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Molecules involved in developmental signaling pathways have emerged as therapeutic targets for various rheumatic diseases. New research sheds light on the consequences of interfering with these processes.
The choice of optimum second-line DMARDs for patients with rheumatoid arthritis is fraught with challenges. The implementation of evidence-based guidelines designed to inform clinicians' decisions requires careful consideration of several important issues.
As of May 1, 2009, PubMed listed approximately 30,000 citations on the topic of vitamin D in humans, highlighting the medical community's avid interest in this field. Two articles published in the Archives of Internal Medicine diverge with previous reports on the prevalence of hypovitaminosis D and the capability of vitamin D to reduce fractures.
Several high-profile institutions are now following the trend of limiting doctors' ties to industry by way of implementing stringent new guidelines. But do the recommendations go far enough?
According to a study by Chevalier and colleagues, a single intra-articular injection of anakinra is no more effective than placebo for treating the symptoms of knee osteoarthritis (OA). This result, however, should not deter future investigations of this agent for the treatment of patients with symptomatic knee OA.
Consistent with evidence from trials in osteoarthritis of the knee, the results of a randomized controlled trial demonstrate that, for symptomatic hip osteoarthritis, a single intra-articular injection of hyaluronic acid is no better than placebo at alleviating pain.
Despite a lack of definitive evidence supporting their efficacy, nonselective immunosuppressive drugs are frequently prescribed for patients with systemic sclerosis (SSc). An analysis of data collected for a German registry provides a review of their experience with the use of these medications.
Several studies have shown that tumor necrosis factor (TNF) inhibitors are associated with an overall increased risk of serious infections compared with standard immunosuppressive regimens in patients with rheumatoid arthritis (RA). A study by Strangfeld et al. adds specificity by showing a moderately increased risk of herpes zoster in patients receiving anti-TNF antibody treatment, and raises the question of whether live zoster vaccines should be utilized in this patient group.
The link between exposure to exogenous estrogen and the incidence of systemic lupus erythematosus is controversial, but new data suggest that the use of combined oral contraceptives could increase the risk of developing the disease.
Many people with chronic rheumatic diseases choose to use complementary and alternative therapies on the basis of information from unreliable sources. Does a report from a UK-based arthritis charity meet the need for rigorous, evidence-based recommendations for the public and for health-care providers?
In clinical trials testing new treatments for systemic lupus erythematosus (SLE), the failure of the 15-year drug development program for Riquent™ (abetimus sodium) is the latest in a string of disappointments for a disease that has seen no new drugs approved in over 50 years.
Two consecutive trials of rituximab, a B-cell-depleting anti-CD20 monoclonal antibody, have threatened the future of B-cell-targeted therapy for systemic lupus erythematosus (SLE). While rumors of the demise of this approach might be greatly exaggerated, the outcomes of these studies should force academics and the pharmaceutical industry back to the drawing board.
The comprehensiveness of clinical guidelines is a major determinant of their usefulness, but covering a broad range of topics in depth can prove difficult.
The current treatment options for Raynaud phenomenon are often ineffective and can have undesirable adverse effects. Topical, or transdermal, treatments that increase digital blood flow without systemic adverse effects are, therefore, an attractive option. A novel topical nitroglycerin formulation has shown promise in treating Raynaud attacks.
Tumor necrosis factor inhibitors are an effective treatment for psoriatic arthritis, but no single agent is effective in all patients. Novel therapies that target other cytokines have now been tested, with encouraging results.
Opioids are increasingly used for the treatment of chronic noncancer pain, but this practice remains controversial. A new set of clinical recommendations attempts to guide clinicians through the issues.
Studies performed during the past 2 years have provided a deeper understanding into the role of CTLA-4, which is expressed on regulatory T cells, in preventing autoimmunity, and also provide mechanistic insight into protein-based therapeutics such as abatacept for rheumatic diseases.
Achieving effective maintenance therapy with minimal adverse effects for patients with antineutrophil cytoplasmic autoantibody associated vasculitis is a major challenge facing the vasculitis community. A study by Pagnoux et al. shows that azathioprine and methotrexate have similar efficacy and adverse event profiles when used for remission maintenance in these patients.
