Axial spondyloarthritis (axSpA) diagnoses are often delayed, which is associated with poorer patient outcomes. To improve understanding of diagnostic delay in France, we describe the time and patient journey to axSpA diagnosis in primary care.

MicroRNAs (miRNAs) play critical roles in regulating immune cell differentiation and maintaining innate and adaptive immune homeostasis. The aim of this study was to determine the mechanisms by which miR-23b-3p modulates crosstalk between innate and adaptive immunity in immunoglobulin A (IgA) vasculitis (IgAV) and to evaluate its therapeutic potential.

Most studies on renal outcomes in ANCA-associated vasculitis (AAV) focus on GN; however, the prognosis of patients without clinically apparent kidney involvement is understudied. We aimed to characterize kidney prognosis in this overlooked subgroup.

Juvenile psoriatic arthritis and enthesitis-related arthritis are two categories of juvenile idiopathic arthritis (JIA). Despite available treatments including non-steroidal anti-inflammatory drugs, glucocorticoids, conventional synthetic disease-modifying antirheumatic drugs (DMARDs), and biological DMARDs, a substantial proportion of people do not adequately respond to treatment or do not have long-lasting clinical remission. The aim of this trial was to show the efficacy and safety of ixekizumab in children with active enthesitis-related arthritis and juvenile psoriatic arthritis.

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.