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Current guidelines for classification of symptoms of neuropsychiatric systemic lupus erythematosus have not proven helpful for the dissection of pathological mechanisms of this disorder or the identification of appropriate therapy. A reclassification of symptoms is proposed in this Viewpoint; the new scheme is based on pathoanatomic localization of the disease.
Detecting and treating rheumatoid arthritis as early as possible in the disease stage can mean that long-term treatment might not be necessary. In this Viewpoint, Dr Liang and colleagues propose a novel method for the identification of persons with symptoms of early rheumatoid arthritis in the general population.
Metalloproteinases are thought to be involved in the pathological destruction of joint tissues in rheumatoid arthritis and osteoarthritis; however, matrix metalloproteinase inhibitors failed to effectively treat disease in early clinical trials. It is now clear that more-specific inhibition of these enzymes is required for the success of this therapeutic approach.
Autoantibodies and autoimmune diseases such as drug-related lupus can occur following exposure to certain drugs; however, although many patients develop autoantibodies only a minority develops lupus-like features. As discussed in this Review, clinicians should consider the possibility of a drug-related effect in patients treated with medications such as tumor necrosis factor inhibitors and minocycline who develop an apparent 'flare' of the disease.
Systematic reviews, with or without meta-analyses, offer an objective appraisal of the available evidence compared with traditional narrative reviews. In this Review, Dr Finckh and Dr Tramèr examine the analytical strengths of and the main problems encountered by both systematic reviews and meta-analyses, focusing on how to best assess the validity of each for the practicing clinician.
This Case Study describes a rehabilitation program for an athletic man who sustained an injury that caused knee joint effusion. The torque and muscle size of the injured leg was comparable to that of the patient's contralateral, healthy, leg after 11 weeks of a regimen incorporating repetition of knee aspiration and resistance training.
Pulmonary arterial hypertension (PAH) contributes significantly to the morbidity and mortality of patients with systemic sclerosis. Clinical symptoms of PAH are unspecific and are late manifestations of disease. This Case Study highlights the challenges of diagnosing PAH in patients with systemic sclerosis and includes discussion of screening options.
