Volume 10 Issue 1, January 2014

New studies demonstrate the development of anti-flagellin antibodies in patients with ankylosing spondylitis. Does their presence point to mucosal dysregulation as a pathogenic mechanism of the disease?

The 2013 update of the EULAR recommendations for the treatment of rheumatoid arthritis has evolved in several domains, and has, for the first time, elevated non-TNF-inhibitor biologic agents to the same status as TNF inhibitors. These transparently derived and scholarly recommendations will contribute to the evolving dialogue on the proper use of these agents.

The association of environmental dietary factors and polymorphisms of urate transporters with an increased risk of gout has been well established. Nevertheless, the influence of genetics and diet on serum urate concentrations, and the clinical relevance to individual patients, seems to be limited.

If a drug is intended to work in a joint, then direct injection seems likely to be an appropriate route of delivery, to minimize adverse events and limit the amount of therapeutic agent required. Ensuring such a drug remains in the joint long enough to produce an effect, however, is another matter. Successes seen, lessons learned, and developmental prospects in intra-articular therapy are explored in this Review.

Despite our increased knowledge of the complex pathways of immune dysregulation that occur in systemic lupus erythematosus, advanced-phase clinical trials of new biologic agents have repeatedly failed to achieve their clinical end points. In this Review, the authors discuss the progress and pitfalls that have been faced by some of the investigational treatments in this field.

Autoantibody testing is key for the diagnosis, classification and management of systemic autoimmune rheumatic diseases; however, issues regarding the reproducibility and reliability of these tests currently limit their usefulness. Approaches to harmonize autoantibody tests, including the development of technical guidelines and the availability of suitable reference materials for calibration and quality control, are discussed in this Review.

Intervertebral disc (IVD) degeneration is a common cause of back, neck, and radicular pain. High levels of a number of inflammatory cytokines that are secreted by IVD cells characterize, and are involved in the pathogenesis of, IVD degeneration. In this comprehensive Review, the authors describe the key inflammatory cytokines that are involved in different phases of disc degeneration, and they describe the outcomes of the clinical studies that have investigated blocking cytokine function.

Comparative effectiveness research (CER) takes the clinical characteristics of patients into account to determine the most beneficial treatments. Here, the methodological approaches and the analytical challenges of CER are described, as well as the considerations needed to ensure high-standards of CER in rheumatology.