Metabolic-Immune Crosstalk in Pediatric Rheumatology: From Pathogenesis to Precision Therapy

The immune system and metabolic pathways are strongly interconnected, influencing each other in both physiological and pathological contexts. Nutrient signaling and cellular energy levels significantly impact immune system function, from activation to differentiation and survival. In children, where both the immune and metabolic systems are still developing, disturbances in this balance can markedly influence disease manifestation and treatment response. Recent advances in immunometabolism have revealed that metabolic dysfunction is not merely a consequence of inflammation but can also serve as a primary driver of immune dysregulation. Accordingly, this review explores how metabolic disturbances may mimic or modify rheumatic diseases, and, conversely, how immune-mediated disorders can disrupt metabolic homeostasis. Understanding this bidirectional relationship provides novel insights into pathogenesis and opens avenues for metabolism-based diagnostic and therapeutic strategies in pediatric rheumatology.