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Lookup NU author(s): Professor John IsaacsORCiD
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© 2026 European Alliance of Associations for Rheumatology (EULAR). Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies.Objectives: This article aimed to articulate the most important unmet scientific needs in rheumatology. Methods: At the 25th Advances in Targeted Therapies (ATT) meeting, over 100 investigators joined 6 disease-focused breakout groups (rheumatoid arthritis [RA], psoriatic arthritis [PsA], axial spondyloarthritis [axSpA], systemic lupus erythematous [SLE], systemic sclerosis [SSc], and osteoarthritis [OA]). Each group, led by a facilitator and rapporteur, mapped (i) key unmet needs, (ii) promising mechanistic or therapeutic approaches, and (iii) near-term priorities for research and trials. This report synthesises the consensus highlights. Results: Six disease-focused groups (RA, PsA, axSpA, SLE, SSc, and OA) identified convergent priorities: earlier detection and interception; validated molecular and clinical endotypes to guide therapy; strategies for immune reset and short-course induction combinations with strict safety oversight; metabolic modifiers; precision targets in axSpA and fibroblast-directed approaches in RA; phenotype-driven therapeutic development and intra-articular options in OA; and pragmatic trial designs that include pregnant persons and very early disease. Conclusions: Across immune-mediated diseases, progress will hinge on validated endotypes, practical interception strategies, and trials that reflect real-world populations. The immediate agenda is to de-risk immune reset and induction approaches, standardise tissue and digital biomarkers, and close evidence gaps for refractory disease. Prevention—and ultimately cure—remains the horizon.
Author(s): Winthrop KL, Kerschbaumer A, Isaacs JD, Mease P, Baraliakos X, Crow MK, Buch M, Siebert S, Basu N, Conaghan P, Kloppenburg M, Distler O, Landewe R, Orange DE, Wei K, Aletaha D, McInnes IB, Huizinga TWJ, Voll R, Gravallese EM, Breedveld FC, Smolen JS
Publication type: Review
Publication status: Published
Journal: Annals of the Rheumatic Diseases
Year: 2026
Pages: epub ahead of print
Online publication date: 23/04/2026
Acceptance date: 17/03/2026
ISSN (print): 0003-4967
ISSN (electronic): 1468-2060
Publisher: Elsevier B.V.
URL: https://doi.org/10.1016/j.ard.2026.03.024
DOI: 10.1016/j.ard.2026.03.024
