📊 How common is difficult-to-manage axial spondyloarthritis? In a 10-year analysis of the DESIR cohort: 🔹 D2M-axSpA occurred in 6.8–14.4%, depending on definition 🔹 True treatment-refractory disease was rare 🔹 Female sex and higher baseline disease activity were associated with D2M-axSpA 🔹 D2M-axSpA carried greater fibromyalgia, healthcare use and opioid burden Findings highlight the importance of a broader, patient-centred approach beyond treatment escalation alone. 🔗 rmdopen.bmj.com/content/12/3…

🚬 Heat-not-burn tobacco: biologically neutral for #RA risk? In bronchial epithelial cells, heat-not-burn cigarette extract, like traditional cigarette extract, increased: ✅ Protein citrullination ✅ Protein carbamylation ✅ Apoptosis, shown by annexin V/PI and cleaved PARP1 These RA-related mechanisms raise concern that “smoking alternatives” may not be biologically neutral in rheumatology. 🔓 rmdopen.bmj.com/content/12/2…

🔬 The TREAT EARLIER trial investigated which arthralgia patients with subclinical inflammation respond best to a 1-year course of methotrexate treatment. 📊 Only 38% of treated patients achieved MRI-defined response. Responders were identified by higher baseline subclinical inflammation, particularly multiple sites of tenosynovitis (PPV 77–79%). 💡 Results support a precision medicine approach: arthralgia patients with extensive subclinical tenosynovitis/osteitis may benefit most from early methotrexate intervention. 🔗 rmdopen.bmj.com/content/12/1…

🔄🩺 Relapse patterns in Granulomatosis with Polyangiitis matter for risk counselling. In 795 patients, organ involvement at diagnosis strongly predicted relapse in the same organ (ENT, lungs, kidneys, eyes, CNS). 🔹 56% relapsed only in initially involved organs 🔹 New organ disease was uncommon and rarely isolated 🔹 Certain baseline features lowered risk of new-organ relapse Useful data to personalise follow-up and patient counselling 🔗rmdopen.bmj.com/content/11/4…

🧬 Who is really “at risk” of RA among first-degree relatives? In the SCREEN-RA cohort (n=1544 RA- first-degree relatives , mean follow-up 7.1 yrs): ✅ 27 developed RA (1.7%) ✅ 126 developed seropositive inflammatory arthritis (8.2%) Using a balanced random forest model: 🔹 High sensitivity (≥0.82), but modest specificity 🔹 Top predictors of future RA: • Rheumatoid factor • EULAR clinically suspected arthralgia symptoms • Multiple affected family members 🔹 For seropositive IA, age, gender and anti-RA33 autoantibodies were most important 🔓 rmdopen.bmj.com/content/11/4…