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In patients with autoimmune rheumatic disease, methotrexate therapy has been associated with poor immune response to vaccines, including those intended to provide protection against COVID-19. Emerging evidence supports the practice of temporarily discontinuing this treatment in order to improve immunogenicity.
Assessing systemic sclerosis (SSc) disease activity is challenging, and improved outcome measures are needed. This Review describes clinical and biochemical outcome measures of distinct features of SSc, with an emphasis on the dermatological manifestations and interstitial lung disease, including insights into biomarkers gained from single-cell RNA sequencing.
Although the multitude of pathways involved in the pathogenesis of systemic lupus erythematosus (SLE) seem to be interconnected, each predominates in only a fraction of patients. This complexity means that many agents tested in SLE clinical trials — now including iberdomide — produce only a small clinical benefit.
This Evidence-Based Guideline presents the latest treatment recommendations for medication selection in psoriatic arthritis (PsA), covering the six clinical domains of PsA, related conditions and associated comorbidities, and reflecting important advances in the field since the previous update.
In this Review, the authors summarize the pathophysiological mechanisms of IL-1-mediated autoinflammation. They describe the epidemiological and clinical features of autoinflammatory diseases, challenges associated with diagnostics and disease management, and current and future therapies for targeting the IL-1 pathway.
In this Review, the authors provide an overview of the mechanisms contributing to joint damage in rheumatoid arthritis, particularly the interactions among immune cells, fibroblasts and bone, and discuss how this knowledge could inform the development of novel therapies.
Do you inform patients about risks and chances of success associated with different choices when treatment needs to be changed? This approach takes time and requires patient health literacy. Results from a discrete-choice experiment in scleroderma lung disease add to the debate on shared decision-making.
In this Review, the authors discuss the characterization of distinct synovial tissue macrophage (STM) populations and their functions in the context of the healthy and arthritic joint. They also describe how distinct STMs are specified, how they respond to danger signals and the clinical implications of understanding STM heterogeneity.
In this Review, the authors discuss the latest insights into how autoantibodies and autoreactive B cells relate to the disease process in rheumatoid arthritis, from the development of pre-disease seropositivity to the onset of overt symptoms and the maintenance of disease chronicity.
New research reveals that outcomes for patients with rheumatoid arthritis are affected less by pre-existing comorbid conditions than by socioeconomic factors. Future research should address the mechanisms of this relationship and develop holistic treatment approaches that reduce disparities attributed to socioeconomic status.
Here, the authors propose that more stringent MRI definitions for inflammatory and structural lesions in the sacroiliac joints should be used in randomized controlled trials in non-radiographic axial spondyloarthritis. They argue that such an approach might enhance diagnostic accuracy and thereby increase discrimination between therapies.
Intervertebral disc calcification is an often overlooked phenotype that can have considerable clinical consequences. In this article, the authors aim to raise awareness of intervertebral disc calcification and discuss its implications for the management and prognosis of degenerative spinal changes.
Ubiquitylation is involved in the regulation of most cellular systems, including the innate immune system. Here, the authors describe the molecular pathogenesis of disorders of ubiquitylation that result in innate immune overactivation and systemic autoinflammatory disease.
The new ACR guideline for the treatment of juvenile idiopathic arthritis provides an update on several important topics, including management of oligoarthritis, temporomandibular joint arthritis and systemic-onset arthritis. Overall, the new guideline reflects changes in practice, but also highlights a concerning lack of high-quality evidence.
In this Review, the authors discuss a comprehensive mechanistic concept of psoriatic arthritis, including discussion of the genetic, biomechanical, metabolic and microbial factors that contribute to the development of the disease as well as its manifestations and consequences.
Sphingosine 1-phosphate has essential roles in vascular barrier function, lymphocyte trafficking and differentiation, and inflammatory response in autoimmune rheumatic diseases; modulation of sphingosine 1-phosphate signalling is a potential therapeutic approach in systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis.
In this Review, the authors discuss how the inflammatory, hypoxic environment of joints in rheumatoid arthritis affects metabolism in fibroblasts, endothelial cells and immune cells. Understanding the competing requirements of these cells can enable effective therapeutic targeting of synovial metabolism.
New classification criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis endorsed by ACR and EULAR reflect important developments in the field since the 1990 criteria were published, including bringing ANCA testing to the fore.
Endothelial progenitor cells are essential for the maintenance of endothelial function, which in turn is crucial for cardiovascular physiology. The reduced function and numbers of endothelial progenitor cells in individuals with systemic lupus erythematosus could contribute to the excessive cardiovascular disease mortality in this patient population.
New evidence implicates necroptosis in muscle fibre damage in idiopathic inflammatory myopathies, but is it too soon to suggest that interfering with this cell-death pathway could offer a novel therapeutic strategy?
