Review Articles in 2011

Inflammatory brain disease can affect patients of all ages, and are becoming increasingly recognized. Central nervous system (CNS) vasculitis is one such disease. Here, the authors describe the current knowledge on this devastating inflammatory brain disease and provide a direct comparison of CNS vasculitis in adults and children. Clinical features, diagnosis, treatment, mimics and the spectrum of the disease are also discussed.

Osteonecrosis of the jaw (ONJ) is associated with high-dose bisphosphonate therapy in patients with cancer, and has also been linked to bisphosphonate use in patients with osteoporosis. In this Review, the authors examine the epidemiology and pathogenesis of ONJ.

Hand osteoarthritis (OA) is a prevalent, heterogeneous disorder that was, until recently, often overlooked in clinical research. In this Review, the authors provide an overview of hand OA, describing the diagnosis, clinical burden, disease course and associated risk factors, with particular attention to the key features of the hand OA subsets thumb base OA and erosive OA.

Comorbid cardiovascular disease is a substantial problem in rheumatoid arthritis (RA). Disease-related factors such as inflammation combine with traditional risk factors to produce an interrelated excess of risk that can be pharmacologically modified. Here, the authors summarize the evidence—and knowledge gaps—regarding the influence of biologic therapies on cardiovascular risk parameters in patients with RA.

The perioperative management of patients with rheumatic diseases who are due to undergo surgical procedures presents unique challenges, such as the increased cardiovascular risk associated with these diseases, the effect on infection risk associated with drugs used for their treatment, and the altered coagulation state associated with antiphospholipid antibodies. In this Review, the authors present a decision-support system intended to aid the rheumatologist faced with this clinical scenario.

Psoriasis and psoriatic arthritis (PsA) are interrelated: PsA is a 'disease within a disease', and research into psoriasis can inform understanding of its less frequent inflammatory comorbidity. Genetic studies in both conditions are revealing substantial genetic heterogeneity in PsA, and how susceptibility, pathogenesis and treatment response are thereby affected, as summarized in this Review.

The value of biomarkers in clinical decision marking is increasingly recognized, and numerous studies aimed at identifying or validating potential new biomarkers are underway. In this Review, the authors appraise six promising candidate biomarkers, covering diagnosis, disease activity assessment, and prognosis, in order to highlight study design features that are important for biomarker validation.

Fibrosis of the skin and other organs is a key feature of systemic sclerosis (SSc). Studies performed during the past decade have provided a more detailed insight to the cellular and immune mechanisms underlying the fibrotic process in SSc. In this Review, the authors describe these important recent findings, and how our improved understanding of SSc fibrosis has facilitated the development of potential targeted therapies.

Targeted therapies for chronic joint diseases are now able to control many of the disease symptoms—the research focus has now shifted towards the structural damage that occurs in skeletal tissues. Lories provides a timely update on the current knowledge in osteoimmunology, with a discussion of the role of tissue repair and remodeling in chronic arthritis such as ankylosing spondylitis and rheumatoid arthritis.

Biologic therapies, which have transformed the treatment of rheumatoid arthritis (RA) in the 21^stCentury, have the potential to modulate immune responses and thus are associated with a risk of infection, as well as other adverse events. This Review summarizes the available safety data for all such agents approved for the treatment of RA, to assist clinicians in weighing potential risks and therapeutic benefits.

Developmental processes are emerging as a key element in the etiology and pathogenesis of osteoarthritis. In this Review, the authors describe the latest supporting evidence that links skeletal development with osteoarthritis, including the roles of chondrogenesis, patterning and joint formation in cartilage development and predisposition to osteoarthritis, and chondrocyte hypertrophy in cartilage degeneration.

Dermatomyositis is a connective tissue disease within the group of idiopathic inflammatory myopathies. Although juvenile and adult dermatomyositis share some disease features, they differ in several key aspects. In this Review, Robinson and Reed discuss the unique characteristics that differ between juvenile and adult disease, including clinical features, pathogenesis and treatment.

Neutrophils, increasing evidence suggests, play an important part in the development and perpetuation of autoimmunity in patients with systemic lupus erythematosus (SLE). In this Review, the author highlights defects in the phenotype and function of SLE-derived neutrophils. Intriguing links between aberrant neutrophil death, production of proinflammatory mediators, and the presentation of and response to autoantigens are explored. The potential contribution of defective neutrophil activity to organ dysfunction is also discussed.

Advances in our understanding of bone remodelling have revealed a number of potential therapeutic targets in metabolic bone disorders such as postmenopausal osteoporosis. In this Review, Dr Michael Lewiecki describes these novel targets and the relevant experimental therapies that are at various stages of clinical development.

An individual's risk of developing cardiovascular disease is somewhat dependent on their ethnic origin, and is increased by the presence of inflammatory rheumatic disease. However, little is known about the relative contributions of ethnicity and rheumatic disease activity to a patient's overall risk of cardiovascular morbidity and mortality. This Review explores known risk factors for, surrogate markers of, and the epidemiology of heart disease in Asian and non-Asian patients with rheumatic diseases.

Untreated psoriatic arthritis can have severe long-term consequences, and patients benefit from early intervention. The disease typically presents as psoriasis initially, so dermatologists are ideally placed to manage such interventions, and should coordinate with rheumatologists to ensure optimum patient care. Treatment guidelines and assessment tools from dermatology consortia are among the patient management aspects discussed in this Review.

Periprosthetic osteolysis is a common reason for failure or revision of joint replacement surgery, and is a result of the inflammatory reaction to debris particles generated by wearing of the implant over time. In this Review, the authors describe the cellular and molecular mediators of this process and how it might be prevented or treated.

The microbes that inhabit our bodies play an important part in regulating the homeostasis of the immune system—disequilibrium in this symbiotic relationship can lead to development of disease. In this Review, the authors present an overview of the historical evidence implicating microbes in the development of rheumatoid arthritis (RA), and describe how the use of DNA sequencing techniques and germ–free animal models of disease are elucidating the role of host–microbial interactions in the pathogenesis of RA.

Who will not respond adequately to traditional DMARDs? Which patients would benefit most from expensive, sometimes-effective biologic agents, and who is most likely to experience adverse events? Although firm answers to these questions are pending, pharmacogenetic studies offer insight into how an individual's genetic identity determines the metabolic fate and outcome of drug therapies. In this article the authors summarize the extent of such knowledge in rheumatology today, and discuss the hurdles remaining before the ultimate goal of personalized therapy can be achieved.

The use of biologic agents has revolutionized treatment in a number of rheumatic and non-rheumatic autoimmune and inflammatory disorders. In this Review, the authors discuss whether rheumatologists can learn lessons from the application of biologic agents in non-rheumatic diseases such as psoriasis, asthma and multiple sclerosis.