Volume 9 Issue 11, November 2013

Clinical findings and responses to biologic agents are increasing the evidence that undifferentiated spondyloarthritis (SpA) may represent the earliest stage of ankylosing spondylitis and psoriatic arthritis. New results also lend support to the hypothesis that the SpA spectrum represents one clinical condition, but hurdles in improving classification and diagnosis remain.

Takayasu arteritis is an understudied disease but a recent article emphasizes the heavy burden it imposes on patients. New assessments devised to improve disease understanding are based on physicians' concepts of disease severity. However, wide differences exist between patient and physician priorities and more work is now needed to improve patient quality-of-life.

Low back pain is a common health problem that is usually attributable to mechanical disorders of the spine. In this comprehensive Review, David Borenstein outlines the usual characteristics and pathology of mechanical low back pain—from a Rheumatologist's perspective—as well as describing the available diagnostic technologies and treatment options for patients.

In this Review, Malfait and Schnitzer provide an accessible discussion of the peripheral and central mechanisms involved in OA pain, and explain how NSAIDs, antidepressants and anti-NGF antibodies modulate these pain pathways to exert their analgesic effects. They propose that an enhanced understanding of such mechanisms might permit a more targeted and individualized approach to pain management in the future.

Biologic agents have now been studied in over 200 randomized controlled trials and 100 subsequent meta-analyses in rheumatic diseases. This Review highlights the shortcomings in the evidence derived from such studies. The authors discuss how the issues identified could be addressed in the future by revisiting trial design and improving reporting of findings; the responsibilities of the regulatory authorities, the pharmaceutical industry and academia are also debated.

What is oxidative stress and how is it implicated in the pathogenesis of systemic lupus erythematosus (SLE)? Complex molecular pathways leading to and from redox imbalance in the context of SLE, including oxidative modification of autoantigens, are reviewed in this manuscript, alongside developmental approaches that aim to tackle and/or exploit oxidative stress in the clinical management of this disease.

Systemic lupus erythematosus (SLE) is a heterogeneous condition characterized by a wide range of symptoms, rendering its diagnosis an often difficult task. In this article, the authors highlight the current approaches and challenges in SLE diagnosis, propose an algorithm to facilitate this process, and argue for the development of endorsed diagnostic criteria.