News & Views in 2019

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.

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?

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?

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?

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?

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?

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?

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.

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?

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.

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?

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.

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.

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.

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?

Studies across multiple autoimmune diseases, including rheumatoid arthritis and coeliac disease, have identified a pathologically expanded PD1^hiCXCR5⁻CD4⁺ 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?

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?

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?

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?

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?