This case-based literature review aims to challenge a common misconception that elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, halo sign on temporal artery ultrasound, and arteritic anterior ischemic optic neuropathy are essential to make a diagnosis of giant cell arteritis (GCA). Here, we present a case of a 70-year-old woman with a biopsy-proven GCA who met the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology Classification Criteria for Giant Cell Arteritis. On admission she complained of left temporal headache, left scalp tenderness, constitutional symptoms and visual disturbances in her left eye that was diagnosed as posterior ischemic optic neuropathy. Erythrocyte sedimentation rate and CRP levels were within normal limits, and the patient had no halo sign on the temporal artery ultrasound. It is crucial to carefully evaluate visual disturbances in elderly patients, since missing a diagnosis of GCA can have catastrophic consequences, such as bilateral blindness, aortic dissection, stroke, or myocardial infarction.

Capillaroscopy is a non-invasive examination used for imaging of capillary vessels of the papillary layer of the finger nailfold. It allows the detection of microcirculation disorders in systemic connective tissue diseases. According to the "Fast Track" algorithm recommended by the European Alliance of Associations for Rheumatology, capillaroscopic findings should be categorized as a scleroderma or non-scleroderma pattern. Scleroderma microangiopathy may also occur in polymyositis and "scleroderma spectrum" diseases such as dermatomyositis, mixed connective tissue disease, or undifferentiated connective tissue disease. These capillaroscopic features are called scleroderma-like microangiopathy. Numerous studies have shown a correlation between capillaroscopic patterns and the severity of organ involvement. Available data indicate the occurrence of capillaroscopic changes in patients with other systemic connective tissue diseases, such as systemic lupus erythematosus, Sjögren's disease, rheumatoid arthritis, and antiphospholipid syndrome. The importance of capillaroscopy in diseases beyond the scleroderma spectrum requires further investigation.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis defined by asthma, hypereosinophilia, and multiorgan involvement. Differentiating EGPA from other eosinophilic disorders is crucial because management differs substantially. The aim of the study is to summarize the pathogenesis, epidemiology, genetics, clinical manifestation, and treatment of EGPA and to provide a comparative differential diagnosis of eosinophilic disorders.

Time to pregnancy is prolonged in women with rheumatoid arthritis. Rheumatoid arthritis-related factors that influence time to pregnancy include high disease activity, high daily prednisone intake (exceeding 7·5 mg), and non-steroidal anti-inflammatory drug (NSAID) use. The aim of this study was to investigate whether a treat-to-target approach aimed at remission, while avoiding NSAIDs and high doses of prednisone, was associated with a reduced time to pregnancy in women with rheumatoid arthritis who wanted to conceive.

Large language models have generated intense interest in clinical artificial intelligence (AI), yet their evolution from passive chatbots into agentic systems capable of autonomous planning, tool use, and multistep execution represents a distinct technological paradigm. Unlike conversational AI, which makes suggestions and awaits review, agentic systems act independently and can chain clinical decisions across electronic health records, laboratory data, and patient communications. Rheumatology, with its decades-long disease trajectories, multimodal data streams, and iterative treatment adjustments, is a field well suited to such automation, but also particularly vulnerable to its failures. Errors in autonomous chains compound silently, verification demands exceed those of any previous clinical decision support tool, and the foundational tasks most suited to automation are precisely those through which trainees develop clinical expertise. This Viewpoint critically appraises the agentic AI landscape, analyses its applications and risks within rheumatology, and proposes a tiered governance framework to ensure meaningful human oversight.

Patients with PsA are at increased risk of cardiovascular (CV) disease, which is not fully captured by traditional risk calculators. SCORE2 is widely recommended in Europe for CV risk stratification, but it may underestimate the burden of subclinical atherosclerosis in PsA. Carotid intima-media thickness (cIMT) is a validated surrogate marker of early atherosclerosis and may provide incremental value. We aimed to determine whether cIMT improves the performance of SCORE2 in detecting subclinical atherosclerosis in patients with PsA.

The use of heterogeneous empirical definitions to assess disease activity in adult-onset Still's disease limits evidence on the efficacy of immunosuppressive agents. Thus, we aimed to specifically develop and validate definitions of clinical criteria for the assessment of disease activity in adult-onset Still's disease.

Immunoglobulin G4-related disease (IgG4-RD) is a chronic fibroinflammatory disorder with heterogeneous clinical behavior. Although glucocorticoids remain the mainstay of treatment, relapse and fibrosis are common. This study investigated predictors of relapse and mortality, integrating disease subtype and cumulative drug exposure using the defined daily dose (DDD) framework.