Rheumato

Background/Objectives: Autoimmune rheumatic diseases (AIRDs) are complex, heterogeneous, and relapsing–remitting conditions in which early diagnosis, flare prediction, and individualized therapy remain major unmet needs. This review aims to synthesize recent progress in AI-driven, biomarker-based precision medicine, integrating advances in imaging, multi-omics, and digital health to enhance diagnosis, risk stratification, and therapeutic decision-making in AIRD. Methods: A comprehensive synthesis of 2020–2025 literature was conducted across PubMed, Scopus, and preprint databases, focusing on studies applying artificial intelligence, machine learning, and multimodal biomarkers in rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, spondyloarthritis, and related autoimmune diseases. The review emphasizes methodological rigor (TRIPOD+AI, PROBAST+AI, CONSORT-AI/SPIRIT-AI), implementation infrastructures (ACR RISE registry, federated learning), and equity frameworks to ensure generalizable, safe, and ethically governed translation into clinical practice. Results: Emerging evidence demonstrates that AI-integrated imaging enables automated quantification of synovitis, erosions, and vascular inflammation; multi-omics stratification reveals interferon- and B-cell-related molecular programs predictive of therapeutic response; and digital biomarkers from wearables and smartphones extend monitoring beyond the clinic, capturing early flare signatures. Registry-based AI pipelines and federated collaboration now allow multicenter model training without compromising patient privacy. Across diseases, predictive frameworks for biologic and Janus kinase (JAK) inhibitor response show growing discriminatory performance, though prospective and equity-aware validation remain limited. Conclusions: AI-enabled fusion of imaging, molecular, and digital biomarkers is reshaping the diagnostic and therapeutic landscape of AIRD. Standardized validation, interoperability, and governance frameworks are essential to transition these tools from research to real-world precision rheumatology. The convergence of registries, federated learning, and transparent reporting standards marks a pivotal step toward pragmatic, equitable, and continuously learning systems of care.

Introduction: In hemoglobinopathies, the amount of globin synthesis in hemoglobin (Hb) or its structure is altered. Clinical features are related to the rate and kind of structural aberrations. The heterozygous form of the Lepore syndrome resembles minor thalassemia both clinically and hematologically. On electrophoresis, abnormal Hb Lepore fractions are found at a rate of 5–15%, with a mildly higher percentage of HbF and lower HbA. In general, Hb Lepore heterozygotes are asymptomatic. Case presentation: A 32-year-old male was admitted to our hospital with complaints of pain and swelling in multiple large joints and high-grade fever for 11 days. His past history was unremarkable; one of his sisters had the β-thalassemia trait. On physical examination, he was moderately anemic, with mild hepatomegaly and normal spleen; both knees and ankles were tender and swollen. Laboratory showed mild microcytic hypochromic anemia with variables similar to the thalassemia trait and signs of inflammation with very high CRP, serum ferritin, and leukocytosis. Blood sugars were increased. Hb electrophoresis showed an abnormal pattern with mild elevation in HbS, normal Hb F, mild reduction in HbA, and high HbA2, compatible with heterozygosity for the Hb Lepore beta chain variant. He was initially diagnosed with diabetes (treated with insulin) and sepsis from unknown origin, but fever and joint pains did not respond to NSAIDs or antibiotics. He had very good response on high-dose methylprednisolone. Undifferentiated arthritis was diagnosed in the patient with Hb Lepore, and he was treated with oral prednisolone and sulfasalazine (SSZ). At follow up, the patient was doing well. He refused further investigations and did not allow testing on his family members. In summary: Hb Lepore is a rare hemoglobinopathy linked to thalassemia, which may manifest with musculoskeletal problems. Our patient with the Hb Lepore trait presented with undifferentiated polyarthritis and fever, but in our case, a causal relationship remains unclear. This is one of the first adult cases of Hb Lepore in Bangladesh and the first with arthritis of unknown origin. The prevalence of Hb Lepore in Bangladesh is unknown.

Background: Chimeric Antigen Receptor T-cell (CAR-T) cell therapy has revolutionized cancer treatment and is now being explored as a novel approach to treat refractory autoimmune diseases by targeting autoreactive immune components, especially B cells. Objective: Our aim was to provide a narrative review of the current evidence, mechanisms, efficacy, safety, and future directions of CAR-T cell therapy in autoimmune diseases. Methods: A structured literature search was conducted in MEDLINE via PubMed using keywords such as “CAR-T”, “chimeric antigen receptor T-cell”, “autoimmune diseases”, “lupus”, “rheumatoid arthritis”, “multiple sclerosis”, and “vasculitis”. Studies on CAR-T mechanisms, efficacy, safety, and clinical outcomes were included. Results: CAR-T cell therapies, especially CD19-directed constructs, demonstrated sustained drug-free remission in all patients across early SLE case series (n = 5–7), with normalization of serological markers and improved renal outcomes. Emerging preclinical and early clinical data in rheumatoid arthritis, multiple sclerosis, ANCA-associated vasculitis, juvenile autoimmune diseases, and idiopathic inflammatory myopathies also report clinical improvement and biomarker normalization. Reported adverse events in autoimmune cohorts were limited to mild cytokine release syndrome in a minority of cases, with no severe neurotoxicity or life-threatening infections, suggesting a more favorable safety profile compared to oncology settings. In parallel, next-generation innovations—including dual-target CARs, CAR-Tregs, and molecular safety switches—are advancing toward clinical translation. Conclusions: CAR-T cell therapy is emerging as a transformative strategy for autoimmune disease management, especially in refractory cases. Although initial outcomes are promising, long-term safety, cost-effectiveness, and broader accessibility remain key challenges. Future research should focus on optimizing cell targets, minimizing off-target effects, and improving affordability.