Reviews & Analysis

Changes in the gut microbiome are thought to be important environmental triggers for inflammatory forms of arthritis, including rheumatoid arthritis. Could interactions between gut parasites, such as helminths, and gut microbiota be the key to normalizing an unbalanced microbiome and preventing arthritis?

Establishing suitable outcome measures is an important goal for the classification and monitoring of patients with early knee osteoarthritis. This Perspectives article highlights various outcome measures that have potential use in clinical and/or research settings for early knee osteoarthritis.

The pleiotropic cytokine macrophage migration inhibitory factor (MIF) is involved in the pathogenesis of autoimmune inflammatory disorders. This Review discusses MIF biology and signalling, its mechanisms of action and its involvement in rheumatic diseases, including opportunities for targeted therapies.

Pregnancy can affect the underlying disease and vice versa, and drug therapy may need to be altered before, during and after pregnancy. With careful planning, monitoring and treatment, most women with inflammatory rheumatic diseases can have successful pregnancies.

A series of successive failures of new therapies for systemic lupus erythematosus (SLE) in clinical trials has left clinicians with limited options to treat this disease. Could any of the therapies currently in development offer hope for patients with SLE?

Studies across multiple autoimmune diseases, including rheumatoid arthritis and coeliac disease, have identified a pathologically expanded PD1^hiCXCR5⁻CD4⁺ T cell population that accumulates in inflamed tissues. Can this peripheral T helper cell population be harnessed as a predictive biomarker or targeted therapeutically in these diseases?

Hyperuricaemia is a risk factor for gout, and mouse models of this condition can help dissect the underlying regulatory mechanisms. However, these models come with both advantages and disadvantages, and interpreting and comparing data from these models can be challenging.

The HLA region is strongly associated with many rheumatic diseases, including inflammatory arthritis. In this Review, potential mechanisms underpinning these associations are discussed, as are the clinical implications of HLA associations for the diagnosis and treatment of these diseases.

¹⁸F-FDG-PET is not currently recommended for use in the diagnosis of cranial giant cell arteritis (GCA). A new study has compared ¹⁸F-FDG-PET with temporal artery biopsy and clinical diagnosis as gold standards, but is ¹⁸F-FDG-PET accurate enough to be used on temporal arteries?

Pain management is presently the focus of osteoarthritis (OA) therapy, but traditional pain-relieving drugs such as NSAIDs and glucocorticoids have limited utility. In this Review, the next generation of OA analgesics and their potential mechanisms of action are discussed.

Single-cell sequencing technologies enable transcriptomic, epigenomic and proteomic analysis of rare or heterogeneous populations of cells. In this Review, Kuo and colleagues discuss current and future uses of single-cell sequencing technologies for rheumatology research.

Inclusion body myositis (IBM) and polymyositis can normally be distinguished on the basis of clinical features. However, patients with an atypical disease presentation, particularly those with early-stage disease, can be challenging to diagnose. Can imaging with amyloid-PET help distinguish these two diseases?

The use of NSAIDs in rheumatology could be improved by an appropriate risk scoring system that accounts for adverse events such as bleeding and thrombosis. Such a risk score has now been developed using data from the PRECISION trial, but is this score ready to be applied in clinical practice?

Antibodies against phosphatidylserine–prothrombin complexes (PS–PT) are one type of antiphospholipid antibody that is responsible for lupus anticoagulant activity. Anti-PS–PT antibodies are not currently included in the classification criteria for antiphospholipid syndrome (APS), but should they replace lupus anticoagulant testing to improve the diagnosis of APS?

Next-generation sequencing (NGS) technologies are being developed at a rapid pace. This Review highlights advances in our understanding of rheumatic diseases that have been gained from NGS and offers guidance to rheumatology researchers using these technologies.

B cells contribute to the pathogenesis of many rheumatic diseases. Targeting immune checkpoints that control the activation and effector function of B cells represents a promising therapeutic avenue.

Myeloid cells come in many shapes and sizes and are central to inflammatory processes. This Review puts myeloid cells and their inflammatory functions into the context of fibrosis and their contribution to pathology in systemic sclerosis.

Osteoarthritis occurs spontaneously in pet dogs, which often share environmental and lifestyle risk-factors with their owners. This Review aims to stimulate cooperation between medical and veterinary research under the One Medicine initiative to improve the welfare of dogs and humans.

Sensing of cytosolic DNA by cyclic GMP–AMP synthase (cGAS) is central to the pathogenesis of a number of autoinflammatory syndromes and possibly some autoimmune diseases, such as systemic lupus erythematosus (SLE). Activation of cGAS signalling requires its deacetylation, so might aspirin have therapeutic potential to treat SLE by acetylating cGAS?

The molecular mechanisms responsible for initiation and progression of osteoarthritis (OA) are incompletely understood. New data implicate cholesterol, its metabolites and the receptor RORα as catabolic drivers of OA-like disease in mice, but do these data identify new targets for treating patients with OA?