Nature Reviews Rheumatology最新文献

The gut-joint axis in osteoarthritis. 骨关节炎中的肠-关节轴。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-07 DOI: 10.1038/s41584-026-01378-2

Jie Wei, Yuqing Zhang, Cen Xie, Guanghua Lei, Chao Zeng

{"title":"The gut-joint axis in osteoarthritis.","authors":"Jie Wei, Yuqing Zhang, Cen Xie, Guanghua Lei, Chao Zeng","doi":"10.1038/s41584-026-01378-2","DOIUrl":"https://doi.org/10.1038/s41584-026-01378-2","url":null,"abstract":"Osteoarthritis (OA) is a complex condition driven by biomechanical, metabolic and inflammatory factors; however, effective disease-modifying treatments remain unavailable. Growing evidence suggests that gut microbiota dysbiosis has an important role in OA pathogenesis, giving rise to the emerging concept of a functional and targetable gut-joint axis. Gut microbiota dysbiosis can impair enteroendocrine signalling, intestinal immunity and gut barrier integrity, alter the secretion of hormones and cytokines and facilitate the translocation of gut microorganisms, pro-inflammatory molecules and metabolites into the circulation or joints. These processes can disrupt systemic and local homeostasis, promote metabolic dysregulation and obesity, trigger low-grade inflammation and contribute to both the onset and progression of OA. Although these insights open up new avenues for disease-modifying treatments and build on the long-standing paradigm in OA, which primarily focuses on pain relief rather than disease modification, evidence supporting therapeutic strategies that target the gut-joint axis remains limited. Further research is needed to translate this promising biology into clinical benefits, including deeper mechanistic elucidation through integrated multi-omics approaches, exploration of the interplay between host genetics, environmental factors and the gut microbiota and also multidimensional validation of the safety and efficacy of treatments that target this axis using complementary models (such as organoids and large animal models), clinical trials and real-world studies.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":" ","pages":""},"PeriodicalIF":32.7,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Sex and gender differences in rheumatology: clinical impact and future directions. 风湿病学中的性别差异：临床影响和未来方向。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-05 DOI: 10.1038/s41584-026-01376-4

Marina Pierdominici, Marta Borgi, Francesca Romana Spinelli, Fabrizio Conti, Huaxun Wu, Ki Won Moon, Uta Kiltz, Elena Ortona

{"title":"Sex and gender differences in rheumatology: clinical impact and future directions.","authors":"Marina Pierdominici, Marta Borgi, Francesca Romana Spinelli, Fabrizio Conti, Huaxun Wu, Ki Won Moon, Uta Kiltz, Elena Ortona","doi":"10.1038/s41584-026-01376-4","DOIUrl":"https://doi.org/10.1038/s41584-026-01376-4","url":null,"abstract":"Sex and gender shape disease presentation, diagnostic accuracy, treatment response and clinical outcomes in rheumatology, yet these dimensions remain insufficiently embedded in clinical practice. Owing to the markedly unbalanced sex prevalence ratios across many rheumatic diseases, the 'minority' sex is consistently under-represented in clinical studies, limiting the interpretation of long-term outcomes and treatment effectiveness. Sex-related differences in pain perception, inflammatory biomarkers and imaging patterns further complicate disease assessment, and treatment allocation and drug persistence also differ between women and men. Gender-related factors - including disparities in care-seeking behaviours, social roles and lifestyle factors - additionally modulate symptom burden and disease trajectories. Evidence remains particularly scarce for transgender, gender-diverse and intersex individuals, who are rarely captured in clinical cohorts, restricting the development of inclusive and generalizable evidence. Embedding sex-aware and gender-aware approaches into diagnostic reasoning, risk assessment and therapeutic decision-making is therefore essential for advancing precision, equity and truly personalized rheumatological care. Such integration enables clinicians to interpret disease signals more accurately, anticipate divergent multimorbidity trajectories and tailor treatment strategies to the biological and sociocultural contexts of each patient.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":" ","pages":""},"PeriodicalIF":32.7,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Small but relevant effects of exercise therapy in osteoarthritis. 运动疗法对骨关节炎的影响虽小但相关。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-05 DOI: 10.1038/s41584-026-01377-3

Sita Bierma-Zeinstra, Jos Runhaar

引用次数: 0

The complexity of pain in osteoarthritis. 骨关节炎疼痛的复杂性。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-30 DOI: 10.1038/s41584-026-01372-8

Kristian Kjær-Staal Petersen, Daniel Ciampi de Andrade, Gisèle Pickering, Rocco Giordano, Emma Hertel, Robert R Edwards, Esther Pogatzki-Zahn, Ali Mobasheri, Lars Arendt-Nielsen

{"title":"The complexity of pain in osteoarthritis.","authors":"Kristian Kjær-Staal Petersen, Daniel Ciampi de Andrade, Gisèle Pickering, Rocco Giordano, Emma Hertel, Robert R Edwards, Esther Pogatzki-Zahn, Ali Mobasheri, Lars Arendt-Nielsen","doi":"10.1038/s41584-026-01372-8","DOIUrl":"https://doi.org/10.1038/s41584-026-01372-8","url":null,"abstract":"Chronic pain is the hall-mark symptom of osteoarthritis (OA) and although several therapies are available, a sizeable number of patients do not gain adequate pain relief from these therapies. Predicting those patients who will not respond to current therapies remains a challenge. Although psychosocial, sensitivity, inflammation and genetic factors have been identified as pain mechanisms that predict response to pain therapy, none of these is a sufficiently strong predictor alone. An emerging approach to this challenge is the use of machine-learning algorithms that integrate several pain mechanisms, which are superior to previous prediction models. Importantly, these machine-learning algorithms identify networks of pain mechanisms that could be targeted therapeutically. From these models, a new mechanistic framework is proposed, in which pain in OA can be viewed either as a simpler joint disease with inflammation or as a complex pain problem that involves multiple factors. The latter is associated with a higher risk of poor response to standard OA pain therapy. Understanding the complexity of pain in OA and predicting those who are at risk of not responding to standard OA pain therapy are essential for improving the management of pain in OA.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":" ","pages":""},"PeriodicalIF":32.7,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Is cam morphology a cause of osteoarthritis? 凸轮形态是骨关节炎的原因吗？

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-20 DOI: 10.1038/s41584-026-01373-7

Benjamin G Faber,George Davey Smith,Jonathan H Tobias

引用次数: 0

Reply to 'Is cam morphology a cause of osteoarthritis?' 回复“cam形态学是骨关节炎的原因吗？”

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-20 DOI: 10.1038/s41584-026-01374-6

Joshua Heerey,Joanne Kemp,Pim van Klij,Vasco Mascarenhas,Mark Scholes,Fleur Boel,Paul Dijkstra,Kay Crossley,Sita Bierma-Zeinstra,Rintje Agricola

引用次数: 0

Positive results for obinutuzumab in SLE phase III trial 在SLE III期临床试验中，obinutuzumab获得阳性结果。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-08 DOI: 10.1038/s41584-026-01371-9

Sarah Onuora

引用次数: 0

Fertility, pregnancy and lactation in women with systemic lupus erythematosus 系统性红斑狼疮妇女的生育、妊娠和哺乳期。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-07 DOI: 10.1038/s41584-026-01366-6

Irene E. M. Bultink, Wendy Dankers, Marjon A. de Boer, Karen Schreiber

{"title":"Fertility, pregnancy and lactation in women with systemic lupus erythematosus","authors":"Irene E. M. Bultink, Wendy Dankers, Marjon A. de Boer, Karen Schreiber","doi":"10.1038/s41584-026-01366-6","DOIUrl":"10.1038/s41584-026-01366-6","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects women of childbearing age. As the prevalence of SLE rises, and advances since the 1960s have substantially improved survival and quality of life, the number of women with SLE who become pregnant is steadily increasing. Although pregnancy is feasible for most patients with well-controlled SLE, pregnancy remains challenging for both women with SLE and clinicians because the risk of maternal complications and adverse fetal outcomes is higher than that in the general population. Moreover, the increased risk of pregnancy complications persists in subsequent pregnancies in women with SLE, whereas in healthy women this risk decreases owing to the development of maternal–fetal immune tolerance. During pregnancy and the postpartum period, women remain at risk of disease flares and other complications, particularly those with active disease at conception, a history of lupus nephritis, antiphospholipid syndrome or recent medication withdrawal. Important knowledge gaps persist regarding the mechanisms underlying these complications and the safety of treatment during conception, pregnancy and lactation. Preconception counselling, assessment of risk factors for adverse outcomes, pregnancy planning, timely medication adjustment and multidisciplinary management are essential to improve the maternal and fetal outcomes in women with SLE. This Review examines fertility, pregnancy and lactation in SLE, highlighting the bidirectional effects of pregnancy and disease and summarizing evidence-based approaches to counselling, risk stratification, monitoring and medication safety throughout the reproductive journey.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 5","pages":"302-318"},"PeriodicalIF":32.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147630413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Germinal-centre and extrafollicular B cell pathways in systemic lupus erythematosus 系统性红斑狼疮的生发中心和滤泡外B细胞通路。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-07 DOI: 10.1038/s41584-026-01365-7

Danni Yi-Dan Zhu, Carlos Castrillon, Elliot Akama-Garren, Michael C. Carroll

{"title":"Germinal-centre and extrafollicular B cell pathways in systemic lupus erythematosus","authors":"Danni Yi-Dan Zhu, Carlos Castrillon, Elliot Akama-Garren, Michael C. Carroll","doi":"10.1038/s41584-026-01365-7","DOIUrl":"10.1038/s41584-026-01365-7","url":null,"abstract":"Autoantibody flares are important drivers of pathology in systemic lupus erythematosus (SLE), highlighting the pivotal role of B cells in initiating and propagating chronic autoimmunity. Although autoreactive specificities are a normal feature of the naive B cell repertoire, these cells are normally suppressed by layered tolerance checkpoints that limit inappropriate activation. Autoimmune-prone environments can lower these tolerance thresholds, rendering naive autoreactive B cells more sensitive to aberrant cues. Cytokines and other microenvironmental signals shape tissue niches that direct autoreactive B cells towards either germinal-centre or extrafollicular differentiation pathways. Germinal centres support the entry, selection and diversification of autoreactive B cells, with T cell help sustaining these repertoires. By contrast, naive autoreactive B cells entering the extrafollicular pathway exhibit an attenuated requirement for cognate T cell help and strong dependence on complement and TLR signalling. Emerging evidence continues to refine our understanding of germinal-centre and extrafollicular responses as complementary sources of autoreactive effector cells. With this progress, investigations into the origin, development, longevity and tissue dynamics of autoreactive memory B cells as chronic sources of autoantibodies are warranted. Although broad B cell depletion therapies have yielded benefit, a key challenge now is developing precision strategies that selectively target pathogenic B cell subsets. Autoreactive B cells normally held in check by tolerance checkpoints can be driven towards germinal-centre or extrafollicular differentiation in autoimmune environments. This Review examines the cellular, molecular and contextual cues that shape these pathways and considers their implications for systemic lupus erythematosus pathogenesis and therapy.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 5","pages":"285-301"},"PeriodicalIF":32.7,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147630412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lactylation of SOD1 promotes oxidative damage in IVDD SOD1的乳酸化促进IVDD的氧化损伤。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-04-02 DOI: 10.1038/s41584-026-01369-3

Jessica McHugh

引用次数: 0