Purpose: Anti-tumour necrosis factor-alpha (TNF-α) agents are often used for Behçet’s disease (BD) in clinical practice, but they have not been validated by a high level of evidence. We systematically reviewed published controlled trials to investigate the efficacy and safety of anti-TNF-α therapy and summarize the efficacy of anti-TNF-α therapy relative to the available therapeutic options.Methods: A systematic database search was conducted (PubMed, Embase and Cochrane) using specific search terms. All controlled studies of anti-TNF-α treatment of BD patients prior to December 2021 were included. Single-arm studies were excluded. The decision of whether to incorporate data into the meta-analysis or summarize the data by qualitative synthesis was based on the results of the literature screening.Results: Of 4389 screened studies, 13 (total 778 patients) were included in accordance with our retrieval strategy, comprising 1 randomized controlled trial, 1 prospective study, 10 retrospective studies, and 1 multicentre open-label study. Ten studies (76.9%) involved Behçet’s uveitis (BU), 1 involved intestinal BD, and the other studies had undefined subtypes. Subgroup reviews were conducted according to the control drug. Four studies involving 167 participants reported relapse rates. Meta-analysis of three of these studies demonstrated that, compared with traditional immunosuppressant (TIS) therapy, anti-TNF-α therapy reduced the relapse rates in patients with BU. In targeted drug comparison studies, the efficacy appeared to be similar between the anti-TNF-α agent and interferon in BU patients. The rates of adverse events were comparable between a variety of different therapeutic controls. Serious adverse events were not observed in 53.8% (7/13) of the studies.Conclusions: Compared with TIS therapy, anti-TNF-a therapy reduces the relapse of uveitis in patients with BD. However, the evidence regarding anti-TNF-α therapy is very limited for the full spectrum of BD subtypes, which calls for caution.

Full Papers; Authors: X. Shi, X. Pu, D. Cao, T. Yan, Q. Ye

Introduction: Systemic lupus erythematosus (SLE) is a complex autoimmune disease, and despite the availability of multiple treatments, striking a balance between long-term efficacy and side effects remains a major clinical challenge. B-cell–directed therapy has attracted much attention because of its unique mechanism of action. Belimumab and obinutuzumab, as representative drugs for B-cell–directed therapy, have shown their respective advantages for SLE treatment. However, data on combination therapy with obinutuzumab and belimumab are currently unavailable.Case presentation: We present the severe case report of a patient who was diagnosed with lupus nephritis (LN) with gastrointestinal involvement and developed acute renal failure. The patient responded to the first dose of obinutuzumab but failed to achieve a complete response to LN. The repeated use of obinutuzumab was limited by persistently low IgG levels and frequent infections. This is a real-world challenge that must be addressed. Therefore, the patient was subsequently treated with a novel sequential regimen of obinutuzumab followed by belimumab. After 18 months of follow-up, the patient achieved a complete clinical response with a favourable safety profile, along with the conversion of all autoantibodies from positive to negative and sustained negativity. To date, the patient has achieved a dual clinical and serological response.Conclusion: There is a reason to believe that this novel combination regimen could be developed as a therapeutic strategy, with the expectation of balancing efficacy and safety.

Primary biliary cholangitis (PBC) and immune-mediated necrotizing myositis (IMNM) are both rare autoimmune disorders, and their coexistence is uncommon. Low back pain (LBP) as the initial presentation of this overlap is extremely rare and may delay diagnosis. A case is presented of a 46-year-old woman with recurrent LBP and mild proximal muscle weakness, along with laboratory findings of elevated liver and muscle enzymes, positive anti-mitochondrial antibody subtype M2 (AMA-M2), anti-GP210, and anti-SSA antibodies, and negative myositis-specific antibodies. Imaging revealed paraspinal myositis, and histopathology confirmed PBC (stage 1) and IMNM. The patient responded well to a combination of ursodeoxycholic acid, corticosteroids, hydroxychloroquine, and mycophenolate mofetil, achieving normalization of laboratory parameters and complete symptom resolution after 15 months. This case underscores the need for clinicians to consider systemic autoimmune diseases in patients with atypical LBP and highlights the potential for AMA-M2–positive myositis to involve the paraspinal muscles, providing insight into a rare manifestation of PBC–IMNM overlap. Cite this article as: Zhu L, Yan T, Ye Q. Primary biliary cholangitis presenting with low back pain and complicated by immune-mediated necrotizing myositis: A case report. Eur J Rheumatol. 2026, 13(1), 0050, doi:10.5152/eurjrheum.2026.25050.