Biologics in the treatment of Sjogren's syndrome, systemic lupus erythematosus, and lupus nephritis
Purpose of review It is an understatement to say that drug approvals in systemic lupus erythematosus (SLE), lupus nephritis, and Sjogren's syndrome have lagged far behind those in other autoimmune diseases, such as rheumatoid arthritis and psoriatic arthritis. Reasons for this are multiple and include the molecular and clinical heterogeneity of these conditions; confounding by background medications, especially corticosteroids; and clinical trial endpoints. However, the tides are changing, and there have been several bright spots in our attempts to bring more efficacious drugs to our patients. Recent findings Several ...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

Biologic therapies for systemic lupus erythematosus: where are we now?
Purpose of review Conventional approaches using hydroxychloroquine, corticosteroids and immunosuppressives have improved the prognosis for systemic lupus erythematosus (SLE) patients. Unfortunately, they have reached the limits of what they can achieve and patients still die prematurely and/or find their quality of life greatly impaired. Here, we discuss the problems of assessing activity in SLE, optimizing clinical trial design and more recent biologic approaches. Recent findings The success of B-cell depletion using Rituximab in open clinical studies, the approval of Belimumab (blocks the B-cell activating factor BA...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

New classification criteria for systemic lupus erythematosus
Purpose of review To compare the recently published European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) classification criteria for SLE with the Systemic Lupus International Collaborating Centers (SLICC) criteria and the earlier ACR criteria, focusing on their key concepts. Recent findings Although the SLICC criteria introduced numbers of new criteria items, the new EULAR/ACR criteria added only noninfectious fever, based on an early SLE cohort study and an SLE patient survey, and condensed hematological, mucocutaneous and neurological items. Whereas the SLICC criteria maintained the over...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

Cutaneous and systemic connections in lupus
Purpose of review Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multiple manifestations, with a majority of SLE patients having cutaneous involvement. Despite ongoing research, the relationship between SLE and cutaneous lupus erythematosus (CLE) pathogeneses remains unknown. This review will compare advances in understanding the cause and pathogenesis of SLE and CLE. Recent findings Recently, mechanisms by which immune cell populations contribute to the pathogenesis of SLE and CLE have been queried. Studies have pointed to transitional B cells and B-cell activating factor (BAFF) signaling as...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

Update on antimalarials and systemic lupus erythematosus
Purpose of review The purpose of this review is highlighting the most recent evidence on the clinical efficacy and toxicity of antimalarials in systemic lupus erythematosus (SLE). Recent findings New data confirm the effects of antimalarials in preventing SLE activity, damage and infections and in decreasing mortality. An important reduction in use of health resources is related to continued antimalarial use. Hydroxychloroquine (HCQ) may prevent preeclampsia in pregnant women with SLE. HCQ ocular toxicity is infrequent and could be associated with blood levels. Gastrointestinal and skin toxicity are underrecognized an...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

Immunometabolism in the pathogenesis of systemic lupus erythematosus: an update
Purpose of review To provide an update on state-of-the-art evidence on the role of immunometabolism reprogramming in the pathogenesis of systemic lupus erythematosus (SLE). Recent findings Mitochondrial dysfunction and enhanced oxidative stress, along with specific defects in other metabolic pathways, can promote dysregulation of innate and adaptive immune responses in SLE. These abnormalities appear to be driven by genetic and epigenetic factors, modulated by stochastic events. In addition to extensive descriptions of abnormalities in immunometabolism of lupus lymphocytes, recent studies support the critical role of ...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: SYSTEMIC LUPUS ERYTHEMATOSUS AND SJOGREN SYNDROME: Edited by Mariana J. Kaplan Source Type: research

Monitoring disease activity and damage in adult and juvenile idiopathic inflammatory myopathy
Purpose of review We have reviewed the literature to identify significant advances related to disease activity and damage in the idiopathic inflammatory myopathies (IIMs) from January 2019 to July 2020. Recent findings New observations in the field from 2019 to 2020 have resulted in a better understanding of the clinical association and pathogenic origins of IIM. The use of patient-reported outcome measures and perspectives, identifying biomarkers and making better use of autoantibody testing are summarized. Basic sciences have led to an improved understanding of the role of NETosis in calcinosis, and of interferon ty...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Myositis autoantibodies: recent perspectives
Purpose of review To provide an overview of recent discoveries related to myositis-specific autoantibodies (MSAs) and assays used for their measurement. Recent findings New autoantibody specificities have been reported including a MSA directed against eukaryotic initiation factor 3 and a myositis-associated autoantibody directed against heat shock factor 1. The association of anti-TIF1γ with cancer-associated dermatomyositis dependent on age has been confirmed in several large cohorts. Despite MSAs being almost entirely mutually exclusive, several myositis autoantigens are overexpressed in regenerating muscle an...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Pathogenesis of inclusion body myositis
Purpose of review To review the pathogenesis of inclusion body myositis (IBM). Recent findings IBM is an autoimmune disease. Multiple arms of the immune system are activated, but a direct attack on muscle fibers by highly differentiated T cells drives muscle destruction. Summary Further understanding of the pathogenesis of IBM guides rational approaches to developing therapeutic strategies. (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Cytokines and inflammatory mediators as promising markers of polymyositis/dermatomyositis
Purpose of review Idiopathic inflammatory myopathies (IIMs), known also as myositis, represent challenging group of heterogeneous muscle disorders characterized by symmetric proximal muscle weakness and evidence of muscle inflammation. The purpose of this review is to provide important updates on cytokines and inflammatory mediators related to myositis. Recent findings In the past 5 years, multiple studies brought a fresh insight into the pathogenesis of myositis by introducing new factors or further characterizing the role of the well established mediators in myositis. Among the mediators reviewed in this article, sp...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Cardiac involvement in inflammatory myopathies and inherited muscle diseases
Purpose of review To examine recent developments relating to cardiac involvement in the adult idiopathic inflammatory myopathies (IIM) and those inherited muscle diseases which may present in adulthood and mimic IIM. Recent findings Cardiac involvement is a common feature of IIM and inherited muscle diseases. Frequency according to disease subtype varies, with serotype having particular influence in IIM, and genotype in the inherited muscle diseases. Innovative techniques for examining cardiac function have been investigated further, including speckle-tracking echocardiography and cardiac magnetic resonance tomography...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Up-to-date treatment and management of myositis
Purpose of review Myositis, or idiopathic inflammatory myopathy, is an overarching concept that includes dermatomyositis, polymyositis, immune-mediated necrotizing myopathy and the antisynthetase syndrome. Glucocorticoids are still considered the mainstay of treatment of myositis but some patients require add-on immunosuppressive therapy because of insufficient response to glucocorticoids, relapses when glucocorticoids are tapered, or because they incur glucocorticoid-related side effects. Recent findings The goal of this article was to review (PubMed search from January 2019 through June 2020) the efficacy and safety...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Nonimmune mechanisms in idiopathic inflammatory myopathies
Purpose of review This review encompasses the main novelties regarding nonimmune mechanisms implicated in the pathogenesis of idiopathic inflammatory myopathies (IIM). Recent findings In recent years, growing data support a role for endoplasmic-reticulum (ER) stress as a propagator of muscular damage, together with the release of interferon type I and reactive oxygen species in hypoxemic muscle fibers. Other studies evaluating the relationship between autophagy and Toll-like receptors (TLRs) in IIM subtypes have shown increased TLR3 and TLR4 expression in fibers of IIM patients and colocalization with LC3, an autophag...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: MYOSITIS AND MYOPATHIES: Edited by Andrea Doria, Anna Ghirardello and Mariele Gatto Source Type: research

Systemic sclerosis pathogenesis: contribution of recent advances in genetics
Purpose of review To review susceptibility genes and how they could integrate in systemic sclerosis (SSc) pathophysiology providing insight and perspectives for innovative therapies. Recent findings SSc is a rare disease characterized by vasculopathy, dysregulated immunity and fibrosis. Genome-Wide association studies and ImmunoChip studies performed in recent years revealed associated genetic variants mainly localized in noncoding regions and mostly affecting the immune system of SSc patients. Gene variants were described in innate immunity (IRF5, IRF7 and TLR2), T and B cells activation (CD247, TNFAIP3, STAT4 and BL...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

Detection, screening, and classification of interstitial lung disease in patients with systemic sclerosis
Purpose of review Interstitial lung disease (ILD) associates with disease burden and reduced life expectancy in systemic sclerosis (SSc). As ILD afflicts around 50% of SSc patients and is often present from early on, there is rationale for early and universal ILD screening. With the approval of the first SSc-ILD therapy last year, there is an increasing need for ILD classifications to assign the right treatment to the right patient. Here, we discuss recent advances on screening, detection, and classification of SSc-ILD. Recent findings Although prospective datasets from a nationwide population-based SSc cohort confirm...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

The NADase enzyme CD38: an emerging pharmacological target for systemic sclerosis, systemic lupus erythematosus and rheumatoid arthritis
Purpose of review Here we review recent literature on the emerging role of nicotinamide adenine dinucleotide (NAD+) metabolism and its dysfunction via the enzyme CD38 in the pathogenesis of rheumatologic diseases. We evaluate the potential of targeting CD38 to ameliorate NAD+-related metabolic imbalance and tissue dysfunction in the treatment of systemic sclerosis (SSc), systemic lupus erythematous (SLE), and rheumatoid arthritis (RA). Recent findings In this review, we will discuss emerging basic, preclinical, and human data that point to the novel role of CD38 in dysregulated NAD+-homeostasis in SSc, SLE, and RA. In...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

Cancer and scleroderma: recent insights
Purpose of review As survival in systemic sclerosis (SSc) improves, research interest has shifted to the leading cause of non-SSc-related death, namely cancer, which accounts for over a third of non-SSc-related deaths. This review will provide an overview of the recent insights into the evolving relationship between SSc and cancer. Recent findings Recent studies confirm the increased risk of cancer in SSc compared with the general population (standardized incidence ratio 1.9–2.2) in particular the risk of breast, lung and skin cancer. This increased cancer risk, particularly occurring in close proximity to SSc o...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

Calcinosis: insights from other calcinoses
Purpose of review This review examines the current knowledge and recent developments in the field of vascular calcification focusing on the emerging role of senescence and inflammation in driving this disorder and exploring the overlap and relevance of these pathways to calcinosis in rheumatic disease. Recent findings Vascular calcification is an age-associated disorder. Recent studies have identified DNA damage, cellular senescence and consequent inflammation as key drivers of vascular smooth muscle cell osteogenic change and mineralization. Similar ageing and inflammatory factors are associated with calcinosis in rh...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

Novel classifications for systemic sclerosis: challenging historical subsets to unlock new doors
Purpose of review Systemic sclerosis (SSc) is a severe rheumatic disease characterized by a considerable heterogeneity in clinical presentations and pathophysiological mechanisms. This variability has a substantial impact on morbidity and mortality and limits the generalizability of clinical trial results. This review aims to highlight recent studies that have proposed new innovative approaches to decipher this heterogeneity, in particular, by attempting to optimize disease classification. Recent findings The historical dichotomy limited/diffuse subsets based on cutaneous involvement has been challenged by studies hig...
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: RAYNAUD PHENOMENON, SCLERODERMA, OVERLAP SYNDROMES AND OTHER FIBROSING SYNDROMES: Edited by John Varga Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - October 5, 2020 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Severe acute respiratory syndrome coronavirus 2, original antigenic sin, and antibody-dependent enhancement: ménage à trois
Background Shortly after its emergence in December 2019, the coronavirus disease 2019 (COVID-19) was declared as a pandemic by the World Health Organization. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the seventh member of the Coronaviridae family of viruses that causes disease in humans. The problem Despite the established role of molecular diagnostics, COVID-19 serodiagnosis remains a poorly discovered and enigmatic area. Although there are numerous commercial serological products available globally, there is a severe paucity of high-quality peer-reviewed literature on their true performance ch...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

Role for antimalarials in the management of COVID-19
Purpose of review The current review highlights recent insights into direct antiviral effects by antimalarials against severe acute respiratory syndrome (SARS)-CoV-2 and other viruses and their potential indirect effects on the host by avoiding exaggerated immune responses (reduced cytokine release, Toll-like receptor response, antigen presentation related to lysosomal processing). Recent findings Currently, there is a large debate on the use of antimalarials for prophylaxis and treatment of SARS-CoV-2-induced disease based on preclinical in-vitro data, small case series and extrapolation from earlier studies of their...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

Tracking clinical resources for coronavirus disease 2019
Purpose of review Assimilating and disseminating information during the novel coronavirus disease 2019 (COVID-19) has been challenging. The purpose of this review is to identify specific threats to the validity of the COVID-19 literature and to recommend resources for practicing rheumatologists and their patients. Recent findings The COVID-19 literature has rapidly expanded and includes 17 998 publications through May of 2020, 1543 of which also address rheumatic disease-related topics. Specific obstacles to acquiring high-quality information have arisen, including ‘pandemic research exceptionalism’ and ...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

Epidemiology and outcomes of novel coronavirus 2019 in patients with immune-mediated inflammatory diseases
This article analyzes peer-reviewed research on the epidemiology and outcomes of COVID-19 in those with IMID. Recent findings Published literature on approximately 1400 patients was included from rheumatology, gastroenterology, and dermatology. Data suggest that those who are older and have comorbidities have poorer outcomes. This is consistent with the reports from the general population of patients with COVID-19. Adjusted analyses from the largest published studies demonstrate independent effects of systemic glucocorticoids, as well as age and comorbidities with poorer COVID-19 outcomes (SECURE-IBD registry, n = 5...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

COVID-19: a primer for the rheumatologist: management of patients and care settings
Purpose of review There are currently many unanswered questions surrounding the management of patients with immune-mediated inflammatory diseases during the COVID-19 pandemic and several ‘rapid’ guidelines have been released, although are subject to be updated and changed in the near future. The purpose of this review is to discuss the approach to management of patients with immune-mediated diseases during the COVID-19 pandemic. Recent findings At present, there is little evidence to suggest an increased risk of COVID-19 infection or its complications in patients with immune-mediated diseases or associated...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

Editorial: Reflections on rheumatological aspects of COVID-19
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: RHEUMATOLOGICAL ASPECTS OF COVID-19: Edited by Leonard H. Calabrese and Cassandra Calabrese Source Type: research

Comparing children and adults with chronic nonbacterial osteomyelitis
Purpose of review To describe the main clinical differences of children and adults with chronic nonbacterial osteomyelitis (CNO). Recent findings CNO is a severe systemic autoinflammatory syndrome characterized by multiple bone lesions because of inflammatory osteitis. Delay to diagnosis of CNO can lead to functional impairment, fractures, and chronic pain. Key clinical aspects and disease patterns differ in children and adults, including onset and time to diagnosis, symptom localization, associated comorbidities (i.e. skin, joints), bone lesion distribution pattern, and treatment approach. Novel biomarkers, such as u...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Tackling global challenges in pediatric rheumatology
Purpose of the review To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. Recent findings Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of hea...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Update on the treatment of nonsystemic juvenile idiopathic arthritis including treatment-to-target: is (drug-free) inactive disease already possible?
Purpose of review This review concerns the outcome for nonsystemic juvenile idiopathic arthritis (JIA) with emphasis on treatment-to-target (T2T) and treatment strategies aiming at inactive disease by giving an overview of recent articles. Recent findings More efficacious therapies and treatment strategies/T2T with inactive disease as target, have improved the outcome for JIA significantly. Recent studies regarding treatment strategies have shown 47–68% inactive disease after 1 year. Moreover, probability of attaining inactive disease at least once in the first year seems even higher in recent cohort-studies, re...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Update on noninfectious uveitis in children and its treatment
We describe the most important reports in this field that may help to tailor the screening and monitoring of this population in the future and might become the target of novel therapies. The advances in the biologic therapy of paediatric uveitis, thanks to evidence provided by the SYCAMORE, ADJUVITE and APTITUDE trials, offer new possibilities for the treatment of patients who fail methotrexate with adalimumab and tocilizumab. We discuss the importance of comprehensive outcome measures as proposed by the Multinational Interdisciplinary Working Group for Uveitis in Childhood (MIWGUC). Summary Paediatric noninfectious uve...
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - August 2, 2020 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

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