Rheumatoid arthritis (RA) is a chronic inflammatory disease that impacts patients' quality of life. Evidence regarding the effectiveness of metformin use as an adjunct therapy in RA is limited and fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness of metformin as an adjunct therapy in RA and to quantitatively synthesize available evidence.

Current treatment guidelines for rheumatoid arthritis (RA) favor discontinuation of methotrexate (MTX) over biologic (b) DMARDs. To assess acceptability of this approach, we conducted a cross-sectional study evaluating the perspectives of patients and providers on MTX tapering at one urban and one rural health care center.

Clinicians often recognise broader deterioration in a patient's overall condition that is not fully captured by conventional disease-specific measures. Ageing is associated with reduced physiological reserve and altered body fluid distribution. However, objective markers that capture these changes remain limited. Because the extracellular water-to-total body water ratio (ECW/TBW) reflects fluid distribution, we hypothesised that its prognostic relevance is age-dependent rather than uniform.

Delays in JIA diagnosis may impact long-term outcomes and health-related quality of life (HRQoL). This study investigated referral pathways, initial treatment patterns and changes in HRQoL among UK children and young people with JIA stratified by ethnic group and socioeconomic position.

To assess the inter- and intra-rater reliability of minor salivary gland biopsy (MSGB) interpretation for the evaluation of Sjögren's disease (SjD), in accordance with the 2017 EULAR recommendations.

Systemic lupus erythematosus (SLE) is an established, independent risk factor for cardiovascular disease (CVD), most notably premature atherosclerotic cardiovascular disease (ASCVD). This association is thought to relate to chronic immune mediated inflammation. Clonal expansion of haematopoietic stem and progenitor cells (HSPCs) with acquired mutations, but no evidence of a blood disorder, is known as clonal haematopoiesis of indeterminate potential (CHIP). CHIP is associated with a pro-inflammatory immune phenotype, driven predominantly by mutant myeloid cells, and is similarly strongly associated with ASCVD. When SLE and CHIP co-occur, there may be synergy of their canonical cellular and molecular inflammatory pathways or even convergence of pathways through shared mechanisms of immune dysregulation, which accelerate CVD. Furthermore, enrichment of HSPC clones carrying CHIP driver mutations has been observed in chronic inflammatory conditions, including SLE. In this review, we explore the emerging role of CHIP in the relationship between SLE and ASCVD, proposing it as a pathogenic nexus in a triangular inflammatory network. Defining these relationships will help early identification of high-risk individuals and facilitate therapeutic targeting of CHIP to mitigate ASCVD complications in SLE patients.

Many childhood-onset chronic conditions continue into adulthood. Life-course research is essential to understand long-term outcomes in these individuals. Parents/guardians consent children into cohort studies and data-linkage with medical records. However, under UK ethics, linkage must stop at age 16 without specific re-consent. This presents challenges, as many young adults have moved, been discharged or changed hospitals. This research aims to understand opinions on contributing data to research studies, particularly continuing to use long-term health outcome data into adulthood.

Targeting stromal cells such as inflammatory fibroblasts presents a potential avenue to alleviate autoimmune inflammation and fibrosis. This study aimed to characterize LRRC15 expression in rheumatoid arthritis (RA) and systemic sclerosis (SSc) across fibroblast subsets and assess whether targeting LRRC15-expressing fibroblasts can be beneficial for the treatment of fibrosis and fibroblast-mediated inflammation.

To examine associations between smoking and Sjögren's disease (SjD) diagnosis, compared with non-Sjögren's sicca syndrome (sicca) and population controls, and to explore immunomodulatory effects of smoking on disease phenotype.

To evaluate the utility of CD19-directed chimeric antigen receptor T cell (CAR-T) therapy in patients with persistent inflammatory refractory RA (PIRRA), who failed ≥5 biologic/targeted synthetic DMARDs classes.

SLE is a chronic autoimmune disease associated with substantial cardiovascular, metabolic and renal morbidity. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed for type 2 diabetes (T2D), have demonstrated beneficial effects beyond glucose lowering, including improvements in metabolic, cardiovascular and renal outcomes. These effects span multiple domains, including glycaemic control, body weight and blood pressure reduction, heart failure and atherosclerotic cardiovascular disease outcomes, kidney function preservation and potential immunomodulatory pathways. This narrative review summarizes the metabolic, cardiovascular, renal and immunomodulatory effects of SGLT2i relevant to SLE. Evidence from the general population supports cardiometabolic and renal benefits, while observational studies and early-phase trials in SLE and LN suggest potential benefits in selected patients. However, SLE-specific evidence remains limited, and important gaps persist regarding efficacy and safety in active disease. Further studies are needed to define the role of SGLT2i in SLE.

Interstitial lung disease (ILD) is a serious extra-articular complication of rheumatoid arthritis (RA) and a leading cause of mortality. This meta-analysis aims to comprehensively evaluate the diagnostic utility and clinical relevance of tumor-associated biomarkers in patients with Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).

Systemic lupus erythematosus (SLE) is a lifelong autoimmune condition with multi-system involvement that is associated with morbidity, mortality, and poor quality of life. The key aim of management should be to empower individuals with SLE to manage their condition, suppressing systemic disease activity, and preventing organ damage. This guideline builds on and expands the recommendations developed for the first guideline published in 2017 for adults living with SLE. This comprehensive life-course guideline was developed according to the British Society for Rheumatology Guidelines Protocol by a Guideline Working Group (GWG) comprising healthcare professionals with expertise in paediatric and adult SLE, and people with lived experience. The GWG reviewed published guidelines, undertook a systematic literature review and utilised expertise from specialist lupus centres across the UK and patient representatives to formulate a list of 102 recommendations with corresponding strength of recommendations and agreement scores. These recommendations encompass advances in the assessment, diagnosis, monitoring, general approaches to management, non-pharmacological and pharmacological management of SLE, organ-specific treatment including lupus nephritis and cutaneous lupus erythematosus, as well as the delivery of care in the context of the UK healthcare system. Furthermore, we have provided research and audit recommendations to support equitable access to care and improve health outcomes in SLE.

Anti-MDA5 antibody-positive DM (MDA5+DM) is frequently complicated by rapidly progressive interstitial lung disease (RP-ILD). The current study aims to identify predictors for the development of RP-ILD in MDA5+DM, thereby providing an objective basis for early intervention strategies.

The ROSA study evaluated real-world persistence and effectiveness of upadacitinib and tumour necrosis factor inhibitors (TNFi) in patients with rheumatoid arthritis (RA), using data from two Canadian registries, RHUMADATA and Ontario Best Practices Research Initiative (OBRI), and the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) registry.

This Health Policy compares the current recommendations from the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for new treatments in rheumatoid arthritis, highlighting where they align, where they differ, and how harmonisation could make drug development more efficient. We examined the EMA's Guidelines on Clinical Trials of Medicinal Products for the Treatment of rheumatoid arthritis and the FDA's draft guidance rheumatoid arthritis Development of Drugs for Treatment, together with relevant cross-indication FDA guidelines and labelling decisions in rheumatoid arthritis in the last two decades. The key aspects of trial design, including study populations, endpoints, safety requirements, and statistical considerations were analysed. The findings were reviewed and interpreted by a panel of rheumatologists, who proposed strategies for aligning regulatory expectations. The FDA and EMA agree on several core principles such as the use of composite clinical endpoints, validated patient-reported outcomes, the importance of preventing structural joint damage, need for adequate long-term safety exposure, and limits on placebo duration. The EMA, however, favours remission or low disease activity as the preferred primary endpoints, generally requires two pivotal trials in distinct rheumatoid arthritis populations, and background methotrexate unless contraindicated. The FDA offers more flexibility in primary endpoint selection, allows for a single pivotal trial if supported by strong confirmatory evidence, and places greater emphasis on early dose-response characterisation. Greater alignment between FDA and EMA requirements could help reduce duplication, streamline global data interpretation, and speed patient access to effective rheumatoid arthritis therapies globally.