Reviews & Analysis

In this Viewpoint, Professor van den Berg discusses cytokine control of the inflammatory and erosive processes of rheumatoid arthritis, and how insight into this control will allow the development of specific therapeutic tools to complement those already available.

The increase in viral epidemics leading to arthritis is evident. In his Viewpoint, Dr Calabrese discusses the role of the rheumatologist in the evaluation of ill travelers returning from exotic lands.

For patients with osteoarthritis, considerable changes occur before they can be visualised by plain radiography. MRI has been invaluable in improving our understanding of early joint changes, as is discussed in this Viewpoint.

Neuropsychiatric manifestations are present in approximately 70% of patients with systemic lupus erythematosus, and are often associated with a poor prognosis. In this Viewpoint, Dr Strous and Dr Shoenfeld discuss the potential role for autoimmune factors in contributing to neuropsychiatric expressions via direct and indirect autoantibody-induced neuronal damage.

Systemic scleroderma is one of the most severe chronic autoimmune connective tissue diseases. In this Viewpoint, Dr Deleuran and Dr Abraham discuss the importance of understanding the development, regulation and function of the type 17 T-helper subpopulation of CD4⁺T cells in order to explore treatment possibilities in systemic scleroderma.

Although the prognosis of patients with systemic lupus erythematosus (SLE) has improved over the past few decades, the increased occurrence of atherosclerotic vascular disease in these patients has become apparent. This Viewpoint discusses the increased risk of cardiovascular disease in patients with SLE, and how levels of risk can be assessed in order to determine the group of SLE patients most suited to preventative therapy with statins.

Many rheumatologists and other rheumatology health professionals find the management of patients with fibromyalgia syndrome (FMS) difficult. In this Viewpoint, Dr Scarbrough and Dr Crofford discuss whether or not rheumatologists should have a role in the diagnosis and management of FMS patients, and if so, how their improved knowledge of this condition can help patients receive optimal care.

The effects of biologic agents on the liver are both a cause for concern with regards to potential toxicity and an opportunity to discover new therapeutic opportunities, as is discussed in this Viewpoint.

Thalidomide was widely disparaged following recognition of its teratogenicity; however, its immunomodulatory activities have become increasingly apparent. At present, thalidomide is approved by the FDA only for use in the treatment of multiple myeloma and erythema nodosum leprosum. In this Viewpoint, Dr Lehman discusses reports in the literature which indicate that thalidomide is effective for a wide variety of immune-mediated conditions.

The main emphasis of research in osteoarthritis has been the delineation of the mechanism of articular cartilage degradation. In this Viewpoint, Dr Bailey and colleagues discuss the importance of bone in osteoarthritis, the focus of which has been neglected to date.

Glucosamine is indicated for the treatment of osteoarthritis, but questions surround its efficacy and long-term safety. In this article, Professor Wollheim discusses the results of recent trials, and provides his opinion on when glucosamine could be used.

The synovium is the primary target of disease in various forms of arthritis. In this Viewpoint, the authors discuss the possibilities of making a diagnosis based on clinical examination, routine laboratory tests, radiographic examination of the synovium, or by synovial fluid analysis or biopsy.

There has been much speculation on the potential use of kinase inhibitors, such as imatinib mesylate, for the treatment of autoimmune rheumatic diseases. Imatinib inhibits a select set of tyrosine kinases at submicromolar concentrations. In this Viewpoint, the authors discuss how imatinib could provide a potent therapeutic option for a variety of autoimmune and inflammatory diseases, for which current therapies are insufficient.

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.

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.

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.