Nature Reviews Rheumatology最新文献_第7页

The evolving comorbidity landscape of rheumatoid arthritis 类风湿关节炎并发疾病的发展趋势。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-29 DOI: 10.1038/s41584-026-01386-2

Rebecca T. Brooks, Bryant R. England, Vanessa L. Kronzer, Cynthia S. Crowson

{"title":"The evolving comorbidity landscape of rheumatoid arthritis","authors":"Rebecca T. Brooks, Bryant R. England, Vanessa L. Kronzer, Cynthia S. Crowson","doi":"10.1038/s41584-026-01386-2","DOIUrl":"10.1038/s41584-026-01386-2","url":null,"abstract":"Rheumatoid arthritis (RA) is associated with a wide spectrum of comorbidities that substantially influence quality of life and long-term outcomes. These include extra-articular manifestations, cardiovascular disease, cerebrovascular accidents, dementia, malignancy, infection, mental health disorders and osteoporosis. Patterns of comorbidity in RA have evolved over the past three decades, with declining prevalence of some complications alongside persistently high or increasing burdens of interstitial lung disease, anxiety and depression. Shifts in the comorbidity landscape probably reflect advances in RA management, including the expanded use of biologic and targeted synthetic disease-modifying antirheumatic drugs (DMARDs) and a widespread adoption of treat-to-target strategies. Consideration of comorbidity-specific epidemiology, the potential effect of DMARDs on comorbidity risk and opportunities to address both RA and comorbid disease are increasingly relevant in clinical care. Preventive strategies, including selected enhanced screening approaches such as those for cervical cancer, interstitial lung disease, cardiovascular disease and osteoporosis, form an important component of comprehensive RA management. Awareness of the changing comorbidity landscape could support more integrated and individualized care for people with RA. This Review examines evolving comorbidity patterns in rheumatoid arthritis, highlighting improving trends in some conditions, persistent burdens in others, and implications for treatment selection, preventive screening and integrated, individualized care.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 7","pages":"447-458"},"PeriodicalIF":33.7,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055803","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

Rethinking early-stage knee osteoarthritis beyond radiography 从影像学角度重新思考早期膝关节骨关节炎。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-27 DOI: 10.1038/s41584-026-01389-z

Armaghan Mahmoudian, Ida K. Haugen

引用次数: 0

Type I interferon mediates autoimmune photosensitivity I型干扰素介导自身免疫光敏。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-27 DOI: 10.1038/s41584-026-01392-4

Holly Webster

引用次数: 0

Decoding variants of uncertain significance in systemic autoinflammatory diseases 解码全身性自身炎症疾病中不确定意义的变异。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-26 DOI: 10.1038/s41584-026-01380-8

Guilaine Boursier, Alessandra Carbone, Sinisa Savic, Thomas Henry

{"title":"Decoding variants of uncertain significance in systemic autoinflammatory diseases","authors":"Guilaine Boursier, Alessandra Carbone, Sinisa Savic, Thomas Henry","doi":"10.1038/s41584-026-01380-8","DOIUrl":"10.1038/s41584-026-01380-8","url":null,"abstract":"The development and implementation of genetic testing has revolutionized the diagnostic landscape of autoinflammatory diseases, leading to an exponential increase in the identification of disease-associated genetic variants. Yet a substantial proportion of these are considered variants of uncertain significance (VUS), complicating both diagnosis and therapeutic decision-making. This challenge is relevant not only for monogenic systemic autoinflammatory diseases, but also in the context of genetically complex disorders that can involve multiple low-penetrance variants. Advances in protein structure prediction tools, machine learning and artificial intelligence provide powerful computational frameworks for the classification of variants; however, their predictive accuracy must be benchmarked against functional assays, particularly with respect to gain-of-function variants. Functional screening approaches benefit from both technological progress and expanding knowledge of the innate immune pathways underlying systemic autoinflammatory diseases. Large-scale analyses of variants including multiplexed functional assays and deep mutational scanning experiments have enabled the assessment of hundreds of variants, notably in NLRP3, MEFV and ADA2, generating datasets that improve variant interpretation and genetic diagnosis. Altogether, these advances increase the potential of accurately predicting in the near future the effects of missense VUS, although numerous challenges remain to be addressed, especially those concerning our understanding of the influence of non-coding VUS in systemic autoinflammatory diseases. In this Review, the authors discuss novel approaches to improving the functional classification of variants of uncertain significance that are associated with systemic autoinflammatory diseases, as well as the challenges that remain to be addressed.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 7","pages":"429-446"},"PeriodicalIF":33.7,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148033151","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

Treat-to-target in Behçet syndrome behet综合征的靶向治疗。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-21 DOI: 10.1038/s41584-026-01381-7

Alessandra Bettiol, George Bertsias, Bahram Bodaghi, Aykut Ferhat Celik, George E. Fragoulis, David Saadoun, Rosaria Talarico, Uğur Uygunoğlu, Giacomo Emmi, Petros P. Sfikakis, Gülen Hatemi

{"title":"Treat-to-target in Behçet syndrome","authors":"Alessandra Bettiol, George Bertsias, Bahram Bodaghi, Aykut Ferhat Celik, George E. Fragoulis, David Saadoun, Rosaria Talarico, Uğur Uygunoğlu, Giacomo Emmi, Petros P. Sfikakis, Gülen Hatemi","doi":"10.1038/s41584-026-01381-7","DOIUrl":"10.1038/s41584-026-01381-7","url":null,"abstract":"Behçet syndrome is a complex systemic immune-mediated form of vasculitis characterized by diverse clinical manifestations and a variable disease course. The treat-to-target (T2T) concept has emerged as a pivotal approach in managing various systemic autoimmune rheumatic diseases; however, its application in Behçet syndrome requires further work. Despite the limited literature on this subject, advancements from clinical trials have underscored the necessity for a T2T approach in Behçet syndrome. This article proposes an evidence-based perspective on the T2T strategy in Behçet syndrome, featuring a multidisciplinary and comprehensive collaboration of international experts, including rheumatologists, immunologists, ophthalmologists, gastroenterologists and neurologists. By adopting an organ-based approach to tackling crucial challenges, we aim to define treatment goals for organ involvement, discuss outcome measures that can be used as targets and definitions of remission and relapse, and also propose monitoring strategies (including treatment targets). The goal of this Perspective is to pave the way for future research and clinical practice, enhance the management of this complex condition and ultimately improve patient outcomes. In this Perspective article, the authors propose an organ-based treat-to-target approach for Behçet syndrome. They highlight clinical challenges and knowledge gaps that need to be addressed before treat-to-target implementation and provide a framework for future research with the aim of improving long-term patient outcomes.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 7","pages":"459-470"},"PeriodicalIF":33.7,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147988461","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

Lytic cell death turns TRIM21 into an autoantigen 溶解性细胞死亡将TRIM21转化为自身抗原。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-20 DOI: 10.1038/s41584-026-01387-1

Jessica McHugh

引用次数: 0

Treatment strategies in giant cell arteritis and polymyalgia rheumatica: beyond glucocorticoids 巨细胞动脉炎和风湿性多肌痛的治疗策略：超越糖皮质激素。

IF 33.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-20 DOI: 10.1038/s41584-026-01379-1

Francesco Muratore, Kenneth J. Warrington, Christian Dejaco, Maria C. Cid, Bernhard Hellmich, Ann W. Morgan, Stefania Croci, Carlo Salvarani

{"title":"Treatment strategies in giant cell arteritis and polymyalgia rheumatica: beyond glucocorticoids","authors":"Francesco Muratore, Kenneth J. Warrington, Christian Dejaco, Maria C. Cid, Bernhard Hellmich, Ann W. Morgan, Stefania Croci, Carlo Salvarani","doi":"10.1038/s41584-026-01379-1","DOIUrl":"10.1038/s41584-026-01379-1","url":null,"abstract":"Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are closely related chronic inflammatory conditions. Glucocorticoids remain the cornerstone of treatment for both conditions, as they rapidly control inflammation and also reduce the risk of ischaemic complications in GCA. However, glucocorticoid therapy is often prolonged and associated with substantial treatment-related morbidity. In addition, many patients experience relapses during glucocorticoid maintenance therapy and can accrue vascular damage. Advances in understanding the immunopathology of GCA and PMR have led to the development of targeted therapies, particularly agents inhibiting the IL-6 pathway and, more recently, Janus kinase (JAK) signalling. IL-6 receptor inhibitors reduce the risk of disease relapse and allow for reduction in glucocorticoid use in both GCA and PMR, and JAK inhibition enables glucocorticoid sparing and lowers the risk of relapse in GCA. Optimal management of GCA and PMR requires close monitoring, careful assessment of disease activity and treatment-related toxicity, as well as individualized therapeutic strategies. Ongoing research continues to refine treatment algorithms and could help to define therapeutic targets across GCA and PMR. Emerging therapeutic options and evolving treatment algorithms reflect the dynamic and patient-centred nature of advancements in GCA and PMR management. In this Review, the authors provide an overview of current and emerging therapeutic strategies for giant cell arteritis and polymyalgia rheumatica, including glucocorticoids and glucocorticoid-sparing approaches, and also discuss challenges including monitoring disease activity, defining treatment targets and managing relapse.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 7","pages":"411-428"},"PeriodicalIF":33.7,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147982734","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

Innate lymphoid cells in rheumatoid arthritis as mediators of pathology and resolution 先天淋巴样细胞在类风湿关节炎中作为病理和消退的介质。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-11 DOI: 10.1038/s41584-026-01375-5

Ahmed K. Kabil, I-Chih Kuo, Marco Colonna, Kelly M. McNagny

{"title":"Innate lymphoid cells in rheumatoid arthritis as mediators of pathology and resolution","authors":"Ahmed K. Kabil, I-Chih Kuo, Marco Colonna, Kelly M. McNagny","doi":"10.1038/s41584-026-01375-5","DOIUrl":"10.1038/s41584-026-01375-5","url":null,"abstract":"Innate lymphoid cells (ILCs) are emerging as critical modulators of inflammation in rheumatoid arthritis, contributing to both disease pathology and resolution. Group 3 ILCs (ILC3s) mirror TH17 cells in their production of IL-17A and IL-22, promoting fibroblast activation, neutrophil recruitment and synovial inflammatory cascades. By contrast, group 2 ILCs (ILC2s) engage reparative and immunoregulatory pathways via secretion of IL-9, IL-13 and IL-10. Lymphoid tissue inducer (LTi) ILCs contribute to ectopic lymphoid tissue neogenesis and stromal remodelling in early disease. Clinically, alterations in ILC subset composition correlate with disease activity, therapeutic responsiveness and inflammatory burden. Advances in high-dimensional immunophenotyping, spatial transcriptomics and single-cell multi-omics now enable precise mapping of ILC subsets and their effector programmes across peripheral blood and synovial tissue, supporting their use in biomarker discovery and treatment pipelines. Furthermore, modulation of ILCs by targeting upstream cytokines, signalling pathways or the use of microbiota-derived metabolites is a potential therapeutic strategy. Finally, cell-based avenues include IL-10-producing ILC2s (ILC210) and engineered chimeric antigen receptor (CAR)-ILC2s for targeted, tissue-resident immune modulation. Although still in the preclinical stages, these approaches highlight the translational potential of ILCs as biomarkers and therapeutic targets in rheumatoid arthritis. Innate lymphoid cells (ILCs) influence rheumatoid arthritis by amplifying inflammatory circuits through ILC3 activity and promoting immune regulation via ILC2 responses. These context-dependent functions position ILC subsets as emerging biomarkers and targets for innovative therapies.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"22 6","pages":"390-402"},"PeriodicalIF":32.7,"publicationDate":"2026-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147874789","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

Senotherapeutics suppress disc degeneration 老年治疗药物抑制椎间盘退变。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-11 DOI: 10.1038/s41584-026-01384-4

Jessica McHugh

引用次数: 0

Adjunctive glucocorticoids in Kawasaki disease 川崎病的辅助糖皮质激素。

IF 32.7 1区医学

Nature Reviews Rheumatology Pub Date : 2026-05-11 DOI: 10.1038/s41584-026-01385-3

Sarah Onuora

引用次数: 0