CAR-T cell therapy in rheumatic diseases

CAR-T cell therapy, originally developed to treat blood cancers, is now being explored as a treatment for autoimmune and rheumatic diseases. This therapy works by genetically modifying a patient’s T cells to produce special receptors (CARs) that help them target and destroy harmful immune cells.

The review discusses how CAR-T therapy could help in diseases like systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SSc). In SLE, it shows promise in removing harmful B cells and helping patients stay in remission. In tough-to-treat RA, it may kill immune cells that fuel the disease. For SSc, CAR-T therapy could target both abnormal B cell activity and tissue scarring (fibrosis), which are key parts of the illness.

There’s also growing interest in using CAR-T therapy for other autoimmune diseases like Sjögren’s syndrome and dermatomyositis.

While CAR-T therapy offers precise and long-lasting immune control, there are still challenges like serious side effects, immune reactions, and high costs. New approaches, like CAR-Tregs (regulatory T cells) and advanced gene-editing, might make the treatment safer and more specific.

More research and clinical trials are needed to confirm how effective, safe, and affordable CAR-T therapy is for autoimmune diseases. Still, this treatment has the potential to significantly improve care for patients with hard-to-treat rheumatic conditions.

SUMMARY:

CAR-T cell therapy, first used for blood cancers, is being explored for autoimmune and rheumatic diseases.

It works by modifying T cells to target and kill harmful immune cells.

Promising results have been seen in:

• SLE: Targets autoreactive B cells to maintain remission.
• RA: Helps eliminate disease-driving immune cells in tough cases.
• SSc: May reduce abnormal B cell activity and tissue fibrosis.

Potential applications are emerging in Sjögren’s syndrome and dermatomyositis.

Benefits: Targeted action, long-lasting effects, minimal overall immune suppression.

Challenges: Risk of cytokine release syndrome, immune toxicity, and high costs.

Future improvements may come from:

• CAR-Tregs (regulatory cells for better control),
• Gene-editing for more precision and safety.

More trials and long-term studies are needed to confirm effectiveness and affordability.

Overall, CAR-T therapy could transform treatment for difficult autoimmune diseases.

SOURCE: Patil, H., Bharadwaj, R.K., Dutta, N. et al. CAR-T cell therapy in rheumatic diseases: a review article. 2025 Clinical Rheumatology  https://doi.org/10.1007/s10067-025-07451-7