Current opinion in rheumatology最新文献

{"title":"Selective immunoglobulin E deficiency: an overlooked hypogammaglobulinemia and its association with rheumatoid arthritis.","authors":"Benedict K Tiong, Tamara Dahhan","doi":"10.1097/BOR.0000000000001150","DOIUrl":"10.1097/BOR.0000000000001150","url":null,"abstract":"<p><strong>Purpose of review: </strong>As part of current rheumatoid arthritis management, immunosuppressive treatments with disease-modifying antirheumatic drugs can potentially result in needing to manage immunodeficiency in our patient population. The purpose of this review is to evaluate one specific type of hypogammaglobulinemia, selective immunoglobulin E deficiency, and examine the association with rheumatoid arthritis.</p><p><strong>Recent findings: </strong>In patients with hypogammaglobulinemia, there is consensus that autoimmunity is more prevalent, though there is heterogeneity among specific immunodeficiency disorders.</p><p><strong>Summary: </strong>Given the potential for high-risk complications associated with immunosuppressive therapies in rheumatoid arthritis and other systemic autoimmune diseases, including the risk for severe infections, furthering our understanding of the association between immunodeficiency and autoimmune disease will only allow for more thorough care of these patients.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"246-249"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282664","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":"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":"232-237"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13236051/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cholinergic anti-inflammatory pathway and vagus nerve stimulation in rheumatoid arthritis.","authors":"Marcos Renato de Assis, Izabela Guimarães","doi":"10.1097/BOR.0000000000001170","DOIUrl":"10.1097/BOR.0000000000001170","url":null,"abstract":"<p><strong>Purpose of review: </strong>To integrate mechanistic and clinical evidence on vagal regulation of immunity via the cholinergic anti-inflammatory pathway, linking neural and inflammatory signaling in rheumatoid arthritis (RA). It highlights how reduced vagal tone contributes to disease onset and progression and frames neuromodulation as a rationale for adjunctive therapeutic strategies.</p><p><strong>Recent findings: </strong>Preclinical and clinical data demonstrate that vagal efferent activity modulates immune responses through noradrenergic circuits and activation of α7-nicotinic-acetylcholine-receptors on immune cells, inhibiting NF-κB nuclear translocation and reducing pro-inflammatory cytokines. This neuroimmune axis interacts with the hypothalamic-pituitary-adrenal axis and the microbiome, supporting an integrated model of inflammation. Vagus nerve stimulation (VNS) has been associated with reductions in inflammatory markers and clinically meaningful improvements in patients with RA. Implantable VNS has demonstrated efficacy and has received regulatory approval for moderate-to-severe RA refractory to disease-modifying antirheumatic drugs; however, the available evidence remains limited and requires confirmation in larger and more diverse populations. Noninvasive approaches show favorable safety profiles but heterogeneous efficacy and currently lack regulatory approval for immune-mediated diseases.</p><p><strong>Summary: </strong>VNS represents a promising adjunct to conventional immunosuppressive therapy for RA. Further well-designed trials are needed to standardize stimulation protocols, and define optimal strategies for clinical implementation.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"238-245"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147962562","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":"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":"191-201"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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}

{"title":"What's next in psoriatic arthritis therapy? A look at the pipeline.","authors":"Enrique R Soriano","doi":"10.1097/BOR.0000000000001157","DOIUrl":"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":"215-224"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"Glucagon-like peptide-1 receptor agonists in rheumatoid arthritis.","authors":"Ryan Massay, Angela Malani, Aaron Stubbs","doi":"10.1097/BOR.0000000000001153","DOIUrl":"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":"250-254"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"Pathogenesis-directed lupus therapeutics.","authors":"Bhavya Poudyal, Andras Perl","doi":"10.1097/BOR.0000000000001160","DOIUrl":"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":"282-296"},"PeriodicalIF":5.4,"publicationDate":"2026-07-01","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":"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":5.4,"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":5.4,"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":5.4,"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}