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The diverse clinical symptoms associated with systemic lupus erythematosus (SLE) probably reflect its complex genetic underpinnings. Evidence from a new study indicates that analysis of common risk alleles can predict susceptibility to several end-organ manifestations of SLE, which could influence patient screening and support personalized approaches to treatment.
'Re-setting' autoimmunity through autologous hematopoietic stem cell transplantation is undergoing extensive clinical testing. A small randomized clinical trial in patients with systemic sclerosis now reports positive outcomes in all those treated with the therapy, compared with those receiving cyclophosphamide. Nevertheless, major questions about toxicity and long-term efficacy remain unanswered.
Repair of bone erosions in rheumatoid arthritis has been considered a difficult goal to achieve. However—with better therapies at hand to control synovial inflammation—sensitive μCT imaging techniques now available confirm that repair of bone erosion is possible, and begins at the base of erosive lesions.
Systemic sclerosis is associated with a high level of patient mortality. A promising prognostic model that could enable more effective management and improve survival was recently validated; however, the results demonstrate that choosing the best cohorts for development and validation of predictors of mortality is essential.
Advances in our understanding of bone remodelling have revealed a number of potential therapeutic targets in metabolic bone disorders such as postmenopausal osteoporosis. In this Review, Dr Michael Lewiecki describes these novel targets and the relevant experimental therapies that are at various stages of clinical development.
Biologic therapies, which have transformed the treatment of rheumatoid arthritis (RA) in the 21stCentury, have the potential to modulate immune responses and thus are associated with a risk of infection, as well as other adverse events. This Review summarizes the available safety data for all such agents approved for the treatment of RA, to assist clinicians in weighing potential risks and therapeutic benefits.
Developmental processes are emerging as a key element in the etiology and pathogenesis of osteoarthritis. In this Review, the authors describe the latest supporting evidence that links skeletal development with osteoarthritis, including the roles of chondrogenesis, patterning and joint formation in cartilage development and predisposition to osteoarthritis, and chondrocyte hypertrophy in cartilage degeneration.
Dermatomyositis is a connective tissue disease within the group of idiopathic inflammatory myopathies. Although juvenile and adult dermatomyositis share some disease features, they differ in several key aspects. In this Review, Robinson and Reed discuss the unique characteristics that differ between juvenile and adult disease, including clinical features, pathogenesis and treatment.
Juvenile systemic sclerosis (JSSc) is a relatively rare disease compared to its adult equivalent. As a result, much of our knowledge of the disease is derived from studies in adult. Our understanding of JSSc has improved over the past 5 years, but considerable challenges remain in determining the optimal diagnostic and therapeutic protocols in these patients.
