Volume 10 Issue 9, September 2014

Osteoarthritis (OA) is a heterogeneous group of diseases with different pathogenesis in different joints. What effect do metabolic factors, inflammation and obesity have on OA in non-loadbearing structures? A new study reports that, in the absence of knee OA, systemic processes are important in the pathogenesis of hand OA.

Stressful life events can change the clinical expression of rheumatoid arthritis (RA). Stress increases the proinflammatory load in healthy individuals and patients with RA. A new study demonstrates that short-term experimental stress transiently increases serum IL-1β and IL-2 levels in patients with RA, but how does stress affect chronic inflammation?

A study from the Netherlands has investigated the link between rheumatoid arthritis (RA) and subfertility, finding that more aggressive disease as well as NSAID or prednisone treatment is associated with an increased time-to-pregnancy. Should methodological confounders, such as gynaecological history and psychological factors, also be assessed?

Prevention of rheumatoid arthritis (RA) by intervening before the development of overt symptoms requires knowing which individuals are at risk of developing the disease. In this Review, Hunt and Emery consider several distinct at-risk cohorts, with a focus on those with systemic autoimmunity, and discuss the prospects for RA prevention in these cohorts drawing on lessons from disease prevention in other autoimmune conditions and early trials in RA.

In this Review, the authors discuss the development of screening tools, outcome measures and new pharmaceutical interventions for managing patients with psoriatic arthritis (PsA). Screening tools are suggested to enable referral from dermatology clinics to rheumatologists for the diagnosis of patients early in the course of disease, and to help identify the best drugs to treat this heterogeneous disease. The authors also discuss the distinctions and similarities of 'tight control' and a treat-to-target approach for the management of PsA.

Regulatory T (T_REG) cells can be subdivided into functional subsets. In this Review the authors apply advances in our understanding of mouse and human T_REG-cell biology to outline methods for T_REG-cell expansion and regulation. These techniques, which include antigen-specific expansion in vitro and in vivo, could soon be used to treat patients with autoimmune rheumatic diseases.

Rheumatoid arthritis (RA) is not just a disease of the joints and can be associated with ocular inflammatory conditions, including dry eye and scleritis. In this Review, the authors describe the immunopathogenic pathways that underlie ocular inflammation in RA, detailing commonalities in immune dysfunction between systemic and ocular manifestations.

Strategies to repair damaged intervertebral discs rely on the premise that these structures can be regenerated using cellular-based approaches. Here, Huang and colleagues highlight the importance of nutrient balance for maintenance of disc cell function and question whether disc repair can be successfully achieved in degenerate human discs where nutrient supply is compromised.

Active systemic lupus erythematosus (SLE) can manifest in heterogeneous clinical forms, making description of SLE clinical states difficult in patients with high disease activity. In this Opinion article, the authors argue the time has come to change the way SLE is managed by defining a treatment goal based on defining a low disease activity state, and they suggest possible inclusions in, and obstructions to, such a goal.