Current opinion in rheumatology最新文献

{"title":"Rheumatoid arthritis contributes to comorbidity burden through systemic inflammation and autoimmunity: examples of atherosclerotic cardiovascular disease, interstitial lung disease, and depression.","authors":"Madeleine Y Beaulé, Liya S Getachew, Jeffrey A Sparks","doi":"10.1097/BOR.0000000000001169","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001169","url":null,"abstract":"<p><strong>Purpose of review: </strong>To summarize the recent literature investigating systemic impact of rheumatoid arthritis (RA) on comorbidity burden, using atherosclerotic cardiovascular disease (ASCVD), interstitial lung disease (ILD), and depression as examples.</p><p><strong>Recent findings: </strong>People with RA have consistently higher rates of comorbidities compared to the general population that include ASCVD, ILD, and depression. In addition to enrichment of traditional risk factors such as smoking and obesity, people with RA have unique factors related to inflammation, autoimmunity, and medications that contribute to excess comorbidities across diverse organ systems. Specific inflammatory pathways contribute to excess ASCVD in RA perhaps through dysregulated lipid metabolism. Trials for ASCVD prevention have been performed or underway for several RA medications. Seropositivity and high articular disease activity are associated with RA-ILD that may lead to lung fibrosis/inflammation. Several antifibrotic medications show utility in RA-ILD, and the contribution of specific anti-inflammatory medications is being investigated. Pain from uncontrolled inflammation and autoimmunity may impact mental health, leading to higher risk of depression in people with RA.</p><p><strong>Summary: </strong>RA contributes directly and indirectly to comorbidity burden across diverse organ systems through systemic inflammation and autoimmunity. While further work is needed, controlling RA disease activity through specific RA medications may mitigate excess risk for comorbidities such as ASCVD, ILD, and depression risk.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial introduction.","authors":"","doi":"10.1097/BOR.0000000000001156","DOIUrl":"10.1097/BOR.0000000000001156","url":null,"abstract":"","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"38 3","pages":"v"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147510388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic granulomatosis with polyangiitis: recent therapeutic advances.","authors":"Emanuele Chiara, Michelangelo Tesi, Giacomo Emmi, Augusto Vaglio","doi":"10.1097/BOR.0000000000001148","DOIUrl":"10.1097/BOR.0000000000001148","url":null,"abstract":"<p><strong>Purpose of review: </strong>The aim of this review is to describe the substantial advances that have been made in the past 2 years on new treatment options in eosinophilic granulomatosis with polyangiitis (EGPA).</p><p><strong>Recent findings: </strong>The therapeutic scenario in EGPA has been recently broadened by the publication of the results from the multicenter, double-blind randomized MANDARA trial, which proved the noninferiority of benralizumab to another anti-interleukin-5 (IL-5) drug, mepolizumab, for the induction of remission in patients with EGPA. A few real-world studies have confirmed these results. Furthermore, the first randomized controlled trial exploring the efficacy of rituximab (anti-CD20) in induction of remission of EGPA was recently published. Targeting other molecular pathways did not always show adequate control of systemic manifestations of EGPA, with only limited evidence of effectiveness from small case series. Interestingly, cases of EGPA onset in severe asthma patients treated with monoclonal antibodies were described.</p><p><strong>Summary: </strong>Biological drug therapy targeting IL-5 consolidated its role in the management of EGPA, becoming the cornerstone of the treatment of this rare disease. Future guidelines should consider these recent findings to improve the management of EPGA. Notably, while selective IL-5 targeting is highly effective for remission maintenance, its role in inducing remission in EGPA remains to be fully established. Rituximab was non-superior to standard therapy in induction of remission in patients with EGPA, demonstrating a similar rate of response. The role of other targeted therapies, albeit promising in some cases, remains a matter of debate.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"182-190"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146257742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in the use of Janus kinase inhibitors.","authors":"Stanley Cohen, Kevin L Winthrop","doi":"10.1097/BOR.0000000000001154","DOIUrl":"10.1097/BOR.0000000000001154","url":null,"abstract":"<p><strong>Purpose of review: </strong>Over the last two decades, oral small molecules that target intracellular protein kinases that mediate intracellular signaling have been found to be effective in multiple immune mediated inflammatory diseases (IMIDs). Tofacitinib was the first Janus kinase inhibitor (JAKi) approved for rheumatoid arthritis (RA) in 2012 and subsequently baricitinib, upadacitinib, and filgotinib have been approved by various regulatory agencies around the world. Substantial efficacy in RA as well as other rheumatic diseases (axial spondyloarthritis, psoriatic arthritis, giant cell arteritis) and other IMIDs (inflammatory bowel disease, atopic dermatitis) has been demonstrated. Various JAKi are in trials for lupus, inflammatory myopathies and Sjogrens with recent positive results noted in phase 2/3 clinical trials.</p><p><strong>Recent findings: </strong>Although efficacy has been clearly demonstrated safety concerns have been raised based on the oral surveillance postmarketing clinical trial which demonstrated in RA patients ≥ 50 years old with cardiovascular risk factors treated with tofacitinib have an increase risk of venous thromboembolism and possibly major adverse cardiovascular events/malignancy compared to tumor necrosis factor inhibitor treated patients. Extensive investigations in clinical trials and real world observations over the last few years have addressed the safety issues with mixed results but have allowed for risk stratification and appropriate use of JAKi. Efforts to develop JAKi that are more selective for specific JAK isoforms are ongoing such as deucravacitinib - a TYK2 inhibitor with a different mechanism of action compared to other JAKi that might have an enhanced safety profile.</p><p><strong>Summary: </strong>Increased use of JAKi in the management of IMIDs is ongoing and will accelerate if the positive results noted in trials for lupus, inflammatory myopathies, and psoriatic arthritis result in regulatory approval. The article highlighted in this review provide an update on the progress being made in newer rheumatic disease indications as well as efforts to better understand the adverse event profile for patients on treatment.</p><p><strong>Introduction: </strong>Delineation of the JAK-STAT pathway critical for type 1/II cytokine signaling in late 1990s resulted in the development of multiple JAKi for IMIDs. Tofacitinib was the original JAK inhibitor approved in 2012 followed by baricitinib in 2017 and upadacitinib in 2019 with filgotinib and pefecitinib approved ex-US all for rheumatoid arthritis. Since the original approval JAK inhibitors have been approved for multiple IMIDs. In this manuscript, data from clinical trials evaluating JAK inhibitors for new IMID indications will be reviewed as well as an update on safety data from real world experience.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"176-181"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of patients with antiphospholipid antibodies or antiphospholipid syndrome during pregnancy.","authors":"Brooke S Mills, Bonnie L Bermas","doi":"10.1097/BOR.0000000000001152","DOIUrl":"10.1097/BOR.0000000000001152","url":null,"abstract":"<p><strong>Purpose of review: </strong>Given the persistently high rates of adverse pregnancy outcomes (APOs) in women with antiphospholipid syndrome (APS) despite standard therapy, updated guidance is needed to support individualized care. This review summarizes current understanding of the obstetric management of APS, including pathogenic mechanisms, preconception evaluation, pregnancy management, and emerging therapeutic approaches.</p><p><strong>Recent findings: </strong>Recent studies reinforce the central role of inflammation, rather than thrombosis alone, in APS-related pregnancy morbidity. This evolving paradigm has prompted interest in immune-modulating strategies alongside conventional treatment. Early prospective data suggest that TNF-α inhibition may significantly reduce APOs in pregnant women with APS. Animal studies demonstrate immunomodulatory effects of statins at the maternal-fetal interface, although human evidence regarding statins remains limited. Updated clinical recommendations also clarify management surrounding assisted reproductive technology, emphasizing the importance of preconception antiphospholipid antibody screening and risk-based thromboprophylaxis to mitigate complications during ovarian stimulation and early pregnancy.</p><p><strong>Summary: </strong>Obstetric APS remains a major cause of maternal-fetal morbidity. Advances in understanding placental inflammation have expanded potential therapeutic targets, but standardized treatment remains limited. Optimal care requires risk-stratified, multidisciplinary management and further research to improve pregnancy outcomes.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"163-167"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147456190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting the CD40-CD40L axis: from mechanistic insight to therapeutic renewal in autoimmune disease.","authors":"Sonali J Bracken, E William St Clair","doi":"10.1097/BOR.0000000000001149","DOIUrl":"10.1097/BOR.0000000000001149","url":null,"abstract":"<p><strong>Purpose of review: </strong>CD40 ligand (CD40L, CD154) is a costimulatory molecule required for adaptive immune responses. It arms CD4 + T cells to provide critical \"help\" to B cells, dendritic cells, and other antigen-presenting cells through interactions with CD40. Enhanced CD40L signaling promotes autoreactive B cell activation, germinal center hyperactivity, and autoantibody production, processes central to autoimmune pathogenesis. Recognition of the pathway's importance in autoimmunity prompted clinical trials of anti-CD40L monoclonal antibodies in lupus, but early enthusiasm faded after unexpected thrombotic events. These first generation anti-CD40L antibodies were later found to trigger platelet activation through an Fc-mediated mechanism and led to re-engineering of antagonist therapeutic proteins.</p><p><strong>Recent findings: </strong>Preclinical studies confirm that CD40L inhibition ameliorates disease across diverse autoimmune models by restraining aberrant B-cell and T-cell responses. Novel Fc-silent anti-CD40L antibodies, nonantibody CD40L antagonists, and anti-CD40 antibodies have since been developed to overcome prior safety concerns. These new-generation CD40L and CD40 antagonists have shown promising results in phase 2 trials spanning multiple autoimmune settings, renewing interest in therapeutic blockade of this pathway.</p><p><strong>Summary: </strong>Next-generation CD40L and CD40-directed therapies are redefining costimulatory blockade in autoimmunity. Integrating preclinical discoveries with clinical translation offers new opportunities to optimize treatment and transform management of B cell-driven autoimmune disease.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"168-175"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cellular therapies for rheumatic disease.","authors":"Fotios Koumpouras, Roberto Caricchio","doi":"10.1097/BOR.0000000000001159","DOIUrl":"10.1097/BOR.0000000000001159","url":null,"abstract":"<p><strong>Purpose of review: </strong>Cellular therapies, particularly chimeric antigen receptor (CAR)-modified lymphocytes, have progressed from experimental oncology into serious consideration for selected autoimmune rheumatic diseases. Autologous and emerging allogeneic CAR-T platforms now offer the possibility of deep, drug-free remission in systemic lupus erythematosus (SLE), idiopathic inflammatory myopathies (IIM), systemic sclerosis (SSc), and related conditions for which conventional therapies remain inadequate. This timely article reviews the rationale, current clinical experience, safety profile, and future directions of cell therapies in rheumatology with a focus on efficacy, safety, and \"immune reset\" in autoimmune rheumatic disease. The review is particularly pertinent as multiple parallel cell-based platforms (autologous and allogeneic CAR T cells, transient RNA CARs, CAR-NK, and T cell engagers) are entering the rheumatology space faster than practice guidelines or trial frameworks can fully adjust.</p><p><strong>Recent findings: </strong>Recent studies show that CD19-directed CAR T cells can induce deep B-cell depletion with high rates of drug-free remission in refractory SLE and promising responses in SSc and IIM, accompanied by distinctive toxicity patterns such as mostly low-grade CRS, rare ICANS, and the newly described organ-specific LICATS. Parallel work demonstrates mechanistic \"immune reset\" (including type I IFN pathway suppression and naïve-skewed B-cell repopulation), expansion of indications to neurologic autoimmunity, emergence of off-the-shelf platforms (allogeneic CARs, γδ-CAR, CAR-NK, RNA CARs), and early human experience with CD19- and BCMA-directed T cell engagers in rheumatic disease.</p><p><strong>Summary: </strong>Collectively, these findings position cellular therapies as powerful, potentially transformative options for highly selected patients with severe, refractory lupus and autoimmune rheumatic disease, but also underscore the need for disciplined trial design, long-term safety surveillance, and strategies to ensure equitable access.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"155-162"},"PeriodicalIF":4.3,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13045811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147479983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MRI sacroiliitis mimics.","authors":"Anne Grethe Jurik, Robert G W Lambert, Rosa Marie Kiil","doi":"10.1097/BOR.0000000000001165","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001165","url":null,"abstract":"<p><strong>Purpose of review: </strong>MRI of the sacroiliac joints (SIJ) is frequently performed in diagnostic workup of axial spondyloarthritis (axSpA), especially to detect not only early active inflammatory changes but also structural changes. The presence of subchondral bone marrow edema (BME) is an important early sign of sacroiliitis, but can also occur in many other conditions, whereas structural changes, especially erosions, are more specific axSpA features. The purpose of this review is to describe and illustrate MRI features of the most common conditions in adults that can mimic axSpA sacroiliitis.</p><p><strong>Recent findings: </strong>These findings have focused on the frequently occurring anatomical SIJ variations, as their presence can be accompanied by non-inflammatory BME mimicking sacroiliitis. Studies of pregnancy-related changes, osteitis condensans ilii and other strain-related conditions have shown that non-inflammatory strain-related BME is most common in the anterior portion of the SIJ, whereas axSpA changes are more widespread. Awareness of data-driven MRI lesion thresholds with at least 95% specificity for axSpA may facilitate the differentiation between axSpA and the mimics with the exception of osteitis condensans ilii and postpartum changes.</p><p><strong>Summary: </strong>Early accurate detection of axSpA is important for treatment in the clinic and for classification in research settings, and sacroiliitis misdiagnoses can result in inappropriate treatment.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital monitoring in rheumatoid arthritis: remote assessment, wearables, and data-driven disease management.","authors":"Asimina Karampela, Elena Nikiphorou","doi":"10.1097/BOR.0000000000001166","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001166","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the emerging role of digital monitoring technologies in rheumatoid arthritis (RA) management, including electronic patient-reported outcome measures (ePROMs), wearable sensors, and data-driven approaches. The aim is to evaluate how these tools support continuous disease monitoring, timely flare detection, and patient self-management, aligning with treat-to-target principles.</p><p><strong>Recent findings: </strong>Recent evidence suggests increasing digital health monitoring feasibility through the use of smartphone applications, wearables, and analysis of the multisource data collection. However, barriers such as digital literacy from both patients and healthcare professionals, accuracy of the data collected, correct interpretation still need to be addressed. While digital health has overall shown benefits in terms of appointment distribution, waiting time reduction, continuous monitoring of disease activity, and psychological outcomes, the safe shift to digital monitoring without compromising safety and individuals personal preferences should remain a priority.</p><p><strong>Summary: </strong>Digital monitoring technologies represent a novel shift in RA management, offering continuous assessment beyond traditional clinic visits. While patient acceptance is generally high, implementation challenges include clinician awareness, software integration, and ensuring equitable access. Future directions involve refining predictive algorithms, establishing standardized digital biomarkers, and integrating multimodal data streams for personalized disease management.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The challenge of bringing advances in sacroiliac joint imaging to the clinic.","authors":"Robert G W Lambert, Matthew D Li, Anne Grethe Jurik","doi":"10.1097/BOR.0000000000001163","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001163","url":null,"abstract":"<p><strong>Purpose of review: </strong>Recently reported criteria are more stringent for classification of axial spondyloarthritis (axSpA) in the absence of positive imaging. This places increased reliance on the accuracy of sacroiliac joint (SIJ) imaging. This review highlights some of the key challenges to bringing advances in SIJ imaging to clinical practice.</p><p><strong>Recent findings: </strong>The first international consensus for an MRI acquisition protocol for sacroiliitis, published in 2024, defines how the sequences should be orientated, and which sequences are required to identify various lesions that may be seen in inflammatory sacroiliitis and degeneration. However, as anatomical and physiological variation and degeneration are very common in the SIJ, new techniques are not necessarily specific for sacroiliitis and may be more sensitive to changes in the SIJ regardless of cause. Artificial intelligence techniques are currently in use for improvement in image acquisition, but models used for enhancement of diagnostic ascertainment still need development and validation.</p><p><strong>Summary: </strong>New techniques, especially adherence to a recommended MRI protocol, are essential for accurate assessment of sacroiliitis. However, the introduction of new techniques to clinical practice must be accompanied by the appropriate education to assist less experienced observers with appropriate interpretation of novel images.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}