Comment in 2025

Autologous haematopoietic stem cell transplantation revolutionized the treatment of severe systemic sclerosis as the first therapy able to induce long-term remission in this relentlessly fibrosing disease. Nevertheless, questions remain about patient selection, conditioning, and how this treatment fits into the evolving immune-modifying therapeutic landscape. The field should move beyond standardization towards precision therapy.

Generative artificial intelligence promises to reshape clinical care in rheumatology by supporting diagnostic reasoning, treatment planning and patient communication. Yet its potential rests on careful validation, transparent integration and thoughtful collaboration that strengthens, rather than substitutes, the human expertise central to patient care.

Both rheumatology and the publishing environment have seen tremendous changes over the past two decades. Here, the first Editor in-Chief reflects on the challenges faced by this journal and what it has taken to remain at the forefront of the field.

In the past two decades the field of hand osteoarthritis (OA) has moved from resignation to action. Despite progress, such as the recognition of the phenotypic heterogeneity of hand OA (including inflammation- and/or metabolic syndrome-associated hand OA) and the standardization of imaging and treatment outcomes, challenges remain in achieving truly disease-modifying therapies.

The collective priorities of the rheumatology field represent the lived experience, and therefore diversity of its members. The ‘mould’ of rheumatology, that is, its culture, structures and expectations, was not created for or by women, but women have slowly changed this mould to make space for diverse perspectives.

The future of rheumatology research will be defined by the growing era of personalized and stratified medicine, with a focus on establishing drug-free remission. In the face of substantial global upheaval, now is the time to ensure no patient group is left behind by prioritizing research equity and inclusion.

Seronegative rheumatoid arthritis (RA) is often misunderstood and underrecognized, and this leads to delays in diagnosis and treatment. Emerging studies highlight distinct features and unmet needs of seronegative RA, calling for increased awareness of the challenges faced by patients and the need for tailored therapeutic approaches to improve outcomes.

Over the past decades, considerable progress has been made in the pharmacological treatment of immune-mediated joint diseases such as rheumatoid arthritis and psoriatic arthritis; however, treatment-resistant arthritis remains a major clinical challenge. To tackle insufficient treatment outcomes, further research into the underlying mechanisms and patterns of non-responsiveness is needed.

Withdrawing immunosuppressive treatment in systemic lupus erythematosus offers reduced toxicity and improved quality of life for patients in remission but carries a risk of disease reactivation. Emerging studies emphasize the importance of identifying patients who can safely discontinue therapy using clinical criteria and molecular profiling to guide personalized strategies.

Urate crystals alone are required but not sufficient to trigger gout flares; they can also be modulated by environmental, metabolic, genetic and epigenetic factors. Avoiding large variation in urate levels, maintaining prophylaxis until crystal clearance and initiating low-dose urate-lowering therapy are efficient strategies for disease management.

Although numerous therapies are available for axial spondyloarthritis, more than half of patients do not achieve remission or respond to treatment. Understanding the reasons for non-response in axial spondyloarthritis is essential for effective management of this disease.

Calcium pyrophosphate deposition (CPPD) disease is secondary to the pathological accumulation of calcium pyrophosphate (CPP) crystals inside joints and involves acute or chronic inflammatory arthritis. Epidemiological research on CPPD has been slow despite the suspected high prevalence of this condition. Here we highlight key challenges in CPPD imaging, diagnosis and nomenclature that need to be addressed for epidemiological research to progress at a faster pace.

Although autoimmune rheumatic diseases are more prevalent in women than men, few clinical trials report findings on the basis of sex and gender. Future clinical trials should report sex and gender differences in treatment and safety outcomes in a standardized manner to improve outcomes for all patients.

Despite having a robust drug development pipeline, lupus remains far behind other rheumatic and autoimmune conditions for which dozens of targeted therapies have been developed. Addressing the pervasive, long-standing challenges impeding the field requires a paradigm shift and a patient-powered, community-wide approach, exemplified by the Lupus Accelerating Breakthroughs Consortium (Lupus ABC).

Advances in spatial omics, such as transcriptomics and proteomics, have provided vital insights into cartilage microenvironments, revealing cellular diversity, zonal organization and links between cartilage structure and function. Analysing cartilage using spatial omics could deepen the understanding of diseases such as osteoarthritis and guide the development of targeted, disease-modifying therapies.