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Research related to the role of the synovium and its cell constituents during the pathogenies of osteoarthritis (OA) has taken a back seat to that of the cartilage and chondrocytes. The influence of synoviocytes in OA is increasingly recognized, but are synoviocytes equal in their contributions to disease progression?
The design of effective inhibitors of protein–protein interactions is challenging. In a new study, thermal fluctuation of protein structure was simulated to identify small-molecule candidates that inhibit protein–protein interactions. The application of this technique to other protein–protein interactions might facilitate the replacement of biologic agents with orally available small-molecule drugs.
Contemporary guidelines for the management of systemic lupus erythematosus (SLE) recommend prescribing hydroxychloroquine dosages of 5 mg/kg per day or lower to minimize toxicity. However, new evidence raises serious concerns about the risk of SLE flare associated with such doses. How do the benefits and risks of this controversial recommendation balance out?
Structural modification of RNA by adenosine-to-inosine editing renders self-RNA invisible to RNA sensors of the innate immune system. Lack of RNA editing unleashes inflammatory responses that can lead to autoinflammation. A deeper understanding of the associated signalling pathways might reveal potential targets for drug discovery for autoinflammatory diseases.
Although neutrophils are vital components of the innate immune system, they can also contribute to the inflammation and autoantibody formation that characterize a number of rheumatic diseases. The ability to specifically target neutrophils, and in particular activated neutrophils, could enable the direct delivery of drugs for therapeutic modulation of neutrophil activity.
Glucocorticoids are common medications that are used in research trials and clinical practice. Measuring the toxicity of glucocorticoids in children is complicated by various factors such as age and growth. A standardized tool could help to record these toxicities across different specialities in a systematic manner.
New research reinforces the fact that most recommendations in rheumatology are not informed by comparative efficacy randomized controlled trials. Performing these studies is time and resource intensive. Policies and funding to perform these studies in a timely and resource constraint manner are essential.
Often viewed as merely an inconsequential episode of acute joint pain, gout flare has also been associated with an increased risk of acute myocardial infarction and stroke. New findings suggest the risk is highest within the first 60 days of gout flare, and could be influenced by flare treatment.
New research shows that TNF can directly induce osteoclastogenesis from transforming growth factor-β (TGFβ)-primed macrophages and that knockout of TGFβ signalling limits TNF-induced arthritic bone erosion in mice, suggesting that TGFβ inhibition could enhance the effect of anti-TNF therapy in rheumatoid arthritis.
Transitional care in rheumatology has been debated for over three decades and yet unmet needs of young people are still being reported. Why the slow progress? Perhaps we need to stop talking about transitional care in rheumatology and talk more about developmentally appropriate health care for young people with rheumatic conditions.
Multisystem inflammatory syndrome in children (MIS-C) and Kawasaki disease are both hyperinflammatory disorders associated with infectious diseases, but are they distinct syndromes or do they exist along a continuum? A comparison of the host immune response in these illnesses provides surprising new insights.
Lack of understanding of the immunology of sarcoidosis has limited therapeutic progress. However, evidence from a small open-label trial suggests that treatment with the Janus kinase inhibitor tofacitinib can improve sarcoidosis symptoms, predominantly by inhibiting type 1 immunity.
In patients with autoimmune rheumatic disease, methotrexate therapy has been associated with poor immune response to vaccines, including those intended to provide protection against COVID-19. Emerging evidence supports the practice of temporarily discontinuing this treatment in order to improve immunogenicity.
Although the multitude of pathways involved in the pathogenesis of systemic lupus erythematosus (SLE) seem to be interconnected, each predominates in only a fraction of patients. This complexity means that many agents tested in SLE clinical trials — now including iberdomide — produce only a small clinical benefit.
Do you inform patients about risks and chances of success associated with different choices when treatment needs to be changed? This approach takes time and requires patient health literacy. Results from a discrete-choice experiment in scleroderma lung disease add to the debate on shared decision-making.
New research reveals that outcomes for patients with rheumatoid arthritis are affected less by pre-existing comorbid conditions than by socioeconomic factors. Future research should address the mechanisms of this relationship and develop holistic treatment approaches that reduce disparities attributed to socioeconomic status.
The new ACR guideline for the treatment of juvenile idiopathic arthritis provides an update on several important topics, including management of oligoarthritis, temporomandibular joint arthritis and systemic-onset arthritis. Overall, the new guideline reflects changes in practice, but also highlights a concerning lack of high-quality evidence.
New classification criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis endorsed by ACR and EULAR reflect important developments in the field since the 1990 criteria were published, including bringing ANCA testing to the fore.
New evidence implicates necroptosis in muscle fibre damage in idiopathic inflammatory myopathies, but is it too soon to suggest that interfering with this cell-death pathway could offer a novel therapeutic strategy?
New EULAR recommendations offer useful guidance for improving cardiovascular health in patients with rheumatic and musculoskeletal disease. However, an interdisciplinary model of care is crucial to the optimal management of cardiovascular risk in these patients.
