News & Views in 2009

Researchers have identified a new molecular pathway for the regulation of bone and energy metabolism that challenges the conventional view of the role of leptin in bone turnover.

Two randomized controlled trials have shown no significant differences in outcome between vertebroplasty and a sham procedure in patients with back pain and vertebral fracture. What conclusions can be drawn from these results?

New research shows that intensive bisphosphonate therapy for Paget disease of bone has no beneficial effect on quality of life, bone pain or clinical complications compared with symptomatic management. What are the implications of these findings on the management of patients with Paget disease?

Adipocytokines are usually regarded as signaling molecules that originate from and act within the adipose tissue. However, recent data show that adipocytokines, especially adiponectin, exert various functions throughout the organism that are neither unambiguously protective nor solely harmful.

In the late 1990s, bone cell biologists predicted inhibition of RANKL as an important therapeutic target for osteoporosis. The theory has now been confirmed by two studies showing that denosumab reduces fracture risk. This success for translational research should be tempered by awareness of the need for long-term monitoring for adverse effects.

Insight into the immunopathogenesis of crystal-induced inflammation has opened the door to a new approach to therapy. Could interleukin-1 antagonists be the answer to managing acute gout?

Transcriptomics and proteomics are transforming our understanding of juvenile idiopathic arthritis by revealing molecular signatures associated with the various clinical classifications. The challenge now is to find biomarkers that will predict disease course and response to medication in order to improve outcomes for children with arthritis.

Golimumab effectively reduces the signs and symptoms of active rheumatoid arthritis in patients who have previously failed treatment with at least one tumor necrosis factor inhibitor. Is it now time to develop strategies for sequential drug administration?

Randomized controlled trials investigating non-pharmacological therapies for hand osteoarthritis are rare. One such study now suggests that neoprene splints could be effective for the treatment of base-of-thumb osteoarthritis—but some questions remain unanswered.

A rare but often fatal viral disease has been reported in a number of patients treated with rituximab, but how the risk of this complication should affect prescription practices demands consideration of several important factors.

Biologic therapies that target interleukin (IL)-1 are known to dramatically improve symptoms of a group of rare, heritable chronic inflammatory diseases. The results of a phase III trial confirm the place of canakinumab in the treatment arsenal for these disorders.

Why are female athletes more susceptible to knee ligament injuries than male athletes performing the same activities? Several theories have been put forward to explain this phenomenon.

The results of two new studies suggest mutations in the gene encoding the interleukin (IL)-1 receptor antagonist (IL-1Ra) are responsible for a spectrum of childhood inflammatory disorders characterized by an imbalance in IL-1 expression. What implications do these intriguing results have for the diagnosis and management of IL1-driven inflammatory disorders?

New research reports that primary human dermal fibroblasts seeded into a three-dimensional biodegradable matrix can differentiate in vitro into osteoblasts and chondrocytes, and form three-dimensional bone-like and cartilage-like constructs, respectively. Is skeletal tissue engineering from skin biopsy tissue on the horizon?

The latest guidelines from the American Pain Society (APS) provide a comprehensive analysis of the evidence on the use of interdisciplinary rehabilitation and surgical and interventional procedures for the treatment and diagnosis of chronic low back pain. But will they have any impact on clinical practice?

What is the relationship between genetic and environmental risk factors in predisposing for rheumatoid arthritis (RA)? A new study provides more details on the interaction between the HLA DRB1 shared epitope (SE) alleles and smoking in conferring the risk of autoantibody-positive RA.

Medications that inhibit gastric acid secretion are standard co-therapy with NSAIDs, but evidence is emerging of a link between prolonged use of these agents and an increased risk of hip fracture.

Clinical tests of the novel small-molecule inhibitor of p38α MAPK, VX-702, have resulted in an all-too-familiar outcome: modest clinical efficacy and transient inhibition of inflammatory markers. Why have p38α inhibitors failed, and what can we learn about the regulation of signal transduction pathways in inflammatory arthritis?

The degree to which the elevated risk of malignant lymphomas in patients with rheumatoid arthritis (RA) is related to disease activity or to therapy is uncertain. Evidence is mounting in support of a strategy of more-intensive cancer screening in these patients.

In April 2009, efalizumab was withdrawn from the market for the treatment of psoriasis after reports emerged of an association between long-term therapy and the development of progressive multifocal leukoencephalopathy (PML). This event highlights an urgent need for greater awareness and research into the screening, diagnosis and treatment of this potentially fatal disease in patients undergoing immunosuppressive therapy for chronic inflammatory disorders.