Reviews & Analysis

In this Review, the authors provide an overview of the mechanisms contributing to joint damage in rheumatoid arthritis, particularly the interactions among immune cells, fibroblasts and bone, and discuss how this knowledge could inform the development of novel therapies.

Do you inform patients about risks and chances of success associated with different choices when treatment needs to be changed? This approach takes time and requires patient health literacy. Results from a discrete-choice experiment in scleroderma lung disease add to the debate on shared decision-making.

In this Review, the authors discuss the characterization of distinct synovial tissue macrophage (STM) populations and their functions in the context of the healthy and arthritic joint. They also describe how distinct STMs are specified, how they respond to danger signals and the clinical implications of understanding STM heterogeneity.

In this Review, the authors discuss the latest insights into how autoantibodies and autoreactive B cells relate to the disease process in rheumatoid arthritis, from the development of pre-disease seropositivity to the onset of overt symptoms and the maintenance of disease chronicity.

New research reveals that outcomes for patients with rheumatoid arthritis are affected less by pre-existing comorbid conditions than by socioeconomic factors. Future research should address the mechanisms of this relationship and develop holistic treatment approaches that reduce disparities attributed to socioeconomic status.

Here, the authors propose that more stringent MRI definitions for inflammatory and structural lesions in the sacroiliac joints should be used in randomized controlled trials in non-radiographic axial spondyloarthritis. They argue that such an approach might enhance diagnostic accuracy and thereby increase discrimination between therapies.

Intervertebral disc calcification is an often overlooked phenotype that can have considerable clinical consequences. In this article, the authors aim to raise awareness of intervertebral disc calcification and discuss its implications for the management and prognosis of degenerative spinal changes.

Ubiquitylation is involved in the regulation of most cellular systems, including the innate immune system. Here, the authors describe the molecular pathogenesis of disorders of ubiquitylation that result in innate immune overactivation and systemic autoinflammatory disease.

The new ACR guideline for the treatment of juvenile idiopathic arthritis provides an update on several important topics, including management of oligoarthritis, temporomandibular joint arthritis and systemic-onset arthritis. Overall, the new guideline reflects changes in practice, but also highlights a concerning lack of high-quality evidence.

In this Review, the authors discuss a comprehensive mechanistic concept of psoriatic arthritis, including discussion of the genetic, biomechanical, metabolic and microbial factors that contribute to the development of the disease as well as its manifestations and consequences.

Sphingosine 1-phosphate has essential roles in vascular barrier function, lymphocyte trafficking and differentiation, and inflammatory response in autoimmune rheumatic diseases; modulation of sphingosine 1-phosphate signalling is a potential therapeutic approach in systemic lupus erythematosus, rheumatoid arthritis and systemic sclerosis.

In this Review, the authors discuss how the inflammatory, hypoxic environment of joints in rheumatoid arthritis affects metabolism in fibroblasts, endothelial cells and immune cells. Understanding the competing requirements of these cells can enable effective therapeutic targeting of synovial metabolism.

New classification criteria for antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis endorsed by ACR and EULAR reflect important developments in the field since the 1990 criteria were published, including bringing ANCA testing to the fore.

Endothelial progenitor cells are essential for the maintenance of endothelial function, which in turn is crucial for cardiovascular physiology. The reduced function and numbers of endothelial progenitor cells in individuals with systemic lupus erythematosus could contribute to the excessive cardiovascular disease mortality in this patient population.

New evidence implicates necroptosis in muscle fibre damage in idiopathic inflammatory myopathies, but is it too soon to suggest that interfering with this cell-death pathway could offer a novel therapeutic strategy?

New EULAR recommendations offer useful guidance for improving cardiovascular health in patients with rheumatic and musculoskeletal disease. However, an interdisciplinary model of care is crucial to the optimal management of cardiovascular risk in these patients.

In this Perspective article, the authors discuss the results of the post-marketing ORAL Surveillance study comparing the safety of the JAK inhibitor tofacitinib and TNF inhibition in patients with rheumatoid arthritis, as well as the potential implications for clinical practice.

In this Review, the authors discuss the challenges of multimorbidity, polypharmacy and geriatric syndromes in older patients with inflammatory rheumatic diseases. They note that individually tailored interventions are needed in this patient group in order to preserve patient independence and overall functioning.

The quality of life of patients with diffuse cutaneous systemic sclerosis is greatly affected by progressive painful and itchy skin tightening. Here, Herrick, Assassi and Denton describe skin involvement, the prediction of progression, outcome measures, imaging techniques and best-practice management.

Axial spondyloarthritis, an immune-mediated inflammatory disease, is characterized by chronic back pain, joint stiffness and fatigue that can severely affect the quality of life. This Review summarizes the progress in the pharmacological management of this disease, including newly approved biologic DMARDs.