Reviews & Analysis

A new patient self-assessment tool shows promise as a simple measure of the overall impact of rheumatoid arthritis on a patient, but will it be able to gain the international acceptance required to become a clinical standard?

Joint injury represents a major risk factor for the development of osteoarthritis, but a link between severity of injury and the level of cartilage damage is difficult to test in humans. However, promising advances in our understanding of this relationship have been made with the aid of animal models of joint injury.

The assessment of children with juvenile idiopathic arthritis is a challenge for the clinician, in particular with regard to the ability to elicit patients' subjective values. The development of a new tool that provides an efficient and thorough overview of a patient's status could provide an important step forward.

A proportion of patients with lupus nephritis, a serious complication of systemic lupus erythematosus, progress to end-stage renal disease (ESRD). Despite major advances in treatment, the results of two new studies show that the incidence of lupus nephritis-associated ESRD has increased and outcomes have not improved in recent years.

New data unexpectedly suggest that sera from patients with PR3-ANCA-associated vasculitis are less reactive than those of healthy controls to the 'antisense' product of the PR3 gene. How does this result fit with the theory of autoantigen complementarity, and the proposed role of anti-idiotypic antibodies in the development of ANCA-associated vasculitis?

Glucocorticoids, such as prednisone, are often administered concomitantly with biologic agents for the treatment of rheumatoid arthritis. An evaluation of the main studies of biologic agents reveals that information about such therapy is insufficiently reported, which could have important consequences.

A decade and a half of rapid progress in treating rheumatoid arthritis (RA) has left clinicians with many options, yet few validated guidelines on how best to use them. What difference will new recommendations on the use of rituximab make to clinical practice?

Substantial recent advances in the treatment of juvenile idiopathic arthritis have enabled the development of validated recommendations for the appropriate and safe use of several therapeutic agents. These recommendations, developed by an international group of experts, could prove a valuable resource for physicians treating these patients.

Advances in therapy mean a state of remission is increasingly an achievable goal in rheumatoid arthritis. However, using remission as a target of treatment begs the question of how this state should be defined. The fruits of a transcontinental collaboration have brought a uniform definition a step closer.

Calcium pyrophosphate disease remains—50 years after its initial description—a challenging disease to diagnose and manage. Newly-reached consensus among European experts suggests standard nomenclature, some recommendations for diagnosis and treatment, and an ambitious future research agenda based on these decisions.

After a half-century wait, a new drug has been approved for the treatment of systemic lupus erythematosus. The success of belimumab could bolster the feasibility of B-cell-targeted approaches to treating the disease.

Although, overall, joint damage correlates with physical disability in rheumatoid arthritis, damage to cartilage and to bone might contribute unequally. New data suggest that cartilage damage has the greater influence on disability, but—besides questions about the practical consequences of this finding—further studies are needed to exclude potential confounders.

Given the risks associated with pregnancy for patients with systemic lupus erythematosus, advice about contraception is vital for this patient group; however, patient reports indicate serious gaps in the provision of such counseling services.

Nonpharmacological therapies are important in the management of hand osteoarthritis, but high quality evidence upon which to base guidelines for their clinical use has been lacking. A systematic review confined to such studies highlights the strengths and gaps in research in this field.

The establishment of new benchmarks for treatment outcomes promises to drive great advances in rheumatoid arthritis therapy, but data on 'real life' experience with biologic therapy demonstrate that geographic location influences the stage of disease at which these agents are initiated.

Seemingly contrasting genetic backgrounds in anti-citrullinated-protein antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA) support the notion that these are in fact two distinct disease subsets, with different underlying pathogenesis, that might need tailored treatment strategies.

OA is not a disease in short supply of phenotypic definitions. Indeed, numerous classification options complicate the design of genetic studies seeking associations within the obscuring array of heterogeneity. New recommendations offer some progress toward clarifying OA definitions, but much-needed guidelines are wanting.

A substantial proportion of patients with rheumatoid arthritis do not respond to tumor necrosis factor blocking therapy. Results of a large genome-wide association study demonstrate evidence of novel genetic factors that determine response to treatment, which could provide a basis for individualizing therapy.

In patients with active rheumatoid arthritis despite therapy with DMARDs, treatment with a spleen tyrosine kinase inhibitor has achieved similar response rates to those achieved in clinical trials of other drugs, including biologic agents. Where might these agents fit in the current armamentarium against this disease?

Several new recommendations for the vaccination of adults with autoimmune inflammatory diseases could represent an important step forward in the prevention of infections in these high-risk patients.