Reviews & Analysis

A working group including authors of the latest OARSI and ESCEO recommendations for the management of knee osteoarthritis and independent experts compare and contrast these guidelines, and provide insights into their differences that could help inform application of the recommendations.

The association of immune-mediated necrotizing myopathy (IMNM) with myositis-specific autoantibodies has led to the classification of three subclasses of IMNM and provided insight into the pathogenesis of, and treatment options for, these inflammatory myopathies.

In this Review, the authors discuss how new approaches, including imaging, tissue analysis and omics technologies, could be applied to identify patients with a poor prognosis and to predict response to treatment, thus enabling precision medicine and improving outcomes in psoriatic disease.

Fibromyalgia is a complex and common condition characterized by chronic widespread pain and numerous other symptoms. This Review outlines different clinical aspects of fibromyalgia, including the burden, diagnosis and treatment of this condition, and discusses various hypotheses of fibromyalgia etiopathogenesis.

The effects of sex steroids (oestrogens, androgens and progesterone) on immune responses contribute to the sex bias in autoimmune rheumatic diseases in complex ways. Targeting these effects could hold potential for treating patients with autoimmune rheumatic diseases.

Cardiac toxicity can be induced by hydroxychloroquine, especially when used in combination with azithromycin. Interest in hydroxychloroquine and azithromycin as potential therapies for COVID-19 has renewed concerns about the possible cardiovascular risk these drugs present to patients with rheumatoid arthritis.

Gender disparities persist in many aspects of working life for women in academic rheumatology. To move forward, we must find ways to address the gender gap in rheumatology with the goal of creating a workforce as diverse as the patient population it serves.

Over the past few years, considerable advances have been made in understanding the pathogenesis of IgG4-related disease. Our increased knowledge of the important roles of B cells and T cells is now starting to make its way into the clinic.

Comorbidities are highly prevalent in patients with rheumatoid arthritis (RA), yet clinical care for such patients is often of inferior quality, even in rheumatology clinics. Suggestions for good clinical practice interventions from an expert panel aim to improve the quality of care for patients with RA who have associated comorbidities.

In this article, the authors discuss how the use of innovative clinical trial designs could facilitate the efficient evaluation of new and existing drugs in specific subgroups of patients, in order to optimize therapy allocation and address unmet clinical needs.

Antinuclear antibodies (ANAs), characteristic features of systemic lupus erythematosus (SLE), are a requirement for disease classification and trial enrolment. In this Review, the authors re-examine the role of ANAs in SLE and discuss changing attitudes towards using ANAs as biomarkers.

Fibroblast growth factor signalling pathways have crucial roles in the development and maintenance of healthy cartilage. In this Review, the authors discuss strategies for targeting these pathways in osteoarthritis and cartilage repair.

Suboptimal medication adherence, a major problem among individuals with systemic lupus erythematosus, is often more pronounced among minority racial groups. As the roots of racial disparities in treatment adherence are beginning to be untangled, the need for multidisciplinary, multilevel approaches to tackle this complex problem is emerging.

Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are heterogeneous, interrelated diseases. This Review outlines current evidence on the monitoring and long-term management of patients with GCA and PMR, including the tapering of treatment and the handling of complications.

The DNA methylation profile of various cells types are altered in autoimmune rheumatic diseases. Particular DNA methylation profiles are associated with the prognosis, subtype, progression and/or treatment responses of various rheumatic diseases and hence have potential as clinical biomarkers.

Pain in osteoarthritis is multifactorial, but a disconnect between radiographic features and symptoms hampers our understanding of pain. New imaging data suggest that pain arises from virtually all structures in the joint and that cartilage loss is only a minor contributor to pain symptoms but is important for disease progression.

A subset of patients with coronavirus disease 19 (COVID-19) develop a thrombotic disorder that resembles a virally induced, complement-mediated thrombotic microangiopathy. Here, the authors present the theory and evidence for this disease model and discuss important considerations for treatment.

Exactly how nucleic acids trigger type I interferon responses via certain Toll-like receptors has been uncertain. Now, a new pathway involving gene products previously linked to systemic lupus erythematosus but not known to interact has been unravelled, which could be of relevance to the female sex bias in this disease.

Digital health technologies (DHTs) have a variety of interesting current and possible future applications in rheumatology. In this article, the authors describe some of the key barriers that prevent DHT integration into rheumatology care and discuss ways in which these barriers could be addressed.

Early diagnosis of immune-mediated arthropathies is important for early and effective treatment, but often relies on clinical expertise. Can the use of a new genetic risk score help rule out and prioritize certain diagnoses? And does this score add any clinical utility to current clinical diagnostic pathways?