Volume 10 Issue 6, June 2014

Gene variants have been discovered that cause a range of vascular inflammatory phenotypes with a characteristic onset in childhood. What might these exciting findings mean for the understanding, diagnosis and treatment of systemic vasculitis?

Updated guidelines from the Osteoarthritis Research Society International and the UK's National Institute for Health and Care Excellence provide a clear summary of the evidence supporting current therapeutic strategies in osteoarthritis (OA), but in reality they serve to highlight the inability of modern medicine to fully relieve OA pain and dysfunction.

New research reports that ultrasonography predicts absence of clinical flare following discontinuation of biologic therapy in patients with rheumatoid arthritis in clinical remission. Other studies also support the inclusion of ultrasonography and MRI in future remission criteria. Ongoing studies to clarify clinical and structural damage benefits of imaging-based treat-to-target strategies are awaited.

Although effective treatments for rheumatoid arthritis are now available, many patients are found to be unresponsive to, or cannot tolerate, particular therapeutic options; therefore, selecting the most appropriate treatment on an individualized basis is important. Genetic and epigenetic factors probably represent key determinants of a patient's response to therapy, and herein the potential of such factors as predictive biomarkers of therapeutic responsiveness is discussed.

In systemic lupus erythematosus (SLE), central nervous system involvement can present as various neurological and psychiatric features, as a primary manifestation of SLE or arising from other causes. In this Review, the author discusses advances in knowledge of the immunopathogenesis, diagnosis and management of neuropsychiatric events in patients with SLE.

Pain is subjective and depends on the context in which it is experienced. In this Review the authors examine the effect of expectation (negative and positive), and other contextual factors, on the differential activation of neurochemical pathways and the sensation of pain and effectiveness of analgesia. The reviewers use data from placebo and nocebo response experiments to argue that the overall context, including the relationship between patient and doctor, can control the effectiveness of pharmaceutical intervention.

Extracellular vesicles are now thought to mediate inflammation and immunity by carrying PAMPs, DAMPs, autoantigens, microRNAs, cytokines and various metabolites and cellular components. In this Review, the authors put these findings in the context of rheumatic diseases and hint at the future of therapies that might use extracellular vesicles to modulate immune responses.

In this article the authors review the 'BAFF/APRIL system', a complex of the cytokines BAFF and APRIL, their receptors and signalling pathways. The efficacy of belimumab, an anti-BAFF biologic agent used in clinical trials for SLE, is used to develop an argument that the BAFF/APRIL system is an important regulator of autoimmunity. Future therapies for SLE could fine-tune these cytokine signalling pathways to regulate autoreactive B cell survival and autoimmunity.

The most common symptom of osteoarthritis is pain, but current treatments do not identify or treat different types of osteoarthritis-associated pain. In this Opinion article the authors argue that some patients with osteoarthritis have neuropathic pain, and that analgesic drugs generally prescribed for neuropathic pain that is unrelated to osteoarthritis should also be used to treat this subset of patients.