Volume 5 Issue 9, September 2009

New research reports that primary human dermal fibroblasts seeded into a three-dimensional biodegradable matrix can differentiate in vitro into osteoblasts and chondrocytes, and form three-dimensional bone-like and cartilage-like constructs, respectively. Is skeletal tissue engineering from skin biopsy tissue on the horizon?

The latest guidelines from the American Pain Society (APS) provide a comprehensive analysis of the evidence on the use of interdisciplinary rehabilitation and surgical and interventional procedures for the treatment and diagnosis of chronic low back pain. But will they have any impact on clinical practice?

The degree to which the elevated risk of malignant lymphomas in patients with rheumatoid arthritis (RA) is related to disease activity or to therapy is uncertain. Evidence is mounting in support of a strategy of more-intensive cancer screening in these patients.

Clinical tests of the novel small-molecule inhibitor of p38α MAPK, VX-702, have resulted in an all-too-familiar outcome: modest clinical efficacy and transient inhibition of inflammatory markers. Why have p38α inhibitors failed, and what can we learn about the regulation of signal transduction pathways in inflammatory arthritis?

What is the relationship between genetic and environmental risk factors in predisposing for rheumatoid arthritis (RA)? A new study provides more details on the interaction between the HLA DRB1 shared epitope (SE) alleles and smoking in conferring the risk of autoantibody-positive RA.

Medications that inhibit gastric acid secretion are standard co-therapy with NSAIDs, but evidence is emerging of a link between prolonged use of these agents and an increased risk of hip fracture.

The results of two new studies suggest mutations in the gene encoding the interleukin (IL)-1 receptor antagonist (IL-1Ra) are responsible for a spectrum of childhood inflammatory disorders characterized by an imbalance in IL-1 expression. What implications do these intriguing results have for the diagnosis and management of IL1-driven inflammatory disorders?

Patients with Paget disease are often asymptomatic, but some experience considerable morbidity in the form of bone pain and skeletal deformity, as well as a variety of regional complications. Bisphosphonates are an effective treatment for Paget disease, but questions still need answering as to when and when not to treat symptomatic and asymptomatic patients with this potentially painful and deforming disease.

In patients with rheumatoid arthritis, the benefits of tight control of inflammation to prevent or delay joint erosion are clear. Markers predictive of erosive disease enable physicians to identify those patients who would benefit most from aggressive therapy, thus avoiding unnecessary risks and costs associated with this intensive treatment approach. This Review discusses various prognostic factors as well as issues that confound their identification and application.

The risk of experiencing a fracture is lower in men than in women beyond the age of 50 years, but the burden of fractures is, nevertheless, substantial in men. This difference in fracture incidence is likely to be accounted for by differences in bone-related and fall-related factors, which are outlined, along with other data relating to the epidemiology, pathophysiology and treatment options for osteoporosis in men, in this Review.

Sensorineural hearing disorders are more common in patients with rheumatic disease than in the general population, so it is important that rheumatologists know how to diagnose and treat these comorbidities. In this Review, the categories of sensorineural hearing loss are introduced, and diagnostic and therapeutic approaches for these disorders are outlined.

Song and colleagues describe the diagnosis and treatment of a 50-year old man with pansclerotic morphea with immune-mediated bone-marrow failure and cytopenias. Although standard therapies for fibrotic skin disorders were ineffective, the patient responded to T-cell-targeted treatment with antithymocyte globulin.

Clinical guidelines and recommendations, as well as clinicians and patients, consider non-pharmacological modalities to be the mainstay of treatment for osteoarthritis (OA). Despite this consensus in opinion, however, the evidence base for the non-pharmacological management of hand and hip OA continues to lag far behind that for knee OA, which suggests that more research is required to optimize the management of hand and hip OA.