Interstitial lung disease (ILD) is a frequent and often clinically significant complication of connective tissue diseases (CTDs), with substantial heterogeneity in prevalence, clinical manifestations and disease trajectories. This themed issue of Rheumatology presents a comprehensive collection of original studies addressing critical aspects of CTD-associated ILD, including early detection, disease monitoring, prognostication and therapeutic strategies. Advances in screening, such as lung ultrasound and deep-learning algorithms, are enhancing early ILD detection, quantification and characterization. Novel biomarkers and genetic risk factors are being explored to support individualized risk stratification across CTDs. With the publication of recent international guidelines, evidence-based management of CTD-ILD has become more structured, providing clinicians with a clearer framework for decision-making, while real-world studies continue to refine these approaches and identify remaining therapeutic gaps. The issue also highlights emerging therapies and the need for precision-based interventions tailored to disease subtype, progression risk and comorbidities. Collectively, these contributions underscore the importance of multidisciplinary collaboration and continued research to improve outcomes for patients with CTD-ILD.

Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disease, associated with various inflammatory conditions. IL-1 is involved in the underlying pathogenesis of both FMF and psoriatic arthritis (PsA). However, data on the association of FMF with PsA are scarce. We aimed to assess this association using data from a large population database.

Osteoarthritis (OA) is the most common form of arthritis, and its prevalence is increasing. We developed an educational tool to improve primary care provider (PCP) comfort with diagnosis and management of non-inflammatory arthritis.

To investigate adrenal function and the prevalence of glucocorticoid (GC) induced adrenal insufficiency (GIAI) in patients with polymyalgia rheumatica (PMR), the first 18 months after diagnosis.

Despite increasing gender equity in the rheumatology workforce, disparities persist in leadership roles and prestigious career awards. The study aimed to identify key factors contributing to the under-representation of women among recipients of prestigious career awards in rheumatology.

The progression of Behçet's disease (BD) from a mucocutaneous-limited form to major organ involvement (MOI) represents a significant challenge. This study aims to identify patients without MOI at BD onset who are at increased risk of developing MOI in later stages.

Childhood-onset systemic lupus erythematosus (SLE) is associated with more active disease trajectories, increased cardiovascular risk, earlier development of organ damage (which commonly affects the kidney, central nervous and musculoskeletal systems) and increased use of glucocorticoids and immunosuppressive treatments than adult-onset SLE. However, the understanding of immunopathogenic mechanisms in childhood-onset SLE is far less established than in adult-onset disease. Technological advances over the past decade have accelerated progress in understanding the immune, genetic, epigenetic, metabolic and proteomic profiles of childhood-onset SLE, and have also established the mechanistic roles of immune dysregulation, interferon signalling, biological sex, gender and ethnicity in shaping disease heterogeneity. These insights have led to the elucidation of the mechanisms that drive the increased severity of childhood-onset SLE and point towards new pathways for personalized therapeutic approaches aimed at improving long-term outcomes and quality of life for patients.

CT-P13 SC, a new subcutaneous (SC) formulation of biosimilar infliximab (IFX), was approved by the European Medicines Agency in 2020 for the treatment of radiographic axial spondyloarthritis (axSpA) in adult patients. The present study aimed to assess the real-world outcomes of CT-P13 SC (SC IFX) as a treatment for both radiographic and non-radiographic axSpA.

Organ damage in SLE is assessed using the SLICC/ACR Damage Index (SDI), which quantifies damage in 12 organ systems but generally reports a total score. We examined whether the risk factors for overall organ damage accrual captured those associated with domain-specific damage accrual in patients with SLE.

The early diagnosis of rheumatoid arthritis (RA) is essential in order to start the treatment as soon as possible; this process usually begins in primary care and the diagnosis is subsequently confirmed by a rheumatologist. The objective of this study was to increase the knowledge about the barriers rheumatologists perceive to early diagnosis in patients with RA in Spain. It is necessary to optimize the diagnostic process.

Systemic lupus Erythematous (SLE) with its multisystem manifestations can sometimes throw the treating team into scientific oblivion. Bone marrow suppression increases the susceptibility to infection and life-threatening bleeding manifestations and hence timely diagnosis and treatment can be lifesaving in these patients.

To evaluate the impact of oral low-dose glucocorticoids (GCs) on the effectiveness of Janus kinase inhibitors (JAKis) compared with non-TNF-targeted bDMARDs (other mechanisms of action [OMA] including tocilizumab, abatacept and rituximab) in RA patients with inadequate response to TNF inhibitors (TNFi-IRs).

Tumour markers may correlate with interstitial lung disease (ILD). We conducted a large, population-based retrospective study to investigate the relationship between serum carcinoembryonic antigen (CEA) levels and disease severity and 1-year mortality in different ILD subtypes.

The effects of systemic tumour necrosis factor (TNF) inhibition on glucose homeostasis are not fully understood. This study aims to evaluate the effects of TNF inhibitors (TNFis) on gastric inhibitory polypeptide (GIP), amylin and pancreatic polypeptide (PP), hormones involved in the fine-tuning of postprandial glucose homeostasis, in patients with RA, PsA and axial spondylarthritis (axSpA).

The Pan American League of Associations for Rheumatology has developed evidence-based recommendations for the pharmacological management of rheumatoid arthritis in Latin America. A panel of rheumatoid arthritis experts from Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, Panama, Peru, Uruguay, and Venezuela formulated clinically relevant questions in the population, intervention, comparator, outcome format. Systematic literature reviews were done following the Grading of Recommendations Assessment, Development and Evaluation method. Recommendations were formulated based on evidence quality and expert consensus, which required at least 70% agreement among the voting members to be included in the guidelines. Ten recommendations and a treatment algorithm were developed. Key topics include early initiation of conventional synthetic disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, parenteral methotrexate for intolerance, cautious glucocorticoid use, switching mechanisms of action after unsuccessful biological or targeted synthetic DMARD treatment, tapering in remission, and guidance for rheumatoid arthritis-associated interstitial lung disease and vasculitis. Special attention is given to cost-effectiveness and accessibility considering the socioeconomic characteristics of Latin America. These recommendations aim to support clinicians in Latin America by providing a practical, evidence-based, and contextually relevant framework that addresses the unique challenges faced in the region.

Autoantibodies represent a serological hallmark of SSc. Heart involvement in SSc patients includes diastolic dysfunction, conduction block, pericardial effusion, altered left ventricular ejection fraction (LVEF), valvular pathology, as well as myocardial inflammation and/or fibrosis. To characterize the role of anti-RNA polymerase III (RNAPIII) antibody positivity in the pathophysiology of coronavirus disease 2019 (COVID-19)-related cardiac involvement in SSc patients.