30-Second Takeaway
- Use updated EULAR Behçet’s guidance to individualise organ-based therapy and escalate early to TNF inhibitors for severe disease.
- Apply nr-axSpA recommendations to tighten diagnostic specificity and rationalise MRI/CT and biologic use.
- Recognise fibroblast activation and subclinical inflammation as predictors of psoriatic arthritis development in psoriasis with arthralgia.
- Continue aggressive cardiovascular prevention in RA; excess MI and mortality persist despite temporal improvements.
- Initiate tocilizumab earlier in giant cell arteritis when feasible, and monitor avacopan hepatotoxicity, especially in older women.
Week ending March 28, 2026
Targeted updates in vasculitis, spondyloarthritis, Behçet’s, and psoriatic disease for immediate practice impact
2025 EULAR Behçet’s update: organ-based management and earlier TNF use in severe disease
The 2025 EULAR Behçet’s recommendations include 5 overarching principles and 12 organ-based treatment statements. They emphasise recognising relapsing–remitting disease, stratifying by prognostic factors, and using multidisciplinary, shared decision-making care. Colchicine is recommended first-line for mucocutaneous and joint disease, with apremilast or immunosuppressives, including TNF inhibitors, for refractory cases. Organ involvement warrants aggressive induction with glucocorticoids plus immunosuppressives, with early monoclonal TNF inhibitors encouraged for life-threatening manifestations.
Chinese nr-axSpA recommendations: clarifying diagnosis and rational biologic strategies
These national recommendations target diagnostic uncertainty and overdiagnosis in non-radiographic axial spondyloarthritis. Six overarching principles and 17 recommendations clarify axSpA and nr-axSpA definitions, focusing on differential diagnosis, monitoring, and reassessment. They critically evaluate MRI and CT in diagnosis and highlight limitations of ASAS criteria specificity in routine practice. The document offers guidance on non-pharmacologic management, NSAID use, biologic and JAK inhibitor indications, switching, and tapering in sustained remission.
Systemic sclerosis blood-vessel organoids link autoantibodies to EndMT and early fibrosis
Investigators generated blood vessel organoids from systemic sclerosis and control induced pluripotent stem cells to model vasculopathy–fibrosis transitions. Systemic sclerosis organoids exposed to patient serum showed impaired angiogenesis, reduced vessel integrity, and endothelial-to-mesenchymal transition with upregulated fibrosis genes. Spatial proteomics demonstrated altered endothelial–pericyte subpopulations and interactions reminiscent of systemic sclerosis tissue. IgG depletion restored vascular structure, while systemic sclerosis IgG transfer induced pathology, implicating autoantibodies in endothelial injury. Bosentan and γ-secretase inhibition partially reversed vascular abnormalities and EndMT markers, highlighting potentially targetable pathways.
68Ga-FAPI-PET/CT fibroblast activation predicts psoriatic arthritis in psoriasis with arthralgia
This prospective study followed 45 psoriasis patients with arthralgia after baseline 68Ga-FAPI-PET/CT. Fibroblast activation (FAPI positivity) was present in 82% and associated with higher BMI and higher DAS28-CRP. FAPI uptake clustered in large, mechanically stressed joints and correlated with low-grade synovial hyperplasia, entheseal Power Doppler, and osteoarthritis. Psoriatic arthritis developed in 49% of FAPI-positive versus 12.5% of FAPI-negative patients, indicating substantially higher progression risk with fibroblast activation.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.