Review Articles in 2009

Recurrent febrile syndromes are rare autoinflammatory disorders characterized by recurrent episodes of fever and systemic inflammation that present a diagnostic challenge to rheumatologists. In this Review, the authors outline the clinical features, pathophysiologic mechanisms, diagnostic challenges, and therapeutic strategies for these syndromes.

In the context of a multidisciplinary approach to the management of fibromyalgia, guidelines recommend that pharmacologic therapies be individually tailored to a patient's symptoms but do not offer a method of assessment. In this Review, the authors provide a rapid, easily-remembered framework for the quantitation and pharmacologic management of symptoms that is suitable for use in a busy clinical practice.

A wealth of evidence suggests that the prevalence of cardiovascular disease is increased in patients suffering from chronic inflammatory disorders, particularly rheumatoid arthritis and systemic lupus erythematosus, as discussed in this Review. In the absence of specific guidelines, Dr Kaplan highlights strategies for the prevention and treatment of cardiovascular events in patients with chronic inflammatory disease.

In patients with systemic sclerosis, impaired activity of transforming growth factor β (TGF-β) has a central role in the pathogenesis of fibrosis, which leads to the progression of the disease and severe organ damage. In this context, the authors discuss the mechanisms of aberrant TGF-β signaling and highlight the potential of TGF-β as a therapeutic target in systemic sclerosis.

A potential association between periodontitis, a chronic inflammatory disease characterized by loss of the periodontal ligament and alveolar bone, and systemic rheumatic diseases—particularly rheumatoid arthritis—has been suggested. Results from studies that support such a link are outlined in this article, as are causal and non-causal factors that could determine an association between the two conditions.

Congenital heart block is a serious cardiac manifestation of neonatal lupus erythematosus that is associated with exposure to maternal autoantibodies against components of the SSA/Ro–SSB/La ribonucleoprotein complex. This Review outlines our current hypothesis regarding the pathogenesis of this disease and discusses how basic research can be applied to ensure appropriate prevention and management strategies are followed.

In this Review, Dr Erkan and Prof Lockshin discuss the current management strategies for patients who are persistently positive for antiphospholipid antibodies, and also introduce some of the new and experimental 'immunomodulatory' approaches that are being investigated for managing antiphospholipid syndrome.

Traditionally, diagnosis of osteoarthritis has relied upon conventional radiography, but there are discrepancies between clinical symptoms and radiographic findings. Novel imaging modalities, especially MRI, are providing new insights into the osteoarthritis phenotype and the potential tissue origins of pain in joint disease.

Vitamin D is known to have many complex roles in human health-notably in the maintenance of immune homeostasis. In this Review Prof. Shoenfeld and colleagues explore the relationship between skin pigmentation and therefore vitamin D synthesis, with the incidence of autoimmune disease.

NSAIDs are commonly used to treat pain following injury or orthopedic surgery, but these agents are associated with impaired fracture healing. In this Review, the authors discuss the role of neurotrophic factors in mediating post-injury or post-operative inflammatory pain, and the potential of nerve growth factor inhibitors as an alternative pain management modality in this setting.

Neurocognitive impairment is a frequent manifestation of systemic lupus erythematosus in pediatric patients; however, the evidence base for the epidemiology, pathogenesis, diagnosis and treatment of this phenomenon is limited. The authors of this Review article discuss the available data and highlight avenues for future research in this clinically important field.

In this Review, the authors highlight recently identified genetic associations that confer susceptibility to both psoriasis and psoriatic arthritis, and describe how these associations provide insight into the pathogenesis of these diseases.

Breakdown of the extracellular matrix leading to loss of articular cartilage and bone is a characteristic feature of arthritis. The author of this Review discusses the potential role of two novel members of the ADAMTS (a disintegrin and metalloproteinase with thrombospondin motifs) family, ADAMT-7 and ADAMTS-12, in the degradation of cartilage oligomeric matrix protein, and suggests that that α₂-macroglobulin and granulin-epithelin precursor could represent their endogenous inhibitors.

Knowledge of the action of the bone remodeling cycle in patients with osteoporosis has led to the discovery of a number of novel targets for therapy. In this Review, Dr Deal summarizes currently available therapies and agents in development for the treatment of low bone mass and their modes of action.

To date, participation has not been widely evaluated as an outcome measure of ankylosing spondylitis. In this Review, the authors argue that the evaluation of participation is critical to understanding the benefit of various interventions in ankylosing spondylitis and arthritis in general. Issues for consideration in the development and use of participation as an outcome measure are also discussed.

Understanding and treating the complex pains of rheumatic disease remains an ongoing challenge. In this Review Dr Samad and colleagues discuss the molecular pathways involved in nociceptive, inflammatory and rheumatic pain and highlight how they might be therapeutically targeted.