News & Views in 2021

New research reports that men with inflammatory arthritis experience an impact on sexual health beyond erectile dysfunction, affecting their emotional, mental, and social health. Training to empower health professionals to have conversations about sex could improve support for people with rheumatic diseases.

Smoking during adulthood is a known risk factor for seropositive rheumatoid arthritis (RA) but how exposure to passive smoking affects RA risk is uncertain. New data from the Nurses’ Health Study on passive smoking over a lifetime suggest childhood exposure could be an important factor for future RA development.

The results of several retrospective studies have reported that systemic treatment in patients with psoriasis reduces the risk of incident psoriatic arthritis (PsA). Although encouraging from a prevention perspective, such studies are limited in their ability to provide a conclusive understanding of PsA risk, preventing a clear picture from emerging.

The ACR have published their first guideline for the management of large vessel vasculitis, which covers giant cell arteritis and Takayasu arteritis. The new guideline differs from the current EULAR recommendations on some important points, but do these different views actually affect patient care?

New evidence has emerged that DNA can bind to cell surface HLA class II molecules. If true, this surprising interaction could lead to T cell and B cell activation by DNA, and surface DNA could also provide a target for cell killing by anti-DNA antibodies in systemic lupus erythematosus.

The development of treatments for systemic sclerosis has historically been hampered by the clinical heterogeneity of the disease and limited understanding of its pathogenesis. Encouragingly, advances including the identification of important molecular targets and improvements in clinical trial design have now greatly increased the number of investigative therapies.

Limited data suggest associations between air pollution and rheumatic disease risk and outcomes. More sophisticated research is needed to clarify the conditions under which air pollution might influence the health of people with rheumatic disease, including their response to biologic drugs.

Short telomere length is implicated in lung diseases and can be caused by mutations in telomere genes. Acquired autoimmunity directed against components of the telomere system is now reported in some patients with systemic sclerosis or idiopathic pulmonary fibrosis, suggesting a novel explanation for short telomeres in these diseases.

The 2021 ACR guideline for the treatment of rheumatoid arthritis provides an update on several important topics, including the use of targeted synthetic DMARDs (tsDMARDs). But how does the new guideline compare to EULAR recommendations, and is the growing importance of tsDMARDs adequately accounted for?

Sensation of mechanical stimuli by chondrocytes is critical to cartilage homeostasis and osteoarthritis development. The earliest responses in chondrocyte mechanotransduction pathways involve calcium influx and changes in mitochondrial function, which occur in seconds to minutes. Deeper understanding of these events can elucidate new therapeutic targets for early intervention to prevent osteoarthritis.

Underrepresentation of patients with non-white skin in rheumatology educational resources impairs practitioners’ competence in caring for patients with skin of colour and reduces patients’ confidence in the medical system. Medical publishers and educators should reconsider how to promote equal representation and care of patients with all skin types.

According to new data, overexpression of the nicotinamide adenine dinucleotide (NAD) hydrolase, CD38, in systemic sclerosis (SSc) leads to NAD depletion and fibrosis. These intriguing findings link inflammation, NAD metabolism and fibrosis and bare striking resemblance to age-related changes in SSc. Could DNA damage also connect these seemingly unrelated pathways?

The discovery that autoantibodies and other factors can predict the future onset of rheumatoid arthritis (RA) has encouraged the development of clinical trials looking at RA prevention. Although an exciting area of research, finding an approach that results in the successful completion of an RA prevention trial is challenging.

The transcription factor Sox9 is important for cartilage formation during development, but its role in postnatal growth plates and adult articular cartilage has been uncertain. New research is revealing essential roles for Sox9 in postnatal cartilage homeostasis and in preventing post-traumatic osteoarthritis, along with new mechanisms for chondrocyte-to-osteoblast transition.

The accurate homogeneous differentiation of human induced pluripotent stem cells into chondrocytes is crucial for cartilage regenerative therapies. Discovery of the signalling pathways responsible for the differentiation of unwanted cell types during in vitro chondrogenesis could herald a breakthrough for in vitro cartilage generation.

Myositis is a group of conditions that vary greatly in risk factors, clinical manifestations, laboratory markers, presumed pathogenetic mechanisms, treatment responses and prognoses. Approaches to divide myositis into mutually exclusive and stable phenotypes are being considered, but are we thinking comprehensively enough in our attempts at classification?

The field of rheumatology is poised to categorize the phenotypes of systemic autoimmune diseases on the basis of measurable and quantifiable molecular signatures. Emerging efforts to identify similarities across diseases, predict clinical outcomes and predict response to therapy using quantitative, data-driven approaches could considerably change treatment paradigms.

A multitude of factors contribute to the development and progression of systemic lupus erythematosus (SLE) through their effects on immune cells and tissue resident cells. Ultraviolet light instigates skin inflammation in SLE, and now new findings suggest that neutrophils in the inflamed skin migrate to the kidneys, spreading the inflammatory response.

An important question for patients and providers is whether and to what extent dietary interventions, diet supplements or weight loss can help to prevent incident gout or manage existing gout. Evidence is emerging, but randomized trials are still needed to fill this important knowledge gap.

Janus kinase (JAK) inhibitors have become standard treatment for patients with rheumatoid arthritis who do not respond well to other DMARDs. Concerns have been raised over an increased risk of venous thromboembolism with JAK inhibitors, tempering enthusiasm for their use in the clinic, but are these concerns justified?