Osteoporosis epidemiology using international cohorts
Purpose of review The field of osteoporosis research has been active for the past 20 years and has allowed significant advancement in the management of osteoporosis. This review will give an overview of the latest data from international cohorts that relate to current and recent osteoporosis research. Recent findings The clinical diagnosis of osteoporosis relies heavily on bone mineral density (BMD) measured at femoral neck or spine and although BMD has excellent predictive value for future fractures, fracture risk assessment has evolved over the years, resulting in the birth of fracture prediction tools. Fracture ris...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPECIAL COMMENTARY Source Type: research

The management of enthesitis in clinical practice
Purpose of review Enthesitis is a hallmark feature of the spondyloarthropathies (SpA). This review provides an overview of recent insights on diagnosis and management of enthesitis. Recent findings Recent studies support the use of imaging for diagnosis because of its higher sensitivity and specificity compared with clinical examination. Several new MRI and ultrasound scoring systems have been developed for enthesitis, which may facilitate the use of imaging in research. Enthesitis has been evaluated as a primary study outcome mainly in psoriatic arthritis (PsA); however, the use of different indices and definitions o...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Therapeutic drug monitoring in patients on biologics: lessons from gastroenterology
Purpose of review To give an overview on the role of therapeutic drug monitoring (TDM) of biologics in patients with inflammatory bowel disease (IBD). Recent findings Numerous prospective exposure–response relationship studies and post-hoc analyses of randomized controlled trials (RCTs) show a positive correlation between biologic drug concentrations and favorable clinical outcomes in IBD. These studies also demonstrate that higher drug concentrations appear to be needed to achieve more stringent objective therapeutic outcomes. Reactive TDM rationalizes the management of primary nonresponse and secondary loss of...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Physical therapy in axial spondyloarthritis: guidelines, evidence and clinical practice
We present evidence supporting the use of exercise as treatment for patients with axSpA, recent updates among different exercise modalities, and make clear its critical place in the management of this condition. Recent large, multicentre data have shown that high-intensity exercise can improve disease activity and also positively impact cardiovascular risk factors in these patients. Although international treatment guidelines advocate the inclusion of physical activity and exercise for the optimal management of axSpA, specific guidance about the amount of exercise required to produce a beneficial effect is lacking. Summar...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

MRI of the sacroiliac joints: what is and what is not sacroiliitis?
Purpose of review MRI has, as the only imaging modality, the ability to visualize both the inflammatory and destructive aspects of sacroiliitis and is a crucial element in the diagnosis and classification of axial spondyloarthritis (axSpA). However, the MRI appearance of several potential differential diagnoses may resemble axSpA sacroiliitis. Recent findings The appearances of sacroiliac joint (SIJ) MRIs of various diseased and healthy populations have recently been intensively studied. BME, the key requirement in the Assessment of Spondyloarthritis international Society (ASAS) definition of a ‘MRI positive of ...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

The IL-23/IL-17A axis in spondyloarthritis: therapeutics informing pathogenesis?
Purpose of review To give an overview of the recently published trials relating to IL-23/IL-17 pathway in spondyloarthritis (SpA). Recent findings Recent studies in psoriasis confirmed the efficacy of targeting the IL-23/IL-17 pathway, with emerging evidence from head-to-head studies suggesting functional hierarchy of these inhibitors. In psoriatic arthritis (PsA), recent studies have indicated the efficacy of inhibiting IL-23p19, in addition to IL-23p40 and IL-17A, albeit all with lower hurdle results than those seen in psoriasis. The first head-to-head study of an IL-17A and tumour necrosis factor inhibitor in PsA h...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Barrier lymphocytes in spondyloarthritis
Purpose of review The clinical overlap between spondyloarthritis (SpA) and inflammation of barrier tissues such as the intestine and skin indicates a role of barrier tissue immunity in the development of SpA. Herein, we review the recent advances in understanding lymphocyte populations and functions within the intestine and skin implicated in the pathophysiology of SpA. Recent findings A number of unique lymphocyte populations have been identified to be expanded within the gut and skin of patients with SpA, including γδ T cells, mucosa-associated invariant T (MAIT) cells, innate lymphoid cells (ILCs) and T...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Sex differences in disease activity and efficacy of treatment in spondyloarthritis: is body composition the cause?
Purpose of review The body composition and fat distribution is different between men and women, with different levels of circulating adipokines. These differences become more evident when suffering from an inflammatory disease, such as spondyloarthritris. In this review, we will explore the influence of obesity, body composition and adipokines on the differences in disease activity, progression and response to treatment, between men and women with spondyloarthritis. Recent findings Obesity, mainly determined by the body fat content, which is higher in women, is related to worse disease activity scores. Men with higher...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

MHC class I associations beyond HLA-B27: the peptide binding hypothesis of psoriatic arthritis and its implications for disease pathogenesis
Purpose of review To provide an overview of the heterogeneous human leucocyte antigen (HLA) associations of psoriatic arthritis, their relationship to particular clinical features of the disease, and how a hypothesis of binding specific peptides could provide a unifying basis for this heterogeneity. Recent findings There have been substantive advances in understanding the role of HLA molecules in binding self-peptides that select our repertoire of T cells, the specific peptide-binding properties of these HLA allotypes, and their crystallographic structure. These advances provide a means to envision the significance of...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Spondyloarthritis evolution: what is in your history?
Purpose of review This review encompasses a detailed history of spondyloarthritis (SpA) evolution as early as the 17th century, continues on to the current concept of SpA, and ends with current gaps in our understandings of SpA. Recent findings Until the early 1960s, ankylosing spondylitis and other SpA family members were considered to be variants of rheumatoid arthritis (RA). The formal medical community separated them from RA at that time, and shortly thereafter they were recognized to be inter-connected based on shared clinical, laboratory, and imaging features. The last two decades have witnessed the formal disti...
Source: Current Opinion in Rheumatology - May 29, 2020 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Joerg Ermann Source Type: research

Treatment of immune checkpoint inhibitor-induced inflammatory arthritis
Purpose of review This review summarizes the current evidence on treatment strategies for inflammatory arthritis because of cancer treatment with immune checkpoint inhibitors (ICI), prognosis of ICI-induced arthritis, and management of patients with preexisting inflammatory arthritis receiving ICI therapy. Recent findings Inflammatory arthritis is the most common rheumatic immune-related adverse event observed in patients receiving ICI therapy. Most patients can successfully be treated with low doses of corticosteroids or conventional synthetic disease modifying anti-rheumatic drugs (DMARDs). A small minority will dev...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Benefits and promotion of physical activity in rheumatoid arthritis
Purpose of review The aim of this article is to describe the benefits of physical activity and exercise on rheumatoid arthritis disease activity, functioning, and symptoms; and offer recommendations for promotion of physical activity and exercise among people with rheumatoid arthritis. Recent findings In addition to well-known benefits of exercise such as improving cardiovascular health and metabolic syndrome and reducing obesity, exercise has consistently shown rheumatoid arthritis-specific benefits. Exercise and increases in physical activity improve clinically measured disease activity, reduce symptoms such as fati...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Skeletal muscle disease in rheumatoid arthritis: the center of cardiometabolic comorbidities?
Purpose of review Despite its critical roles in body movement, structure, and metabolism, skeletal muscle remains underappreciated in the context of rheumatoid arthritis. In rheumatoid arthritis, chronic inflammation, physical inactivity, and medication toxicities impair skeletal muscle. These skeletal muscle alterations contribute to continued rheumatoid arthritis disparities in physical function and cardiometabolic health. Recent findings In the prebiologic disease-modifying antirheumatic drug era, rheumatoid arthritis skeletal muscle atrophy was the central feature of ‘rheumatoid cachexia,’ a hypermetab...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Preclinical rheumatoid arthritis and rheumatoid arthritis prevention
Purpose of review This review is to provide an update on the current understanding of rheumatoid arthritis (RA) development related to disease development prior to the onset clinically apparent synovitis (i.e. Pre-RA), and opportunities for disease prevention. Recent findings A growing number of studies have demonstrated that serum elevations of autoantibodies rheumatoid factor, antibodies to citrullinated protein/peptide antigens (ACPAs) and antibodies to other posttranslationally modified proteins (e.g. carbamylated proteins) are highly predictive of future development of inflammatory arthritis/RA during a period th...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis
Purpose of review The current review summarizes the current evidence on inhalants other than personal cigarette smoking and risk for developing rheumatoid arthritis (RA). Recent findings Personal cigarette smoking has been implicated as an environmental risk factor for seropositive RA, perhaps by inducing autoimmunity at pulmonary mucosa. Since many patients with RA are nonsmokers, other inhalants are being investigated as potential RA risk factors. Recent case–control and cohort studies have investigated passive cigarette smoking, air pollution, inhalant-related occupations, silica, pesticides, household enviro...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

New galaxies in the universe of shared decision-making and rheumatoid arthritis
Purpose of review Implementing shared decision-making (SDM) is a top international priority to improve care for persons living with rheumatoid arthritis. Using SDM tools, such as decision aids improve patients’ knowledge and support communication with their clinicians on treatment benefits and risks. Despite calls for SDM in treat-to-target, studies demonstrating effective SDM strategies in rheumatology clinical practice are scarce. Our objective was to identify recent and relevant literature on SDM in rheumatoid arthritis. Recent findings We found a burgeoning literature on SDM in rheumatoid arthritis that tack...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Future use of musculoskeletal ultrasonography and magnetic resonance imaging in rheumatoid arthritis
Purpose of review Musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) play important roles in diagnosis, monitoring, and prognostication of rheumatoid arthritis. This review highlights recent literature in this field and aims to provide insight into the future use in clinical practice. Recent findings Recent studies concerning the use of MSUS and MRI in clinical practice show how MSUS and MRI can improve diagnosis and monitoring of rheumatoid arthritis and how they can predict both radiographic progression and clinical outcome (e.g., successful tapering of medical treatment). Moreover, novel te...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Management issues in rheumatoid arthritis-associated interstitial lung disease
Purpose of review Summarize recent evidence on the identification and management of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Recent findings Clinical and subclinical interstitial lung disease (ILD) are frequent extra-articular manifestations of rheumatoid arthritis (RA). Better means of identifying and treating RA-ILD are needed to improve the prognosis, with a median survival of only 3–7 years after diagnosis. Several serum biomarkers are currently being evaluated for their ability to detect RA-ILD. Thorough evaluation and multidisciplinary discussion remains the gold standard for est...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research

Lyme disease: diagnosis and treatment
Purpose of review Lyme disease is an important, vector-borne infection found throughout the temperate Northern hemisphere. The disease causes rash, acute systemic illness, and in some untreated patients, inflammatory arthritis. This review examines the emergence, clinical features and management of early Lyme disease and Lyme arthritis. Recent findings There has been continuing progress in characterizing the clinical manifestations, diagnostic testing and treatment of Lyme disease. Almost all patients with early Lyme disease can be cured with antibiotic treatment. In most cases, Lyme arthritis also responds to antibio...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Antirheumatic medications in pregnancy and breastfeeding
Purpose of review As active rheumatic and musculoskeletal disease during pregnancy increases the risk for pregnancy loss, preterm birth, and maternal illness, ongoing management with pregnancy-compatible medications can improve these outcomes. Selecting and taking these medications can be challenging for rheumatologists and patients due to limited knowledge about potential risks and benefits. Recent findings Fortunately, the American College of Rheumatology, American College of Obstetrics and Gynecology, British Rheumatology Society, and the European League Against Rheumatism have each published recommendations to gui...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Management of systemic sclerosis: the first five years
Purpose of review This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset. Recent findings Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated pulmonary arterial hypertension have improved with combination treatment, in either an upfront or sequential treatment pattern. Traditional therapies for interstitial lung disease (SSc-ILD) have targeted those with clinically significant and progressive ILD with immunosuppression. New data suggest a possib...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Treatment of thrombotic antiphospholipid syndrome in adults and children
Purpose of review Antiphospholipid syndrome (APS), more common than once believed, is an autoimmune disease best known for its high risk of incident and recurrent thrombotic events. The approach to treatment potentially differs from treatment of thrombosis in the general population, and this article endeavors to review the latest updates on this topic. Recent findings The epidemiology of APS is being increasingly elucidated by large population-based studies, with APS perhaps affecting as many as 1 in 2000 individuals. Vitamin K antagonists, aspirin, and heparinoids continue to have obvious roles in the management of p...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Treatment of cutaneous lupus erythematosus: current approaches and future strategies
Purpose of review Cutaneous lupus erythematosus (CLE) is a highly heterogeneous autoimmune disease. No specific Federal Drug Administration-approved therapies for CLE-alone are available, and resistance to conventional treatments is common. This review will summarize current treatment approaches and pending treatment strategies. Recent findings Research into the pathogenesis of CLE is accelerating. A skewed type I interferon production and response contribute to CLE lesions. The pathophysiology of lesions may be similar among the lesional subtypes, and patients with a more TLR9-driven disease mechanism may have more b...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Recent advances in the diagnosis and management of giant cell arteritis
Purpose of review Giant cell arteritis (GCA) has classically been diagnosed by temporal artery biopsy and treated with high-dose, long-term glucocorticoid therapy. Noninvasive imaging increasingly is employed for diagnostic purposes, but further studies are needed to determine the role of imaging in monitoring longitudinal disease activity. Glucocorticoid-sparing therapy mitigates the numerous adverse effects of glucocorticoids. This review addresses new developments in these areas. Recent findings For diagnosis, when performed at a center with expertise in its use, temporal artery ultrasound has an estimated sensitiv...
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - March 28, 2020 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Metabolic control of T cells in autoimmunity
Purpose of review Th1, Th17, and Treg cells play distinct roles in autoimmune diseases, including systemic lupus erythematosus, multiple sclerosis, and rheumatoid arthritis. During the last 5 years we have learned that T-cell metabolism affects cell survival, differentiation and fate of T cells. Recent findings We highlight recent studies which have reported on T-cell metabolism in autoimmune diseases, differences in cellular metabolisms in T-cell subsets among various diseases and transcription factors which control the expression and function of central metabolic enzymes. Summary Distinct metabolic processes cont...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

Metabolic pathways mediate pathogenesis and offer targets for treatment in rheumatic diseases
Purpose of review The cause of autoimmune diseases remains incompletely understood. Here, we highlight recent advances in the role of proinflammatory metabolic pathways in autoimmune disease, including treatment with antioxidants and mechanistic target of rapamycin (mTOR) inhibitors. Recent findings Recent studies show that mTOR pathway activation, glucose utilization, mitochondrial oxidative phosphorylation, and antioxidant defenses play critical roles in the pathogenesis of autoimmune diseases, including rheumatoid arthritis, immune thrombocytopenia, Sjögren's syndrome, large vessel vasculitis, and systemic lup...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

The immunopathogenesis of rheumatic immune adverse events from checkpoint inhibitors: prospects for targeted therapy
Purpose of review The introduction of checkpoint inhibitors as well as other allied advances in cancer immunology has made immunotherapy a pillar in the treatment of cancer. At the same time, these therapies have been associated with a remarkable array of immune-mediated toxicities observed in virtually every organ system, a portion of which are rheumatic in nature or multisystem in expression making them of particular relevance for rheumatologists. Recent findings Most of our knowledge of these immune-related adverse events (irAEs) stems from clinical descriptive reports; we lack detailed understanding on immunopatho...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

Autoimmunity and immunodeficiency
Purpose of review Advances in genomics and animal models of human disease have enabled the discovery of mechanisms important for host immunity and self-tolerance. Here, we summarize conceptual and clinical discoveries identified from 2018 to 2019 in the field of primary immunodeficiencies and autoimmunity. Recent findings Three new primary immunodeficiencies with autoimmunity were identified and the clinical phenotypes of NFKB1 haploinsufficiency and RASGRP1 deficiency were expanded. A diversity of novel mechanisms leading to autoimmunity associated with primary immunodeficiencies (PIDs) was reported, including pathwa...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

The metabolic signature of T cells in rheumatoid arthritis
Purpose of review Rheumatoid arthritis (RA) is a prototypic autoimmune disease manifesting as chronic inflammation of the synovium and leading to acceleration of cardiovascular disease and shortening of life expectancy. The basic defect causing autoimmunity has remained elusive, but recent insights have challenged the notion that autoantigen is the core driver. Recent findings Emerging data have added metabolic cues involved in the proper maintenance and activation of immune cells as pathogenic regulators. Specifically, studies have unveiled metabolic pathways that enforce T cell fate decisions promoting tissue inflam...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

Advances in the diagnosis, pathogenesis and treatment of neuropsychiatric systemic lupus erythematosus
Purpose of review Diagnosing and treating neuropsychiatric systemic lupus erythematosus (NPSLE) remains challenging as the pathogenesis is still being debated. In this review, we discuss studies evaluating recent advances in diagnostic methods, pathogenic mediators and potential treatments. Recent findings Screening tools used for neurodegenerative diseases were found to be both sensitive and moderately specific for cognitive dysfunction in NPSLE. Neuroimaging can be used to distinguish systemic lupus erythematosus (SLE) patients from healthy controls, but further refinement is needed to differentiate between lupus pa...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

Immune mechanisms of fibrosis and inflammation in IgG4-related disease
Purpose of review To summarize recent advances in the understanding of the pathogenesis of IgG4-related disease. Recent findings Limited data exist to explain genetic susceptibility to IgG4-related disease and the underlying triggers for this disease have not yet been identified. Cytotoxic CD4+ T cells and activated B cells infiltrate affected organs and express proinflammatory and profibrotic molecules. Antigen presented by activated B cells likely reactivates cytotoxic CD4+ T cells in disease tissues and these T cells in turn induce the targeted apoptotic death of host cells in certain organs – which presumabl...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research

Progresses in the imaging of calcium pyrophosphate crystal disease
Purpose of review Calcium pyrophosphate crystal disease (CPPD) may be considered a neglected disorder, common in clinics and wards, but not receiving enough attention since the time it was recognized as a disease entity. This review aims to highlight the advances occurred in recent years in terms of imaging of CPPD, and their potential aid in diagnosing CPPD. Recent findings The main advances in CPPD imaging have occurred with ultrasound and computed tomography. Ultrasound has been shown as more sensitive than conventional radiography in detecting chondrocalcinosis. OMERACT definitions of ultrasound signs of CPPD have...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: CRYSTAL DEPOSITION DISEASES: Edited by Sara K. Tedeschi Source Type: research

Debates in gout management
Purpose of review This review discusses the findings of recently published translational research studies that have the potential to directly impact on the management of gout patients. Recent findings Recent research suggests that treat-to-target urate-lowering treatment (ULT) alongside individualized education about gout, and shared decision making results in excellent adherence with ULT and prevents gout flares in the long term. Such interventions should preferentially be delivered face-to-face rather than remotely. The recently published CARES study raises the possibility that febuxostat increases the risk of death...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: CRYSTAL DEPOSITION DISEASES: Edited by Sara K. Tedeschi Source Type: research

Comorbidities in gout and hyperuricemia: causality or epiphenomena?
Purpose of review To review advances in the understanding of potentially causal relationships between gout, hyperuricemia and comorbidities. Recent findings Observational studies reveal 4–5 comorbidity clusters in gout patients. There tend to be gout alone, gout with chronic kidney disease and gout with other metabolic comorbidities. However, heterogeneous study populations and confounding make inference difficult for causal relationships. Mendelian randomization leverages genetic information as an instrumental variable to indicate putatively causal relationships between traits of epidemiological interest. Thus ...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: EPIDEMIOLOGY AND HEALTH-RELATED SERVICES: Edited by Kenneth G. Saag Source Type: research

Rural health issues in rheumatology: a review
Purpose of review Early access to rheumatology is imperative to achieve appropriate outcomes in rheumatologic diseases. But there seems to be a significant gap and disparity in the access to rheumatology care between urban and rural areas. This review was undertaken to analyze this issue. Recent findings A significant delay in diagnosis of rheumatic disorder has been correlated to the travel distance to rheumatologist. It is also clear that currently, a significant rheumatology workforce shortage exists and is projected to worsen significantly, thereby making this gap and disparity much bigger. Summary The scope of...
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: EPIDEMIOLOGY AND HEALTH-RELATED SERVICES: Edited by Kenneth G. Saag Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - January 29, 2020 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Unpicking observational relationships between hip shape and osteoarthritis: hype or hope?
Purpose of review To review recent findings concerning the observational relationship between hip shape and hip osteoarthritis (HOA) and their shared genetic influences, and the potential for clinical application. Recent findings Recent observational studies have strengthened the evidence that specific shape deformities, such as cam and acetabular dysplasia, are related to HOA. Statistical shape modelling has emerged as a method to measure hip shape holistically, with the added advantage that this can be applied to dual X-ray absorptiometry scan images. This has led to several additional aspects of hip shape variation...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: OSTEOARTHRITIS: Edited by Mukundan Attur Source Type: research

Current status of functional MRI of osteoarthritis for diagnosis and prognosis
Purpose of review Osteoarthritis is a major source of disability, pain and socioeconomic cost worldwide. The epidemiology of the disorder is multifactorial including genetic, biological and biomechanical components, some of them detectable by MRI. This review provides the most recent update on MRI biomarkers which can provide functional information of the joint structures for diagnosis, prognosis and treatment response monitoring in osteoarthritis trials. Recent findings Compositional or functional MRI can provide clinicians with valuable information on glycosaminoglycan content (chemical exchange saturation transfer,...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: OSTEOARTHRITIS: Edited by Mukundan Attur Source Type: research

The gut microbiome-joint connection: implications in osteoarthritis
Purpose of review Osteoarthritis is a debilitating disease leading to joint degeneration, inflammation, pain, and disability. Despite efforts to develop a disease modifying treatment, the only accepted and available clinical approaches involve palliation. Although many factors contribute to the development of osteoarthritis, the gut microbiome has recently emerged as an important pathogenic factor in osteoarthritis initiation and progression. This review examines the literature to date regarding the link between the gut microbiome and osteoarthritis. Recent findings Studies showing correlations between serum levels of...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: OSTEOARTHRITIS: Edited by Mukundan Attur Source Type: research

Understanding osteoarthritis pathogenesis: a multiomics system-based approach
Purpose of review Osteoarthritis is a heterogeneous, multifactorial condition regulated by complex biological interactions at multiple levels. Comprehensive understanding of these regulatory interactions is required to develop feasible advances to improve patient outcomes. Improvements in technology have made extensive genomic, transcriptomic, epigenomic, proteomic, and metabolomic profiling possible. This review summarizes findings over the past 20 months related to omics technologies in osteoarthritis and examines how using a multiomics approach is necessary for advancing our understanding of osteoarthritis as a diseas...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: OSTEOARTHRITIS: Edited by Mukundan Attur Source Type: research

Asymptomatic hyperuricemia: is it really asymptomatic?
Purpose of review Hyperuricemia is highly prevalent, affecting approximately 38 million individuals in the United States. However, the significance of asymptomatic hyperuricemia – hyperuricemia in the absence of gout – continues to be debated. Recent findings Asymptomatic hyperuricemia results in monosodium urate crystal deposition in tissues, which may promote chronic inflammation. Intracellularly, hyperuricemia inhibits the master regulator adenosine monophosphate (AMP)-associated protein kinase and may condition innate immune responses through durable epigenetic modifications. At the population level, a...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: MEDICAL PHYSIOLOGY AND RHEUMATIC DISEASES: Edited by Jose U. Scher Source Type: research

Deadliest catch: neutrophil extracellular traps in autoimmunity
Purpose of review To summarize recent evidence on the pathogenic effects of neutrophils and neutrophil extracellular traps (NETs) in autoimmune diseases, including systemic lupus erythematosus and rheumatoid arthritis. Recent findings NETs can orchestrate innate and adaptive immune dysregulation through diverse mechanisms. NETs induce potent inflammatory responses and represent sources of many autoantigens, creating a feed-forward loop that may perpetuate disease and lead to organ damage. NETs are also increasingly relevant in atherosclerosis and could contribute to the increased risk of premature cardiovascular disea...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: MEDICAL PHYSIOLOGY AND RHEUMATIC DISEASES: Edited by Jose U. Scher Source Type: research

Evolving concepts of the pathogenesis of rheumatoid arthritis with focus on the early and late stages
Purpose of review To provide an overview of recently published work covering key mechanisms involved in the pathogenesis of rheumatoid arthritis (RA), with focus on the early and late stages. Recent findings Present understanding of RA pathogenesis has been mainly focused on the inflammatory process at the established phase of the disease, but recent work has shed light on important molecular and cellular mechanisms involved both at the early and late/refractory stages. In early RA, the involvement of anticitrullinated protein antibodies in RA induction has been identified with a critical role of the IL-23/Th17 axis i...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: MEDICAL PHYSIOLOGY AND RHEUMATIC DISEASES: Edited by Jose U. Scher Source Type: research

Immune checkpoint inhibitors and vasculitis
Purpose of review Clinical use of immune checkpoint inhibitor (ICI) therapy has revolutionized the therapeutic landscape of cancer. By activating the immune system using monoclonal anti-CTLA-4 and PD(L)-1 antibodies, remission can be induced in previously terminal cancers. However, these breakthroughs come at a price. Multiple de-novo autoimmune illnesses, termed immune-related adverse events (irAEs), have been reported with patients increasingly being referred to rheumatologists with varying diagnoses. Among these are vasculitic syndromes, which may be limited to an organ or systemic and potentially-life threatening. Re...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research

Vasculitis and the ear: a literature review
This article reviews the recent literature about vasculitis of the ear or the cochleovestibular system, focusing on giant-cell arteritis, Takayasu's arteritis, polyarteritis nodosa, Kawasaki disease, microscopic polyangiitis, granulomatosis with polyangiitis (GPA), eosinophilic GPA, systemic lupus erythematosus, Cogan's syndrome and Behçet's disease. Recent findings In patients with vasculitis, hearing impairment is a frequent problem, followed by tinnitus and vertigo. The severity of sensorineural hearing loss can range from mild impairment to deafness. Autoimmune diseases can induce a conductive hearing loss as...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research

Central nervous system vasculitis: advances in diagnosis
Purpose of review The main purpose of this review is to present advances in diagnostics of central nervous system vasculitis (CNS-V). Recent findings Progress in molecular technologies and neuroimaging have added formidably to our knowledge of CNS-V. Next-generation sequencing has the promise to enhance our ability to diagnose, interrogate, and track infectious diseases, making this test attractive and capable of avoiding brain biopsy in cases where CNS infections are suspected. Further the continuum of neuroimaging progress has advanced our ability to diagnose CNS-V. Our capability to visualize the vessel wall have a...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research

Management of Behçet syndrome
Purpose of review New treatment options have been studied over the last several years, with a recent approval, a first for Behçet syndrome, in the United States. New management guidelines have also been published, helping with this nowadays more commonly recognized condition's management. The goal of this review is to summarize the most important and potentially clinically relevant recent developments and discuss their impact in the management of patients with Behçet syndrome. Recent findings Apremilast is now approved for the treatment of oral ulcer of Behçet syndrome in the United States. It's p...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research

Venous involvement in inflammatory disorders
Purpose of review To review the association of venous thrombosis and inflammatory disorders. Recent findings Various systemic inflammatory diseases of which Behçet's syndrome is the prototype are associated with an increased risk of venous thrombosis. Recent data indicate that venous wall thickness is increased among Behçet's syndrome patients with no history of venous thrombosis and thrombosis in Behçet's syndrome could be a unique model of inflammation-induced thrombosis. Patients with inflammatory bowel disease (IBD) have a two to three time-fold increased risk of developing thromboembolic comp...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research

Common and rare forms of vasculitis associated with Sjögren's syndrome
Purpose of review Although uncommon, systemic vasculitis is one of the most severe extraglandular manifestations of primary Sjögren's syndrome (pSS) accounting for the increased morbidity and mortality of the disease. This review aims to describe major previous and recent reports regarding the clinical presentation, prognosis and treatment of systemic vasculitis associated with pSS. Recent findings Both older and recent pSS cohort studies performed over the past several and recent years, have clearly shown that cryoglobulinaemic vasculitis is the most frequent type of systemic vasculitis accompanying pSS. Antineu...
Source: Current Opinion in Rheumatology - November 29, 2019 Category: Rheumatology Tags: VASCULITIS SYNDROMES: Edited by Hasan Yazici and Yusuf Yazici Source Type: research