Viewpoint

Even well-performed systematic reviews do not necessarily provide informative guidance for patient care. In this Viewpoint, Professor Pincus and colleagues argue that evidence from observational research and clinical experience is needed to supplement clinical trials to improve health and outcomes for people with rheumatoid arthritis.

The author of this Viewpoint argues that there is currently insufficient evidence to guide the choice of therapy in rheumatoid arthritis, and highlights the need for large, simple, pragmatic trials designed to determine the best way to treat early or established rheumatoid arthritis, how aggressively to approach comorbidity, and how patients should be monitored.

In the treatment of rheumatoid arthritis, where can clinicians find the information to help them decide which drugs to use in what combination and when to use them? In this Viewpoint, the author argues that there is a need to look beyond short-term efficacy studies, and highlights several unanswered questions still to be addressed.

The biology of disc degeneration is complex. Some remarkable advances in molecular and cellular biology have recently been achieved in this rapidly evolving field and biological technologies for intervertebral disc repair are currently being developed. In this Viewpoint, Dr Peng discusses the problems that need to be resolved before these technologies can advance from the laboratory to clinical trials.

Most patients with chronic conditions, such as osteoarthritis, only have contact with healthcare professionals for a few hours over the course of a year. Good self-management programs are, therefore, critical for patients to cope with their conditions on a daily basis. Drs Osborne, Jordan and Rogers discuss the importance of engaging patients, clinicians and policymakers in the development and implementation of self-management programs.

Anti-tumor necrosis factor therapy is used to treat patients with psoriasis; however, use of this therapy for the treatment for other immune-mediated disorders has been associated with the onset of psoriasis or psoriasiform lesions in some patients. In this Viewpoint, Dr Laurindo and Dr Scheinberg discuss the clinical implications of, and potential explanations for, this paradoxical effect of tumor necrosis factor blockade.

This Viewpoint discusses the enrolment of patients into clinical trials as a means to provide access to medications that would not otherwise be available to them. Dr Romain argues that there are inherent problems associated with this mode of treatment.

Detecting and treating rheumatoid arthritis as early as possible in the disease stage can mean that long-term treatment might not be necessary. In this Viewpoint, Dr Liang and colleagues propose a novel method for the identification of persons with symptoms of early rheumatoid arthritis in the general population.

Current guidelines for classification of symptoms of neuropsychiatric systemic lupus erythematosus have not proven helpful for the dissection of pathological mechanisms of this disorder or the identification of appropriate therapy. A reclassification of symptoms is proposed in this Viewpoint; the new scheme is based on pathoanatomic localization of the disease.

In this Viewpoint, Professor van den Berg discusses cytokine control of the inflammatory and erosive processes of rheumatoid arthritis, and how insight into this control will allow the development of specific therapeutic tools to complement those already available.

The increase in viral epidemics leading to arthritis is evident. In his Viewpoint, Dr Calabrese discusses the role of the rheumatologist in the evaluation of ill travelers returning from exotic lands.

For patients with osteoarthritis, considerable changes occur before they can be visualised by plain radiography. MRI has been invaluable in improving our understanding of early joint changes, as is discussed in this Viewpoint.

Neuropsychiatric manifestations are present in approximately 70% of patients with systemic lupus erythematosus, and are often associated with a poor prognosis. In this Viewpoint, Dr Strous and Dr Shoenfeld discuss the potential role for autoimmune factors in contributing to neuropsychiatric expressions via direct and indirect autoantibody-induced neuronal damage.

Systemic scleroderma is one of the most severe chronic autoimmune connective tissue diseases. In this Viewpoint, Dr Deleuran and Dr Abraham discuss the importance of understanding the development, regulation and function of the type 17 T-helper subpopulation of CD4⁺T cells in order to explore treatment possibilities in systemic scleroderma.

Although the prognosis of patients with systemic lupus erythematosus (SLE) has improved over the past few decades, the increased occurrence of atherosclerotic vascular disease in these patients has become apparent. This Viewpoint discusses the increased risk of cardiovascular disease in patients with SLE, and how levels of risk can be assessed in order to determine the group of SLE patients most suited to preventative therapy with statins.

Many rheumatologists and other rheumatology health professionals find the management of patients with fibromyalgia syndrome (FMS) difficult. In this Viewpoint, Dr Scarbrough and Dr Crofford discuss whether or not rheumatologists should have a role in the diagnosis and management of FMS patients, and if so, how their improved knowledge of this condition can help patients receive optimal care.

The effects of biologic agents on the liver are both a cause for concern with regards to potential toxicity and an opportunity to discover new therapeutic opportunities, as is discussed in this Viewpoint.

Thalidomide was widely disparaged following recognition of its teratogenicity; however, its immunomodulatory activities have become increasingly apparent. At present, thalidomide is approved by the FDA only for use in the treatment of multiple myeloma and erythema nodosum leprosum. In this Viewpoint, Dr Lehman discusses reports in the literature which indicate that thalidomide is effective for a wide variety of immune-mediated conditions.

The main emphasis of research in osteoarthritis has been the delineation of the mechanism of articular cartilage degradation. In this Viewpoint, Dr Bailey and colleagues discuss the importance of bone in osteoarthritis, the focus of which has been neglected to date.

Glucosamine is indicated for the treatment of osteoarthritis, but questions surround its efficacy and long-term safety. In this article, Professor Wollheim discusses the results of recent trials, and provides his opinion on when glucosamine could be used.