Volume 16 Issue 2, February 2020

The availability of biosimilars to treat inflammatory diseases has generated concern about changing patients from a bio-originator to its biosimilar to save costs. Studies published in 2019 support the effectiveness and safety of ‘nonmedical switching’ and highlight the benefits of communicating information about biosimilars to patients in a positive light.

The synovium is the main target tissue of inflammatory arthritides such as rheumatoid arthritis and psoriatic arthritis. In 2019, new technologies for examining the molecular characteristics of specific cell subsets have enabled advances in our understanding of the architecture of synovial lymphoid aggregates, macrophage infiltrates and synovial fibroblast subsets.

Machine learning and high-throughput technologies hold promise for the classification, diagnosis and treatment of patients with rheumatic diseases, with the ultimate goal of precision medicine. Several studies in 2019 highlight the feasibility and clinical utility of using machine learning in rheumatology to stratify patients and/or predict treatment responses.

Use of prescription opioids is prevalent in patients with rheumatic diseases. Studies in 2019 reported the trends and safety of opioids in patients with rheumatoid arthritis or osteoarthritis. Treating underlying disease processes must be the rheumatologists’ priority. Without better long-term safety and effectiveness data, opioid use should be generally limited.

Dysregulation in the formation and/or clearance of neutrophil extracellular traps (NETs) is important in immune dysregulation and organ damage in chronic inflammatory conditions. Studies in 2019 have shown how certain genetic susceptibilities to autoimmunity can promote NET-mediated inflammation, and expanded the role for NETs in vascular damage and premature atherosclerosis.

Asymptomatic hyperuricaemia precedes and potentially contributes to the development of gout and other chronic diseases. This review summarizes what is known about the effects of uric acid on pro-inflammatory responses.

Single-cell proteomic techniques that use elemental (heavy metal) reporter ions increase the number of parameters that can be studied at once in whole tissues. This Review discusses the practical aspects of using such technologies in rheumatic disease research.

The activity of various metabolic pathways can influence the function and differentiation of T cells. T cell metabolism is dysfunctional in systemic lupus erythematosus (SLE) and targeting metabolic pathways in SLE could be a promising therapeutic avenue.

Successful pregnancy requires changes to the immune system to enable tolerance of the growing fetus. In this Review, the authors discuss how these immunomodulatory mechanisms contribute to the phenomenon of pregnancy-related improvement of rheumatoid arthritis.