VEXAS is a newly recognised adult-onset autoinflammatory syndrome resulting from a somatic mutation in the UBA1 gene. Herein, we present three cases of VEXAS syndrome in Sydney, Australia, that capture key clinical features and the refractory nature of the condition. They highlight the importance of multidisciplinary collaboration for early diagnosis and the need for new therapeutic options.

Reason for performing study Measurement of lactate in horses with colic has been described for over 20 years. Objectives To systematically review the evidence on the use of plasma and/or peritoneal lactate as a diagnostic test for identifying surgical colic. Study design Systematic review. Methods The primary literature search was conducted in CAB Abstracts (1910–2014), WEB of Science (1950–2014) and MEDLINE (1946–2014) using search terms relating to equine colic. Publications were assessed against inclusion and exclusion criteria, and then reviewed using the QUADAS scoring system. Results The primary search identified 5508 publications relating to colic; 32 studies related to the use of lactate in the diagnosis of colic, 2 papers met the inclusion criteria and were assessed using QUADAS. Both papers investigated the use of plasma and peritoneal lactate to identify strangulating intestinal lesions. Both were cross‐sectional studies, and together they evaluated a total of 71 horses with confirmed strangulating lesions. Appraisal of the studies using the QUADAS tool was performed. Both papers met QUADAS criteria relating to study design and data analysis, but the QUADAS tool did highlight some limitations in terms of sample and control groups in both papers. Data analysis varied, with one study developing a model to predict the presence of a strangulating lesion, which included peritoneal lactate and other measurements, and the other study assessing optimal predictive values associated with concentrations of peritoneal lactate. Both studies concluded that peritoneal lactate was a more useful diagnostic test than blood lactate. Conclusions Despite the large numbers of publications reporting use of lactate, only a small number used study designs considered suitable for evaluation of diagnostic test accuracy as proposed by the Cochrane Library. Although the current evidence is limited, there is agreement on the value of peritoneal lactate as a diagnostic test for strangulating intestinal lesions. Ethical animal research: Not applicable. Sources of funding: Tom Cullen is a Junior Clinical Training Scholar funded by the School of Veterinary Medicine and Science, University of Nottingham and Oakham Veterinary Hospital. Laila Curtis' PhD studentship is funded by the School of Veterinary Medicine and Science, University of Nottingham. Competing interests: None declared.

Reasons for performing study Early identification of surgical cases of colic is critical to improving outcome and welfare. There have been a number of studies on diagnostic tests for colic, evaluating a range of tests to differentiate between medical and surgical cases. Objectives To systematically review and appraise the evidence on diagnostic tests for identifying surgical colic. Study design Systematic review. Methods The primary literature search was conducted in CAB Abstracts (1910–2014), WEB of Science (1950–2014) and MEDLINE (1946–2014) using search terms relating to equine colic. Publications were assessed against inclusion and exclusion criteria, and then reviewed using the QUADAS quality assessment tool. Results The primary search identified 5508 publications relating to equine colic; 976 related to diagnostic tests, 29 met the inclusion criteria and were assessed using the QUADAS tool. Of these, 16 papers reported on peritoneal fluid parameters, 21 on blood parameters, 10 on blood and peritoneal parameters, 3 on physical and blood parameters and one study on urine parameters. A range of different parameters were evaluated, with the majority of tests only being evaluated in single studies. None of the studies met QUADAS criteria 1 (representative spectrum of patients), 7/29 studies met criteria 2 (description of selection criteria) and 10/29 studies met criteria 9 (description of reference standard). Conclusions There are currently no published studies which use appropriate methodology to assess the accuracy of a diagnostic test in differentiating medical and surgical colic. This made direct application of the QUADAS tool challenging; predominantly due to the lack of a pre mortem ‘gold standard’ reference diagnostic test for colic. Very few studies enrolled a randomised selection of patients and there was also a propensity to case–control study design, both increasing the risk of bias and under/overestimating diagnostic accuracy. Ethical animal research: Not applicable. Sources of funding: Laila Curtis' studentship is funded by the School of Veterinary Medicine and Science, University of Nottingham. Tom Cullen is a Junior Clinical Training Scholar funded by the School of Veterinary Medicine and Science, University of Nottingham and Oakham Veterinary Hospital. Competing interests: None declared.