Francisco Rubiño

Multicentric reticulohistiocytosis (MRH) is rare, destructive, and often refractory to treatment. This case series shows JAK inhibitors (tofacitinib, upadacitinib) can induce rapid, sustained, multi-organ responses—including articular, skin, vascular & lung disease. A JAK–STAT–driven signal in MRH? 🔗 rmdopen.bmj.com/content/12/2/e…

1/4 Patients with SLE can present with a staggering array of hematologic abnormalities. Virtually no component of the blood is spared. Everything is fair game: 1. Blood cells - cytopenia and cytoses 2. Hemostasis - thrombosis, TMA 3. Lymphadenopathy/splenomegaly 4. Lymphoma

Reflexión de domingo. A veces me dan ganas de volver a hacer mis infografías. Pero luego veo todo lo que circula por internet y lo fácil que es hacerlo todo con la IA, y pienso, ¿hoy en día merece la pena? Creo que no.

🦴 Rheumatoid Arthritis Treatment — EULAR 2025/2026 Update ⸻ 1️⃣ Methotrexate (MTX) Remains First-Line ➊ Start MTX immediately after diagnosis ➋ Escalate rapidly up to 25 mg/week + folic acid ➌ Aim for remission or low disease activity within 3–6 months ⸻ 2️⃣ Steroids = Short-Term “Bridge” Only ➊ Use the lowest dose possible ➋ Taper rapidly — ideally within 3 months ➌ Avoid chronic steroid use due to cumulative toxicity ⸻ 3️⃣ If MTX Fails → Reassess Risk ➊ Poor prognostic factors: • High RF/ACPA • Early erosions ➋ No poor factors → switch to another csDMARD ➌ Poor factors present → add bDMARD or tsDMARD ⸻ 4️⃣ Biologics vs JAK Inhibitors ➊ bDMARDs and tsDMARDs are now on similar footing after csDMARD failure ➋ Choice depends on: • Comorbidities • Safety profile • Patient preference ⚠️ JAK inhibitors require screening for: • VTE risk • Malignancy history • Major cardiovascular events (MACE) • Herpes zoster risk ⸻ 5️⃣ Combination Therapy Matters ➊ Combine biologics/JAK inhibitors with MTX when possible ➋ Improves efficacy and reduces immunogenicity 📌 If MTX contraindicated → IL-6 inhibitors or JAK inhibitors are preferred monotherapy options ⸻ 6️⃣ Sustained Remission Strategy ➊ Consider tapering only after >6 months stable remission ➋ Taper order: • Steroids first • Then biologics/JAKi • csDMARDs last 🚫 Avoid abrupt discontinuation to reduce flare risk ⸻ 7️⃣ Difficult-to-Treat (D2T) RA ➊ Defined as failure of ≥2 biologic classes ➋ Re-evaluate for fibromyalgia or non-inflammatory pain mimics ➌ Switch mechanism of action rather than cycling within the same class ⸻ 📚 Get our new Musculoskeletal Book —-focused revision notes for USMLE, PLAB, MRCP & NEET-PG 🦴✨ 🌐 Visit our website: mediconotes.com #Rheumatology #MedEd #USMLE #MedicalEducation #NEETPG

May Arthritis & Rheumatology Clinical Connections • Romosozumab and Denosumab Combination Therapy After Denosumab in Postmenopausal Osteoporosis • Risk Factors for Relapse in ANCA-Associated Vasculitis Among Patients With Relapse After Induction of Remission With Rituximab acrjournals.onlinelibrary.wiley.com/doi/epdf/10.10…

Obinutuzumab X Rituximab

A man in his 50s with metastatic squamous-cell lung cancer presented with a 6-week hx of pain and swelling of the right great toe and tip of the right middle finger. No history of fever. Tenderness present. Likely diagnosis?

Causes of eosinophilia: - Malignancy (Chronic eosinophilic leukaemia, eosinophilic myeloproliferative disorders) - Atopy - Adrenal haemorrhage/insufficiency - Medications (beta-lactams, allopurinol) - Infection including parasites (strongyloides), helminths, viruses, bacterial, fungal - eGPA - IgG4RD

📢 En el Día Mundial de la Espondiloartritis Axial, queremos recordar la importancia de conocer los síntomas. Es una enfermedad reumática que se calcula una incidencia de unos 7 casos nuevos por cada 100.000 habitantes al año y aparece entre los 20 y 40 años, tanto en hombres como en mujeres. Con más visibilidad y conocimiento, se consiguen diagnósticos precoces.🙌 @ceade_espax #WorldASDay2026

IgG4 useful talk - diagnostic but also don’t forget Exclusion criteria including Fevers 🌡️ [makes IgG4] quite unlikely! [Dr B Davidson] #Rheumatology #MedTwitter

BSR vs ACR vs EULAR Monitoring Guidelines for SARD-ILD #Rheumatology #MedTwitter

“Qué va, si la inmunología es sencilla” La inmunología:

II JORNADA MULTIDISCIPLINAR VASCULITIS CANARIAS. Todas las intervenciones de alto nivel. Una interesante imagen de propuesta de la fisiopatología por el Dr. Rubiño

Among patients with carpal tunnel syndrome randomized to a rigid wrist splint versus placebo bandage, 12-week change in symptom scores was not significantly different and proportion undergoing surgery within 1 year was similar between the two groups. eviden.cc/4rFztrz

A large-scale observational study using an emulated target trial design, #abatacept was associated with lower all-cause mortality and reduced need for mechanical ventilation compared to #rituximab in patients with #rheumatoid #arthritis–associated interstitial lung disease (RA-ILD). ◦ Study design: Researchers used a large US database (TriNetX) to emulate a target trial. 1,615 patients per group were identified after matching for analysis. ◦ Primary outcome: Abatacept was associated with a significantly lower all-cause mortality risk compared to rituximab (HR 0.689, 95% CI 0.581–0.818). ◦ Secondary outcomes: - Abatacept was linked to a reduced risk of mechanical ventilation (HR: 0.698; 95% CI: 0.521–0.934). - Results for other respiratory events, medical utilization, and infection-related adverse events were evaluated but not highlighted as significantly different in the provided abstract (focus remained on mortality benefit). This large, real-world target trial emulation strengthens the evidence that abatacept may offer a more favorable outcome than rituximab in RA-ILD, with consistently lower risks of all-cause mortality across the subgroup and sensitivity analyses. However, this association cannot be interpreted as causal due to potential residual confounding by indication (e.g., clinicians may preferentially use abatacept in patients with less aggressive or milder RA-ILD). Randomized trials needed. *Shih P-C, Wang S-I, Wei JCC. Association of abatacept with lower mortality risk compared to rituximab in rheumatoid arthritis–associated interstitial lung disease: an emulated target trial. Arthritis Rheumatol. 2026;78(3):592-602. 🔗doi.org/10.1002/art.43…

Presented at #ISNWCN: Alternative complement pathway overactivation contributes to IgA nephropathy. In a placebo-controlled trial, iptacopan, a complement factor B inhibitor, significantly slowed kidney-function decline in patients with IgA nephropathy. Full phase 3 APPLAUSE-IgAN trial results: nejm.org/doi/full/10.10… @ISNWCN

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. 🔗doi.org/10.1016/j.ard.…

Retrospective study evaluated prognosis and management of ANCA-associated vasculitis patients with co-occurring diffuse alveolar hemorrhage and venous thromboembolic events ACR Open Rheumatology doi.org/10.1002/acr2.7… Proposed algorithm for the management of concurrent DAH and VTE in those with active AAV

A 66 y/o woman presented with fever. Exam revealed cachexia, along with cervical & axillary lymphadenopathy. Labs demonstrated electrolyte imbalances & elevated markers of inflammation; ANA, ENA, & ANCA tests were negative. 18F-PET/CT showed soft tissue & lymph node lesions distributed systemically, accompanied by abnormal bone marrow metabolism Clinical images in ACROR doi.org/10.1002/acr2.9…

Interstitial Lung Disease in Antineutrophil Cytoplasmic Antibody–Associated #Vasculitis: A European Multicenter Study - Chalkia - Arthritis & Rheumatology - Wiley Online Library acrjournals.onlinelibrary.wiley.com/doi/full/10.10…