CD19-directed CAR T-cell therapy has rapidly moved into autoimmune disease, driven in large part by striking reports in SLE, where sustained drug-free remission has raised the possibility of a true immune reset. In RA, where multiple effective therapeutic classes already exist, the relevance of such deep immune interventions remains uncertain.

Five years on, are we closer to licensing of the first CAR-T therapy in rheumatic and musculoskeletal diseases (RMD)?

Treatment-refractory RA is more common than we sometimes admit. Roughly 11% of patients fail multiple b/tsDMARD classes, and for the ACPA-positive subset, rituximab has long been the fallback. It works, but it rarely produces durable disease-free intervals. CD19 CAR T-cell therapy was always going to be the question that followed the SLE data. Until EULAR 2026, that question had no prospective answer. The plenary session changed that.