News & Views

EULAR’s 2023 updated recommendations for the non-pharmacological treatment of hip and knee osteoarthritis reiterates and confirms, in an abbreviated form, what we have known for more than a decade. Unfortunately, the abbreviated format of the updated recommendations lacks specificity and clinical usefulness. More detailed guidance could have facilitated wider uptake and improved care.

Characteristic patterns of joint involvement exist in different forms of arthritis. Research now indicates that epigenetic programming of synovial fibroblasts diversifies their response to inflammatory cascades, leading to this anatomical variation in arthritis and its response to treatment.

In 2006, a linear immunological continuum of autoinflammatory and autoimmune disorders ranging from monogenic diseases of innate immunity at one end to monogenic diseases of adaptive immunity at the other end was proposed to classify these conditions. Deep immunophenotyping has now revealed a cell-based nosology of these disorders.

The World Health Organization (WHO) has published new guidelines for the non-surgical management of chronic primary low back pain in adults in primary and community care settings. Although the guidelines are commendable, they lack guidance on when to suspect and how to avoid missing important secondary causes of back pain.

New findings suggest that current cell therapy approaches are not superior to a simple corticosteroid injection for the treatment of osteoarthritis, calling into question the role of existing cell therapies and highlighting the need for further research and development in this field.

Re-establishing tolerance to autoantigens is an important aim for the treatment of rheumatoid arthritis (RA). Immunization of HLA-DR4 transgenic mice with citrullinated self-antigens can induce immune tolerance, which suggests that such antigens could have a therapeutic role in anti-citrullinated peptide antibody-positive RA.

The identification of novel risk variants in the largest genome-wide association study of Raynaud phenomenon to date provides insights into the pathophysiology of the condition, including the potential role for α_2A-adrenoceptors, and suggests opportunities for drug repurposing.

Newly published European guidelines for the management of systemic lupus erythematosus (SLE) and lupus nephritis, specifically recommending early and aggressive use of new medications, signal that the old paradigm of SLE management is shifting. Although it presents challenges, this shift is welcome — and is likely to have far-reaching implications.

Emerging data suggest that the frequency of long-term opioid use is high among individuals with rheumatic and musculoskeletal diseases, which is of concern given the risks of opioid misuse. But is long-term opioid use really that high or is the situation more complicated?

Rheumatoid arthritis synovium contains phenotypically and functionally heterogeneous fibroblast-like synoviocytes. Cutting-edge analyses have now defined at least four distinct states of these cells related to their location in the synovium, epigenetic imprinting and the influence of microenvironment mediators.

The rise in the use of digital health-care technologies such as electronic patient-reported outcome measures enables a transformation of the traditional care model. In light of the increasing demand for rheumatologists, telehealth could enable more efficient usage of scarce face-to-face appointments.

Drug-free remission is a treatment goal in rheumatoid arthritis that can be achieved by tapering and discontinuation of biologic DMARDs. However, newly published real-world evidence suggests that DMARD discontinuation occurs less frequently than results of clinical trials suggest, so it is important to question what the ultimate goal of treatment should be.

The pathogenesis of juvenile dermatomyositis (JDM) is complex and various evidence implicate a role for type I interferons. Could the use of a bioengineered paediatric skeletal muscle model provide insight into this disease and have potential for high throughput testing of therapeutic agents?

The rarity of various forms of vasculitis, as well as other rheumatic diseases, presents difficulties in studying the genetics of these diseases as well as for evaluating treatments. Might new approaches, such as joint genetic analyses and drug repurposing, provide opportunities to learn more about these diseases and identify new therapies and serve as a basis for basket clinical trials?

No drugs are yet approved for the treatment of primary Sjögren syndrome, despite a large number of clinical trials. Non-conventional approaches can help to identify novel therapeutic targets. Using a drug-repositioning transcriptomic approach, interferon has emerged once again as a major target for intervention in this disease process.

Understanding why individuals with Down syndrome are highly predisposed to autoimmunity has broad mechanistic and therapeutic implications. New work identifies novel potential mechanistic pathways driving increased autoimmunity-relevant CD11c⁺ B cells and provides the broadest view to date of the repertoire of autoantibodies generated in individuals with Down syndrome.

Given that intra-articular injections for the knee of treatments such as hyaluronic acid, stem cells and platelet-rich plasma are advised against or only weakly recommended by current clinical-practice guidelines, why do people continue to seek information about these treatments?

Emerging research suggests that chimeric antigen receptor T cell therapy could be an effective treatment for a range of difficult-to-treat autoimmune diseases, and sophisticated approaches are in tests, yet initial reports also highlight several questions that remain to be answered.

Among the wide range of drugs now available for the treatment of psoriatic arthritis, the best option for an individual patient remains unclear. Emerging real-world evidence from several Nordic registries suggests that differences exist in the response rates to different classes of biologic and targeted synthetic DMARDs in psoriatic arthritis.

The full picture of post-COVID-19 autoimmune diseases and their prevalence is lacking despite numerous case reports and small series. Two studies that use large cohorts now highlight that SARS-CoV-2 infection is linked to a substantially increased risk of developing a diverse spectrum of new-onset autoimmune diseases.