Janus kinase–signal transducers and activators of transcription cell signaling in Spondyloarthritis: rationale and evidence for JAK inhibition
Purpose of review
The Janus kinase–signal transducers and activators of transcription (JAK–STAT) signaling proteins represent a group of intracellular kinase molecules that play a central role in the signaling pathways induced by cytokines, chemokines, and certain growth factors associated with systemic and local inflammation of autoimmune diseases including in Spondyloarthritis (SpA). Here, we will discuss (i) the functional significance of the JAK–STAT kinase cascades in the inflammatory-proliferative processes of SpA and its cellular/molecular mechanisms (ii) progress in the development of oral synthetic JAK i...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Intestinal dysbiosis in spondyloarthritis – chicken or egg?
Purpose of review
The well-established link between intestinal inflammation and spondyloarthritis (SpA) remains largely unexplained. Recent sequencing technologies have given access to a thorough characterization of the gut microbiota in healthy and disease conditions. This showed that inflammatory bowel disease (IBD) is associated with dysbiosis – i.e., disturbed gut microbiota composition – which may contribute to disease pathogenesis. Whether gut dysbiosis exists in SpA and could contribute to disease development or be a bystander consequence of chronic inflammation is a question of major interest.
Recent fin...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Out of the shadow of interleukin-17A: the role of interleukin-17F and other interleukin-17 family cytokines in spondyloarthritis
Purpose of review
The last decade has witnessed tremendous advances in revealing an important role for the interleukin (IL)-17 cytokine family in the pathogenesis of spondyloarthritis (SpA). Although most attention has been focused on IL-17A, a potential role of other IL-17 family members in inflammation and tissue remodelling is emerging. Herein, I review recent studies covering the role of IL-17B-F cytokines in the pathogenesis of SpA.
Recent findings
Several recent studies provided new insights into the cellular source, regulation and function of IL-17F. IL-17F/IL-17A expression ratio is higher in psoriatic s...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Low-dose computed tomography for axial spondyloarthritis: update on use and limitations
This article reviews what a ldCT is and its use and limitations for imaging axial spondyloarthritis.
Recent findings
Detection of structural damage in bone with CT is far superior to radiography and ldCT of the sacroiliac joints (SIJ) can now be done at radiation exposure levels equivalent to, or even less than, conventional radiography. ldCT should be considered a ‘first-choice’ test for arthritis imaging, and wherever available, SIJ ldCT may completely replace conventional radiography. Radiation exposure in the spine with ldCT is lower than conventional CT. However, it is unclear whether the additional informa...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Inflammatory back pain: a concept, not a diagnosis
Purpose of review
The concept of inflammatory back pain (IBP) describes a cohort of patients with chronic back pain (CBP) who have distinct clinical characteristics, rather than being a diagnosis in and of itself. IBP is a common and important feature of axial spondyloarthritis (axSpA) but this is not the only differential. This review examines the utility of IBP in both primary and secondary care settings.
Recent findings
There are a number of suggested referral strategies for patients with suspected axSpA that include IBP. These strategies attempt to strike a balance between ensuring potential axSpA patients a...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Educational needs and challenges in axial spondyloarthritis
Purpose of review
Axial spondyloarthritis (axSpA) affects 0.5–1% of the population in many regions of the world. This review summarizes the challenges in medical education around axSpA with attention to evidence around delayed diagnosis, clinician familiarity with typical axSpA features, such as inflammatory back pain and adherence to accepted management principles.
Recent findings
Clinicians who commonly manage patients with chronic back pain or other typical axSpA features are not consistently aware of the concept of inflammatory back pain and common extra-spinal manifestations. Further, clinicians may not b...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Diagnostic delay in axial spondyloarthritis – a past or current problem?
Purpose of review
To evaluate recent data on diagnostic delay in axial spondyloarthritis (axSpA), factors affecting the delay, potential ways of early diagnosis improvement, and risks associated with early diagnostic approaches.
Recent findings
Although axSpA can be diagnosed nowadays within the first months after symptom onset, the diagnostic delay remains with several years still remarkably high in many parts of the world. Female gender, human leukocyte antigen-B27 negativity, and younger age at disease onset are among factors associated with a delayed referral to a rheumatologist and consequently with a large...
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: SPONDYLOARTHROPATHIES INCLUDING PSORIATIC ARTHRITIS: Edited by Joerg Ermann Source Type: research
Editorial introduction
No abstract available (Source: Current Opinion in Rheumatology)
Source: Current Opinion in Rheumatology - June 3, 2021 Category: Rheumatology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Role of Janus Kinase inhibitors in rheumatoid arthritis treatment
Purpose of review
To review recently published articles on use of Janus Kinase inhibitors (Jaki) in the clinic for rheumatoid arthritis (RA).
Recent findings
Several Jaki have been approved for RA patients failing csDMARDS. Over the last 2 years, EULAR and ACR have published updated recommendations for the pharmacologic management of RA providing guidance on the utilization of Jaki after csDMARD failure. Clinical trials have been published addressing the efficacy of Jaki monotherapy as patients often choose monotherapy because of a desire to avoid multiple therapies and aggravating adverse events with csDMARDs...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
Impact of rheumatoid arthritis and biologic and targeted synthetic disease modifying antirheumatic agents on cancer risk and recurrence
Purpose of review
Several new therapeutic drugs are now available for the management of rheumatoid arthritis (RA). Given that RA has been associated with an increased risk of certain cancers like lymphoma and lung cancer, concern remains about the safety of (newer) immunosuppressants used in RA management as it relates to the risk of cancer.
Recent findings
Most meta-analyses of randomized clinical trials of tumor necrosis factor inhibitors (TNFi) have not observed an association between TNFi and risk of incident cancer. Studies of non-TNFi biologic disease modifying antirheumatic drugs (bDMARDs) and targeted sy...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
Interstitial lung disease throughout the rheumatoid arthritis disease course
Purpose of review
To summarize the current understanding of rheumatoid arthritis-associated interstitial lung disease (RA-ILD) throughout the rheumatoid arthritis (RA) disease course from preclinical to established disease.
Recent findings
ILD is a serious extra-articular manifestation of RA. Multiple studies have demonstrated a high prevalence of both subclinical and clinical ILD throughout the RA disease course. Investigations of patients without RA have demonstrated an association between RA-related autoantibodies like anticitrullinated protein antibodies (ACPA) and interstitial abnormalities on lung imaging....
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
Glucocorticoid and opioid use in rheumatoid arthritis management
Purpose of review
Glucocorticoids and opioids are longstanding, common treatments for rheumatoid arthritis (RA) symptoms. High-quality clinical trials have established that glucocorticoids improve outcomes in RA, but debate continues as to whether their benefits outweigh their risks. We reviewed recent studies on patterns of glucocorticoid and opioid prescribing in RA, and associated harms.
Recent findings
At present, a large proportion of RA patients remain on glucocorticoids and/or opioids long-term. Likelihood and risk of both glucocorticoid and opioid exposure vary across the population, and are influenced b...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
Osteoporosis and fractures in rheumatoid arthritis
Purpose of review
Rheumatoid arthritis (RA) is associated with increased risk for osteoporotic fracture. We highlight RA-specific risk factors for bone mineral density (BMD) loss and fractures and considerations regarding the diagnosis and treatment of osteoporosis in patients with RA.
Recent findings
Anticitrullinated protein antibody (ACPA) positivity, although associated with low BMD in early RA, is not associated with accelerated BMD loss over time when compared to ACPA negative individuals. Studies have found reduced BMD in individuals on low doses of glucocorticoids (GCs). Poor functional status and frailt...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
Telerheumatology: before, during, and after a global pandemic
Purpose of review
In early 2020, the COVID-19 global pandemic shifted most healthcare to remote delivery methods to protect patients, clinicians, and hospital staff. Such remote care delivery methods include the use of telehealth technologies including clinical video telehealth or telephone visits. Prior to this, research on the acceptability, feasibility, and efficacy of telehealth applied to rheumatology, or telerheumatology, has been limited.
Recent findings
Telerheumatology visits were found to be noninferior to in-person visits and are often more time and cost effective for patients. Clinicians and patients...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
COVID-19 and rheumatoid arthritis
Purpose of review
The coronavirus disease 2019 (COVID-19) pandemic has caused significant morbidity and mortality worldwide. Patients with rheumatoid arthritis (RA) face unique challenges during the pandemic, including concerns regarding infection risk, drug shortages, limited access to care, social isolation, and mental health. This review will examine the multifaceted impacts of the COVID-19 pandemic on patients living with RA.
Recent findings
In patients with RA, risk factors for severe COVID-19 outcomes include older age and comorbidities, similar to those in the general population. Glucocorticoids, but not ...
Source: Current Opinion in Rheumatology - April 15, 2021 Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Bryant R. England Source Type: research
