Viewpoint

The widespread use of screening for circulating anti-neutrophil cytoplasmic autoantibodies (ANCA) in the diagnosis of ANCA-associated vasculitis has resulted in an increased occurrence of false-positive results and greater difficulty in the interpretation of such test results. Therefore, a rational strategy for ANCA testing is needed. The main problems with ANCA testing are discussed in this Viewpoint and some practical guidelines are given.

Evidence-based medicine and, primarily, data from randomized controlled clinical trials are continually regarded as the only valid sources for all clinical knowledge. This Viewpoint discusses the merits of 'practice-based evidence' and how this important information is currently undervalued in the clinical community.

There has been significant progress in the development of biological markers to assess joint and tissue damage in osteoarthritis. In this Viewpoint, Patrick Garnero discusses the developments in this field and how they will affect the future management of patients with osteoarthritis.

Trials investigating T-cell targeted therapies for rheumatoid arthritis have been of limited success. This Viewpoint considers whether or not the hypothesis that T cells are involved in the pathogenesis of rheumatoid arthritis is true and, if so, why trials so far have not led to an applicable therapy.

Pharmacogenetics is the study of the genetic characteristics that dictate drug response and toxicity. This Viewpoint discusses this rapidly advancing field that might improve the clinician's ability to match a patient with the right drug or drugs for their disease.

Choosing the correct management strategy for patients with rheumatoid arthritis in order to achieve the best possible outcome is a challenge to all rheumatologists. This Viewpoint considers current progress in the field of outcomes research in rheumatoid arthritis, along with future prospects of predicting individual patient response to therapy.

The standards of 'state of the art' in-office imaging are rapidly changing. This Viewpoint assesses the imaging techniques available for in-office use and highlights the obstacles that need to be overcome in this field in order for clinicians to have easy access to the right data in order to provide the best possible care.

There is increasing evidence that treatment in the early stages of rheumatoid arthritis can significantly increase the potential for positive patient outcome and prevention of irreversible damage. This Viewpoint considers the evidence that supports aggressive treatment for early rheumatoid arthritis and investigates the available treatment options.

Diagnosis of early rheumatoid arthritis can be significantly hastened by the screening for serological markers such as autoantibodies. This Viewpoint discusses the merits of this new field of serological screening, focusing on the anti-cyclic citrullinated peptide tests and their value as diagnostic tools for rheumatoid arthritis.