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The performance of the CASPAR criteria, which are known to have high specificity and sensitivity in classifying patients with long-standing psoriatic arthritis, has now been evaluated in early disease. Whereas the findings are likely to boost clinical research, implications for daily practice—and diagnosis—are less certain.
Analysis of a national US database suggests that patients with JIA are at increased risk of serious infection, and that this risk is further increased by treatment with glucocorticoids. By contrast, therapy with methotrexate or TNF inhibitors does not increase this risk, and might even reduce it through steroid-sparing effects.
Establishing a standard definition of systemic lupus erythematosus is a continuously evolving challenge for researchers. How does the latest set of classification criteria compare with previous endeavours?
Gout is often poorly managed, with low rates of successful long-term urate lowering. A new 'package of care' intervention for treatment of patients with gout now offers ways to improve outcomes. The intervention, involving both a rheumatologist and gout nurse specialist, provides a framework for best practice in gout management.
Polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) are inflammatory disorders that commonly occur in the elderly and whose disease patterns variably overlap. In this Review, Salvarani and colleagues describe the main clinical features of both PMR and GCA, detailing the pathogenesis, diagnosis, classification and management of these disorders, offering practical guidance to clinicians.
Antimalarial agents are mainstays in the clinical management of systemic lupus erythematosus, and have been in routine use for more than 50 years. This Review summarizes recent insights into the mechanisms of action of these agents and their clinical implications.
Platelets have an established function in haemostasis, but their role in the development of rheumatic disease is only now emerging. In this focused Review, Boilard and colleagues describe how platelets, and platelet-derived microparticles, contribute to the development of arthritis and systemic lupus erythematosus, highlighting the key advances in the literature and the future of this field.
MicroRNAs (miRNAs) function in several chronic diseases—miRNA-mediated fine control of genetic networks involved in tissue development and homeostasis becomes disrupted. Participating in production and maintenance of articular chondrocytes and skeletogenesis, miRNA are increasingly implicated in the pathogenesis of osteoarthritis. Data from animal and cell studies are discussed in this Review, alongside the potential for targeting miRNA in the clinic.
In this article, the authors propose that clinical teams in the rheumatology setting are well-placed to facilitate self-management—and thereby improve health outcomes—by applying basic cognitive–behavioural techniques to helping patients manage disease-related psychological challenges and the impact of symptoms on their daily lives.
