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, reachi...
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 res...
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 sacr...
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 resident ...
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
