Current opinion in rheumatology最新文献

{"title":"Update on IgA nephropathy: implications for treatment in IgA vasculitis: a guide for rheumatologists.","authors":"Julia A Ford, Ora Gewurz-Singer","doi":"10.1097/BOR.0000000000001171","DOIUrl":"10.1097/BOR.0000000000001171","url":null,"abstract":"<p><strong>Purpose of review: </strong>IgA vasculitis (IgAV) and IgA nephropathy (IgAN) have historically been treated as distinct disease entities in clinical practice and in drug development, despite growing evidence speaking to a shared pathogenesis. Recent years have seen an explosion in therapeutic trials in the IgAN space, with multiple approvals of targeted therapies and a shifting paradigm of care; meanwhile, IgAV has lagged behind with a paucity of randomized trials. What can rheumatologists learn from IgAN, and can IgAV patients benefit from therapeutic advances in IgAN?</p><p><strong>Recent findings: </strong>In this article, we will compare and contrast the epidemiology and clinical presentations of IgAV and IgAN, and explore the evidence supporting a shared pathogenesis including the 'four hit hypothesis'. We will review emerging therapies in IgAN and their biologic basis for the rheumatology audience, and discuss how lessons learned in IgAN might be applied to IgAV.</p><p><strong>Summary: </strong>Rheumatologists should be aware of the therapeutic advances in IgAN, which may inform future management of IgAV patients, particularly those with renal involvement.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"336-342"},"PeriodicalIF":5.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13566460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223504","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":"Beyond fibrinolysis: the multifaceted role of the fibrinolytic system in systemic sclerosis.","authors":"Irene Rosa, Eloisa Romano, Chiara Cirillo, Mirko Manetti","doi":"10.1097/BOR.0000000000001186","DOIUrl":"10.1097/BOR.0000000000001186","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review summarizes the emerging role of the fibrinolytic system in the pathogenesis of systemic sclerosis (SSc) and its potential as a source of novel therapeutic targets.</p><p><strong>Recent findings: </strong>Increasing evidence indicates that SSc is characterized by impaired fibrinolysis, largely driven by upregulation of plasminogen activator inhibitor-1 (PAI-1) and α2-antiplasmin, which limits extracellular matrix degradation and promotes myofibroblast differentiation. A key pathogenic mechanism involves matrix metalloproteinase-12-mediated proteolytic cleavage of the urokinase-type plasminogen activator receptor (uPAR), which compromises angiogenesis and promotes endothelial-to-mesenchymal transition, thereby contributing to both vascular remodeling and fibrosis. Moreover, aberrant crosstalk between cleaved uPAR and N-formyl peptide receptors (FPRs) on fibroblasts induces excessive reactive oxygen species generation and sustained fibroblast proliferation. Clinically, circulating soluble uPAR and PLAUR gene polymorphisms have emerged as candidate biomarkers of severe microvascular dysfunction and internal organ involvement. From a therapeutic perspective, several innovative strategies, including uPAR-targeting peptides, PAI-1 inhibitors, and molecules disrupting uPAR-FPR interaction, have shown encouraging antifibrotic efficacy in preclinical models.</p><p><strong>Summary: </strong>The fibrinolytic system has emerged as a central molecular hub linking SSc microvascular dysfunction, immune dysregulation, and fibrosis. Thus, restoring fibrinolytic homeostasis may offer a promising strategy to simultaneously improve angiogenesis, reduce fibrosis, and slow disease progression.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2026-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789456","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.0000000000001168","DOIUrl":"10.1097/BOR.0000000000001168","url":null,"abstract":"","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"38 4","pages":"v"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041465","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":"MRI sacroiliitis mimics.","authors":"Anne Grethe Jurik, Robert G W Lambert, Rosa Marie Kiil","doi":"10.1097/BOR.0000000000001165","DOIUrl":"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":"202-214"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"Choosing NSAID treatment in axial spondyloarthritis: factors guiding clinical decision-making.","authors":"Lianne S Gensler, Cailean E McKay, Adam S Mayer","doi":"10.1097/BOR.0000000000001164","DOIUrl":"10.1097/BOR.0000000000001164","url":null,"abstract":"<p><strong>Purpose of review: </strong>Nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line therapy for axial spondyloarthritis (axSpA), improving pain, function, and disease activity. This review evaluates evidence for NSAID efficacy, potential disease modification, and safety considerations in patients with axSpA, particularly those with inflammatory bowel disease (IBD) or elevated cardiovascular risk.</p><p><strong>Recent findings: </strong>Evidence for NSAID-mediated disease modification remains inconsistent. In patients with IBD, contemporary data suggest variable risk of disease exacerbation depending on NSAID selectivity and exposure patterns. Established gastrointestinal toxicities persist outside the IBD context, though risk-mitigation strategies are available. While general-population studies demonstrate increased cardiovascular risk with certain NSAIDs, emerging axSpA-specific observational data suggest a smaller excess risk of major adverse cardiovascular events, potentially reflecting the counterbalancing effect of inflammation control. Pharmacogenomic data increasingly support CYP2C9 variation as a determinant of NSAID exposure and toxicity.</p><p><strong>Summary: </strong>NSAIDs remain foundational in axSpA management, but long-term use requires individualized assessment of gastrointestinal, cardiovascular, and IBD-related risks. Pharmacogenomic considerations may further refine patient selection and dosing strategies.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"38 4","pages":"225-231"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041422","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":"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":"255-262"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"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":"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":"268-273"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"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":"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":"274-281"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"Digital monitoring in rheumatoid arthritis: remote assessment, wearables, and data-driven disease management.","authors":"Asimina Karampela, Elena Nikiphorou","doi":"10.1097/BOR.0000000000001166","DOIUrl":"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":"263-267"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236049/pdf/","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":"OA","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":"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":"297-303"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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}