Volume 9 Issue 10, October 2013

Consensus guidelines for patient management can increase disease awareness and education, and facilitate evidence-based clinical decision-making. Nevertheless, new gout recommendations leave a 'déjà vu' impression. Novel evidence from clinical trials is needed to robustly advance patient care and build the next generation of guidelines.

The mind and body are thought to interact in a manner that influences health, but modelling the right aspects of each so as to best inform treatment is a tricky proposition. A new study discusses how stress can affect rheumatoid arthritis symptoms.

Recent progress in our understanding of the pathogenesis of primary Sjögren's syndrome (pSS) and the development of indices to measure disease activity in patients with this condition, offer us ample possibilities for treatment with biologic DMARDs. New biomarkers further aid selection of patients with pSS for appropriate treatment options.

In this Review, the authors analyse the genetic loci associated with osteoarthritis to identify biological pathways that might be involved in the disease pathogenesis. In particular, they highlight the potential importance of certain regulators of skeletogenesis, endochondral ossification and gene transcription in this disease.

Encouraging data from preclinical studies, and ongoing clinical trials, suggest that mesenchymal stem cells (MSCs) might provide the disease-modifying therapy that has long been lacking in osteoarthritis. If the potential of these multipotent cells is to be fully realized, subtleties such as minor phenotypic differences between specific MSC populations as well as the paracrine responses that transplanted MSCs elicit from joint-resident cells, must be better understood. MSC-related changes that occur in OA, the regenerative capacity of transplanted MSCs, and progress toward clinical use of such therapy are reviewed in this article.

Annexin A1 mediates many of the anti-inflammatory actions of glucocorticoids. This Review describes our current understanding of the biological activities of this protein and their relevance to the pathogenesis of rheumatoid arthritis (RA). The possibility that targeted approaches to potentiation of annexin A1 signalling could enable steroid sparing in RA and other inflammatory diseases is also discussed.

The population of elderly patients with rheumatoid arthritis (RA) is growing, primarily as a consequence of increasing life expectancies. In addition, processes linked to ageing of the immune system might directly contribute to development of this disease. This Review discusses the evidence supporting this hypothesis, as well as the challenges facing management of RA in elderly patients.

Nanotechnology, building on advances in nanoscience, has developed substantially over the past decade. In this Review, Cameron Brown outlines applications of nanotechnology that are advancing understanding in rheumatology and musculoskeletal research, including labelling, imaging and targeting techniques used to probe and manipulate cell behaviour. Nanoscale therapeutics might also enter the rheumatology clinic in future, but the potential for adverse events must first be explored; data accumulated in life-threatening illnesses will inform developments for chronic conditions.

A number of issues limit the utility of the definitions and classifications of autoinflammatory disease proposed to date. In this Perspectives, the authors propose a new clinically-based definition and classification of autoinflammatory diseases. In addition, a potential future approach to classification of the entire spectrum of immunological diseases is discussed.

Skeletal abnormalities of the hip can place unnecessary stress on structures within the hip. One of these abnormalities, in which the head of the femur develops a cam-shaped outgrowth, has been associated with the subsequent development of osteoarthritis. In this Perspectives, the etiology of cam abnormalities and their contribution to osteoarthritis are discussed.