{"title":"Region-specific, data-driven guidelines are needed for rheumatic diseases in LMICs","authors":"Amita Aggarwal","doi":"10.1038/s41584-025-01265-2","DOIUrl":"https://doi.org/10.1038/s41584-025-01265-2","url":null,"abstract":"Separate guidelines are needed for the management and diagnosis of rheumatic diseases in low- and middle-income countries, especially with the advent of expensive biological therapies and monitoring techniques. The lack of robust data on the efficacy of low-cost drugs and biosimilars in these countries limits the development of data-driven guidelines.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"44 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143933545","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}
{"title":"Understanding rheumatic disease through continuous cell state analysis","authors":"Lysette Marshall, Soumya Raychaudhuri, Sebastien Viatte","doi":"10.1038/s41584-025-01253-6","DOIUrl":"https://doi.org/10.1038/s41584-025-01253-6","url":null,"abstract":"<p>Autoimmune rheumatic diseases are a heterogeneous group of conditions, including rheumatoid arthritis (RA) and systemic lupus erythematosus. With the increasing availability of large single-cell datasets, novel disease-associated cell types continue to be identified and characterized at multiple omics layers, for example, ‘T peripheral helper’ (T<sub>PH</sub>) (CXCR5<sup>−</sup> PD-1<sup>hi</sup>) cells in RA and systemic lupus erythematosus and MerTK<sup>+</sup> myeloid cells in RA. Despite efforts to define disease-relevant cell atlases, the very definition of a ‘cell type’ or ‘lineage’ has proven controversial as higher resolution assays emerge. This Review explores the cell types and states involved in disease pathogenesis, with a focus on the shifting perspectives on immune and stromal cell taxonomy. These understandings of cell identity are closely related to the computational methods adopted for analysis, with implications for the interpretation of single-cell data. Understanding the underlying cellular architecture of disease is also crucial for therapeutic research as ambiguity hinders translation to the clinical setting. We discuss the implications of different frameworks for cell identity for disease treatment and the discovery of predictive biomarkers for stratified medicine — an unmet clinical need for autoimmune rheumatic diseases.</p>","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"12 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920033","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}
{"title":"Targeting anti-PAD4 autoantibodies in RA","authors":"Holly Webster","doi":"10.1038/s41584-025-01264-3","DOIUrl":"https://doi.org/10.1038/s41584-025-01264-3","url":null,"abstract":"Findings implicate anti-PAD4 antibodies in the pathogenesis of rheumatoid arthritis.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"53 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909896","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}
{"title":"Arterial and venous thrombosis in systemic and monogenic vasculitis.","authors":"Federica Bello,Filippo Fagni,Giacomo Bagni,Catherine L Hill,Aladdin J Mohammad,Sergey Moiseev,Iacopo Olivotto,Emire Seyahi,Giacomo Emmi","doi":"10.1038/s41584-025-01252-7","DOIUrl":"https://doi.org/10.1038/s41584-025-01252-7","url":null,"abstract":"Systemic vasculitis, common forms of which include anti-neutrophil cytoplasmic antibody-associated small-vessel vasculitis, large-vessel vasculitis and Behçet syndrome, are frequently complicated by arterial or venous thrombotic events (AVTEs). Newly identified entities such as DADA2 (deficiency of adenosine deaminase 2) and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, which are driven by genetic mutations, also exhibit vasculitic features and are associated with a high risk of AVTEs. AVTEs in systemic vasculitis, including monogenic forms of vasculitis, are due to the complex interaction of inflammation and coagulation. New insights into the pathogenetic mechanisms implicate endothelial dysfunction, immune complex deposition and the interplay of pro-inflammatory cytokines with prothrombotic factors, which collectively promote thrombus formation. AVTEs impose a substantial disease burden, complicate diagnosis and negatively affect prognosis by increasing the risk of morbidity and mortality. Early diagnosis and treatment are crucial to prevent lasting damage. Management strategies should target both thrombosis and underlying inflammation. Antithrombotic therapies, including low-dose aspirin, or oral anticoagulants should be used on the basis of individual thrombotic risk assessment. Immunosuppressive therapy is the cornerstone of treatment for arterial and venous thrombosis, particularly in Behçet syndrome, in which vascular inflammation has a crucial role in thrombotic complications.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"56 3 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915091","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}
{"title":"Risks and benefits of immunosuppressant withdrawal in systemic lupus erythematosus","authors":"Catriona A. Wagner, Judith A. James","doi":"10.1038/s41584-025-01262-5","DOIUrl":"https://doi.org/10.1038/s41584-025-01262-5","url":null,"abstract":"Withdrawing immunosuppressive treatment in systemic lupus erythematosus offers reduced toxicity and improved quality of life for patients in remission but carries a risk of disease reactivation. Emerging studies emphasize the importance of identifying patients who can safely discontinue therapy using clinical criteria and molecular profiling to guide personalized strategies.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143901314","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}
{"title":"Glycosylation switch in synovial fibroblasts promotes ECM degradation","authors":"Holly Webster","doi":"10.1038/s41584-025-01258-1","DOIUrl":"https://doi.org/10.1038/s41584-025-01258-1","url":null,"abstract":"Activation of N-acetylgalactosaminyltransferases in synovial fibroblasts promotes the degradation of the extracellular matrix in arthritis.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143862087","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}
{"title":"Factors beyond urate levels for managing gout flares","authors":"Hang Korng Ea, Pascal Richette","doi":"10.1038/s41584-025-01255-4","DOIUrl":"https://doi.org/10.1038/s41584-025-01255-4","url":null,"abstract":"Urate crystals alone are required but not sufficient to trigger gout flares; they can also be modulated by environmental, metabolic, genetic and epigenetic factors. Avoiding large variation in urate levels, maintaining prophylaxis until crystal clearance and initiating low-dose urate-lowering therapy are efficient strategies for disease management.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"69 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866445","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}
{"title":"Understanding the causes of treatment failure is crucial for the management of axial spondyloarthritis","authors":"Denis Poddubnyy, Xenofon Baraliakos","doi":"10.1038/s41584-025-01254-5","DOIUrl":"https://doi.org/10.1038/s41584-025-01254-5","url":null,"abstract":"Although numerous therapies are available for axial spondyloarthritis, more than half of patients do not achieve remission or respond to treatment. Understanding the reasons for non-response in axial spondyloarthritis is essential for effective management of this disease.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"5 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866446","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}
{"title":"Targeting osteoarthritis where it hurts: the osteochondral junction","authors":"Anne-Marie Malfait, Alia M. Obeidat","doi":"10.1038/s41584-025-01257-2","DOIUrl":"https://doi.org/10.1038/s41584-025-01257-2","url":null,"abstract":"In joints with osteoarthritis, angiogenesis and neuronal growth occur at the osteochondral junction, a process that can contribute to structural joint damage and pain. Targeting this neurovascularization process represents a possible strategy for the development of disease-modifying drugs for osteoarthritis.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"15 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857903","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}
{"title":"Current challenges in understanding the epidemiology of calcium pyrophosphate crystal deposition","authors":"Charlotte Jauffret, Tristan Pascart","doi":"10.1038/s41584-025-01256-3","DOIUrl":"https://doi.org/10.1038/s41584-025-01256-3","url":null,"abstract":"Calcium pyrophosphate deposition (CPPD) disease is secondary to the pathological accumulation of calcium pyrophosphate (CPP) crystals inside joints and involves acute or chronic inflammatory arthritis. Epidemiological research on CPPD has been slow despite the suspected high prevalence of this condition. Here we highlight key challenges in CPPD imaging, diagnosis and nomenclature that need to be addressed for epidemiological research to progress at a faster pace.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 1","pages":""},"PeriodicalIF":33.7,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841199","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}