Current opinion in rheumatology最新文献

{"title":"Food additives, emulsifiers, microplastics, and ultra-processed foods in rheumatic disease pathogenesis.","authors":"Ibrahim Chowdhury, Ryan Massay, Aaron Stubbs","doi":"10.1097/BOR.0000000000001161","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001161","url":null,"abstract":"<p><strong>Purpose of review: </strong>Dietary patterns have changed significantly over time, with ultra-processed foods now comprising a large proportion of daily energy intake in many countries. Ultra-processed foods (UPFs) contain numerous additives and may also increase exposure to processing- and packaging-related contaminants that could influence immune function. This review summarizes why UPFs have drawn growing attention and evaluates their potential relevance to autoimmune inflammation, with a focus on rheumatoid arthritis (RA) and related disorders.</p><p><strong>Recent findings: </strong>Population studies suggest that higher UPF intake is associated with an increased risk of RA after adjustment for obesity and lifestyle factors. Experimental and translational studies suggest that components common in UPF-rich diets (e.g., emulsifiers, thickeners, synthetic colorants, added sugars, excess sodium, and some nonnutritive sweeteners), as well as microplastic exposures, may disrupt gut barrier integrity, remodel the microbiome, and promote low-grade inflammation. These mechanisms overlap with pathways implicated in RA and systemic inflammation, including dysregulation of Treg/Th17 balance, loss of mucosal tolerance, endotoxemia, and innate immune activation.</p><p><strong>Summary: </strong>Overall, evidence supports biologically plausible mechanisms and epidemiologic associations linking UPF-rich dietary patterns to immune dysregulation relevant to rheumatic disease, but direct RA-specific interventional and mechanistic clinical data remain limited. Dietary exposures may represent modifiable risks; however, stronger longitudinal studies with validated RA phenotyping and pragmatic dietary interventions are needed before firm clinical recommendations can be made.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765268","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":"Contraception in systemic lupus erythematosus and antiphospholipid antibody syndrome.","authors":"Lauren He, Wendy Marder","doi":"10.1097/BOR.0000000000001162","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001162","url":null,"abstract":"<p><strong>Purpose of review: </strong>Family planning and contraception are central to disease management in people with rheumatic musculoskeletal diseases (RMD), particularly systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS), in whom unplanned pregnancy can carry substantial maternal and fetal risk. This review summarizes current evidence and guideline-based recommendations regarding contraceptive choices in women with SLE and APS, with a focus on thrombotic risk, bone health, and cardiovascular considerations.</p><p><strong>Recent findings: </strong>Estrogen-containing hormonal contraception is well established as a pro-thrombotic risk and should be avoided in those with APS, antiphospholipid antibodies (aPL), lupus nephritis, or at least moderately active SLE. Emerging data also suggest an association of certain higher dose progestins such as norethindrone acetate, and injectable preparations such as depot medroxyprogesterone acetate (DMPA), with increased venous thromboembolism (VTE) risk. Regarding bone health, oral contraceptive pills (OCPs) and combined hormonal contraception (CHC) may slow the rate of bone mass acquisition in adolescents with uncertain long-term effects on fracture risk, whereas use in adult women is associated with modestly higher bone mineral density and lower osteoporotic risk. While awareness of the importance of contraception in the rheumatology community is improving, real-world practice reveals that implementation of reproductive health guidelines is lagging.</p><p><strong>Summary: </strong>For women with SLE and APS, contraception selection must account for thrombotic risk, bone health, and cardiovascular comorbidities. Long-acting reversible contraceptives, particularly progestin-only intrauterine devices (IUDs) and subdermal implants, remain highly effective and well tolerated for those with SLE and APS. Ongoing efforts to improve guideline implementation, shared decision-making, and patient and provider education are essential to reduce unplanned pregnancies and optimize reproductive outcomes in this population.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765345","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":"Pathogenesis-directed lupus therapeutics.","authors":"Bhavya Poudyal, Andras Perl","doi":"10.1097/BOR.0000000000001160","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001160","url":null,"abstract":"<p><strong>Purpose of review: </strong>Systemic lupus erythematosus (SLE) is a complex autoimmune disease characterized, posing significant challenges to effective management. This review summarizes current United States Food and Drug Administration -approved therapies and management guidelines of the American College of Rheumatology.</p><p><strong>Recent findings: </strong>Contemporary SLE management is guided by organ systems involvement and disease severity. Discoveries of molecular mechanisms underlying disease pathogenesis have driven the development of targeted biologic therapies, including natural and engineered antibodies, chimeric antigen receptor-guided cell therapies, and T-cell engagers, transforming the therapeutic landscape of lupus. In addition to traditional B-cell and plasma cell surface targets, emerging molecular targets include transmembrane signaling molecules such as CD40L and intracellular organelles such as endosomes and mitochondria.</p><p><strong>Summary: </strong>While antibody and cell-based biologic therapies target pathogenesis-driving molecules, they suppress key immune pathways and thus infection remains a leading cause of morbidity and mortality. Accordingly, this review also addresses nonpharmacologic strategies - such as dietary modifications - that may confer therapeutic benefit without increasing susceptibility to infection. With a rapidly expanding portfolio of mechanistically driven clinical trials, the future of SLE management appears increasingly promising.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147615936","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":"Evidence-based follow-up in axial spondyloarthritis: how much is (not) enough?","authors":"Marius L Smits, Casper Webers, Astrid van Tubergen","doi":"10.1097/BOR.0000000000001158","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001158","url":null,"abstract":"<p><strong>Purpose of review: </strong>Present follow-up strategies for axial spondyloarthritis (axSpA) entail frequent preplanned in-person outpatient visits. Capacity constraints make this approach increasingly difficult, and it is plausible that regular follow-up in axSpA is not necessary for all patients. The purpose of this review is to discuss emerging alternative follow-up strategies to improve care efficiency in axSpA, and the challenges of applying these solutions in clinical practice.</p><p><strong>Recent findings: </strong>Patient-initiated follow-up (PIFU) and remote monitoring have been investigated in axSpA in two recent trials. These strategies demonstrated meaningful reductions in the number of outpatient visits and associated healthcare costs in patients with stable (ax)SpA, without negatively affecting health outcomes. Qualitative studies have additionally shown widespread acceptability of PIFU and remote monitoring from the perspective of both patients and healthcare providers, and their ability to enhance self-efficacy of patients. Loss to follow-up, delayed care, and logistical limitations are associated concerns requiring further consideration.</p><p><strong>Summary: </strong>PIFU and remote monitoring hold potential as effective, efficient, and safe strategies for the follow-up of patients with axSpA. For successful implementation in practice, their inherent challenges must be addressed, including the careful selection and training of patients, and ensuring the necessary infrastructure.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497789","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":"What's next in psoriatic arthritis therapy? A look at the pipeline.","authors":"Enrique R Soriano","doi":"10.1097/BOR.0000000000001157","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001157","url":null,"abstract":"<p><strong>Purpose of review: </strong>Psoriatic arthritis (PsA) outcomes have improved, yet many patients do not achieve sustained control, and a meaningful proportion develop difficult-to-treat disease. This review summarizes relevant new therapies in the PsA pipeline and highlights emerging strategies likely to shape near-term care, including interception, metabolic targeting, combination/sequence approaches, and early precision-medicine efforts.</p><p><strong>Recent findings: </strong>Pipeline innovation clusters in three areas: interleukin (IL)-17 pathway advances, including dual IL-17A/IL-17F blockade and engineered formats (nanobodies/small scaffolds) that may alter tissue pharmacology; selective tyrosine kinase 2 inhibition (allosteric and highly selective catalytic-site inhibitors) expanding oral options; and oral IL-23 receptor antagonism progressing from strong psoriasis efficacy into phase 3 PsA development. Beyond new molecules, strategies are evolving. Exploratory evidence supports further evaluation of dual-targeted approaches for highly refractory PsA, while metabolic targeting with incretin-based therapy is being tested as an adjunct to immunomodulation to address obesity-linked inflammatory amplification and cardiometabolic risk. EULAR transition frameworks, prodromal musculoskeletal symptoms and imaging abnormalities support a plausible interception window in at risk psoriasis.</p><p><strong>Summary: </strong>The next wave in PsA will be defined by both new agents and smarter strategies: more oral/selective therapies, testing interception in risk-enriched psoriasis, integrating metabolic approaches, and evaluating optimized sequencing and selected combination therapy while precision tools mature.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497769","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":"Synovial lymphatic system structure and function in rheumatoid arthritis: lymphatic phases, telocytes, and therapeutic modulation through Eexercise.","authors":"Yue Peng, Daniel J Belcher, Andriy Kobryn, Calvin L Cole, Edward M Schwarz","doi":"10.1097/BOR.0000000000001151","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001151","url":null,"abstract":"<p><strong>Purpose of review: </strong>Lymphatic changes are associated with rheumatoid arthritis (RA), commencing with lymphangiogenesis in the \"expanding phase\", which transitions to the \"collapsed phase\" with dysfunction and advanced disease. Here, we review our understanding of the synovial lymphatic system (SLS) during joint homeostasis and arthritis, and the potential of exercise therapy.</p><p><strong>Recent findings: </strong>How collecting lymphatic vessels (cLV) responsible for joint drainage sense effusion is unknown. Recently, murine models identified peri-cLV telocytes (interstitial mesenchymal cells involved in tissue maintenance and the regulation of muscle contraction). These telocytes were found buried within the rich extracellular matrix (ECM) of the cLV, and in networks extending from the synovium to the joint-draining cLV. In vivo telocyte depletion studies demonstrated decreased lymphatic drainage and exacerbated synovitis and bone erosions during zymosan-induced arthritis. Gene expression studies demonstrated that Efhd1, Dpp4, and Pi16 are specific markers of human and murine synovial telocytes, which are absent in RA synovium and mice with inflammatory arthritis. Preliminary studies demonstrate that ad libitum exercise increases the number of synovial telocytes in mice.</p><p><strong>Summary: </strong>Telocytes maintain the ECM of the SLS and may transmit signals to joint-draining cLV. Telocyte loss is associated with arthritic progression, which may be abated with exercise.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354216","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":"Glucagon-like peptide-1 receptor agonists in rheumatoid arthritis.","authors":"Ryan Massay, Angela Malani, Aaron Stubbs","doi":"10.1097/BOR.0000000000001153","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001153","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article synthesizes current preclinical and clinical literature regarding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in rheumatoid arthritis (RA), highlights mechanistic hypotheses and explores potential clinical roles and limitations of their use.</p><p><strong>Recent findings: </strong>GLP-1 RAs are established therapies for type 2 diabetes mellitus and obesity, with demonstrated benefits on glycemic control and cardiovascular risk reduction. Emerging evidence suggests that GLP-1 RAs may exert anti-inflammatory and immunomodulatory effects relevant to RA.</p><p><strong>Summary: </strong>Present evidence is insufficient to recommend GLP-1 RAs as standard RA therapy. Well designed randomized controlled trials are needed to establish their efficacy and optimal role.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147354236","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":"Environmental and occupational contributors to autoimmune, inflammatory, and musculoskeletal rheumatic disease: a review of emerging evidence and clinical implications.","authors":"Nicole K Ward, Richard S Panush","doi":"10.1097/BOR.0000000000001130","DOIUrl":"10.1097/BOR.0000000000001130","url":null,"abstract":"<p><strong>Purpose of review: </strong>Autoimmune and inflammatory rheumatic diseases as well as certain musculoskeletal diseases treated by rheumatologists result from a complex interplay between genetic predisposition and environmental factors.</p><p><strong>Recent findings: </strong>Accumulating research has examined the possible roles of physical trauma, psychological stress, pollutants, and occupational exposures as triggers or influencers of disease. We review and summarize existing evidence for these contributors for conditions including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, spondyloarthritis, systemic sclerosis, Sjogren's syndrome, vasculitis, myositis and fibromyalgia. We highlight findings from case-control, cohort, and twin studies that associate trauma, chronic stress and environmental exposure with immune dysregulation and increased disease risk. We apply the GRADE framework to assess the strength of evidence and identify key research gaps. Summary tables are included to guide clinical assessment which could also support interdisciplinary communication in medico-legal contexts.</p><p><strong>Summary: </strong>These data have implications for disease etiopathogenesis; management; historical appreciation; public health, policy and safety; and legal considerations.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"121-142"},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145354033","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":"Neuropsychiatric systemic lupus erythematosus - current and novel treatments.","authors":"Rohan Gupta, Maeva Agapoff, Betty Diamond","doi":"10.1097/BOR.0000000000001141","DOIUrl":"10.1097/BOR.0000000000001141","url":null,"abstract":"<p><strong>Purpose of review: </strong>Here, we provide a broad overview of the current treatment landscape of neuropsychiatric systemic lupus erythematosus (NPSLE) focusing on diffuse central nervous system manifestations and potential new treatments based on studies of murine models and neuroimaging studies of patients.</p><p><strong>Recent findings: </strong>The therapeutic landscape focuses on three approaches: modulation of B cell activity and circulating autoantibodies (CAR-T cell and BTK inhibitor therapies), reduction of systemic inflammation (JAK, TYK2, and anti-IFN inhibitors), and direct neuroprotection (ACE inhibitors and ARBs).</p><p><strong>Summary: </strong>These findings broaden the therapeutic landscape for NPSLE beyond general immunosuppression. Future research must prioritize clinical trials inclusive of NPSLE patients to validate these promising strategies.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"115-120"},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539627","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":"Spatial transcriptomics: challenges and future directions in musculoskeletal diseases.","authors":"Keemo Delos Santos, Jason S Rockel, Mohit Kapoor","doi":"10.1097/BOR.0000000000001140","DOIUrl":"10.1097/BOR.0000000000001140","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines recent advancements in spatial transcriptomics and its current and potential use to advance musculoskeletal (MSK) research. These insights will be vital to address the complexity of MSK diseases and will pave the way for future therapeutic developments.</p><p><strong>Recent findings: </strong>The advent of next-generation sequencing has significantly improved our understanding of the cellular and transcriptomic heterogeneity in the MSK system. Spatial transcriptomics has revolutionized research allowing in-situ gene expression analyses directly from intact histological sections. Understanding spatial transcriptomes of cells within tissues will shed light into the biological complexity of MSK diseases. Here, we summarize the role of spatial transcriptomics in unveiling molecular mechanisms underlying MSK diseases and the challenges prohibiting its widespread application in MSK research, and opportunities to overcome these challenges.</p><p><strong>Summary: </strong>We provide a summary of emerging techniques in spatial transcriptomic field and its use in advancing MSK research. Furthermore, challenges in its application in MSK tissues are discussed as well as potential future considerations to improve spatial transcriptomics insights.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"143-153"},"PeriodicalIF":4.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12863588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563362","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}