News & Comment

Medication adherence in gout is low, and discontinuation of urate-lowering therapy puts patients at risk of flares and cardiovascular events. A strategy to regularly monitor serum urate levels and the dissolution of urate deposits (particularly if visualized by patients) might encourage adherence in the long term.

Multidimensional and single-cell profiling of peripheral blood and inflamed tissues is a powerful and high-resolution tool for the stratification of patients with autoimmune rheumatic diseases into distinct cellular and/or molecular endotypes. The road towards precision rheumatology is long, but the time has come to enter the territory of clinical validation.

Despite the transformative potential of treatments for systemic autoinflammatory diseases, these conditions remain underfunded and understudied. Urgent, coordinated action among stakeholders is needed to overcome regulatory and research barriers, as is innovation and advocacy for the development of effective therapies for these rare diseases.

As in rheumatoid arthritis, achieving low disease activity or remission in psoriatic arthritis (PsA) remains a challenge and unmet need for many individuals. However, the complex pathogenesis, heterogeneity and varied tissue involvement in PsA mean that dedicated definitions and novel solutions are required for difficult-to-treat disease.

Janus kinase inhibitors have therapeutic potential for patients with immune-mediated inflammatory diseases, and evidence of greater risks of cardiovascular disease and malignancy than with TNF inhibitors should be carefully considered before recommendations against their use are made. Assessment of the risk–benefit ratios in these patients can instead guide clinical decision-making.

Globally, rheumatic musculoskeletal diseases constitute the most common causes of disability, related morbidity and economic loss worldwide. A shortage of rheumatologists warrants education of primary care doctors in primary care rheumatology, public awareness initiatives and advocacy for rheumatic musculoskeletal health.

Biosimilars have an important place in the treatment of rheumatic conditions. The non-inferiority of biosimilars to bio-originators is ensured, but full and effective clinical adoption of these agents nonetheless requires consideration of several important issues, including the need for shared decision-making and a potential nocebo effect.

Since entering the clinic 25 years ago, biologic TNF inhibitors have transformed the outlook for people with rheumatoid arthritis and set the standard for all other targeted therapies. Despite changes to the therapeutic landscape, TNF inhibitors look set to remain an important treatment option for the foreseeable future.

IL-17 signalling regulates both protective and harmful immune responses; therefore, its complete inhibition can have adverse effects. Detailed consideration and fine-tuning of IL-17-inhibition strategies is needed to selectively regulate disease outcomes.

Individuals with chronic diseases that require constant medical support are particularly vulnerable during wartime and often remain so after the last shot has been fired. What consequences might the Russia–Ukraine war bring for rheumatology?

Combining the diverse expertise of clinical and scientific researchers from across Europe as well as patient representatives and pharmaceutical industry partners, the HIPPOCRATES consortium aims to characterize the molecular pathways underlying psoriatic arthritis in order to improve early diagnosis and precision treatment strategies for the disease.

Built by and for the research community, the Musculoskeletal Knowledge Portal (MSK-KP) offers researchers a single integrated platform on which to display, access, distill and explore results from large genomic and epigenomic studies to formulate hypotheses and accelerate the development of patient-centered therapeutics for complex, multi-factorial conditions such as osteoarthritis.

The Systemic Lupus International Collaborating Clinics–ACR Damage Index (SDI) has been widely used for 25 years. This index, however, has its limitations, providing a rationale for a global initiative to create a revised, updated SDI to capture organ damage across the age-spectrum.

The Human Cell Atlas (HCA) project aims to map tissues and organs during development, maturation and pathology at single cell resolution. The musculoskeletal HCA network is a community for fostering collaboration and shared expertise to help develop the therapeutic approaches needed to address the high global burden of musculoskeletal disorders.

The COVID-19 pandemic has compelled the global community to work together to understand SARS-CoV-2 and mitigate its effects, but it has also highlighted health disparities faced by people from minority racial or ethnic groups and other marginalized populations. International collaboration needs to be leveraged to address these disparities and inequities.

To gauge the relative efficacy of treatments, authors of review articles and commentary might attempt to compare results across clinical trials, but failure to recognize inherent differences across studies or apply proper statistical principles could yield flawed conclusions. Several approaches can mitigate the risks in these cross-trial comparisons.

Physical inactivity is common during periods of self-isolation, but for patients with rheumatic diseases, there are crucial benefits to be gained from maintaining an active lifestyle throughout the COVID-19 pandemic. Patients should be provided with support to maintain physical activity and avoid prolonged periods of time spent sitting.

The global COVID-19 pandemic has the potential to severely affect those with rheumatic diseases or who are taking immunosuppressive therapies. Information is lacking as to how these groups will fare if they become infected. A global alliance has rapidly formed to try to address this information deficit.

The World Health Organization (WHO) Essential Medicines List (EML) informs policy makers about which medications should be prioritized and is particularly important for countries with limited resources. However, the EML lacks vital medicines used in paediatric rheumatology, the inclusion of which could transform the lives of many children around the world.

For too long, the definition of ‘remission’ in rheumatoid arthritis has been distorted by the widespread use of an inadequate tool, with consequences for clinical care and for making sense of clinical trial data. Has the time come to move away from DAS28-defined remission?