News & Views

Knee arthroscopy, the most common orthopaedic procedure, is used to treat middle-aged or elderly patients with knee pain, with over two million patients undergoing this surgery every year worldwide. A new clinical practice guideline advises against the use of arthroscopy in these patients, contradicting the common use of this procedure in clinical practice.

The optimal definition of clinical remission in juvenile idiopathic arthritis is still uncertain. A new study has found that the current criteria for clinically inactive disease do not always identify the same group of patients. Why is there such a discrepancy? And which approach to defining remission is the most advantageous?

Early, targeted treatment improves the outcome of rheumatoid arthritis, reducing disease-associated disability and mortality. Until now, it was unknown whether these beneficial effects extended beyond 10 years following initial therapy. Could these effects persist even after 20 years?

Patient-reported outcomes are important predictors of morbidity and mortality. The validity and reliability of the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CATs) has been assessed in patients with systemic lupus erythematosus, but does PROMIS deliver on its promise?

A newly identified insertion–deletion variant of the B cell activating factor (BAFF)-encoding TNFSF13B gene leads to increased levels of soluble BAFF and is associated with the development of systemic lupus erythematosus. The discovery raises a number of compelling questions for further investigation.

The theory of Mendelian inheritance states that half our genes are maternal and half are paternal. This view is incomplete, as maternal–fetal exchange creates a legacy of non-native cells within an individual that can affect their health for better or worse, including contributing to their risk of developing autoimmune disease.

The highly anticipated NOR-SWITCH trial results provide valuable information for patients and physicians concerned about the effects of switching between a biologic agent and a biosimilar product. However, the possibility of frequent switches, potentially involving more than one biosimilar, raises more questions.

Pain in osteoarthritis (OA) can be resistant to the medical and surgical treatments currently in use. Local denervation of the arthritic joint could offer a new approach to relieve OA pain, if the results of a new cryoneurolysis clinical trial are confirmed.

When considering the role of imaging in the management of symptomatic, peripheral joint osteoarthritis (OA) in clinical practice, clinicians should be aware that radiography has its drawbacks, and also consider that the use of advanced imaging techniques such as MRI should not be discouraged.

The changing microbial and clinical profile of reactive arthritis suggests that rheumatologists need to reconsider the approach to its identification and treatment.

Clinical trials of novel therapeutics in systemic lupus erythematosus (SLE) have so far been disappointing. A high placebo response rate in these trials owing to continued use of background immunosuppressive therapy could be confounding results. Could patient stratification and minimization of entry medications improve the effect size and interpretability of SLE trials?

The infrapatellar fat pad and other adipose tissues in close proximity to the joint have been linked with osteoarthritis (OA), but the nature of this relationship is unclear. Two new studies elucidate the features of intra-articular adipose tissues in OA and raise important questions for future investigations.

New insights into the ability of platelets to modify lymphocyte biology suggest a potential anti-inflammatory role for platelet therapy in rheumatoid arthritis. The success of this therapy will depend on researchers being able to define the best formulation to manipulate the crosstalk between inflammatory, vascular and synovial cells.

Results from a cohort study are challenging the diagnostic algorithm proposed by the Assessment of Spondyloarthritis International Society by showing that rheumatologists are not always confirming a diagnosis of axial spondyloarthritis in patients with multiple features of spondyloarthritis. How will these results affect the future development of classification criteria?

A pioneering new study scrutinising the genetic aetiology of Sjögren syndrome across different ancestries and clinical subtypes shows that the striking heterogeneity of associations observed in Sjögren syndrome cannot be explained by subphenotype differences alone.

There is mounting evidence that osteoblasts are involved in the regulation of global energy metabolism. Although osteocalcin signalling remains important, the complexity of systemic energy storage and expenditure makes it likely that hitherto unknown factors are also involved in osteoblast-mediated regulation of metabolism.

The increased risk of mortality in patients with gout is increasingly recognized, and multiple guidelines call for better management of this disease and its comorbidities. A new study, however, has found that excess mortality in patients with gout has remained unchanged since 1999.

Updated recommendations for the management of axial spondyloarthritis provide a useful framework for physicians treating this disease. However, the guidance on use of biologic therapies and treat-to-target strategies seems to raise more questions than it answers.

New guidelines from EULAR and the Paediatric Rheumatology European Society recommend a set of quality standards for the care of young adults with childhood-onset rheumatic diseases during their transfer from paediatric to adult rheumatology care providers. Can the application of these guidelines prevent patients from getting lost in the system?

The PRECISION trial demonstrates that celecoxib is noninferior to ibuprofen and naproxen in regard to cardiovascular safety. Do these findings mark the end of the debate on this issue, or do aspects of the trial mean the implications for clinical practice are not clear-cut?