August 2025 to November 2025
Author: Nikolaos Vlachogiannis
Effectiveness of treat-to-target tapering of TNF inhibitors in spondyloarthritides: a 24-month follow-up study
Amy C D Peeters et al. (10.1016/s2665-9913(25)00070-0) examined whether a tapering strategy with TNF inhibitors is non-inferior to continuation of the same TNF inhibitor dose for up to 12 months in patients with psoriatic arthritis and axial spondyloarthritis. All patients had stable low disease activity for at least 6 months at the time of recruitment. Tapering consisted of extending the interval between TNF inhibitor doses. In this 12-month extension study, similar proportions of patients in the ‘tapering’ and ‘control’ groups maintained low disease activity at 24 months. Adverse events were also comparable between groups, with no significant differences in infections or injection-site reactions.
One-month methotrexate delay improves pneumococcal vaccine response without affecting disease control in early rheumatoid arthritis
Jacques Morel et al. (10.1016/s2665-9913(25)) found that administering the PCV13 pneumococcal vaccine one month before starting methotrexate in patients with early rheumatoid arthritis resulted in stronger humoral immune responses than simultaneous vaccination and treatment initiation. Higher IgG concentrations (~1.5-fold) and opsonophagocytic assay activity (~1.7-fold) were observed in the delayed methotrexate group adjusted for sex and true DMARD-naive status, with sustained functional antibody activity at 12 months. Disease activity, cumulative doses of corticosteroids and the number of patients who were receiving targeted DMARDs were comparable between groups throughout the 12-month follow-up.
Risk factors and screening for interstitial lung disease in early rheumatoid arthritis: the SAIL-RA study
Gregory C McDermott et al. (10.1016/s2665-9913(25)00158-4) found that 11% of patients with early rheumatoid arthritis (≤2 years from diagnosis) had interstitial lung disease (ILD) on high-resolution CT (HRCT). Older age (≥60 years; adjusted odds ratio(OR): 3.9) and moderate-to-high disease activity (DAS28-ESR≥3.2; adjusted OR: 7.0) were strongly associated with the presence of ILD. Several screening strategies using routinely available clinical factors showed variable sensitivity and specificity, with some identifying all ILD cases but at the cost of low specificity. These findings support early, risk-based ILD screening in RA.
Biologic-first versus step-up treat-to-target strategies in psoriatic arthritis: 1-year results of the STAMP trial
This randomised trial (10.1016/s2665-9913(25)00223-1) compared early treatment with secukinumab versus standard step-up care in newly-diagnosed individuals with psoriatic arthritis (DMARD-naive, ≥2 swollen joints). Individuals in the secukinumab group received 300mg secukinumab/ 4 weeks, plus 15mg weekly oral methotrexate. If minimal disease activity (MDA), assessed every 3 months, was not reached, patients were switched to an anti-TNF agent, followed by a second TNF-inhibitor and apremilast. Individuals in the standard-of-care group received 15 mg weekly oral methotrexate, escalating to 25mg at 6 weeks. Treatment was escalated according to standard-of-care. ACR50 responses and adverse event rates were similar between groups at 6 and 12 months.
Cardiovascular risk factor control in primary and SLE-related antiphospholipid syndrome: an international study
This international cross-sectional study of 1003 patients (17 centres from 11 countries) with primary (56%) and systemic lupus erythematosus (SLE)-related (46%) antiphospholipid syndrome (APS) (10.1016/s2665-9913(25)00257-7) showed a high prevalence of cardiovascular risk factors (CVRFs) and poor attainment of recommended CVRF targets. Hypertension, hyperlipidaemia, obesity, and current smoking were common. Patients with primary APS had worse overall CVRF target attainment than those with SLE-related APS, despite lower prevalence of hypertension and hyperlipidemia. Older age and prior arterial thrombosis were associated with poorer target attainment. These results underscore the need for improved cardiovascular prevention in APS.
Nikolaos Vlachogiannis
Nikos is a postdoctoral researcher in Rheumatology and Internal Medicine resident at the Medical School of the National and Kapodistrian University of Athens, Greece. His main clinical and research interests include systemic sclerosis, and specifically the pathogenetic mechanisms connecting vasculopathy / innate immunity with fibrosis. Nikos is also the EMEUNET country liaison for Greece and a member of the Social Media Subcommittee.