroderma
Tam A, et al. (doi: 10.1002/art.43104) aimed to investigate the expression and function of transglutaminase 2 (TGM2) in scleroderma skin and to determine its potential role. Scleroderma fibroblasts exhibited elevated TGM2 expression, which correlated with increased expression of fibrosis markers. The effects of TGM2 inhibition were similar to those observed with TGFβ neutralization. They concluded that TGM2 can regulate several key pro-fibrotic activities of TGFβ, suggesting that attenuating TGM2 function may be of benefit in severe forms of connective tissue disease with skin fibrosis.
Association of thigh intramuscular fat infiltration with incident knee and hip osteoarthritis: a longitudinal cohort study
Weng Q, et al. (doi:10.1002/art.43159) examined the associations between thigh intramuscular fat infiltration (IMFI) and incident knee and hip osteoarthritis. IMFI in the anterior thigh was significantly associated with incident knee osteoarthritis, with adjusted HRs of 1.78 (95% CI 1.19-2.65), 2.00 (95% CI 1.34-2.99) and 2.34 (95% CI 1.53-3.59) across the second to fourth quartiles, respectively. Both anterior and posterior thigh IMFI were significantly associated with hip osteoarthritis. They concluded that elevated thigh IMFI is significantly associated with increased incidence of both knee and hip osteoarthritis.
Clementina López-Medina
Clementina is a rheumatologist and associate professor at Reina Sofía University Hospital and the University of Córdoba, Spain. Her main research interest is in clinical and translational research in spondyloarthritis and psoriatic arthritis. She also leads the Spondyloarthritis Unit at her hospital. Clementina is a member of the Spanish Society of Rheumatology (SER), the Spanish Group of Interest in Spondyloarthritis (GRESSER), the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA), and a full member of the Assessment of Spondyloarthritis International Society (ASAS). She is a member of the EMEUNET Social Media Sub-Committee.
Rym Abida
Rym is a specialty doctor who graduated in Tunis, Tunisia, focusing on autoimmune rheumatic diseases and vasculitis. She is currently a clinical research fellow and a PhD student in the department of Ageing, Rheumatology and Regenerative Medicine at University College London, and an honorary clinical fellow in the Rheumatology department at University College London Hospital. Her research interests are mainly focused on systemic lupus erythematosus, trying to understand long-term remission. She is also contributing to ongoing research trials in the department. Rym is the past president of the Tunisian Association of Young Internists and past representative of Tunisia in the European Young Internists board. Rym is a member of the EMEUNET Country Liaison sub-committee.
Thank you for highlighting these important and diverse findings in rheumatology. Each study underscores the evolving complexity of our field—from the role of TGM2 in scleroderma fibrosis to the implications of prophylaxis timing in PJP and adalimumab tapering in pediatric uveitis. Particularly notable is the dietary impact on female gout risk, which reinforces the importance of personalized, lifestyle-integrated care. As a rheumatologist in Houston, I find these insights vital for refining treatment strategies and improving patient outcomes across autoimmune and degenerative rheumatic diseases.