Volume 5 Issue 8, August 2009

As of May 1, 2009, PubMed listed approximately 30,000 citations on the topic of vitamin D in humans, highlighting the medical community's avid interest in this field. Two articles published in the Archives of Internal Medicine diverge with previous reports on the prevalence of hypovitaminosis D and the capability of vitamin D to reduce fractures.

In April 2009, efalizumab was withdrawn from the market for the treatment of psoriasis after reports emerged of an association between long-term therapy and the development of progressive multifocal leukoencephalopathy (PML). This event highlights an urgent need for greater awareness and research into the screening, diagnosis and treatment of this potentially fatal disease in patients undergoing immunosuppressive therapy for chronic inflammatory disorders.

Molecules involved in developmental signaling pathways have emerged as therapeutic targets for various rheumatic diseases. New research sheds light on the consequences of interfering with these processes.

Several high-profile institutions are now following the trend of limiting doctors' ties to industry by way of implementing stringent new guidelines. But do the recommendations go far enough?

The choice of optimum second-line DMARDs for patients with rheumatoid arthritis is fraught with challenges. The implementation of evidence-based guidelines designed to inform clinicians' decisions requires careful consideration of several important issues.

New clinical guidelines incorporate the concept of absolute fracture risk, an important advance in the field of rheumatology. This Review article discusses the background, history and recent advances in the use of absolute fracture risk assessment in the management of patients with osteoporosis.

B-cell-directed therapies for autoimmune diseases have been the focus of extensive research during the past few years. In this Review, the authors discuss therapies that directly and indirectly target B cells. They outline clinical experience to date, mechanisms of action at the cellular level and possible issues of relevance to the efficacy and safety of these therapeutics.

The signaling pathways regulating the closely linked processes of adipogenesis and osteoblastogenesis are controlled by numerous transcription factors. This article focuses on the role of peroxisome proliferator activated receptor γ in the promotion of adipogenesis, and the Wnt–β-catenin and noncanonical Wnt signaling pathways in the promotion of osteoblastogenesis, and the crosstalk between these pathways.

A tripartite sensing apparatus, comprising Toll-like receptors, retinoid acid-inducible gene-I-like receptors and other cytosolic nucleic acid sensors, and nucleotide-binding and oligomerization domain-like receptors, has evolved to bring about an immediate but short-lived defense response to microbial pathogens and their products. The main components of these three systems and their function in detecting cellular danger are outlined in this article.

This Case Study presents a 70-year-old woman who was administered etanercept to treat rheumatoid arthritis that was active, despite therapy with conventional DMARDs. During follow-up, the patient's symptoms improved but she developed weakness and numbness in her arms and legs. Investigations revealed a mass in her cervical spine, which was histopathology confirmed to be a benign meningioma.

Since the 1970s, rheumatologists have increasingly reported seeing patients with milder onset of rheumatoid arthritis and a less-severe disease course than in preceding decades. Are these improvements attributable to earlier diagnosis, better therapeutic options, or simply a milder natural disease course? Uhlig and Kvien review the evidence for the perceived decrease in disease severity and discuss the potential reasons for this phenomenon.