News & Views

Positioned at the crossroads of TNF, IL-1 and Toll-like receptor signalling cascades and cytokine-driven chromatin remodelling, TAK1 is emerging as a new therapeutic target in rheumatoid arthritis.

The treatment of systemic sclerosis (SSc) is complex as multiple organs are frequently involved and treatment is either for overall disease modification or is organ specific. EULAR has updated its treatment recommendations for SSc, reflecting data from some new trials. However, some features of SSc are not included.

The 2016 ACR–EULAR classification criteria for primary Sjögren syndrome, which are intended to facilitate uniform classification of patients for enrolment in clinical studies, combine features of previous criteria sets. These new criteria are a step in the right direction, but further refinement would increase their utility.

New criteria have been proposed to enable a rapid diagnosis of cryopyrin-associated periodic syndromes (CAPS) in children and adults. Will these diagnostic criteria advance the management of autoinflammatory syndromes, or will physicians now think of zebras rather than horses when they hear hoofbeats?

Although an imbalance between proinflammatory and anti-inflammatory cytokines has been implicated in rheumatoid arthritis (RA), the identification of specific cytokines regulating RA pathophysiology is still challenging. Modelling cytokine signalling networks and evaluating associated pathway activities might facilitate the effective identification of cytokines for treatment and prevention of RA.

The transition of HIV and AIDS from a death sentence to a chronic disease has not come without problems. Rheumatologists need to be aware of the full spectrum of rheumatic diseases seen in patients with HIV and AIDS, and know the best strategies for disease management.

Despite conflicting evidence from clinical trials, rituximab continues to be used off-label in the treatment of systemic lupus erythematosus (SLE). A new study has now investigated the use of this drug for SLE in Europe, including indications for use and patient characteristics.

Sedentary behaviour is reported to have adverse consequences for metabolic, functional and cardiovascular health — outcomes already prevalent in patients with rheumatoid arthritis (RA). This commentary considers the relevance of sedentary behaviour in the context of RA, highlighting the limitations of past work and offering suggestions for a new research agenda.

The concept of treating to a target of remission is gaining ground in systemic lupus erythematosus. New research suggests that achievement of this treatment goal is rare, but are the definitions of remission used in these studies fit for purpose?

An unmet need exists for more-effective and selective therapeutics in systemic lupus erythematosus. Advances in understanding of the pathogenetic mechanisms of this severe autoimmune disease have led to the clinical translation of low-dose IL-2 therapy, which primarily aims to restore the activity of regulatory T cells.

Historically, rheumatic diseases have received little attention in Africa and rheumatologists have been few and far between. Now, supported by the global rheumatology community, interest in the specialty is growing, despite the formidable challenges faced by those practicing rheumatology in Africa.

Despite a multitude of confounding variables, common themes are emerging in metabolomic studies of systemic lupus erythematosus (SLE). Newly revealed metabolites and pathways are likely to complement the biomarkers and insights into SLE pathogenesis that are emerging from genomic, transcriptomic and proteomic studies.

Revised recommendations for the management of fibromyalgia have been published by a multinational EULAR working group. Applying these guidelines to clinical practice will require good clinical judgement and flexibility.

New research shows that an extended autoantibody repertoire is associated with adverse clinical outcomes in patients with rheumatoid arthritis. Testing for rheumatoid factor and antibodies against citrullinated proteins is now routine in the evaluation of patients with rheumatoid arthritis; should this testing be extended to include other classes of autoantibody?

Changes in DNA methylation patterns are emerging as an important feature in the development and progression of primary Sjögren syndrome. However, questions remain regarding the contribution of epigenetic (and genetic) factors to the recruitment and activation of autoreactive lymphocytes in the glandular tissues primarily affected by the disease.

Many of the 2016 updated EULAR recommendations for the management of gout lack robust evidence and rely on expert opinion, indicating gaps in our understanding of this common disease. More research is needed to fill these gaps, move towards an evidence-based approach, and improve patient care.

A new study of 'symptom-free' volunteers reports a surprisingly high prevalence of MRI features usually associated with rheumatoid arthritis (particularly bone marrow oedema), but the interpretation of these findings highlights several methodological issues. MRI assessment of healthy joints is clearly essential but should be carried out in a stringent fashion.

Adalimumab, an anti-TNF monoclonal antibody used to treat rheumatoid arthritis and other autoimmune disorders, paradoxically enhances the capacity of TNF to expand TNF receptor type II-expressing regulatory T cells. This provocative finding opens a new avenue for exploring the mechanisms that underlie efficacy, non-responsiveness and adverse effects associated with therapeutic targeting of TNF signalling.

Fibroblast-like synoviocytes isolated from the knee and hip joints of patients with rheumatoid arthritis or osteoarthritis have now been shown to have site-specific DNA methylation signatures. Although preliminary, the data point towards a new view of joint involvement in arthritis.

Interstitial lung disease is one of the most important causes of mortality in patients with polymyositis or dermatomyositis. Understanding the risk factors for development and progression of interstitial lung disease is crucial to improving clinical outcomes.