Volume 10 Issue 5, May 2014

Rheumatoid vasculitis is one of the most severe complications of rheumatoid arthritis. New data suggests that hydroxychloroquine and low-dose aspirin might be protective, but that there remains notable mortality despite intensive immunosuppression with cyclophosphamide or biologic agents.

What is the best rheumatoid arthritis therapy after failure of a first anti-TNF drug? No consensus has been reached on whether to switch to rituximab or an alternative TNF inhibitor. New observational studies suggest that either course can be effective. But are more data needed?

New data suggest that the first 2 years of treatment for giant-cell arteritis carry substantial risks, including myocardial infarction and death. Will these findings have implications for clinical practice?

Pathogenesis, treatment options and outcomes for antiphospholipid syndrome (APS) are poorly defined. A new observational collaborative study has analysed morbidity and mortality in APS, but, ultimately, the data that will guide us to optimally treat patients with APS are lacking. Here we provide a construct for future large-scale collaborative studies.

Most rheumatologists recognize the characteristic presentation of fibromyalgia in everyday clinical practice, but for other clinicians diagnosis can be difficult because of poor understanding of the nature of the condition and lack of familiarity with important clinical features. Simple and accurate criteria are essential to improve the study and management of fibromyalgia.

Despite the availability of effective treatments, the clinical management of gout is frequently suboptimal, leading to continued acute attacks and the risk of irreversible joint damage in many patients. In this article, the authors review the available treatments and barriers to successful management, and discuss how gout could be 'cured' by improving the current standard of care, with individualized management plans incorporating patient education, application of recommended best practice and shared decision-making.

Concerns have been raised over an association between biologic agents used in the treatment of rheumatoid arthritis (RA) and noninfectious serious respiratory adverse events, particular in patients with pre-existing RA-associated interstitial lung disease (RA-ILD). In this Review, the current evidence regarding the comparative pulmonary safety of the available biologic therapies is discussed and a framework to guide treatment decisions is provided. The authors also identify the considerable gaps in our understanding of the associations between biologic agents and RA-ILD, and propose a research agenda aimed at addressing them.

In this Review the authors provide an account of prostaglandin and leukotriene involvement in muscle health and function. Various components of the arachidonic acid cascade are discussed in relation to their effect on the pathogenesis of inflammatory muscular diseases. Selective modulation of individual components of these pathways are considered as potential therapeutic options for the treatment of polymyositis and dermatomyositis.

High-resolution peripheral quantitative CT (HR pQCT) has emerged as a unique way to evaluate bone and joints, by producing high-resolution, 3D images of cortical and trabecular bonein vivo. In this Review, the authors describe how HR pQCT is used in the evaluation of bone and joint diseases, together with an evaluation of its technical features, advantages, limitations, and potential in basic research, clinical trials and clinical practice.

With the advent of the internet and advances in social media and mobile devices, how people access information is rapidly evolving. In this Perspectives, Francis Berenbaum discusses the emerging uses of social media in medicine, with insights as to how social media is used in rheumatology in particular and how these developments are changing the way in which clinicians and patients interact.