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Although the benefits of exercise for individuals with fibromyalgia are well known, it can be difficult for individuals to begin or maintain an exercise regimen. A recent trial examined whether defining “exercise” as increases in regular home-based physical activities might improve exercise compliance.
Both etanercept and ustekinumab have been shown to be strikingly effective in patients with psoriasis. A phase III trial comparing these two biologic agents for the treatment of moderate-to-severe psoriasis found that ustekinumab was superior to high-dose etanercept over a 12-week period; however, several questions remain to be addressed.
A key component of Paget disease of bone is a localized increase in osteoclastic activity, which might be attributable, in part, to mutations in the sequestosome 1 gene. A study has identified three new genes that regulate osteoclasts and are implicated in Paget disease; however, the clinical utility of these findings remains questionable.
Studies of mouse models of lupus provided the rationale for targeting BAFF in the treatment of patients with systemic lupus erythematosus, and could also help explain why individuals might differ in their response to this therapeutic approach.
Treatment guidelines are an increasingly prominent topic of discussion in medicine. Can rheumatologists avoid the 'fatal flaw' inherent in attempts to standardize treatment decision-making—in which overly strict adherence to guidelines might be pursued at the expense of optimizing individual patients' outcomes?
Technological innovations have contributed greatly to advancing our knowledge of the genetic basis of osteoporosis. This article reviews the current understanding of osteoporosis genetics with a focus on developments since 2007. The potential clinical implications of this information and future directions for research are also discussed.
Heterotopic ossification is the formation of extraskeletal bone within soft tissues in the body. In two inherited heterotopic ossification disorders, fibrodysplasia ossificans progressiva and progressive osseous heteroplasia, specific gene mutations have been identified and, as outlined in this Review, result in aberrant bone formation and abnormal regulation of cell-fate signaling pathways in patients with these disorders.
Sjögren's syndrome (SS) is a chronic autoimmune disorder that affects the exocrine glands, but the pathogenesis of this disease is not fully understood. This Review article describes the available evidence on the important pathogenetic mechanisms involved in the development of SS with a particular focus on how the disease is initiated and perpetuated. The authors also discuss the disease outcome and survival of patients with SS.
Pediatric-onset systemic lupus erythematosus (pSLE) is associated with higher disease severity and damage accrual compared with adult-onset SLE. In this Review, the authors describe specific features of pSLE, including epidemiology, disease activity and outcomes, and the effects of the disease on patients' quality of life, bone health and comorbidities.
After decades during which little has changed with respect to the therapeutic options available to clinicians treating patients with lupus nephritis, the use of targeted biologic agents is emerging as a possible treatment strategy. The authors discuss the potential of these agents, including both B-cell-directed and T-cell-directed therapies, and consider the specific circumstances in which they should be used, either alone or combined with conventional or other new therapies.
