Volume 8 Issue 3, March 2012

The reproducibility and reliability of ELISA assays used to detect autoantibodies that recognize cardiolipin or β₂-glycoprotein I remain unacceptable, which can complicate the diagnosis of antiphospholipid syndrome. Now, much needed international consensus guidelines have been proposed for the development and use of these diagnostic tests, which should improve their performance.

Peripheral neuropathy can be a manifestation of small-vessel vasculitides such as antineutrophil cytoplasmic antibody-associated vasculitis. Diagnosing vasculitic neuropathy is, however, difficult in many cases. Early treatment focused on achieving remission of the underlying vasculitic process is important as chronic neuropathy has a major influence on a patient's quality of life.

Allocation of therapy for systemic lupus erythematosus (SLE) remains complex, as most drugs used to treat this disease are used off-label—a situation compounded by the emergence of new therapeutics. In this rapidly changing clinical setting, organ-specific therapeutic guidelines might be useful for 'real world' management of patients with SLE.

Increasing evidence implicates metabolic dysfunction in the development and progression of osteoarthritis (OA). Large-scale 'omics' studies, particularly metabolomics, have the potential to answer many questions relating to the pathogenesis of so-called 'metabolic OA' and other OA phenotypes, and could be key to the identification of novel biomarkers for these conditions.

The interplay between the cells that regulate bone architecture and the immune system is increasingly recognized. In this Review, as well as providing an overview of fracture treatment and healing, the authors discuss our current knowledge of the part played by inflammation in the fracture repair process. The influence of biomechanical and biological factors on bone healing is also considered, focusing on the effects of excessive local and systemic inflammation, as occurs in autoimmune diseases such as rheumatoid arthritis.

Highly specific for rheumatoid arthritis (RA), anti-citrullinated protein antibodies (ACPA) are emerging as suspects in the disease pathogenesis. Do these autoantibodies define a subtype of RA, how does their presence and maturation relate to the course and characteristics of the disease, and how can we use them to improve patient outcomes? Essential facts about ACPA are explained in this Review.

The role of inflammation in rheumatoid arthritis (RA) is well characterized, but how hypoxia affects RA and the potential interplay between inflammation, angiogenesis and hypoxia in this disease is less defined. Here, the authors describe how hypoxia affects RA, in terms of both inflammation and angiogenesis, and provide insights as to how depleted oxygen levels affect the RA synovium. Potential therapies for RA that target angiogenesis will also be discussed.

Patients over the age of 50 years who present with a fracture seem to have the highest risk of subsequent fracture and also mortality immediately after the initial fracture is incurred. In this Review, the authors summarize the evidence that demonstrate this trend and discuss the factors that influence fracture risk. Finally, they propose a five-step systematic approach to management of patients who present with a fracture, aimed at preventing subsequent fracture, decreasing mortality rates and reducing undertreatment or overtreatment.

Advances in the fields of cell biology and imaging have allowed researchers to dig deeper into the underlying mechanisms of joint damage in patients with tophaceous gout. This Review describes some of the recent advances in our understanding of bone erosion and cartilage damage in this disease.