In this Perspective, the authors discuss how integrating difficult-to-treat into the treat-to-target strategy could improve outcomes for those patients with rheumatoid arthritis who do not follow the standard treat-to-target trajectory. The proposed strategy is aimed at providing a more personalized approach to disease management for those patients with difficult-to-treat disease.

Neurodevelopmental disorders frequently co-occur with juvenile systemic autoimmune and autoinflammatory diseases, driven by immune–neurodevelopmental interactions. Early screening, multidisciplinary care and personalized interventions are essential, alongside research into mechanisms, biomarkers and long-term outcomes to improve education, psychosocial wellbeing and quality of life.

Drawing on my contrasting experiences as a patient in oncology and rheumatology, I have seen how the lack of precision-based diagnostics and meaningful endpoints limits progress in rheumatic disease. I believe biologically grounded classification systems and greater patient involvement are essential for more effective and responsive care.

Findings show that lytic cell death releases TRIM21, promoting immune complex uptake by macrophages and autoimmune inflammation in Sjögren disease.

In a phase III trial, the addition of glucocorticoids to standard therapy did not prevent the development of coronary artery lesions in children with Kawasaki disease.

Positive results of the phase III VALOR trial suggest that the TYK2–JAK1 inhibitor brepocitinib is safe and effective for the treatment of dermatomyositis.

In mice with early-onset disc degeneration, treatment with dasatinib and quercetin suppressed senescence-associated signalling and preserved disc cell phenotype.

Findings reveal that stem-like CD8⁺ T cells migrate from renal lymph nodes and cause tissue damage in lupus nephritis.