News & Views

Sensation of mechanical stimuli by chondrocytes is critical to cartilage homeostasis and osteoarthritis development. The earliest responses in chondrocyte mechanotransduction pathways involve calcium influx and changes in mitochondrial function, which occur in seconds to minutes. Deeper understanding of these events can elucidate new therapeutic targets for early intervention to prevent osteoarthritis.

Underrepresentation of patients with non-white skin in rheumatology educational resources impairs practitioners’ competence in caring for patients with skin of colour and reduces patients’ confidence in the medical system. Medical publishers and educators should reconsider how to promote equal representation and care of patients with all skin types.

According to new data, overexpression of the nicotinamide adenine dinucleotide (NAD) hydrolase, CD38, in systemic sclerosis (SSc) leads to NAD depletion and fibrosis. These intriguing findings link inflammation, NAD metabolism and fibrosis and bare striking resemblance to age-related changes in SSc. Could DNA damage also connect these seemingly unrelated pathways?

The discovery that autoantibodies and other factors can predict the future onset of rheumatoid arthritis (RA) has encouraged the development of clinical trials looking at RA prevention. Although an exciting area of research, finding an approach that results in the successful completion of an RA prevention trial is challenging.

The transcription factor Sox9 is important for cartilage formation during development, but its role in postnatal growth plates and adult articular cartilage has been uncertain. New research is revealing essential roles for Sox9 in postnatal cartilage homeostasis and in preventing post-traumatic osteoarthritis, along with new mechanisms for chondrocyte-to-osteoblast transition.

The accurate homogeneous differentiation of human induced pluripotent stem cells into chondrocytes is crucial for cartilage regenerative therapies. Discovery of the signalling pathways responsible for the differentiation of unwanted cell types during in vitro chondrogenesis could herald a breakthrough for in vitro cartilage generation.

Myositis is a group of conditions that vary greatly in risk factors, clinical manifestations, laboratory markers, presumed pathogenetic mechanisms, treatment responses and prognoses. Approaches to divide myositis into mutually exclusive and stable phenotypes are being considered, but are we thinking comprehensively enough in our attempts at classification?

The field of rheumatology is poised to categorize the phenotypes of systemic autoimmune diseases on the basis of measurable and quantifiable molecular signatures. Emerging efforts to identify similarities across diseases, predict clinical outcomes and predict response to therapy using quantitative, data-driven approaches could considerably change treatment paradigms.

A multitude of factors contribute to the development and progression of systemic lupus erythematosus (SLE) through their effects on immune cells and tissue resident cells. Ultraviolet light instigates skin inflammation in SLE, and now new findings suggest that neutrophils in the inflamed skin migrate to the kidneys, spreading the inflammatory response.

An important question for patients and providers is whether and to what extent dietary interventions, diet supplements or weight loss can help to prevent incident gout or manage existing gout. Evidence is emerging, but randomized trials are still needed to fill this important knowledge gap.

Janus kinase (JAK) inhibitors have become standard treatment for patients with rheumatoid arthritis who do not respond well to other DMARDs. Concerns have been raised over an increased risk of venous thromboembolism with JAK inhibitors, tempering enthusiasm for their use in the clinic, but are these concerns justified?

Genetic variation contributes to immune cell function. An unprecedented analysis of genetic associations with immune cell traits provides insights into the complex regulation of immune cells, reveals variants that coincidently influence immune traits and autoimmune disease risk, and offers specific therapeutic targets for these diseases.

The new 2019 EULAR–ACR classification criteria for systemic lupus erythematosus (SLE) performed well in the initial derivative and validation cohorts. But do these criteria outperform previous classification criteria across sexes, disease durations or ethnicities?

The ability to predict how a patient might respond to a medication would shift treatment decisions away from trial and error and reduce disease-associated health and financial burdens. Machine learning approaches applied to genomic datasets offer great promise to deliver personalized medicine but their application must first be optimized.

For young people with rheumatic diseases, the transition from paediatric to adult rheumatology care is a vulnerable time, and delays or disruption in their care can lead to adverse outcomes. Research into the factors associated with gaps in transitional care could improve the identification and targeting of vulnerable groups.

Cardiac toxicity can be induced by hydroxychloroquine, especially when used in combination with azithromycin. Interest in hydroxychloroquine and azithromycin as potential therapies for COVID-19 has renewed concerns about the possible cardiovascular risk these drugs present to patients with rheumatoid arthritis.

Gender disparities persist in many aspects of working life for women in academic rheumatology. To move forward, we must find ways to address the gender gap in rheumatology with the goal of creating a workforce as diverse as the patient population it serves.

Comorbidities are highly prevalent in patients with rheumatoid arthritis (RA), yet clinical care for such patients is often of inferior quality, even in rheumatology clinics. Suggestions for good clinical practice interventions from an expert panel aim to improve the quality of care for patients with RA who have associated comorbidities.

Suboptimal medication adherence, a major problem among individuals with systemic lupus erythematosus, is often more pronounced among minority racial groups. As the roots of racial disparities in treatment adherence are beginning to be untangled, the need for multidisciplinary, multilevel approaches to tackle this complex problem is emerging.

Pain in osteoarthritis is multifactorial, but a disconnect between radiographic features and symptoms hampers our understanding of pain. New imaging data suggest that pain arises from virtually all structures in the joint and that cartilage loss is only a minor contributor to pain symptoms but is important for disease progression.