Lupus nephritis (LN) is one of the common and severe complications of systemic lupus erythematosus. Characterized by diverse pathological patterns and variable clinical manifestations, LN presents significant challenges for disease management. Conventional immunosuppressive agents, while representing the classic therapeutic approach for LN, are associated with substantial limitations, including variable efficacy, high risk of relapse, and notable adverse effects. In recent years, the introduction of immunotherapeutic agents, particularly biologics, has inaugurated a new era of precision treatment for LN. By virtue of their high target specificity and favorable safety profiles, these agents are reshaping the therapeutic landscape of LN. This article reviews the current status and future prospects of precision immunotherapy for LN, aiming to provide insights for its clinical management.

The incidence of the opportunistic infection of pneumocystis carini pneumonia(PCP) in patients with autoimmune diseases has increased over recent years, because of the use of glucocorticoids, immunosuppressants, small molecule targeted drugs and biological agents. This group of patients show more rapid progress and higher mortality than human immunodeficiency virus positive patients with PCP. Sulfonamide is the first-line treatment for PCP. Many scholars advocate taking trimethoprim-sulfamethoxazole(TMP-SMZ) for prophylaxis of PCP. However, the adverse effects of sulfonamides and drug resistance cannot be ignored. This article reviews the risk factors for the development of PCP in patients with autoimmune diseases, the effectiveness of PCP prevention with TMP-SMZ, and adverse drug reactions, tolerance, and drug resistance.

Gut microbiota is indispensable for the maintenance of human immune homeostasis. Dysbiosis and translocation of gut microbes as well as aberrance of microbiome metabolites, which are commonly seen in many autoimmune diseases, are suggested to participate in the breakdown of immune tolerance and the excessive inflammatory responses. The involved mechanisms include immune equilibrium skewing, molecular mimicry, bystander activation and epitope spreading, which contributes to the initiation and progression of autoimmune diseases. In addition, the microbial biotransformation of antirheumatic drugs help determine the bioactivity and toxicity of these drugs. Herein, gut microbiota-based intervention may shed light on developing novel strategies for prophylaxis and treatment of autoimmune diseases. In this review, recent advances in exploring the potential pathogenic role of gut microbiota in autoimmunity are summarized and the prospect of applying microbiota-based intervention in systemic autoimmune diseases is addressed.