Practice Matters Prevalence of Undiagnosed Psoriatic Arthritis among Psoriasis Patients: Systematic Review and Meta-Analysis Villani AP, et al. J Am Acad Dermatol. 2015. Patients with cutaneous psoriasis are at very high risk of developing psoriatic arthritis. It has been increasingly recognized that many patients with psoriasis have “undiagnosed” psoriatic arthritis. The current study has synthesized the available literature and estimates that the point prevalence of undiagnosed psoriatic arthritis (PsA) to be approximately 15.5%. It is hoped that early identification and diagnosis of PsA will lead to better long-term outcomes. Development of an ASAS-endorsed Recommendation for the Early Referral of Patients with a Suspicion of Axial Spondyloarthritis Poddubnyy D, et al. Ann Rheum Dis. 2015. Delayed diagnosis of SpA, especially axial SpA, remains a major problem. This paper reports the development of ASAS recommendations for early referral of patients with axial SpA. These recommendations will now need to be formally evaluated in different settings but will also need education of primary care physicians on the importance of early referral as well as the methods of recognition of parameters such as inflammatory back pain, enthesitis, and dactylitis. Adult Primary Central Nervous System Vasculitis Treatment and Course: Analysis of One Hundred Sixty-Three Patients Salvarani C. et al. Arthritis Rheumatol. 2015;67(6):1637–1645. In this retrospective study, a cohort of 163 consecutive patients with primary central nervous system (CNS) vasculitis who were seen at the Mayo Clinic over a 29-year period were assessed for treatment response and outcome. A favorable response was observed in 85% of patients treated with prednisone alone and in 80% of patients treated with prednisone and cyclophosphamide. Relapses were observed in 27% of patients, and 25% of patients had discontinued therapy by the time of the last follow-up visit. Treatment with prednisone alone was associated with more frequent relapses (odds ratio [OR]=2.90), and large vessel involvement (OR=6.14) and cerebral infarcts at the time of diagnosis (OR=3.32) were associated with a poor response to treatment. Increased mortality was associated with increasing age at diagnosis (hazard ratio [HR]=1.39), diagnosis by angiography (HR=3.28), cerebral infarction (HR=4.44), and large vessel involvement (HR=4.98), and reduced mortality was associated with gadolinium-enhanced cerebral lesions or meninges (HR=0.20). Immunosuppressive Therapies for the Maintenance Treatment of Proliferative Lupus Nephritis: A Systematic Review and Network Meta-analysis Tian SY, et al. J Rheumatol. 2015. A systematic review of randomized controlled trials was conducted. The data suggested that (MMF) may be superior to other treatments for the maintenance treatment of proliferative lupus nephritis (PLN), but the evidence is not conclusive. Characteristics and Long-term Outcome of Patients with Noninfectious Retinal Vasculitis Shulman S, et al. Retina. 2015. This was a retrospective multicenter study to investigate the characteristics and long-term outcome of patients with noninfectious retinal vasculitis. A new systemic or ocular disease associated with retinal vasculitis was found in more than half of the patients. Behçet disease was the most common newly diagnosed disease. Specific diagnosis leading to proper management is important to maintain favorable long-term visual outcome. T Regulatory and T Helper 17 Cells in Primary Sjögren’s Syndrome: Facts and Perspectives Alunno A, et al. Mediators Inflamm. 2015;2015:243723. Epub 2015 Apr 28. Primary Sjögren syndrome traditionally is believed to be a Th1-driven disease with high interferon levels. This review, which is full text, free online, describes the role of the newer subsets Th17, TREGs, and the follicular helper T cells, their cytokine profiles, and effect of treatment on these subsets. With the change in this paradigm, newer therapies will follow. Risk of Serious Infection in Biological Treatment of Patients with Rheumatoid Arthritis: A Systematic Review and Meta-analysis Singh JA, et al. Lancet. 2015. pii: S0140-6736(14)61704-9. Whether tumor necrosis factor (TNF)-α inhibitors are associated with an increased risk of serious infections is yet to be determined. Data from individual randomized trials and large observational studies have been inconsistent on this issue. This meta-analysis of randomized trials of patients with rheumatoid arthritis who received biologic drugs including TNF-α inhibitors found that standard-dose biologic drugs and high-dose biologic drugs were associated with an increased risk of serious infections compared with traditional disease-modifying antirheumatic drugs (DMARDs), but low-dose biologic drugs were not. The risk was lower in patients who were methotrexate-naïve compared with those who had previously received a traditional DMARD or a TNF-α inhibitor.