Volume 16 Issue 3, March 2020

Obesity promotes osteoarthritis (OA) through complex and incompletely understood biomechanical, metabolic and inflammatory factors. New data in mice add to this complexity by showing that eating a high-fat diet increases the risk of OA for two generations of offspring, raising questions about disease mechanisms and future treatment strategies.

Trials studying rare diseases, including immune-mediated inflammatory diseases such as Castleman disease, hyper IgD syndrome and undifferentiated vasculitis, frequently end in noncompletion and nonpublication. A new cross-sectional analysis identifies underlying reasons, but also calls for action to establish international networks that might facilitate recruitment of patients into trials and to ensure timely publication of research findings to advance the field.

Glucocorticoids are anti-inflammatory therapies commonly used in rheumatology, but have wide-ranging adverse effects. Understanding the pharmacokinetic properties and mechanisms of action of glucocorticoids could inform in the development of novel therapies with fewer adverse effects.

Methotrexate can suppress inflammation via multiple mechanisms that can differ across different cell types. Understanding these mechanisms might enable better understanding of the disease and prediction of treatment responses.

Hydroxychloroquine and chloroquine are antimalarial drugs commonly used for the treatment of rheumatic diseases. Multiple mechanisms might explain the efficacy and adverse effects of these drugs, but further investigation could lead to the development of more specific and potent drugs.

Mycophenolate mofetil, azathioprine and tacrolimus are conventional DMARDs that originate in the field of transplantation medicine. This Review discusses the history, mechanisms, current indications and future prospects of these drugs in the field of rheumatology.

Breakthroughs in the field of rheumatology have transformed the management of rheumatic diseases and improved patient outcomes, but clinical challenges remain. Looking back at ‘older’ drugs could provide new lessons for future drug strategies and development.