Immunometabolic dysregulation in autoimmune rheumatic diseases: the central role of glycolytic reprogramming in pathogenesis and traditional Chinese medicine therapy

Immunometabolic dysregulation has emerged as a key driver in the pathogenesis of autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis (RA), osteoarthritis (OA), and systemic lupus erythematosus (SLE). This review highlighted the central role of glycolytic reprogramming in driving immune cell dysfunction and disease progression. In RA, enhanced glycolysis promoted T cell dysregulation, synovial fibroblast activation, and macrophage polarization. In OA, glycolytic alterations in chondrocytes and synovial tissues were central to disease pathology, while SLE was characterized by metabolic shifts in podocytes, T cells, and NETosis processes. Traditional Chinese medicine (TCM) may be a promising therapeutic strategy by targeting glycolytic pathways to modulate immune responses and restore metabolic balance. Despite existing challenges, the integration of multi-omics and artificial intelligence (AI) may facilitate the development of personalized immunometabolic therapies. This review underscored glycolysis as a pivotal therapeutic target and advocated for interdisciplinary approaches in future ARD research.