Maria Andreo

FEA Medicina Interna. Hospital General Universitario de Elche. Enfermedades Autoinmunes Sistémicas/Autoinflamatorias/ Minoritarias. Profesor asociado en UMH.

[Dr.Mukesh , MD , DM @dr_immuno29]

🚨 Sjögren’s disease is on the verge of its first approved disease-modifying therapy.

🔹 Ianalumab (BAFF-R): 1st successful Phase III → ↓ESSDAI, sustained B-cell depletion, preserved salivary function.
🔹 Telitacicept (BAFF/APRIL): ↓ESSDAI, ↓ESSPRI, ↑STAR responses.
🔹 Nipocalimab (FcRn): ↓IgG & anti-Ro/La; validates the pathogenic role of autoantibodies.
🔹 Remibrutinib (BTK): ↓CXCL13, ↓SSA/SSB, promising systemic benefit.
🔹 Deucravacitinib (TYK2), anti-CD40 & CAR-T are the next frontier.

🎯 Key therapeutic targets: BAFF • APRIL • FcRn • BTK • JAK/TYK2 • CD40 • IFN-I

❌ Why have trials failed before?
• Disease heterogeneity
• High placebo response
• Inadequate outcome measures

✅ Future: Precision medicine • Biomarker-guided therapy • STAR/CRESS endpoints • Earlier intervention

A new era in Sjögren’s disease is finally within reach.

#SjogrensDisease #Rheumatology #Autoimmunity #Immunology #RheumX #MedTwitter #ClinicalTrials #PrecisionMedicine

DOI: 10.1136/rmdopen-2024-004310

[Rheuma Doc @LastManStand85]

Approach to Inflammatory eye disease
& Systemic inflammatory diseases associated with Uveitis #Rheumatology #MedTwitter #ACR2025

[Ravi Kumar @RheumattDoc]

Should we classify AAV by clinical phenotype or ANCA specificity?

PR3-ANCA is associated with granulomatous disease (ENT, lungs), more relapses, and typically seen with GPA.

MPO-ANCA is linked to capillaritis (GN, alveolar hemorrhage, ILD), higher mortality, and most commonly MPA.

EGPA spans both ANCA-positive and ANCA-negative phenotypes, reflecting its biological heterogeneity.

ANCA specificity complements clinical phenotype, improving prognostication, patient stratification, and therapeutic decision-making.

The future of AAV classification isn’t syndrome vs serology - it’s the integration of both.

📖 Image Source: Nature Reviews Rheumatology

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Rheuma Doc @LastManStand85]

The 2026 British Society for Rheumatology guideline for the management of children, young people and adults with systemic lupus erythematosus #Rheumatology #MedTwitter Full Ref Link below 👇

[NEJM @NEJM]

Presented at #EULAR2026:

Among patients with relapsed polymyalgia rheumatica, treatment with secukinumab plus a 24-week glucocorticoid taper resulted in a higher percentage of patients with remission than a glucocorticoid taper alone. Full phase 3 REPLENISH trial results: https://t.co/w1oD5ug1kJ

Editorial: Emerging Era for Polymyalgia Rheumatica and GCA — Interleukin-17A Targeting https://t.co/I13JtK01EA

Original Article in @NEJMEvidence: Secukinumab for Giant Cell Arteritis (phase 3 GCAptAIN trial) https://t.co/0dWjwDaEHs

@eular_org

[NEJM @NEJM]

Presented at #EULAR2026:

In a phase 3 trial, obexelimab led to a lower risk of disease flares than placebo among patients with IgG4-related disease. Glucocorticoid use was lower and the incidence of remission was higher with obexelimab than with placebo. Full INDIGO trial results: https://t.co/Lynf6nmA9N

Editorial: Obexelimab and the Promise of Nondepleting B-Cell Therapy in IgG4-Related Disease https://t.co/BUQ7r8jVWz

@eular_org

[NatRevRheumatol @NatRevRheumatol]

New content online: Type I interferon mediates autoimmune photosensitivity https://t.co/DiiGFmS55D

[Ravi Kumar @RheumattDoc]

Managing Giant Cell Arteritis (GCA): treatment at a glance 👇

• Visual/ischemic symptoms → consider IV methylprednisolone
• Start prednisone 40–60 mg/day
• Tocilizumab or upadacitinib can help reduce steroid exposure
• Relapse management depends on severity

📚 Source: Nature Reviews Rheumatology

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[NatRevRheumatol @NatRevRheumatol]

New content online: Decoding variants of uncertain significance in systemic autoinflammatory diseases https://t.co/omMEkwzrRq

[Ravi Kumar @RheumattDoc]

🚨 Infliximab vs Cyclophosphamide in Severe Behçet’s Syndrome

This multicenter phase 2 Bayesian randomized controlled trial compared infliximab with cyclophosphamide in patients with severe Behçet’s syndrome.

🧪 Study Design

• 52 patients with severe Behçet’s syndrome
• Major vascular involvement: 71%
• Neuro-Behçet’s syndrome: 29%

Patients were randomized to receive:

🔹 Infliximab 5 mg/kg at weeks 0, 2, 6, 12, and 18
OR
🔹 Cyclophosphamide IV pulses every 4 weeks

All patients received glucocorticoids.

🎯 Primary Outcome

Complete response at week 22 defined as:
✅ Clinical remission
✅ Biological remission
✅ Radiological remission
✅ Prednisone dose ≤0.1 mg/kg/day

📊 Results

✅ Complete response achieved in:
• 81% with infliximab
• 56% with cyclophosphamide

📉 Overall adverse events:
• 29.6% with infliximab
• 64% with cyclophosphamide

⚠️ Serious adverse events were similar between groups.

💡 Key Takeaway

Infliximab demonstrated superior efficacy with fewer adverse events compared with cyclophosphamide, supporting TNF inhibition as a preferred induction strategy in severe Behçet’s syndrome with vascular or CNS involvement.

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[NatRevRheumatol @NatRevRheumatol]

New content online: Treat-to-target in Behçet syndrome https://t.co/kOrIFzT2Bm

[NatRevRheumatol @NatRevRheumatol]

New content online: Treatment strategies in giant cell arteritis and polymyalgia rheumatica: beyond glucocorticoids https://t.co/b73BXXezcS

[Rheuma Doc @LastManStand85]

Autoinflammatory syndromes [Prof Lachman] BSR26 #Rheumatology #MedTwitter

[Ahmed El Askary @a_elaskary81]

Rheumatologic Serologies

[Autoinmunes Medicina Interna Parc Taulí @autoinMI_tauli]

VEXAS syndrome- Nature Reviews

⏩autoinflammatory syndrome caused by somatic UBA1 mutations ⏩mainly affecting older men with systemic inflammation, cytopenias & hematologic features
⏩Steroids help, but stem cell transplant may be curative.

https://t.co/opJTzCp9K5

[Aravind Palraj @Rheumat_Aravind]

🧠 Rheumatology MCQ — Clinical Trap

Fever + arthralgia + salmon rash
Ferritin 12,000
ANA/RF negative

Best initial treatment?

A MTX
B NSAIDs ± steroids
C Rituximab
D Cyclophosphamide

#Rheumatology #AOSD #MedEd @docakx @IhabFathiSulima

[Mauricio Ambriz @AmbrizMau]

Recomendaciones EULAR 2025 para el manejo del síndrome de Behçet:

Ann Rheum Dis 2026; DOI: https://t.co/csbSSbjRFS

[@ReumatologiaJ @ReumatologiaJ]

A concise and practical guide for clinicians navigating complex eosinophilic disorders
👉https://t.co/EPK258qJNL
#EGPA #vasculitis

[Ravi Kumar @RheumattDoc]

Clinical Indications for ANCA Testing

ANCA testing should be considered when there is suspicion of ANCA-associated vasculitis (AAV), particularly in the following scenarios:

🫘 Renal
•Glomerulonephritis (especially rapidly progressive GN)

🫁 Pulmonary
•Pulmonary hemorrhage
•Pulmonary–renal syndrome
•Multiple lung nodules

🧴 Cutaneous
•Cutaneous vasculitis with systemic features

👃 ENT / Upper airway
•Chronic destructive disease of upper airways
•Long-standing sinusitis or otitis
•Subglottic tracheal stenosis

🧠 Neurological
•Mononeuritis multiplex
•Peripheral neuropathy

👁️ Ocular / Orbital
•Retro-orbital mass
•Scleritis

Order ANCA only when there is strong clinical suspicion of AAV-not as a screening test.

Source: Revised 2017 international consensus on testing of ANCAs in granulomatosis with polyangiitis and microscopic polyangiitis

#RheumattDoc #MedTwitter #RheumTwitter #Medicine #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1

[Alberto Giraldo @alb_giraldo]

The 2025 update of EULAR recommendations for the management of #Behçet’s syndrome, recently published in Annals of the Rheumatic Diseases, include 5 overarching principles and 12 recommendations organised by organ involvement.

◦ Overarching principles stress the relapsing-remitting nature of the disease, individualised treatment based on activity and prognostic factors, a multidisciplinary approach, patient education, and shared decision-making.

◦ Key recommendations:
- Mucocutaneous and joint involvement: Colchicine is first-line; apremilast or TNFα inhibitors for refractory cases.
- Organ-threatening disease: Early aggressive therapy with glucocorticoids + immunosuppressives, with prompt use of monoclonal TNFα inhibitors encouraged for severe or life-threatening manifestations.

Of the 12 recommendations, 1 is entirely new, 7 were modified, and 4 had only wording changes.

*Hatemi G, Ramiro S, Ozguler Y, et al. EULAR recommendations for the management of Behçet’s syndrome: 2025 update. Ann Rheum Dis. Published online March 23, 2026.
🔗https://t.co/dVblStDVGn