Volume 8 Issue 12, December 2012

Arthropathy is a common manifestation of systemic lupus erythematosus (SLE), but remains poorly understood. Recent ultrasonographic evidence demonstrating high levels of joint and tendon pathology in SLE challenges our previous concepts of arthritis subtypes in this multisystem disease.

In the wake of publication of clinical data for new drugs in the management of lupus nephritis, European rheumatology and renal societies have issued new recommendations for management of this condition. Coming hot on the heels of American guidelines, how does this latest advice compare?

The emphasis placed on HLA-B27 positivity in classification criteria for axial spondyloarthritis has generated some concern over potential misclassification of patients with chronic back pain. The results of a recent study suggest that these worries could have some foundation, at least in regions with high HLA-B27 prevalence.

Aberrant expression of microRNAs is associated with the pathogenesis of systemic lupus erythematosus (SLE). In this Review, Shen and colleagues discuss the potential of microRNAs to act as biomarkers for the diagnosis and assessment of patients with SLE, as well as the future therapeutic potential of targeting miRNAs in the management of patients with SLE.

Pregnancy in women with systemic lupus erythematosus (SLE) is increasingly common, as patients' survival and quality of life improve. However, these pregnancies are associated with substantially higher risk of maternal and fetal morbidity and mortality than those in healthy women. Especially in the presence of anti-Ro, anti-La and antiphospholipid antibodies, increased fetal loss, premature births and neonatal syndromes including congenital heart block are major issues. Although success rates of pregnancies have increased considerably, pregnancy management in women with SLE is not optimal. This Review discusses the risk factors and outcomes and proposes a pregnancy planning strategy for women with SLE.

Noninvasive biomolecular imaging techniques, such as thermography, near-infrared imaging, PET and single photon emission CT (SPECT), can be used to detect the earliest biological and physiological changes that are associated with rheumatoid arthritis (RA). The authors describe these new imaging approaches, which could enable targeted intervention in early RA before the occurrence of irreversible joint damage.

Metabolic osteoarthritis (OA) is increasingly recognized as a subtype of OA, and its aetiology has much in common with that of metabolic syndrome (MetS). Indeed, as the authors explain in this Review, mounting evidence suggests that metabolic OA could be considered as the fifth component of MetS. The prospects for treating OA by tackling underlying metabolic disease are also discussed.

The association between coagulation and the immune system has been increasingly recognised to have a role in the development of inflammatory rheumatic diseases. The fact that the risk of venous thromboembolism is increased in patients with rheumatoid arthritis (RA) and citrullinated fibrinogen is an early autoantigen in RA indicates an adaptive immune response to coagulation factors in inflammatory rheumatic diseases. In this article, Hoppe and Dörner describes the pathophysiology of an induced procoagulatory state in inflammatory rheumatic diseases, discussing the roles of endothelial cell and platelet activation, and coagulation and fibrinolytic systems, and providing insights into future research for innovative therapeutic interventions.

Alongside great sporting achievements, unfortunately, are inadvertent unwanted effects, as intense physical training in elite athletes can lead to long-term musculoskeletal issues. Here, Bennell and colleagues provide insights into the long-term consequences of sporting activity on the joint, in particular osteoarthritis, and describe how best to prevent and manage this damage in athletes.