News & Views

  • News & Views |

    Idiopathic inflammatory myopathies (IIMs) are heterogeneous conditions, and the optimal way to classify patients and divide them into subgroups remains unclear. Could machine learning techniques be the answer to the problem of defining homogeneous disease phenotypes, enabling stratified treatment approaches and the formulation of future IIM classification criteria?

    • James B. Lilleker
    •  & Hector Chinoy
  • News & Views |

    Methotrexate is commonly used in combination with biologic DMARDs in the treatment of rheumatoid arthritis on the basis that the combined therapy has synergistic benefits. New data challenge this concept in the treatment of older adults and highlight the uncertainty of the mode of action of methotrexate in this population.

    • Clément Lahaye
    •  & Martin Soubrier
  • News & Views |

    New research suggests that cytotoxic T cells are dominant in the lesional skin of patients with early diffuse cutaneous systemic sclerosis (SSc) and contribute to vasculopathy and tissue fibrosis. Could therapeutic strategies that prevent T cell activation and cytotoxicity therefore present an option to potentially halt progression of SSc?

    • Patrizia Fuschiotti
  • News & Views |

    Children and young people with rheumatic diseases face considerable challenges to their mental health, yet the research guiding prevention and intervention strategies is limited. A new research agenda provides an important step forward by highlighting important issues, but can these research priorities be addressed within the paediatric rheumatology health-care context?

    • Lis Cordingley
    •  & Rebecca Rachael Lee
  • News & Views |

    Patients with clinically suspect arthralgia have articular symptoms such as pain and stiffness of the small joints without clinical signs of arthritis. Some of these patients progress and develop ‘true’ disease, but how can we differentiate evolving chronic disease from disease that will resolve?

    • Axel J Hueber
    •  & Gerhard Krönke
  • News & Views |

    Newly discovered small-molecule TNF inhibitors serve as antagonists of pro-inflammatory TNF signalling by uniquely harnessing the conformational plasticity of trimeric TNF. The development of this approach could mark a resurgence of non-biologic modulators of clinically relevant protein–protein interactions in rheumatology.

    • Savvas N. Savvides
    •  & Dirk Elewaut
  • News & Views |

    Trials studying rare diseases, including immune-mediated inflammatory diseases such as Castleman disease, hyper IgD syndrome and undifferentiated vasculitis, frequently end in noncompletion and nonpublication. A new cross-sectional analysis identifies underlying reasons, but also calls for action to establish international networks that might facilitate recruitment of patients into trials and to ensure timely publication of research findings to advance the field.

    • Anne Musters
    •  & Sander W. Tas
  • News & Views |

    Obesity promotes osteoarthritis (OA) through complex and incompletely understood biomechanical, metabolic and inflammatory factors. New data in mice add to this complexity by showing that eating a high-fat diet increases the risk of OA for two generations of offspring, raising questions about disease mechanisms and future treatment strategies.

    • Timothy M. Griffin
    •  & Jacob E. Friedman
  • News & Views |

    B cells can assume protective or pathogenic roles in immune-mediated diseases (IMDs). Analysis of the B cell receptor (BCR) repertoires in six IMDs provides insights into the diversity of B cell repertoires across diseases as well as into potential pathological mechanisms and the effects of different treatments.

    • Nitya S. Ramadoss
    •  & William H. Robinson
  • News & Views |

    NSAIDs are first line therapy for patients with axial spondyloarthritis and are recommended to be taken continuously in patients with active disease, but their ability to affect radiographic disease progression has been uncertain. Does a new meta-analysis shed light on this matter, or is it too soon to tell?

    • Jürgen Braun
    •  & Xenofon Baraliakos
  • News & Views |

    The 2019 ACR–SAA–SPARTAN treatment recommendations for axial spondyloarthritis incorporate useful advice on new therapies, treatment strategy and the use of imaging. But is it appropriate to still recommend different treatment strategies for non-radiographic and radiographic disease when available evidence suggests they are part of the same clinical spectrum?

    • Xabier Michelena
    •  & Helena Marzo-Ortega
  • News & Views |

    A machine learning model to predict whether patients with rheumatoid arthritis will respond to TNF inhibitors has been produced following an international crowd-sourced competition, but is the mixture of clinical and omics biomarkers used in this model optimal for clinical use?

    • Nisha Nair
    •  & Anthony G. Wilson
  • News & Views |

    Autologous haematopoietic stem cell transplantation (HSCT) can be an effective treatment for refractory autoimmune diseases. With reports of the use of allogeneic HSCT emerging, how do these two very different types of stem cell transplantation compare and is allogeneic HSCT advisable?

    • Keith M. Sullivan
    •  & Stefanie Sarantopoulos
  • News & Views |

    Immunopathology in autoimmune diseases is promoted by complex interactions between many types of immune cells, and adequate disease inhibition relies on targeting molecules that orchestrate these interactions. One such molecule, IL-7, has well-known effects on lymphoid cells, but could this cytokine also affect innate immune cells to induce immunopathology?

    • Anneline C. Hinrichs
    •  & Joel A. G. van Roon
  • News & Views |

    Early diagnosis of primary Sjögren Syndrome (pSS) is difficult but important for long-term disease management. Emerging data support the usefulness of salivary gland ultrasonography in the diagnosis of pSS. But is this imaging tool relevant to clinical practice and should it be added to current classification criteria?

    • Alain Saraux
    •  & Valérie Devauchelle-Pensec
  • News & Views |

    In patients with chronic inflammatory rheumatic diseases, non-adherence to methotrexate therapy could lead to lower drug efficacy, unnecessary adjustments of medication, and avoidable health-care costs. Use of a novel blood assay to measure methotrexate could help prevent or reduce non-adherence in clinical practice.

    • Maxime Dougados
  • News & Views |

    EULAR has published points to consider for the use of big data in rheumatology research that open up discussions and debates that are necessary and important, but are they missing the opportunities presented by cross-discipline collaboration to expand our perspective of disease beyond what is clinically visible?

    • Marta E. Alarcón-Riquelme
  • News & Views |

    Gout diagnostic criteria help focus attention on the accurate and early diagnosis of gout. New recommendations reinforce that joint aspiration and demonstration of monosodium urate crystals remains the gold standard for a diagnosis of gout and should be attempted in every patient with suspected gout.

    • Jasvinder A. Singh
  • News & Views |

    Criteria to define remission in gout could be valuable in clinical trials and practice. But do the available preliminary criteria truly predict the long-term absence of gout signs and symptoms?

    • Thomas Bardin
    •  & Pascal Richette
  • News & Views |

    Epidemiological data on the prevalence and severity of specific manifestations of systemic lupus erythematosus (SLE) among different ethnic groups are now emerging. The use of rigorous epidemiological methods should enable a better understanding of these features of SLE in different ethnic groups, which could influence disease management.

    • Naureen Kabani
    •  & Ellen M. Ginzler
  • News & Views |

    New data highlight the contribution of IL-6 to vascular calcification in chronic inflammation. Given that increased vascular calcification and accelerated atherosclerosis occur in patients with chronic inflammatory diseases, new therapies that block the IL-6 pathway might reduce the risk of cardiovascular events in these patients.

    • Raquel López-Mejías
    •  & Miguel A. González-Gay
  • News & Views |

    Analysis of data from the European Scleroderma Trials and Research (EUSTAR) cohort has initially identified six subsets of systemic sclerosis (SSc), as opposed to the binary classification of limited and diffuse cutaneous SSc. We now move closer to a more actionable SSc classification for improved clinical care and trial design.

    • Monique Hinchcliff
    •  & J. Matthew Mahoney
  • News & Views |

    Changes in the gut microbiome are thought to be important environmental triggers for inflammatory forms of arthritis, including rheumatoid arthritis. Could interactions between gut parasites, such as helminths, and gut microbiota be the key to normalizing an unbalanced microbiome and preventing arthritis?

    • Gillian Coakley
    •  & Nicola L. Harris
  • News & Views |

    Studies across multiple autoimmune diseases, including rheumatoid arthritis and coeliac disease, have identified a pathologically expanded PD1hiCXCR5CD4+ T cell population that accumulates in inflamed tissues. Can this peripheral T helper cell population be harnessed as a predictive biomarker or targeted therapeutically in these diseases?

    • Deepak A. Rao
  • News & Views |

    18F-FDG-PET is not currently recommended for use in the diagnosis of cranial giant cell arteritis (GCA). A new study has compared 18F-FDG-PET with temporal artery biopsy and clinical diagnosis as gold standards, but is 18F-FDG-PET accurate enough to be used on temporal arteries?

    • Dario Camellino
    •  & Christian Dejaco
  • News & Views |

    Inclusion body myositis (IBM) and polymyositis can normally be distinguished on the basis of clinical features. However, patients with an atypical disease presentation, particularly those with early-stage disease, can be challenging to diagnose. Can imaging with amyloid-PET help distinguish these two diseases?

    • Iago Pinal-Fernandez
    •  & Andrew L. Mammen
  • News & Views |

    The use of NSAIDs in rheumatology could be improved by an appropriate risk scoring system that accounts for adverse events such as bleeding and thrombosis. Such a risk score has now been developed using data from the PRECISION trial, but is this score ready to be applied in clinical practice?

    • Michael T. Nurmohamed
  • News & Views |

    Antibodies against phosphatidylserine–prothrombin complexes (PS–PT) are one type of antiphospholipid antibody that is responsible for lupus anticoagulant activity. Anti-PS–PT antibodies are not currently included in the classification criteria for antiphospholipid syndrome (APS), but should they replace lupus anticoagulant testing to improve the diagnosis of APS?

    • Yuichiro Fujieda
    •  & Tatsuya Atsumi
  • News & Views |

    Sensing of cytosolic DNA by cyclic GMP–AMP synthase (cGAS) is central to the pathogenesis of a number of autoinflammatory syndromes and possibly some autoimmune diseases, such as systemic lupus erythematosus (SLE). Activation of cGAS signalling requires its deacetylation, so might aspirin have therapeutic potential to treat SLE by acetylating cGAS?

    • Keith B. Elkon
  • News & Views |

    The molecular mechanisms responsible for initiation and progression of osteoarthritis (OA) are incompletely understood. New data implicate cholesterol, its metabolites and the receptor RORα as catabolic drivers of OA-like disease in mice, but do these data identify new targets for treating patients with OA?

    • Frank Beier
  • News & Views |

    Biologic DMARDs are a cornerstone treatment for severe axial spondyloarthritis. Although indications for treatment initiation are well codified, the timing and modalities for tapering remain unclear, despite medical and economic concerns. Encouraging data about treatment tapering are emerging that might guide future management strategies.

    • Nelly R. Ziade
    •  & Xenofon Baraliakos
  • News & Views |

    New disease activity measures are needed for systemic lupus erythematosus (SLE). Is the new SLE-DAS better than existing measures or are other instruments, or combined scoring methods, required to manage the spectrum of SLE?

    • Anca D. Askanase
    •  & Joan T. Merrill
  • News & Views |

    New research indicates that tocilizumab limits the beneficial effects of exercise on abdominal fat loss. What does this mean for patients with chronic disease who are being treated with tocilizumab or other inhibitors of IL-6 signalling?

    • Antonios Stavropoulos-Kalinoglou
    •  & George D. Kitas
  • News & Views |

    Negative results of yet another IL-1 inhibitor in the treatment of knee osteoarthritis add to a pool of data indicating that this strategy does not reduce pain or inflammation and is thereby a dead end. Should we therefore shelve further plans to test or use this therapeutic strategy?

    • Xavier Chevalier
    •  & Florent Eymard
  • News & Views |

    No drugs are currently approved that change the natural course of osteoarthritis (OA) and translate to long-term, clinically relevant benefits. Two-stage clinical trial designs for OA have now received FDA approval, but remaining challenges lie in defining suitable study populations, surrogate outcomes and pivotal long-term, clinically relevant trial endpoints.

    • L. Stefan Lohmander
    •  & Ewa M. Roos
  • News & Views |

    Autoantibodies have been recognized and studied for decades, but evaluation of the cellular and molecular processes underlying autoantibody production has until now been fairly limited. Can the use of cutting-edge technology to isolate autoreactive B cells and characterize their transcriptional activity provide further insight?

    • Jeremy Sokolove
  • News & Views |

    The use of assays to detect anti-citrullinated protein antibodies (ACPAs) is helpful in the diagnosis of rheumatoid arthritis. But how good are these assays at detecting ACPAs and do we really know what the results are telling us about ACPA specificity?

    • Lotte A. van de Stadt
    •  & Theo Rispens
  • News & Views |

    Shifts in cellular metabolism are central to activation, differentiation and proliferation of inflammatory cells and can contribute to the pathogenesis of inflammatory diseases. Integrating metabolomics data with other omics data is a major challenge but might enable clinicians to stratify stages of disease and response to therapy in patients with rheumatoid arthritis.

    • Catherine M. McGrath
    •  & Stephen P. Young
  • News & Views |

    Vitamin D is important for skeletal metabolism and calcium homeostasis, but conflicting evidence exists as to whether vitamin D supplementation has a protective effect on musculoskeletal outcomes. Do the results of a new meta-analysis bring clarity or increase confusion?

    • Iacopo Chiodini
    •  & Luigi Gennari
  • News & Views |

    ‘Patient-centered’ research has traditionally meant that researchers and clinicians design trials for the benefit of patients. By contrast, patients today are central to study design and reporting outcomes, and new research agendas recognize that patients can point the way to research questions and how to address them.

    • Laura E. Schanberg
    •  & C. Daniel Mullins
  • News & Views |

    Despite the previous identification of genes involved in the treatment response to TNF inhibition in rheumatoid arthritis, no genetic biomarkers are currently used in clinical decision-making. Might the heterogeneous nature of the disease activity score, which is often used as the outcome measure in genetic studies, partly explain this gap?

    • Marieke J. H. Coenen
  • News & Views |

    The search for the identity of skeletal stem cells has reached a point at which skeletogenic cell populations with self-renewing capacity can be enriched and studied in detail. These advances provide new hope for skeletal regenerative medicine.

    • Frank P. Luyten
    •  & Scott J. Roberts
  • News & Views |

    Gasdermin D is a pore-forming protein that can cause pyroptosis, a form of inflammatory cell death. New research indicates that the pores generated by gasdermin D can also promote the formation of neutrophil extracellular traps, potentially opening new therapeutic avenues for the treatment of inflammatory diseases.

    • Lotte Spel
    •  & Fabio Martinon
  • News & Views |

    A variety of comorbidities of gout exist, but most of these associations are not causally linked. Mendelian randomization analysis of genome-wide association study data now suggests that iron overload might increase serum uric acid levels and hence the risk of gout flares.

    • Pascal Richette
    •  & Augustin Latourte
  • News & Views |

    Current guidelines for the treatment of osteoarthritis involve exercise and lifestyle modifications as well as pharmaceutical therapeutics for effective pain management. Is this message reaching patients, and are they exercising enough?

    • Philip G. Conaghan
  • News & Views |

    Seropositive RA can present with two different types of autoantibodies that have distinct features: anti-citrullinated protein antibodies (ACPAs) and rheumatoid factors (RFs). With a single-cell approach, researchers provide evidence that the underlying B cell subsets of these autoantibody specificities develop in parallel by different mechanisms.

    • Vivianne Malmström
    •  & Caroline Grönwall
  • News & Views |

    Tight regulation of signalling cascades is vital for the correct development and function of bones and joints. A new study suggests that Notch signalling might join the likes of the transforming growth factor superfamily and Wnt signalling cascades as having an important function in joint homeostasis and disease.

    • Silvia Monteagudo
    •  & Rik J. Lories
  • News & Views |

    Using mice with targeted deletion of the glucocorticoid receptor, a new study has examined the cell types that mediate the anti-arthritic effects of therapeutic glucocorticoids. Surprisingly, in the serum transfer-induced arthritis model, glucocorticoids target stromal cells rather than immune cells.

    • Rowan Hardy
    •  & Mark S. Cooper
  • News & Views |

    Inappropriate activation of Toll-like receptor 4 (TLR4) on resident fibroblasts, through the binding of damage-associated molecular patterns, is a potential driver of fibrosis in systemic sclerosis. New evidence suggests that targeting fibroblast-specific TLR4 or an accessory molecule MD2 could have therapeutic value.

    • Steven O’Reilly
    •  & Jacob M. van Laar
  • News & Views |

    Stimulator of interferon genes (STING), an important component of the cytosolic DNA sensing pathway, is an attractive therapeutic target for ameliorating interferon-driven systemic inflammation. New findings are shedding light on how STING functions and on a strategy to target STING therapeutically.

    • Carolina Uggenti
    •  & Yanick J. Crow