Volume 9 Issue 7, July 2013

Periarticular bone erosions are a central feature of rheumatoid arthritis (RA) and their exact assessment is crucial for diagnosis, monitoring responses to therapy and aiding decision-making. High-resolution peripheral quantitative CT and MRI—two imaging modalities with the potential to improve the diagnosis and monitoring of RA—have now been compared.

When nonsurgical options for osteoarthritis of the glenohumeral joint are exhausted, total shoulder arthroplasty has been well studied and carries the most predictable outcome. For patients wishing to remain active, however, proven shoulder-preserving options have been less predictable. A new study now adds to preliminary evidence supporting the complete arthroscopic management procedure.

The ankylosing spondylitis disease activity score (ASDAS) is a measure of axial spondyloarthritis (SpA) disease activity endorsed by the Assessment of SpA International Society and Outcome Measures in Rheumatology. Accumulating evidence supports the utility of ASDAS in axial SpA. So, is it time to replace the Bath ankylosing spondylitis disease activity index (BASDAI)?

As molecular complexes that promote inflammation, inflammasomes have been implicated in several autoimmune and autoinflammatory disorders, including cryopyrin-associated periodic syndromes and microcrystal-induced pathologies. Here, the authors discuss the roles of inflammasomes in these conditions, as well as their potential involvement in other rheumatic diseases, and consider therapeutic approaches to inhibit inflammasome activity.

Biologic agents have been used successfully to treat rheumatoid arthritis, but are less effective in osteoarthritis. Chevalier et al. discuss the use of cytokine blockers, inhibitors of nitrogen oxide production, and growth factors to treat osteoarthritis—clinical trial data has been overwhelmingly negative but glimmers of hope still exist.

Both the classical effects of vitamin D on bone and its other, nonclassical, effects, particularly those on the immune system, could be of relevance to rheumatic diseases; indeed vitamin D deficiency has been associated with such conditions in observational studies. The clinical importance of these findings, however, is unclear. This Review appraises the current evidence in this area, particularly in relation to whether vitamin D supplementation should be considered, or not, in approaches to the management of rheumatic disease.

Patients with rheumatoid arthritis or ankylosing spondylitis can have disease-associated complications involving the spine. Cha and An discuss these cervical spine manifestations and how they should be managed, risks associated with inaction, potential complications of treatment, and indications for surgery. Whereas biologic agents are sufficient to slow progression of spinal pathology in many patients with rheumatoid arthritis, the authors recommend early surgical intervention in those who develop neurological deficits.

Musculoskeletal ultrasonography is widely used for evaluating patients with RA and these imaging techniques can also allow the comparison of therapeutic agents, as well as monitoring patient response to treatment. Here, Ohrndorf and Backhaus describe the ultrasonographic features that can be used as predictive markers, and the ultrasonographic scores that can be used to reflect overall RA disease activity.

Myositis results from the combined activities of immune-specific and muscle-specific cell types. Immune muscle precursors could have a pivotal role, as they stimulate inflammation and the generation of autoantigens. Tournadre and Miossec explain this phenomenon.