Reviews & Analysis

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.

Risk factors-genetic and environmental-for rheumatoid arthritis (RA) are gradually becoming clear, leading to considerable heterogeneity in the pathological processes and clinical features of this disease. Preclinical abnormalities can precede manifestation of symptoms by a decade. Precisely how endogenous predisposing factors interact with environmental triggers to produce clinical disease remains unclear, but the authors of this Review unite diverse strands of research to present a state-of-the-art mechanism for RA pathogenesis.

Peripheral neuropathy is a common neurological disorder that can be observed in the context of a range of rheumatic diseases. In this Review, Vallat and colleagues provide a broad overview of the different types of peripheral neuropathy that can be associated with rheumatic disease, with a particular emphasis on recognition and diagnosis of the condition.

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.

Osteoporosis and vascular calcification share a number of pathogenetic mechanisms. In this article, the authors discuss the pathophysiology of the interaction between these two processes, and review clinical evidence that confirms the correlation between osteoporosis and cardiovascular disease.

MicroRNAs (miRNAs) function in several chronic diseases—miRNA-mediated fine control of genetic networks involved in tissue development and homeostasis becomes disrupted. Participating in production and maintenance of articular chondrocytes and skeletogenesis, miRNA are increasingly implicated in the pathogenesis of osteoarthritis. Data from animal and cell studies are discussed in this Review, alongside the potential for targeting miRNA in the clinic.

Establishing a standard definition of systemic lupus erythematosus is a continuously evolving challenge for researchers. How does the latest set of classification criteria compare with previous endeavours?

Platelets have an established function in haemostasis, but their role in the development of rheumatic disease is only now emerging. In this focused Review, Boilard and colleagues describe how platelets, and platelet-derived microparticles, contribute to the development of arthritis and systemic lupus erythematosus, highlighting the key advances in the literature and the future of this field.

Subchondral bone remodelling in osteoarthritis (OA) is biphasic and spatially variable. Early-stage disease is associated with bone loss owing to increased bone remodelling. As disease progresses, the remodelling rate slows down leading to densification of the subchondral plate and complete loss of cartilage. In this article, Burr and Gallant review the current knowledge on OA and discuss the role of subchondral bone in the initiation and progression of disease. They also present a hypothetical model of OA pathogenesis.

The past decade has seen exciting progress in the management of lupus nephritis, a manifestation of systemic lupus erythematosus that accounts for its major morbidity and mortality. The American College of Rheumatology has issued new guidelines for screening and treatment of lupus nephritis, based on expert recommendations.

Gout is often poorly managed, with low rates of successful long-term urate lowering. A new 'package of care' intervention for treatment of patients with gout now offers ways to improve outcomes. The intervention, involving both a rheumatologist and gout nurse specialist, provides a framework for best practice in gout management.

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.

The performance of the CASPAR criteria, which are known to have high specificity and sensitivity in classifying patients with long-standing psoriatic arthritis, has now been evaluated in early disease. Whereas the findings are likely to boost clinical research, implications for daily practice—and diagnosis—are less certain.

Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders that commonly occur in the elderly and whose disease patterns variably overlap. In this Review, Salvarani and colleagues describe the main clinical features of both PMR and GCA, detailing the pathogenesis, diagnosis, classification and management of these disorders, offering practical guidance to clinicians.

Analysis of a national US database suggests that patients with JIA are at increased risk of serious infection, and that this risk is further increased by treatment with glucocorticoids. By contrast, therapy with methotrexate or TNF inhibitors does not increase this risk, and might even reduce it through steroid-sparing effects.

Antimalarial agents are mainstays in the clinical management of systemic lupus erythematosus, and have been in routine use for more than 50 years. This Review summarizes recent insights into the mechanisms of action of these agents and their clinical implications.

In this article, the authors propose that clinical teams in the rheumatology setting are well-placed to facilitate self-management—and thereby improve health outcomes—by applying basic cognitive–behavioural techniques to helping patients manage disease-related psychological challenges and the impact of symptoms on their daily lives.

Paediatric systemic lupus erythematosus (SLE) has higher morbidity and mortality than adult-onset SLE. Interestingly, a new paper reinforces these differences between adult and childhood disease, but reasons for the more severe phenotype in children are varied and poorly understood.

Tissue engineering and regenerative medicine hold great promise for the treatment of joint and cartilage destruction in rheumatic disease. Here, the authors describe the progress in this field, focusing on the clinical aspects of these emerging therapies and exploring the scientific and regulatory challenges in translating these tissue engineering approaches to the clinic.

Osteoporosis can be secondary to an underlying metabolic, nutritional, pharmacologic or disease-related cause; in such cases the triggering factor should be identified and treated. Approaches to the identification and management of patients with secondary osteoporosis are outlined in this Review, alongside mechanistic insights into the bone pathology.