Volume 12 Issue 3, March 2016

The new ACR guideline for the treatment of rheumatoid arthritis (RA) is technically solid, but the new recommendations miss some of the most topical issues in RA therapeutics. The fact that evidence from many high-quality clinical studies in RA was not deemed sufficient to support stronger recommendations is also worrying.

A new study attributes the pathogenicity of anti-Ro60 autoantibodies and type I interferon in systemic lupus erythematosus and Sjögren syndrome to Alu retroelements, but is this RNA the complete story?

Systemic sclerosis (SSc) is characterized by an abnormal immune response to innocuous antigens that might lead to autoantibody production. New observations suggest that nucleosomes can mediate both IgG production and B-cell proliferation, via Toll-like receptor signalling, and thereby affect the pathogenesis of SSc.

Polymyalgia rheumatica (PMR) is an inflammatory disorder of unknown aetiology that can be extremely disabling when active. Glucocorticoids are currently the therapy of choice for patients with PMR, but responsiveness to treatment varies considerably. The identification of different morphological patterns of disease defined by distinct extracapsular or capsular-based inflammation might, at least in part, explain this variability in responses to treatment.

Nephritis remains an important cause of morbidity and mortality in many patients with systemic lupus erythematosus (SLE), but knowledge of the factors contributing to the heterogeneity of kidney disease in these patients has been lacking. This article outlines various pathogenic pathways that contribute to renal damage in SLE and explains how disease phenotyping based on these mechanisms could lead to the novel and individualized therapies for patients with lupus nephritis.

The bone marrow niche is a unique microenvironment that integrates the physiology of the skeleton and the marrow to maintain the haematopoietic stem cell pool and support whole-organism homeostasis. Reagan and Rosen examine the features of this microenvironment and the consequences of its disruption, particularly in relation to invasion by cancer cells, and discuss how better understanding of the niche could inform treatments for various disorders including skeletal diseases and malignancies.

The mechanistic target of rapamycin (mTOR) pathway has a central role in cell activation, particularly in cells of the immune system. Discovery of the involvement of mTOR in the pathophysiology of several human disorders has led to the development of inhibitors and upstream regulators of this pathway to treat autoimmune and hyperproliferative pathologies — hallmarks of rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus.

During the past 35 years rheumatology in Korea has progressed remarkably swiftly in terms of academic activity, clinical practice and health care. However, the future of rheumatology in Korea requires continued efforts by rheumatologists, as well as government support, to enable translation of advances in basic research to clinical practice and promote the development of new treatments and technologies targeting rheumatic diseases.