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Managing rheumatic and musculoskeletal diseases — past, present and future

Abstract

Progress in rheumatology has been remarkable in the past 70 years, favourably affecting quality of life for people with rheumatic and musculoskeletal diseases. Therapeutics have advanced considerably in this period, from early developments such as the introduction of glucocorticoid therapy to the general use of methotrexate and other disease-modifying agents, followed by the advent of biologic DMARDs and, most recently, small-molecule signalling inhibitors. Novel strategies for the use of such agents have also transformed outcomes, as have multidisciplinary nonpharmacological approaches to the management of rheumatic musculoskeletal disease including surgery, physical therapy and occupational therapy. Breakthroughs in our understanding of disease pathogenesis, diagnostics and the use of 'big data' continue to drive the field forward. Critically, the patient is now at the centre of management strategies as well as the future research agenda.

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Figure 1: A timeline summarizing the evolution of treatment for rheumatoid arthritis.
Figure 2: A timeline summarizing the development of diagnostic tools in rheumatology.

References

  1. Bijlsma, J. W. et al. Early rheumatoid arthritis treated with tocilizumab, methotrexate, or their combination (U-Act-Early): a multicentre, randomised, double-blind, double-dummy, strategy trial. Lancet 388, 343–355 (2016).

    CAS  Article  Google Scholar 

  2. Strehl, C. et al. Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations: viewpoints from a EULAR task force. Ann. Rheum. Dis. 75, 952–957 (2016).

    CAS  Article  Google Scholar 

  3. Svartz, N. Salazopyrin, a new sulphanilamide preparation. Acta Med. Scand. 110, 577–598 (1942).

    Article  Google Scholar 

  4. Weinblatt, M. E. et al. Efficacy of low-dose methotrexate in rheumatoid arthritis. N. Engl. J. Med. 312, 818–822 (1985).

    CAS  Article  Google Scholar 

  5. Bakker, M. F. et al. Low-dose prednisone inclusion in a methotrexate-based, tight control strategy for early rheumatoid arthritis: a randomized trial. Ann. Intern. Med. 156, 329–339 (2012).

    Article  Google Scholar 

  6. Smolen, J. et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann. Rheum. Dis. 76, 960–977 (2017).

    Article  Google Scholar 

  7. Johnsen, A. K. & Weinblatt, M. E. in Rheumatology (eds Hochberg, M. C. et al.) 509–517 (Elsevier, 2011).

    Book  Google Scholar 

  8. Grigor, C. et al. Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. Lancet 364, 263–269 (2004).

    Article  Google Scholar 

  9. Maini, R. et al. Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet 354, 1932–1939 (1999).

    CAS  Article  Google Scholar 

  10. Siebert, S. et al. Cytokines as therapeutic targets in rheumatoid arthritis and other inflammatory diseases. Pharmacol. Rev. 67, 280–309 (2015).

    CAS  Article  Google Scholar 

  11. Evaluate Ltd. EvaluatePharma® world preview 2015, outlook to 2020. Evaluate Group http://info.evaluategroup.com/rs/607-YGS-364/images/wp15.pdf (2015).

  12. Yamaoka, K. Janus kinase inhibitors for rheumatoid arthritis. Curr. Opin. Chem. Biol. 32, 29–33 (2016).

    CAS  Article  Google Scholar 

  13. European Medicines Agency. EMA/CHMP/32752/2017 Committee for Medicinal Products for Human Use (CHMP). Summary of opinion (initial authorisation) Xeljanz (tofacitinib). EMA http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/004214/WC500220221.pdf (2017).

  14. European Medicines Agency. EMA/CHMP/843822/2016 Committee for Medicinal Products for Human Use (CHMP). Summary of opinion (initial authorisation) Olumiant (baricitinib). EMA http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion_-_Initial_authorisation/human/004085/WC500218183.pdf (2016).

  15. Daigle, M. E. et al. The cost-effectiveness of total joint arthroplasty: a systematic review of published literature. Best Pract. Res. Clin. Rheumatol. 26, 649–658 (2012).

    Article  Google Scholar 

  16. Leon, L. et al. Orthopedic surgery in rheumatoid arthritis in the era of biologic therapy. J. Rheumatol. 40, 1850–1855 (2013).

    Article  Google Scholar 

  17. Van der Woude, J. A. et al. Knee joint distraction compared to total knee arthroplasty for treatment of end stage osteoarthritis: simulating long-term outcomes and cost-effectiveness. PLoS ONE. 11, e0155524 (2016).

    CAS  Article  Google Scholar 

  18. Ruiz, M., Cosenza, S., Maumus, M., Jorgensen, C. & Noël, D. Therapeutic application of mesenchymal stem cells in osteoarthritis. Expert Opin. Biol. Ther. 16, 33–42 (2016).

    CAS  Article  Google Scholar 

  19. American College of Rheumatology. ARHP distinguished lecturer hails 50 years of advances. ACR Daily News Live http://www.acrdailynewslive.org/arhp-distinguished-lecturer-hails-50-years-of-advances/ (2015).

  20. Voshaar, M. J., Nota, I., van de Laar, M. A. & van den Bemt, B. J. Patient-centred care in established rheumatoid arthritis. Best Pract. Res. Clin. Rheumatol. 29, 643–663 (2015).

    CAS  Article  Google Scholar 

  21. Dörner, T., Egerer, K., Feist, E. & Burmester, G. R. Rheumatoid factor revisited. Curr. Opin. Rheumatol. 16, 246–253 (2004).

    Article  Google Scholar 

  22. Puszczewicz, M. & Iwaszkiewicz, C. Role of anti-citrullinated protein antibodies in diagnosis and prognosis of rheumatoid arthritis. Arch. Med. Sci. 7, 189–194 (2011).

    CAS  Article  Google Scholar 

  23. Aletaha, D. et al. Rheumatoid arthritis classification criteria. An American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann. Rheum. Dis. 69, 1580–1588 (2010).

    Article  Google Scholar 

  24. Shi, J. et al. Carbamylation and antibodies against carbamylated proteins in autoimmunity and other pathologies. Autoimmun. Rev. 13, 225–230 (2014).

    CAS  Article  Google Scholar 

  25. Ospelt, C. et al. Carbamylation of vimentin is inducible by smoking and represents an independent autoantigen in rheumatoid arthritis. Ann. Rheum. Dis. http://dx.doi.org/10.1136/annrheumdis-2016-210059 (2017).

  26. Hargraves, M. M., Richmond, H. & Morton, R. J. Presentation of two bone marrow elements: the 'tart' cell and the 'L.E.' cell. Proc. Staff Meet. Mayo Clin. 23, 25–28 (1948).

    CAS  PubMed  Google Scholar 

  27. Miescher, P. & Fouconnet, M. L'absorption du facteur 'LE' par des noyaux cellulaires isolés [French]. Experimentia 10, 252–254 (1945).

    Article  Google Scholar 

  28. Hiepe, F., Dörner, T. & Burmester, G. R. Editorial overview: antinuclear antibody- and extractable nuclear antigen-related diseases. Int. Arch. Allergy Immunol. 123, 5–9 (2000).

    CAS  Article  Google Scholar 

  29. van der Woude, F. J. et al. Autoantibodies against neutrophils and monocytes: tool for diagnosis and marker of disease activity in Wegener's granulomatosis. Lancet 8426, 425–429 (1985).

    Article  Google Scholar 

  30. Sheehan, N. J. The ramifications of HLA-B27. J. R. Soc. Med. 97, 10–14 (2004).

    CAS  Article  Google Scholar 

  31. Haase, A., Landwehr, G. & Umbach, E. (eds) Röntgen Centennial: X-rays in Natural and Life Sciences (World Scientific, 1997).

    Book  Google Scholar 

  32. Larsen, A., Dale, K. & Eek, M. Radiographic evaluation of rheumatoid arthritis. Acta Radiol. Diagn. (Stockh.) 18, 481–491 (1977).

    CAS  Article  Google Scholar 

  33. Sharp, J. T. et al. Reproducibility of multiple-observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis. Arthritis Rheum. 27, 61–64 (1985).

    Google Scholar 

  34. Van der Heijde, D. M., van Riel, P. L., Nuver-Zuwart, H. H., Gribnau, F. W. & van de Putte, L. B. Effects of hydroxochloroquin and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1846, 1036–1038 (1989).

    Article  Google Scholar 

  35. Greenberg, J. O. Obituary: William H. Oldendorf — a tribute. J. Neuroimaging 3, 148–149 (1993).

    Article  Google Scholar 

  36. Mishra, S. K. & Singh, P. History of neuroimaging: the legacy of William Oldendorf. J. Child Neurol. 25, 508–517 (2010).

    Article  Google Scholar 

  37. Rubin, G. D. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology 273, S45–S74 (2014).

    Article  Google Scholar 

  38. Two Views. A quick history of the MRI in two views — words and pictures. Two Views http://www.two-views.com/mri-imaging/history.html#sthash.GbJKG4v0.7vGwlRGx.dpbs (2016).

  39. Lassere, M. et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J. Rheumatol. 30, 1366–1375 (2003).

    PubMed  Google Scholar 

  40. Woo, J. A short history of the development of ultrasound in obstetrics and gynecology. Ob-ultrasound http://www.ob-ultrasound.net/history1.html (2002).

  41. Gompelt, B. M. & Darlington, L. G. Grey scale ultrasonography and evaluation of popliteal cyst. Clin. Radiol. 30, 539–545 (1979).

    Article  Google Scholar 

  42. Graf, R. The diagnosis of congenital hip-joint dislocation by the ultrasonic Combound treatment. Arch. Orthop. Trauma Surg. 97, 117–133 (1980).

    CAS  Article  Google Scholar 

  43. Backhaus, M. et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann. Rheum. Dis. 60, 641–649 (2001).

    CAS  Article  Google Scholar 

  44. Maricq, H. R. & LeRoy, E. C. Patterns of finger capillary abnormalities in connective tissue disease by 'widefield' microscopy. Arthritis Rheum. 16, 619–628 (1973).

    CAS  Article  Google Scholar 

  45. Cutolo, M., Sulli, A. & Smith, V. Assessing microvascular changes in systemic sclerosis diagnosis and management. Nat. Rev. Rheumatol. 6, 578–587 (2010).

    Article  Google Scholar 

  46. Abdollahi-Roodsaz, S., Abramson, S. B. & Scher, J. U. The metabolic role of the gut microbiota in health and rheumatic disease: mechanisms and interventions. Nat. Rev. Rheumatol. 12, 446–455 (2016).

    CAS  Article  Google Scholar 

  47. van der Vlist, M., Kuball, J., Radstake, T. R. & Meyaard, L. Immune checkpoints and rheumatic diseases: what can cancer immunotherapy teach us? Nat. Rev. Rheumatol. 12, 593–604 (2016).

    CAS  Article  Google Scholar 

  48. Topol, E. Digital medicine: empowering both patients and clinicians. Lancet 388, 740–741 (2016).

    Article  Google Scholar 

  49. Barnes, C. G. The History of EULAR (EULAR, 2007).

    Google Scholar 

  50. European League Against Rheumatism (EULAR). EULAR mission statement. EULAR https://www.eular.org/eular_mission.cfm (2005).

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Acknowledgements

G.R.B.'s research work is supported by the German Science Foundation and the Federal Ministry for Education and Research.

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Correspondence to Gerd R. Burmester.

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Burmester, G., Bijlsma, J., Cutolo, M. et al. Managing rheumatic and musculoskeletal diseases — past, present and future. Nat Rev Rheumatol 13, 443–448 (2017). https://doi.org/10.1038/nrrheum.2017.95

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