Reviews & Analysis

The impact of biologic therapy for rheumatoid arthritis on quality of life has clear relevance to studies of the cost-effectiveness of these agents. As discussed in this Viewpoint, however, several deficiencies in current economic evaluations need to be overcome in order to enhance the utility of such research.

Although rituximab specifically binds to CD20 on B cells, it also has efficacy in the treatment of autoimmune diseases that are predominantly mediated by T helper cells. In this Viewpoint, Dr Datta proposes a novel hypothesis to explain this: the association of the pathogenic autoreactive T cells with anti-CD20 opsonized B cells might in fact make rituximab specific for autoreactive T cells.

A considerable increase in the risk of developing cardiovascular disease is conveyed not only by inflammation, but also by the use of glucocorticoids to treat inflammation. In this Viewpoint, the authors discuss the challenge of balancing the relative benefits and hazards of glucocorticoid treatment for inflammatory diseases, as well as the tantalizing prospect of identifying subgroups of the population at risk for cardiovascular disease.

Updated guidance from the UK National Institute for Health and Clinical Excellence on the use of tumor necrosis factor (TNF) antagonists for rheumatoid arthritis recommends that patients who do not respond to initial anti-TNF therapy should not switch to another TNF inhibitor. In this Viewpoint, the authors discuss the rationale and controversies surrounding this recommendation.

Since 1998, six new drugs have been approved for the treatment of rheumatoid arthritis, with the hope of at least two more in the next year—a unique success story in terms of drug approval for one indication. In this Review, Dr Schwieterman discusses the history of clinical trial design for new rheumatoid arthritis therapeutics, what we have learnt and the challenges that lie ahead.

Tuberculosis is one of the most common severe infections seen in patients receiving tumor necrosis factor inhibitors, and nontuberculous mycobacterial infection is an increasingly recognized condition in this setting. In this Review article, van Ingen et al. highlight the drug-related risks, clinical presentation, and screening and prevention of mycobacterial disease in patients undergoing treatment with biological agents.

Evidence from animal models indicates that B cells have both pathogenic and protective functions in autoimmune diseases. In this Review, the authors highlight recent insights into the suppressive functions of activated B cells in mice, describe the potential of B cells for use as cell-based therapy for experimental autoimmune diseases, and finally discuss the possibility of translating this cellular approach to treat human autoimmune diseases.

Although arthroscopic removal is the usual treatment for intra-articular tophi, surgery is not always an option. This Case Study demonstrates that continuous urate-lowering therapy is a suitable alternative: in a 67-year-old man, painful locking of the knee secondary to intra-articular tophi was alleviated following continuous allopurinol therapy. Resolution of the tophi was demonstrated by CT.

Scleroderma-like disorders, which often have marked clinical overlap with scleroderma, can present a diagnostic challenge. In this Viewpoint, the author describes key clinical and laboratory features that can aid early diagnosis and prompt appropriate management.

Bone mineral density testing is used to diagnose osteoporosis, assess the associated fracture risk and monitor changes over time. In this Review, the authors describe the common technical and interpretation errors that are encountered in the clinical use of bone densitometry, with a primary focus on DXA.

Hypovitaminosis D, encompassing both vitamin D insufficiency and deficiency, is highly prevalent in the general population and has potentially deleterious musculoskeletal effects. In this Review, the authors focus on the pathophysiology, clinical correlates, evaluation and treatment of hypovitaminosis D.

In light of the impressive efficacy of tumor necrosis factor blockers in the treatment of ankylosing spondylitis, particularly in patients with short disease duration, defining outcome parameters to monitor the structural damage of the disease has become more pertinent. In this Viewpoint the authors explore the relevance of osteoproliferation amongst other outcome parameters.

For many years, patients with chronic inflammatory disease of joints or muscles were advised to rest; however, exercise is now known to result in improved muscle performance, soft tissue integrity and health outcomes in these patients. In this Review, Dr Lundberg and Dr Nader discuss the systemic effects of exercise, as well as local effects in skeletal muscle and cartilage, in patients with rheumatic disease.

Osteoarthritis is a progressively degenerative joint condition that is influenced by various metabolic and structural factors. In this third in a series of three Reviews on Wnt–β-catenin signaling, Dr Corr provides insights into recent advances in research into the role of Wnt signaling in the pathogenesis of osteoarthritis, and discusses some of the genetic and regulatory factors involved.

This Case Study describes a 13-year-old girl with systemic juvenile idiopathic arthritis who developed features consistent with macrophage activation syndrome. The patient's disease remained active following treatment with high-dose steroids, immunoglobulin and ciclosporin, but was successfully controlled following the introduction of anakinra.

The role of dietary antioxidants in the prevention and amelioration of symptoms in inflammatory joint disease has been of interest for many years. In this Review, the authors provide an overview of current evidence and discuss the potential prophylactic and therapeutic effects of antioxidants in arthritis.

Rheumatic diseases are typified by aberrant cellular immune responses. The advent of antibody engineering has now led to the development of anti-inflammatory therapy to target these responses. In this Review, Rothe and colleagues highlight advances in recombinant technologies for the development of novel biologic therapies in rheumatology.

In this Viewpoint, Drs Doria and Briani highlight recent advances in efforts to improve the long-term prognosis of patients with systemic lupus erythematosus. The strategies discussed aim to prevent both the occurrence of the disease and its complications.

Hypermobility-related disorders are frequently encountered in clinical practice, but are too often dismissed as trivial. In this Viewpoint, Prof. Grahame discusses why the current perception of these disorders is inadequate, and highlights recent advances in the field as well as challenges and opportunities for future research and therapy.

'Growing pains' is a term that has been applied for almost 200 years to describe and diagnose some forms of childhood limb pain. To date no clear mechanism has been identified. The authors present a thorough historical Review of the physical presentation, differential diagnoses, potential causative factors and management options for this phenomenon.