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The 2016 ACR–EULAR classification criteria for primary Sjögren syndrome, which are intended to facilitate uniform classification of patients for enrolment in clinical studies, combine features of previous criteria sets. These new criteria are a step in the right direction, but further refinement would increase their utility.
How and why systemic autoimmunity targets the joints in rheumatoid arthritis remains a major unanswered question. In this Review, Catrina et al. discuss the evidence for a driving role for osteoclasts in the homing of autoimmunity to the joints.
New criteria have been proposed to enable a rapid diagnosis of cryopyrin-associated periodic syndromes (CAPS) in children and adults. Will these diagnostic criteria advance the management of autoinflammatory syndromes, or will physicians now think of zebras rather than horses when they hear hoofbeats?
Although an imbalance between proinflammatory and anti-inflammatory cytokines has been implicated in rheumatoid arthritis (RA), the identification of specific cytokines regulating RA pathophysiology is still challenging. Modelling cytokine signalling networks and evaluating associated pathway activities might facilitate the effective identification of cytokines for treatment and prevention of RA.
The endoplasmic reticulum (ER) is vital for cellular function and differentiation in every organ system. In this Review, the authors discuss how cells respond to ER stress and outline the ways that this stress can contribute towards rheumatic diseases.
The transition of HIV and AIDS from a death sentence to a chronic disease has not come without problems. Rheumatologists need to be aware of the full spectrum of rheumatic diseases seen in patients with HIV and AIDS, and know the best strategies for disease management.
In this Review, the authors discuss the use of mass spectrometry imaging in rheumatology. This technique enables the identification and spatial localization of molecules in tissues, with potential applications in both clinical and research settings.
Despite conflicting evidence from clinical trials, rituximab continues to be used off-label in the treatment of systemic lupus erythematosus (SLE). A new study has now investigated the use of this drug for SLE in Europe, including indications for use and patient characteristics.
In this Review, Tsokos et al. describe recent advances in our understanding of systemic lupus erythematosus (SLE) that are driving repurposing of existing drugs as well as development of new treatments. Cytokines, tolerance pathways, local tissue mediators, and epigenetic mechanisms all show promise as novel targeted therapies that could lead to individualized care in SLE.
In 2016, two international organizations published recommendations for the management of psoriatic arthritis. This article reviews the development of the recommendations, considers their similarities and differences, and provides guidance on how to interpret and apply the recommendations in practice.
Cronstein and Sitkovsky discuss the metabolic changes that regulate adenosine levels in inflamed tissue, the receptors that mediate the effects of adenosine and their role in rheumatic diseases, as well as the potential role for therapeutic targeting of adenosine and its receptors.
Sedentary behaviour is reported to have adverse consequences for metabolic, functional and cardiovascular health — outcomes already prevalent in patients with rheumatoid arthritis (RA). This commentary considers the relevance of sedentary behaviour in the context of RA, highlighting the limitations of past work and offering suggestions for a new research agenda.
Genetic association studies have uncovered more than 100 genetic loci related to susceptibility to rheumatoid arthritis. This Review discusses the latest insights into rheumatoid arthritis pathogenesis gained from genetic studies and their application for drug discovery and development.
The concept of treating to a target of remission is gaining ground in systemic lupus erythematosus. New research suggests that achievement of this treatment goal is rare, but are the definitions of remission used in these studies fit for purpose?
Methotrexate remains the first-line therapy for rheumatoid arthritis (RA). However, not all treated patients respond, and its mechanism of action remains incompletely understood. This Review describes putative mechanisms of action of methotrexate at the low doses used in RA and discusses potential biomarkers of treatment response, which could ultimately inform precision use of this therapy.
An unmet need exists for more-effective and selective therapeutics in systemic lupus erythematosus. Advances in understanding of the pathogenetic mechanisms of this severe autoimmune disease have led to the clinical translation of low-dose IL-2 therapy, which primarily aims to restore the activity of regulatory T cells.
Historically, rheumatic diseases have received little attention in Africa and rheumatologists have been few and far between. Now, supported by the global rheumatology community, interest in the specialty is growing, despite the formidable challenges faced by those practicing rheumatology in Africa.
Reverse translation of data obtained from trials of B-cell-targeted therapies in systemic lupus erythematosus (SLE), along with advances in understanding of B-cell intracellular signalling pathways and post-activation status, highlight pathogenic roles for autoantigen-presenting B cells and regulatory B cells in autoimmune diseases. These insights could lead to innovative treatments for SLE based on modulation of B-cell activation and regulatory functions.
Alarmins are endogenous molecules that have host-protective roles but have also been implicated in the pathogenesis of joint diseases. This Review summarizes the roles of alarmins in osteoarthritis and inflammatory arthritis, highlighting them as novel therapeutic targets in these diseases.
Despite a multitude of confounding variables, common themes are emerging in metabolomic studies of systemic lupus erythematosus (SLE). Newly revealed metabolites and pathways are likely to complement the biomarkers and insights into SLE pathogenesis that are emerging from genomic, transcriptomic and proteomic studies.
