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Mounting evidence indicates that cognitive and emotional processes are important determinates of how individuals with rheumatic disorders experience pain. Depression and catastrophizing, in particular, shape pain responses and pain outcomes through several distinct pathways, and could represent targets for improving and individualizing therapy.
Immunological memory is a cornerstone of the defence against pathogens, ensuring that repeated exposures to an antigen produce faster, more robust responses. Might chronic autoimmune diseases likewise owe their persistence and reactivation to an equivalent cellular memory? In this Review, the authors summarize the current understanding of long-lived autoreactive plasma cells, including how they are generated and where they reside, and explore their implications for the treatment of autoimmune disorders.
Programmed cell death (PCD) is a vital process in the development and maintenance of immune cell populations. In this Review, the authors describe some of the major mechanisms of apoptosis, the role of defective PCD in autoimmunity, and the potential of therapeutic targeting of apoptosis pathways in patients with rheumatic diseases.
Although tens of millions of individuals worldwide use NSAIDs daily, balancing the competing risks and benefits of these agents continues to be a challenge. Evidence-based treatment guidelines and expert opinions have been promulgated, but will they actually translate to improved patient care? A new web-based tool could aid physicians' treatment decision-making.
Antirheumatic agents are associated with a wide range of hepatotoxic effects. Research insights into susceptibility to hepatotoxicity and understanding of the interaction between drug, host and environmental factors involved in the pathogenesis of these adverse reactions could enable their mitigation or prevention.
Autologous bone grafts are the 'gold standard' repair strategy for large defects of bone, but a growing body of evidence suggests that synthetic biomaterials designed to have osteoinductive properties could provide an alternative approach.
The 1987 ACR classification criteria for rheumatoid arthritis were criticized for their lack of sensitivity in early disease. To overcome this limitation, new criteria have now been developed. The question is how will these criteria be implemented in clinical and basic research, and in daily clinical practice?
Recent experimental evidence has indicated that mitochondrial function is impaired in chondrocytes from patients with osteoarthritis (OA). In this Review, the authors discuss how this mitochondrial dysfunction might affect pathogenetic pathways in OA, such as cartilage degradation, and whether the mitochondria might provide useful prognostic or diagnostic biomarkers or act as potential targets for therapy in patients with OA.
