In a phase III clinical trial of abatacept for idiopathic inflammatory myopathy, the primary endpoint was not met but the results suggest abatacept could have benefits in some subtypes of the disease.

Synovial dendritic cell profiles and localization patterns provide insights about the roles of dendritic cell subsets in the initiation, remission and relapse of rheumatoid arthritis.

In a new study, inhibition of CDK7 disrupted the RNA polymerase II transcription cycle, leading to anti-inflammatory effects and metabolic reprogramming in macrophages and attenuation of arthritis in mouse models.

The updated 2023 EULAR recommendations for treatment of systemic sclerosis bring notable changes to recommendations for skin, peripheral vascular disease, interstitial lung disease and pulmonary arterial hypertension therapies, based on newer evidence. These updates provide the first glimmer of personalized patient management.

Emerging research in intervertebral disc degeneration in 2024 highlights microbial, immune and inflammatory mechanisms that drive chronic low back pain. These insights pave the way for potential transformative therapies that address the root causes of intervertebral disc degeneration and could improve patient outcomes.

In a phase III trial, the CD19-targeting antibody inebilizumab was effective for the treatment of IgG4-related disease over 52 weeks.

The role of proteases in cartilage degradation and the development of osteoarthritis is undeniable. Despite over two decades of research on protease inhibitors, however, the transition from preclinical promise to clinical success remains elusive, underscoring the urgent need to critically appraise the challenges and limitations inherent in preclinical studies.

Correction to: Nature Reviews Rheumatology https://doi.org/10.1038/s41584-024-01158-w, published online 24 September 2024.

Shared T cell clones identified in the lungs and joints of smokers with early RA.

A study reports that adipocytes can regulate the metabolism of fibroblasts in the healthy synovium via cortisol, but in inflammatory arthritis adiposity is lost and fibroblasts become pathogenic.

New research suggests that insulin-like growth factor 1 is an important contributor to Wnt-induced joint damage, and that its suppression could represent a promising therapeutic strategy for osteoarthritis.

The release of TGFβ by a subset of ITGA5+ synovial fibroblasts can promote the differentiation of pathogenic PD-1hiCXCL13+ T cells in RA, altering the inflammatory niche.

Analysis of exome sequencing data indicates that the prevalence of DADA2 is higher in China compared with other regions.

The identification of shared molecular mechanisms across systemic inflammatory autoimmune diseases with overlapping clinical manifestations has prompted research into the underlying genetics that could be driving these manifestations; elucidating these genes could aid in the diagnosis, treatment and outcome prediction of these complex diseases.

Studies published in 2024 suggest that although the repurposing of established rheumatology drugs seems to deliver incremental benefits for pain management, greater benefits could be gained in the future by targeting newly discovered pain mechanisms.

During the past year, four studies have reported ten mutations in UNC93B1, which encodes the Toll-like receptor (TLR) chaperone protein UNC93B1. All variants increased TLR7 and TLR8 signalling and caused systemic lupus erythematosus in young individuals, and highlight the therapeutic potential of targeting TLR7 and TLR8 in this disease.

Correction to: Nature Reviews Rheumatology https://doi.org/10.1038/s41584-024-01163-z, published online 2 October 2024.

In an open-label clinical trial, collagenase injection was not noninferior to limited fasciectomy for the treatment of Dupuytren contracture.

The presence of anti-IFI16 autoantibodies in patients with idiopathic interstitial pneumonia is linked to poor prognosis and could inform treatment.

Findings from an observational study suggest that the frequency of uveitis in patients with spondyloarthritis has declined since the introduction of biologic DMARDs.

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.

New research demonstrates a key role for osmo-sensitive LRRC8 anion channels in crystal-induced inflammation.

Synovial fibroblasts from individuals with OA release small extracellular vesicles with potentially pathogenic miRNA cargo.

Consistent with findings from clinical trials, in a retrospective cohort study, Janus kinase inhibitors improved pain associated with rheumatoid arthritis as well as or better than biologic DMARDs in clinical practice.

Neoself-antigens presented by MHC-II molecules in the absence of invariant chain drive clonal expansion of autoreactive T cells in SLE.

The bispecific T cell engager antibody teclistamab has now been used to successfully treat five patients with treatment-resistant autoimmune rheumatic diseases.

A study has compared the safety and efficacy of three different immunomodulatory drugs combined with glucocorticoids for the treatment of Behçet uveitis.

New classification criteria for axial disease in juvenile spondyloarthritis aim to enhance the identification and study of this condition in affected youth, offering a tool for future non-interventional studies and interventional trials. Better understanding of the efficacy of various interventions in the axial domain could help tailor treatment strategies.

Findings show a role for the PU.1–IL-9 axis in TH9 cells in the pathogenesis of RA.

Correction to: Nature Reviews Rheumatology https://doi.org/10.1038/s41584-024-01130-8, published online 16 July 2024.

Researchers have identified a mechanistic link between SARS-CoV-2 infection and multisystem inflammatory syndrome in children, providing evidence for the involvement of molecular mimicry.

New findings reveal a potential mechanism by which Helicobacter pylori exacerbates rheumatoid arthritis

The first guidelines for the screening, monitoring and treatment of interstitial lung disease (ILD) in patients with systemic autoimmune rheumatic diseases (SARDs) are now available after a major multidisciplinary effort by the ACR and the American College of Chest Physicians. These guidelines demonstrate that multidisciplinary collaborations can improve SARD-ILD management.

Autoimmune diseases such as systemic lupus erythematosus preferentially affect women, and multiple hypotheses are under investigation to elucidate this phenomenon. Emerging research suggests that multiple pathophysiological mechanisms and pathways are likely involved, including several that involve the X chromosome, but is skewing of X chromosome inactivation one of them?

In a new study, researchers use M2 macrophage exosomes and membranes to disguise a tri-drug-carrying nanosystem that reduces inflammation and urate levels in rats with gouty arthritis.

Increasing diversity in genomic studies is essential to advance precision medicine and health equity in rheumatic diseases. Addressing structural and logistical barriers to include underrepresented populations, particularly in Africa and Latin America, could improve our understanding of rheumatic diseases and lead to better healthcare outcomes for all.