Articles in 2025

Fibromyalgia remains a challenge for researchers and clinicians. Three studies published in 2025 shed light on mechanisms and management by implicating gut microbiota in symptom perpetuation, demonstrating the potential of home-based neuromodulation, and examining the uncertain role of low-dose naltrexone.

Advances in cellular and spatial profiling technologies have rapidly expanded the understanding of fibroblast heterogeneity within the target tissues of disease. In 2025, there has been a shift towards a consensus definition of shared cross-tissue fibroblast states and a greater understanding of their molecular drivers and disease-relevant effector functions.

A new study reveals that the Epstein–Barr virus can reprogramme autoreactive B cells into pathogenic antigen-presenting cells in systemic lupus erythematosus, providing a mechanistic link between infection and autoimmunity.

New research published in 2025 sheds light on the pre-clinical period that precedes the onset of classifiable rheumatoid arthritis, from risk factors to immunological events and opportunities to prevent the transition to clinical disease.

Monogenic disorders involving key elements of the TNF pathway now encompass a diverse and expanding group of conditions, spanning autoinflammatory, autoimmune, immunodeficiency and neurodegenerative diseases. This Review discusses the genetic causes, clinical features and current therapeutic strategies for these disorders, emphasizing the value of accurate molecular diagnosis and targeted interventions.

In 2025, a new wave of ‘off-the-shelf’ B cell-depleting modalities for the treatment of autoimmune diseases emerged, encompassing allogeneic cellular therapies, in vivo chimeric antigen receptor engineering, and bispecific antibodies.

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.

In this Review, the authors summarize the potential role of emerging viruses in autoimmune rheumatic diseases (AIRDs). They describe the association between viruses and AIRD flare ups, the putative mechanisms linking AIRD to viral infections and hormone modulation of viral pathogenesis and autoimmune diseases.

Endosomal traffic orchestrates important immune functions, including receptor signalling, antigen processing and metabolic regulation, and has a pivotal role in maintaining self-tolerance. Disruption of these pathways contributes to autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis, offering new therapeutic opportunities.

A new study uncovers how UBA1 mutations in VEXAS syndrome simultaneously promote myeloid inflammatory cell death and skew haematopoietic stem cells towards a myeloid lineage.

Advances in artificial intelligence (AI) are transforming patient stratification in rheumatology. In 2025, three landmark studies demonstrated how multimodal AI approaches spanning clinical, molecular and longitudinal data can uncover distinct disease subtypes and predict therapeutic response, advancing the field towards precision rheumatology.

Emerging evidence suggests a paradigm shift in viewing osteoarthritis (OA) as a systemic, bidirectional disease. This Review examines the current data supporting this concept, outlines key challenges in research approaches, and proposes strategies to improve preclinical studies and clinical trial design.

Immune-checkpoint agonists are a promising therapeutic approach for autoimmune disease. This Review discusses the immune-checkpoint receptors PD-1, BTLA and TIGIT as well as the preclinical and clinical evidence for therapeutically targeting these receptors for the treatment of rheumatic diseases.

Many of the current therapies for arthritis lack a targeted approach, limiting clinical benefits. Nanoparticle-based delivery systems have enabled more precise and efficient delivery of therapeutic agents, particularly nucleic acids. Studies in 2025 emphasize the promise of these strategies for the treatment of various forms of arthritis.

T helper 17 cells that lose IL-17 expression drive inflammation in a mouse model of chronic rheumatoid arthritis.

In this Consensus Statement, a Group for Research and Assessment of Psoriasis and Psoriatic Arthritis task force presents consensus definitions for two distinct states, complex-to-manage PsA and treatment-refractory PsA, with the aim of standardizing terminology, improving patient stratification and guiding clinical decision-making and future research.

A nanobody that targets IL-17A and IL-17F has shown promise in a phase II study of patients with active psoriatic arthritis.

Cam morphology can cause intra-articular joint damage and lead to femoroacetabular impingement syndrome and eventually hip osteoarthritis. This Review explores the development and effect of cam morphology on femoroacetabular impingement syndrome and hip osteoarthritis, discussing relevant terminology, diagnostic approaches, pathophysiological insights and management strategies.

The results of the phase II DAHLIAS trial support the development of the neonatal Fc receptor blocker nipocalimab for the treatment of Sjögren disease.

This Review explores the complex relationship between obesity and psoriatic disease. The authors highlight the underlying mechanisms that drive this association and propose a comprehensive approach to managing obesity in individuals with psoriatic disease to improve overall disease management and therapeutic response.