Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain
the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in
Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles
and JavaScript.
Although tens of millions of individuals worldwide use NSAIDs daily, balancing the competing risks and benefits of these agents continues to be a challenge. Evidence-based treatment guidelines and expert opinions have been promulgated, but will they actually translate to improved patient care? A new web-based tool could aid physicians' treatment decision-making.
In patients with active rheumatoid arthritis despite therapy with DMARDs, treatment with a spleen tyrosine kinase inhibitor has achieved similar response rates to those achieved in clinical trials of other drugs, including biologic agents. Where might these agents fit in the current armamentarium against this disease?
A substantial proportion of patients with rheumatoid arthritis do not respond to tumor necrosis factor blocking therapy. Results of a large genome-wide association study demonstrate evidence of novel genetic factors that determine response to treatment, which could provide a basis for individualizing therapy.
Antirheumatic agents are associated with a wide range of hepatotoxic effects. Research insights into susceptibility to hepatotoxicity and understanding of the interaction between drug, host and environmental factors involved in the pathogenesis of these adverse reactions could enable their mitigation or prevention.
Programmed cell death (PCD) is a vital process in the development and maintenance of immune cell populations. In this Review, the authors describe some of the major mechanisms of apoptosis, the role of defective PCD in autoimmunity, and the potential of therapeutic targeting of apoptosis pathways in patients with rheumatic diseases.
Recent experimental evidence has indicated that mitochondrial function is impaired in chondrocytes from patients with osteoarthritis (OA). In this Review, the authors discuss how this mitochondrial dysfunction might affect pathogenetic pathways in OA, such as cartilage degradation, and whether the mitochondria might provide useful prognostic or diagnostic biomarkers or act as potential targets for therapy in patients with OA.
Immunological memory is a cornerstone of the defence against pathogens, ensuring that repeated exposures to an antigen produce faster, more robust responses. Might chronic autoimmune diseases likewise owe their persistence and reactivation to an equivalent cellular memory? In this Review, the authors summarize the current understanding of long-lived autoreactive plasma cells, including how they are generated and where they reside, and explore their implications for the treatment of autoimmune disorders.
The natural history of untreated Lyme arthritis is rarely observed as most cases are successfully treated with antibiotics. This Case Study discusses a patient with Lyme disease who refused antibiotic therapy during the first 4 years of her illness and demonstrates that antibiotic therapy is still likely to be effective, even following a long-term infection withBorrelia burgdorferi.
MRI has emerged as an important tool for the assessment of rheumatoid arthritis, and in research has had a clear impact on how the disease process is understood. In this Perspectives article, the authors consider the role of MRI in the evaluation of rheumatoid arthritis, including pathogenesis, diagnosis and outcomes of therapy, and examine the issues that surround the use of MRI in clinical and research settings.
