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December 2025 to March 2026

Author: Cecile Philippoteaux

Smoking, but not obesity, associated with reduced secukinumab retention in patients with psoriatic arthritis

Ahmadzay et al. investigated the impact of smoking and body mass index (BMI) on secukinumab retention at 12 months and DAPSA28 low disease activity (LDA) achievement at 6 months in 1202 European patients with psoriatic arthritis. Adjusted hazard ratios (HR) for treatment withdrawal were numerically higher in former (HR 1.32; 95% CI 1.00–1.75) and current smokers (HR 1.27; 0.93–1.74) versus never smokers. Response rates were 56%, 61%, and 49% in never, former, and current smokers respectively. No significant association was found between BMI category and either retention or LDA achievement, although each unit increase in BMI was associated with marginally lower odds of achieving DAPSA28 LDA (OR 0.97; 0.94–1.00).

Interferon-related gene signature predicts anti-TNF response in rheumatoid arthritis via meta-analysis and machine learning

Choi et al. combined meta-analysis of 8 blood transcriptome datasets (341 patients with rheumatoid arthritis; 172 responders, 169 non-responders) with machine learning to identify predictors of anti-TNF response. A core set of 39 recurrently upregulated genes, enriched for type I interferon signaling, achieved an area under the curve (AUC) of 0.76 (±0.03) in internal cross-validation and 0.77 (95% CI: 0.48–0.98) in external validation, outperforming both the full transcriptome (AUC 0.71) and compact gene panels. The ensemble model (random forest + XGBoost + logistic regression) yielded a sensitivity of 0.98 and a specificity of 0.96 in the training cohort. Two genes, IFI44L and IFIT1, were consistently identified across meta-analysis, patent curation, and effect-size prioritization strategies, highlighting their potential as companion diagnostic biomarkers for TNF inhibitor therapy.

Older age, insurance type and lower gross domestic product (GDP) among key drivers of b/tsDMARD access disparities

Wright et al. conducted a scoping review of 104 observational studies examining disparities in access to and use of biologic and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) in inflammatory rheumatic and musculoskeletal diseases (iRMDs). Older age negatively affected likelihood of receiving b/tsDMARDs in 43% of relevant publications, government-funded insurance (Medicare/Medicaid) in 6 studies, and lower gross domestic product (GDP) per capita reduced access in 53% of access-reporting studies. Female sex was the most consistent predictor of reduced treatment persistence (48% of relevant publications). Heterogeneity across studies limited firm conclusions.

Tocilizumab biosimilar RGB-19 demonstrates equivalent efficacy and comparable safety in active rheumatoid arthritis

Matsuno et al. evaluated biosimilar RGB-19 versus reference tocilizumab in a phase 3 randomised trial of 368 Japanese adults with active rheumatoid arthritis (RA) inadequately responding to methotrexate. The mean difference in DAS28-ESR change from baseline at week 12 was       -0.21 (95% CI: -0.43 to 0.02), within the predefined equivalence margin of ±0.6. ACR20/50/70, remission rates, pharmacodynamic parameters, and immunogenicity were comparable through week 52, with similarly low rates of treatment-emergent antidrug antibodies (RGB-19: 2.2%; tocilizumab: 4.3%).

B and T lymphocyte attenuator (BTLA) agonist venanprubart fails to demonstrate clinical efficacy in active systemic lupus erythematosus

Ghosh et al. reported a phase 2 trial of venanprubart, a B and T lymphocyte attenuator (BTLA) agonist antibody, in 85 patients with moderately-to-severely active systemic lupus erythematosus (SLE), terminated early for futility. At week 24, remission of rash and/or arthritis was achieved in 11.9% versus 20.9% with placebo (P=0.452), with no significant differences in Systemic Lupus Erythematosus Disease Activity Index-4 (SLEDAI-4) or Systemic Lupus Erythematosus Responder Index-4 (SRI-4) response rates (9.5% vs 16.3%, P=0.520). Despite near-complete BTLA receptor occupancy throughout, molecular changes did not translate into clinical benefit.

Cécile Philippoteaux

Cécile Philippoteaux is a physician and clinical fellow in the Rheumatology Department at Lille University Hospital, France. Her clinical and research interests primarily focus on bone diseases, including secondary osteoporosis, rare and constitutional bone disorders, and the use of real-world data for outcomes research. She is currently pursuing a PhD in medical informatics and epidemiology. Her work leverages the French nationwide health claims database to study pharmaco-epidemiological and prognostic aspects of bone diseases, such as drug-induced osteoporosis, fracture risk prediction, and comorbidity profiles in rare skeletal disorders. Cécile is an active member of the young division working group of the French Society of Rheumatology (SFR) and a member of the EMEUNET Newsletter Sub-Committee.

December 2025 to March 2026

Author: Cecile Philippoteaux

GLP-1 receptor agonists reduce vertebral fracture risk in patients with type 2 diabetes

Khor et al. assessed the association between GLP-1 receptor agonist (GLP-1 RA) use and vertebral fracture (VF) risk in patients with type 2 diabetes using the TriNetX database. After propensity score matching (n=193,563 pairs), GLP-1 RA use was associated with significantly lower odds of VF (incidence 1.5% vs 1.8%; OR 0.83 [95% CI 0.79–0.87]) and reduced need for vertebroplasty or kyphoplasty (OR 0.80 [95% CI 0.65–0.99]). These findings suggest a potential bone-protective role of GLP-1 RAs, possibly mediated through RANKL/OPG signaling and modulation of bone microarchitecture.

Higher RA disease activity doubles the risk of incident osteoporotic fractures: the VARA registry

Wysham et al. examined the relationship between disease activity and osteoporotic fracture in 2,912 veterans with rheumatoid arthritis from the multicenter VARA registry over 21,759 person-years. Each unit increase in time-varying DAS28-ESR conferred an 18% increased fracture risk (aHR 1.18 [95% CI 1.09–1.28]), while moderate and high disease activity categories carried approximately a 2-fold risk versus remission (aHR 2.24 and 2.01 respectively). Fractures affected predominantly the extremities (33%), ribs (24%), spine (20%), and hip (18%). Patient global assessment was the strongest individual predictor, underscoring the importance of treat-to-target strategies for fracture prevention.

Obinutuzumab superior to placebo in active systemic lupus erythematosus: the ALLEGORY phase 3 trial

Furie et al. conducted a phase 3, double-blind, placebo-controlled trial of obinutuzumab, a glycoengineered type II anti-CD20 monoclonal antibody, in 303 adults with active systemic lupus erythematosus (SLE) without proliferative lupus nephritis. At week 52, SLE Responder Index-4 (SRI-4) response was achieved in 76.7% of obinutuzumab-treated patients versus 53.5% with placebo (adjusted difference 23.1 percentage points; P<0.001). Obinutuzumab was superior on all key secondary endpoints including BILAG-based Composite Lupus Assessment (BICLA) response, sustained glucocorticoid reduction, and time to first flare, with a manageable safety profile.

Frailty independently increases fracture risk, partially mediated by inflammatory biomarkers: UK Biobank study

Zhang et al. investigated the association between frailty and incident fractures in 418,700 UK Biobank participants over a median follow-up of 13.6 years. Frailty was associated with a >50% increased risk of any fracture (HR 1.53), with the strongest effect observed for vertebral fractures (HR 2.33). Mediation analyses revealed that CRP, neutrophils, and platelets significantly mediated 0.86–2.20% of the frailty–fracture association, highlighting inflammation as a partial mechanistic pathway linking frailty to skeletal fragility.

Accelerated spine age estimated from DXA predicts fractures and mortality independently of BMD

Cho et al. applied a deep learning convolutional neuronal network (CNN) to DXA vertebral fracture assessment images from 8,810 adults in the Manitoba Bone Mineral Density (BMD) Registry to estimate “spine age“, a biological age derived from vertebral morphology that may differ from chronological age. Each standard deviation increase in predicted age difference (spine age minus chronological age) was independently associated with higher risks of any fracture (aHR 1.11), hip fracture (aHR 1.25), and mortality (aHR 1.12), after adjustment for age, BMD, vertebral fractures, and other covariates. This imaging-derived biological age biomarker may enhance fracture risk stratification beyond conventional tools.

Cécile Philippoteaux

Cécile Philippoteaux is a physician and clinical fellow in the Rheumatology Department at Lille University Hospital, France. Her clinical and research interests primarily focus on bone diseases, including secondary osteoporosis, rare and constitutional bone disorders, and the use of real-world data for outcomes research. She is currently pursuing a PhD in medical informatics and epidemiology. Her work leverages the French nationwide health claims database to study pharmaco-epidemiological and prognostic aspects of bone diseases, such as drug-induced osteoporosis, fracture risk prediction, and comorbidity profiles in rare skeletal disorders. Cécile is an active member of the young division working group of the French Society of Rheumatology (SFR) and a member of the EMEUNET Newsletter Sub-Committee.

December 2025 to March 2026

Author: Sonia Melo Gomes

Multi-omics analysis identifies neutrophil extracellular traps-associated candidate genes in IgA vasculitis

Lin et al. performed multi-omics analysis on peripheral blood bulk transcriptomic data from patients with IgA vasculitis and healthy controls, focusing on the differential expression of a set of 646 NET-associated genes. Different analyses were intersected for candidate gene prioritization.
Five NET-associated candidate genes—AGER, TLR2, CXCR2, TEK, and THBD—were consistently prioritized across analyses. Mendelian randomization results indicated that higher expression of AGER, TLR2, and CXCR2 was associated with increased IgAV risk, whereas TEK and THBD showed inverse associations. These results need to be validated in larger studies and with functional studies.

Biomarkers for recalcitrating disease course in children with Kawasaki disease/ MIS-C

Satirer et al. analysed data from a cohort of 80 children with hyperinflammation in order to identify early biomarkers predictive of recalcitrant disease course (56-70%). Rash, mucosal involvement, and conjunctivitis were more common in the monophasic group, while abdominal pain, neurological signs, pleural effusion, lymphopenia, thrombocytopenia, hypoalbuminemia, and elevated ferritin characterised the recalcitrant group (p < 0.01). Myocarditis and reduced ejection fraction occurred only in the recalcitrant group; coronary artery changes were more frequent in monophasic cases (21% vs. 5%).
NT-proBNP, IL-2R, and SAA were strongly associated with a recalcitrant hyperinflammatory course and may aid early prognostication and monitoring.

CARRA survey identifies variability in vaccination practices in children with rheumatological diseases

De Souza et al. conducted a 44-question survey about vaccine practices amongst the CARRA network aiming to understand provider approach to vaccine review/ reconciliation and identify possible barriers to immunization.
Up to 90% of responders endorsed diverse approaches to vaccine review. Immunosuppressant changes prompted providers to assess baseline receipt of live vaccines over non-live vaccines (p < 0.001).
Provider-identified barriers to immunization included lack of clinic resources (58%), patient or parent vaccine hesitancy (27%), and family concerns regarding vaccines (20%).
Standardized vaccine review practices and improved communication with primary care providers can optimise opportunities to improve vaccination rates and increase awareness.

Use of iv anakinra in paediatric patients with inflammatory conditions seems to have a good safety profile

Klanjscek et al. conducted a multicenter, retrospective cohort study of 113 children treated with intravenous anakinra: 64 (56.6%) had underlying rheumatologic diseases, 27 (23.9%) had onco-hematologic diseases, 22 (19.5%) had severe systemic infections.
Adverse events were observed in 10 children (8.8%). The most common events were transient elevation of liver or pancreatic enzymes (6.2%) and maculopapular rash (1.2%). One patient (0.9%) experienced an anaphylactoid reaction. Sixteen patients (14.2%) died. The rheumatological disease subgroup comprised cases of HLH, MAS, Kawasaki disease, and MIS-C. The mean anakinra dose was 8.38 mg/kg/day (range 2.2-20 mg/kg/day). There were no deaths in this subgroup.

Delays over 6 months in the diagnosis of juvenile idiopathic arthritis impact service use, health-related costs and quality of life

Von Huben et al. performed a cost analysis study over a lifetime horizon comparing the time from actively seeking treatment to formal diagnosis (< 6 months, 6 + months) to quantify the impact of diagnostic delays on health service use, health-related quality of life (HRQoL) and associated costs. The group diagnosed within 6 months (n=102/163) had a lower use of health services, resulting in a mean annual decrease in costs >AUD$10,000 per child. Most of the cost savings were due to reductions in hospitalizations for pain, inflammation, and investigative procedures. There were also significant increases in HRQoL, which persisted over 20 years.

PRO-KIND group establishes consensus protocol for classification, monitoring and therapy in persistent oligoarticular juvenile idiopathic arthritis

Peitz et al. formulated a group of 23 statements concerning the management of persistent oligoarticular JIA. These statements were circulated as survey amongst medical members of the  German Society for Paediatric and Adolescent Rheumatology achieving a 65% response rate (80/124). Overall agreement with the statements was between 87.7-100%. Comments and proposals for change were discussed in the working group and incorporated into the statements where appropriate, resulting in a total of 20 statements being agreed upon.
The resulting statements focus on diagnosis (1-2), diagnostic and monitoring (3-9) and treatment (10-20).

Superb microvascular imaging (doppler) ultrasound of the knee in JIA patients shows excellent repeatability measures for assessment of synovial vascularity

Dohna et al. conducted a prospective multicenter repeatability study for assessment of intra and inter-observer reliability of the novel doppler technique Superb Microvascular Imaging (SMI). The 76 children with JIA included in the study underwent 3 standardized SMI scans, 2 by the same examiner and a third by a different one. Intra-observer reliability was excellent (ICC = 0.972, 95% CI: 0.956–0.982). Inter-observer reliability was strong (ICC = 0.828–0.928), regardless of examiner experience.
Agreement between imaging planes was substantial (κ = 0.72, p = 0.32). Synovial vascularity scores correlated significantly with clinical measures of active arthritis (OR = 1.182, p = 0.0004), particularly with swelling (OR = 1.249, p < 0.0001).

A systematic literature review and metanalysis identifies risk factors for macrophage activation syndrome (MAS) in patients with systemic JIA (sJIA)

Li et al. conducted a systematic literature review on publication databases and subsequent meta-analysis of case-control studies investigating risk factors for MAS in sJIA. A total of 10 studies involving 1,936 patients were included, comprising 643 cases and 1,293 controls. Meta-analysis showed that central nervous system (CNS) involvement, hypofibrinogenemia, markedly elevated ferritin levels, and leukopenia were significantly associated with MAS in sJIA, with odds ratios (95% confidence intervals) of 4.30 (2.13–8.65), 4.03 (2.87–5.65), 8.28 (5.66–12.10), and 5.98 (2.80–12.75), respectively.

Analysis of multicenter vs single-center cohorts shows discordance between rates of non-zero physician’s global scores with absence of active joints in JIA

Ribollo-Gimenez et al. performed a study comparing the frequency of instances in which the physician’s global assessment of disease activity (PhGA) was scored >0 despite the absence of active joints in children with JIA, using two multicenter patient datasets and one single-center dataset from a paediatric rheumatology center with expertise in clinimetric assessments. The percentage of PhGA scores >0 as the sole unmet clinical Inactive disease (CID) criterion was 14.8% /13.7% in the multicenter datasets and 5.1% in the single-center dataset. The CID criteria most frequently unmet for PhGA scores>0 were elevated acute-phase reactants and morning stiffness lasting ≥15min.

Sonia Melo Gomes

Sonia is undertaking her training in paediatric rheumatology at Guys and St Thomas NHS Foundation Trust in London after completing a PhD in autoinflammatory diseases at UCL GOS Institute of Child Health. Her main research interests are genetics of autoinflammation, including mosaicism and novel gene discovery.
Sonia is a member of the Paediatric Rheumatology European Society (PReS). Sonia founded the Global Affairs Subcommittee of EMERGE (Emerging paediatric rheumatologists and researchers) and was the EMERGE chair elect since September 25, stepping up as chair in January 2026. Sonia is also a member of the EULAR PAED committee and is on the editorial board of the Paediatric Rheumatology Online Journal.