Reviews & Analysis

The ACR has published an update to its guideline on gout management, which was mostly based on the results of randomized controlled trials (RCTs). Although rigorous, the methodology used for these recommendations can be called into questioned given the lack of robust data from RCTs on all aspects of gout.

In this article, the authors summarize the latest clinical and basic research on gut inflammation in spondyloarthritis and highlight important questions to address in future research.

Various core and adjunctive therapies are available for osteoarthritis (OA) that can have beneficial effects on the well-being of the individual; however, challenges remain in implementing best-evidence, high-value care.

Various types of programmed cell death, including necroptosis, pyroptosis, NETosis and apoptosis, contribute to acute and chronic inflammation, and dysregulation of these pathways is implicated in rheumatic diseases. Understanding the mechanisms and overlap between cell death pathways might lead to new therapies.

Biomarkers help in the diagnosis and monitoring of disease, but robust biomarkers can be difficult to discover and validate. This Review explores the state of biomarker discovery for axial spondyloarthritis and suggests future developments to advance this field.

Researchers have developed an in silico (computer) platform that couples tissue adaptation with cellular and molecular interactions to simulate bone adaptation to mechanical loading and progress and treatment of metabolic bone diseases. What is the benefit of such in silico tools, and how can credibility of the simulation outcomes be established?

This Perspective article explores similarities in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID-19, as well as the effect of the COVID-19 pandemic on rheumatology.

Gout is a chronic crystal deposition disorder in which sustained hyperuricaemia leads to formation and deposition of monosodium urate crystals in the joints. The prevalence and incidence of gout are increasing globally, which may be related to changes in the prevalence of gout risk factors (such as obesity) and comorbidities.

Rheumatologists lack guidance on how to manage the reproductive health of their patients, and communication to patients on reproductive health issues is an unmet need. New guidelines from the ACR provide support in the counselling of both female and male patients on the different aspects of their reproductive life.

Results from phase II randomized controlled trials (RCTs) determine whether promising therapeutics will progress to phase III. According to detailed analyses in rheumatoid arthritis and psoriatic arthritis, phase II efficacy data systematically overestimate subsequent phase III results, raising the question of how this discrepancy might be addressed in future RCTs.

The COVID-19 pandemic has catalysed the sudden adoption of telemedicine in the management of rheumatic diseases. In this abrupt transition from in-person visits to telemedicine, can patient-reported outcomes (PROs) help ensure that we continue to achieve optimum disease control and address the concerns of people living with rheumatoid arthritis?

Emerging reports show that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection precedes the appearance of various autoimmune and autoinflammatory diseases, including paediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), thus adding to the growing mystery of this virus and raising questions about the nature of its link with autoimmune and autoinflammatory sequelae.

Atherosclerotic cardiovascular disease is a major cause of morbidity and mortality in patients with rheumatoid arthritis. In this Review, Semb and colleagues outline atherosclerotic cardiovascular disease risk management and prevention for patients with rheumatoid arthritis.

This Review outlines the pathophysiology of Kawasaki disease and discusses the progress gained from experimental mouse models and their potential therapeutic translation to human disease.

Fibroblast-like synoviocytes in rheumatoid arthritis have an aggressive phenotype caused, in part, by epigenetic imprinting, which contributes to various pathological processes. Understanding the mechanisms underlying the cell abnormalities and phenotypes, including their spatial and temporal differences, could lead to new therapies.

The heterogeneity of systemic lupus erythematosus (SLE) confounds the diagnosis and treatment of this disease, and attempts at disease stratification are nascent. Researchers have identified a common set of biomarkers in patients with SLE that could identify new therapeutic targets and lead to new clinical assays to help address this issue.

Peptidylarginine deiminases (PADs) citrullinate proteins, thereby creating the targets of the autoimmune response in rheumatoid arthritis; yet, in some individuals, PADs themselves can be the targets of immune responses. The mechanisms behind this complex relationship are unravelled in this Review.

In this Perspective article, the authors recount the earliest stages of translational research into IL-6 biology and the subsequent development of therapeutic IL-6 pathway inhibitors for the treatment of autoimmune rheumatic diseases and potentially numerous other indications.

Baseline immune variation predicts immune responses during vaccination, and the gene signatures capturing such immune variation seem to correlate with systemic lupus erythematosus (SLE) disease activity. Will the definition of these gene sets enable the development of the much needed concept of personalized medicine in SLE?

Emerging data on the interactions between epigenetic mechanisms and genetic risk loci are providing insights into the underlying mechanisms of osteoarthritis that could identify novel and exploitable therapeutic targets