Rheumatology articles within Nature Reviews Rheumatology

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  • Research Highlight |

    A wearable smart device that uses reconfigurable electronics and conductive polymer-based microneedles was able to monitor inflammation and provide transdermal drug delivery and electrical stimulation in a rat model of arthritis.

    • Maria Papatriantafyllou

  • News & Views |

    Guidelines for the management of psoriatic arthritis (PsA) need to undergo revision to take on board new evidence, particularly in relation to therapeutics. In March 2024, EULAR published updated recommendations for the pharmacological treatment of PsA, and an expert group published consensus statements intended to complement existing guidelines.

    • Ennio Lubrano
    •  & Fabio Massimo Perrotta

  • Comment |

    Understanding the molecular endotypes that influence clinical phenotypes is a critical step for the stratification of patients with osteoarthritis (OA) into therapeutic subtypes that can help the development of targeted disease-modifying OA drugs (DMOADs) to provide genuine, long-term clinical benefit.

    • Ali Mobasheri
    •  & Richard Loeser

  • News & Views |

    The management of antiphospholipid syndrome is hindered by heterogeneous clinical presentations. Whole-blood transcriptomics have the potential to identify previously unknown disease endotypes, which could inform new treatment strategies. However, such hypothesis-generating data must still account for the results of randomized clinical trials, such as those focused on direct oral anticoagulants in APS.

    • Jason S. Knight
    •  & Maria G. Tektonidou

  • Research Highlight |

    Drugs used to treat osteoporosis could slow the progression of osteoarthritis, according to the findings of a study in mice.

    • Sarah Onuora

  • Review Article |

    In this Review, Knight and Erkan consider how the 2023 ACR–EULAR classification criteria for antiphospholipid syndrome (APS) can guide future research to subphenotype APS by understanding its pathophysiology, paving the way for the personalized and proactive management of individuals with APS.

    • Jason S. Knight
    •  & Doruk Erkan

  • Review Article |

    Relapsing polychondritis, a rare inflammatory disorder that affects cartilaginous structures, presents challenges in diagnosis owing to overlapping symptoms with other conditions. This Review provides a clinical update on relapsing polychondritis, emphasizing the importance of distinguishing this disease from similar conditions.

    • Philippe Mertz
    • , Nathalie Costedoat-Chalumeau
    •  & Laurent Arnaud

  • Comment |

    Medication adherence in gout is low, and discontinuation of urate-lowering therapy puts patients at risk of flares and cardiovascular events. A strategy to regularly monitor serum urate levels and the dissolution of urate deposits (particularly if visualized by patients) might encourage adherence in the long term.

    • Pascal Richette
    •  & Nicola Dalbeth

  • Comment |

    Multidimensional and single-cell profiling of peripheral blood and inflamed tissues is a powerful and high-resolution tool for the stratification of patients with autoimmune rheumatic diseases into distinct cellular and/or molecular endotypes. The road towards precision rheumatology is long, but the time has come to enter the territory of clinical validation.

    • George D. Kalliolias
    •  & Athanasios G. Papavassiliou

  • Comment |

    Despite the transformative potential of treatments for systemic autoinflammatory diseases, these conditions remain underfunded and understudied. Urgent, coordinated action among stakeholders is needed to overcome regulatory and research barriers, as is innovation and advocacy for the development of effective therapies for these rare diseases.

    • Natalie M. Zitoun
    • , Erkan Demirkaya
    •  & Micol Romano

  • Review Article |

    Rheumatoid arthritis has a substantial genetic component, some of which is associated with the presence of low-frequency or rare variants. Next-generation sequencing in large and well-defined cohorts can continue to identify these variants and thereby contribute to the future prediction, diagnosis and treatment of rheumatoid arthritis.

    • Vanessa L. Kronzer
    • , Jeffrey A. Sparks
    •  & James R. Cerhan

  • Research Highlight |

    A nanoparticle-based formulation of the anticancer drug pazopanib, which inhibits VEGFR1 and VEGFR2, shows promise as a disease-modifying drug for osteoarthritis.

    • Rebecca Kelsey

  • News & Views |

    EULAR’s 2023 updated recommendations for the non-pharmacological treatment of hip and knee osteoarthritis reiterates and confirms, in an abbreviated form, what we have known for more than a decade. Unfortunately, the abbreviated format of the updated recommendations lacks specificity and clinical usefulness. More detailed guidance could have facilitated wider uptake and improved care.

    • Marius Henriksen

  • Evidence-based Guidelines |

    In this Evidence-Based Guideline article, an international multidisciplinary working group of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases presents recommendations for the diagnosis, monitoring and treatment of osteoporosis in men.

    • Nicholas R. Fuggle
    • , Charlotte Beaudart
    •  & Nicholas C. Harvey

  • News & Views |

    Characteristic patterns of joint involvement exist in different forms of arthritis. Research now indicates that epigenetic programming of synovial fibroblasts diversifies their response to inflammatory cascades, leading to this anatomical variation in arthritis and its response to treatment.

    • Chrissy Bolton
    •  & Adam P. Croft

  • News & Views |

    In 2006, a linear immunological continuum of autoinflammatory and autoimmune disorders ranging from monogenic diseases of innate immunity at one end to monogenic diseases of adaptive immunity at the other end was proposed to classify these conditions. Deep immunophenotyping has now revealed a cell-based nosology of these disorders.

    • Michael F. McDermott

  • Research Highlight |

    New research has identified apolipoprotein E expressed by fibroblasts and macrophages in the infrapatellar fat pad and synovium as a pathogenetic mediator and potential therapeutic target in knee osteoarthritis.

    • Robert Phillips

  • Research Highlight |

    Results of a new study indicate that eosinophils have a role in maintaining bone homeostasis through their inhibitory effects on bone-resorbing osteoclasts.

    • Sarah Onuora

  • Perspective |

    Beyond the traditional classification of monogenic or complex, many genetic diseases can be considered genetically transitional disease. In this Perspective, the authors consider the application of the genetically transitional disease model to rheumatic diseases and the potential implications for patient care, genetic counselling and research.

    • Timothy B. Niewold
    • , Ivona Aksentijevich
    •  & Qingping Yao

  • Review Article |

    Immunoengineering involves the design of materials with specific properties relating to the immune system. In this Review the authors consider the application of immunoengineering to systemic autoimmune diseases via site-specific and antigen-specific immunoregulation, the facilitation of immune cell therapy, novel approaches to immunodiagnostics and the generation of models to study autoimmunity.

    • David A. McBride
    • , Ryan M. Jones
    •  & Nisarg J. Shah

  • News & Views |

    The World Health Organization (WHO) has published new guidelines for the non-surgical management of chronic primary low back pain in adults in primary and community care settings. Although the guidelines are commendable, they lack guidance on when to suspect and how to avoid missing important secondary causes of back pain.

    • Mohamad Bittar
    •  & Atul Deodhar

  • Research Highlight |

    A meta-analysis of data from six genome-wide association study cohorts implicates several signalling pathways, including Hedgehog and Notch signalling, in Dupuytren disease.

    • Sarah Onuora

  • Review Article |

    Deep learning is a powerful technique with great potential for the analysis and interpretation of rheumatological images. To successfully use deep learning, rheumatologists should understand the tasks involved in image processing and the potential confounders and limitations that can affect the analysis of clinical data.

    • Berend C. Stoel
    • , Marius Staring
    •  & Annette H. M. van der Helm-van Mil

  • Review Article |

    Juvenile idiopathic arthritis treatment has evolved with new therapies, early remission goals and global efforts, including randomized trials and a treat-to-target strategy. This Review summarizes current evidence and therapeutic approaches to the management of non-systemic phenotypes of juvenile idiopathic arthritis.

    • Susan Shenoi
    • , Gerd Horneff
    •  & Angelo Ravelli

  • Review Article |

    This Review discusses the interplay of the gut microbiome and the immune system in the context of systemic lupus erythematosus. Dysbiosis and gut-barrier dysfunction are implicated in promoting disease and are potential therapeutic targets.

    • Gregg J. Silverman
    • , Doua F. Azzouz
    •  & Abhimanyu Amarnani

  • Comment |

    As in rheumatoid arthritis, achieving low disease activity or remission in psoriatic arthritis (PsA) remains a challenge and unmet need for many individuals. However, the complex pathogenesis, heterogeneity and varied tissue involvement in PsA mean that dedicated definitions and novel solutions are required for difficult-to-treat disease.

    • Stefan Siebert
    •  & Helena Marzo-Ortega

  • News & Views |

    New findings suggest that current cell therapy approaches are not superior to a simple corticosteroid injection for the treatment of osteoarthritis, calling into question the role of existing cell therapies and highlighting the need for further research and development in this field.

    • Scott A. Rodeo

  • News & Views |

    Re-establishing tolerance to autoantigens is an important aim for the treatment of rheumatoid arthritis (RA). Immunization of HLA-DR4 transgenic mice with citrullinated self-antigens can induce immune tolerance, which suggests that such antigens could have a therapeutic role in anti-citrullinated peptide antibody-positive RA.

    • Ranjeny Thomas
    •  & William H. Robinson

  • News & Views |

    The identification of novel risk variants in the largest genome-wide association study of Raynaud phenomenon to date provides insights into the pathophysiology of the condition, including the potential role for α2A-adrenoceptors, and suggests opportunities for drug repurposing.

    • Ariane L. Herrick
    •  & Gisela Orozco

  • Research Highlight |

    New research has shown that tryptophan metabolism is altered in patients with rheumatoid arthritis, and that correction of this metabolic alteration has a protective effect against collagen-antibody-induced arthritis in mice.

    • Robert Phillips

  • Comment |

    Janus kinase inhibitors have therapeutic potential for patients with immune-mediated inflammatory diseases, and evidence of greater risks of cardiovascular disease and malignancy than with TNF inhibitors should be carefully considered before recommendations against their use are made. Assessment of the risk–benefit ratios in these patients can instead guide clinical decision-making.

    • Francesco Ciccia
    •  & Roberto Caporali

  • Research Highlight |

    In patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis in sustained remission, reinfusion with rituximab after B cell repopulation resulted in fewer clinical relapses than did reinfusion following serological ANCA flare.

    • Sarah Onuora

  • Review Article |

    In this Review, the authors describe shared pathophysiology of systemic juvenile idiopathic arthritis and adult-onset Still’s disease and their life-threatening complication, macrophage activation syndrome. Therapeutic developments now enable the targeting of multiple pathways in these conditions, and evidence suggests that early use of DMARDs has the potential to prevent chronic disease.

    • Piero Ruscitti
    • , Luca Cantarini
    •  & Roberto Giacomelli

  • Year in Review |

    Advances in gene, protein and cellular engineering provide unprecedented opportunities to redirect immune cells to treat autoimmunity. In 2023, novel cellular and precision immunotherapies showed remarkable promise in the treatment of rheumatic diseases.

    • Maximilian F. Konig

  • Year in Review |

    Research published in 2023 has demonstrated the efficacy of sarilumab for IL-6 blockade in polymyalgia rheumatica and of secukinumab for IL-17 blockade in giant cell arteritis (GCA). Furthermore, preliminary results with human monocyte-derived suppressive cells suggest the potential of cellular therapeutics for the treatment of GCA.

    • Lindsay Lally
    •  & Robert Spiera

  • Year in Review |

    In 2023, large language models demonstrated potential for use in rheumatology to accurately suggest diagnoses and provide empathetic patient education. However, the propensity of this technology to generate misleading information continues to pose risks. Balancing innovation with physician guidance is essential.

    • Vincenzo Venerito
    •  & Latika Gupta

  • Review Article |

    In this epidemiological Review, the authors summarize the available evidence relating to the prevalence, incidence, risk factors and mortality associated with the autoimmune disorder Sjögren syndrome, with or without the co-occurrence of other connective tissue diseases.

    • Maxime Beydon
    • , Sara McCoy
    •  & Raphaèle Seror

  • Year in Review |

    For individuals with gout, the treatment options beyond conventional urate-lowering therapies are expanding. Notable advancements in 2023 include developments in uricase therapy, new xanthine oxidase inhibitors, and a class of medications that offer dual benefits for the control of type 2 diabetes mellitus and gout.

    • Kanon Jatuworapruk
    •  & Worawit Louthrenoo

  • Year in Review |

    Studies in 2023 have described eight new monogenic autoinflammatory diseases and their accompanying disease-causing mutations, uncovering clinical phenotypes, pathogenic mechanisms and therapeutic targets. Researchers have identified autoinflammatory pathways linked to mitochondrial dysfunction or overactivation of SRC family kinases.

    • Riccardo Papa
    •  & Marco Gattorno

  • Review Article |

    In this Review, the authors discuss the role of IL-18 in human inflammatory disease. They describe the mechanisms of IL-18 biology, discuss how dysregulation of this biology leads to immunopathology, and note the biological and clinical circumstances in which therapeutic manipulation might alleviate suffering and save lives.

    • Emily Landy
    • , Hallie Carol
    •  & Scott Canna

  • Research Highlight |

    A novel combination of ceria nanoparticles and mesenchymal stem cell nanovesicles modified both inflammation and autoimmunity in a mouse model of arthritis.

    • Robert Phillips

  • Review Article |

    In this Review, the authors provide an overview of what is known of the clinical features, pathogenesis and treatment of anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis, including emerging biomarkers and clinical subtypes.

    • Xin Lu
    • , Qinglin Peng
    •  & Guochun Wang

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