The incidence of autoimmune diseases is on the rise, and multiple pathophysiological mechanisms may contribute to this trend. These include sequence similarity, cross reactive antibodies, molecular mimicry, dysbiosis, post-translational modification of processed nutrients, and luminal horizontal gene transfer. Recently, environmental adjuvants have been suggested to play an active role in auto-immunogenesis, collectively referred to as the ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants). The present narrative review provides a comprehensive overview of gluten, a widely consumed food additive, known for its pro-inflammatory and immunogenic properties. Gluten is implicated in several autoimmune conditions and meets both the major and minor diagnostic criteria for ASIA syndrome as an adjuvant. It is hoped that this present review will stimulate furthermore research on gluten, aiming to mitigate its risky aspects for public health. 

This study reviewed reports of ankylosing spondylitis (AS) following vaccination by searching Scielo, PubMed, and Web of Science (1966–April 2024). Only two articles were found, encompassing 3,862,339 participants and 910 post-vaccination AS cases (793 after COVID-19 vaccines and 117 after other vaccines, including 22 following influenza vaccination). The mean age was 45.7±18.7 years, and symptom onset occurred 2 (1–7) days post-vaccination. Preliminary evidence suggests vaccine-induced AS, warranting standardized prospective research.

Autoimmune diseases are heterogeneous, multifactorial disorders defined by a loss of immunological tolerance to self-antigens, resulting in chronic inflammation and tissue damage. Even though the immune system dysregulation most commonly elicits physical symptoms, neuropsychiatric manifestations are frequently observed in autoimmune diseases and are associated with increased morbidity, elevated mortality, and a marked decline in health-related quality of life. Although extensively characterized in systemic lupus erythematosus (SLE) due to its epidemiological relevance and diagnostic complexity, neuropsychiatric involvement holds clinical significance across a wider spectrum of rheumatologic disorders. The frequent co-occurrence of connective tissue disorders with mood and anxiety symptoms suggests shared etiological mechanisms. The early identification of neuropsychiatric manifestations in patients with chronic autoimmune diseases represents the cornerstone of clinical management, given the substantial impact these symptoms have on individuals already burdened by debilitating conditions. We reviewed the principal neuropsychiatric manifestations associated with selected systemic autoimmune diseases: the novelty of this research lies not only in its approach to autoimmune-related neuropsychiatric symptoms but also in the special emphasis placed on the immunopathogenic mechanisms potentially responsible for these manifestations and, more significantly, on therapeutic decision-making, including an evaluation of treatment strategies targeting immune dysregulation and their potential impact on the neuropsychiatric profile, to optimize clinical outcomes and ensure patients have a comprehensive cure.

Introduction: Folate, in its supplemental form as folic acid, plays a crucial role in cellular metabolism, DNA synthesis, and cell division. Folate deficiency can lead to elevated homocysteine (HHcy) levels, which contribute to endothelial dysfunction, atherosclerosis, and cardiovascular disease (CVD). Since CVD is a leading cause of mortality in patients with autoimmune rheumatic diseases (ARDs), investigating folate’s potential role in modulating disease progression and inflammatory processes is of clinical relevance. Objective: To review the current evidence on the impact of folate supplementation in patients with ARDs. Methods: A comprehensive literature search was conducted in PubMed, SciELO, and LILACS databases from 1965 to May 2023, using MeSH terms related to folic acid, folate, and various ARDs. The reference lists of selected articles were also screened to identify additional relevant studies. Results: Among all retrieved articles, only one randomized controlled trial met the inclusion criteria. The study included 26 patients, primarily women, with autoimmune hand osteoarthritis (AHO). Participants received either folate alone (6400 mg), folate plus cobalamin (6400 mg + 20 mcg), or a lactose placebo for two months. The combination of folate and cobalamin significantly improved handgrip strength compared with the other groups, achieving outcomes similar to nonsteroidal anti-inflammatory drug (NSAID) therapy but with fewer tender joints and no reported side effects. Conclusion: Current evidence on folate supplementation in ARDs remains extremely limited. The available trial suggests potential benefits of folate, particularly when combined with cobalamin, in symptom management for AHO. Given its low cost and favorable safety profile, further randomized, double-blind, placebo-controlled studies are warranted to investigate the efficacy of folate in managing pain and slowing disease progression in ARDs.

Intravenous immunoglobulin (IVIg) is a pooled product containing polyclonal IgG collected from the plasma of thousands of healthy donors. Originally developed as a replacement therapy for patients with humoral immunodeficiencies, IVIg has since been widely adopted in the treatment of several autoimmune and inflammatory conditions, owing to its extensive immunomodulatory and anti-inflammatory effects. IVIg exerts a wide range of actions by influencing multiple components of both the innate and adaptive immune systems. These include modulation of Fcγ receptor expression and function, inhibition of complement activation, neutralization of autoantibodies, regulation of cytokine networks, control of pro-inflammatory monocytes, and regulation of multiple immune cells, also through epigenetic modulation. Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) represents one of the most complex conditions in pediatric neuropsychiatry, involving the basal ganglia and characterized by a broad range of abrupt-onset neuropsychiatric symptoms, irrespective of the underlying infectious trigger. Recent clinical and translational studies indicate that IVIg can attenuate neuropsychiatric symptoms and restore immune balance in children with PANS. Randomized trials have produced variable results. Converging clinical and mechanistic evidence supports the potential therapeutic value of IVIg in selected patients with moderate-to-severe or relapsing disease. In this overview, we examine current data on IVIg use in PANS, emphasizing its immunological rationale, emerging clinical benefits, and the need for biomarker-guided studies to better identify responders and optimize treatment outcomes. 

Background: Pantothenic acid (PA), the dietary precursor of coenzyme A, plays a central role in mitochondrial metabolism, lipid regulation, and the synthesis of steroid hormones and neurotransmitters. Although PA has been traditionally applied in areas such as wound healing and immunomodulation, its potential therapeutic relevance in rheumatology has not been well characterized. Objective: To provide an updated overview of the clinical effectiveness, safety, and research gaps related to PA supplementation in rheumatic diseases. Methods: A structured search was performed across PubMed/MEDLINE, Web of Science, SciELO, and LILACS for human studies published up to July 2024. Eligible articles investigated PA supplementation in patients with rheumatic diseases and reported clinical outcomes. Key data relating to population characteristics, dosage, treatment duration, outcomes, and adverse effects were extracted. Results: Seven studies involving 183 participants were included: two focused on osteoarthritis (OA), one on fibromyalgia (FM), and four addressing systemic lupus erythematosus (SLE). PA was administered using heterogeneous regimens, generally in combination with other micronutrients, at doses ranging from 12.5 mg to 12 g/day and over variable follow-up durations. Clinical improvement was reported in most studies, especially in cutaneous lupus, in which substantial resolution of lesions was frequently observed. Benefits in fatigue in SLE and pain reduction in OA and FM were also noted. Adverse events were rare and predominantly mild. Conclusions: Available clinical evidence suggests that PA supplementation may provide symptomatic benefit in selected rheumatic diseases, with a favorable safety profile. However, current data remain limited by small sample sizes, lack of standardized protocols, and frequent co-supplementation. Well-designed randomized clinical trials—especially in SLE and OA—are required to determine therapeutic efficacy, optimal dosing, and mechanistic pathways.