Reviews & Analysis

Knee arthroscopy, the most common orthopaedic procedure, is used to treat middle-aged or elderly patients with knee pain, with over two million patients undergoing this surgery every year worldwide. A new clinical practice guideline advises against the use of arthroscopy in these patients, contradicting the common use of this procedure in clinical practice.

Visual loss is a major concern for patients with giant cell arteritis (GCA). In this Review, the authors discuss visual loss and other ischaemic events in GCA, its epidemiology, associated risk factors, clinical presentation and current therapeutic approaches.

Rheumatic diseases can affect sexual health, which can sometimes be overlooked by health professionals. In this Review, the author discusses the effect of rheumatic diseases and anti-rheumatic drugs on a patients' fertility and sexual functioning, and highlights how this knowledge should improve the managing and counselling of patients with rheumatic disease.

The optimal definition of clinical remission in juvenile idiopathic arthritis is still uncertain. A new study has found that the current criteria for clinically inactive disease do not always identify the same group of patients. Why is there such a discrepancy? And which approach to defining remission is the most advantageous?

Early, targeted treatment improves the outcome of rheumatoid arthritis, reducing disease-associated disability and mortality. Until now, it was unknown whether these beneficial effects extended beyond 10 years following initial therapy. Could these effects persist even after 20 years?

Patient-reported outcomes are important predictors of morbidity and mortality. The validity and reliability of the Patient Reported Outcomes Measurement Information System (PROMIS) computerized adaptive tests (CATs) has been assessed in patients with systemic lupus erythematosus, but does PROMIS deliver on its promise?

A newly identified insertion–deletion variant of the B cell activating factor (BAFF)-encoding TNFSF13B gene leads to increased levels of soluble BAFF and is associated with the development of systemic lupus erythematosus. The discovery raises a number of compelling questions for further investigation.

In this Review, the authors summarize the different types of pain experienced by patients with ankylosing spondylitis, the underlying neurobiology and studies that are providing insights into the complex interplay between the immune system and neural pain-processing pathways.

Specific patterns of joint and organ involvement exist in different rheumatic diseases. Ospelt and Frank-Bertoncelj delve into the reasons behind these patterns, and what they mean for future research into rheumatic disease pathogenesis.

In this review, the authors discuss the role of IL-6 in the defence against infection, outlining insight gained from both preclinical and clinical studies, and examining the effects of IL-6-targeting therapies on immunocompetence and its clinical implications.

The field of rheumatology has seen remarkable progress in the past 70 years. This Perspectives article provides a concise overview of developments in the diagnosis and management of musculoskeletal rheumatic diseases, and what the future of rheumatology might hold.

The theory of Mendelian inheritance states that half our genes are maternal and half are paternal. This view is incomplete, as maternal–fetal exchange creates a legacy of non-native cells within an individual that can affect their health for better or worse, including contributing to their risk of developing autoimmune disease.

The highly anticipated NOR-SWITCH trial results provide valuable information for patients and physicians concerned about the effects of switching between a biologic agent and a biosimilar product. However, the possibility of frequent switches, potentially involving more than one biosimilar, raises more questions.

Pain in osteoarthritis (OA) can be resistant to the medical and surgical treatments currently in use. Local denervation of the arthritic joint could offer a new approach to relieve OA pain, if the results of a new cryoneurolysis clinical trial are confirmed.

The need to accurately assess the effectiveness of biologic therapies for rheumatoid arthritis in real-world settings has seen an explosion in nationwide biologics registers. In this Perspectives article, the authors discuss how to make the most of data from such registers.

This Review discusses the major insights gained from genetic studies in rheumatic diseases, such as genome-wide association studies, meta-analyses, fine-mapping and studies performed across different diseases and/or ethnicities, which have vastly increased our understanding of these diseases.

When considering the role of imaging in the management of symptomatic, peripheral joint osteoarthritis (OA) in clinical practice, clinicians should be aware that radiography has its drawbacks, and also consider that the use of advanced imaging techniques such as MRI should not be discouraged.

The presence of antinuclear antibodies (ANAs) is an important criterion for the classification of autoimmune diseases such as systemic lupus erythematosus, but the specificity of ANA tests is controversial. This Perspectives article critically discusses the methods used in ANA testing for different diseases, as well as ways to improve the use of these assays in clinical and research settings.

A growing body of evidence supports a shift away from bed rest and inactivity to prescribing physical activity for children and adolescents with rheumatic diseases. Increasing physical activity levels, as well as reducing hypoactivity, can improve symptoms and outcomes in this paediatric population.

The changing microbial and clinical profile of reactive arthritis suggests that rheumatologists need to reconsider the approach to its identification and treatment.