Volume 11 Issue 2, February 2015

Important advances in 2014 foster new perspectives on definitions of early and end-stage disease, and promote a shift in the clinical management of osteoarthritis (OA) through implementing treatment algorithms intended to minimize strain on current health-care models. Collectively, these changes shed new light on developing and optimizing approaches to OA treatment.

Three monogenic diseases, with features of both autoinflammation and autoimmunity, were described for the first time in 2014. As well as providing insights into the molecular basis of several rare immunological disorders, the discoveries have implications for their diagnosis and treatment.

2014 saw the emergence of a novel rheumatoid arthritis therapy to rival methotrexate, as well as advances in our understanding of mouse T-cell biology and of the cross-talk between the nervous system and the immune system. How will these advances affect the future of rheumatoid arthritis research and therapy?

Optimizing the management of childhood arthritis requires detailed knowledge of the disease in an individual patient. Advances in 2014 show how in-depth genetic studies and insights into immunopathogenesis could translate into clinical biomarkers and, eventually, individualized therapy.

The treatment and study of systemic sclerosis (SSc) is entering a new era with the reporting and preparation of several randomized controlled trials according to an improved understanding of SSc pathogenesis. Advances in trial designs reported in 2014 should now be built upon with further improvements to patient selection to enable targeting of therapies to specific subgroups of patients with SSc.

Even though activation of immunity is associated with bone destruction, new mechanisms have been described in 2014 through which immunology-associated pathways can cooperate to support osteogenesis. These advances support the view of the immune system as a central mechanism which can regulate bone homeostasis, regeneration and destruction.

In comparison with traditional surgery techniques, arthroscopic surgeries induce less tissue damage and can reduce morbidity and complications. In this Review, Carr and colleagues focus on the increased use of therapeutic arthroscopy as a tool for excision, reconstruction and replacement of damaged or abnormal tissue, and signal the need for additional studies to allow this surgical approach to reach its full potential.

Contrary to earlier beliefs, evidence now exists that exercise does not exacerbate systemic inflammatory diseases, such as rheumatoid arthritis. In this Review of exercise therapy for rheumatic diseases, the authors propose that, by interrupting a cycle of local inflammation, obesity, metabolic dysregulation and systemic inflammation, exercise is medicine.

Glucocorticoid therapy is associated with bone loss and increased risk of fracture, but these deleterious effects can be avoided or mitigated with appropriate treatment. When to initiate anti-osteoporosis therapy and what form this preventive therapy should take is the focus of this Review.

The ASAS classification criteria for axial and peripheral subgroups are beginning to alter our understanding of spondyloarthritis. In this article, Astrid van Tubergen discusses how these criteria are changing not only our clinical understanding, but also the epidemiology, including prevalence and incidence calculations.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral infection of the central nervous system that is associated with several immunosuppressive therapies. In this Opinion article, Calabrese and colleagues propose a ranking of immunosuppressive agents based on their risk of PML to support a better-informed decision-making process.