Dear Colleagues,

Welcome to the first edition of our IRA newsletter in 2026 conceived by a fresh newletter team built around the central theme of “Cracking the Daily Dilemmas: Navigating Rheumatologist’s Toughest Calls.”

Rheumatology is a specialty where certainty is often elusive and clinical judgment matters as much as guidelines. Many of our most difficult decisions arise not from lack of knowledge, but from overlap, mimicry, evolving phenotypes, and emerging evidence. This edition is dedicated to precisely those scenarios that keep us thinking long after the clinic doors close.

We begin by revisiting diagnostic conundrums—tuberculosis versus sarcoidosis, a debate that continues to evolve with newer insights, and the increasingly common IgG4-RD trap, where the challenge often lies in recognizing what is not IgG4-related disease. Moving beyond traditional frameworks, we explore avascular necrosis through phenotypes rather than stages, encouraging a more nuanced and individualized approach. No discussion of tough calls is complete without addressing urgency and uncertainty. Our feature on macrophage activation syndrome in 2026 focuses on early recognition, contemporary concepts, and practical treatment strategies in an era of expanding therapeutic options. I hope the newsletter resonates with your daily practice and sparks meaningful reflection and discussion.

We also have multiple new sections introduced from this edition onwards like RheumaLexicon, RheumaBITES , RheumaIndia ,RheumaConnect , RheumaRoots , RheumaLegends. Its time to enjoy reading our newsletter ! Happy Reading

Warm regards,

Dr Balaji Chilukuri
Professor of Rheumatology , SRMC Chennai
Consultant Rheumatologist , Parvathy Hospital , Chennai