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[Personal View] Exploiting a unified vascular framework to predict organ-specific complications and accomplish disease modification in systemic sclerosis

Immune-mediated vascular endothelial injury is considered one of the earliest pathological features in systemic sclerosis and is thought to occur simultaneously within a broad range of organs, although typically clinically manifesting only as Raynaud's phenomenon in the early stages. Overt vascular systemic sclerosis manifestations include Raynaud's phenomenon, abnormal nailfold capillary morphology, digital ulcers, pulmonary arterial hypertension, cardiovascular disease (primary and coronary), telangiectasia, renal crisis, and gastric antral vascular ectasia.

[Articles] Risk factors for interstitial lung disease in early rheumatoid arthritis and external validation of screening strategies: a cross-sectional analysis of the prospective SAIL-RA cohort in the USA

In this population with early rheumatoid arthritis, 11% had rheumatoid arthritis-associated ILD. Moderate or high disease activity and age of 60 years or older were strongly associated with rheumatoid arthritis-associated ILD in early rheumatoid arthritis. Several proposed screening strategies using factors routinely available at the point of care showed promise for detecting rheumatoid arthritis-associated ILD in early rheumatoid arthritis.

[News] The Nobel celebrates tolerance

On Oct 6, 2025, the Nobel Prize in Physiology or Medicine was awarded to Mary Brunkow, Fred Ramsdale, and Shimon Sakaguchi for their discoveries around the mechanisms governing peripheral immune tolerance. Not only did their work uncover a fundamental facet of human health, it also solved a decades-old genetic mystery and breathed new life into a long-abandoned immunological concept. Whether these discoveries are now poised to transform treatment for patients with autoimmune rheumatic diseases remains to be seen.

[News] Research in Brief

Ghaith Noaiseh and colleagues assessed the safety and efficacy of nipocalimab, a neonatal Fc receptor blocker that reduces circulating IgG, in patients with Sjögren's disease in a phase 2 trial. 163 patients were randomly assigned (1:1:1) to receive intravenous nipocalimab 5 mg/kg (n=53), intravenous nipocalimab 15 mg/kg (n=54), or placebo (n=56), every 2 weeks for 22 weeks. At week 24, the change in Clinical EULAR Sjögren's Syndrome Disease Activity Index score from baseline (primary outcome) was –3·74 (90% CI –4·74 to –2·75) in the placebo group versus –6·40 (–7·43 to –5·36) in the nipocalimab 15 mg/kg group (least squares mean difference –2·65 [–4·03 to –1·28]; p=0·0018) and –4·08 (–5·10 to –3·07) in the nipocalimab 5 mg/kg group (least squares mean difference from placebo –0·34 [–1·71 to 1·03]; p=0·68).

[Corrections] Correction to Lancet Rheumatol 2025; 7: e747

The Lancet Rheumatology. Psoriatic arthritis: strategy shaping treatment. Lancet Rheumatol 2025; 7: e747—In this Editorial, in the third sentence of the third paragraph and in the margin link, the trial name should have read “TICOPA”. Additionally, the final sentence of the fifth paragraph should have read “While GRAPPA distinguishes between complex-to-manage and treatment-refractory disease, EULAR defines difficult-to-manage psoriatic arthritis as persistent disease despite optimal therapy and problematic disease burden by the patient or clinician.” These corrections have been made as of Oct 29, 2025.

[Correspondence] Anti-BCMA CAR-T for the treatment of IgG4-related disease: clinical assessment and single-cell transcriptomic analysis

IgG4-related disease is an autoimmune disease entity with high relapse rate during and after glucocorticoid tapering, in which B cells and their deriving antibody-secreting cells exert important pathogenic effects.1 Despite several attempts of conventional immunosuppressants and B cell-targeting biologics to help reduce the risk of disease flares, there are still a number of individuals with disease relapse even within the first 6 months after treatment initiation.2,3 The successful application of chimeric antigen receptor (CAR)-T-cell therapy in treating several autoimmune diseases in those who have completely stopped immunosuppressant and glucocorticoid use implies its potential in managing IgG4-related disease.

[Comment] Revisiting safety and refining benefit of rituximab–belimumab combination for refractory SLE

B-cell depletion using rituximab is used to treat systemic lupus erythematosus (SLE), particularly for patients whose disease is refractory to conventional immunosuppressants (eg, mycophenolate), and is included in guidelines for the management of SLE, including lupus nephritis.1 In one study, SLE was the most common diagnosis for off-label use of rituximab.2 Rituximab is now off patent, and acquisition costs are lower than other advanced therapies for SLE, facilitating its availability for patients.

[Comment] Can AI be used to classify the focus score in Sjögren's disease?

Sjögren's disease is a rheumatic disorder evidenced predominantly by exocrine gland-impairment that disproportionally affects women. The gold-standard diagnostic tool includes a microscopic evaluation of the minor salivary gland biopsy. Characteristically, a biopsy is considered positive for Sjögren's disease if the number of lymphocytic aggregates comprising at least 50 mononuclear inflammatory cells per 4 mm2 of glandular tissue (focus score) exceeds one. However, interpreting the focus score accurately requires expertise found in a limited number of diagnostic laboratories.

[Comment] ILD risk prediction in routine care for rheumatoid arthritis

Rheumatoid arthritis-associated interstitial lung disease (ILD) is one of the most serious extra-articular manifestations of rheumatoid arthritis, being strongly associated with increased morbidity, mortality, and health-care costs. The possibility of ILD should be systematically considered both at initial evaluation and throughout longitudinal follow-up of patients with rheumatoid arthritis. Rheumatologists play a key role in screening for rheumatoid arthritis-associated-ILD, as early recognition and assessment are essential to ensure timely treatment and limit disease progression.

[Comment] Modelling allopurinol-induced severe adverse cutaneous reactions

Severe adverse cutaneous reactions, including Stevens–Johnson syndrome, drug rash with eosinophilia and systemic symptoms, and toxic epidermal necrolysis, are serious and life-threatening but fortunately rare adverse events associated with allopurinol. Although the incidence of allopurinol-induced severe adverse cutaneous reactions is low (estimated 0·69 cases per 1000 person-years),1 the resulting substantial morbidity and mortality mean any reasonable steps to prevent occurrence of severe adverse cutaneous reactions should be implemented.

[Editorial] The stark reality of living with arthritis in the UK

Arthritis takes a substantial toll, affecting every aspect of daily life. This is the message of Left Waiting, Left Behind: The Reality of Living with Arthritis, a survey from Arthritis UK (formally Versus Arthritis), capturing the lived experience of almost 8000 people with arthritis in the UK. Two-thirds live with persistent pain; a third report severe interference with daily life. The psychological impact of arthritis is striking; in the past 12 months, three-quarters of respondents felt low or anxious some or all of the time.

[Seminar] Community-acquired pneumonia

Community-acquired pneumonia is a major global health challenge that disproportionately affects vulnerable populations, including older people, immunocompromised people, those with chronic conditions, and young children. Once considered solely an acute illness, community-acquired pneumonia is now recognised as a disease with long-term complications, including cardiovascular events, respiratory impairment, and cognitive decline. Advances, such as nucleic acid amplification tests (NAATs) and the broader availability of point-of-care lung ultrasound, allow for rapid pathogen detection and personalised treatment.

[Articles] Zanzalintinib plus atezolizumab versus regorafenib in refractory colorectal cancer (STELLAR-303): a randomised, open-label, phase 3 trial

STELLAR-303 is the first phase 3 trial to show a significant improvement in overall survival with an immunotherapy-based regimen, zanzalintinib–atezolizumab, in patients with relapsed or refractory metastatic colorectal cancer that is not MSI-H or dMMR. This combination represents a chemotherapy-free treatment option with a novel mechanism of action for heavily pretreated patients in need of improved therapies.

[Articles] Global variation in patterns of care and time to initial treatment for breast, cervical, and ovarian cancer from 2015 to 2018 (VENUSCANCER): a secondary analysis of individual records for 275 792 women from 103 population-based cancer registries in 39 countries and territories

The VENUSCANCER project provides the first global picture of patterns of care for three of the most common cancers in women. These findings offer crucial real-world evidence to support the implementation and monitoring of global initiatives on cancer control such as WHO's Global Breast Cancer Initiative and Cervical Cancer Elimination Initiative. Although guideline-consistent treatment has become more accessible for women diagnosed with early-stage tumours in LMICs, the proportion of these women diagnosed early remains far too low.

[Department of Error] Department of Error

Patel PD, Liang Y, Meiring JE, et al. Efficacy of typhoid conjugate vaccine: final analysis of a 4-year, phase 3, randomised controlled trial in Malawian children. Lancet 2024; 403: 459–68—In this Article, in table 3, the third year Vi-TT incidence rate should have been 21·4 (95% CI 6·9–66·3). This correction has been made to the online version as of Nov 13, 2025.