Canadian Rheumatology Today
type: channel
publisher: Catalytic Health
language: en
publication name: Canadian Rheumatology Today
issn: 2818-2596
items: Vaccination in Adult Patients with Rheumatic Diseases: A Practical Guide for Canadian Rheumatology Practice
items: Updates on the Treatment and Management of Large Vessel Vasculitis
items: The Emerging Role of IgG4 in Rheumatology
items: Why Rheumatologists Should Know About Nociplastic Pain
items: Frailty in the Rheumatology Clinic: Current Approaches to Assessment and Management
items: Interstitial Lung Disease for the Rheumatologist: Pearls and Insights
items: Latest Developments in Imaging for Axial Disease in Psoriatic Arthritis
items: Management of Adult Patients with Lupus Nephritis: Therapeutic Algorithm Based on the Current Treatment Guidelines
items: IL-17 Inhibition vs IL-23 Inhibition for Psoriatic Arthritis: An Ongoing Debate
items: Can We Prevent Psoriatic Arthritis?
items: Idiopathic Inflammatory Myopathy-Associated Cancer: A Review of Risk Factors and Screening Recommendations
items: What Can We Tell Our Patients About Rheumatoid Arthritis Risk?
items: Capillaroscopy in Systemic Autoimmune Rheumatic Diseases: A Clinical Tool Linking Diagnosis and Pathogenesis
items: Glucagon-like-peptide 1 (GLP-1) Receptor Agonists in Rheumatologic Disease
items: The Past, Present and Future of Antinuclear Antibody (ANA) Testing
items: The Impact of Chimeric Antigen Receptor (CAR) T Cell Therapy: Its Potential to Reshape Rheumatology Practice
items: Imaging for Diagnosis and Differential Diagnosis of Axial Spondyloarthritis
items: Echoes of Change: How Ultrasound Has Transformed Giant Cell Arteritis Detection
items: Contemporary Management of Raynaud’s Phenomenon
items: The 2023 ACR/EULAR Classification Criteria for Antiphospholipid Syndrome: Implications for the Inclusion of Participants in Research vs Diagnosis in Clinical Practice
items: An Update on the Benefits and Safety Profile of Hydroxychloroquine
items: Update on Lupus Nephritis
items: Sjogren’s Syndrome: Strategies for Treatment
items: Updates in Treatment of Refractory Inflammatory Myositis
items: What the Rheumatologist Needs to Know about IBD Treatment
items: Management of Rheumatologic Immune-Related Adverse Events (Rh-irAEs) – An Overview of Immunosuppressive Therapies
items: Shifting Paradigms in the Treatment of Systemic Lupus Erythematosus
items: Exploring Newer Topical Therapies for Inflammatory Skin Diseases: A Guide for Rheumatologists
items: Osteoporosis in 2024: Frequency, Monitoring and Treatment
items: Screening and Management of Atherosclerotic Cardiovascular Disease in Inflammatory Arthritis: A Comprehensive Approach for the Rheumatologist

Vaccination in Adult Patients with Rheumatic Diseases: A Practical Guide for Canadian Rheumatology Practice
type: item
description: Vaccination remains one of the most effective interventions to reduce morbidity and mortality in patients with rheumatic and musculoskeletal diseases. Individuals with autoimmune inflammatory rheumatic diseases face an increased risk of infection due to both immune dysregulation and immunosuppressive therapy. This article summarizes current recommendations on the vaccination of patients with rheumatic diseases put forth by the National Advisory Committee on Immunization (NACI). NACI is a national advisory committee that develops recommendations for the use of vaccines in Canada. These recommendations are reviewed and implemented by provincial and territorial public health authorities; thus, publicly funded schedules may differ between jurisdictions. It is recommended that all practitioners review their local guidelines prior to administration of vaccines. In addition, this article incorporates recommendations from the Canadian Rheumatology Association and American College of Rheumatology where they align with NACI guidance.
subject: Articles
  topic: section
creator: Eilish Scallan
creator: Daniel Warshafsky
creator: Jane Purvis
rights: Copyright (c) 2026 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 35
ending page: 38
doi: 10.58931/crt.2026.3173

Updates on the Treatment and Management of Large Vessel Vasculitis
type: item
description: Background: Large vessel vasculitis (LVV), encompassing giant cell arteritis (GCA) and Takayasu arteritis (TAK), causes granulomatous inflammation of large- and medium-sized arteries with potentially devastating ischemic complications. Glucocorticoids remain first-line therapy but carry significant long‑term morbidity. Methods: This narrative review synthesizes current evidence on the classification, diagnosis, monitoring, and management of LVV, incorporating data from randomized controlled trials, meta‑analyses, and international guidelines. Results: Advances in vascular imaging have improved diagnostic accuracy and increasingly supplement or replace temporal artery biopsy. In GCA, phase 3 trials have demonstrated that tocilizumab and upadacitinib have superior remission rates and glucocorticoid-sparing effects. In TAK, tumour necrosis factor inhibitors remain the preferred biologic for refractory disease, with emerging evidence supporting Janus kinase (JAK) inhibition and novel disease-modifying anti-rheumatic drug combinations. Conclusion: Targeted therapies have transformed LVV management, though reliable biomarkers for disease activity and consensus on optimal treatment duration remain unmet needs. Keywords: large vessel vasculitis, giant cell arteritis, Takayasu arteritis, tocilizumab, upadacitinib, glucocorticoid-sparing, JAK inhibitors
subject: Articles
  topic: section
creator: Stephanie Garner,
rights: Copyright (c) 2026 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 27
ending page: 34
doi: 10.58931/crt.2026.3172

The Emerging Role of IgG4 in Rheumatology
type: item
description: Immunoglobulin G4 (IgG4) is the least abundant IgG subclass and possesses unique structural and functional properties, including Fab-arm exchange, weak complement activation, and reduced Fc receptor binding. These features confer a predominantly immunomodulatory profile that distinguishes IgG4 from other IgG subclasses. Historically associated with allergic responses and immune tolerance, IgG4 has gained increasing attention following the recognition of IgG4-related disease (IgG4-RD), a systemic fibroinflammatory condition characterized by tumefactive lesions, IgG4-positive plasma cell infiltration, and storiform fibrosis. Beyond IgG4-RD, IgG4 responses have also been described in several rheumatic diseases, including rheumatoid arthritis, systemic lupus erythematosus, anti-neutrophil cytoplasmic autoantibody-associated vasculitis, and Sjögren disease. In these diseases, IgG4 may function as a marker of chronic immune activation, an immunomodulatory adaptation, or contribute to disease pathogenesis; however, its precise role remains poorly understood. Elevated serum IgG4 levels or tissue infiltration by IgG4+ plasma cells lacks disease specificity and should be interpreted within an appropriate clinical and histopathologic context. This review summarizes the biological features of IgG4, its established association with IgG4-RD, and its emerging significance across rheumatic diseases. Understanding the context-dependent role of IgG4 may improve diagnostic interpretation and advance our understanding of immune-mediated disease in rheumatology.
subject: Articles
  topic: section
creator: Sinthiha Krishnan
creator: Andreu Fernández-Codina
rights: Copyright (c) 2026 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 20
ending page: 26
doi: 10.58931/crt.2026.3171

Why Rheumatologists Should Know About Nociplastic Pain
type: item
description: The story of nociplastic pain in rheumatology practice begins with fibromyalgia (FM). More than three decades ago, rheumatologists played a leading role in establishing criteria for FM, with early criteria requiring examination of tender points. With increasing knowledge that FM encompassed more than pain alone, along with evidence that the tender point examination showed poor reliability, the American College of Rheumatology developed updated criteria. These updates eliminated tender point assessment and instead incorporated the concept that FM was a syndrome that included “central” symptoms of fatigue, unrefreshed sleep, and cognitive dysfunction, as well as associated conditions such as headaches, abdominal pain, and depression. At that time, the concept of pain sensitization as an explanation for “invisible pain” was being actively studied by basic scientists, but had not yet translated into the clinical domain. The wide range of subjective symptoms experienced by patients with FM were difficult to explain, with many believing that symptoms were exaggerated or primarily psychiatric in origin. With growing recognition, it is now understood that nervous system sensitization is a plausible explanation for “invisible” pain that cannot be sufficiently explained by tissue abnormality. This mechanism is now identified as nociplastic pain, the third pain phenotype alongside nociceptive and neuropathic pain. Nociplastic pain is common and often unrecognized in patients with rheumatic diseases (Table 1).
subject: Articles
  topic: section
creator: Mary-Ann Fitzcharles
creator: Hance Clarke
rights: Copyright (c) 2026 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 12
ending page: 19
doi: 10.58931/crt.2026.3170

Frailty in the Rheumatology Clinic: Current Approaches to Assessment and Management
type: item
description: To illustrate frailty in the context of rheumatic disease, we will consider two women, both 65 years of age who have been living with rheumatoid arthritis (RA) for the past 15 years. Case #1: Rita is a retired lawyer. Her RA has been well-controlled, having remained in remission for the past 5 years on a combination of low‑dose methotrexate and a tumour necrosis factor (TNF) inhibitor. She is otherwise healthy, with no comorbid medical conditions and no additional prescription medications. She lives independently with her husband and enjoys attending group fitness classes at the recreation centre in her neighbourhood. Case #2: Alice lives alone in a rural area. She previously worked as a waitress but has been unable to work for the past 10 years due to chronic mechanical low back pain. Her RA has led to significant joint damage and remains moderately active despite treatment with hydroxychloroquine, sulfasalazine, and chronic low-dose prednisone. She also has a history of diabetes, heart failure, and depression, for which she takes six additional medications. Following a couple of falls last year, she now uses a walker at home. Alice has difficulty leaving the house due to poor mobility along with poor vision. Her neighbour helps with groceries and medical appointments. Although these two women are chronologically identical in age, their health trajectories and risks for adverse outcomes differ substantially. Frailty provides a framework for understanding this heterogeneity.
subject: Articles
  topic: section
creator: Alexandra Legge
rights: Copyright (c) 2026 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2026-07-10
publication date: 2026-07-10
starting page: 5
ending page: 11
doi: 10.58931/crt.2026.3169

Interstitial Lung Disease for the Rheumatologist: Pearls and Insights
type: item
description: Interstitial lung disease (ILD) is a potentially life-threatening complication of systemic autoimmune rheumatic diseases (SARDs). Its prevalence varies according to the underlying SARD, being highest in anti-synthetase and anti‑melanoma-differentiation-associated protein 5 (MDA5) syndromes, but affecting the greatest number of individuals in rheumatoid arthritis due to its higher overall frequency. Because ILD onset may precede, coincide with, or follow SARD diagnosis, rheumatologists may uncover an undiagnosed SARD during ILD evaluation or, conversely, detect ILD through screening of patients with established SARD. The spectrum of SARD-ILD is broad: some patients have mild, stable disease, others experience slowly progressive disease, and some deteriorate rapidly despite treatment, leading to oxygen dependence, lung transplantation, or death. Drug therapies, including immunosuppressive and anti‑fibrotic agents, can slow the progression of SARD-ILD. This article addresses three key clinical questions pertinent to rheumatologists. First, we explore clinical, serological, and morphological features that can aid in diagnosing SARD in patients with ILD, offering practical pearls. Second, we examine screening—covering who to screen, when, how, and at what frequency. Finally, we outline our approach to SARD-ILD management.
subject: Articles
  topic: section
creator: Laurence Poirier-Blanchette
creator: Océane Landon-Cardinal
creator: Sabrina Hoa
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: 4
ending page: 13
doi: 10.58931/crt.2025.2366

Latest Developments in Imaging for Axial Disease in Psoriatic Arthritis
type: item
description: Axial disease in psoriatic arthritis (axPsA), affecting the sacroiliac joints (SIJ) and spine, is recognized as one of the domains in the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for psoriatic arthritis (PsA). Accurate recognition of this manifestation is crucial for comprehensive management of this disease. It is defined according to both clinical and imaging features. Clinically, inflammatory back pain (IBP) is a key feature; however, findings from a recent Canadian inception cohort study—Screening for Axial Spondyloarthritis in Psoriasis, Iritis, or Colitis Cohorts 1 and 2 (SASPIC1 and 2)—which included patients with psoriasis and undiagnosed back pain, showed no differences in the frequency of IBP or non-steroidal anti-inflammatory drug (NSAID) responsiveness between those diagnosed with axPsA and individuals with other causes of chronic back pain. Similarly, data from the global Axial Involvement in Psoriatic Arthritis (AXIS) cohort revealed only minor numerical differences in NSAID responsiveness or frequency of IBP, according to the ASAS criteria, between participants with and without axial involvement when evaluated by central reviewers. Recent post-hoc studies of clinical trials in PsA have attempted to identify axPsA according to a Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) threshold of ≥4. However, MRI-based assessment of axPsA in a large European cohort of 581 PsA patients, recruited across 17 European registries within the EuroSpA network, indicated that a BASDAI ≥4 did not discriminate PsA patients with axial disease from those without. Moreover, only 25–45% of patients with radiographic features of axPsA have been reported to have IBP, with some patients being clinically perceived as asymptomatic. Additionally, axSpA-based IBP criteria have demonstrated limited specificity for axPsA. Studies using MRI have reported poor correlation between sacroiliitis on imaging and bot…
subject: Articles
  topic: section
creator: Walter P. Maksymowych
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: 15
ending page: 21
doi: 10.58931/crt.2025.2367

Management of Adult Patients with Lupus Nephritis: Therapeutic Algorithm Based on the Current Treatment Guidelines
type: item
description: Lupus nephritis (LN) is one of the most significant manifestations of systemic lupus erythematosus (SLE) affecting approximately 35–40% of patients in large cohort studies. It is usually diagnosed in the early phases of the disease; among those with LN, approximately 80% are diagnosed at or shortly after disease onset. LN is characterized by histological and clinical heterogeneity and substantially affects survival. A meta-analysis of 18,309 LN patients reported a 10-year risk for the development of end-stage kidney disease (ESKD) of nearly 17% overall and 33% among those with LN class IV (diffuse proliferative form). Early detection and timely management are essential for optimizing outcomes. Given that LN patients are often asymptomatic, it is recommended that all lupus patients, particularly early in the disease course, undergo routine screening every 3–6 months. This includes assessment of proteinuria with urinary protein‑ or albumin‑to‑creatinine ratio (and 24 hour urine protein if indicated), urinary sediment and serum creatinine, regardless of disease activity. If abnormal findings that cannot be explained by alternative causes are detected (proteinuria ≥500 mg/day, active urinary sediment with acanthocytes ≥5% or red blood cell casts or white blood cell casts, increased serum creatinine) a renal biopsy should be performed, as it remains the gold standard for confirming the diagnosis, management planning, and informing the prognosis. Herein, we present a step-by step approach to the current management of adult LN as recommended by the 2024 American College of Rheumatology (ACR), the 2025 updated European Alliance of Associations for Rheumatology (EULAR), as well as the 2024 KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. New treatment options that will be available in the near future are also discussed briefly. Should emphasize that the focus is on adult LN approach. The ACR guidelines also discuss children, so I think it should be acknowledged …
subject: Articles
  topic: section
creator: Konstantinos Tselios
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-12-19
publication date: 2025-12-19
starting page: 22
ending page: 30
doi: 10.58931/crt.2025.2368

IL-17 Inhibition vs IL-23 Inhibition for Psoriatic Arthritis: An Ongoing Debate
type: item
description: The interleukin-17 (IL-17) and interleukin-23 (IL-23) pathways play a central role in the pathogenesis of psoriatic disease (PsD). This review outlines the immunobiology of these cytokine pathways and summarizes the current evidence on the efficacy and safety of IL-17 and IL-23 inhibitors across PsD domains, including peripheral arthritis, axial arthritis, enthesitis, dactylitis, psoriasis, and inflammatory bowel disease (IBD). IL-17 inhibitors, which target the effector cytokines IL-17A, IL-17F, or their receptors, have demonstrated robust efficacy in psoriasis, peripheral arthritis, and axial disease. IL-23 inhibitors act upstream by targeting the p19 subunit of IL-23 and show comparable efficacy in peripheral arthritis and psoriasis, though evidence for efficacy in axial disease remains limited. While IL-17 inhibitors carry a risk of IBD exacerbation, IL-23 inhibitors are considered therapeutic options for patients with coexisting IBD. In addition, radiographic progression appears better suppressed by IL-17 inhibitors, although emerging data suggest that IL-23 blockade may offer delayed benefits. Both IL-17 and IL-23 drug classes exhibit favourable safety profiles, with clinical trials suggesting slightly better tolerability for IL-23 inhibitors. Future directions include head-to-head comparisons, biomarker-guided treatment selection, and trials assessing long-term structural outcomes. Understanding the tissue- and cell-specific effects of inhibiting these cytokine pathways is key to optimizing therapy in PsD.
subject: Articles
  topic: section
creator: Pankti Mehta
creator: Vinod Chandran
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-08-28
publication date: 2025-08-28
starting page: 4
ending page: 14
doi: 10.58931/crt.2025.2262

Can We Prevent Psoriatic Arthritis?
type: item
description: Psoriatic arthritis (PsA) is a chronic, inflammatory musculoskeletal disease that often develops in individuals with psoriasis (PsO), typically following an average latency period of 7 years. Without treatment, PsA can lead to irreversible joint damage, functional impairment, and a range of comorbidities. Despite therapeutic advances, only a minority of patients achieve sustained remission, highlighting the need for new approaches, including disease prevention and early interception. This review explores the emerging concept of PsA prevention in individuals with psoriasis, by addressing modifiable risk factors—such as severe skin disease, nail involvement, and obesity—and predictors such as arthralgias and asymptomatic abnormalities on musculoskeletal ultrasound. Notably, PsO patients represent a unique preventive opportunity in rheumatology, as many treatments address both PsO and PsA, potentially minimizing additional therapeutic risks. A recently proposed framework by the European Alliance of Associations for Rheumatology (EULAR) outlines three stages of progression from PsO to PsA, ranging from individuals ‘at higher risk’, to those with ‘subclinical PsA’, and finally to those with ‘clinical PsA’. Findings from observational studies suggest that treatment of modifiable risk factors may reduce PsA incidence, though prospective data remain limited. Subclinical inflammation detected on imaging and the presence of arthralgia may identify individuals at imminent risk who could benefit from escalation of therapy. Nonetheless, further refinement of this population is necessary to avoid overtreatment. Ongoing clinical trials are expected to help clarify whether early intervention can truly intercept PsA and alter its natural history. Ultimately, success in PsA prevention will require multidisciplinary collaboration, refinement of risk stratification, and thoughtful integration of these screening strategies into clinical practice.
subject: Articles
  topic: section
creator: Alexandra Kobza
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-08-28
publication date: 2025-08-28
starting page: 16
ending page: 21
doi: 10.58931/crt.2025.2263

Idiopathic Inflammatory Myopathy-Associated Cancer: A Review of Risk Factors and Screening Recommendations
type: item
description: Idiopathic inflammatory myopathies (IIMs) are a group of rare autoimmune diseases that are characterized by autoimmune myositis. However, systemic extramuscular manifestations are frequently observed. IIMs have been associated with cancer, and given the increased frequency of co-incident cancers in IIM, malignancy screening in newly diagnosed IIM patients is an important consideration. That being said, cancer risk varies across IIM subtypes, antibody specificities, and with clinicodemographic factors. As such, cancer screening should be tailored using a risk stratification approach. This review discusses the evidence regarding cancer risk in IIM, as well as recently-published guidelines for cancer screening in IIM.
subject: Articles
  topic: section
creator: Eugene Krustev
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-08-28
publication date: 2025-08-28
starting page: 22
ending page: 31
doi: 10.58931/crt.2025.2264

What Can We Tell Our Patients About Rheumatoid Arthritis Risk?
type: item
description: You are seeing a 45-year-old female with a chief complaint of joint pain in the hands and feet. The symptoms have been apparent for 6 months. There was no preceding illness. She reports morning stiffness of the affected joints. The patient denies any joint swelling. Her medical history is notable for a strong family history of Rheumatoid Arthritis, and she currently smokes one pack of cigarettes daily. On physical examination, the joints appear normal, with full range of motion and no obvious tenderness to palpation. There is no evidence of synovitis or rashes. Laboratory investigations show elevated anti-citrullinated protein antibody level of 135, and her rheumatoid factor level is 45. C-reactive protein is within normal limits. Radiographs of the hands and feet are normal. Questions: 1. What is her likelihood of developing rheumatoid arthritis within the next 3 years? 2. Are there any other tests you need to order? 3. Can rheumatoid arthritis be prevented in this individual? What advice can you provide her?
subject: Articles
  topic: section
creator: Liam O’Neil
creator: Hani El-Gabalawy
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-08-28
publication date: 2025-08-28
starting page: 32
ending page: 35
doi: 10.58931/crt.2025.2265

Capillaroscopy in Systemic Autoimmune Rheumatic Diseases: A Clinical Tool Linking Diagnosis and Pathogenesis
type: item
description: Systemic autoimmune rheumatic diseases (SARDs) including systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and idiopathic inflammatory myopathies (IIMs) are multisystemic, potentially life-threatening autoimmune diseases. These diseases are associated with the highest frequency of disease-associated morbidity and mortality among rheumatic diseases, largely because their complex pathophysiology remains poorly and incompletely understood. Mortality in SARDs is associated with profound vascular dysfunction ranging from cardiovascular disease to more discreet localized vascular complications including Raynaud’s phenomenon (RP), digital ulcers, and pulmonary arterial hypertension (PAH). These vascular complications stem from damage to endothelial cells caused by immune complex deposition, platelet activation, autoantibodies that promote thrombosis (e.g., antiphospholipid antibodies), and immune dysregulation. The relationship between endothelial cell dysfunction and SARDs was first recognized by Maurice Raynaud in the 19th-century, particularly in the context of localized digital ischemia and gangrene. RP is a frequently-encountered problem in clinical practice, with a prevalence in the general population ranging from approximately 5–18%. While most cases of RP are not associated with SARDs, patients with SARDs commonly experience RP. This underscores the importance of vasculopathy related to endothelial dysfunction in the pathogenesis of SARDs. RP is often the earliest presenting feature in up to 20% of patients with SARDs. Indeed, greater than 95% of patients with SSc experience RP.11 Patients with SLE, IIMs including anti‑synthetase syndrome (ASyS), and Sjögren’s disease are also commonly affected. Hence, a closer evaluation for microvascular changes is paramount in the clinical assessment of patients with SARDs. This article will review how nailfold video capillaroscopy is emerging as a valuable point-of-care tool for diagnosis and risk stratification by …
subject: Articles
  topic: section
creator: Roko P.A. Nikolic
creator: Maggie Larché
creator: Mohammed Osman
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-09
publication date: 2025-06-09
starting page: 5
ending page: 15
doi: 10.58931/crt.2025.2157

Glucagon-like-peptide 1 (GLP-1) Receptor Agonists in Rheumatologic Disease
type: item
description: Obesity is a complex chronic disease that increases the risk of long-term medical complications and reduces lifespan due to excess body fat or adiposopathy. As of 2016, obesity affects 8.3 million (26.4%) of the Canadian population. Severe obesity, defined as a body mass index (BMI) >35 kg/m2, affects an estimated 1.9 million Canadians. The financial burden of obesity, including both direct and indirect costs, was estimated to be $7.1 billion in 2010. The pathophysiology of obesity is complex and involves a combination of genetic, metabolic, behavioural, and environmental factors. The hypothalamus regulates appetite and energy expenditure, while the mesolimbic area controls the emotional, pleasurable, and rewarding aspects of eating. The cognitive lobe is responsible for overriding the hedonic drive of the mesolimbic system. Adipose tissue itself contributes to its regulation through the release of leptin in proportion to fat mass. Leptin binds to receptors in the hypothalamus to reduce appetite and increase energy expenditure. Similarly, insulin binds to receptors in the arcuate nucleus of the hypothalamus also reducing appetite and increasing energy expenditure.
subject: Articles
  topic: section
creator: Jill Trinacty
creator: Krista Rostom
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-09
publication date: 2025-06-09
starting page: 16
ending page: 22
doi: 10.58931/crt.2025.2158

The Past, Present and Future of Antinuclear Antibody (ANA) Testing
type: item
description: This article is in memory of Dr. Eng M. Tan (Emeritus: The Scripps Research Institute) and acknowledges the remarkable mentorship and tremendous contributions to our understanding of anti-nuclear antibodies (ANA). Dr. Tan passed away in 2024 at the age of 97. More than 70 years have passed since the discovery of the lupus erythematosus (LE) cell and the development of the LE cell test, which led to the ‘tipping point’ for the discovery of antinuclear antibody (ANA), or what should more correctly be referred to as anti-cellular antibodies (ACA). Paralleling the evolution of ANA testing based on the indirect immunofluorescence assay (IFA) on cryopreserved organ sections in the 1960s and through the early 1970s was an ‘explosion’ in the spectrum of ANA and a remarkable transition in technologies used to detect ANA. This included the transition to IFA on HEp-2 cell substrates beginning in the late 1970s. While some of the ‘octogenarian’ immunoassays such as double immunodiffusion, hemagglutination, complement fixation, radioimmunoassay, and counterimmunoelectrophoresis are fading into oblivion, the ANA IFA has prevailed because of its world-wide use as a screening test for systemic autoimmune rheumatic diseases (SARD), diagnostic criteria for autoimmune hepatitis, a risk factor for the development of uveitis in juvenile idiopathic arthritis, and the entry criterion for classification of systemic lupus erythematosus (SLE). ANA testing, once regarded the domain of rheumatologists and clinical immunologists, has witnessed a widening spectrum of clinicians using these tests because of its links to a growing spectrum of autoimmune and autoinflammatory conditions. All of this is set against the background of remarkable advances in autoantibody detection, especially the emergence of newer high-throughput (i.e., faster turn-around‑time for results), multi-analyte array technologies (MAAT). These technologies use comparatively small serum or plasma volumes and provide higher spe…
subject: Articles
  topic: section
creator: Marvin J. Fritzler
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-09
publication date: 2025-06-09
starting page: 23
ending page: 28
doi: 10.58931/crt.2025.2159

The Impact of Chimeric Antigen Receptor (CAR) T Cell Therapy: Its Potential to Reshape Rheumatology Practice
type: item
description: In recent years, genetically modified T cell therapy, using chimeric antigen receptor (CAR)‑engineered T cells, has revolutionized the field of rheumatology. While CAR T cell therapy is approved by government agencies, including Health Canada, as a standard treatment for B cell lymphoproliferative malignancies, it has also shown remarkable efficacy in refractory cases of rheumatic diseases, including systemic lupus erythematosus, systemic sclerosis, idiopathic inflammatory myopathies, ANCA-associated vasculitis, and rheumatoid arthritis. A single infusion of CAR T cells has demonstrated the potential to induce long-term drug-free remission in most cases. This therapy achieves profound B cell depletion in both blood and tissues—an effect not typically observed with conventional antibody-based B cell-target therapies. Despite its transformative potential, several challenges remain, including questions around long-term safety, high costs, limited accessibility, and the absence of standardized guidelines, which complicate its broader application. Rheumatologists face practical uncertainties, such as determining the optimal timing for treatment, selecting suitable patients, and identifying which diseases might benefit the most from this therapy. This editorial explores the fundamental principles of CAR T cell therapy, highlights the unresolved challenges, and provides insights into how rheumatologists can optimize its use for managing rheumatic diseases. (Please note that this manuscript was written in April 2025. Given the rapid advancements and emerging evidence in this field, there may be updates by the time this article is published.)
subject: Articles
  topic: section
creator: Akihiro Nakamura
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-09
publication date: 2025-06-09
starting page: 29
ending page: 35
doi: 10.58931/crt.2025.2160

Imaging for Diagnosis and Differential Diagnosis of Axial Spondyloarthritis
type: item
description: Spondyloarthritis refers to a group of inflammatory rheumatic diseases characterized by shared clinical features, such as inflammatory involvement of the axial skeleton, a specific pattern of peripheral joint involvement (usually asymmetric mono- or oligoarthritis, predominantly involving the lower extremities), enthesitis, and dactylitis. Common extra-musculoskeletal manifestations include acute anterior uveitis, psoriasis, and inflammatory bowel disease (Crohn’s disease and ulcerative colitis). Axial spondyloarthritis (axSpA) denotes the subset of spondyloarthritis with predominant involvement of the spine and sacroiliac joints. The term axSpA encompasses both non-radiographic disease (no definite structural damage on X-rays of the sacroiliac joints) and radiographic disease, which has historically been referred to as ankylosing spondylitis. In clinical practice, these entities represent a spectrum. axSpA may initially present without X-ray changes and in some patients, may later progress to classic ankylosing spondylitis. In this article, we will review the approach to diagnosing (versus classifying) axSpA and examine the role of imaging modalities in diagnosing axSpA and distinguishing it from common mimics.
subject: Articles
  topic: section
creator: Denis Poddubnyy
rights: Copyright (c) 2025 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2025-06-09
publication date: 2025-06-09
starting page: 36
ending page: 42
doi: 10.58931/crt.2025.2161

Echoes of Change: How Ultrasound Has Transformed Giant Cell Arteritis Detection
type: item
description: Giant cell arteritis (GCA) is the most common form of vasculitis affecting adults. The diagnosis of GCA is suspected in patients older than 50 years of age with a new headache and elevated inflammatory markers. Once the diagnosis of GCA is suspected, patients require urgent treatment with glucocorticoids to prevent ischemic complications such as blindness and stroke. As there are many causes for headache, diagnosing GCA can be a ‘headache’ for many rheumatologists. For years, rheumatologists have relied on the temporal artery biopsy (TAB) as the gold standard for diagnosing GCA, despite the 33–92% sensitivity. As patients with suspected GCA remain on high doses of glucocorticoids, which have multiple side-effects and potential adverse events, rapid access to tests that have a greater impact on clinical decision‑making is essential. Vascular imaging is a non‑invasive tool that can help diagnose, monitor, and predict the course of GCA. This article will focus on how ultrasound has transformed the detection of GCA and its potential to reduce some of the ‘headaches’ faced by both rheumatologists and patients.
subject: Articles
  topic: section
creator: Maria Powell
creator: Mohammad Bardi
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-12-18
publication date: 2024-12-18
starting page: 4
ending page: 11
doi: 10.58931/crt.2024.1353

Contemporary Management of Raynaud’s Phenomenon
type: item
description: Raynaud’s phenomenon (RP) is defined as reversible pallor, and also rubor or cyanosis especially digits and it is very common on the general population. It can be an early sign of a connective tissue disease, especially scleroderma and may negatively impact patients’ quality of life. Lifestyle modifications including smoking cessation, cold-avoidance, and avoidance of medications that could worsen RP should be considered as first-line therapies. For those who are resistant to conservative measures, dihydropyridine calcium channel blockers (CCBs) are the preferred first-line treatment. The majority of treatment trials in RP study nifedipine, but other drugs such as amlodipine and felodipine. Otherwise, there is evidence supporting the use of topical nitrates and oral phosphodiesterase type 5 (PDE5) inhibitors. Intravenous prostaglandins (prostacyclins, PGI2 such as iloprost and PGE1 which is alprostadil) can be used for refractory cases. There remains a paucity of data for the benefit of botulism toxin, fluoxetine, or bosentan for treating RP in these patients.
subject: Articles
  topic: section
creator: Matthew A. Turk
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-12-18
publication date: 2024-12-18
starting page: 13
ending page: 18
doi: 10.58931/crt.2024.1354

The 2023 ACR/EULAR Classification Criteria for Antiphospholipid Syndrome: Implications for the Inclusion of Participants in Research vs Diagnosis in Clinical Practice
type: item
description: Antiphospholipid syndrome (APS) was first described in patients with systemic lupus erythematosus in 1983, and the primary version in 1989. Multiple clinical manifestations have been associated with antiphospholipid antibodies (aPL) including venous and arterial thromboses, transient ischemic attack (TIA), obstetric complications, thrombocytopenia, hemolytic anemia, livedo reticularis, transverse myelitis, cognitive dysfunction, cutaneous ulcers, Libman-Sacks endocarditis, and a peculiar type of nephropathy. Antiphospholipid antibodies include lupus anticoagulant (LAC), anticardiolipin antibodies (aCL) IgG and IgM, and anti‑beta‑2‑glycoprotein antibodies (aβ2GPI) IgG and IgM. Other antibodies such as anti-prothrombin and anti-prothrombin/phosphatidylserine have been proposed as biomarkers of APS, particularly in cases where the standard antibodies are negative, but they are not officially accepted. Since 1999, the original Sapporo Criteria and its revised 2006 version have been used for the classification of patients in research studies and for the diagnosis of patients with APS. Despite the broad spectrum of clinical manifestations and serological markers considered by physicians as part of the APS, the original and revised versions of Sapporo Criteria include only venous, arterial and microvascular thrombotic events and specific obstetric events among the clinical manifestations, and aCL IgG and IgM antibodies, aβ2GPI-I antibodies IgG and IgM or lupus anticoagulant as the serological markers. Consequently, APS was diagnosed as obstetric and/or thrombotic syndrome, not considering other non-criteria manifestations associated to aPL antibodies. The major limitation of these criteria is that they do not reflect the systemic nature of APS. Due to the importance of classification criteria in research, the ACR and EULAR assumed the responsibility of encouraging the development and validation of new and improved classification criteria for various rheumatic diseases, inc…
subject: Articles
  topic: section
creator: Jorge Sánchez-Guerrero
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-12-18
publication date: 2024-12-18
starting page: 19
ending page: 24
doi: 10.58931/crt.2024.1355

An Update on the Benefits and Safety Profile of Hydroxychloroquine
type: item
description: Hydroxychloroquine, an antimalarial drug developed in 1950, has been used for decades in the management of various systemic autoimmune rheumatic diseases. By targeting both the innate and adaptive immune systems, it exerts widespread immunomodulatory effects to attenuate the inflammatory response and exert antirheumatic effects. Its favourable safety profile, coupled with proven benefits in improving disease activity and decreasing morbidity and mortality, especially in patients with systemic lupus erythematosus and rheumatoid arthritis, has solidified its place in the long-term management of patients with rheumatic diseases. Recently, therapeutic drug level monitoring has been used to predict the risks of disease flares and prevent treatment-related toxicity. This review article briefly reviews the benefits of using hydroxychloroquine in the management of systemic autoimmune rheumatic diseases, its common and serious adverse effect profile, and the role of drug blood level monitoring in improving patient-related health outcomes.
subject: Articles
  topic: section
creator: Mais M. Nuaaman
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-12-18
publication date: 2024-12-18
starting page: 25
ending page: 33
doi: 10.58931/crt.2024.1356

Update on Lupus Nephritis
type: item
description: Lupus Nephritis (LN) is a common and severe manifestation of systemic lupus erythematosus (SLE), impacting up to 40% of SLE patients. Despite advancements in understanding the pathogenesis of LN, outcomes have not significantly improved since the early 2000s. LN patients face higher mortality, emphasizing the importance of achieving disease remission. Screening for nephritis involves regular monitoring, especially within the first 5 years of SLE diagnosis. Monitoring includes urinalysis, serum creatinine, and immune serology. Kidney biopsy remains the gold standard for LN diagnosis and classification, providing crucial information for treatment decisions. The standard of care involves hydroxychloroquine for all LN patients, with immunosuppressive treatments tailored to the histologic class. The recently approved medications, belimumab and voclosporin, offer additional therapeutic alternatives. Approximately 20% of LN patients exhibit features of thrombotic microangiopathy, warranting anticoagulation. Optimizing glucocorticoid dosing is recommended, favouring lower doses to minimize adverse effects. Lifelong monitoring is essential, as flares can occur at any point, emphasizing the need for continued immunosuppression. Given the lack of renal response in 30–60% of patients, the addition of combination therapies, such as calcineurin inhibitors or belimumab, should be considered. Duration of treatment is crucial, considering the progressive loss of podocytes and nephron function, which may lead to chronic kidney disease. Regular monitoring, maintenance immunosuppression, and lifestyle modifications contribute to preventing flares and improving long-term outcomes for LN patients.
subject: Articles
  topic: section
creator: Christine A. Peschken
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: 4
ending page: 10
doi: 10.58931/crt.2024.1143

Sjogren’s Syndrome: Strategies for Treatment
type: item
description: Sjogren’s syndrome, characterized by dry eyes, dry mouth, and immunological hyperactivity, has been one of the most difficult rheumatic diseases to differentiate and define. After many hours of consensus group development, studies on large cohorts/registries of over 1500 patients in totality and following national, European, American, and finally consensus iterations, criteria have been agreed upon for the classification of this disease. In the final analysis, these criteria are objective and accessible for measurement, and a number of them can be documented in clinical practice. To treat Sjogren’s syndrome effectively, it is important to rely upon objective evidence with respect to the diagnosis of this disease, as well as the specific component of the condition that one is attempting to manage.
subject: Articles
  topic: section
creator: Arthur A.M. Bookman
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: 11
ending page: 17
doi: 10.58931/crt.2024.1144

Updates in Treatment of Refractory Inflammatory Myositis
type: item
description: Idiopathic immune myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune diseases with varying phenotypes, prognoses, and treatment responses. They are primarily characterized by muscle inflammation, however, many patients have extramuscular involvement including skin rash, arthritis, interstitial lung disease (ILD), cardiomyopathy, and gastrointestinal dysmotility. The discovery of myositis-specific autoantibodies (MSAs) has been a major advancement in the field of IIMs, shaping the new landscape of the clinical, phenotypical, histological, and serological correlations. Based on this discovery, IIM can be more specifically classified into dermatomyositis (DM) (including amyopathic DM), antisynthetase syndrome (ASyS), immune-mediated necrotizing myopathy (IMNM), inclusion body myositis (IBM), polymyositis (PM), and overlap myositis (OM). An increasing number of histological studies have revealed a misdiagnosis of PM because many patients who were previously diagnosed with PM were later reclassified to other forms of IIM, including IBM, IMNM, ASyS, or DM without a rash.
subject: Articles
  topic: section
creator: Kun Huang
creator: Aidan Pye
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: 18
ending page: 25
doi: 10.58931/crt.2024.1145

What the Rheumatologist Needs to Know about IBD Treatment
type: item
description: Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), affect almost 1% of the Canadian population and are characterized by debilitating gastrointestinal (GI) symptoms including chronic diarrhea, rectal bleeding and abdominal pain. Beyond involvement of the GI tract, up to half of patients with IBD will also experience extraintestinal manifestations (EIMs) or be diagnosed with comorbid immune-mediated inflammatory diseases (IMIDs), which are associated with substantial morbidity and impaired quality of life. The most common of these are inflammatory joint diseases, including peripheral and axial spondyloarthritis or concomitant rheumatoid (RA) or psoriatic arthritis (PsA), affecting up to 1 in 5 patients with IBD.
subject: Articles
  topic: section
creator: Christopher Ma
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: 26
ending page: 32
doi: 10.58931/crt.2024.1146

Management of Rheumatologic Immune-Related Adverse Events (Rh-irAEs) – An Overview of Immunosuppressive Therapies
type: item
description: Cancer treatment has entered a new era with the expanding role of immunotherapy, in particular immune checkpoint inhibitors (ICIs). ICIs, including those that target cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed death protein-1 (PD-1), and programmed death ligand-1 (PD-L1), work by blocking the intrinsic down-regulators of the immune system, leading to sustained activation of effector T-cells to enhance endogenous anti-tumour immune responses.
subject: Articles
  topic: section
creator: Shahin Jamal
creator: Jenny Li
creator: Marie Hudson
creator: Carrie Ye
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-04-23
publication date: 2024-04-23
starting page: 33
ending page: 38
doi: 10.58931/crt.2024.1147

Shifting Paradigms in the Treatment of Systemic Lupus Erythematosus
type: item
description: For many years, therapeutic options for patients with systemic lupus erythematosus (SLE) have been extremely limited. However, over the past decade, with the approval of new drugs and several promising phase II trials, treatment paradigms are gradually shifting toward multi‑targeted therapies for lupus nephritis (LN) and earlier usage of biologics in extra-renal lupus. Below, we will present three patient cases that illustrate how, through a multidisciplinary clinic environment, we have incorporated these shifting treatment paradigms into our delivery of care. Finally, we will conclude with a discussion of emerging therapies, which have the potential to further shift, and ultimately transform, treatment paradigms.
subject: Articles
  topic: section
creator: Ann E. Clarke
creator: Megan R.W. Barber
creator: Bryce Barr
creator: Kim Cheema
creator: icholas L. Li
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-09-17
publication date: 2024-09-17
starting page: 4
ending page: 16
doi: 10.58931/crt.2024.1248

Exploring Newer Topical Therapies for Inflammatory Skin Diseases: A Guide for Rheumatologists
type: item
description: Understanding the pathogenesis of many inflammatory skin diseases and their associated signalling pathways has revealed multiple promising therapeutic targets. Given the chronic nature of many of these conditions, products with long-term safety and efficacy are desired. While topical corticosteroids have been the mainstay of topical therapies for years, they are burdened by concerns over long-term safety (i.e., atrophy, striae, telangiectasias), risk of absorption with systemic glucocorticoid side effects, and patient apprehension regarding steroid use. Similarly, topical calcipotriol and retinoids may be ineffective and can cause irritation. Although topical calcineurin inhibitors (i.e., pimecrolimus, tacrolimus) have been approved for atopic dermatitis, their off-label use for many inflammatory conditions may be limited by tolerability issues such as stinging and burning, and lack of effectiveness. The emergence of newer targeted small molecules for topical application, including topical phosphodiesterase-4 inhibitors (PDE4i), topical Janus kinase inhibitors (JAKi), and a therapeutic aryl hydrocarbon modulating agent (TAMA), offer promising new options and will be reviewed here and summarized in Table 1.
subject: Articles
  topic: section
creator: Melinda Gooderham
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-09-17
publication date: 2024-09-17
starting page: 18
ending page: 22
doi: 10.58931/crt.2024.1249

Osteoporosis in 2024: Frequency, Monitoring and Treatment
type: item
description: Osteoporosis is a chronic condition characterized by decreased bone mineral density (BMD) and deterioration of bone architecture, leading to an increased risk of fractures. It is the most common metabolic bone disease globally. It is estimated that more than two million Canadians aged 40 years and older have osteoporosis. Approximately 80% of Canadians who have sustained a fracture due to osteoporosis do not receive appropriate care, leaving them at an elevated risk for subsequent fractures, deconditioning, and premature death.1 Many clinical practice guidelines exist on the management of osteoporosis and fracture prevention. Several of them have separate definitions for patients deemed very high and high risk for fracture and, as such, have specific criteria for the use of anabolic and antiresorptive treatments.
subject: Articles
  topic: section
creator: Matthew Wong-Pack
creator: Arthur N. Lau
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-09-17
publication date: 2024-09-17
starting page: 23
ending page: 28
doi: 10.58931/crt.2024.1250

Screening and Management of Atherosclerotic Cardiovascular Disease in Inflammatory Arthritis: A Comprehensive Approach for the Rheumatologist
type: item
description: Inflammatory arthritis (IA) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) and contributes to significant morbidity and mortality. Early identification and treatment of conventional cardiovascular disease (CVD) risk factors are pivotal in mitigating ASCVD risk among the IA population. Equally crucial is the proactive management of inflammatory disease, necessitating a thorough discussion of the risks and benefits, particularly regarding the use of some advanced therapeutic agents indicated for IA, which may carry an increased risk of CVD in high‑risk subgroups. This article reviews the current evidence for optimal CVD screening in IA. We underscore the importance of a holistic approach that incorporates conventional risk assessment tools, biomarkers, imaging techniques, and interdisciplinary cooperation.
subject: Articles
  topic: section
creator: Shadi Akhtari
creator: Bindee Kuriya
rights: Copyright (c) 2024 Canadian Rheumatology Today https://creativecommons.org/licenses/by-nc-nd/4.0
date: 2024-09-17
publication date: 2024-09-17
starting page: 29
ending page: 39
doi: 10.58931/crt.2024.1251