Volume 7 Issue 10, October 2011

Cyclo-oxygenase (COX) inhibitors are associated with increased cardiovascular risk, and are, therefore, contraindicated in patients with a previous myocardial infarction (MI). Although NSAIDs might induce a similar cardiovascular risk, some guidelines suggest that they can be administered safely for a short period of time. But is this really true?

Irksome to debilitating, fatigue is a frequent symptom of rheumatoid arthritis (RA). Patients regard it as an important, neglected facet of the disease. An analysis of the effect of biologic therapies on fatigue has yielded disappointing results—do current treatments lack efficacy, or are we failing to measure adequate parameters?

Systemic lupus erythematosus is frequently associated with neuropsychiatric syndromes, which can have a serious impact on the quality of a patient's life. Several methods are used to characterize cognitive impairment in these patients; however, studies have identified flaws in these assessments, highlighting the careful consideration needed when undertaking neuropsychological testing.

Rituximab has emerged as an alternative to cyclophosphamide for remission induction in anti-neutrophil cytoplasmic antibody-associated vasculitides, with recommendations now developed to direct its use in these diseases. However, data from extended clinical trials are required to determine whether rituximab is safer or more efficacious than cyclophosphamide in the long term.

The microbes that inhabit our bodies play an important part in regulating the homeostasis of the immune system—disequilibrium in this symbiotic relationship can lead to development of disease. In this Review, the authors present an overview of the historical evidence implicating microbes in the development of rheumatoid arthritis (RA), and describe how the use of DNA sequencing techniques and germ–free animal models of disease are elucidating the role of host–microbial interactions in the pathogenesis of RA.

Cartilage damage frequently occurs during aging, and represents a known risk factor for the development of osteoarthritis (OA). In this Review, the authors discuss the homeostatic processes that maintain cartilage, how these become defective with age, and how these malfunctions can contribute to the development of disease. The tantalizing prospect of augmenting homeostatic mechanisms as a new therapeutic strategy against joint aging and OA is introduced.

Untreated psoriatic arthritis can have severe long-term consequences, and patients benefit from early intervention. The disease typically presents as psoriasis initially, so dermatologists are ideally placed to manage such interventions, and should coordinate with rheumatologists to ensure optimum patient care. Treatment guidelines and assessment tools from dermatology consortia are among the patient management aspects discussed in this Review.

Periprosthetic osteolysis is a common reason for failure or revision of joint replacement surgery, and is a result of the inflammatory reaction to debris particles generated by wearing of the implant over time. In this Review, the authors describe the cellular and molecular mediators of this process and how it might be prevented or treated.

An individual's risk of developing cardiovascular disease is somewhat dependent on their ethnic origin, and is increased by the presence of inflammatory rheumatic disease. However, little is known about the relative contributions of ethnicity and rheumatic disease activity to a patient's overall risk of cardiovascular morbidity and mortality. This Review explores known risk factors for, surrogate markers of, and the epidemiology of heart disease in Asian and non-Asian patients with rheumatic diseases.