Volume 15 Issue 2, February 2019

The Wnt signalling pathway is the target of current anabolic therapies for osteoporosis. Studies in 2018 have revealed more about endogenous control of Wnt-related signalling, including mechanisms of natural Wnt inhibition and new anabolic signalling pathways that could be harnessed to overcome the challenges posed by current therapies.

In 2018, advances in the treatment of gout flares came in the form of a new nurse-led management approach to serum urate lowering and evidence that allopurinol might have a better cardiovascular safety profile than febuxostat. However, are IL-1β blockers such as canakinumab the future of care for patients with gout?

Cell metabolism has long been at the forefront of tumour biology, but in the past decade the importance of cellular bioenergetics has been increasingly recognized in regulating immune cell function. Mechanistic studies in 2018 have highlighted cell metabolism as a potential therapeutic target for the treatment of rheumatoid arthritis.

Systemic lupus erythematosus (SLE), the embodiment of a multi-organ autoimmune disease, results from hyperactivation of host-defence pathways and immune recognition of the most fundamental building blocks of life. In 2018, key advances have placed intestinal immunity and dysregulated expansions of candidate pathobionts at the forefront of SLE pathogenesis.

Janus kinase (JAK) inhibitors (jakinibs) that target downstream signalling by a large range of cytokines are effective in treating autoimmune and rheumatic diseases. Newer jakinibs that selectively inhibit individual JAKs and a narrower spectrum of cytokines have now been developed, but how do these inhibitors compare with existing drugs?

Intra-articular therapies for knee osteoarthritis (OA) are causing excitement among clinicians and patients, but care should be taken when choosing which therapy to use. In this Review, Vangsness and colleagues critically appraise current and future intra-articular therapies for knee OA.

Nakazawa and colleagues describe advances in our understanding of anti-neutrophil cytoplasmic antibody-associated vasculitis. These insights have already generated promising new treatments that target B cells, T cells and cytokines; potential novel approaches targeting additional cells or molecules are also discussed.

Intervertebral disc degeneration is a leading cause of low back pain. Endogenous progenitor cells are still being fully characterized but hold promise for future regeneration strategies.

Dactylitis is diffuse inflammation of the digits and is so closely associated with psoriatic arthritis that it can be used as an outcome measure of it. In this Opinion article, the authors describe how imaging modalities and scoring systems combined with data from animal models can be used to understand the underlying anatomy and immunopathogenesis of dactylitis.