Reviews & Analysis

In this Review, the authors examine how the definition and description of axial spondyloarthritis (axSpA) has evolved, most notably with the introduction of the concept of non-radiographic axSpA, and discuss the implications of these changes for diagnosis, classification and therapy.

Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of SARS-CoV-2 infection that can result in serious illness in the paediatric population but our understanding of this syndrome is in its infancy. Translational studies in 2020 leveraging immune profiling have laid the foundation to enable further discovery in MIS-C.

Since the outset of the COVID-19 pandemic, numerous risk factors for severe disease have been identified. Whether patients with rheumatic diseases, especially those receiving DMARDs, are at an increased risk of SARS-CoV-2 infection or severe COVID-19 disease remains unclear, although epidemiological studies are providing some insight.

Loss of B cell tolerance to autoantigens in systemic lupus erythematosus (SLE) is driven by TLR7, whereas TLR9 appears to protect against SLE by limiting the stimulatory activity of TLR7. The unique features of Toll-like receptor signalling in B cells implicate it as a therapeutic target in SLE.

Interest in therapies for psoriatic arthritis (PsA) has increased in response to recognition that many patients remain undiagnosed and are inadequately treated. In 2020, advances in PsA treatments have included phase III trials of an IL-23 inhibitor, head-to-head trials of IL-17 inhibition against TNF inhibition and updated EULAR treatment guidelines.

Genetic variation contributes to immune cell function. An unprecedented analysis of genetic associations with immune cell traits provides insights into the complex regulation of immune cells, reveals variants that coincidently influence immune traits and autoimmune disease risk, and offers specific therapeutic targets for these diseases.

The immunogenicity of a biologic agent can have clinical consequences in terms of response to therapy and risk of adverse events. In this Review, the authors summarize the latest data on the immunogenicity of biologic agents for various rheumatic indications.

For the past two decades, remission has been the focus of treatment strategies for rheumatoid arthritis (RA). This Review addresses the differences between remission and cure in RA and the underlying factors (‘drivers’) that trigger chronic inflammation and prevent cure.

Refractory rheumatoid arthritis (RA) can present with or without signs of ongoing inflammation. A better understanding of the mechanisms behind refractory RA in the presence and absence of inflammation could help to improve the treatment of this condition.

In inflammatory arthritides, such as rheumatoid arthritis (RA), synovial cells acquire aggressive and disruptive phenotypes that lead to joint disease. Three studies published in 2020 have described phenotypic variation in synovial cells, offering a novel perspective on the potential to resolve pathology and augment treatment options for patients with RA.

The new 2019 EULAR–ACR classification criteria for systemic lupus erythematosus (SLE) performed well in the initial derivative and validation cohorts. But do these criteria outperform previous classification criteria across sexes, disease durations or ethnicities?

In this article, the authors critically appraise the current model of opinion-based academia–industry interactions, and advocate for a realignment towards partnerships that foster innovation and knowledge.

Immune checkpoint inhibitors, which are used to treat many types of cancer, can cause syndromes similar to rheumatic diseases known as immune-related adverse events (irAEs). In 2020, several studies illustrated the clinical heterogeneity of rheumatic irAEs and highlighted their substantial effect on morbidity and mortality.

Nerve growth factor has been investigated as a therapeutic target for osteoarthritis and chronic low back pain, yet worries over adverse effects have stalled drug development. This Review provides an update on the current status of nerve growth factor inhibitors.

The development of osteoarthritis (OA) correlates with an increase in the number of senescent cells in joint tissues and the senescence-associated secretory phenotype is implicated in cartilage degradation and OA. Eliminating or altering senescent cells with senolytics or senomorphics could stop OA progression and pathogenesis.

The ability to predict how a patient might respond to a medication would shift treatment decisions away from trial and error and reduce disease-associated health and financial burdens. Machine learning approaches applied to genomic datasets offer great promise to deliver personalized medicine but their application must first be optimized.

Antinuclear antibodies (ANAs) are valuable biomarkers for various autoimmune rheumatic diseases and can be detected using various assays. This Review discusses the advantages and disadvantages of different ANA assays, to help in the understanding and interpretation of ANA test results.

The COVID-19 pandemic led to unprecedented changes in rheumatology clinical practice. In this Viewpoint article, we asked five experts to describe their experiences of the COVID-19 pandemic, how their clinical practice has changed, and the opportunities and challenges that lie ahead.

For young people with rheumatic diseases, the transition from paediatric to adult rheumatology care is a vulnerable time, and delays or disruption in their care can lead to adverse outcomes. Research into the factors associated with gaps in transitional care could improve the identification and targeting of vulnerable groups.

In this Review, the authors describe the pathophysiological targets and clinical effects of new drugs currently being investigated for the treatment of osteoarthritis.