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The synovium is the main target tissue of inflammatory arthritides such as rheumatoid arthritis and psoriatic arthritis. In 2019, new technologies for examining the molecular characteristics of specific cell subsets have enabled advances in our understanding of the architecture of synovial lymphoid aggregates, macrophage infiltrates and synovial fibroblast subsets.
The availability of biosimilars to treat inflammatory diseases has generated concern about changing patients from a bio-originator to its biosimilar to save costs. Studies published in 2019 support the effectiveness and safety of ‘nonmedical switching’ and highlight the benefits of communicating information about biosimilars to patients in a positive light.
Dysregulation in the formation and/or clearance of neutrophil extracellular traps (NETs) is important in immune dysregulation and organ damage in chronic inflammatory conditions. Studies in 2019 have shown how certain genetic susceptibilities to autoimmunity can promote NET-mediated inflammation, and expanded the role for NETs in vascular damage and premature atherosclerosis.
Janus kinase (JAK) inhibitors (jakinibs) that target downstream signalling by a large range of cytokines are effective in treating autoimmune and rheumatic diseases. Newer jakinibs that selectively inhibit individual JAKs and a narrower spectrum of cytokines have now been developed, but how do these inhibitors compare with existing drugs?
The Wnt signalling pathway is the target of current anabolic therapies for osteoporosis. Studies in 2018 have revealed more about endogenous control of Wnt-related signalling, including mechanisms of natural Wnt inhibition and new anabolic signalling pathways that could be harnessed to overcome the challenges posed by current therapies.
Systemic lupus erythematosus (SLE), the embodiment of a multi-organ autoimmune disease, results from hyperactivation of host-defence pathways and immune recognition of the most fundamental building blocks of life. In 2018, key advances have placed intestinal immunity and dysregulated expansions of candidate pathobionts at the forefront of SLE pathogenesis.
Cell metabolism has long been at the forefront of tumour biology, but in the past decade the importance of cellular bioenergetics has been increasingly recognized in regulating immune cell function. Mechanistic studies in 2018 have highlighted cell metabolism as a potential therapeutic target for the treatment of rheumatoid arthritis.
In 2018, advances in the treatment of gout flares came in the form of a new nurse-led management approach to serum urate lowering and evidence that allopurinol might have a better cardiovascular safety profile than febuxostat. However, are IL-1β blockers such as canakinumab the future of care for patients with gout?
Multiple scientific fields pertaining to inflammation, including the fields of cardiovascular, infection and cancer research, are increasingly contributing to our understanding of rheumatoid arthritis (RA). In 2017, such research has helped develop our understanding of RA comorbidity, the link between RA pathogenesis and infection, and the effects of new therapies.
Osteoarthritis research in 2017 provided new insights into the long-term effects of intra-articular glucocorticoids, and also led to the approval of a novel, longer-lasting glucocorticoid formulation. New drugs for the treatment of osteoarthritis also emerged this year, including a small-molecule inhibitor of the Wnt signalling pathway.
The rarity, severity and complexity of paediatric rheumatic diseases make progress in treating these diseases a challenge. In 2017, a new series of recommendations for treatment, studies that unravel the complexity of juvenile idiopathic arthritis and clinical trials that tackle sight-threatening uveitis have helped to improve paediatric care.
Tremendous progress has been made in the identification of rheumatoid arthritis (RA) risk factors in 2017. The results of epidemiological studies highlighted dietary and hormonal factors that are associated with slowing the transition from one preclinical phase of RA to another, potentially protecting individuals from developing RA.
A large number of patients with osteoporosis are not receiving appropriate treatment, due in part to concerns regarding drug safety. Great progress has been made to address this crisis in therapy in 2017, including highlighting the patients' views, developing new therapies and treatment strategies and addressing these safety concerns.
Inhibitors of β-nerve growth factor (NGF) have impressive effects in reducing musculoskeletal pain, but have also been associated with adverse events of unclear aetiology. Several studies in the past year have sought to clarify the relative benefits and risks of anti-NGF treatment.
In 2016, there have been several major scientific achievements related to myositis, including the discovery of a novel autoantibody and the relationship between autoantibodies and distinct clinical phenotypes. Advances in the way clinical trials are conducted have also led to breakthroughs in treatment strategies.
Rheumatoid arthritis is associated with an expansion of certain gut commensals, although the underlying mechanism remains unknown. In 2016, studies using experimental models of arthritis have begun to unravel the links between the gut microbiota, T follicular helper cells and arthritis.
Gene expression profiling has been used for the first time to stratify patients with systemic lupus erythematosus (SLE) into potentially useful clinical groups, and also to further understand differences in the cell-specificity and nature of the interferon signature typical of SLE and other autoimmune diseases.
Regenerative medicine can be viewed as 'tissue engineering V2.0'. Discoveries and novel applications of technology advanced the field considerably in 2016, with the use of new biomaterials, stem cells and biologically active molecules.
In 2015, a EULAR task force released evidence-based recommendations on the use of imaging in the clinical management of spondyloarthritis, including psoriatic arthritis. These recommendations, together with articles dealing with tight control strategies and use of the IL-17A inhibitor secukinumab, have consolidated progress in the management of psoriatic arthritis.
