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Key Advances in Rheumatology

The Key Advances in Rheumatology collection offers a unique series of specially commissioned ‘Year in Review’ articles that highlight the key discoveries made each year. In these articles, leading experts in the field describe their pick of the top 3–5 key advances of the year, outlining their clinical impact and implications for current and future research.

2020

Interstitial lung disease (ILD) can arise in a variety of connective tissue diseases (CTDs) and various treatment interventions are being explored. In 2020, advances in the treatment of CTD-associated ILD have included the re-evaluation of methotrexate-induced lung injury and emerging insights on anti-IL-6 therapy and anti-fibrotic therapy in this condition.

Year in Review | | Nature Reviews Rheumatology

Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of SARS-CoV-2 infection that can result in serious illness in the paediatric population but our understanding of this syndrome is in its infancy. Translational studies in 2020 leveraging immune profiling have laid the foundation to enable further discovery in MIS-C.

Year in Review | | Nature Reviews Rheumatology

Since the outset of the COVID-19 pandemic, numerous risk factors for severe disease have been identified. Whether patients with rheumatic diseases, especially those receiving DMARDs, are at an increased risk of SARS-CoV-2 infection or severe COVID-19 disease remains unclear, although epidemiological studies are providing some insight.

Year in Review | | Nature Reviews Rheumatology

Interest in therapies for psoriatic arthritis (PsA) has increased in response to recognition that many patients remain undiagnosed and are inadequately treated. In 2020, advances in PsA treatments have included phase III trials of an IL-23 inhibitor, head-to-head trials of IL-17 inhibition against TNF inhibition and updated EULAR treatment guidelines.

Year in Review | | Nature Reviews Rheumatology

In inflammatory arthritides, such as rheumatoid arthritis (RA), synovial cells acquire aggressive and disruptive phenotypes that lead to joint disease. Three studies published in 2020 have described phenotypic variation in synovial cells, offering a novel perspective on the potential to resolve pathology and augment treatment options for patients with RA.

Year in Review | | Nature Reviews Rheumatology

Immune checkpoint inhibitors, which are used to treat many types of cancer, can cause syndromes similar to rheumatic diseases known as immune-related adverse events (irAEs). In 2020, several studies illustrated the clinical heterogeneity of rheumatic irAEs and highlighted their substantial effect on morbidity and mortality.

Year in Review | | Nature Reviews Rheumatology

2019

Machine learning and high-throughput technologies hold promise for the classification, diagnosis and treatment of patients with rheumatic diseases, with the ultimate goal of precision medicine. Several studies in 2019 highlight the feasibility and clinical utility of using machine learning in rheumatology to stratify patients and/or predict treatment responses.

Year in Review | | Nature Reviews Rheumatology

Use of prescription opioids is prevalent in patients with rheumatic diseases. Studies in 2019 reported the trends and safety of opioids in patients with rheumatoid arthritis or osteoarthritis. Treating underlying disease processes must be the rheumatologists’ priority. Without better long-term safety and effectiveness data, opioid use should be generally limited.

Year in Review | | Nature Reviews Rheumatology

The synovium is the main target tissue of inflammatory arthritides such as rheumatoid arthritis and psoriatic arthritis. In 2019, new technologies for examining the molecular characteristics of specific cell subsets have enabled advances in our understanding of the architecture of synovial lymphoid aggregates, macrophage infiltrates and synovial fibroblast subsets.

Year in Review | | Nature Reviews Rheumatology

The availability of biosimilars to treat inflammatory diseases has generated concern about changing patients from a bio-originator to its biosimilar to save costs. Studies published in 2019 support the effectiveness and safety of ‘nonmedical switching’ and highlight the benefits of communicating information about biosimilars to patients in a positive light.

Year in Review | | Nature Reviews Rheumatology

Dysregulation in the formation and/or clearance of neutrophil extracellular traps (NETs) is important in immune dysregulation and organ damage in chronic inflammatory conditions. Studies in 2019 have shown how certain genetic susceptibilities to autoimmunity can promote NET-mediated inflammation, and expanded the role for NETs in vascular damage and premature atherosclerosis.

Year in Review | | Nature Reviews Rheumatology

2018

Janus kinase (JAK) inhibitors (jakinibs) that target downstream signalling by a large range of cytokines are effective in treating autoimmune and rheumatic diseases. Newer jakinibs that selectively inhibit individual JAKs and a narrower spectrum of cytokines have now been developed, but how do these inhibitors compare with existing drugs?

Year in Review | | Nature Reviews Rheumatology

The Wnt signalling pathway is the target of current anabolic therapies for osteoporosis. Studies in 2018 have revealed more about endogenous control of Wnt-related signalling, including mechanisms of natural Wnt inhibition and new anabolic signalling pathways that could be harnessed to overcome the challenges posed by current therapies.

Year in Review | | Nature Reviews Rheumatology

Systemic lupus erythematosus (SLE), the embodiment of a multi-organ autoimmune disease, results from hyperactivation of host-defence pathways and immune recognition of the most fundamental building blocks of life. In 2018, key advances have placed intestinal immunity and dysregulated expansions of candidate pathobionts at the forefront of SLE pathogenesis.

Year in Review | | Nature Reviews Rheumatology

Cell metabolism has long been at the forefront of tumour biology, but in the past decade the importance of cellular bioenergetics has been increasingly recognized in regulating immune cell function. Mechanistic studies in 2018 have highlighted cell metabolism as a potential therapeutic target for the treatment of rheumatoid arthritis.

Year in Review | | Nature Reviews Rheumatology

In 2018, advances in the treatment of gout flares came in the form of a new nurse-led management approach to serum urate lowering and evidence that allopurinol might have a better cardiovascular safety profile than febuxostat. However, are IL-1β blockers such as canakinumab the future of care for patients with gout?

Year in Review | | Nature Reviews Rheumatology

Further reading

The two major lung complications in systemic sclerosis, lung fibrosis and pulmonary arterial hypertension, share some pathogenic mechanisms. Strategies for managing patients with these complications have greatly advanced in the past decade, and many tools and treatments are now available.

Review Article | | Nature Reviews Rheumatology

Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), thus adding to the growing mystery of this virus and raising questions about the nature of its link with autoimmune and autoinflammatory sequelae.

News & Views | | Nature Reviews Rheumatology

The COVID-19 pandemic led to unprecedented changes in rheumatology clinical practice. In this Viewpoint article, we asked five experts to describe their experiences of the COVID-19 pandemic, how their clinical practice has changed, and the opportunities and challenges that lie ahead.

Viewpoint | | Nature Reviews Rheumatology

This Perspective article explores similarities in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID-19, as well as the effect of the COVID-19 pandemic on rheumatology.

Perspective | | Nature Reviews Rheumatology

The authors discuss the preclinical evidence that provides insights into the mechanisms, pathways and mediators that set in motion resolution of inflammation. The time is ripe to establish if, and how, this biology can inform therapeutic innovation in the context of chronic inflammatory diseases.

Review Article | | Nature Reviews Rheumatology

Cancer immunotherapies that function as checkpoint inhibitors are an exciting development but are associated with immune-related adverse events that can occur in almost any organ. Among these events are complications that mirror established rheumatic diseases, so oncologists and rheumatologists must work together.

Review Article | | Nature Reviews Rheumatology