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Chronic low back pain is a common condition that has significant economic consequences for patients and their communities. In this Technology Insight, the author discusses the imaging methods available for the diagnosis of low back pain, and highlights the need for the development of a noninvasive, low-risk technique.
There is increasing insight into the impact of ankylosing spondylitis on employment and the costs of illness associated with this disease. Standardization of cost-effectiveness studies will improve the quality and comparability of these costs. This Review summarizes the literature on work participation, costs of illness and cost-effectiveness of treatment in patients with ankylosing spondylitis.
Improvements in treatments for systemic lupus erythematosus have led to longer survival times, but complications including osteoporosis and osteonecrosis often occur. This Therapy Insight provides an overview of the pathophysiology of osteoporosis and osteonecrosis in these patients, and recommends preventive measures and treatments.
In this Review, the authors discuss how early diagnosis of spondyloarthritis can be achieved for patients with predominantly axial or predominantly peripheral symptoms. The importance of identifying differences between diagnosis and classification, and how this disparity might influence clinical practice, are highlighted.
Antimalarial drugs have been used for many years to treat rheumatic diseases such as rheumatoid arthritis and systemic lupus erythematosus. This Viewpoint will discuss the recent advances in understanding the mechanisms of action of hydroxychloroquine and the possibility of establishing toll-like receptor signalling molecules as targets for new therapies.
Many forms of functional decline are preventable, treatable or manageable, but a screening tool that can identify frail or vulnerable patients is much needed. This Review describes the methods currently available for non-specialist evaluation of patients at risk of functional decline, including behavioral, interview and questionnaire assessments.
Neutrophils are powerful mediators of tissue inflammation, and the balance between neutrophil survival and clearance is crucial to the resolution of inflammation. The cytokine granulocyte colony-stimulating factor is an important regulator of neutrophil production and survival. This Review discusses the roles of neutrophils and granulocyte colony-stimulating factor in chronic inflammatory diseases.
The creation of specific immune tolerance would allow autoimmune disease to be reversed without the need for nonspecific and potentially harmful immunosuppressive therapy. Important progress in research into immune tolerance is summarized in this Review, and the potential use of this technique in immunotherapy of autoimmune disease is discussed.
Pattern recognition molecules belonging to the innate immune response participate in the clearance of apoptotic cells. Among these molecules are the collectins C1q and mannose-binding lectin, and the pentraxins C-reactive protein, serum amyloid P component, and pentraxin 3. This Review discusses the prevalence, actions and clinical significance of these molecules in autoimmune conditions.
New insights into the etiology of rheumatoid arthritis have suggested that humoral autoimmunity might have a substantive, possibly even causal role in the pathogenesis of disease. In this Viewpoint, Dr Holers will discuss the basis of this hypothesis, focusing on the role of anti-cyclic citrullinated peptide antibodies.
A variety of retinal signs can occur in patients who have systemic vasculitides. Although retinal signs are usually treated by treatment of the systemic disease, specific therapy is indicated occasionally to preserve vision. This Review describes the pathogenesis, clinical features and treatment of retinal manifestations of systemic vasculitides.
In this Review, Lars Klareskog and colleagues discuss the experimental approaches that are used to address the issue of gene–environment interactions in the etiology of RA, focusing on the roles of the HLA-DR shared-epitope genes, smoking and anticitrulline immunity in this process.
There is increasing interest in the role of transcription factors in the pathogenesis of inflammatory arthritis. Biologic and genetic studies are adding to current knowledge, and revealing potential targets for anti-inflammatory therapies that aim to modulate transcription factor activity.
Initially used in the treatment of mood disorders, this form of psychotherapy has been extended to other conditions such as chronic pain states. This Review evaluates the role of cognitive behavioral therapy, alone or in combination with other modalities, in the management of patients with fibromyalgia.
Gene therapy suffers the negative perception of being unsafe, expensive and ultimately inapplicable in clinical practice. In this Viewpoint, the authors discuss the benefits of gene therapy being used to treat rheumatic disease, and the requirements that have to be satisfied in order for this to become a clinical reality.
Tumor necrosis factor (TNF) inhibitors have proven highly effective in improving the signs and symptoms of rheumatoid arthritis, in inhibiting the progression of joint damage, and improving patients' quality of life. This Viewpoint will discuss the major concern relating to the actual use of TNF inhibitors in the clinic: their relatively high acquisition costs.