ARP Rheumatology

🌹 Rosacea or lupus rash? The distinction is not always straightforward.

Facial erythema associated with ANA positivity often raises concern for acute cutaneous lupus erythematosus, but patients with SLE can also develop rosacea — and the two conditions may look very similar clinically.

This review explores the key clinical, dermoscopic and histopathological features that can help differentiate rosacea from ACLE.

🔎 Making the correct diagnosis is important because management differs substantially:

• Rosacea is usually treated with trigger avoidance, topical therapies and sometimes oral antibiotics.

• ACLE may require immunosuppressive treatment and long-term monitoring for systemic disease activity.

Recognising the differences can help avoid unnecessary immunosuppression while also preventing delays in treating active lupus

🔗https://www.arprheumatology.com/article_abstract.php?id=1653

👁️ Orbital inflammation, sinusitis and a difficult diagnostic boundary between ANCA-associated vasculitis and IgG4-related disease.

This case describes an 11-year-old girl who initially presented with bilateral orbital inflammation. The first biopsy showed several features suggestive of IgG4-related disease, including an increased IgG4+/IgG+ plasma cell ratio and obliterative phlebitis.

However, markedly elevated MPO-ANCA levels raised suspicion for ANCA-associated vasculitis. After initial improvement with corticosteroids and subsequent relapses, the patient received rituximab. Later development of rhinosinusitis led to a nasal biopsy showing granulomatous inflammation with multinucleated giant cells, supporting granulomatosis with polyangiitis.

🔎 The case illustrates how AAV and IgG4-related disease can overlap clinically and histologically, particularly in the head and neck, and why longitudinal reassessment can be crucial when the initial diagnosis remains uncertain.

🔗https://www.arprheumatology.com/article_abstract.php?id=1659

💉 Live attenuated vaccination after exposure to TNF inhibitors during pregnancy: reassuring real-world evidence.

The management of live vaccines in infants exposed to TNF inhibitors in utero has evolved following the updated 2024 EULAR recommendations.

In this study, 18 of 29 exposed infants received at least one live attenuated vaccine before 6 months of age. Rotavirus vaccine was given to 17 infants and BCG to 5, including two infants whose mothers had continued adalimumab until weeks 27 and 28 of pregnancy.

✅ No vaccine-related adverse events
✅ No serious infections
✅ No hospitalisations

These real-world findings provide further reassurance regarding the safety of live attenuated vaccination in infants exposed to TNF inhibitors during pregnancy

🔗https://www.arprheumatology.com/article_abstract.php?id=1658

🦴 X-linked hypophosphataemia (XLH) can remain unrecognised until adulthood and may closely mimic inflammatory arthritis.

In this case, longstanding pain, skeletal deformities and enthesopathy were initially explained by previously undiagnosed XLH. During follow-up, however, the development of symmetrical erosive polyarthritis revealed coexisting seronegative rheumatoid arthritis.

🔎 This case highlights the importance of considering metabolic bone disease in atypical musculoskeletal presentations, while also reassessing the diagnosis when new inflammatory or erosive features appear.

💡 A useful reminder that new symptoms should not always be attributed to an existing underlying disorder.

🔗https://www.arprheumatology.com/article_abstract.php?id=1655

💊 How common are methotrexate intolerance and liver toxicity in psoriatic arthritis?

Methotrexate (MTX) is the most widely used conventional DMARD in psoriatic arthritis (PsA), but adverse effects can make long-term treatment challenging.

A study of 341 patients found that 26.7% experienced MTX intolerance, while 10.3% developed hepatotoxicity.

Interestingly, the two outcomes showed different clinical patterns. Intolerance was more common among women and was associated with more frequent changes in treatment, whereas hepatotoxicity was more common among men and patients with metabolic comorbidities and treatment-refractory PsA. Arterial hypertension and treatment-refractory disease were independently associated with hepatotoxicity.

Recognising these different profiles may help clinicians optimise monitoring, improve MTX safety, and support treatment persistence.

🔗https://www.arprheumatology.com/article_abstract.php?id=1656

🆕 A large US study provides new insights into hospitalization outcomes in Sjögren’s syndrome.

Researchers analysed more than 272,000 Sjögren’s syndrome-associated hospitalizations between 2016 and 2020, showing the significant inpatient burden associated with this systemic autoimmune disease.

Although overall in-hospital mortality was lower than in matched controls, patients who developed acute complications faced a substantially greater risk of death. Mechanical ventilation, sepsis, stroke, malignancy and interstitial lung disease were among the strongest predictors of mortality.

The study also identified important inequalities in outcomes, with racial and socioeconomic disparities persisting even after adjustment for other clinical factors.

These findings highlight the importance of recognising Sjögren’s syndrome as a multisystem disease, promptly identifying serious complications, and addressing disparities that may contribute to unequal outcomes

🔗https://www.arprheumatology.com/article_abstract.php?id=1648

💬 Sexual health is an important part of living well with a rheumatic disease.

Although sexual health has a major impact on quality of life, emotional well-being, and personal relationships, it is still rarely discussed during routine rheumatology care.

This editorial highlights why we need to move beyond focusing only on sexual dysfunction and develop assessment tools that better reflect the real experiences and needs of people living with rheumatic diseases.

By bringing sexual health into everyday clinical care and research, we can provide more holistic, patient-centred care and improve outcomes that truly matter to patients.

Read the editorial and join the conversation about making sexual health a routine part of rheumatology care

🔗https://www.arprheumatology.com/article_abstract.php?id=1651

Could anifrolumab offer a new treatment option for refractory autoimmune cytopenias in rare interferonopathies?

A new case report describes a patient with spondyloenchondrodysplasia (SPENCD)-associated lupus and transfusion-dependent autoimmune hemolytic anemia who achieved sustained remission after starting anifrolumab.

The article also reviews the current understanding of SPENCD and the growing evidence supporting type I interferon blockade as a targeted, steroid-sparing approach for these challenging conditions.

An important contribution to the evolving field of precision medicine in rare autoimmune diseases.

🔗https://www.arprheumatology.com/article_abstract.php?id=1657

Can subcutaneous methotrexate improve outcomes and reduce costs in rheumatoid arthritis?

A new study from Portugal suggests the answer is yes.

Researchers found that, compared with oral methotrexate, subcutaneous methotrexate provided better health outcomes while reducing lifetime healthcare costs. Patients gained more quality-adjusted life years, experienced better disease control, required biologic therapies later, and had fewer hospitalizations.

These findings support wider adoption of subcutaneous methotrexate as a cost-effective treatment strategy for rheumatoid arthritis.

📖 Read the full article at https://www.arprheumatology.com/article_abstract.php?id=1652

📢 New publication in ARP Rheumatology!

This study shows that patients with systemic sclerosis (SSc) who develop small bowel obstruction (SBO) experience significantly worse outcomes than patients with SBO alone, including:
✔️ Higher mortality
✔️ Lower 5-year survival
✔️ More malnutrition and sepsis
✔️ More hospitalisations

These findings reinforce the importance of early diagnosis, close monitoring, and multidisciplinary care for this high-risk group.

Congratulations to all the authors on this important work!

🔗https://www.arprheumatology.com/article_abstract.php?id=1647