Volume 8 Issue 4, April 2012

Effective osteoarthritis (OA) therapies would delay the need for total joint replacement (TJR). Recently, a committee of researchers attempted to develop a threshold for virtual TJR to be used as a standardized outcome for OA trials; their failure highlights challenges that complicate the measurement of OA and provision of TJR.

In an age in which immunosuppression is the standard of care for many pediatric rheumatic diseases, balancing the risks and benefits of vaccinations is forefront. Three main issues—addressed in new guidelines—surround vaccination practices in these patients: safety, immunogenicity and effects of the vaccine on the underlying rheumatic disease.

Early diagnosis and treatment of rheumatoid arthritis improves long-term outcomes and reduces or halts joint damage progression. However, delays at the patient and medical system levels remain a barrier to early diagnosis and therapy, despite the presence of early arthritis clinics designed to expedite treatment.

New consensus treatment plans state that the combination of glucocorticoids and immunosuppression is treatment of choice for newly diagnosed pediatric patients with proliferative lupus nephritis. However, variations exist in the steroid protocol and in the type of immunosuppressant used, indicating that a gold-standard treatment protocol is yet to be achieved.

HMGB1 is a non-histone nuclear protein that can serve as an alarmin to promote inflammation. In this Review, the authors present an overview of the structure and function of HMGB1. They also describe the role of HMGB1 in autoimmune and inflammatory diseases, including rheumatoid arthritis and systemic lupus erythematosus.

Patients with systemic sclerosis (SSc) are at considerable risk of developing pulmonary arterial hypertension, which has a dramatic impact on the natural history of the disease and overall survival of the patient. Modern imaging modalities, such as novel echocardiographic techniques and cardiac MRI, are highly sensitive, quantitative and reproducible methods that allow noninvasive assessment of regional and global myocardial performance without relying on geometric assumptions. In this Review, the authors describe the standard clinical tests and evolving technologies, which can provide comprehensive and quantitative data on myocardial status that are useful in the clinical management and evaluation of patients with SSc.

Advances in the therapeutic management of systemic lupus erythematosus (SLE) have greatly improved life expectancy in patients with this disease, exposing their increased risk of cardiovascular disease (CVD) compared with the general population. In this Review, the authors discuss the influence that pathogenic processes and therapeutic interventions might have on the accelerated atherosclerosis observed in patients with SLE, as well as the potential approaches to reduction of CVD risk in these individuals.

Rheumatoid diseases such as rheumatoid arthritis are associated with accelerated atherosclerosis, increased cardiovascular morbidity and mortality. The early signs of cardiovascular disease therefore need to be recognized in these patients so that effective cardiovascular protection can be introduced. In this Review the authors discuss validated techniques that are currently available to determine subclinical atherosclerosis in patients with rheumatic conditions.

Despite their different targets, biologic agents used for blockade of TNF and IL 6, inhibition of T cell co-stimulation and B cell depletion all have similar beneficial effects on the outcome of rheumatoid arthritis (RA). This observation raises questions as to whether the targets of these therapies might all be involved in a common pathogenetic pathway. In this Perspective, the authors discuss the disparities in RA therapy and whether clinical trial data can be used to determine at which point a biologic agent might interfere with the pathogenetic RA cascade.