Reviews & Analysis

Single-cell proteomic techniques that use elemental (heavy metal) reporter ions increase the number of parameters that can be studied at once in whole tissues. This Review discusses the practical aspects of using such technologies in rheumatic disease research.

Use of prescription opioids is prevalent in patients with rheumatic diseases. Studies in 2019 reported the trends and safety of opioids in patients with rheumatoid arthritis or osteoarthritis. Treating underlying disease processes must be the rheumatologists’ priority. Without better long-term safety and effectiveness data, opioid use should be generally limited.

The synovium is the main target tissue of inflammatory arthritides such as rheumatoid arthritis and psoriatic arthritis. In 2019, new technologies for examining the molecular characteristics of specific cell subsets have enabled advances in our understanding of the architecture of synovial lymphoid aggregates, macrophage infiltrates and synovial fibroblast subsets.

The availability of biosimilars to treat inflammatory diseases has generated concern about changing patients from a bio-originator to its biosimilar to save costs. Studies published in 2019 support the effectiveness and safety of ‘nonmedical switching’ and highlight the benefits of communicating information about biosimilars to patients in a positive light.

Dysregulation in the formation and/or clearance of neutrophil extracellular traps (NETs) is important in immune dysregulation and organ damage in chronic inflammatory conditions. Studies in 2019 have shown how certain genetic susceptibilities to autoimmunity can promote NET-mediated inflammation, and expanded the role for NETs in vascular damage and premature atherosclerosis.

Repurposing of drugs for and among rheumatic autoimmune inflammatory diseases can introduce promising new treatments. New knowledge about these diseases and the development of data-driven techniques are identifying new pathways and targets for repurposing.

Asymptomatic hyperuricaemia precedes and potentially contributes to the development of gout and other chronic diseases. This review summarizes what is known about the effects of uric acid on pro-inflammatory responses.

Behavioural economics uses psychological and economical insights to explain decision making by individuals to understand the predictable way in which individuals behave irrationally. Concepts from this field can be applied to promote healthy behaviours and could be applicable to rheumatology.

Myofibroblasts are important mediators of wound healing but can also perpetuate fibrosis in diseases such as systemic sclerosis by evading apoptosis. Therapeutic targeting of the survival mechanisms used by these cells in fibrotic disease holds promise for the reversal of fibrosis.

B cells can assume protective or pathogenic roles in immune-mediated diseases (IMDs). Analysis of the B cell receptor (BCR) repertoires in six IMDs provides insights into the diversity of B cell repertoires across diseases as well as into potential pathological mechanisms and the effects of different treatments.

NSAIDs are first line therapy for patients with axial spondyloarthritis and are recommended to be taken continuously in patients with active disease, but their ability to affect radiographic disease progression has been uncertain. Does a new meta-analysis shed light on this matter, or is it too soon to tell?

A number of core pathways and mechanisms of fibrosis, outlined in this Review, are shared across different tissues and might therefore present targets for general antifibrotic strategies. Organ-specific and disease-specific differences in fibrotic diseases could also provide insights for drug development efforts.

Chemokines have an important function in the recruitment and positioning of immune cells, and multiple chemokines are implicated in various rheumatic diseases. Blocking the chemokine system has therapeutic promise for the treatment of these diseases but requires further optimization.

The 2019 ACR–SAA–SPARTAN treatment recommendations for axial spondyloarthritis incorporate useful advice on new therapies, treatment strategy and the use of imaging. But is it appropriate to still recommend different treatment strategies for non-radiographic and radiographic disease when available evidence suggests they are part of the same clinical spectrum?

A machine learning model to predict whether patients with rheumatoid arthritis will respond to TNF inhibitors has been produced following an international crowd-sourced competition, but is the mixture of clinical and omics biomarkers used in this model optimal for clinical use?

This Review outlines several genetic and epigenetic mechanisms that could explain sex bias in rheumatic diseases, including X chromosome inactivation, sex chromosome aneuploidy and microchimerism, considering evidence from clinical and experimental studies.

Palindromic rheumatism has similarities with rheumatoid arthritis (RA) and its prodromes but also has distinct features. This Review explores the concept of palindromic rheumatism as part of the RA continuum and outlines an updated paradigm for this unique syndrome.

Different imaging modalities, such as radiography, MRI and CT, have different advantages and can help the clinician with different aspects in assessing axial spondyloarthritis (axSpA). This Review covers imaging aspects relating to the diagnosis, classification and management of axSpA.

Therapies targeting IL-23 have failed in clinical trials in axial spondyloarthritis (axSpA), despite the importance of the IL-23–IL-17 pathway in axSpA pathogenesis. This Review explores whether IL-17 production might be uncoupled from IL-23 in axSpA.

Autologous haematopoietic stem cell transplantation (HSCT) can be an effective treatment for refractory autoimmune diseases. With reports of the use of allogeneic HSCT emerging, how do these two very different types of stem cell transplantation compare and is allogeneic HSCT advisable?