Mary Canavan, Orla Tynan, Jean Fletcher, Ursula Fearon
{"title":"Hypoxia as an amplifier of synovial inflammation in rheumatoid arthritis","authors":"Mary Canavan, Orla Tynan, Jean Fletcher, Ursula Fearon","doi":"10.1038/s41584-026-01397-z","DOIUrl":"10.1038/s41584-026-01397-z","url":null,"abstract":"Inflammatory arthritis is characterized by neovascularization, leukocyte extravasation and synovial hyperplasia, leading to joint destruction and functional disability. Although increased synovial angiogenesis is a hallmark of synovial inflammation, efficiency of the oxygen supply to the synovium is poor, leading to a hypoxic gradient that impacts differential cellular responses. This hypoxic gradient occurs as infiltrating cells and cells that reside within the joint increase their metabolic demand beyond what the highly dysregulated vasculature can supply. This hypoxic environment favours an increase in reactive oxygen species, leading to oxidative damage that further promotes inflammation. In this adverse microenvironment, synovial cells adapt to generate energy and switch their cellular metabolism from a resting regulatory state to a highly metabolically active state, enabling them to produce essential building blocks to support their proliferation. This metabolic shift results in the accumulation of metabolic intermediates that function as signalling molecules, which further dictate the inflammatory response. However, the synovium is a complex multicellular tissue, and the specific cellular reliance on oxygen and metabolites differs across the synovium. Cellular demands depend on anatomical location, cell–cell interactions and competition for nutrients. Understanding the complex interplay between hypoxia-induced signalling pathways, oxidative stress and inflammatory responses will provide a better insight into the underlying mechanisms of disease pathogenesis. In rheumatoid arthritis (RA) a hypoxic gradient develops in the synovium, which shapes inflammation and immune responses. In this Review, the authors provide insights into the role of hypoxia in the pathogenesis of RA, discuss its role in the wider integrated signalling network that drives inflammation and highlight how hypoxia can be targeted therapeutically to treat RA.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 10","pages":"626-642"},"PeriodicalIF":33.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148552689","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":"Secukinumab shows diverging efficacy in PMR and GCA","authors":"Jessica McHugh","doi":"10.1038/s41584-026-01413-2","DOIUrl":"10.1038/s41584-026-01413-2","url":null,"abstract":"In two phase III trials, secukinumab improved rates of sustained remission and reduced glucocorticoid use in polymyalgia rheumatica but did not improve outcomes in giant cell arteritis.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 9","pages":"533-533"},"PeriodicalIF":33.7,"publicationDate":"2026-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148459262","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":"Lymph node ‘hideouts’ shield B cells from antibody therapy","authors":"Jessica McHugh","doi":"10.1038/s41584-026-01408-z","DOIUrl":"10.1038/s41584-026-01408-z","url":null,"abstract":"Lymph node architecture sequesters B cells away from effector cells, limiting antibody-mediated depletion and highlighting tissue remodelling as a strategy to improve therapeutic responses.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 9","pages":"534-534"},"PeriodicalIF":33.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432095","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}
Cem Gabay, Charlotte Girard-Guyonvarc’h, Laurie Vaillant, Matthias Jarlborg
{"title":"Advances in targeting IL-1 family cytokines for the treatment of inflammatory diseases","authors":"Cem Gabay, Charlotte Girard-Guyonvarc’h, Laurie Vaillant, Matthias Jarlborg","doi":"10.1038/s41584-026-01395-1","DOIUrl":"10.1038/s41584-026-01395-1","url":null,"abstract":"The IL-1 family comprises key pro-inflammatory cytokines that are central to host defence against noxious stimuli, as evidenced by their prominent expression at barrier tissues and their shared myeloid differentiation primary response 88 (MyD88)-dependent signalling pathways with Toll-like receptors. The generation of biologically active IL-1 agonists is tightly controlled by proteolytic processing (including inflammasome-dependent and independent mechanisms), which converts inactive precursors into mature cytokines or substantially amplifies the activity of selected family members. IL-1 signalling is further regulated at multiple levels by endogenous inhibitors, decoy receptors and receptor antagonists, ensuring a finely tuned balance between pro-inflammatory and anti-inflammatory responses; this balance is essential for effective antimicrobial immunity while limiting immunopathology. Converging evidence from human studies and experimental disease models demonstrates that disruption of this regulatory balance underlies a broad spectrum of inflammatory diseases. Numerous therapies that target IL-1 cytokines have been approved for the treatment of inflammatory diseases or are in development, and the clinical efficacy of these therapies provides compelling validation of their pathogenic role in numerous disease contexts. This Review provides an update on the interleukin 1 (IL-1) family of cytokines in inflammatory and rheumatic diseases. The authors discuss advances in mechanistic understanding and highlight therapeutic developments in targeting this family of cytokines.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 8","pages":"514-530"},"PeriodicalIF":33.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148416147","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":"Dapirolizumab pegol improves SLE disease activity in phase III trial","authors":"Sarah Onuora","doi":"10.1038/s41584-026-01409-y","DOIUrl":"10.1038/s41584-026-01409-y","url":null,"abstract":"The results of a 48-week, randomized, placebo-controlled trial suggest that the novel CD40 ligand inhibitor dapirolizumab pegol could have clinical benefits for patients with systemic lupus erythematosus.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 8","pages":"472-472"},"PeriodicalIF":33.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400570","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":"Obexelimab reduces the risk of IgG4-RD flare","authors":"Sarah Onuora","doi":"10.1038/s41584-026-01410-5","DOIUrl":"10.1038/s41584-026-01410-5","url":null,"abstract":"In the phase III INDIGO trial, B cell inhibition with obexelimab reduced the risk of disease flare and exposure to glucocorticoids in patients with IgG4-related disease.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 8","pages":"472-472"},"PeriodicalIF":33.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400509","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":"Going beyond cycling versus swapping for treatment sequencing in psoriatic arthritis","authors":"Jose Manuel Lema Martinez, Laura C. Coates","doi":"10.1038/s41584-026-01404-3","DOIUrl":"10.1038/s41584-026-01404-3","url":null,"abstract":"After treatment failure in psoriatic arthritis (PsA), choosing the next therapy involves more than simply cycling within a drug class or switching to another. Treatment sequencing is increasingly guided by dynamic, individualized strategies that account for a patient’s long-term care pathway.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 9","pages":"537-538"},"PeriodicalIF":33.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400508","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 P2X7R on synovial fibroblasts to treat refractory RA","authors":"Sarah Onuora","doi":"10.1038/s41584-026-01411-4","DOIUrl":"10.1038/s41584-026-01411-4","url":null,"abstract":"New research implicates P2X7 receptor in synovial inflammation and suggests that it could be a promising therapeutic target in refractory rheumatoid arthritis.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 8","pages":"471-471"},"PeriodicalIF":33.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148400510","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":"Dysfunctional UBA1-mutated myeloid cells promote inflammation in VEXAS syndrome","authors":"Holly Webster","doi":"10.1038/s41584-026-01407-0","DOIUrl":"10.1038/s41584-026-01407-0","url":null,"abstract":"Findings show that UBA1-mutated myeloid cells are dysfunctional and highly susceptible to cell death, which promotes inflammation in VEXAS syndrome.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 9","pages":"535-535"},"PeriodicalIF":33.7,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393774","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 ferroptosis resistance in RA fibroblast-like synoviocytes","authors":"Burkhard Möller, Jennifer Amsler","doi":"10.1038/s41584-026-01399-x","DOIUrl":"10.1038/s41584-026-01399-x","url":null,"abstract":"Therapeutic targeting of ferroptosis, particularly in pathogenic fibroblast-like synoviocytes, could hold promise for rheumatoid arthritis. However, ferroptosis research in health and disease is still in its infancy, and further research is needed to identify specific therapeutic targets, inform drug development and assess the possible effects of targeting ferroptosis in other cell types and tissues.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 8","pages":"475-476"},"PeriodicalIF":33.7,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393773","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}