Review Articles in 2012

Complex interactions between obesity, which can predispose to the development of osteoarthritis (OA), and OA, which can curtail weight-management efforts, challenge the managing physician. Nevertheless, weight loss is possible—and advisable—at all stages of the disease. Anita Wluka and colleagues unpick the interconnections between obesity and OA, review strategies for weight loss, and call for a societal approach to the management of these comorbid conditions.

The tremendous improvements in the survival of patients with systemic lupus erythematosus (SLE) in the past several decades have led to increased prevalence of lupus-related organ damage in these patients, which has slowed down the survival improvement and reduced the quality of life of patients. Anselm Mak and colleagues discuss the global pattern, potential mechanisms and advances in tools for early detection of organ damage.

Identifying facet joint pathology as the source—as it frequently is—of neck or back pain involves the use of diagnostic blocks, which also aid in selecting patients who will respond to radiofrequency denervation treatment. How best to administer and interpret the results of anaesthetic injection blocks are described in this Review, alongside current shortfalls and future prospects in the clinical management of facetogenic pain.

The association between coagulation and the immune system has been increasingly recognised to have a role in the development of inflammatory rheumatic diseases. The fact that the risk of venous thromboembolism is increased in patients with rheumatoid arthritis (RA) and citrullinated fibrinogen is an early autoantigen in RA indicates an adaptive immune response to coagulation factors in inflammatory rheumatic diseases. In this article, Hoppe and Dörner describes the pathophysiology of an induced procoagulatory state in inflammatory rheumatic diseases, discussing the roles of endothelial cell and platelet activation, and coagulation and fibrinolytic systems, and providing insights into future research for innovative therapeutic interventions.

Fibroblast-like synoviocytes (FLS) are cellular effectors of the inflammatory milieu that characterizes and precedes joint destruction in rheumatoid arthritis (RA). But what role do these cells have in creating the same environment to which they respond? Bottini and Firestein delve into the double life of FLS in RA pathogenesis.

The peripheral nervous system has a complex and important role in regulating the immune system. With a focus on the sympathetic nervous system, the authors of this Review discuss evidence for neuroimmune regulation of the inflammatory response in the context of autoimmune arthritis.

Anaemia as a result of chronic inflammation is common in patients with rheumatic disease. In this Review, Weiss and Schett provide a broad overview of the topic, covering the pathogenesis, diagnosis, treatment and management of anaemia in inflammatory rheumatic disease, offering practical guidance for clinicians.

The management of patients with systemic sclerosis (SSc) is often challenging. As curative therapies are not yet available, the current goal in clinical practice is prevention of disease progression and end-organ damage. In this Review, the authors discuss approaches to screening patients with SSc for internal organ involvement and monitoring disease activity, as well as the management of patients with SSc and specific complications, including interstitial lung disease, pulmonary arterial hypertension and gastrointestinal disease.

Spinal osteoarthritis primarily manifests as disease of the facet joints of the posterior spine. This Review presents the latest information about the prevalence, presentation, and nature of facet joint osteoarthritis, an important cause of spinal pain that should be viewed as failure of the whole joint rather than a disease of articular cartilage loss and bony hypertrophy.

This article provides an overview on the structure and function of the syndecan family of transmembrane proteoglycans. The authors discuss the regulation of these molecules and their roles in the developing joint as well as in cartilage breakdown and synovial inflammation.

Aberrant expression of microRNAs is associated with the pathogenesis of systemic lupus erythematosus (SLE). In this Review, Shen and colleagues discuss the potential of microRNAs to act as biomarkers for the diagnosis and assessment of patients with SLE, as well as the future therapeutic potential of targeting miRNAs in the management of patients with SLE.

Increasing evidence points towards the skeleton as having an endocrine role in humans. In this Review, DiGirolamo and colleagues introduce the concept of the skeleton as an endocrine organ, summarizing the evolution of skeletal endocrine networks and the role of the skeleton in phosphate and glucose homeostasis.

Despite their association with loss of bone mass and increased fracture risk, glucocorticoids have been an important component of rheumatoid arthritis therapy for more than 60 years. In this article, Ulrike Baschant and colleagues describe the tissue-specific, molecular and cellular mechanisms of glucocorticoid action, and suggest new criteria for selective glucocorticoid receptor agonists, which could have similar anti-inflammatory efficacy to traditional glucocorticoids without the adverse effects.

In this Review, the authors summarize the substantial progress that has been made in understanding the pathophysiology of bone erosions and discuss the improvements in the diagnosis, monitoring and treatment of such lesions.

Noninvasive biomolecular imaging techniques, such as thermography, near-infrared imaging, PET and single photon emission CT (SPECT), can be used to detect the earliest biological and physiological changes that are associated with rheumatoid arthritis (RA). The authors describe these new imaging approaches, which could enable targeted intervention in early RA before the occurrence of irreversible joint damage.

In this Review, the authors discuss issues that surround the diagnosis and differential diagnosis of Behçet syndrome. Current approaches to managing patients with disorders of this complex group are also presented.

In this Review, the authors summarize the latest findings on changes in effector T-cell homeostasis in autoimmune disease and discuss how mechanisms that normally regulate these cells are affected in the inflamed joints of patients with arthritis. The clinical implications of these findings are also described.

Uric acid not only triggers inflammation in gout in its crystallized form, monosodium urate, but is also associated with comorbidities of the disease. New insights into the role of uric acid as a danger signal for both adaptive and innate immune responses could help to explain the pathogenesis of gout and point to potential new avenues of therapy for this and other sterile inflammatory diseases.

In this update on the genetics of hyperuricaemia and gout, the authors describe the associations between common genetic variants, serum uric acid levels and gout as well as the role of these genetic variants in gout pathogenesis. Pharmacogenetic associations betweenHLA-B^*5801and severe allopurinol-hypersensitivity reactions and the potential causal role of urate in cardiovascular disease are also discussed.

Metabolic osteoarthritis (OA) is increasingly recognized as a subtype of OA, and its aetiology has much in common with that of metabolic syndrome (MetS). Indeed, as the authors explain in this Review, mounting evidence suggests that metabolic OA could be considered as the fifth component of MetS. The prospects for treating OA by tackling underlying metabolic disease are also discussed.