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A meta-epidemiological study has revealed that the inclusion of small studies in meta-analyses of osteoarthritis interventions could lead to an overestimation of the benefit of these interventions. Does this mean meta-analyses should be restricted to trials with large sample sizes?
Clinical trials demonstrate that intensive treatment of early rheumatoid arthritis with a combination of DMARDs improves short-term outcomes. An extension study from a pivotal trial has now shown that such intensive early therapy can achieve a reduction in the rate of erosive progression over a period of 11 years.
Therapeutic strategies are in development that aim to use TREG cells in autoimmune diseases. The feasibility of such an approach is challenged, however, by recent findings suggesting that the chronic phase of autoimmune inflammation might not be controlled by these cells. What impact could this study have on the development of TREG cell-based therapies for human diseases?
Bacterial infection is known to trigger a number of autoimmune disorders, an observation that indicates a potentially important role for antibiotics in treating these diseases. Indeed, results from an experimental model of autoimmune arthritis in mice suggest that antibiotics can prevent the onset of disease.
Immunosuppression has been associated with viral reactivation in patients with chronic viral infections. A prospective study has concluded that it is safe to use anti-tumor-necrosis-factor agents in patients with chronic hepatitis B virus infection receiving antiviral prophylaxis. Is there sufficient evidence to back up this conclusion?
MRI has emerged as an important tool for the assessment of rheumatoid arthritis, and in research has had a clear impact on how the disease process is understood. In this Perspectives article, the authors consider the role of MRI in the evaluation of rheumatoid arthritis, including pathogenesis, diagnosis and outcomes of therapy, and examine the issues that surround the use of MRI in clinical and research settings.
In the second of two Perspectives articles regarding the use of MRI to detect inflammatory lesions in early preclinical axial spondyloarthritis, van der Heijde et al. defend the inclusion of MRI sacroiliitis in the 2009 ASAS classification criteria and acknowledge the importance of expert opinion in the diagnosis of this disease.
In the first of two Perspectives articles regarding the use of MRI to detect inflammatory lesions in early preclinical axial spondyloarthritis, De Rycke and colleagues question the diagnostic value of this technique, citing inconsistencies and selection bias in a number of validation studies.
Moving beyond the view of osteoarthritis as a disease of the cartilage, evidence is emerging that synovial inflammation is an important factor in the pathophysiology of the disease. In this article, Sellam and Berenbaum review that evidence, present various methods of assessing synovitis, and discuss the possibility of synovitis-targeted therapy for the treatment of osteoarthritis.
ANCA-associated vasculitides (AAV) involve inflammation and fibrinoid necrosis of the vessel wall. This Review highlights advances in our understanding of the cells and molecules that contribute to AAV pathogenesis and discusses new developments in the treatment of these diseases.
Strategies to reduce the immunogenicity that occurs following treatment with most biologic agents are a growing subject of investigation. A novel approach to induce tolerance to a therapeutic monoclonal antibody, alemtuzumab, has yielded promising results.
Patients over the age of 50 have an increased risk of mortality following hip fracture, which is dependent on factors such as health and post-fracture comorbidities. Findings from a meta-analysis highlight the need to improve fracture management through systematic approaches that will also reduce mortality.
Psoriasis is only observed in humans; however, characteristics of the disease, such as prominent epidermal hyperplasia and a distinct inflammatory infiltrate, have been studied in mouse models of psoriasis. In this Review, the authors highlight the mouse models that have contributed to the discovery of novel disease-relevant pathways.
Many factors can influence the safety and effectiveness of biologic therapies for rheumatoid arthritis (RA) and, as outlined in this Review, the unique genetic, environmental and medical backgrounds of Japanese individuals could affect how they respond to biologic agents. This article describes the biologic agents used in Japan and the extensive post-marketing surveillance data for all patients with RA treated with biologic agents in Japan, which include the drug-related adverse events that have been documented.
Knowledge of the role of regulatory B (BREG) cells in immune suppression and autoimmunity has improved. In this Review, the authors describe the advances in the study of BREG cells, detailing the known BREG cell subsets and the ontogeny and development of these cells. The authors also highlight the role of BREGcells in human health and disease and their potential use as a therapy for a wide range of rheumatic diseases.
Antibodies to citrullinated enolase define a subset of rheumatoid arthritis (RA) associated with smoking and DR4 alleles. In this Perspectives article, the authors review epidemiological and genetic links between periodontitis (a disease in whichPorphyromonas gingivalis is a major pathogen) and RA and propose that that the association might be causal, due to molecular mimicry between epitopes on host and P. gingivaliscitrullinated enolases driving the autoimmune response.
Cyclo-oxygenase (COX) inhibitors relieve musculoskeletal pain by blocking the activity of COX enzymes that regulate prostaglandin production. In this Review, the authors discuss the pharmacokinetics of widely used COX inhibitors and suggest strategies to optimize their analgesic effects and minimize adverse drug reactions.
Although the benefits of exercise for individuals with fibromyalgia are well known, it can be difficult for individuals to begin or maintain an exercise regimen. A recent trial examined whether defining “exercise” as increases in regular home-based physical activities might improve exercise compliance.
A key component of Paget disease of bone is a localized increase in osteoclastic activity, which might be attributable, in part, to mutations in the sequestosome 1 gene. A study has identified three new genes that regulate osteoclasts and are implicated in Paget disease; however, the clinical utility of these findings remains questionable.
Both etanercept and ustekinumab have been shown to be strikingly effective in patients with psoriasis. A phase III trial comparing these two biologic agents for the treatment of moderate-to-severe psoriasis found that ustekinumab was superior to high-dose etanercept over a 12-week period; however, several questions remain to be addressed.
