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[Comment] Targeting B-cell activation to tackle both patient-reported and systemic disease outcomes in Sjögren's disease

A recent series of studies on Sjögren's disease have shown clustering of patients that share clinical features, such as pain, fatigue, and dryness.1–3 Although these delineations might aid patient stratification for a more personalised approach, patient heterogeneity remains considerable within groups, and the overlap in symptoms between groups is substantial. Hence, stratification and a more targeted treatment approach might lead to increased effectiveness and prevention of unnecessary drug exposure for patients.

[Comment] Biomarkers for juvenile idiopathic arthritis treatment response—have we identified them?

Serum biomarkers have increasingly been studied to aid in the diagnosis, prognosis, disease monitoring, and treatment response in patients with juvenile idiopathic arthritis (JIA). One might think that by now we would have found biomarkers for diagnosis and treatment. Ideally, a biomarker that can assist in deciding which treatment would be effective for which patients. However, in 2025, JIA remains a clinical diagnosis, taking into account presenting symptoms, imaging findings, and blood test results (such as rheumatoid factor and antinuclear antibodies).

[Comment] Towards sustainable relief in chronic low back pain

Non-specific low back pain remains one of the leading global causes of disability, substantially diminishing productivity and quality of life among working-age adults. A subset of individuals develop chronic non-specific low back pain, characterised by persistent functional limitations.1 This group accounts for a disproportionate share of health-care resource use compared with people experiencing acute or subacute episodes.2 When symptoms persist for longer than 12 weeks, neurophysiological adaptations can alter pain processing pathways, leading to a shift in the pain profile from predominantly nociceptive or neuropathic to nociplastic.

[Comment] Challenges in the therapeutic management of psoriatic arthritis

In The Lancet Rheumatology, Gabriele De Marco and colleagues1 present their study on the benefit of using methotrexate with golimumab in patients with early psoriatic arthritis. On average, the median time from symptom onset to diagnosis was 10 months. All patients received an intramuscular dose of methylprednisolone 120 mg (or an equivalent intra-articular dose), and methotrexate (increased to 25 mg orally weekly within 28 days) and were randomly assigned to either the golimumab and methotrexate group or the placebo and methotrexate group, stratified by oligoarticular or polyarticular involvement.

[Editorial] Psoriatic arthritis: strategy shaping treatment

Management of psoriatic arthritis has advanced substantially in recent years, with emerging targeted therapies and disease-specific studies redefining patient outcomes. The high burden of comorbidities associated with the disease—the theme of World Psoriasis day 2025—alongside limited understanding of disease pathogenesis, highlights the continued need for optimised care and innovative therapies.

[Personal View] The psychobiological model of disorders of gut–brain interaction: introduction of a novel, integrated, and testable model

Psychogastroenterology encompasses both basic mechanistic research, which identifies psychological mechanisms (eg, fear-learning) that contribute to disorders of gut–brain interaction (DGBIs), and clinical applied research, which evaluates the efficacy of gut–brain behavioural therapies in DGBIs. However, progress in the field is hindered by inadequate communication between these areas, such that mechanistic processes are rarely translated into clinical targets, and interventions are developed with an incomplete understanding of the potential mechanisms by which they work or for whom they work.

[Review] Recompensation in decompensated cirrhosis

Recompensation of decompensated cirrhosis has been defined by the Baveno consensus as control or cure of the main underlying cause; resolution of clinical manifestations, including ascites and hepatic encephalopathy, without the use of prophylactic medications, and without variceal bleeding for 12 months; and restoration of hepatic function. Cure and recompensation are usually associated with regression of liver fibrosis. Recompensation can occur when hepatitis C virus is eradicated, if hepatitis B virus infection (without hepatitis D co-infection) is suppressed, and following persistent alcohol abstinence in patients with alcohol-associated cirrhosis.

[Articles] Service delivery models and care cascade outcomes for people living with chronic hepatitis B: a global systematic review and meta-analysis

Considerable attrition was seen across the chronic hepatitis B care cascade, with low rates of retention especially in patients not on antiviral therapy. Assessment for treatment eligibility and initiation of antiviral therapy were lower in primary versus hospital-based specialist care models. Chronic hepatitis B services need to adopt strategies to optimise linkage to care after diagnosis, initiation of antiviral therapy if eligible, adherence to antiviral therapy and retention in care, as promoted in 2024 WHO hepatitis B guidelines.

[Articles] Risk of hepatic and extrahepatic outcomes associated with metabolic dysfunction-associated steatotic liver disease and metabolic dysfunction and alcohol-associated steatotic liver disease: a systematic review and meta-analysis

MetALD might be associated with a higher risk of liver-related events, hepatocellular carcinoma, and extrahepatic cancers than MASLD, whereas all-cause mortality, extrahepatic cancer-related mortality, and cardiovascular events seem similar between the two conditions. These findings emphasise the need for distinct clinical strategies for these related yet different entities within the steatotic liver disease spectrum and highlight the importance of conducting pharmacological clinical trials in this context.

[Corrections] Correction to Lancet Gastroenterol Hepatol 2025; published online Sept 10. https://doi.org/10.1016/S2468-1253(25)00187-6

Torp N, Bech KT, Schnefeld HL, et al Phosphatidylethanol and self-reported alcohol intake to subclassify individuals at risk of steatotic liver disease: an analysis of data from a prospective cohort study. Lancet Gastroenterol Hepatol 2025; published online Sept 10. https://doi.org/10.1016/S2468-1253(25)00187-6—The title of this Article has been corrected. This correction has been made as of Sept 16, 2025.

[Corrections] Correction to Lancet Gastroenterol Hepatol 2025; 10: 896–903

Budzyń K, Romańczyk M, Kitala D, et al. Endoscopist deskilling risk after exposure to artificial intelligence in colonoscopy: a multicentre, observational study. Lancet Gastroenterol Hepatol 2025; 10: 896–903—A covariate (indication for colonoscopy) had been mistakenly omitted from the multivariable analysis presented in supplementary table 6 in the appendix of this Article. The appendix has been updated with the corrected analysis; the only affected findings are for the variables “After AI introduction (using AI in colonoscopy)” and “Age >60 years”.

[Correspondence] Peripheral blood DNA methylation signatures to predict treatment response in Crohn's disease - Authors' reply

We appreciate the interest in our study from Hui Li and colleagues. Patient selection was a key consideration in the design of our study, requiring a balance between cohort homogeneity and practical feasibility. Because anti-TNF medication is commonly used as first-line therapy, the switch from infliximab to adalimumab is well reflected in our cohort. We acknowledge, in agreement with Li and colleagues, that this introduces an element of heterogeneity. However, it is worth noting that the earlier work by Lin and colleagues,1 which included only patients who were anti-TNF-naive, was unable to develop a pretreatment prediction model independent of dosage.

[Correspondence] Lessons learned from the BOSS trial

We welcome the discussion of the BOSS trial1 by Rebecca C Fitzgerald and Peter Sasieni.2 Interpretation of these data is important to inform future guidelines. The authors suggest that using all-cause mortality as our primary endpoint was a mistake. The choice of outcome measure for cancer screening programmes has been debated and there are strong arguments for using all-cause mortality as a hard endpoint, free from bias of attributing cause of death, particularly when trial allocation cannot be masked.

[Correspondence] Refining the faecal incontinence core outcome set – Authors' reply

We thank Zubing Mei and colleagues for their thoughtful comments. The aim of a core outcome set (COS) is to facilitate the standardisation of outcomes to be measured and reported in clinical trials for a specific condition.1 In the case of this COS, the focus lies on ambulatory patients with faecal incontinence who form the majority of the research population, as shown in the European guidelines.2,3 Although we agree that some outcomes might be more or less relevant to specific subgroups, such as those with minimal mobility and those who depend on caregivers, a single COS cannot cater to all variations without losing its standardising function.

[Correspondence] Pre-emptive TIPS for gastric varices

We read with interest the GAVAPROSEC trial by Jean-Paul Cervoni and colleagues, which reported pre-emptive transjugular intrahepatic portosystemic shunt (p-TIPS) to be a superior modality for secondary prophylaxis of gastric variceal bleeding compared with non-selective beta-blockers (NSBB).1 The results are similar to those reported in previous clinical trials on TIPS in gastric variceal bleeding.2,3 Although the results from this trial are encouraging, several aspects merit further clarification.