Nature Reviews Rheumatology最新文献

{"title":"Hepatic control of immunometabolism: implications for the pathogenesis, diagnosis and treatment of rheumatic diseases","authors":"Andras Perl, Katalin Banki","doi":"10.1038/s41584-026-01421-2","DOIUrl":"10.1038/s41584-026-01421-2","url":null,"abstract":"Autoimmune rheumatic diseases, including systemic lupus erythematosus and antiphospholipid syndrome, arise from interactions between genetic susceptibility and environmental triggers that drive metabolic dysregulation. The liver, a central metabolic and immunological organ, has a key role in initiating and amplifying systemic autoimmunity and organ damage. It functions as an interface between the gut microbiome, nutrients, drugs and environmental toxins. The liver regulates immune cell development, coordinates systemic immune responses through metabolite and cytokine production and modifies self-antigens via oxidation, glycosylation and lipidation. These changes can transform normal molecules into autoantigens. Hepatocytes also produce coagulation, complement factors and apolipoproteins, such as β2-glycoprotein I, a major target of antiphospholipid antibodies. In addition, the liver secretes antioxidants such as glutathione, albumin and paraoxonase-1, which protect lipoproteins from becoming antigenic and reduce risks of atherosclerosis and thrombosis. Liver diseases such as steatosis and steatohepatitis have bidirectional relationships with systemic lupus erythematosus, antiphospholipid syndrome and other rheumatic conditions. Liver cells can also be direct targets of autoimmune responses. Delineating the role of the liver in metabolic control of autoimmunity and inflammation can lead to better understanding of disease pathogenesis, improved clinical diagnosis and identification of new therapeutic targets in rheumatic diseases. Emerging evidence positions the liver as a crucial interface that links immune regulation, metabolism and autoimmunity. This Review explores the associations between hepatic dysfunction and autoimmune rheumatic diseases, highlighting implications for pathogenesis, clinical manifestations and treatment.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 11","pages":"675-695"},"PeriodicalIF":33.7,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148830454","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":"Towards a global collaborative approach to living guideline development in rheumatology","authors":"Laurent Arnaud, Guillermo J. Pons-Estel","doi":"10.1038/s41584-026-01422-1","DOIUrl":"10.1038/s41584-026-01422-1","url":null,"abstract":"Clinical practice guidelines are fundamental to evidence-based care. However, their current development, based on infrequent systematic reviews, is increasingly challenged by the rapid expansion of therapeutic evidence. The implementation of a living guideline framework in rheumatology could enable new, practice-changing evidence to be incorporated into recommendations as it emerges.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 11","pages":"667-668"},"PeriodicalIF":33.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813617","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":"Author Correction: Diagnostic, prognostic and therapeutic biomarkers in rheumatoid arthritis","authors":"Zoltán Szekanecz, Lilla Gunkl-Tóth, Szilvia Szamosi, Diane van der Woude, Iain McInnes, György Nagy","doi":"10.1038/s41584-026-01430-1","DOIUrl":"10.1038/s41584-026-01430-1","url":null,"abstract":"","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"663-663"},"PeriodicalIF":33.7,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41584-026-01430-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based guidelines for the diagnosis and management of adult-onset IgA vasculitis","authors":"Alexandra Audemard-Verger, Evangéline Pillebout, Eva Baier, Ingeborg M. Bajema, Jonathan Barratt, George Bertsias, Annette Bruchfeld, Santos Castañeda, Maria C. Cid, Rosanna Coppo, Haner Direskeneli, Carmela Errichiello, Jürgen Floege, Miguel A. González-Gay, Ahmet Gül, Antoine Hankard, Alojzija Hočevar, Marie Jachiet, Marija Jelusic, Noémie Jourde-Chiche, Alfred D. Mahr, Thomas Neumann, Louise Oni, Seza Özen, Alan D. Salama, Cord Sunderkötter, Benjamin Terrier, Giorgio Trivioli, David Jayne, Augusto Vaglio, the collaborators of the EUGAVAS Study Group on behalf of the European Vasculitis Society (EUVAS)","doi":"10.1038/s41584-026-01420-3","DOIUrl":"10.1038/s41584-026-01420-3","url":null,"abstract":"IgA vasculitis (IgAV) is an immune complex-mediated small-vessel vasculitis that typically affects the skin, gastrointestinal tract, kidneys and joints. Childhood-onset IgAV is a common disease and usually follows a self-limiting course, whereas adult-onset IgAV is considerably less frequent and is associated with a poorer prognosis. The diagnosis, assessment and management of adult-onset IgAV remain challenging owing to the absence of validated diagnostic criteria for adults and lack of IgAV-specific standardized disease activity scores. Short-term outcomes are mainly determined by gastrointestinal complications, whereas kidney involvement and the risk of progression to chronic kidney disease are the major determinants of long-term prognosis. The treatment of adult-onset IgAV is limited by the paucity of high-quality clinical trials and standardized therapeutic approaches. Here, we present evidence-based, multidisciplinary guidelines for the diagnosis and management of adult-onset IgAV that reflect advances in understanding of pathogenesis, differential diagnoses and treatment over the past two decades. Developed by a panel of leading European experts on the basis of systematic literature review and expert opinion, these guidelines comprise 14 recommendation statements and overarching principles that provide a structured and pragmatic clinical framework for the diagnosis, treatment and follow-up of adult-onset IgAV. These evidence-based guidelines provide recommendations for the diagnosis and management of adult-onset IgA vasculitis. Current evidence regarding clinical manifestations, diagnostic investigations, prognostic factors and therapeutic approaches is reviewed, with practical algorithms to support evidence-based clinical practice.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"643-662"},"PeriodicalIF":33.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41584-026-01420-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smart contact lenses enable personalized uric acid monitoring","authors":"Jessica McHugh","doi":"10.1038/s41584-026-01424-z","DOIUrl":"10.1038/s41584-026-01424-z","url":null,"abstract":"A smart contact lens enables the estimation of serum uric acid from tears and supports device-free prediction of uric acid dynamics by using personalized digital twins.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"597-597"},"PeriodicalIF":33.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795336","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":"TYK2 inhibition shows durable efficacy in PsA","authors":"Jessica McHugh","doi":"10.1038/s41584-026-01426-x","DOIUrl":"10.1038/s41584-026-01426-x","url":null,"abstract":"In the phase III POETYK PsA-2 trial, deucravacitinib improved outcomes across multiple domains of psoriatic arthritis and had a favourable safety profile.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"597-597"},"PeriodicalIF":33.7,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795606","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":"Keeping gout on target with nurse-supported urate self-monitoring","authors":"Ana Beatriz Vargas-Santos, Rosa Weiss Telles","doi":"10.1038/s41584-026-01419-w","DOIUrl":"10.1038/s41584-026-01419-w","url":null,"abstract":"Global gout management remains profoundly suboptimal despite readily available treatments. Restructuring care through device-facilitated, nurse-led frameworks challenges traditional medical protectionism and offers a highly effective, scalable strategy to bridge systemic healthcare gaps and optimize patient outcomes.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"603-604"},"PeriodicalIF":33.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148760679","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":"Time for a disease-specific approach to lymphoma in Sjögren disease","authors":"Gaetane Nocturne, Marguerite Vignon","doi":"10.1038/s41584-026-01425-y","DOIUrl":"10.1038/s41584-026-01425-y","url":null,"abstract":"Lymphoma is a severe complication of Sjögren disease, but two challenges remain unresolved: predicting individual risk with precision and defining specific treatment strategies. Now, international collaborative efforts and close partnership with haematologists make the possibility of addressing these challenges a reality.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 11","pages":"669-670"},"PeriodicalIF":33.7,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724969","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":"Adopting treat-to-target in paediatric rheumatic diseases","authors":"Alessandro Consolaro, Angelo Ravelli","doi":"10.1038/s41584-026-01423-0","DOIUrl":"10.1038/s41584-026-01423-0","url":null,"abstract":"Studies in adult rheumatic illnesses have shown that treat-to-target strategies improve disease control, physical function and long-term outcomes compared with conventional management. Recommendations for adopting this approach in paediatric rheumatic disorders have now been developed, and emerging evidence suggests that their application could improve care and health outcomes.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 11","pages":"665-666"},"PeriodicalIF":33.7,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713086","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":"Advances in the treatment of eosinophilic granulomatosis with polyangiitis","authors":"Adrien Cottu, Florence Roufosse, Allyson Egan, Giacomo Emmi, Matthieu Groh, Alexandra M. Nanzer, Ulrich Specks, Michael E. Wechsler, Augusto Vaglio, Benjamin Terrier","doi":"10.1038/s41584-026-01406-1","DOIUrl":"10.1038/s41584-026-01406-1","url":null,"abstract":"Eosinophilic granulomatosis with polyangiitis (EGPA) is a small-vessel vasculitis associated with anti-neutrophil cytoplasmic antibodies and characterized by blood and tissue eosinophilia, severe respiratory manifestations, and multiorgan involvement. The management of newly diagnosed EGPA still relies on therapeutic strategies that were initially validated for other forms of anti-neutrophil cytoplasmic antibody-associated vasculitis, including microscopic polyangiitis and granulomatosis with polyangiitis. Whereas the long-term prognosis of microscopic polyangiitis and granulomatosis with polyangiitis depends primarily on controlling initial organ involvement and preventing relapses, EGPA is distinguished by chronic involvement of both upper and lower respiratory airways, which often necessitates prolonged glucocorticoid therapy. Data from clinical trials suggest that targeting the IL-5 pathway with mepolizumab or benralizumab can effectively control persistent respiratory symptoms and reduce the need for glucocorticoids, yet the role of these agents in the management of EGPA at the time of diagnosis and in the long term remains to be defined. Emerging retrospective data on therapies targeting other type 2 cytokines (such as IL-4, IL-13 and thymic stromal lymphopoietin) suggest potential benefits for relapsing respiratory symptoms; however, prospective evidence remains limited and safety has yet to be established. This Review discusses the role of these new targeted therapies in the management of EGPA, alongside historical treatments. The development of targeted therapeutics has transformed the management of eosinophilic granulomatosis with polyangiitis (EGPA). This Review explores the role of these new therapies, as well as that of the still-relevant historical treatments, for the induction and maintenance of remission in EGPA.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 9","pages":"541-557"},"PeriodicalIF":33.7,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673985","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}