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Methotrexate as first-line therapy for pulmonary sarcoidosis 甲氨蝶呤作为肺结节病的一线治疗
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-06-10 DOI: 10.1038/s41584-025-01273-2
Sarah Onuora
The results of a new clinical trial suggest that methotrexate could be an alternative to prednisone as first-line treatment for pulmonary sarcoidosis.
一项新的临床试验结果表明,甲氨蝶呤可以替代强的松作为肺结节病的一线治疗。
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引用次数: 0
Clonal dominance: mutations in VEXAS syndrome take advantage of inflammation 克隆优势:VEXAS综合征的突变利用炎症
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-06-06 DOI: 10.1038/s41584-025-01270-5
Samuel J. Magaziner, David B. Beck
VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is caused by somatic mutations in UBA1 arising in hematopoietic stem cells, resulting in systemic autoinflammation and clonal outgrowth of these mutant cells. New research provides insights into the paradoxical mechanism behind this clonal hematopoietic dominance.
VEXAS(液泡,E1酶,x -连锁,自身炎症,体细胞)综合征是由造血干细胞中UBA1的体细胞突变引起的,导致这些突变细胞的系统性自身炎症和克隆性生长。新的研究为这种克隆造血优势背后的矛盾机制提供了见解。
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引用次数: 0
Advances in the treatment of ANCA-associated vasculitis anca相关性血管炎的治疗进展
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-06-05 DOI: 10.1038/s41584-025-01266-1
Giorgio Trivioli, Marta Casal Moura, Andreas Kronbichler, Rona M. Smith, Benjamin Terrier, Stephen McAdoo, Rachel B. Jones, Peter A. Merkel, David R. W. Jayne
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) consists of a group of small-vessel vasculitides that often present with organ-threatening or life-threatening manifestations. Current immunosuppressive treatments have improved survival and rates of remission, but are not curative, have frequent toxicities, and do not effectively prevent relapse. Clinical trials have established the role of rituximab, an anti-CD20 B cell-depleting monoclonal antibody, in both the remission-induction and maintenance phases of the disease and demonstrated that glucocorticoid doses can be substantially reduced from historical dosing levels without affecting treatment efficacy. Therapies that have the potential to be more effective and safer have become available or are under investigation. Avacopan, an oral C5a receptor antagonist, was approved as an adjunctive treatment for AAV and use of this drug in combination with rituximab or cyclophosphamide and markedly reduced glucocorticoid dosing demonstrated superior efficacy and potentially greater kidney recovery than prior standard of care. Other agents under study for treatment of AAV include next-generation anti-CD20 monoclonal antibodies, anti-CD19 chimeric antigen receptor T cells, novel complement inhibitors and agents that can target fibrosis. Alongside traditional randomized controlled trials with clinical endpoints, experimental medicine studies are focusing on mechanistic endpoints and disease biomarkers. This Review discusses current treatments and the advances in the management of AAV. This Review discusses the advances and challenges of managing antineutrophil cytoplasmic antibody-associated vasculitis. The authors discuss current treatment options, emerging therapies and unmet needs in the management of this disease.
抗中性粒细胞细胞质抗体(ANCA)相关血管炎(AAV)由一组小血管血管炎组成,通常表现为器官威胁或危及生命的表现。目前的免疫抑制治疗提高了生存率和缓解率,但不能治愈,经常有毒性,不能有效防止复发。临床试验已经确定了利妥昔单抗(一种抗cd20 B细胞消耗单克隆抗体)在疾病的缓解-诱导和维持阶段的作用,并证明糖皮质激素剂量可以从历史剂量水平大幅降低而不影响治疗效果。有可能更有效和更安全的治疗方法已经可用或正在研究中。Avacopan是一种口服C5a受体拮抗剂,已被批准作为AAV的辅助治疗,该药物与利妥昔单抗或环磷酰胺联合使用,并显着减少糖皮质激素剂量,显示出优于先前标准护理的疗效和潜在的更大肾脏恢复。正在研究的其他治疗AAV的药物包括下一代抗cd20单克隆抗体、抗cd19嵌合抗原受体T细胞、新型补体抑制剂和靶向纤维化的药物。除了传统的有临床终点的随机对照试验外,实验医学研究的重点是机械终点和疾病生物标志物。本文综述了目前AAV的治疗方法和治疗进展。
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引用次数: 0
Insights into Lyme arthritis 深入了解莱姆病
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-28 DOI: 10.1038/s41584-025-01269-y
Holly Webster
Two complimentary studies provide a deeper understanding of Lyme disease and the associated chronic complications, such as Lyme arthritis.
两项互补研究提供了对莱姆病及其相关慢性并发症(如莱姆病关节炎)的更深入了解。
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引用次数: 0
How JAK inhibitors tip the prothrombotic balance in rheumatoid arthritis JAK抑制剂如何改变类风湿关节炎的血栓形成平衡
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-16 DOI: 10.1038/s41584-025-01263-4
Vibeke Strand
The increased incidence of deep vein thromboses and pulmonary emboli has long been noted in rheumatoid arthritis and has been ascribed to the effects of chronic inflammation and disease activity, as well as to specific biologic DMARDs and JAK inhibitors. Reporting in ACR Open Rheumatology, Zavoriti and Miossec provide data that might explain the prothrombotic effects of the JAK inhibitor tofacitinib.
深静脉血栓形成和肺栓塞发生率的增加在类风湿关节炎中早已被注意到,并被归因于慢性炎症和疾病活动的影响,以及特定的生物dmard和JAK抑制剂。在ACR Open Rheumatology上,Zavoriti和Miossec的报告提供了可能解释JAK抑制剂tofacitinib的血栓前作用的数据。
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引用次数: 0
Fibroblasts in immune responses, inflammatory diseases and therapeutic implications 成纤维细胞在免疫反应、炎症性疾病及其治疗意义
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-14 DOI: 10.1038/s41584-025-01259-0
Angela E. Zou, Suppawat Kongthong, Alisa A. Mueller, Michael B. Brenner
Once regarded as passive bystander cells of the tissue stroma, fibroblasts have emerged as active orchestrators of tissue homeostasis and disease. From regulating immunity and controlling tissue remodelling to governing cell growth and differentiation, fibroblasts assume myriad roles in guiding normal tissue development, maintenance and repair. By comparison, in chronic inflammatory diseases such as rheumatoid arthritis, fibroblasts recruit and sustain inflammatory leukocytes, become dominant producers of pro-inflammatory factors and catalyse tissue destruction. In other disease contexts, fibroblasts promote fibrosis and impair host control of cancer. Single-cell studies have uncovered striking transcriptional and functional heterogeneity exhibited by fibroblasts in both normal tissues and diseased tissues. In particular, advances in the understanding of fibroblast pathology in rheumatoid arthritis have shed light on pathogenic fibroblast states in other chronic diseases. The differentiation and activation of these fibroblast states is driven by diverse physical and chemical cues within the tissue microenvironment and by cell-intrinsic signalling and epigenetic mechanisms. These insights into fibroblast behaviour and regulation have illuminated therapeutic opportunities for the targeted deletion or modulation of pathogenic fibroblasts across many diseases. This Review provides a comprehensive overview of fibroblast biology in rheumatoid arthritis and other chronic inflammatory diseases. The authors discuss insights into fibroblast behaviour and pathogenicity from single-cell and functional studies and describe how these findings have informed efforts to therapeutically target fibroblasts.
曾经被认为是组织基质的被动旁观者细胞,成纤维细胞已经成为组织稳态和疾病的主动协调者。从调节免疫和控制组织重塑到控制细胞生长和分化,成纤维细胞在指导正常组织的发育、维持和修复中发挥着无数的作用。相比之下,在类风湿关节炎等慢性炎性疾病中,成纤维细胞招募并维持炎性白细胞,成为促炎因子的主要生产者,并催化组织破坏。在其他疾病背景下,成纤维细胞促进纤维化并损害宿主对癌症的控制。单细胞研究发现,在正常组织和病变组织中,成纤维细胞都表现出惊人的转录和功能异质性。特别是,对类风湿关节炎中成纤维细胞病理的理解的进展,揭示了其他慢性疾病中成纤维细胞的致病性状态。这些成纤维细胞状态的分化和激活是由组织微环境中的各种物理和化学线索以及细胞内在信号传导和表观遗传机制驱动的。这些对成纤维细胞行为和调节的见解为靶向删除或调节许多疾病的致病性成纤维细胞提供了治疗机会。
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引用次数: 0
The pathogenesis, clinical presentations and treatment of monogenic systemic vasculitis 单基因系统性血管炎的发病机制、临床表现及治疗
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-14 DOI: 10.1038/s41584-025-01250-9
Ahmet Gül, Ivona Aksentijevich, Paul Brogan, Marco Gattorno, Peter C. Grayson, Seza Ozen
Many monogenic autoinflammatory diseases, including DADA2 (deficiency of adenosine deaminase 2), HA20 (haploinsufficiency of A20), SAVI (STING-associated vasculopathy with onset in infancy), COPA syndrome, LAVLI (LYN kinase-associated vasculopathy and liver fibrosis) and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome, present predominantly with vasculitis and constitute a substantial subgroup of vasculitic conditions associated with a ‘probable aetiology’. The spectrum of monogenic vasculitis encompasses all sizes and types of blood vessel, ranging from large vessels to medium-size and small vessels, and from the arterial side to the venous side of the vasculature. Monogenic vasculitis typically starts early in life during infancy or childhood; VEXAS syndrome, which presents in late adulthood, is an exception. The activation of myeloid cells via inflammasome and nuclear factor-κB pathways, type I interferon-enhanced autoimmune mechanisms and/or dysregulated adaptive immune responses have an important role in the development of immune-mediated endothelial dysfunction and vascular damage. Genetic testing is essential for the diagnosis of underlying monogenic autoinflammatory diseases; however, the penetrance of genetic variants can vary. Increased awareness and recognition of distinctive clinical findings could facilitate earlier diagnosis and allow for more-targeted treatments. This Review discusses the clinical features, pathogenesis, diagnosis and management of monogenic forms of vasculitis. The authors emphasize that increased awareness of these rare diseases could aid earlier diagnosis and better, more-targeted treatment options for patients.
许多单基因自身炎症性疾病,包括DADA2(腺苷脱氨酶2缺乏症)、HA20 (A20单倍功能不全)、SAVI(婴儿期发作的sting相关血管病变)、COPA综合征、LAVLI (LYN激酶相关血管病变和肝纤维化)和VEXAS(空泡、E1酶、x连锁、自身炎症、体)综合征,主要表现为血管炎,构成了与“可能病因”相关的血管疾病的一个重要亚群。单基因性血管炎包括所有大小和类型的血管,从大血管到中、小血管,从动脉侧到静脉侧。单基因血管炎通常在婴儿期或儿童期早期开始;在成年后期出现的VEXAS综合征是一个例外。髓细胞通过炎性体和核因子-κB途径激活、I型干扰素增强的自身免疫机制和/或失调的适应性免疫反应在免疫介导的内皮功能障碍和血管损伤的发展中起重要作用。基因检测对于诊断潜在的单基因自身炎症性疾病至关重要;然而,基因变异的外显率是不同的。提高对独特临床表现的认识和认识可以促进早期诊断,并允许更有针对性的治疗。
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引用次数: 0
Region-specific, data-driven guidelines are needed for rheumatic diseases in LMICs 中低收入国家需要针对特定区域、以数据为导向的风湿病指南
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-12 DOI: 10.1038/s41584-025-01265-2
Amita Aggarwal
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.
低收入和中等收入国家需要制定单独的风湿病管理和诊断指南,特别是随着昂贵的生物疗法和监测技术的出现。这些国家缺乏关于低成本药物和生物仿制药功效的可靠数据,限制了数据驱动指南的制定。
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引用次数: 0
Understanding rheumatic disease through continuous cell state analysis 通过连续的细胞状态分析了解风湿病
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-07 DOI: 10.1038/s41584-025-01253-6
Lysette Marshall, Soumya Raychaudhuri, Sebastien Viatte
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’ (TPH) (CXCR5− PD-1hi) cells in RA and systemic lupus erythematosus and MerTK+ 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. This Review explores the ongoing debate regarding the definition of cell identity, with a focus on the immune and stromal cell landscape within rheumatology. The authors discuss the implications of different frameworks of cell identity for disease treatment and the discovery of predictive biomarkers for stratified medicine.
自身免疫性风湿性疾病是一种异质性疾病,包括类风湿关节炎(RA)和系统性红斑狼疮。随着大型单细胞数据集的增加,新的疾病相关细胞类型继续在多个组学层面被识别和表征,例如RA中的“T外周辅助细胞”(TPH) (CXCR5−PD-1hi)细胞和RA中的系统性红斑狼疮和MerTK+髓样细胞。尽管人们努力定义与疾病相关的细胞图谱,但随着更高分辨率的检测方法的出现,“细胞类型”或“谱系”的定义已被证明是有争议的。本文综述了参与疾病发病机制的细胞类型和状态,重点介绍了免疫和间质细胞分类的转变观点。这些对细胞身份的理解与分析所采用的计算方法密切相关,对单细胞数据的解释有影响。了解疾病的潜在细胞结构对治疗研究也至关重要,因为模糊性阻碍了临床环境的转化。我们讨论了不同的细胞识别框架对疾病治疗的影响,以及分层药物的预测性生物标志物的发现-自身免疫性风湿性疾病未满足的临床需求。
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引用次数: 0
Targeting anti-PAD4 autoantibodies in RA 针对RA的抗pad4自身抗体
IF 32.7 1区 医学 Q1 RHEUMATOLOGY Pub Date : 2025-05-06 DOI: 10.1038/s41584-025-01264-3
Holly Webster
Findings implicate anti-PAD4 antibodies in the pathogenesis of rheumatoid arthritis.
研究结果提示抗pad4抗体参与类风湿关节炎的发病机制。
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引用次数: 0
期刊
Nature Reviews Rheumatology
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