This Week in Rheumatology — May 21, 2026

Welcome to This Week in Rheumatology. This week we're covering 8 notable papers spanning several key areas, including new therapeutic strategies for diseases like Sjögren's and GCA, ways to optimize outcomes in psoriatic arthritis and RA-associated lung disease, and practical guidance on vaccination and clinical trial methodology. Let's dive in. Our first theme explores new and evolving treatment approaches, from repurposing old drugs to pioneering cellular therapies. We begin with a condition that has long lacked effective systemic treatments: Sjögren's disease. A study in The Lancet Rheumatology provides new hope with familiar medications [4]. The Study This was the RepurpSS-II trial, a randomized, double-blind, phase 2b study designed to replicate earlier positive findings. Methods Investigators enrolled 46 adults with an active ESSDAI score of at least 5. Patients were randomized 1-to-1 to receive either a combination of leflunomide 20 milligrams and hydroxychloroquine 400 milligrams daily, or placebo, for 24 weeks. Results The trial successfully met its primary endpoint. At 24 weeks, the group receiving the leflunomide-hydroxychloroquine combination had a mean ESSDAI score that was 4.1 points lower than the placebo group, a statistically significant difference. The treatment was generally well tolerated, with gastrointestinal discomfort being the most common side effect, and only one serious adverse event occurred, which was deemed unrelated to the study medication. Conclusions This study confirms that combination leflunomide and hydroxychloroquine is an effective treatment for systemically active Sjögren's disease, offering a potentially affordable and widely available option for these patients. Shifting from repurposed drugs to targeted biologics, a review in Nature Reviews Rheumatology discusses treatment strategies in giant cell arteritis and polymyalgia rheumatica that go beyond glucocorticoids [3]. The authors highlight the progress made with agents that inhibit the IL-6 pathway and, more recently, Janus kinase or JAK signaling. These therapies have been shown to reduce the risk of relapse and allow for significant reductions in glucocorticoid use for both GCA and PMR. The article underscores the need for individualized therapeutic strategies and close monitoring, reflecting a more patient-centered approach to managing these conditions. Finally, looking toward the future of autoimmune disease treatment, a review in Nature Medicine surveys the rapidly developing field of CAR T-cell therapies [2]. Initially developed for cancer, these engineered cells are now being explored to selectively deplete B cells and 'reset' the immune system. The authors explore the concept of deep B-cell depletion, discuss key targets like CD19 and B-cell maturation antigen, and summarize the current, albeit early, evidence on the efficacy and safety of this approach. While not yet a clinical reality for most rheumatology patients, CAR-T therapy represents a potential paradigm shift for treating severe and refractory autoimmune diseases. Next, we turn to strategies for improving how we measure and manage disease, focusing on radiographic repair in psoriatic arthritis and early detection of lung disease in rheumatoid arthritis. A study in Rheumatology (Oxford) challenges the long-held belief that joint damage in psoriatic arthritis is irreversible [5]. The Study Investigators conducted a cohort study to determine the frequency of radiographic damage repair and identify its predictors. Population The study included 674 patients with psoriatic arthritis who underwent biennial radiographic assessments of their hands and feet. Results The findings were quite striking. Radiographic improvement consistent with damage repair was described as "not infrequent." Of the patients who developed joint damage, nearly 30 percent demonstrated evidence of repair in at least one joint. The key finding was a powerful predictor of this repair: combination therapy with a biologic DMARD and methotrexate. This combination was associated with a roughly 50 percent reduction in the rate of damage progression and nearly doubled the rate of damage repair. Conclusions This study provides robust evidence that structural damage in PsA can improve, and it strongly supports the use of combination biologic and methotrexate therapy to achieve these better structural outcomes. In a similar vein of optimizing management, a perspective piece in Nature Reviews Rheumatology proposes a treat-to-target, or T2T, strategy for Behçet syndrome [1]. While T2T has become a cornerstone in managing other rheumatic diseases, its application in the complex and variable world of Behçet's is less established. This international expert collaboration proposes an organ-based approach to define clear treatment goals, outcome measures for remission and relapse, and specific monitoring strategies. The goal is to pave the way for more standardized and effective management to ultimately improve patient outcomes. From improving structural outcomes to detecting comorbidities earlier, our final paper in this section focuses on rheumatoid arthritis-associated interstitial lung disease, or RA-ILD. A study in RMD Open validated a set of screening criteria in a real-world setting [7]. The Study The multicenter VAR-EPIDSER study included 424 RA patients without a previous diagnosis of ILD. All patients were evaluated with the Spanish Society of Rheumatology's screening criteria and also underwent a high-resolution CT scan of the chest as the gold standard. Results The prevalence of previously undiagnosed ILD was 13 percent, or about 1 in 8 patients. Notably, nearly two-thirds of these cases were subclinical, meaning patients had no cough, dyspnea, or Velcro-like crackles on exam. The screening criteria demonstrated high sensitivity at 93 percent and an excellent negative predictive value of 97 percent. However, the specificity was low at 36 percent. Clinical Implications These findings mean the screening tool is very effective at ruling out ILD; a negative screen is highly reassuring. On the other hand, a positive screen is not very specific, as over two-thirds of the entire study cohort screened positive. Therefore, a positive result warrants confirmation with HRCT to avoid over-diagnosis. Finally, we'll cover two papers providing practical guidance: one on vaccination and another on the very foundation of how we define and measure disease. A review in RMD Open provides a timely summary of the evidence for the recombinant zoster vaccine, or RZV, in patients with inflammatory rheumatic diseases [6]. The Problem Patients with these conditions, particularly those on immunosuppressive therapies like high-dose glucocorticoids, biologics, and JAK inhibitors, have a substantially increased risk of herpes zoster. The Evidence The review confirms that RZV is highly effective, offering durable protection for at least 10 years. Real-world data from rheumatology cohorts show a dramatic reduction in zoster relapse after vaccination—around 95 percent—with an acceptable safety profile. The Controversy The paper also addresses the concern of disease flares post-vaccination. While randomized trials did not show an increased risk of flares versus placebo, a separate pharmacovigilance analysis identified a flare incidence of 8.5 percent and a threefold increased reporting odds ratio for flares after receiving the vaccine. Clinical Implications The takeaway is not to avoid vaccination. Major guidelines from EULAR, the ACR, and the CDC all support using the two-dose RZV series in adults with inflammatory rheumatic diseases. The practical advice is to counsel patients about the significant protection against zoster, while also discussing the small but real risk of a temporary disease flare and the need for short-term monitoring. Our final paper, from Arthritis & Rheumatology, takes a step back to look at the tools we use every day in clinical practice and research [8]. The American College of Rheumatology has published its updated recommended methods for the development of disease classification and response criteria. This paper outlines the guiding principles and methodological approach for creating these essential tools, incorporating contemporary methods and strategies to mitigate bias. While highly technical, this work is fundamental. It ensures that the criteria we rely on to diagnose patients and evaluate treatment efficacy are as robust and reliable as possible, shaping the quality of both research and patient care. If you only have time for one paper this week, make it the RepurpSS-II trial in The Lancet Rheumatology [4]. For patients with systemically active Sjögren's disease, a condition with high unmet need, this study provides strong, replicated evidence for an effective and affordable treatment option using a combination of leflunomide and hydroxychloroquine. Here are the key takeaways from this week in Rheumatology. First, for patients with systemically active Sjögren's disease, consider combination therapy with leflunomide and hydroxychloroquine. A new phase 2b trial confirms this regimen significantly reduces disease activity [4]. Second, in psoriatic arthritis, radiographic joint damage is not always permanent and can be repaired. Using a combination of a biologic DMARD and methotrexate not only slows progression but also nearly doubles the rate of repair, reinforcing its use to achieve better structural outcomes [5]. Third, be aware that undiagnosed interstitial lung disease is common in RA patients, affecting roughly 1 in 8, and is often subclinical. While screening criteria are excellent for ruling out ILD, a positive screen has a low predictive value and requires confirmation with HRCT [7]. And finally, strongly recommend the recombinant zoster vaccine for your patients with inflammatory rheumatic diseases. Counsel them that it is highly effective at preventing shingles, but carries a small risk of a temporary disease flare that warrants monitoring [6]. That's your roundup for This Week in Rheumatology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.