Health equity in rheumatology-the uneven landscape of cellular therapy

Cellular therapies may effectively "reset" the immune system and fundamentally alter the long-term course of chronic autoimmune rheumatic diseases. Clinical application in systemic lupus erythematosus resulting in drug-free remission has driven inquiry into other rheumatic disorders-systemic sclerosis, inflammatory myositis, Sjogren's disease-with early signals of significant therapeutic response. The substantial costs, complex manufacturing processes, and need for intensive patient monitoring limit cellular therapy delivery to certified academic centers-making it out of reach for many patients. The promise of remarkable therapeutic advances is therefore countered by the risk of deepening existing inequities, with limited access fueled by cost and compounded by the complexity of treatment. In this editorial, we argue that this early phase of cellular therapy in rheumatology presents a critical window for rheumatologists, trialists, industry partners and policymakers to embed equity into trial design, access frameworks and reimbursement pathways.