Volume 7 Issue 5, May 2011

After a half-century wait, a new drug has been approved for the treatment of systemic lupus erythematosus. The success of belimumab could bolster the feasibility of B-cell-targeted approaches to treating the disease.

Calcium pyrophosphate disease remains—50 years after its initial description—a challenging disease to diagnose and manage. Newly-reached consensus among European experts suggests standard nomenclature, some recommendations for diagnosis and treatment, and an ambitious future research agenda based on these decisions.

Nonpharmacological therapies are important in the management of hand osteoarthritis, but high quality evidence upon which to base guidelines for their clinical use has been lacking. A systematic review confined to such studies highlights the strengths and gaps in research in this field.

Although, overall, joint damage correlates with physical disability in rheumatoid arthritis, damage to cartilage and to bone might contribute unequally. New data suggest that cartilage damage has the greater influence on disability, but—besides questions about the practical consequences of this finding—further studies are needed to exclude potential confounders.

The potential of epigenetics to explain the complex links between environmental triggers and genetic susceptibility is captivating researchers in many diseases. As this article describes, considerable evidence suggests that aberrant epigenetic modifications contribute to pathogenesis of these diseases, and drugs that can reverse such changes are a tantalizing prospect for future therapy.

The next challenge in rheumatoid arthritis (RA) therapy is the maintenance of disease remission with a minimal-treatment regimen. In this Review the authors propose that this goal could be achieved by restoring a state of immune tolerance and discuss antigen-independent and antigen-specific approaches for the induction of tolerance in the treatment of RA.

Serum level of C-reactive protein (CRP) is commonly measured in rheumatology practice, but it is perhaps less widely appreciated that CRP level is influenced not only by underlying inflammation but also by genetic variation, with possible consequences for clinical decision-making. Mounting functional and genetic evidence also implicates this protein in the pathogenesis of systemic lupus erythematosus.

As the number of patients with childhood-onset rheumatic diseases who survive into adulthood has improved markedly over the past few decades, the long-term effects of these diseases have become an important focus of research. In this Review, the authors describe the most recent outcome data for several pediatric rheumatic diseases in terms of disease activity, functional and quality of life outcomes.

Stratifying patients with myositis into clinically meaningful subtypes would be ideal for enabling research into pathogenic mechanisms and targeted therapies. Incomplete knowledge of the molecular pathways that underlie myositis, inappropriate classification criteria and a lack of specific agents have all been mutually hindering progress in treating these diseases, but, as the authors explain in this Review, insights into the mechanisms—immune and nonimmune—involved in myositis are precipitating wider progress in the field.

The disparity in the occurrence of rheumatoid arthritis (RA) between men and women is well documented, but the reasons for this difference remain poorly understood. In this article, the authors discuss the factors that might explain the sexual dimorphism of RA, including genetic, endocrine and behavioral differences, and how improving our understanding of the influence of these factors might lead to the development of novel treatments for patients with this disease.