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.
Substantial recent advances in the treatment of juvenile idiopathic arthritis have enabled the development of validated recommendations for the appropriate and safe use of several therapeutic agents. These recommendations, developed by an international group of experts, could prove a valuable resource for physicians treating these patients.
A decade and a half of rapid progress in treating rheumatoid arthritis (RA) has left clinicians with many options, yet few validated guidelines on how best to use them. What difference will new recommendations on the use of rituximab make to clinical practice?
Emerging data from cohorts of patients with recent-onset arthritis provide valuable information about the incidence and outcomes of early inflammatory disease, and about the risk factors for transition to full-blown rheumatoid arthritis, which could help improve the diagnosis and therapy of such conditions.
Anti-citrullinated peptide antibodies (ACPA) are an important feature of rheumatoid arthritis (RA), and the presence of these autoantibodies is associated with a more-erosive disease course. In this Review, the authors provide an overview of the discovery and development of ACPA as a biomarker in RA, and discuss the future research directions that might further enhance its clinical utility.
Traditional cardiovascular risk factors combine, in the context of inflammatory rheumatic diseases, with disease-related and treatment-related risk factors, to determine a patient's overall risk of cardiovascular disease (CVD). These competing risks are explored in this Review, which summarizes why CVD risk is increased in these patients, and what remains to understand before patients can be offered the best advice about CVD risk management.
Adapting to life with a chronic illness is difficult—rheumatic diseases can have profound effects on long-term quality of life. A patient's resilience to the challenges of chronic illness is determined by a number of factors that are increasingly understood, and which are outlined in this Review. The authors summarize developments in the psychological care of patients in clinical rheumatology practice, and describe novel approaches to optimizing this care.
Several models for the pathogenesis of systemic juvenile idiopathic arthritis have been proposed, but the mechanisms underlying this disease are unclear. As outlined in this Review, intensive research in these areas has provided intriguing new insights, but numerous issues remain to be addressed.
Autoimmune-like syndromes (AILS), such as lupus-like syndrome and inflammatory neuropathies, are occasionally seen in patients treated with tumor necrosis factor (TNF) antagonists, although the pathogenetic mechanisms underlying these syndromes are not well understood. In this article, the author suggests that infections might trigger, amplify or mimic AILS in patients receiving anti-TNF therapy.
