Review Articles

The prevalence of rheumatic diseases is increasing in African countries, leading to an increased need for specialist rheumatologists and disease-modifying drugs. In this Review, the authors outline what is currently known about the state of rheumatic diseases in Africa.

Various drugs used in rheumatoid arthritis management have anti-inflammatory effects that can hinder atherosclerosis development and progression. However, these drugs can also concurrently have different pro-atherogenic effects, complicating the relationship between these drugs and cardiovascular involvement in rheumatoid arthritis.

Pathogenic, long-lived memory cells of the immune system present a barrier to resolution of chronic inflammatory rheumatic diseases. Approaches to selectively eliminate these cells while sparing protective immune memory cells could restore immunological tolerance and achieve treatment-free remission.

Childhood-onset arthritis has historically been treated as a separate entity to adult-onset arthritis, with its own nomenclature and classification system. Biological evidence has revealed the limitations of the current approach, necessitating a fresh look at the classification of paediatric arthritis.

TNF inhibitors are used to treat various immune-related adverse events caused by immune checkpoint inhibitors (ICIs). However, whether TNF inhibition compromises the anticancer efficacy of ICI therapy is unknown. This Review discusses the relationship between TNF, TNF inhibition and cancer.

Intestinal dysbiosis is thought to be involved in the early stages of rheumatoid arthritis (RA). In this Review, the authors discuss the gut–joint axis in RA and the potentially pathogenic role of gut-derived immune cells in the joints.

In this Review, the authors discuss macrophage activation syndrome (MAS) in relation to other cytokine storm scenarios, and provide a framework for understanding MAS within the spectrum of innate and adaptive immunity in the context of gain or loss of immune function.

Intervertebral disc (IVD) degeneration is a common condition associated with low back pain, but approved pharmacological interventions to prevent progression of IVD degeneration are lacking. This Review discusses the clinical progress and challenges of cell-based therapeutics for repairing the IVD.

Tissues are composed of cells and an extracellular matrix. In this Review, the authors discuss how a greater understanding of the role of the synovial extracellular matrix in rheumatoid arthritis could lead to improved disease diagnosis and new therapies.

In this Review, the authors examine how the definition and description of axial spondyloarthritis (axSpA) has evolved, most notably with the introduction of the concept of non-radiographic axSpA, and discuss the implications of these changes for diagnosis, classification and therapy.

Loss of B cell tolerance to autoantigens in systemic lupus erythematosus (SLE) is driven by TLR7, whereas TLR9 appears to protect against SLE by limiting the stimulatory activity of TLR7. The unique features of Toll-like receptor signalling in B cells implicate it as a therapeutic target in SLE.

The immunogenicity of a biologic agent can have clinical consequences in terms of response to therapy and risk of adverse events. In this Review, the authors summarize the latest data on the immunogenicity of biologic agents for various rheumatic indications.

For the past two decades, remission has been the focus of treatment strategies for rheumatoid arthritis (RA). This Review addresses the differences between remission and cure in RA and the underlying factors (‘drivers’) that trigger chronic inflammation and prevent cure.

Refractory rheumatoid arthritis (RA) can present with or without signs of ongoing inflammation. A better understanding of the mechanisms behind refractory RA in the presence and absence of inflammation could help to improve the treatment of this condition.

Nerve growth factor has been investigated as a therapeutic target for osteoarthritis and chronic low back pain, yet worries over adverse effects have stalled drug development. This Review provides an update on the current status of nerve growth factor inhibitors.

The development of osteoarthritis (OA) correlates with an increase in the number of senescent cells in joint tissues and the senescence-associated secretory phenotype is implicated in cartilage degradation and OA. Eliminating or altering senescent cells with senolytics or senomorphics could stop OA progression and pathogenesis.

Antinuclear antibodies (ANAs) are valuable biomarkers for various autoimmune rheumatic diseases and can be detected using various assays. This Review discusses the advantages and disadvantages of different ANA assays, to help in the understanding and interpretation of ANA test results.

In this Review, the authors describe the pathophysiological targets and clinical effects of new drugs currently being investigated for the treatment of osteoarthritis.

The association of immune-mediated necrotizing myopathy (IMNM) with myositis-specific autoantibodies has led to the classification of three subclasses of IMNM and provided insight into the pathogenesis of, and treatment options for, these inflammatory myopathies.

In this Review, the authors discuss how new approaches, including imaging, tissue analysis and omics technologies, could be applied to identify patients with a poor prognosis and to predict response to treatment, thus enabling precision medicine and improving outcomes in psoriatic disease.