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Understanding the molecular endotypes that influence clinical phenotypes is a critical step for the stratification of patients with osteoarthritis (OA) into therapeutic subtypes that can help the development of targeted disease-modifying OA drugs (DMOADs) to provide genuine, long-term clinical benefit.
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.
