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.

Current therapies for rheumatoid arthritis rely on sustained immunosuppression rather than restoration of immune tolerance, with off-drug remission remaining rare. Recent anecdotal reports suggest that CD19-directed chimeric antigen receptor T (CAR-T) cell therapy may be an effective approach.

Chimeric antigen receptor (CAR) T‑cell therapy, long established in hematologic malignancies, is now emerging as a transformative approach in systemic lupus erythematosus (SLE), a disease historically managed with chronic immunosuppression.