Systemic sclerosis (SSc) is a severe fibrotic disease that affects multiple organs, driven by vascular damage, inflammation and dysregulated repair. The authors of this Review explore the key mechanisms that promote fibrosis in SSc and highlight emerging therapeutic targets.

In this Expert Recommendation, a working group integrating diverse perspectives presents a comprehensive overview of the clinical relevance and applicability of the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the rationale for its use as an outcome measure in clinical trials, addressing a long-standing roadblock in the development of new drugs for CLE.

Although current treatments for axial spondyloarthritis can reduce inflammation, many patients continue to experience pain. This Review examines the complex interplay between pain and inflammation in axial spondyloarthritis and argues that both should be addressed as interconnected therapeutic targets to achieve meaningful pain relief.

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.

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.

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.

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

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

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