Volume 5 Issue 7, July 2009

Despite a lack of definitive evidence supporting their efficacy, nonselective immunosuppressive drugs are frequently prescribed for patients with systemic sclerosis (SSc). An analysis of data collected for a German registry provides a review of their experience with the use of these medications.

Consistent with evidence from trials in osteoarthritis of the knee, the results of a randomized controlled trial demonstrate that, for symptomatic hip osteoarthritis, a single intra-articular injection of hyaluronic acid is no better than placebo at alleviating pain.

The link between exposure to exogenous estrogen and the incidence of systemic lupus erythematosus is controversial, but new data suggest that the use of combined oral contraceptives could increase the risk of developing the disease.

Several studies have shown that tumor necrosis factor (TNF) inhibitors are associated with an overall increased risk of serious infections compared with standard immunosuppressive regimens in patients with rheumatoid arthritis (RA). A study by Strangfeld et al. adds specificity by showing a moderately increased risk of herpes zoster in patients receiving anti-TNF antibody treatment, and raises the question of whether live zoster vaccines should be utilized in this patient group.

According to a study by Chevalier and colleagues, a single intra-articular injection of anakinra is no more effective than placebo for treating the symptoms of knee osteoarthritis (OA). This result, however, should not deter future investigations of this agent for the treatment of patients with symptomatic knee OA.

The homeostatic processes of adipogenesis and osteoblastogenesis are tightly linked, as discussed in this Review. Research into the bone–fat network has led to the elucidation of pathways that could be pharmacologically targeted in an attempt to enhance bone mass and reduce osteoporotic fracture risk.

The use of high-resolution imaging techniques will lead to a better understanding of the relative contribution of the different hierarchical levels to bone competence. Such information could help improve predictions of fracture risk, clarify the pathophysiology of skeletal diseases, and define the response to therapy. This Review focuses on three-dimensional approaches to hierarchical biomechanical imaging in the study of microstructural and ultrastructural bone failure.

The treatment strategy for a patient with rheumatoid arthritis who plans to conceive or is already pregnant must be tailored according to not only disease activity but also which drugs are compatible with pregnancy. The safety of various therapeutic agents during pregnancy is discussed in this Review, as well as issues of handling inadvertent exposure to potentially fetotoxic drugs and managing flares of disease activity during pregnancy.

Mesenchymal stem cells (MSCs) are able to differentiate into chondrocytes, osteoblasts and adipocytes. As well as their potential use in tissue engineering, however, MSCs also potently modulate immune responses, exhibit healing capacities, improve angiogenesis and prevent fibrosis, at least partly by secreting several cytokines and growth factors.

Although major improvements have been made in the management of systemic lupus erythematosus, the numerous burdens associated with long-term disease have a significant impact both on individual patients and society as a whole.

Owing to the critical role of tumor necrosis factor in host immunity, patients receiving tumor necrosis factor inhibitors for the treatment of autoimmune disorders are at significantly increased risk of infection from a variety of pathogens. The authors review the evidence and provide expert opinion on how best to prevent opportunistic infections in this setting.