Systemic vasculitis: one year in review 2026.

Systemic vasculitides are rare, heterogeneous inflammatory diseases associated with significant morbidity due to vascular and end-organ damage.In 2025, major advances have refined pathogenic insights and therapeutic strategies across large-vessel vasculitis (LVV), ANCA-associated vasculitis (AAV), single-organ vasculitis, and cryoglobulinemic vasculitis (CV). Multi-omics and spatial transcriptomic approaches, imaging, and serological biomarkers are informing prognosis and management.Glucocorticoid minimisation remains a unifying therapeutic goal. Targeted therapies such as JAK inhibitors, avacopan and anti-IL-5/IL-5R agents have demonstrated efficacy and steroid-sparing effects in both trials and real-world studies. Together, these advances mark a transition toward precision, phenotype-driven management in systemic vasculitis.