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Biologic medications are highly efficacious in juvenile idiopathic arthritis. However, a recent study found that a subgroup of children treated with anti-TNF agents had persistent pain despite good disease control. This finding highlights the importance of monitoring pain symptoms during treatment with modern DMARDs.
Beneficial effects of bone-acting drugs in osteoarthritis (OA) are increasingly reported, but reliable conclusions regarding their efficacy are hindered by methodological drawbacks in study design. Identifying patients with osteoporotic OA, a phenotype defined by decreased density associated with high remodelling in subchondral bone, might improve the success of bone-directed agents.
In the era of targeted therapy, patients with rheumatic diseases have seen real results. But what about those with systemic sclerosis—where is the long-awaited antifibrotic drug? Disparate aspects of the pathogenesis are gradually being integrated into a cohesive model, and molecular targets that are shared with other diseases are also being defined. As this Review stresses, careful evaluation of new strategies, with a focus on learning fundamental lessons about the underlying biology, will be needed to translate novel approaches into actual clinical progress in this recalcitrant disease.
Genetic factors have critical roles in primary paediatric osteoporosis, which occurs in otherwise healthy individuals in forms that include osteogenesis imperfecta. Secondary osteoporosis results from an underlying illness and is common in children with chronic systemic inflammation, neuromuscular disabilities, or who are receiving glucocorticoid treatment. Mäkitie discusses the occurrence and management of paediatric osteoporosis, with a focus on prevention of skeletal complications, and highlights the need to broaden treatment options.
Multiple genes have been associated with susceptibility to systemic lupus erythematosus (SLE), but how do they promote disease development? In this Review, the authors examine the roles of a selected set of genes in the pathogenesis of SLE, and discuss how epigenetic modifications and microRNAs can mediate pathogenic changes in gene expression.
In this Review, Little and Hunter discuss the use of animal models in osteoarthritis (OA) research, focusing on their importance in understanding post-traumatic OA, the human form of the disease that the models most accurately reflect. The authors also outline the approach necessary for the successful translation of scientific data into clinically useable drugs.
Imaging is central for the classification and diagnosis of axial spondyloarthritis, as well as for monitoring disease progression and predicting response to treatment. Xenofon Baraliakos and Jürgen Braun provide an overview of the role of imaging for patients with axial spondyloarthritis and discuss how imaging techniques might influence research and clinical practice in the future.
