Current opinion in rheumatology最新文献

{"title":"Understanding psoriatic disease at single-cell resolution: an update.","authors":"Tran H Do, Nicole L Ward, Johann E Gudjonsson","doi":"10.1097/BOR.0000000000001085","DOIUrl":"10.1097/BOR.0000000000001085","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines recent advancements in psoriasis research through single-cell technologies, including single-cell RNA sequencing (scRNA-seq) and spatial transcriptomics. These methods have uncovered the cellular diversity underlying psoriasis, identifying immune cell, keratinocyte, and fibroblast subtypes that play pivotal roles in disease progression. Such insights are vital for addressing the complexity and heterogeneity of psoriasis, paving the way for targeted therapies.</p><p><strong>Recent findings: </strong>Recent studies emphasize the roles of IL-17-producing T cells (T17), keratinocytes, and fibroblasts in driving inflammation. T-cell cytokines, including IL-17A and IL-17F, induce keratinocyte hyperproliferation and amplify inflammation through an IL-36 feed-forward loop. Fibroblast subsets, such as SFRP2+ and WNT5A+/IL24+ fibroblasts, contribute to extracellular matrix remodeling and cytokine release, worsening the inflammatory environment. These studies also reveal the intricate fibroblast-keratinocyte crosstalk via the IL-17/IL-36 and PRSS3-F2R pathways. More recently, advancement with spatial transcriptomics has uncovered metabolic dysregulation in psoriatic keratinocytes, highlighting HIF1α-driven glycolysis and lactate production as critical in sustaining chronic inflammation. Furthermore, nonlesional skin from severe psoriasis patients exhibits transcriptomic changes resembling lesional skin, suggesting systemic \"prelesional\" state with the upregulation of lipid metabolism genes.</p><p><strong>Summary: </strong>These discoveries have significant clinical implications. Integrating single-cell and spatial technologies into psoriasis research offers promising avenues for developing tailored treatments and improving patient outcomes. Specifically, with spatial transcriptomics revealing immune signatures and cell-cell colocalization that may serve as early indicators of disease severity and systemic involvement. Targeting metabolic pathways in keratinocytes and localized immune microenvironments may enhance precision therapies for psoriasis.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"254-260"},"PeriodicalIF":5.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143751750","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":"Update on streptococcal-associated rheumatic disease.","authors":"Sharon Shemesh, Ruby Haviv, Yosef Uziel","doi":"10.1097/BOR.0000000000001101","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001101","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review provides a comprehensive perspective on poststreptococcal rheumatic manifestations in pediatric patients by integrating recent updates and a literature review, with particular focus on poststreptococcal reactive arthritis and acute rheumatic fever.</p><p><strong>Recent findings: </strong>Poststreptococcal reactive arthritis presents with a unique clinical profile, distinguishing it from other poststreptococcal conditions in pediatric patients, especially acute rheumatic fever. Recent updates underscore the importance of diligent monitoring and management to mitigate potential cardiac complications, despite the relatively low incidence of carditis following poststreptococcal reactive arthritis.</p><p><strong>Summary: </strong>The diagnosis of poststreptococcal reactive arthritis is often challenging due to significant overlap with other poststreptococcal syndromes, particularly acute rheumatic fever. Given the potential for cardiac complications in acute rheumatic fever, accurate differentiation between the two conditions is imperative. Ongoing research continues to refine diagnostic criteria and treatment approaches, emphasizing the need for clinicians to remain vigilant in recognizing and differentiating between the two syndromes.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215188","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":"Evolution of the axial spondyloarthritis disease activity score and uptake in clinical practice.","authors":"Saad Ahmed, Pedro M Machado","doi":"10.1097/BOR.0000000000001100","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001100","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review outlines the development of the axial spondyloarthritis disease activity score (ASDAS) as a composite index to assess disease activity in axial spondyloarthritis (axSpA) and guide treatment decisions. Our review describes the iterative process by which the ASDAS was validated and its cut off values and improvement scores developed. We compare the ASDAS to the Bath ankylosing spondylitis disease activity index (BASDAI) as a tool for measuring disease activity in axSpA and how its better measurement properties have led to its widespread use in clinical and research settings.</p><p><strong>Recent findings: </strong>Recent international guidelines have recommended the use of the ASDAS as a tool for measuring and monitoring disease activity. ASAS has changed the nomenclature so that ASDAS is based on CRP values whereas ASDAS-ESR retains its original meaning. The BASDAI can be employed as an alternative tool when using the ASDAS is not possible. The ASDAS now forms an important outcome measure in clinical trials and aiming for ASDAS remission has been shown to retard radiographic progression in axSpA.</p><p><strong>Summary: </strong>The ASDAS demonstrates improved measurement properties, including greater validity and sensitivity to change, compared to single item variables. It offers a unified metric that enables healthcare professionals to collaborate and communicate more effectively about disease activity and treatment response to interventions in axSpA.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109514","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 of juvenile idiopathic arthritis.","authors":"Megan M Simonds, AnneMarie C Brescia","doi":"10.1097/BOR.0000000000001099","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001099","url":null,"abstract":"<p><strong>Purpose of review: </strong>To provide an overview of the most recent updates in the pathogenesis of juvenile idiopathic arthritis (JIA).</p><p><strong>Recent findings: </strong>Recent genetic studies on the pathogenesis of JIA have revolved around using in silico multiomic analyses to identify genetic variants that may play a role in the pathogenesis of JIA. Genome wide association studies (GWAS) have provided bulk-RNA and single cell-RNA sequencing datasets to identify groups of enhanced genes, signaling pathways, and other genetic variants. These data have led to the exploration of processes that regulate T-cell receptor signaling and T-cell differentiation, as well as genes linked to interferon-gamma signaling. Immune dysregulation is a major driver of JIA pathogenesis and neutrophil extracellular traps (NETs) are emerging as contributors to disease progression. The contribution of immune cells to the microenvironment in the inflamed joints of patients with JIA may hold the key to how inflammation is regulated and how the immune response from these cells contributes to disease progression.</p><p><strong>Summary: </strong>This review will focus on emerging insights from large scale multiomic studies, which reveal pathways involved in JIA pathogenesis. In addition, recent studies have identified immune dysregulation, especially in the microenvironment of the inflamed joint.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":5.2,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955600","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.0000000000001081","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001081","url":null,"abstract":"","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"37 3","pages":"v"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708518","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":"Should CAR-T cells be used as monotherapy?","authors":"William Joseph McCune","doi":"10.1097/BOR.0000000000001078","DOIUrl":"https://doi.org/10.1097/BOR.0000000000001078","url":null,"abstract":"","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"37 3","pages":"165-166"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708546","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":"Isolated aortitis - is it truly isolated? An approach to diagnosis and management.","authors":"Ora Gewurz-Singer, Elizabeth Lee","doi":"10.1097/BOR.0000000000001084","DOIUrl":"10.1097/BOR.0000000000001084","url":null,"abstract":"<p><strong>Purpose of review: </strong>With the rise in incidence of aortic aneurysm surgeries and the advances in large vessel imaging's ability to detect vessel wall inflammation, rheumatologists can expect to see an increase in isolated aortitis (IA) cases in their clinics. The purpose of this article is to review the latest data on IA, discuss its natural history and to provide an approach on how to diagnose and manage this inflammatory aortic disease.</p><p><strong>Recent findings: </strong>IA can be diagnosed on surgical histology or on imaging studies. Preoperative imaging in patients with thoracic aortic aneurysms does not detect all aortitis cases. Patients with IA have a high risk (up to 50%) of developing new aortic and branch lesions. Histologic and mechanistic studies show an overlap with giant cell arteritis.</p><p><strong>Summary: </strong>Evaluation for underlying infections and systemic diseases is recommended for diagnosis. Surveillance of patients with IA with repeated clinical assessments and imaging is recommended.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"185-191"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656327","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":"An update on the pathogenesis of idiopathic inflammatory myopathies.","authors":"Eleni Tiniakou","doi":"10.1097/BOR.0000000000001077","DOIUrl":"10.1097/BOR.0000000000001077","url":null,"abstract":"<p><strong>Purpose of review: </strong>As the question of the pathogenesis of inflammatory myopathies remains unanswered, there has been a significant effort in recent years to investigate various components of the innate and adaptive immune systems, with evidence pointing that they work together to initiate and propagate the autoimmune response. This review aims to explore recent advancements in understanding the mechanisms underlying myopathies.</p><p><strong>Recent findings: </strong>Recent research has concentrated on uncovering potential triggers, examining the role of immune cells, both lymphocytes and myeloids, and investigating the contribution of inflammatory mediators to the autoimmune response in inflammatory myopathies. Unsuccessful clinical trials helped reshape established hypotheses about pathogenesis, while genetic mutations offered clues to the disease's root causes. The pathogenic role of autoantibodies is being reconsidered based on transcriptional data. Repurposing existing medications to combat muscle fiber dysfunction is also emerging as a potential therapeutic approach.</p><p><strong>Summary: </strong>Our understanding of inflammatory myopathies has evolved significantly as our understanding of the disease has grown. Even though breakthroughs have been documented on the underlying mechanisms of myopathies, important questions remain unanswered.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"192-198"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143406157","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 cutaneous manifestations of systemic sclerosis: current approaches and emerging therapies.","authors":"Rocio Bautista Sanchez, Yasmin Khader, Dinesh Khanna","doi":"10.1097/BOR.0000000000001082","DOIUrl":"10.1097/BOR.0000000000001082","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the most recent approaches in managing cutaneous involvement, one of the main clinical manifestations of systemic sclerosis (SSc). The following article is written for clinicians and researchers looking for optimizing patient care and exploring new therapies.</p><p><strong>Recent findings: </strong>Recent studies have shown advancements in the management of cutaneous manifestations of SSc. While mycophenolate remains the first-line treatment, other immunosuppressive therapies targeting different pathways have shown promising results. B-cell depleting agents, such as Rituximab (RTX), are being increasingly utilized for cutaneous scleroderma with positive outcomes. Intravenous immunoglobulins (IVIG) have also demonstrated potential benefit for refractory cases with advanced skin fibrosis.Moreover, emerging approaches such as autologous hematopoietic stem cell transplant (AHSCT) have been evaluated in clinical trials, with evidence suggesting its ability to reset the immune system and achieve remission in skin involvement in severe cases. Chimeric antigen receptor (CAR) T cell therapy is the most recent potential pathway to target refractory skin and systemic disease.</p><p><strong>Summary: </strong>Management of cutaneous involvement in SSc remains challenging. The following study provides a comprehensive review of the most recent updates in treating cutaneous aspects (and associated complications) of SSc to help clinicians establish a more effective approach managing this condition.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"167-175"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540514","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":"Pediatric antiphospholipid syndrome: expanding our understanding of antiphospholipid syndrome in children.","authors":"Kevin Lewis, Ajay Tambralli, Jacqueline A Madison","doi":"10.1097/BOR.0000000000001083","DOIUrl":"10.1097/BOR.0000000000001083","url":null,"abstract":"<p><strong>Purpose of review: </strong>Antiphospholipid syndrome (APS) is an autoimmune, thromboinflammatory disease, which affects children and adults. There are particular features of the disease and nuances to diagnosis and management in a pediatric population, which must be appreciated to improve clinical care.</p><p><strong>Recent findings: </strong>Pediatric-specific epidemiological studies highlight that pediatric APS is quite rare with incidence in some populations of 0.2 per 100 000. There are new classification criteria in APS, which include a wider range of clinical features increasingly identified in registry data and case series of pediatric APS, though validation in pediatric APS is still needed. There is a particularly high proportion of pediatric APS patients with noncriteria antiphospholipid antibodies (aPL). Recurrent thrombosis is especially common in pediatric APS, highlighting the difficulty of management of this disease with high morbidity in children.</p><p><strong>Summary: </strong>Recent research has enhanced understanding of pediatric-specific APS epidemiology, laboratory findings, the wide variety of clinical features, and challenges in successful treatment. Future directions could include evaluation of potentially unique features in pediatric pathophysiology, an evaluation of the new APS classification criteria in children, broader prospective data on clinical and laboratory features, and a continued search for treatment beyond committing young patients to lifelong anticoagulation.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"176-184"},"PeriodicalIF":5.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11945550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467308","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}