The pharmacology treatment in SLE is a rapidly expanding field of research that provides excitement and optimism to both the patients and the clinicians. We now have three licensed targeted therapies (belimumab and voclosporin in active lupus nephritis and anifrolumab in non-renal SLE) over the last 3 years compared to one therapy (belimumab in non-renal SLE) in the previous 50 years. What are other promising therapies on the horizon? 

In the last 2 years, there has been more caution and vigilance with the use of JAK inhibitors in the treatment of rheumatoid arthritis due to the risk of CV events, including MACE and VTE. The ORAL surveillance study, a post-approval safety study conducted in RA patients aged ≥50 years with ≥1 CV risk factor, has resulted in increased caution and greater emphasis on assessment of MACE and VTE risks in patients starting JAK inhibitors. 

Interstitial lung disease (ILD) is a severe extra articular manifestation of RA, with limited treatment strategies and poor prognosis. While for a long time RA treatments, such as methotrexate (MTX), have been considered a risk factor, recent data have shown the innocuity of MTX on lung disease (and in fact suggests it could reduce risk of ILD by increasing disease control and remission).