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There is increasing evidence that treatment in the early stages of rheumatoid arthritis can significantly increase the potential for positive patient outcome and prevention of irreversible damage. This Viewpoint considers the evidence that supports aggressive treatment for early rheumatoid arthritis and investigates the available treatment options.
Diagnosis of early rheumatoid arthritis can be significantly hastened by the screening for serological markers such as autoantibodies. This Viewpoint discusses the merits of this new field of serological screening, focusing on the anti-cyclic citrullinated peptide tests and their value as diagnostic tools for rheumatoid arthritis.
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.
