Viewpoint

The synovium is the primary target of disease in various forms of arthritis. In this Viewpoint, the authors discuss the possibilities of making a diagnosis based on clinical examination, routine laboratory tests, radiographic examination of the synovium, or by synovial fluid analysis or biopsy.

There has been much speculation on the potential use of kinase inhibitors, such as imatinib mesylate, for the treatment of autoimmune rheumatic diseases. Imatinib inhibits a select set of tyrosine kinases at submicromolar concentrations. In this Viewpoint, the authors discuss how imatinib could provide a potent therapeutic option for a variety of autoimmune and inflammatory diseases, for which current therapies are insufficient.

Patient-derived functional measures such as the Health Assessment Questionnaire (HAQ) are important tools in the assessment of general health, function, and disability in patients with rheumatic diseases, such as rheumatoid arthritis. In this Viewpoint, Dr Aletaha and Dr Smolen discuss the use of these measures and their derivatives in predicting outcome in patients with rheumatic disease.

Anti-TNF therapy is widely used for the treatment of rheumatoid arthritis, but whether or not it should be administered to patients with previous malignancy is not known. This Viewpoint article evaluates the existing literature to help physicians gauge the risks and benefits of initiating anti-TNF therapy in patients with rheumatic disease and a history of cancer.

A high percentage of patients with rheumatic diseases use complementary medicine, particularly traditional Chinese medicine. In this Viewpoint, Dr Tsang discusses how the efficacy of traditional Chinese medicine could be assessed, and proposes a collaboration between clinical scientists trained in traditional Chinese medicine and scientists trained in Western medicine.

Studies have shown that some patients with fibromyalgia can benefit from prescribed medication. In this Viewpoint, Dr Ferrari and Dr Russell discuss drug-seeking behaviour in patients with fibromyalgia, and how this affects prescribing patterns in the clinic.

Imaging techniques such as MRI and musculoskeletal ultrasound are becoming increasingly important in the management of patients with rheumatic disease. In this Viewpoint, Dr Freeston and Dr Emery discuss the role of advanced imaging modalities with regards to the use of biologic therapy in patients with rheumatic disease.

Juvenile rheumatoid arthritis is one of the most common chronic diseases of childhood. In this Viewpoint, Dr Connelly and Dr Schanberg discuss the limited knowledge regarding the widespread occurrence of pain in children with arthritis. Research into treatment with opioids in these patients has fostered clinical myths inhibiting optimum patient care.

Systemic lupus erythematosus is a disease triggered by environmental factors in individuals with a genetically predetermined alteration of the threshold for induction or maintenance of immune tolerance. In this Viewpoint, Professor Davidson discusses the immune activation pathways involved in systemic lupus erythematosus, and highlights the importance of understanding these pathways and their role in disease activity.

Tumor necrosis factor (TNF) inhibitors have changed the therapeutic standard of treatment for patients with rheumatoid arthritis. Despite the efficacy of these agents, a significant proportion of patients demonstrate an inadequate response to one or more TNF inhibitor. In this Viewpoint, Dr Keystone discusses the outstanding issues related to the scientific and clinical rationale for switching TNF inhibitors.

Although sciatica is usually caused by a mechanical abnormality, pathophysiologic considerations provide a sound rationale for local corticosteroid therapy. There is evidence that this treatment should be started early to prevent persistent nerve-root pain due to peripheral and central sensitization. In this Viewpoint, Dr Valat discusses the use of epidural corticosteroid injections in early sciatica.

Antimalarial drugs have been used for many years to treat rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. This Viewpoint will discuss the recent advances in understanding the mechanisms of action of hydroxychloroquine and the possibility of establishing toll-like receptor signalling molecules as targets for new therapies.

New insights into the etiology of rheumatoid arthritis have suggested that humoral autoimmunity might have a substantive, possibly even causal role in the pathogenesis of disease. In this Viewpoint, Dr Holers will discuss the basis of this hypothesis, focusing on the role of anti-cyclic citrullinated peptide antibodies.

Gene therapy suffers the negative perception of being unsafe, expensive and ultimately inapplicable in clinical practice. In this Viewpoint, the authors discuss the benefits of gene therapy being used to treat rheumatic disease, and the requirements that have to be satisfied in order for this to become a clinical reality.

Tumor necrosis factor (TNF) inhibitors have proven highly effective in improving the signs and symptoms of rheumatoid arthritis, in inhibiting the progression of joint damage, and improving patients' quality of life. This Viewpoint will discuss the major concern relating to the actual use of TNF inhibitors in the clinic: their relatively high acquisition costs.

The introduction of tumor necrosis factor antagonist therapies has transformed expectations for the management of rheumatoid arthritis. Although all available agents have demonstrated comparable clinical efficacy, heterogeneity of response and treatment failure has been observed in up to 40% of patients. This Viewpoint will discuss the use of alternative TNF-blocking therapy in patients who have failed treatment.

Randomized, blinded, controlled experiments have often been considered the highest level of evidence in the methodological hierarchy. This Viewpoint discusses the strengths and limitations of both observational studies and randomized controlled trials, and the benefits that can be gained by researchers and clinicians through the appreciation of both methods.

Chronic back pain has a huge impact on health-care systems and governments globally, being responsible for millions of days of lost work and disability. In this Viewpoint, Dr Hadler discusses how improved patient management and workplace policies can help reduce the escalating costs that are associated with this condition.

MRI shows great promise as a scoring system for spinal inflammation in ankylosing spondylitis. This Viewpoint discusses the progress in the development of MRI scoring methods and the prospective use of MRI as a tool to evaluate disease activity in patients with ankylosing spondylitis.

There have been many exciting advances in tissue engineering. This Viewpoint discusses the future application of this technology in the chronic rheumatic diseases, focusing on the advantages of methods of cartilage regeneration, such as scaffolds, gels, cell-seeding, fibers or cell cultures.