The impact of biologic sex in axial juvenile spondyloarthritis (axJSpA) is unknown. We assessed whether biologic sex is associated with disease manifestations, patient-reported outcomes, or characteristic sacroiliac joint (SIJ) MRI lesions in a large cohort of youths with classified axJSpA.

Neurodevelopmental disorders affect a substantial proportion of children and represent a major public health challenge worldwide. Emerging evidence highlights complex interactions among genetic, environmental and immune factors - particularly during the critical window of neurodevelopmental vulnerability. These insights raise the possibility that children with juvenile systemic autoimmune and autoinflammatory diseases are at an increased risk of developing neurodevelopmental disorders. Early onset and delayed treatment of these autoimmune and autoinflammatory diseases seem to increase this vulnerability. Growing awareness of these associations is transforming paediatric rheumatology, highlighting the need for early screening, multidisciplinary management, and personalized interventions that target both inflammatory disease and neurodevelopment. International research collaborations, biomarker discovery and long-term follow-up are crucial for closing knowledge gaps and subsequently advancing care and outcomes. Recognizing and tackling neurodevelopmental disorders as frequent comorbidities of juvenile systemic autoimmune and autoinflammatory diseases is vital for improving educational attainment, psychosocial wellbeing and lifelong quality of life in children with chronic inflammatory conditions.

The treat-to-target (T2T) strategy, which involves predefined therapy objectives and a focused monitoring system, has substantially improved the management of rheumatoid arthritis (RA). These benefits probably result from a reduction in undertreatment, prevention of overtreatment and thus an improvement in long-term outcomes for both articular manifestations and comorbidities. However, T2T has also revealed a subgroup of patients who, despite following guideline-based treatment, do not reach the predefined outcomes. This finding has led to the emerging concept of 'difficult-to-treat' (D2T) RA. D2T-RA might reflect true pharmacological refractoriness, but D2T-RA is also increasingly recognized as having broader underlying causes, including psychosocial distress, comorbidities, chronic pain syndromes and patient or system-related barriers. If these underlying factors remain unidentified, unnecessary treatment escalation can occur, which could worsen long-term outcomes. Although T2T focuses on predefined targets and regular monitoring, which works well for the majority of patients, the structured multidomain approach characteristic of the D2T framework might provide a guide for managing patients who do not reach these targets despite guideline-based care. For this population, the D2T approach could offer better stratification and serve as a practical, precision-medicine-oriented extension of T2T by providing a more mechanism-informed, personalized management strategy. Integrating this D2T perspective into T2T practices keeps the strengths of T2T while also offering individualized care for patients with more complex disease trajectories, representing an unmet need.

Despite major scientific advances, delivering high-quality care for children with inflammatory rheumatic and musculoskeletal diseases remains challenging. The field of paediatric rheumatology lies at the intersection of different disciplines, and requires excellent highly specialised medical expertise based on rapidly deepening knowledge in rheumatology and immunology. At the same time, this field relies on compassionate paediatricians understanding the needs of developing children as a vulnerable population. Training pathways and professional recognition vary widely between countries, and formal subspecialty accreditation is available inconsistently. Based on a Europe-wide expert survey, this Viewpoint examines why paediatric rheumatology is still not universally recognised as a distinct subspecialty and how insufficient access to formal accreditation leads to fragmented representation and low visibility of this discipline. We argue that stronger international advocacy involving patients and families is urgently required to support the sustainable development of the field and to ensure equitable, evidence-based, developmentally and psychologically appropriate care for all affected children.

Drug development for osteoarthritis (OA) has faced significant challenges, mainly due to the lack of alignment between joint structure observations and patient-reported outcomes (PROs), such as pain. Weight loss has been linked to positive effects on symptomatic outcomes. Blood-based biomarkers indicating collagen and extracellular matrix turnover can be used to measure injury severity in specific tissues, offering a more precise assessment of disease progression. This study aimed to explore the relationship between obesity and PROs and its impact on serum and urinary biomarkers of bone (CTX-I and osteocalcin), synovial (type III collagen degradation and C3M), and cartilage (type II collagen degradation, CTX-II, and C2M) turnover.

To investigate longitudinal IgG4 dynamics in IgG4-related disease (IgG4-RD), identify the predictive value of IgG4 rising kinetics for relapse and evaluate outcomes of intensified treatment following IgG4 surge.

To identify HLA associations with clinical and autoantibody-defined subgroups of idiopathic inflammatory myopathy (IIM) and predict potential immunogenic epitopes presented by subgroup-specific HLA alleles.

Anti-synthetase syndrome (ASyS) is a rare autoimmune disorder defined by anti-synthetase antibodies. While malignancy is established in DM, its association with ASyS remains unclear. We aimed to estimate malignancy prevalence in ASyS and assess whether autoantibody subtype, age, sex or clinical features influence malignancy risk.

Systemic sclerosis-associated heart involvement (SHI) is an enigmatic disease manifestation associated with high mortality. The Scleroderma Clinical Trials Consortium (SCTC) Cardiac Working Group developed SHI classification criteria to enable systematic investigation of this condition.

To assess the demographic and clinical characteristics (including the burden of comorbidities) and the survival rates of patients with connective tissue disease-associated pulmonary arterial hypertension (CTD-PAH) and to compare them with those of contemporary patients with idiopathic PAH (IPAH). We also evaluated the impact of emerging age-related comorbidities on survival.

Systemic sclerosis (SSc) is a connective tissue disease that can affect multiple organs, including the musculoskeletal system and the temporomandibular joint (TMJ). This study aimed to determine the frequency and clinical characteristics of temporomandibular disorders (TMD) among patients with SSc.

The optimal treatment of polymyalgia rheumatica (PMR) is far from being fully elucidated. Only a few trials explored the role of conventional DMARDs: none of them adequately ruled out subclinical giant cell arteritis (GCA). The aim of this study was to assess whether the precocious administration of methotrexate (MTX) and a short course of glucocorticoids (GCs) could be safe and effective in recently diagnosed PMR.

Rheumatic disease registries systematically collect real-world longitudinal data, improving patient care and research. Despite the high burden of rheumatic diseases, national registries are scarce in the Middle East. Rheumatology Research Center, with support from Iran’s Ministry of Health, launched Rheumatry in 2016 as the country’s first national rheumatic disease registry.

Inborn errors of metabolism comprise a clinically diverse group of conditions that arise from the decreased activity of an enzyme or metabolite transporter and subsequent blockade in a metabolic pathway. These disorders are typically considered in the differential diagnosis of critically ill neonates or young children presenting with hypoglycaemia, metabolic acidosis or hyperammonaemia. However, beyond these classic presentations, a broader group of inborn errors of metabolism can manifest more subtly, with progressive articular and multi-systemic involvement that mimics or overlaps with typical features of rheumatological disease. Consequently, these conditions might be misdiagnosed for years as rheumatological diseases, including juvenile idiopathic arthritis, systemic sclerosis, idiopathic inflammatory myopathies and systemic lupus erythematosus. Moreover, these disorders provide unique opportunities to understand the complex interplay between metabolism and immune function. With the growing availability of disease-modifying therapies for inborn errors of metabolism, rheumatologists must be able to recognize these disorders, particularly in patients with atypical features or treatment-refractory disease.