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Common involvement of inflammation can account in part for the strong association between rheumatoid arthritis and cardiovascular disease. Statins have both lipid-modifying and anti-inflammatory effects and are established in the general prevention and treatment of cardiovascular disease; their role in rheumatoid arthritis, however, is only more recently being explored.
Belimumab was recently shown to reduce disease activity in patients with systemic lupus erythematosus. This observation raises important questions about where belimumab might best fit into the treatment paradigm for this disease, and how the agent might compare to other biologic agents currently under investigation.
The effects of tumor necrosis factor inhibition on carcinogenesis and tumor progression are incompletely understood. In 2009, an analysis by the FDA suggested an increased risk of cancer in children and adolescents with systemic inflammatory diseases treated with those agents. By contrast, a recent population-based assessment of cancer risk did not find an overall elevation with anti-TNF treatment, and no increase with longer follow-up times.
Standard therapy for vasculitis associated with antineutrophil cytoplasmic antibodies can achieve high rates of remission, but with the risk of serious toxic effects. The results of a placebo-controlled trial in patients with severe disease suggest that an effective alternative could be on the horizon.
In this Review, the author discusses therapeutic principles that guide the treatment of myositis, in the context of issues including clinical presentation, diagnostic procedures, and practical approaches to treatment. Insights into the immunopathogenesis of myositis and the emergence of new therapeutic agents are also reviewed.
Sciatica is a common condition for which management strategies can vary considerably. This article draws on evidence-based medicine and clinical experience to provide an overview of the diagnosis and treatment of sciatica, including a comparison of conservative and surgical interventions and the role of rehabilitation.
By engaging innate immune receptors and inducing the production of proinflammatory cytokines, cells can sense and respond to danger signals. Defective regulation of these sensory and response mechanisms by indiscriminate recognition of self molecules or as a result of genetic mutation can result in autoimmune or autoinflammatory rheumatic diseases, as outlined in this Review.
Rheumatoid arthritis (RA) is increasingly recognized as a risk factor for cardiovascular disease, independent of the presence of classic cardiovascular risk factors such as smoking and obesity. In this article, the authors review the pathophysiology of accelerated atherosclerosis in RA, and discuss the potential role of statins in the reduction of both inflammation and atherosclerosis in these patients.
Although the link between bacterial infections and tumor necrosis factor (TNF) inhibitors is becoming increasingly established, much less is known about the risk of viral infections with these agents. The authors of this Review highlight emerging reports of viral infections in patients receiving anti-TNF therapy, and discuss treatment implications and potential strategies for preventing such infections.
Methotrexate is a proven and efficacious therapy for inflammatory diseases such as rheumatoid arthritis. The main mechanism of action of methotrexate as an anti-cancer drug, at high doses, involves folate antagonism, but what other mechanisms might be operative in the use of this drug at lower doses as an effective anti-inflammatory agent?
