Volume 11 Issue 12, December 2015

Functional MRI (fMRI) is increasingly used in efforts to unravel the neuropathological processes of neuropsychiatric systemic lupus erythematosus (NPSLE). Standardization of scan protocols, imaging expertise and disease-related confounders of neuronal activities remain major challenges to the use of fMRI in the diagnosis and prognosis of NPSLE.

In the development of rheumatoid arthritis, which factors govern the transition from systemic autoimmunity to synovitis? A study combining findings from human disease and animal models suggests that autoantibodies to neutrophil-derived citrullinated histone 2B are important for this transition; however, a 'second hit' involving intra-articular inflammation and citrullination could also be crucial to this process.

Comorbidities affect outcomes and treatment decisions in patients with immune-driven systemic inflammatory disorders. New recommendations for the management of comorbidities in rheumatoid arthritis, psoriasis and psoriatic arthritis might help optimize the management of these diseases and improve patient outcomes, but several considerations are relevant to their clinical implementation.

The burden of cardiovascular disease is high in patients with inflammatory joint disease, owing to the presence of inflammation and traditional cardiovascular risk factors. Current management of cardiovascular risk factors and control of disease activity are unsatisfactory, and patients could benefit from improvements in screening and coordination between the cardiology and rheumatology branches of health care.

Most core sets of outcomes in rheumatology include some patient-reported outcomes (PROs), most commonly pain, function, and patient global assessment of disease activity. According to van Tuyl and Boers, further research is needed to understand the value of the patient assessment and to define how these three key PROs contribute to the broader concept of health-related quality of life.

The increasing use of biosimilars in the context of rheumatic diseases has been met with several challenges unique to this type of drugs. In this Review, Dörner and Kay describe the fast adoption of biosimilar agents worldwide, highlighting the different approaches to regulation implemented by national and supranational health care policy-makers. Issues such as extrapolation of indications and the definition of strategies for adequate postmarketing pharmacovigilance are also discussed.

Gout is caused by the precipitation of monosodium urate monohydrate (MSU) crystals in the joints and in other tissues. Although direct observations of MSU crystals as they form on tissues are lacking, morphological findings and comparison with the physiological process of biomineralization suggests possible mechanisms of pathological MSU crystal formation and the conditions that might favour the nucleation and growth of crystals at particular anatomical sites.

This article presents the concept that Behçet disease and several spondyloarthropathies might have a common immunopathogenetic basis. The authors propose that barrier dysfunction in environmentally exposed organs, and aberrant innate immune reactions at sites of mechanical stress, trigger secondary adaptive immune CD8⁺T-cell responses characterized by prominent neutrophilic inflammation. The differential immunopathology of these 'MHC-I-opathies' could reflect antigenic differences in target tissues.