Reviews & Analysis

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  • Gout can be effectively treated with long-term urate-lowering therapy. Current guidelines advocate the use of a treat-to-target serum urate strategy, with a target serum urate concentration of <5 mg/dl (<0.30 mmol/l) or <6 mg/dl (<0.36 mmol/l), but specific targets are under debate. In this Review, the authors consider the rationale and evidence for the recommendations.

    • Lisa K. Stamp
    • Nicola Dalbeth
    Review Article
  • In this Review, the authors discuss age-related arthropathy and the similarities and differences between childhood loss of immune tolerance and adult development of immune-mediated arthritis, and develop three hypotheses describing age-related mechanisms that contribute to the onset of arthritis.

    • Yannick Degboe
    • Sebastiaan J. Vastert
    • Iain B. McInnes
    Review Article
  • This Review summarizes our understanding of sex- and gender-related differences in psoriatic arthritis, with a focus on disease progression and outcomes, underlying mechanisms and response to therapies.

    • Sanjana Tarannum
    • Ying-Ying Leung
    • Lihi Eder
    Review Article
  • 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.

    • Ana C. Medeiros-Ribeiro
    • Nadia E. Aikawa
    News & Views
  • Assessing systemic sclerosis (SSc) disease activity is challenging, and improved outcome measures are needed. This Review describes clinical and biochemical outcome measures of distinct features of SSc, with an emphasis on the dermatological manifestations and interstitial lung disease, including insights into biomarkers gained from single-cell RNA sequencing.

    • Robert Lafyatis
    • Eleanor Valenzi
    Review Article
  • 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.

    • Afroditi Boulougoura
    • George C. Tsokos
    News & Views
  • This Evidence-Based Guideline presents the latest treatment recommendations for medication selection in psoriatic arthritis (PsA), covering the six clinical domains of PsA, related conditions and associated comorbidities, and reflecting important advances in the field since the previous update.

    • Laura C. Coates
    • Enrique R. Soriano
    • Penelope Esther Palominos
    Evidence-based Guidelines
  • In this Review, the authors summarize the pathophysiological mechanisms of IL-1-mediated autoinflammation. They describe the epidemiological and clinical features of autoinflammatory diseases, challenges associated with diagnostics and disease management, and current and future therapies for targeting the IL-1 pathway.

    • Lori Broderick
    • Hal M. Hoffman
    Review Article
  • 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.

    • Janet E. Pope
    News & Views
  • In this Review, the authors discuss the characterization of distinct synovial tissue macrophage (STM) populations and their functions in the context of the healthy and arthritic joint. They also describe how distinct STMs are specified, how they respond to danger signals and the clinical implications of understanding STM heterogeneity.

    • Mariola Kurowska-Stolarska
    • Stefano Alivernini
    Review Article
  • 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.

    • Zara Izadi
    • Gabriela Schmajuk
    News & Views
  • Here, the authors propose that more stringent MRI definitions for inflammatory and structural lesions in the sacroiliac joints should be used in randomized controlled trials in non-radiographic axial spondyloarthritis. They argue that such an approach might enhance diagnostic accuracy and thereby increase discrimination between therapies.

    • Walter P. Maksymowych
    • Robert G. W. Lambert
    • Mikkel Østergaard
  • Intervertebral disc calcification is an often overlooked phenotype that can have considerable clinical consequences. In this article, the authors aim to raise awareness of intervertebral disc calcification and discuss its implications for the management and prognosis of degenerative spinal changes.

    • Uruj Zehra
    • Marianna Tryfonidou
    • Dino Samartzis
    Review Article
  • Ubiquitylation is involved in the regulation of most cellular systems, including the innate immune system. Here, the authors describe the molecular pathogenesis of disorders of ubiquitylation that result in innate immune overactivation and systemic autoinflammatory disease.

    • David B. Beck
    • Achim Werner
    • Ivona Aksentijevich
    Review Article
  • 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.

    • Roberta Naddei
    • Angelo Ravelli
    News & Views
  • In this Review, the authors discuss a comprehensive mechanistic concept of psoriatic arthritis, including discussion of the genetic, biomechanical, metabolic and microbial factors that contribute to the development of the disease as well as its manifestations and consequences.

    • Georg Schett
    • Proton Rahman
    • Jose U. Scher
    Review Article
  • Sphingosine 1-phosphate has essential roles in vascular barrier function, lymphocyte trafficking and differentiation, and inflammatory response in autoimmune rheumatic diseases; modulation of sphingosine 1-phosphate signalling is a potential therapeutic approach in systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis.

    • Nathalie Burg
    • Jane E. Salmon
    • Timothy Hla
    Review Article