Filippo Santoro

Infectious disease screening is now a routine component in the management of patients with rheumatological conditions and is mandatory in some settings before initiating biologic or conventional immunosuppressive therapies. In this narrative review, we summarize the current literature to assist clinicians in interpreting screening results and risk stratification, and to guide subsequent clinical management, including prophylaxis, monitoring, and treatment strategies. The review of the literature was performed using MEDLINE and Embase, complemented by manual searches of reference lists and gray literature, to identify evidence on infectious disease screening in patients with rheumatologic conditions undergoing immunosuppressive therapy. Available evidence supports the importance of effective pre-treatment screening and risk assessment in patients requiring immunosuppression. However, significant knowledge gaps remain, particularly regarding infectious risks linked to certain drug classes and the optimal implementation of screening strategies.

Introduction: Belimumab is a monoclonal antibody with proven efficacy in systemic lupus erythematosus. However, its role in other connective tissue diseases or vasculitides is still not clear. Methods: A systematic literature review (SLR) of original research article up to March 22 2025 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were selected according to the Patients Exposure Outcome (PEO) framework and evaluated by quality assessment of diagnostic accuracy studies (QUADAS). Results: Thirty-seven articles were identified as relevant and assessed for eligibility. After full evaluation, 15 articles were selected to be included in the review. Conclusion: The SLR showed that data on the use of belimumab in rheumatic conditions, other than SLE, are still scarce. However, belimumab may have therapeutic potential in specific subsets of patients with rheumatic diseases characterized by aberrant B cell activation. Future research should focus on large, randomized phase 3 trials with extended follow-up to better define the role of belimumab in rheumatic diseases beyond SLE, particularly in combination with standard-of-care therapies.

Introduction: This study evaluates the real-world application of anifrolumab in managing articular involvement in systemic lupus erythematosus (SLE), providing insights into its efficacy and safety in routine clinical practice. Additionally, a systematic review examines anifrolumab’s role specifically in joint manifestations of SLE, consolidating existing real-world data on its therapeutic impact in articular disease. Methods: This monocentric case series presents data from four patients with SLE-related arthritis treated with anifrolumab. Clinical outcomes, including joint symptoms, clinimetric indices (DAS28, SLEDAI-2K, and SLICC), and treatment tolerability, were assessed. Ultrasound evaluation did not represent an outcome since it was not performed regularly. A systematic review was conducted to explore anifrolumab’s real-world application in articular disease manifestations, offering a comparative perspective. Results: All patients achieved complete remission of arthritis and lupus disease activity within four months, with no serious adverse reactions and without treatment discontinuation. Additionally, two patients completely discontinued corticosteroid (GC) therapy within two months, while the remaining two significantly reduced their GC doses. Only three promising relevant articles emerged from the systematic review, underlining the need for further studies to better support the role of anifrolumab in the treatment of arthritis in SLE. Conclusions: These findings highlight anifrolumab’s practical utility in real-world settings, particularly for articular involvement, while the systematic review contextualizes its impact within SLE management. The results underscore anifrolumab’s potential as a valuable treatment option for joint manifestations of SLE, addressing an unmet clinical need in routine practice. This evidence may assist clinicians in selecting the most suitable therapeutic approach based on predominant clinical features, thus enhancing personalized treatment strategies in SLE.