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The improved prognosis of children with systemic lupus erythematosus over the past 50 years means that rheumatologists now focus on preventing the long-term complications associated with this disease and its treatment. As discussed in this review, a specialized multidisciplinary approach is needed to ensure optimum family education, treatment and patient outcome in pediatric systemic lupus erythematosus.
Pulmonary arterial hypertension is particularly common in individuals with systemic sclerosis, but is also seen in other rheumatic diseases. A number of treatment optionsfor this serious complication are available, including selective and unselective endothelin-receptor antagonists, which are the subject of this review.
Molecular biology techniques have enabled the pathophysiologic pathways involved in joint destruction in rheumatoid arthritis to be elucidated at the cellular and molecular level. In this review, the authors discuss the various cell-to-cell and cell-to-matrix interactions, highlighting the role of cytokine-independent pathways and the innate immune system in these processes.
The link between chronic inflammation and bone loss has been the subject of intense research over the past decade. This has led to the identification of key molecules that bridge the gap between immune function and bone turnover, including receptor activator of NFκB ligand, which represents a potential therapeutic target for patients with chronic inflammatory arthritis, and is the subject of this review.
Antiphospholipid syndrome, a disorder characterized by pregnancy morbidity and thrombosis in young individuals, is diagnosed by detection of anticardiolipin antibodies or lupus anticoagulant using laboratory tests. As discussed in this review, correct identification of patients with this syndrome is important as prophylactic anticoagulant therapy can prevent recurrent thrombosis and reduce complications during pregnancy.
Renal involvement is common and is a major cause of morbidity in patients with systemic lupus erythematosus. Treatment approaches for lupus nephritis are discussed in this review, based, when available, on data from randomized controlled trials. The authors conclude with their recommendations for the optimum management of this complex and heterogeneous disease.
Cytokine targeting is an established approach for treating patients with rheumatoid arthritis following success with tumor-necrosis-factor and interleukin-1 blockade. Many patients fail to respond completely to these cytokine antagonists, however, meaning that novel cytokine targets are keenly sought. This review describes the new generation of anticytokine therapies that are in preclinical and clinical development.
