Review Articles

There is increasing insight into the impact of ankylosing spondylitis on employment and the costs of illness associated with this disease. Standardization of cost-effectiveness studies will improve the quality and comparability of these costs. This Review summarizes the literature on work participation, costs of illness and cost-effectiveness of treatment in patients with ankylosing spondylitis.

Improvements in treatments for systemic lupus erythematosus have led to longer survival times, but complications including osteoporosis and osteonecrosis often occur. This Therapy Insight provides an overview of the pathophysiology of osteoporosis and osteonecrosis in these patients, and recommends preventive measures and treatments.

In this Review, the authors discuss how early diagnosis of spondyloarthritis can be achieved for patients with predominantly axial or predominantly peripheral symptoms. The importance of identifying differences between diagnosis and classification, and how this disparity might influence clinical practice, are highlighted.

Many forms of functional decline are preventable, treatable or manageable, but a screening tool that can identify frail or vulnerable patients is much needed. This Review describes the methods currently available for non-specialist evaluation of patients at risk of functional decline, including behavioral, interview and questionnaire assessments.

Neutrophils are powerful mediators of tissue inflammation, and the balance between neutrophil survival and clearance is crucial to the resolution of inflammation. The cytokine granulocyte colony-stimulating factor is an important regulator of neutrophil production and survival. This Review discusses the roles of neutrophils and granulocyte colony-stimulating factor in chronic inflammatory diseases.

The creation of specific immune tolerance would allow autoimmune disease to be reversed without the need for nonspecific and potentially harmful immunosuppressive therapy. Important progress in research into immune tolerance is summarized in this Review, and the potential use of this technique in immunotherapy of autoimmune disease is discussed.

Pattern recognition molecules belonging to the innate immune response participate in the clearance of apoptotic cells. Among these molecules are the collectins C1q and mannose-binding lectin, and the pentraxins C-reactive protein, serum amyloid P component, and pentraxin 3. This Review discusses the prevalence, actions and clinical significance of these molecules in autoimmune conditions.

A variety of retinal signs can occur in patients who have systemic vasculitides. Although retinal signs are usually treated by treatment of the systemic disease, specific therapy is indicated occasionally to preserve vision. This Review describes the pathogenesis, clinical features and treatment of retinal manifestations of systemic vasculitides.

In this Review, Lars Klareskog and colleagues discuss the experimental approaches that are used to address the issue of gene–environment interactions in the etiology of RA, focusing on the roles of the HLA-DR shared-epitope genes, smoking and anticitrulline immunity in this process.

There is increasing interest in the role of transcription factors in the pathogenesis of inflammatory arthritis. Biologic and genetic studies are adding to current knowledge, and revealing potential targets for anti-inflammatory therapies that aim to modulate transcription factor activity.

Initially used in the treatment of mood disorders, this form of psychotherapy has been extended to other conditions such as chronic pain states. This Review evaluates the role of cognitive behavioral therapy, alone or in combination with other modalities, in the management of patients with fibromyalgia.

Progress in our understanding of fibromyalgia has identified aberrant central pain processing as a key abnormality in affected individuals. This Review describes a multimodal approach to treating this central pain syndrome, using neuroactive drugs that modulate sensory processing, and nonpharmacologic therapies such as exercise and cognitive behavioral therapy.

The pathogenesis of the spondyloarthropathies is thought to relate to interactions between genes, including HLA-B27, bacteria, and innate and acquired immune responses. This Review provides an insight into the validity of the genes–bacteria–immune response paradigm, and explores how interactions between these factors might result in disease.

To achieve goodin vivofunction, engineered cartilage needs to exhibit biological and physical properties similar to those of native articular cartilage. Adult multipotent stem cells are considered the cell type of choice for cartilage tissue engineering; this emerging technology shows high promise for producing transplantable cartilage constructs to improve the function of degenerated joints.

Our comprehension of the role of the complement system in autoimmunity and tissue injury in systemic lupus erythematosus has progressed since mice lacking early components of the complement pathway were developed. Elucidation of these disease mechanisms might lead to the development of improved therapeutic approaches.

Both systemic and local biomechanical factors contribute to joint degeneration in osteoarthritis, and diverse molecular mechanisms of the disease pathogenesis are being uncovered. Can mechanism-based treatments be developed for patients with this disease, as has happened with rheumatoid arthritis, and what are the challenges in drug development?

Nonpharmacological treatments cannot be assessed according to the same standards used for pharmacological treatments. This Review gives guidance on trial designs that address specific methodological issues encountered in assessment of nonpharmacological treatments, and on interpretation of data from such trials.

The risk of cardiovascular disease is increased in patients with rheumatoid arthritis, as discussed in this Review. Joan M Bathon and colleagues outline some preliminary recommendations for how these complications can be prevented and managed by aggressive control of both synovitis and conventional cardiovascular risk factors.

Despite extensive research, the etiopathogenesis of primary Sjögren's syndrome is not well understood. In this article, the hypothesis that activation of the type I interferon system contributes to the disease process is outlined and potential new therapeutic targets from this system for Sjögren's syndrome are discussed.

Paget's disease of bone, which is the second most common metabolic bone disorder and is characterized by focal increases in bone turnover, has a strong genetic component. As discussed in this Review, mutations in four genes have been described that cause Paget's disease of bone or related disorders, and all affect the receptor activator of nuclear factor κB signaling pathway.