Rheumatology Digest

ALLEGORY is a phase 3 RCT of the type II anti-CD20 antibody obinutuzumab added to standard therapy in active non-renal SLE. It met its primary endpoint (SRI-4 76.7% vs 53.5% at week 52) and all five key secondary endpoints, achieving both steroid-sparing and a ~40% reduction in flare hazard — reinforcing that depth of B-cell depletion matters and that type II succeeds where rituximab failed.

A 2026 narrative review of T-cell engagers (TCEs) in autoimmune rheumatic disease — off-the-shelf bispecific antibodies that redirect a patient’s own T cells against autoreactive B/plasma cells, pitched as a repeatable, dose-adjustable alternative to CAR-T. Early efficacy across SLE, SSc, RA, myositis and Sjögren’s is real but preliminary, and the review’s headline problem is under-dosing relative to oncology, which likely drives frequent relapse.

A 2026 narrative review arguing that B cells are the single through-line of Sjögren disease — connecting autoantibodies, glandular pathology, the highest lymphoma risk of any autoimmune disease, and the emerging drug pipeline. Endotyping by B-cell activity may identify who develops lymphoma and who responds to B-cell-targeted therapy, as newer BAFF/APRIL, CD40L, BTK and FcRn agents succeed where rituximab failed.

The 2026 Sjögren’s Foundation clinical practice guideline for peripheral nervous system involvement in Sjögren’s disease — an aligned neuro-rheumatology nomenclature, 31 evaluation good-practice statements, and 20 treatment recommendations (6 strong), covering mononeuropathies, polyneuropathies, and autonomic disease. Evidence is very low certainty, so most guidance rests on expert consensus.

WILLOW Cohort A is the first placebo-controlled RCT of a TLR7/8 inhibitor in lupus: the oral agent enpatoran met its primary endpoint with a dose-dependent reduction in cutaneous disease activity (CLASI-A) at 16 weeks, and — the headline — rapidly and reversibly switched off the skin type I interferon signature, pinning TLR7/8 as an upstream driver of cutaneous IFN activation. Steroid-sparing was not demonstrated.

RepurpSS-II is a phase 2b, placebo-controlled RCT of leflunomide plus hydroxychloroquine in active systemic Sjögren’s disease, given without any background immunomodulatory therapy. The combination met its primary endpoint — a clinically meaningful ESSDAI improvement (−4.14) at 24 weeks, replicating RepurpSS-I — but dryness and patient-reported symptoms (ESSPRI) did not separate from placebo.

SELECT-SWITCH is the first double-blind RCT to test mechanism-of-action switching (to the JAK inhibitor upadacitinib) versus cycling to a second TNF inhibitor (adalimumab) after a first TNFi fails in RA. At 12 weeks, upadacitinib roughly doubled low-disease-activity rates and beat adalimumab on the primary endpoint and 4 of 5 ranked secondaries — though HAQ-DI function did not separate and safety was comparable.

A 2026 review of steroid-sparing therapy across the GCA–PMR spectrum: glucocorticoids still induce remission but drive substantial cumulative toxicity, so the field has pivoted to IL-6 receptor inhibition (tocilizumab in GCA, sarilumab in PMR) and JAK inhibition (upadacitinib now approved for GCA) — none of which reliably restores treatment-free remission, against a backdrop of weak monitoring tools and GCA-specific vascular-damage risk.

A combined individual-patient-data analysis of the NORD-STAR and BeSt trials shows that where early RA is distributed carries prognostic signal: hand-dominant disease (JIP-Hand) predicts better treatment response and polyarthritis (JIP-Poly) worse — independent of sex and serology, and equally across csDMARDs and bDMARDs, with ACPA/RF showing no association with short-term activity response.

A 2026 practical review of morphea (localized scleroderma) across age groups — an organ-sparing autoimmune skin disease distinct from systemic sclerosis. Covers classification, the high-stakes subtypes (pansclerotic, facial linear), activity-vs-damage assessment, and management anchored on long-course methotrexate plus a steroid bridge, where depth and site dictate aggressiveness.