E126: Risk Signals, JAKs, and SELECTIVE-ity

Covering an interesting but ultimately disappointing post hoc study of multiple upadacitinib trials in RA. Initially some hope for clarity in the "Do JAKs cause all the badness?" questions, but ultimately landing me about where I have been since ORAL-SURVEILLANCE was published Paper: https://www.sciencedirect.com/science/article/pii/S0003496724423091  

Interesting read this week - I cover a nifty little paper that presented data about adrenal insufficiency after stopping prednisolone, published in JAMA Open in March 2025.     Open Access Journal Here: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831668

Interesting NEJM trial this week comparing methotrexate to prednisone for pulmonary sarcoidosis. Paper available here: https://www.nejm.org/doi/full/10.1056/NEJMoa2501443 

Podcast this week about the recently published SELECT-GCA study, which evaluated the use of the janus kinase inhibitor upadacitinib (Rinvoq) for patients with new and relapsing GCA. Successful trial and an interesting topic. Paper itself here: https://www.nejm.org/doi/full/10.1056/NEJMoa2413449

This week I cover another of my newsletters, though I mostly use it as a skeleton to riff on a common (and challenging) issue for rheumatology consultants; diagnosing HLH. Check out the guidelines themselves here and have a listen to the podcast!    https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00273-4/fulltext

Another day, another b cell podcast. Seems to be all the rage! This week I discuss the recently published NEJM trial of the anti CD20 agent obinutuzumab in lupus nephritis. Worth a read and listen, paper can be found here: https://www.nejm.org/doi/full/10.1056/NEJMoa2410965

What do you do when observational data and RCTs conflict? This week I'm covering the "real world PEXIVAS" study that was done by the French Vasculitis Study Group. Great read, interesting issues, have a listen and be sure to share with friends! 

One of my rare case-report podcasts, a topic that I typically avoid. The craze about CAR-T has also made me a little crazy, though, so I wanted to share what I think may be the ultimate destination for "more B cell depletion than rituximab" strategies.    Article: https://www.nejm.org/doi/full/10.1056/NEJMc2407150

Podcast this week about overdiagnosis! Currently one of my favorite topics and something that I think will be an emerging issue in our field. We recently published a Viewpoint in Lancet Rheumatology (https://pubmed.ncbi.nlm.nih.gov/39341221/) addressing this issue. I'm going to read from it and after that will be giving a few final (spicy) thoughts on the topic. Hope you find it worthwhile! s

New RCT in a new disease with a new drug! But is it as shiny as one would hope? Interesting discussion today about what a trial means, how it will affect practice, and how we could do better as a field. Happy holidays everyone!