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Severity scoring systems for adult familial Mediterranean fever (FMF) are established and used as important clinical and analytical tools in disease management and research. A recent paper highlights the need for a paediatric FMF severity measure. How should such a score be built and what challenges might be faced?
New evidence suggesting an X chromosome effect underlies the development and progression of male systemic lupus erythematosus comes from a study of sex chromosome aneuploidy in men with this disease. The description of a number of immunoregulatory mechanisms encoded on the X chromosome support this hypothesis; however, further studies are warranted.
Rheumatoid arthritis (RA) is partly heritable; genetic and serological markers are known to confer risk of developing pathology. But given clinical heterogeneity in RA, can we predict who will develop severe disease? Substantial heritability of erosive progression rates has now been identified, but better prognostic biomarkers remain wanting.
Recently reported associations between synovitis, cartilage damage and plasma levels of omega-3 and omega-6 fatty acids in patients with osteoarthritis suggest that fish oil supplements might be beneficial additions to the therapeutic regime in this disease; however, questions remain regarding the details of this approach, and controlled trials are required.
Multiplexed assay technologies at the gene, protein, and cellular levels have enabled the identification of 'actionable biomarkers' that can inform clinical practice. Powerful new methods, including mass cytometry and protein arrays, are reviewed.
Imaging modalities are vital for the accurate assessment of joint disease. In this Review, the authors focus on imaging in paediatric rheumatic disease, which presents unique challenges. They discuss the utility and limitations of various imaging techniques—including MRI, ultrasonography and conventional radiography—in the assessment and treatment of children with juvenile idiopathic arthritis.
Aberrant T-cell help has been implicated in the expansion of self-reactive B-cell clones and subsequent autoantibody production in many systemic autoimmune diseases, including systemic lupus erythematosus. In this Review, Joseph Craft discusses the T-helper-cell populations, particularly follicular helper T cells, which are key regulators of B-cell survival and maturation during normal immune responses and in autoimmunity.
Chronic infection with hepatitis B virus (HBV) or hepatitis C virus (HCV) is a global health problem. Management of patients with co-existing rheumatic disease and viral hepatitis can be challenging, given that immunosuppressive and biologic agents used to treat rheumatic disease can have serious complications. This Review provides a guide to viral hepatitis for the rheumatologist, describing the characteristics, complications and treatment of chronic HBV or HCV infection in rheumatic disease.
Oxygen is thought to be an indispensable regulatory signal in tissue development and homeostasis, via its controlling of specific genetic programs. Hypoxia-inducible transcription factors (HIFs), which are regulated by oxygen tension, are central mediators of the homeostatic response that enables cells to survive and differentiate in low-oxygen conditions. In this Review, the authors summarize the current knowledge of HIF signalling in cartilage, bone and blood, and pay particular attention to the complex relationship between HIF and VEGF in these tissues based on data collected from animal models, which can also be relevant in diseases like cancer and ischemia.
