Impact of infections in autoimmune rheumatic diseases and pregnancy
Purpose of review To provide an update about the impact of infections in autoimmune rheumatic diseases (ARDs), from the analysis of the role of infections in pregnant women without ARDs, to the identification of maternal–fetal infections and their role in the maternal–fetal outcome of women with ARDs. Recent findings Recent studies indicate that patients with ARDs and pregnancy are also susceptible to presenting infections of varying degrees, including serious infections, which contribute to the morbidity and mortality observed in pregnancy and postpartum of these patients. Any type of infectious agent wi...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Periodontal bacteria and the rheumatoid arthritis-related antigen RA-A47: the cross-reactivity potential
Purpose of review The purpose of this review is to evaluate the mechanisms that underlie the association between periodontal pathogens and rheumatoid arthritis (RA). Recent findings This review focuses on the cross-reactivity hypothesis as a mechanism that might contribute to explain the pathologic evolution of periodontal infections from periodontitis to RA. The scientific rationale is that immune reactions following infection by periodontal bacteria might cross-react with RA autoantigens, in this way eventually leading to autoimmunity. Summary Using the rheumatoid antigen associated with RA-A47 arthritis as an an...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Complement, infection, and autoimmunity
Purpose of review Complement system dysfunction in terms of upregulation, downregulation, or dysregulation can create an imbalance of both host defense and inflammatory response leading to autoimmunity. In this review, we aimed at describing the role of complement system in host defense to inflection and in autoimmunity starting from the evidence from primary and secondary complement system deficiencies. Recent findings Complement system has a determinant role in defense against infections: deficiencies of complement components are associated with increased susceptibility to infections. Primary complement system defic...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Infections as triggers of flares in systemic autoimmune diseases: novel innate immunity mechanisms
This article reviews the recent scientific literature in this regard and highlights the key issues needing investigation. Recent findings Thanks to its high specificity mediated by pattern recognition receptors, the IIR is not called unspecific anymore. The discovery of these increasingly accurate recognizing molecular mechanisms has also evidenced their involvement in breaking self-immune tolerance and to maintain chronic inflammation in autoimmune responses. Neutrophil extracellular traps (NETS) as the main source of antinuclear antibodies; the ‘neutrophils-pDC activation loop’ theory; and the Th1/Th2/Th17...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Porphyromonas gingivalis and rheumatoid arthritis
Purpose of review To explore the pathogenic association between periodontal disease and rheumatoid arthritis focusing on the role of Porphyromonas gingivalis. Recent findings In the last decades our knowledge about the pathogenesis of rheumatoid arthritis substantially changed. Several evidences demonstrated that the initial production of autoantibodies is not localized in the joint, rather in other immunological-active sites. A central role seems to be played by periodontal disease, in particular because of the ability of P. gingivalis to induce citrullination, the posttranslational modification leading to the produc...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Osteoarticular manifestations of Mayaro virus infection
Purpose of review To carry out an update on the state of the art of the Mayaro virus (MAYV) infection and its osteoarticular implications. Recent findings There is a wide distribution of MAYV in Latin America and documented exported cases to the United States and Europe. Although osteoarticular involvement is not the most frequent, it is one the most associated with disability. The main mechanisms related to arthropathy involves cellular infiltrates (i.e. macrophages, natural killer cells, lymphocytes) together with production of cytokines, such as IL-6, IL-7, IL8, IL-12p70. Summary MAYV infection is an emerging di...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

The dark side of Sjögren's syndrome: the possible pathogenic role of infections
Purpose of review To highlight recent findings on pathogenic mechanisms and clinical associations which characterize the role of infectious agents as triggers for Sjögren's syndrome development. Recent findings Several candidate infectious agents have been identified to induce the autoimmune and inflammatory pathways leading to Sjögren's syndrome clinical appearance in the setting of a genetic background. This is reinforced by the demonstration that Sjögren's syndrome patients are characterized by higher prevalence of seropositivity to virus and bacterial agents in comparison with general population. Mo...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

The dilemma of treating hepatitis C virus-associated cryoglobulinemia
Purpose of review The present review focuses on the new therapeutic opportunities offered by the combination of biological drugs, mainly Rituximab, with direct-acting antiviral agents (DAAs). Recent findings Hepatitis C virus (HCV) is known to be the etiologic agent in the majority of patients with mixed cryoglobulinemia syndrome. Clinical research has been focused on antiviral drugs and, more recently, on the new, highly potent DAAs. New DAAs assure sustained virologic response (SVR) rates greater than 90% with relief of mild-to-moderate symptoms. Summary Mixed cryoglobulinemia may present with multiorgan vasculit...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

The association between hepatitis B, hepatitis C and systemic sclerosis: a cross-sectional study
Purpose of review To investigate the association between systemic sclerosis (SSc) to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) carriage. We utilized the database of Clalit Health Services, the largest healthcare organization in Israel and performed a cross-sectional study. Recent findings The study included 2431 SSc patients and 12 710 age-and-sex matched controls, HBV was found in 38 SSc patients (1.56%) and 64 controls (0.5%). HCV was found in 30 SSc patients (1.23%) and 83 controls (0.65%). In multivariable logistic regression model, HBV was found to be associated with smoking, dialysis treatmen...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

From hepatitis C virus immunoproteomics to rheumatology via cross-reactivity in one table
Purpose of review To give an overview of molecular and immunologic data that link hepatitis C virus (HCV) infection to rheumatic diseases in the human host. Recent findings A high level of peptide sharing exists between immunopositive HCV epitopes and human proteins that, when altered, associate with rheumatic manifestations. Summary The findings suggest the involvement of HCV infection in the induction of most rheumatic diseases via a mechanism of autoimmune cross-reactivity. (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Zika autoimmunity and Guillain–Barré syndrome
Purpose of review To summarize the recent data regarding Guillain–Barré syndrome (GBS) as an autoimmune disorder following infection with Zika virus (ZIKV) infection, including the proposed pathogenic mechanisms and the role of autoantibodies. Recent findings The loss of self-tolerance that leads to autoimmune diseases is a multifactorial process that may be illustrated as ‘the mosaic of autoimmunity’. Infectious agents may contribute to the development of autoimmunity by several proposed mechanisms. One of the central mechanisms is molecular mimicry, which is also the most plausible mechanism...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

The role of Epstein–Barr virus infection in primary Sjögren's syndrome
Purpose of review The purpose of this article is to draw attention to the role of Epstein–Barr virus (EBV) virus in the pathogenesis of the primary Sjögren's syndrome. The article introduces the problem of consequences of EBV acute infection, and its reactivation, in association with the immune response modulation by the virus and with an increased risk of developing systemic autoimmune diseases and EBV-associated cancers. Recent findings The knowledge about the mechanisms by which the virus may stay for years in a latent phase, unrecognized by the host response immune cells is constantly expanding. There a...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Microbiome and autoimmune diseases: cause and effect relationship
Purpose of review The human body is the host of trillions of different prokaryotic microorganisms that colonize the skin and the mucosae. The interaction between human cells and these organisms is mediated by the immune system, sustaining a very complex and fragile balance. The immune cells need to prevent uncontrolled growth of pathogenic microbes and promote tolerance toward the existence of the beneficial ones. Growing evidence associates the disruption of this symbiotic relationship with the development of autoimmune diseases. Recent findings Human studies led to the identification of gut dysbiosis patterns in pat...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: INFECTIONS AND ENVIRONMENTAL ASPECTS OF AUTOIMMUNITY: Edited by Yehuda Shoenfeld Source Type: research

Update on the treatment and outcome of systemic lupus erythematous in children
Purpose of review Provide an update of studies published in last 2 years on the outcomes and therapies in childhood-onset systemic lupus erythematous (cSLE). Recent findings Additional evidence has been provided about the benefits of universal hydroxychloroquine in SLE patients, although antimalarial maculopathy may be more prevalent than previously thought. Recent studies support lower glucocorticoid doses than used in the past may provide comparable therapeutic benefits, and cSLE patients can mount adequate immunogenic response and sustain long-term seroprotective titers when vaccinated. Long-term studies of adults ...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

The role of epigenetics in paediatric rheumatic disease
Purpose of review Autoimmune/inflammatory disorders can be stratified along a spectrum based on the primary involvement of innate vs. adaptive mechanisms. Stratifying patients based on molecular mechanisms rather than clinical phenotypes may allow for target-directed and individualized treatment. Recent findings Epigenetic events are gene regulatory mechanisms that contribute to inflammation across inflammatory diseases and resemble shared mechanisms that may be used as disease biomarkers and treatment targets. Significant progress has been made dissecting the epigenome in paediatric rheumatic diseases and identifies ...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer?
Purpose of review To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use. Recent findings High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound fi...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Treatment of juvenile idiopathic arthritis: what's new?
Purpose of review The present review highlights the advances in disease outcome achieved with currently available biologic medications and future perspectives for JIA management. Recent findings In the last two decades, the management of juvenile idiopathic arthritis (JIA) has been revolutionized by appropriate legislative initiatives, the existence of very large collaborative networks and the increased availability of the novel biologic medications. Summary A more rational approach to the management of JIA is being fostered by the recent publication of therapeutic recommendations, consensus treatment plans and for...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Interleukin-18 in pediatric rheumatic diseases
Purpose of review IL-18 is a pleiotropic cytokine involved in the regulation of innate and adaptive immune responses. IL-18 pro-inflammatory activities are finely regulated in vivo by the inhibitory effects of the soluble IL-18-binding protein (IL-18BP). The elevation of circulating levels of IL-18 has been described in children with systemic juvenile idiopathic arthritis (sJIA). In the recent years, the role of IL-18 in the pathogenesis of secondary haemophagocytic lymphohistiocytosis (sHLH), also referred to as macrophage activation syndrome (MAS), in the context of autoinflammatory diseases, including sJIA, is emergin...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Cutaneous manifestations of pediatric lupus
Purpose of review To review recent evidence on cutaneous manifestations of lupus, with a focus on evidence for pediatric patients. Recent findings Cutaneous manifestations of SLE are common and may precede signs or symptoms of systemic disease. Early recognition and initiation of therapy improves quality of life by reducing cutaneous disease activity. Antimalarials are first line for moderate-to-severe disease. Photo protection is a critical component of therapy and perhaps the only modifiable risk factor for SLE. Recognition of cutaneous vasculopathy may reduce mortality from vascular occlusion. Summary There is a...
Source: Current Opinion in Rheumatology - July 31, 2019 Category: Rheumatology Tags: PEDIATRIC AND HERITABLE DISORDERS: Edited by Polly J. Ferguson Source Type: research

Implications of juvenile idiopathic arthritis genetic risk variants for disease pathogenesis and classification
Purpose of review We assess the implications of recent advances in the genetics of juvenile idiopathic arthritis (JIA) for the evolving understanding of inflammatory arthritis in children. Recent findings JIA exhibits prominent genetic associations with the human leukocyte antigen (HLA) region, extending perhaps surprisingly even to the hyperinflammatory systemic JIA category. Some HLA associations resemble those for adult-onset inflammatory arthritides, providing evidence for pathogenic continuity across the age spectrum. Genome-wide association studies have defined an increasing number of JIA-linked non-HLA loci, ma...
Source: Current Opinion in Rheumatology - July 31, 2019 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 - July 31, 2019 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Renal insufficiency and bone loss
Purpose of review Patients with chronic kidney disease have a high risk of fractures and no established treatments that have been shown to prevent the bone disease. The physiology of renal osteodystrophy is complex and recently more factors have been found that complicate the mineral metabolism. The recognition that vascular calcifications are related to bone disease has made treatment even more challenging. Recent findings The most exciting new findings relate to the signaling pathways that are seen in kidney disease and how they cause abnormalities in bone physiology. In particular, wnt and activin signaling pathway...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research

Glucocorticoid-induced osteoporosis update
Purpose of review Steroid-induced osteoporosis or glucocorticoid-induced osteoporosis (GIOP) is a common form of secondary osteoporosis and is a cause of increased morbidity and mortality. The pathogenesis of GIOP includes decreased bone formation and increased bone resorption. Clinicians can rely on several effective medications for the treatment and prevention of GIOP, including antiresorptive drugs (i.e. bisphosphonates) and bone anabolic drugs (i.e. teriparatide). Recent findings Recent studies have further highlighted that GIOP is a major public health concern and have provided new insights on the pathogenesis of...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research

Update on hypoparathyroidism
Purpose of review Hypoparathyroidism is a rare endocrine disorder characterized by low or insufficient parathyroid hormone (PTH) concentrations leading to hypocalcemia, hyperphosphatemia, and markedly reduced bone turnover. Despite being a rare disease, hypoparathyroidism has a profound impact on affected patients. Recent findings Recent epidemiologic surveys demonstrate a prevalence of between 5.3 and 40/100 000, confirming the orphan status of this disease. There is a female predominance, and anterior neck surgery is the most common etiology. Recent studies have better elucidated the chronic manifestations of the ...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research

The evolving role of anabolic therapy in the treatment of osteoporosis
Purpose of review Many physicians have long considered anabolic osteoporosis medication to be the last resort for patients after multiple fractures have already occurred. Thinking is evolving toward the view that anabolic agents should be used more proactively earlier in patients who are at high risk for fracture. Recent findings Recent data suggest that the three anabolic agents, teriparatide, abaloparatide and romosozumab, reduce nonvertebral and vertebral fractures faster and to a greater extent than the best antiresorptive treatments. Summary This review will summarize the evolving role of anabolic therapy in t...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research

Artificial intelligence, osteoporosis and fragility fractures
Purpose of review Artificial intelligence tools have found new applications in medical diagnosis. These tools have the potential to capture underlying trends and patterns, otherwise impossible with previous modeling capabilities. Machine learning and deep learning models have found a role in osteoporosis, both to model the risk of fragility fracture, and to help with the identification and segmentation of images. Recent findings Here we survey the latest research in the artificial intelligence application to the prediction of osteoporosis that has been published between January 2017 and March 2019. Around half of the ...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: METABOLIC BONE DISEASE: Edited by Stephen Honig Source Type: research

Application of machine learning in the diagnosis of axial spondyloarthritis
Purpose of review In this review article, we describe the development and application of machine-learning models in the field of rheumatology to improve the detection and diagnosis rates of underdiagnosed rheumatologic conditions, such as ankylosing spondylitis and axial spondyloarthritis (axSpA). Recent findings In an attempt to aid in the earlier diagnosis of axSpA, we developed machine-learning models to predict a diagnosis of ankylosing spondylitis and axSpA using administrative claims and electronic medical record data. Machine-learning algorithms based on medical claims data predicted the diagnosis of ankylosing...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

The promise and perils of ‘Big Data’: focus on spondyloarthritis
Purpose of review This review will describe the available large-scale data sources to study spondyloarthritis (SpA), enumerate approaches to identify SpA and its disease-related manifestations and outcomes, and will outline existing and future methods to collect novel data types [e.g. patient-reported outcomes (PRO), passive data from wearables and biosensors]. Recent findings In addition to traditional clinic visit-based SpA registries, newer data sources, such as health plan claims data, single and multispecialty electronic health record (EHR) based registries, patient registries and linkages between data sources, h...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

The use of biologics for uveitis associated with spondyloarthritis
Purpose of review The term spondyloarthritis (SpA) encompasses a group of chronic inflammatory disorders of the joints, including ankylosing spondylitis, psoriatic arthritis, reactive arthritis, inflammatory bowel disease, juvenile SpA and undifferentiated SpA. These diseases can also present with uveitis, or intraocular inflammation, which can be controlled with biologics. Recent findings Profound success has occurred with the tumor necrosis factor-α inhibitors infliximab and adalimumab, moderate success with certolizumab pegol and golimumab and less encouraging results with etanercept. Promising results have a...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

Treat-to-target in axial spondyloarthritis: gold standard or fools’ gold?
Purpose of review Treat-to-target (T2T) is an emerging management strategy in axial spondyloarthritis (axSpA). The concept was originally based on evidence from other chronic conditions, such as hypertension, diabetes and hypothyroidism, as well as some rheumatic diseases, such as rheumatoid arthritis and gout. The purpose of this review is to discuss the arguments against and in favour of adopting a T2T strategy in the management of axSpA. Recent findings International groups have recommended a T2T strategy in axSpA. Inactive disease according to the Ankylosing Spondylitis Disease Activity Score (ASDAS) has been sugg...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

Mimics of axial spondyloarthritis
We present in this review article recent updates about the various disease entities and conditions that may mimic AxSpA and how to differentiate among them. The sensitivity and specificity of MRI in diagnosing AxSpA has limitations and needs to be interpreted in the context of the clinical picture. Interestingly, some recent studies have highlighted that a relatively high prevalence of bone marrow edema on pelvic MRIs in healthy volunteers which could even be categorized as having a ‘positive MRI’ as defined by Assessment of Spondyloarthritis International Society. Another study revealed that a substantial prop...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

Psoriatic spondylitis or ankylosing spondylitis with psoriasis: same or different?
Purpose of review Of the four musculoskeletal domains of psoriatic arthritis (PsA), the axial domain is the least studied. With the advent of targeted therapy that is efficacious in some but not all manifestations of spondyloarthritis (SpA), there is interest in understanding the similarities and differences between axial PsA (axPsA) and ankylosing spondylitis. Moreover, there is also interest in evaluating the axial domain in PsA clinical trials, domain that has traditionally been ignored in such studies. This review aims to summarize the current understanding of the differences between ankylosing spondylitis and axPsA....
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

Harnessing the power of social media: how can it help in axial spondyloarthritis research?
This article discusses four areas in the biomedical field that social media has infused with novel ideas: (i) the use of patient-generated health data from social media to learn about their disease experience, (ii) delivering health education and interventions, (iii) recruiting study participants, and (iv) reform, transfer, and disseminate medical education. We conclude with promising studies in rheumatology that have incorporated social media and suggestions for future directions. Summary Rheumatologists now have the opportunity to use social media and innovate on many aspects of their practice. We propose further expl...
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES: Edited by Atul A. Deodhar Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - May 29, 2019 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Changing rates in fracture trends are temporally associated with declining testing and treatment: reality or ecologic fallacy?
Purpose of review The changing patterns of osteoporosis treatment and fragility fractures have led to what leaders are calling a ‘crisis in the osteoporosis.’ We address data on changing patterns in fractures, and highlight strengths and limitations of recently published data. Recent findings Declines in hip fracture rates have been shown in studies from around the world. However, recently, using national Medicare data, Michael Lewiecki and colleagues show a plateau in the decline of hip fracture incidence in the United States from 2012 to 2015. Population-based data is integral for evaluating temporal tre...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: SPECIAL COMMENTARIES Source Type: research

Pathogenesis and treatment of autoimmune rheumatic diseases
Purpose of review Autoimmune diseases are of unknown origin, and they represent significant causes of morbidity and mortality. Here, we review new developments in the understanding of their pathogenesis that have led to development of well tolerated and effective treatments. Recent findings In addition to the long-recognized genetic impact of the HLA locus, interferon regulatory factors, PTPN22, STAT4, and NOX have been implicated in pathogenesis of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Smoking, ultraviolet light, diet, and microbiota exert strong environmental influence on development of R...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: SPECIAL COMMENTARIES Source Type: research

Perioperative management of immunosuppression in patients with rheumatoid arthritis
Purpose of review Patients with rheumatoid arthritis are at increased risk of infection after surgery. Recent literature has provided more data and updated guidelines to guide the management of immunosuppression in the perioperative period. Recent findings Studies over the past few years have confirmed that patients with rheumatoid arthritis are at increased risk of infection after surgery. Patients treated with biologics are at greater risk of postoperative infection, but this risk might be explained by the comorbidities and greater disease severity often seen in these patients. Recent observational studies have sugg...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Arthritis risk with immune checkpoint inhibitor therapy for cancer
Purpose of review This review summarizes the current evidence on inflammatory arthritis following cancer treatment with immune checkpoint inhibitors (ICI), and the effects of these therapies in patients with preexisting autoimmune arthritis. Recent findings As the use of ICI for cancer therapy continues to expand, a myriad of immune-related adverse events (irAE) caused by these therapies are being recognized. Arthritis has been increasingly reported as a de novo irAE, presenting sometimes as a well defined disorder, such as rheumatoid arthritis or psoriatic arthritis, and in other occasions as undifferentiated monoart...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Prediction of infection risk in rheumatoid arthritis patients treated with biologics: are we any closer to risk stratification?
Purpose of review There are currently several available biologics for rheumatoid arthritis (RA) with similar efficacy in most trials. A major consideration therefore in choosing a biologic, continues to be safety concerns such as infection. Considerable advances have been made in the understanding of biologic safety on a population level; however, how close are we to stratifying risk for individual patients? This review discusses evidence published in the last year, with reference to key previous literature. Recent findings Comparative safety of biologics has been studied in observational cohorts, with a possible incr...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Depression and the risk of rheumatoid arthritis
Purpose of review Rheumatoid arthritis (RA) is associated with negative changes in mental health. This is generally attributed to symptoms of inflammation and the adverse impact of RA on quality of life and functioning. Until recently, causal pathways in the opposite direction have not been fully appreciated. This review examines the recent literature on the risk of RA associated with depression. Recent findings Current literature links depression with an increased risk of RA and with a more detrimental disease course. These effects are likely to be partially mediated by negative effects of depression on coping with R...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Joints for joints: cannabinoids in the treatment of rheumatoid arthritis
Purpose of review An increasing number of patients with rheumatoid arthritis (RA) are using cannabis to treat their symptoms, although systematic studies regarding efficacy in RA are lacking. Within this review we will give an overview on the overall effects of cannabinoids in inflammation and why they might be useful in the treatment of RA. Recent findings Peripherally, cannabinoids show anti-inflammatory effects by activating cannabinoid type 2 receptors (CB2) which decrease cytokine production and immune cell mobilization. In contrast, cannabinoid type 1 receptor (CB1) activation on immune cells is proinflammatory ...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Opioid use in rheumatoid arthritis: trends, efficacy, safety, and best practices
Purpose of review The opioid epidemic remains prominent in both the medical literature and popular media. Rheumatologists are among the physicians at the forefront of the epidemic because of the prominent role of pain in rheumatoid arthritis (RA) and the limited options for treatment of pain. The purpose of this review is to provide an update on the trends of opioid use among patients with RA, to discuss the various mechanisms of RA pain, review the available evidence for opioid efficacy in RA, and to promote a guideline for best practices in opioid prescribing. Recent findings Recent cohort studies have estimated tha...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Patient preferences for rheumatoid arthritis treatment
Purpose of review To provide an overview of recent articles discussing patient preferences for rheumatoid arthritis (RA) treatment. Recent findings Recent studies examined patient preferences for RA treatment in several populations, finding that most participants were willing to accept certain risks of adverse effects to gain potential benefits. Perspectives regarding cannabis were studied, with patients describing medical marijuana as an alternative therapy to be used with prescription medications or as means of tapering off these medications. Treatment preferences for different RA therapies were explored using a con...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Jon T. Giles Source Type: research

Treatment of neuromyelitis optica spectrum disorders
Purpose of review This review discusses concepts for diagnosing neuromyelitis optica spectrum disorders (NMOSD), distinguishing NMOSD from other inflammatory diseases of the central nervous system, and highlights recent and forthcoming data on acute and maintenance therapy of NMOSD. Recent findings The neurologic manifestations of NMOSD are heterogenous, extending beyond classic presentations of optic neuritis and longitudinally extensive transverse myelitis. NMOSD may be comorbid with rheumatologic diseases, such as systemic lupus erythematosus, but is recognized as a distinct entity. Recent studies of acute treatmen...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: CLINICAL THERAPEUTICS & HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Management of systemic sclerosis-associated interstitial lung disease
Purpose of review To review the recently published data and provide a practical overview for management of systemic sclerosis-interstitial lung disease (SSc-ILD). Recent findings Published evidence shows considerable practitioner variability in screening patients for ILD. Recent published data support use of cyclophosphamide or mycophenolate mofetil as first-line treatment of SSc-ILD. For patients not responding to first-line therapies, consideration is given to rituximab as rescue therapy. Recent trials of hematopoietic autologous stem cell transplantation have demonstrated benefit in patients with progressive SSc-IL...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: CLINICAL THERAPEUTICS & HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Cryptic conspirators: a conversation about thrombocytopenia and antiphospholipid syndrome
Purpose of review Although antiphospholipid syndrome (APS) is best known for conveying increased risk of thrombotic events and pregnancy morbidity, thrombocytopenia is also recognized as a common association. In this review, we will explore the relationship between thrombocytopenia and APS, highlighting our evolving understanding – and persistent knowledge gaps – through clinically oriented questions and answers. Recent findings A history of thrombocytopenia likely portends a more severe APS phenotype (including increased risk of thrombosis). Although the pathophysiology underlying thrombocytopenia in APS ...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: CLINICAL THERAPEUTICS & HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Management of scleroderma renal crisis
Purpose of review Scleroderma renal crisis (SRC) is a life-threatening manifestation in systemic sclerosis (SSc) and is usually presented by an acute onset of severe hypertension together with an acute kidney injury. We can conceptualize SRC as a systemic syndrome with features that extend beyond the involvement of the kidney. The goal of this review is to inform clinicians about the risk factors for SRC in patients with SSc and to emphasize the importance of early identification and initiation of treatment. Recent findings For the past 3 decades, the use of angiotensin-converting enzyme inhibitors (ACE-I) to treat SR...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: CLINICAL THERAPEUTICS & HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research

Treatment of primary and secondary immune thrombocytopenia
Purpose of review Medical therapies for the treatment of immune thrombocytopenia (ITP) complicating SLE are increasingly being investigated as alternatives to splenectomy and IVIG. The purpose of this review is to highlight the therapies that are utilized in the treatment of primary ITP and ITP secondary to lupus. Recent findings Corticosteroids are still the standard initial treatment of ITP, with the addition of IVIG when a rapid response is needed. There are few studies dedicated to assessing the efficacy of disease-modifying antirheumatic (DMARD), biologic, and nonimmunosuppressive agents as treatment for lupus th...
Source: Current Opinion in Rheumatology - March 29, 2019 Category: Rheumatology Tags: CLINICAL THERAPEUTICS & 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 29, 2019 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research

Low-dose interleukin-2 therapy for the treatment of systemic lupus erythematosus
Purpose of review To provide an overview behind the concept and recent advances of low-dose interleukin-2 (IL-2) therapy in systemic lupus erythematosus (SLE). Recent findings A disruption of regulatory T cell homeostasis caused by an acquired deficiency of IL-2 is a crucial event in the pathogenesis of SLE. Here, we highlight the key rationales for the clinical translation of low-dose IL-2 therapy in SLE and summarize the main findings from two independent, early phase uncontrolled clinical studies that investigated the immunological and clinical responses to low-dose IL-2 therapy in patients with active SLE. Importa...
Source: Current Opinion in Rheumatology - January 29, 2019 Category: Rheumatology Tags: IMMUNOPATHOGENESIS AND TREATMENT OF AUTOIMMUNE DISEASES: Edited by George C. Tsokos Source Type: research