Current opinion in rheumatology最新文献

{"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":5.4,"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":5.4,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13168908/pdf/","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":"OA","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":5.4,"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":"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":"Epidemiology and outcomes of rheumatoid arthritis.","authors":"Lauren E Klingemann, Ted R Mikuls, Bryant R England","doi":"10.1097/BOR.0000000000001142","DOIUrl":"10.1097/BOR.0000000000001142","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to summarize recent developments in the epidemiology of rheumatoid arthritis (RA) focusing on disease burden, risk factors, and disease outcomes.</p><p><strong>Recent findings: </strong>Globally, the prevalence of RA is increasing, affecting an estimated 17.6 million people worldwide. Emerging data implicate other environmental and occupational inhaled exposures apart from cigarette smoking as RA risk factors. Risk models integrating clinical, serological, and imaging data are useful in predicting the pre-RA to RA transition. Extra-articular manifestations and multimorbidity are key complications of RA that drive excess mortality and avoidable hospitalizations, though overall mortality trends in RA are improving. RA-associated interstitial lung disease is recognized to affect the lungs of early RA patients, and risk models based on clinical and advanced biomarker phenotyping have shown potential for risk stratification. Large cohort studies have identified heart failure and valvular heart disease as cardiovascular complications in RA, in addition to atherosclerosis. Observational studies continue to evaluate the safety of TNF inhibitors in the setting of cancer.</p><p><strong>Summary: </strong>RA prevalence is rising globally, while mortality rates are declining. Continued investigation aimed at elucidating RA risk factors, the transition from pre-RA to RA, extra-articular involvement, and multimorbidity remains critical to optimize patient outcomes.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"38 2","pages":"69-75"},"PeriodicalIF":5.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148148670","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":"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}

{"title":"Vasculitis in autoinflammatory diseases.","authors":"Emilie Bohbot, Eldad Ben-Chetrit","doi":"10.1097/BOR.0000000000001120","DOIUrl":"10.1097/BOR.0000000000001120","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review aims to explore the relationship between autoinflammatory diseases (AIDs) and vasculitis, with a focus on recently identified syndromes and newly published data since 2016.</p><p><strong>Recent findings: </strong>While the connection between innate immune dysregulation and systemic inflammation is well established in AIDs, the occurrence of vasculitis in these disorders remains underrecognized and often misclassified.We discuss vasculitic manifestations in a wide range of AIDs, including familial Mediterranean fever, DADA2, HA20, VEXAS, CAPS, TRAPS, HIDS/MKD, Blau syndrome, and others. Each condition presents a unique pattern of vascular involvement, ranging from incidental cutaneous findings to life-threatening systemic vasculitis. The underlying mechanisms often involve overactivation of inflammatory pathways such as IL-1β, or NF-κB, and in some cases, novel genetic mutations affecting non-inflammatory pathways such as purine metabolism. The histologic, clinical, and genetic features often differ from classic vasculitic syndromes.</p><p><strong>Summary: </strong>Recognizing vasculitis in the context of AIDs is critical for early diagnosis, especially in pediatric patients or those with treatment-resistant or atypical presentations. Genetic testing should be considered in such cases. Understanding these distinct disease patterns allows physicians to tailor management strategies, including biologic therapies or hematopoietic stem cell transplantation, improving outcomes in these complex and often severe disorders.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"12-19"},"PeriodicalIF":5.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144946215","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":"Vasculitis associated with nonhematological malignancies.","authors":"Zeynep Hande Turna","doi":"10.1097/BOR.0000000000001131","DOIUrl":"10.1097/BOR.0000000000001131","url":null,"abstract":"<p><strong>Purpose of review: </strong>There is a complex relationship between nonhematological malignancies and vasculitis Paraneoplastic vasculitis may present in many different forms. Cancer risk is high in patients with some types of vasculitis. Also, immune checkpoint inhibitors (ICIs) used in treatment of many solid tumors may cause vasculitis.</p><p><strong>Recent findings: </strong>Vasculitis associated with solid tumors is less frequently seen when compared to vasculitis associated with hematological malignancies. Cutaneous leukocytoclastic vasculitis (vasculitis of small vessels) is the most frequently encountered paraneoplastic vasculitis type. Paraneoplastic vasculitis is usually seen in patients with lung, genitourinary and gastrointestinal system tumors. The timing of paraneoplastic vasculitis varies as before, after or concurrently with the diagnosis of malignancy. Vasculitis is usually considered to be paraneoplastic when time gap between the onset of vasculitis and diagnosis of cancer is within 12 months. ICIs used frequently in treatment of many solid tumors may cause vasculitis by stimulating T cell activation. They usually cause large vessel (temporal arteritis and single organ vasculitis), central nervous system vasculitis or small vessel vasculitis.</p><p><strong>Summary: </strong>Close monitoring of patients with vasculitis is essential for early recognition of an underlying malignancy and directing treatment options towards cancer specific treatments. Vasculitis due to ICIs should be recognized as early as possible when ICIs should be stopped, and immunosuppressives should be started to avoid severe complications of immune adverse events diagnosed to with- hold ICIs and start immunosuppressive treatments precluding severe complications of immune adverse events.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":"38 1","pages":"1-5"},"PeriodicalIF":5.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145667642","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":"Vasculitis associated with haematologic malignancies.","authors":"Ayse Salihoglu, Muhlis Cem Ar","doi":"10.1097/BOR.0000000000001138","DOIUrl":"10.1097/BOR.0000000000001138","url":null,"abstract":"<p><strong>Purpose of review: </strong>This review examines the complex bidirectional relationship between vasculitis and hematologic malignancies, highlighting the importance of meticulous diagnostic assessment.</p><p><strong>Recent findings: </strong>Vasculitis may emerge in the setting of hematologic malignancies via mechanisms such as paraneoplastic inflammation, immune dysregulation, drug exposure, and clonal hematopoiesis. Myeloid neoplasms - especially myelodysplastic syndrome (MDS) and chronic myelomonocytic leukemia (CMML) - show a stronger association than lymphoid malignancies, with cutaneous small vessel vasculitis being the most common subtype. VEXAS syndrome exemplifies the overlap between autoinflammation and hematologic disease, often presenting with vasculitic features and macrocytic anemia.In lymphoproliferative disorders and plasma cell dyscrasias, vasculitis may precede, mimic, or complicate the malignancy. Entities such as intravascular lymphoma, angioimmunoblastic T-cell lymphoma, and monoclonal gammopathies - including MGUS and multiple myeloma - can manifest with vasculitic symptoms, requiring histopathologic and molecular evaluation. Emerging concepts like monoclonal gammopathy of cutaneous and rheumatologic significance highlight the need for interdisciplinary care.Drug-induced vasculitis, particularly from immunomodulatory agents and biologics, adds diagnostic complexity. Atypical features - such as unexplained cytopenias, dual autoantibody positivity, or poor response to immunosuppression - should prompt evaluation for underlying hematologic disease. Conversely, vasculitis may signal complications in patients with known hematologic disorders.</p><p><strong>Summary: </strong>Early suspicion of vasculitis associated with hematologic malignancies and accurate diagnosis are important in guiding therapeutic approaches.</p>","PeriodicalId":11145,"journal":{"name":"Current opinion in rheumatology","volume":" ","pages":"20-25"},"PeriodicalIF":5.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145480979","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}