Volume 9 Issue 5, May 2013

In Lyme disease endemic areas, a noninvasive clinical prediction model to distinguish septic arthritis from Lyme arthritis would be useful, especially in children. A new study suggests that in highly selected patients, such prediction might be possible. But failure to recognize even a few cases of septic arthritis could have devastating consequences.

Bisphosphonates are the mainstay of treatment for osteoporosis, but uncertainties exist regarding their long-term use. The identification of patients who will benefit from continuing therapy is of primary clinical importance and a subject of current research. Risk factors for fractures are helping to improve decision making, but unanswered questions remain.

The results of a recent randomized, controlled study suggest than intra-articular injection of autologous stem cells collected from peripheral blood might improve the outcome of surgical approaches to regeneration of articular cartilage after injury. However, questions remain regarding the clinical benefit and feasibility of such an approach.

Biomarkers have the potential to improve all aspects of clinical practice, from diagnosis to monitoring of treatment effectiveness. In this Review, the authors use current and potential biomarkers from rheumatology and beyond to highlight the value of different types of biomarker in drug development and clinical decision making. Particular emphasis is placed on mechanistic biomarkers, which are rooted in disease pathogenesis and can provide an accurate reflection of disease activity.

Nestled at the interface of rheumatology—which tackles biochemical modulation of joint homeostasis—and orthopaedics, with its focus on mechanical joint homeostasis, is the burgeoning field of cartilage tissue structure-modifying therapies. Besides halting damage, though, is actual repair of cartilage clinically possible? This Review is a comprehensive guide to the extensive developmental progress, both made and that remains to come, in regenerative medicine for degenerative joint disease.

Pathogenic IgG autoantibodies have established roles in diseases including systemic lupus erythematosus and rheumatoid arthritis. Less familiar are the influences of naturally arising IgM autoantibodies, which enhance phagocytic clearance of apoptotic cells and have the capacity to block inflammatory responses induced by Toll-like receptor ligands and autoantibody-containing immune complexes. Intriguing data from animal models and clinical studies, suggesting that it might become possible to exploit these protective effects in the treatment of autoimmune rheumatic disease, are reviewed in this manuscript.

The tremendous improvements in the survival of patients with systemic lupus erythematosus (SLE) in the past several decades have led to increased prevalence of lupus-related organ damage in these patients, which has slowed down the survival improvement and reduced the quality of life of patients. Anselm Mak and colleagues discuss the global pattern, potential mechanisms and advances in tools for early detection of organ damage.

The contribution of epigenetic mechanisms, primarily comprising microRNAs and modifications of DNA and histones, to rheumatoid arthritis (RA) is increasingly recognized. In this article, the authors discuss the role of the epigenetic machinery in this disease, with a particular focus on the enzymes that regulate protein acetylation, and the therapeutic potential of targeting these factors in RA. The authors suggest that returning to the original, broader definition of epigenetics, comprising all nongenetic regulatory mechanisms, might improve our understanding of disease and facilitate the development of novel therapeutic strategies.