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Although the multitude of pathways involved in the pathogenesis of systemic lupus erythematosus (SLE) seem to be interconnected, each predominates in only a fraction of patients. This complexity means that many agents tested in SLE clinical trials — now including iberdomide — produce only a small clinical benefit.
Do you inform patients about risks and chances of success associated with different choices when treatment needs to be changed? This approach takes time and requires patient health literacy. Results from a discrete-choice experiment in scleroderma lung disease add to the debate on shared decision-making.
New research reveals that outcomes for patients with rheumatoid arthritis are affected less by pre-existing comorbid conditions than by socioeconomic factors. Future research should address the mechanisms of this relationship and develop holistic treatment approaches that reduce disparities attributed to socioeconomic status.
The new ACR guideline for the treatment of juvenile idiopathic arthritis provides an update on several important topics, including management of oligoarthritis, temporomandibular joint arthritis and systemic-onset arthritis. Overall, the new guideline reflects changes in practice, but also highlights a concerning lack of high-quality evidence.
New classification criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis endorsed by ACR and EULAR reflect important developments in the field since the 1990 criteria were published, including bringing ANCA testing to the fore.
New evidence implicates necroptosis in muscle fibre damage in idiopathic inflammatory myopathies, but is it too soon to suggest that interfering with this cell-death pathway could offer a novel therapeutic strategy?
New EULAR recommendations offer useful guidance for improving cardiovascular health in patients with rheumatic and musculoskeletal disease. However, an interdisciplinary model of care is crucial to the optimal management of cardiovascular risk in these patients.
Undifferentiated arthritis (UA) was redefined by the introduction of the 2010 rheumatoid arthritis (RA) classification criteria. But UA is more than just not having RA — it is about selecting the right patients for DMARD treatment even before diagnosis, and about protecting those with self-limiting disease from potential drug toxicity.
The COVID-19 pandemic has caused a rapid transition towards telemedicine, raising concerns about assessment accuracy, medical-relationship building and potential inequalities between patient groups. For some rheumatology patients, telemedicine is convenient and acceptable, but careful selection and choice are important.
New research reports that men with inflammatory arthritis experience an impact on sexual health beyond erectile dysfunction, affecting their emotional, mental, and social health. Training to empower health professionals to have conversations about sex could improve support for people with rheumatic diseases.
Smoking during adulthood is a known risk factor for seropositive rheumatoid arthritis (RA) but how exposure to passive smoking affects RA risk is uncertain. New data from the Nurses’ Health Study on passive smoking over a lifetime suggest childhood exposure could be an important factor for future RA development.
The results of several retrospective studies have reported that systemic treatment in patients with psoriasis reduces the risk of incident psoriatic arthritis (PsA). Although encouraging from a prevention perspective, such studies are limited in their ability to provide a conclusive understanding of PsA risk, preventing a clear picture from emerging.
The ACR have published their first guideline for the management of large vessel vasculitis, which covers giant cell arteritis and Takayasu arteritis. The new guideline differs from the current EULAR recommendations on some important points, but do these different views actually affect patient care?
New evidence has emerged that DNA can bind to cell surface HLA class II molecules. If true, this surprising interaction could lead to T cell and B cell activation by DNA, and surface DNA could also provide a target for cell killing by anti-DNA antibodies in systemic lupus erythematosus.
The development of treatments for systemic sclerosis has historically been hampered by the clinical heterogeneity of the disease and limited understanding of its pathogenesis. Encouragingly, advances including the identification of important molecular targets and improvements in clinical trial design have now greatly increased the number of investigative therapies.
Limited data suggest associations between air pollution and rheumatic disease risk and outcomes. More sophisticated research is needed to clarify the conditions under which air pollution might influence the health of people with rheumatic disease, including their response to biologic drugs.
Short telomere length is implicated in lung diseases and can be caused by mutations in telomere genes. Acquired autoimmunity directed against components of the telomere system is now reported in some patients with systemic sclerosis or idiopathic pulmonary fibrosis, suggesting a novel explanation for short telomeres in these diseases.
The 2021 ACR guideline for the treatment of rheumatoid arthritis provides an update on several important topics, including the use of targeted synthetic DMARDs (tsDMARDs). But how does the new guideline compare to EULAR recommendations, and is the growing importance of tsDMARDs adequately accounted for?
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.
