Rheumatology

Staying Current in Rheumatology: RA, Lupus, Spondyloarthritis, and Vasculitis Research

Rheumatology has experienced a biologic therapy revolution over the past two decades — and that revolution continues. New JAK inhibitors, IL-17 and IL-23 inhibitors, and novel mechanisms continue to reach clinical practice. This guide covers practical strategies for rheumatologists to stay current across the major inflammatory disease domains.

Core journals for rheumatologists

Annals of the Rheumatic Diseases (ARD) — EULAR flagship, highest impact rheumatology journal
Arthritis & Rheumatology — ACR flagship, broad scope including clinical, basic, and epidemiological research
Rheumatology (Oxford) — BSR journal, clinically oriented
Arthritis Research & Therapy — open-access, emerging mechanistic and clinical data
The Lancet Rheumatology — newer high-impact journal, clinical trials and reviews

Rheumatoid arthritis: JAK inhibitor safety — the defining recent controversy

The ORAL Surveillance trial (tofacitinib vs. TNF inhibitors in RA patients at cardiovascular risk) demonstrated increased risk of major adverse cardiovascular events (MACE) and malignancy with JAK inhibitors compared to TNF inhibitors in high-risk patients. The FDA response — a class black box warning on all approved JAK inhibitors — has fundamentally changed prescribing practice and patient counseling in RA.

This remains an actively evolving evidence base. Key questions now include: Does the cardiovascular signal apply equally to all JAK inhibitors (tofacitinib, baricitinib, upadacitinib, filgotinib)? Does it apply to younger patients without cardiovascular risk factors? How should this change first- vs. second-line positioning? Rheumatologists need ongoing surveillance of the safety literature and updated ACR guidance.

Lupus: the new therapeutic landscape

Systemic lupus erythematosus management has new options for the first time in decades. Key developments:

Belimumab (Benlysta) — established efficacy in systemic SLE and lupus nephritis (BLISS-LN)
Voclosporin (Lupkynis) — calcineurin inhibitor combination for lupus nephritis
Anifrolumab (Saphnelo) — type I interferon receptor blocker, approved for moderate-to-severe SLE
Obinutuzumab — anti-CD20 in lupus nephritis — NOBILITY trial data and positioning relative to rituximab

The ACR/EULAR lupus nephritis guidelines (2019-2020) provide the current treatment framework, with ongoing updates reflecting new approvals.

Emerging area: CAR-T cell therapy in refractory SLE — case series and early trials from German centers have shown remarkable responses including drug-free remission in patients with severe refractory disease. This is hypothesis-generating but represents a potentially transformative approach if confirmed in controlled trials.

Spondyloarthritis: expanding the biologic armamentarium

Axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) now have multiple classes of approved biologics, creating complex positioning decisions:

IL-17A inhibitors (secukinumab, ixekizumab) — superior to TNF for skin and axial disease; no IBD benefit
IL-23 inhibitors (guselkumab, risankizumab) — strong PsA data; emerging axSpA data
JAK inhibitors (upadacitinib, tofacitinib) — effective across PsA domains with JAK safety considerations applying
Non-radiographic axSpA — the expanding recognition of this category and TNF/IL-17 evidence in this population

Vasculitis: avacopan and changing GCA management

Vasculitis management has two major recent developments:

Avacopan (Tavneos) in ANCA vasculitis — the ADVOCATE trial established avacopan as a glucocorticoid-sparing option, changing the standard of care for GPA and MPA alongside rituximab or cyclophosphamide
Giant cell arteritis — tocilizumab (Actemra) established in ACT-NEW trial; ongoing questions about treatment duration, glucocorticoid tapering, and management of relapse

ACR and EULAR guidelines: the rheumatology reference framework

ACR and EULAR guidelines are updated on rolling cycles across disease areas. High-priority recent updates include:

ACR RA Guidelines (2021) — updated biologic positioning incorporating JAK safety data
EULAR RA Recommendations (2022)
ACR/EULAR Lupus Nephritis Guidelines (2019-2020)
ACR Axial SpA Guidelines
EULAR Vasculitis Recommendations

Conference priorities in rheumatology

ACR/ARP Annual Meeting (November) — the primary US rheumatology conference, late-breaking abstracts session essential
EULAR Congress (May/June) — primary European rheumatology conference, strong on European multicenter trial data

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