Reviews & Analysis

No detailed guidelines exist for treating pain in children with rheumatic diseases. In this Review, the authors discuss the multifactorial nature of pain in these children and advise that pain treatment should be interdisciplinary and consist of nonpharmacologic as well as pharmacologic interventions.

Patient-derived functional measures such as the Health Assessment Questionnaire (HAQ) are important tools in the assessment of general health, function, and disability in patients with rheumatic diseases, such as rheumatoid arthritis. In this Viewpoint, Dr Aletaha and Dr Smolen discuss the use of these measures and their derivatives in predicting outcome in patients with rheumatic disease.

Anti-TNF therapy is widely used for the treatment of rheumatoid arthritis, but whether or not it should be administered to patients with previous malignancy is not known. This Viewpoint article evaluates the existing literature to help physicians gauge the risks and benefits of initiating anti-TNF therapy in patients with rheumatic disease and a history of cancer.

Medical risk information is important as it contributes to the understanding, prevention and treatment of disease. In this article, the authors explain the risk measures that are commonly used in medical literature and discuss the issues surrounding risk communication.

Despite the success of operative joint replacement, aseptic loosening of prosthetic implants can occur and 10% of all implants have to undergo operative revision within 15 years of the initial operation. In this Review, the authors outline the molecular mechanisms responsible for loosening and discuss possible future therapeutic approaches for this complication of joint replacement surgery.

Patients with antiphospholipid syndrome suffer from recurrent thrombosis and pregnancy morbidity as a result of moderate to high levels of antiphospholipid antibodies. Treatment has predominantly focused on anticoagulation, using heparin and low-dose aspirin, but there is evidence that inflammation is a key mediator of pregnancy complications, as outlined in this Review.

Behçet's syndrome is an inflammatory disease involving articular, gastrointestinal, central nervous system, and peripheral vascular manifestations. In this Review, Dr Yazici and co-authors discuss the incidence, manifestations and advances in treatment of this complex disease.

Although environmental factors have been implicated as risk factors for the development of rheumatic disease, our understanding of which exposures are important in disease pathogenesis and possible mechanisms by which these factors might act remains limited, as discussed in this Review.

No increased risk of adverse pregnancy outcome has been reported in patients with inflammatory arthropathies treated with tumor necrosis factor antagonists. More data are required, however, before firm conclusions can be drawn regarding the safety of these agents during pregnancy, childbirth and lactation, as outlined in this article.

A high percentage of patients with rheumatic diseases use complementary medicine, particularly traditional Chinese medicine. In this Viewpoint, Dr Tsang discusses how the efficacy of traditional Chinese medicine could be assessed, and proposes a collaboration between clinical scientists trained in traditional Chinese medicine and scientists trained in Western medicine.

Studies have shown that some patients with fibromyalgia can benefit from prescribed medication. In this Viewpoint, Dr Ferrari and Dr Russell discuss drug-seeking behaviour in patients with fibromyalgia, and how this affects prescribing patterns in the clinic.

Research into the epidemiology of and risk factors for osteoarthritis has been inconclusive. This Review focuses on data from systematic reviews on risk, incidence and prognostic factors of knee and hip osteoarthritis, and provides insight into how these findings can be interpreted in clinical practice.

Multiplex antigen microarrays can profile the high titers of autoantibodies found in the biological fluids of patients with many autoimmune diseases, which enables rapid identification of antibody and antigen biomarker sets. The potential applications of this technology for improved diagnosis, prognosis and selection of targeted therapies are reviewed in this article.

Many genes, as well as environmental factors, contribute to complex diseases such as rheumatoid arthritis. Inbred rat and mouse strains have a similar genetic system to humans and can provide relevant disease models. This article outlines the potential use of animal models for identifying the genetic basis of arthritis.

The clinical benefits associated with rituximab therapy in patients with B-cell lymphomas or autoimmune diseases are well established. Rituximab has been hypothesized to act by promoting elimination of B cells, but in this Review the authors propose another theory to explain how this agent works in autoimmune diseases—the immune-complex decoy hypothesis.

Imaging techniques such as MRI and musculoskeletal ultrasound are becoming increasingly important in the management of patients with rheumatic disease. In this Viewpoint, Dr Freeston and Dr Emery discuss the role of advanced imaging modalities with regards to the use of biologic therapy in patients with rheumatic disease.

The incidence of Lyme disease continues to increase despite the availability of effective prevention strategies for this disease. In this article the authors outline the various prevention strategies and discuss a rationale for promoting the use of preventative behaviors in people who are at risk of contracting this disease.

Most ultrasound machines can now perform color and power Doppler ultrasonography, which can be used to assess synovitis, tenosynovitis, enthesitis and vascular disease. This Review discusses musculoskeletal and vascular Doppler ultrasonography and provides advice for the rheumatologist on how to make the most of these techniques.

High mobility group box 1 protein is a dual function alarmin that can activate innate immune responses. Extracellular levels of this protein are increased in patients and animals with inflammatory diseases and it might, therefore, represent a new target for therapy of inflammatory arthritis, as outlined in this Review.