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The essential roles of memory B cells in the pathogenesis of systemic lupus erythematosus 记忆 B 细胞在系统性红斑狼疮发病机制中的重要作用
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-07 DOI: 10.1038/s41584-024-01179-5
Thomas Dörner, Peter E. Lipsky

Emerging evidence indicates that memory B cells are dysfunctional in systemic lupus erythematosus (SLE). They are hyporesponsive to signalling through the B cell receptor (BCR) but retain responsiveness to Toll-like receptor (TLR) and type I interferon signalling, as well as to T cell-mediated activation via CD40–CD154. Chronic exposure to immune complexes of ribonucleoprotein (RNP)-specific autoantibodies and TLR-engaging or BCR-engaging cargo is likely to contribute to this partially anergic phenotype. TLR7 or TLR8 signalling and the resulting production of type I interferon, as well as the sustained activation by bystander T cells, fuel a positive feedforward loop in memory B cells that can evade negative selection and permit preferential expansion of anti-RNP autoantibodies. Clinical trials of autologous stem cell transplantation or of B cell-targeted monoclonal antibodies and chimeric antigen receptor (CAR) T cells have correlated replenishment of the memory B cell population with relapse of SLE. Moreover, the BCR hyporesponsiveness of memory B cells might explain the failure of non-depleting B cell-targeting approaches in SLE, including BTK inhibitors and anti-CD22 monoclonal antibodies. Thus, targeting of dysfunctional memory B cells might prove effective in SLE, while also avoiding the adverse events of broad-spectrum targeting of B cell and plasma cell subsets that are not directly involved in disease pathogenesis.

新的证据表明,记忆B细胞在系统性红斑狼疮(SLE)中功能失调。它们对通过 B 细胞受体(BCR)发出的信号反应迟钝,但对 Toll 样受体(TLR)和 I 型干扰素信号以及通过 CD40-CD154 激活 T 细胞介导的信号仍有反应。长期暴露于核糖核蛋白(RNP)特异性自身抗体和 TLR 抗原或 BCR 抗原的免疫复合物可能会导致这种部分过敏表型。TLR7或TLR8信号和由此产生的I型干扰素,以及旁观者T细胞的持续激活,在记忆B细胞中形成了一个正向前馈循环,可以逃避负向选择,允许抗RNP自身抗体优先扩增。自体干细胞移植或B细胞靶向单克隆抗体和嵌合抗原受体(CAR)T细胞的临床试验表明,记忆B细胞群的补充与系统性红斑狼疮的复发有关。此外,记忆性B细胞对BCR的低反应性可能是非消耗性B细胞靶向疗法(包括BTK抑制剂和抗CD22单克隆抗体)在系统性红斑狼疮中失败的原因。因此,靶向功能失调的记忆B细胞可能会被证明对系统性红斑狼疮有效,同时还能避免广谱靶向不直接参与疾病发病机制的B细胞和浆细胞亚群的不良反应。
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引用次数: 0
The management of adult and paediatric uveitis for rheumatologists 风湿免疫科医生对成人和儿童葡萄膜炎的管理
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-06 DOI: 10.1038/s41584-024-01181-x
Sarah L. N. Clarke, Panagiotis Maghsoudlou, Catherine M. Guly, Andrew D. Dick, Athimalaipet V. Ramanan

Uveitis encompasses multiple different conditions that are all characterized by intra-ocular inflammation. Uveitis occurs in the context of many different rheumatological conditions and carries a substantial risk to vision. Uveitis can develop both at the early stages of rheumatic diseases, sometimes even preceding other clinical features, and at later stages of disease. Uveitis can also occur as either a direct or an indirect complication of therapies used to treat patients with rheumatic disease. Conversely, patients with uveitis of non-rheumatic aetiology sometimes require immunosuppression, a treatment option that is not readily accessible to ophthalmologists. Thus, collaborative working between rheumatologists and ophthalmologists is critical for optimal management of patients with uveitis. This Review is written with rheumatologists in mind, to assist in the care of patients with uveitis. We collate and summarize the latest evidence and best practice in the diagnosis, management and prognostication of uveitis, including future trends and research priorities.

葡萄膜炎包括多种不同的疾病,其特征都是眼内炎症。葡萄膜炎发生于多种不同的风湿病,对视力有很大的危害。葡萄膜炎既可以在风湿病的早期阶段(有时甚至先于其他临床特征)发生,也可以在疾病的晚期阶段发生。葡萄膜炎也可能是治疗风湿病患者的疗法的直接或间接并发症。相反,非风湿病因的葡萄膜炎患者有时需要免疫抑制,而眼科医生并不容易获得这种治疗方法。因此,风湿免疫科医生和眼科医生之间的合作对于葡萄膜炎患者的最佳治疗至关重要。本综述以风湿病学家为读者对象,旨在协助治疗葡萄膜炎患者。我们整理并总结了葡萄膜炎诊断、管理和预后方面的最新证据和最佳实践,包括未来趋势和研究重点。
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引用次数: 0
Dupuytren contracture treatments compared 杜普伊特伦挛缩症治疗方法比较
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-05 DOI: 10.1038/s41584-024-01186-6
Sarah Onuora
In an open-label clinical trial, collagenase injection was not noninferior to limited fasciectomy for the treatment of Dupuytren contracture.
在一项开放标签临床试验中,胶原酶注射治疗杜普伊特伦挛缩症的效果并不优于有限筋膜切除术。
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引用次数: 0
Novel autoantigen in idiopathic lung disease 特发性肺病中的新型自身抗原
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-11-04 DOI: 10.1038/s41584-024-01187-5
Maria Papatriantafyllou
The presence of anti-IFI16 autoantibodies in patients with idiopathic interstitial pneumonia is linked to poor prognosis and could inform treatment.
特发性间质性肺炎患者出现抗IFI16自身抗体与预后不良有关,可为治疗提供参考。
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引用次数: 0
Rheumatology in the digital health era: status quo and quo vadis? 数字医疗时代的风湿病学:现状与未来?
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-31 DOI: 10.1038/s41584-024-01177-7
Johannes Knitza, Latika Gupta, Thomas Hügle

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient–provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.

风湿病学面临着专业医护人员严重短缺的问题,患者人口老龄化和成本上升又加剧了这一问题,导致医疗差距不断扩大。过去五年来,数字医疗技术(DHT)取得了飞速发展,为应对这些挑战提供了新的机遇,并有助于全面改善医疗服务。然而,如何跟上创新的步伐并将其融入临床实践是一项挑战。本综述探讨了风湿病学中的 DHT 在重塑整个患者治疗路径、重新定义患者和医疗服务提供者角色方面的变革潜力,并讨论了 DHT 整合的潜在障碍。关键技术,如大型语言模型、临床决策支持系统、数字疗法、电子患者报告结果、数字生物标记物、机器人、自采样设备和基于人工智能的抄写员,都可以在患者路径中实施。以数字为先的混合阶梯式护理患者路径可将面对面护理和远程护理结合起来,通过数字安全网实现个性化和持续监测。本文讨论了利用技术将传统的患者-医疗服务提供者关系转变为数字医疗三方关系的潜在好处和风险。我们需要通力合作,驾驭不断发展的数字医疗格局,利用数字医疗技术的潜力改善风湿病护理。
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引用次数: 0
Risk of uveitis in SpA is changing SpA 葡萄膜炎的风险正在发生变化
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-31 DOI: 10.1038/s41584-024-01185-7
Sarah Onuora
Findings from an observational study suggest that the frequency of uveitis in patients with spondyloarthritis has declined since the introduction of biologic DMARDs.
一项观察性研究结果表明,自生物 DMARDs 问世以来,脊柱关节炎患者发生葡萄膜炎的频率有所下降。
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引用次数: 0
Rheumatic diseases and metabolism: where centre and periphery meet 风湿病与新陈代谢:中心与边缘的交汇点
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-30 DOI: 10.1038/s41584-024-01178-6
Miguel López, Oreste Gualillo

Over the past few decades, the connection between metabolism and various inflammatory and rheumatic diseases has been an area of active investigation. Nonetheless, the precise mechanisms underlying these relationships remain a topic of ongoing debate, owing in part to conflicting data. This discrepancy can be attributed to the predominant focus on peripheral mechanisms in research into the metabolic consequences of rheumatic diseases. However, a wealth of evidence supports the notion that the central nervous system, specifically the hypothalamus, has an important influence on metabolic homeostasis. Notably, links have been established between crucial hypothalamic mechanisms responsible for regulating energy balance (including food intake, thermogenesis, and glucose and lipid metabolism), such as AMP-activated protein kinase, and the pathophysiology of rheumatoid arthritis. This Review aims to comprehensively examine the current understanding of central metabolic control in rheumatic diseases and explore potential therapeutic options that target this pathophysiological mechanism.

过去几十年来,新陈代谢与各种炎症和风湿性疾病之间的关系一直是人们积极研究的领域。然而,这些关系的确切机制仍是一个争论不休的话题,部分原因是数据相互矛盾。这种差异可归因于风湿性疾病代谢后果的研究主要侧重于外周机制。然而,大量证据表明,中枢神经系统,特别是下丘脑,对代谢平衡具有重要影响。值得注意的是,负责调节能量平衡(包括食物摄入、产热、葡萄糖和脂质代谢)的下丘脑关键机制(如 AMP 激活蛋白激酶)与类风湿性关节炎的病理生理学之间已建立了联系。本综述旨在全面审视目前对风湿性疾病中枢代谢控制的认识,并探讨针对这一病理生理机制的潜在治疗方案。
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引用次数: 0
Management strategies in rheumatoid arthritis 类风湿关节炎的管理策略
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-24 DOI: 10.1038/s41584-024-01169-7
Victoria Konzett, Daniel Aletaha

Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the ‘maximum’ level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as ‘difficult to treat’. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient’s multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives.

类风湿性关节炎(RA)的管理已从简单地将药物疗效结果从临床试验直接转化为患者护理,发展为一个更为复杂的纵向过程,不仅要考虑药物疗效,还要考虑治疗的安全性、患者情况和偏好以及健康经济因素。由于治疗 RA 的 DMARDs 种类繁多,有关试验疗效的知识已变得不那么重要,重要的是能为最佳选择和使用这些药物的适当临床策略提供依据的数据。例如,过于雄心勃勃地追求 "最大 "成功率的方法很容易导致失败和挫败感,并导致大量患者被视为 "难以治疗"。对于精准医疗方法而言,安全性分析可能比疗效分析更有参考价值。因此,当代的 RA 管理策略可能会采取一种更全面的方法,而不仅仅是疗效,以设定可提高依从性的目标,而不是期望的成功,同时考虑到每位患者的多病情况和偏好,以及每种治疗方法的安全性。归根结底,我们的目标始终不变:最大限度地提高与健康相关的生活质量;然而,我们关注的是最佳平衡,而不是夸夸其谈。
{"title":"Management strategies in rheumatoid arthritis","authors":"Victoria Konzett, Daniel Aletaha","doi":"10.1038/s41584-024-01169-7","DOIUrl":"https://doi.org/10.1038/s41584-024-01169-7","url":null,"abstract":"<p>Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the ‘maximum’ level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as ‘difficult to treat’. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient’s multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives.</p>","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":null,"pages":null},"PeriodicalIF":33.7,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488859","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
Mito+ RBCs prompt IFN and IL-1β release by SLE monocytes 线粒体+红细胞促使系统性红斑狼疮单核细胞释放 IFN 和 IL-1β
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-23 DOI: 10.1038/s41584-024-01183-9
Holly Webster
In a subset of monocytes in systemic lupus erythematosus, internalization of mitochondria-retaining red blood cells leads to type I interferon-mediated IL-1β release.
在系统性红斑狼疮的单核细胞亚群中,线粒体保留红细胞的内化会导致 I 型干扰素介导的 IL-1β 释放。
{"title":"Mito+ RBCs prompt IFN and IL-1β release by SLE monocytes","authors":"Holly Webster","doi":"10.1038/s41584-024-01183-9","DOIUrl":"https://doi.org/10.1038/s41584-024-01183-9","url":null,"abstract":"In a subset of monocytes in systemic lupus erythematosus, internalization of mitochondria-retaining red blood cells leads to type I interferon-mediated IL-1β release.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":null,"pages":null},"PeriodicalIF":33.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487842","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
Osmo-sensitive anion channels reduce crystal-induced inflammation Osmo 敏感阴离子通道可减少晶体诱发的炎症
IF 33.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2024-10-16 DOI: 10.1038/s41584-024-01182-w
Holly Webster
New research demonstrates a key role for osmo-sensitive LRRC8 anion channels in crystal-induced inflammation.
新研究表明,对渗透敏感的 LRRC8 阴离子通道在晶体诱发的炎症中发挥着关键作用。
{"title":"Osmo-sensitive anion channels reduce crystal-induced inflammation","authors":"Holly Webster","doi":"10.1038/s41584-024-01182-w","DOIUrl":"https://doi.org/10.1038/s41584-024-01182-w","url":null,"abstract":"New research demonstrates a key role for osmo-sensitive LRRC8 anion channels in crystal-induced inflammation.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":null,"pages":null},"PeriodicalIF":33.7,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439813","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
期刊
Nature Reviews Rheumatology
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