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Outcome assessment of disease modification represents a major challenge to the development of therapies and management of spondyloarthritis, particularly for patients with axial disease. Could a new approach to imaging assessment of the spine using low-dose CT provide an answer to this perennial problem?
Biologic agents targeting key proteins involved in bone homeostasis are revolutionizing the management of osteoporosis. New clinical data support the use of these novel therapies to rapidly increase bone mass and decrease the risk of fractures.
Whether TNF inhibitors prevent structural damage in ankylosing spondylitis remains a controversial topic, as three prospective trials failed to show any evidence to support this notion. However, data are accumulating from retrospective analyses of well-characterized cohorts of patients that could provide the solution to this controversy.
TNF inhibition is associated with an increased risk of lymphoma development. But is this association due to the TNF inhibitors themselves or the patient's underlying disease?
Identifying different phenotypes of osteoarthritis is currently a subject of much research; however, a new systematic review has sparked discussion about the discrepancies in how research into disease phenotypes is conducted. Can we define individual phenotypes if we cannot agree on what constitutes a phenotype in the first place?
Biosimilar therapeutics for immune-mediated disease are approved in many countries and are increasingly being utilized in clinical practice. Although much has been written about the effectiveness and safety of biosimilars, less focus has been placed on why, how and when (or when not) to use these medications — until now.
Gout and osteoarthritis are known to coexist in certain joints, with urate and calcium crystals being associated with the development of osteoarthritis. Now, research is shedding light on the depth of this association and bringing surprising observations to the fore.
For patients with osteoarthritis, the current palliative approach of analgesic prescription followed by joint replacement is often inappropriate. Instead, care should be tailored to the needs of individuals and targeted towards the central complaints of pain and functional limitation. So why are we still getting it wrong?
An unmet need exists for effective glucocorticoid-sparing agents for the treatment of giant cell arteritis (GCA). Tocilizumab, the first intervention to demonstrate substantial therapeutic benefits for patients with newly diagnosed or relapsing GCA, is changing the landscape of treatment and ushering in a new era of biologic therapy.
A new publication by the ACR provides clear recommendations for the prevention and treatment of osteoporosis in patients being treated with glucocorticoids, but will they improve the historically inadequate management of this patient population?
Interpreting existing patient-reported outcome measures for the experience of remission by patients with rheumatoid arthritis is not straightforward. The challenge is to find a better, more accurate measure.
Increasing evidence points to a mechanistic link between gut and joint pathology as the gut contains the largest number of immune cells of any tissue and trillions of commensals that contribute to immune development and homeostasis. New research is putting the role of Ruminococcus gnavus in arthritic disease in the spotlight.
The newly published findings from the Chondroitin Versus Celecoxib Versus Placebo Trial (CONCEPT) underscore the complexity of performing clinical trials in the field of knee osteoarthritis. But do the results of CONCEPT merit the consideration of chondroitin sulfate as a first-line therapy?
The DRESS study has shown that safety and efficacy were maintained for up to 3 years upon disease activity-guided dose reduction of TNF inhibitors. However, which patients are ideally suited for de-escalation remains to be investigated.
Regeneration of articular cartilage has been a long-standing challenge in the field of regenerative medicine. In the past 2 years, several studies have genetically identified the presence of stem cells in the surface of articular cartilage, but questions remain as to the healing properties of these cells.
Targeting IL-5 could improve outcomes and have steroid-sparing effects in the management of eosinophilic granulomatosis with polyangiitis. However, some questions remain about how this approach affects specific aspects of the disease.
Opioids provide some modest pain relief for patients with rheumatoid arthritis, but prescription of these drugs is influenced by their association with risks for the individual and for society. Is denial of a treatment, even if that treatment is imperfect, justified when patients experience considerable pain and other treatment options are limited?
Intra-articular corticosteroid injections are a long-established treatment for knee osteoarthritis (OA), but new findings indicate they are not effective, and even potentially harmful. Is it time to rethink the use of this treatment?
Like the mythical eagle devouring Prometheus's liver as fast as it regrew, chronic inflammation hinders cartilage regeneration in inflammatory arthritis. Using stem cells engineered to secrete anti-inflammatory molecules in response to local inflammatory factors could provide a way to keep the eagle at bay as the stem cells differentiate into chondrocytes.
Systemic sclerosis-associated interstitial lung disease (SSc-ILD) requires accurate diagnosis and staging to identify patients with the highest risk of disease progression, who might benefit from treatment with immunosuppressants. New insights into predictors of mortality in patients with SSc-ILD should improve patient care and inform the design of future clinical trials.