News & Views in 2015

Polymyalgia rheumatica (PMR) is an inflammatory disorder of unknown aetiology that can be extremely disabling when active. Glucocorticoids are currently the therapy of choice for patients with PMR, but responsiveness to treatment varies considerably. The identification of different morphological patterns of disease defined by distinct extracapsular or capsular-based inflammation might, at least in part, explain this variability in responses to treatment.

A new study attributes the pathogenicity of anti-Ro60 autoantibodies and type I interferon in systemic lupus erythematosus and Sjögren syndrome to Alu retroelements, but is this RNA the complete story?

Glucocorticoids are the mainstay of treatment for patients with polymyalgia rheumatica (PMR) and often produce substantial clinical improvements, but treatment can be complicated by relapse, adverse effects of therapies, and concomitant conditions. New recommendations aim to guide clinicians and improve the management of this disorder.

Functional MRI (fMRI) is increasingly used in efforts to unravel the neuropathological processes of neuropsychiatric systemic lupus erythematosus (NPSLE). Standardization of scan protocols, imaging expertise and disease-related confounders of neuronal activities remain major challenges to the use of fMRI in the diagnosis and prognosis of NPSLE.

In the past 10 years, the rheumatology community has seen an explosion in the number of new therapies licensed for use across the rheumatic diseases, many with outstanding clinical success. Here, the drugs and strategies that constitute landmarks in the management of rheumatic diseases are highlighted.

Technological advances over the past decade have revolutionized many areas of rheumatology, ranging from diagnosis, prognosis and therapeutic development to the mechanistic understanding of rheumatic diseases. This overview highlights key technological innovations and discusses the major impact that these developments are having on research and clinical practice.

In the development of rheumatoid arthritis, which factors govern the transition from systemic autoimmunity to synovitis? A study combining findings from human disease and animal models suggests that autoantibodies to neutrophil-derived citrullinated histone 2B are important for this transition; however, a 'second hit' involving intra-articular inflammation and citrullination could also be crucial to this process.

Defining key advances in any medical discipline can be challenging, but is especially so in rheumatology—a rapidly advancing field so broad that it defies traditional classifications. Here, we approach the Sisyphean task of summarizing the translational advances in rheumatology in the past decade within several broad categories of basic research.

The study of rheumatic diseases that affect children has thrived in the past 10 years. A look at several important advances in this area illustrates how organized collaborations and advanced technologies are contributing to the understanding and, ultimately, to improving the treatment of these disorders.

Comorbidities affect outcomes and treatment decisions in patients with immune-driven systemic inflammatory disorders. New recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis and psoriatic arthritis might help optimize the management of these diseases and improve patient outcomes, but several considerations are relevant to their clinical implementation.

Although new therapeutic options are available for patients with autoinflammatory diseases, evidence-based treatment guidelines are lacking. An initiative in European paediatric rheumatology aims to develop best-practice recommendations for the management of these rare disorders.

Early identification of secondary Raynaud phenomenon is essential to treat the underlying disease—most frequently systemic sclerosis (SSc). Integrated therapeutic approaches and monitoring systems that offer improved modalities of care feature in the new best practice recommendations for the treatment of digital vasculopathy in SSc.

The treatment recommendations for rheumatoid arthritis (RA) have been updated. Among the changes included, rheumatologists are advised to share treatment decision-making with patients and to maximize patients' quality of life by aiming for clinical remission. The update is based on scientific evidence, but more research is needed to strengthen RA treatment strategies.

In the past decade, the consequences of temporomandibular joint arthritis in patients with juvenile idiopathic arthritis have received increasing attention. Intra-articular corticosteroid injections have been suggested as a treatment option, but concerns that this treatment could reduce mandibular growth have been raised and are supported by new data published in The Journal of Rheumatology.

An inverse relationship between BMI and risk of death has been noted in patients with rheumatoid arthritis. Does being overweight or obese really have a favourable effect on mortality in these individuals, or could other factors explain the association?

Comparative effectiveness research could help inform the choice of agent for urate-lowering therapy, the central component of successful gout management. However, if such studies reflect current clinical practice, are they comparing poor management with inadequate management?

A new study suggests that rheumatoid arthritis does not increase cancer-related mortality in patients with cancer, particularly in those with advanced stage malignancies. Could the inclusion of quantitative measures of inflammation, physical function or socioeconomic status have changed these findings?

Arthroscopic surgery to remove torn meniscal tissue is a controversial treatment that, together with the meniscal tear itself, is associated with a high risk of developing knee osteoarthritis (OA). But what of surgical approaches to repair or replace the meniscus? Are these procedures justified with respect to the later development of OA?

The quest for new biomarkers of response to therapies in rheumatoid arthritis (RA), particularly to TNF inhibitors, continues. Two recent studies add to this body of literature, finding both established and novel genetic variants that correlate with response to TNF inhibitors in RA.

Substantial advances have been made in the field of imaging in spondyloarthritis, with respect to both the techniques themselves and their applications, but how should clinicians and radiologists make the most of these developments? New recommendations from EULAR could provide valuable guidance.