Differential Metabolome in Rheumatoid Arthritis: a Brief Perspective
AbstractPurpose of ReviewRheumatoid arthritis (RA) is a chronic autoimmune, inflammatory disease of the synovium that affects the movable joints. It develops due to the infiltration and invasion of the synovial joints by immune cells. Metabolism is anabolic or catabolic chemical reactions occurring in a cell. The biochemical pathways in synovial and immune cells are altered affecting the downstream metabolite formation. Changes in the metabolite levels alter signaling cascades which further intensify the disease. Despite current knowledge of metabolomics, there remain certain features that need to be elucidated to correlat...
Source: Current Rheumatology Reports - April 28, 2021 Category: Rheumatology Source Type: research
Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond
AbstractPurpose of ReviewThis review examines axial spondyloarthritis (axSpA) and the wider field of rheumatology through a value-based healthcare (VBHC) lens. VBHC is focused on ensuring patients receive high quality care to improve outcomes and reduce unnecessary costs.Recent FindingsThere are many opportunities to apply the principles of VBHC in axSpA. These include the appropriate utilization of diagnostic investigations, such as HLA-B27 and magnetic resonance imaging, assessing outcomes meaningful to patients, and optimizing care pathways. Multidisciplinary care may improve value, and reduced specialist review and med...
Source: Current Rheumatology Reports - April 28, 2021 Category: Rheumatology Source Type: research
Novel Therapies for ANCA-associated Vasculitis
AbstractPurpose of ReviewThe purpose of this review is to discuss the most recent evidence on the treatment innovations and future prospective in the management of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs).Recent FindingsIn AAV, a growing body of research is available on novel treatment options for remission induction and to clarify some uncertainties concerning the optimal use of available drugs. Efforts are being made to reduce the toxicity associated with high-dose, prolonged glucocorticoids (GC) regimens. Despite major advances in the prognosis of AAV, relapses are still common and the ...
Source: Current Rheumatology Reports - April 28, 2021 Category: Rheumatology Source Type: research
Recent Updates in the Immunopathology of Type 3 Immunity-Mediated Enthesitis
AbstractPurpose of ReviewEnthesitis is a cardinal feature of spondyloarthritis (SpA). Despite increasing available treatments, challenges remain in adequately controlling inflammation and subsequent new bone formation (NBF) in entheses; thus, a better understanding of the immunopathogenesis is warranted.Recent FindingsIncreasing evidence has identified immune cells playing key roles in enthesitis such as γδ T cells and group 3 innate lymphoid cells (ILC3), possibly with site-specific regulatory systems. The presence of T cells producing interleukin (IL)-17 independent of IL-23 in human spinal entheses was recently report...
Source: Current Rheumatology Reports - April 24, 2021 Category: Rheumatology Source Type: research
Involvement of Macrophages and Spinal Microglia in Osteoarthritis Pain
AbstractPurpose of ReviewChronic pain in osteoarthritis (OA) is characterized by pain sensitization, which involves both peripheral and central mechanisms. Studies suggest synovial macrophage and spinal microglia are implicated in pain sensitization in OA. We, therefore, reviewed the evidence of whether synovial macrophage and spinal microglia facilitated pain sensitization at diverse levels and how this event occurred in OA.Recent FindingsPeripherally, joint inflammation is now believed to be a source of OA-related pain. Synovial macrophages accumulate in OA inflamed synovium and display a pro-inflammatory phenotype. Abun...
Source: Current Rheumatology Reports - April 24, 2021 Category: Rheumatology Source Type: research
Intersections Between Mitochondrial Metabolism and Redox Biology Mediate Posttraumatic Osteoarthritis
AbstractPurpose of ReviewThis review will cover foundational studies and recent findings that established key concepts for understanding the importance of redox biology to chondrocyte mitochondrial function and osteoarthritis pathophysiology after injury.Recent FindingsArticular chondrocyte mitochondria can be protected with a wide variety of antioxidants that will be discussed within a framework suggested by classic studies. These agents not only underscore the importance of thiol metabolism and associated redox function for chondrocyte mitochondria but also suggest complex interactions with signal transduction pathways a...
Source: Current Rheumatology Reports - April 24, 2021 Category: Rheumatology Source Type: research
Clinical Characteristics of Myositis Associated with Graft-Versus-Host Disease
AbstractPurpose of ReviewRecipients of allogeneic hematopoietic stem cell transplantation (HSCT) are at increased risk for inflammatory myositis; histological subsets reported include dermatomyositis, necrotising myopathy and chronic graft-versus-host disease (cGVHD) –related myositis. Though corticosteroids and various immunosuppressive therapies have been used, there is a lack of consensus guidelines dictating therapy.Recent FindingsRecent evidence suggests the fascia as a preferential target in cGVHD myositis, with conditioning regimens promoting fascial microtrauma. Positron emission tomography (PET) can be a useful ...
Source: Current Rheumatology Reports - April 24, 2021 Category: Rheumatology Source Type: research
COVID-19 and Disease-Modifying Anti-rheumatic Drugs
AbstractPurpose of ReviewPatients on disease-modifying anti-rheumatic drugs (DMARDs) remain concerned about potential risks of severe COVID-19 outcomes. Meanwhile, several DMARDs have been proposed as COVID-19 therapies.Recent FindingsIn patients with autoimmune diseases, baseline glucocorticoid use is associated with severe COVID-19. While classes of DMARDs (e.g., conventional synthetic, targeted synthetic, and biologic) do not appear to be associated with higher risk, specific medications such as rituximab and sulfasalazine may be associated. Randomized clinical trials (RCTs) show that glucocorticoids reduce mortality in...
Source: Current Rheumatology Reports - April 24, 2021 Category: Rheumatology Source Type: research
Gut Microbiota in Lupus: a Butterfly Effect?
AbstractPurpose of ReviewSystemic lupus erythematosus (SLE) is a prototypic autoimmune disease that typically displays chronic inflammatory tissue damage and miscellaneous circulatory autoantibodies, as well as distinctive type 1 interferon signatures. The etiology of SLE is unclear and currently is attributed to genetic predisposition and environmental triggers. Gut microbiota has recently been considered a critical environmental pathogenic factor in immune-related disorders, and studies are ongoing to uncover the key pathogens and the imputative mechanisms. Fundamental advancements on the role of the microbiota in SLE pa...
Source: Current Rheumatology Reports - April 16, 2021 Category: Rheumatology Source Type: research
Persistent Joint Pain Following Arthropod Virus Infections
AbstractPurpose of ReviewPersistent joint pain is a common manifestation of arthropod-borne viral infections and can cause long-term disability. We review the epidemiology, pathophysiology, diagnosis, and management of arthritogenic alphavirus infection.Recent findingsThe global re-emergence of alphaviral outbreaks has led to an increase in virus-induced arthralgia and arthritis. Alphaviruses, including Chikungunya, O ’nyong’nyong, Sindbis, Barmah Forest, Ross River, and Mayaro viruses, are associated with acute and/or chronic rheumatic symptoms. Identification of Mxra8 as a viral entry receptor in the alphaviral repli...
Source: Current Rheumatology Reports - April 13, 2021 Category: Rheumatology Source Type: research
Cognitive Impairment in SLE: Mechanisms and Therapeutic Approaches
AbstractA wide range of patients with systemic lupus erythematosus (SLE) suffer from cognitive dysfunction (CD) which severely impacts their quality of life. However, CD remains underdiagnosed and poorly understood. Here, we discuss current findings in patients and in animal models. Strong evidence suggests that CD pathogenesis involves known mechanisms of tissue injury in SLE. These mechanisms recruit brain resident cells, in particular microglia, into the pathological process. While systemic immune activation is critical to central nervous system injury, the current focus of therapy is the microglial cell and not the sys...
Source: Current Rheumatology Reports - March 29, 2021 Category: Rheumatology Source Type: research
Use of Rescue Therapy with IVIG or Cyclophosphamide in Juvenile Myositis
AbstractPurpose of ReviewThis review aims to present the literature available to date on the use of intravenous immunoglobulin and cyclophosphamide for juvenile patients with inflammatory myopathies, to evaluate the strength of the evidence so far for both these medications, and to reach conclusions about their efficacy.Recent FindingsJuvenile idiopathic inflammatory myopathies, mainly represented by juvenile dermatomyositis (JDM), are rare diseases but quite debilitating for the patients. JDM is an autoimmune condition with predominantly muscle and skin involvement but also systemic features affecting the cardiovascular, ...
Source: Current Rheumatology Reports - March 8, 2021 Category: Rheumatology Source Type: research
Outcome Scores in Pediatric Rheumatology
AbstractPurpose of ReviewProviding a summary of the latest research on outcome measures in juvenile idiopathic arthritis, childhood -onset systemic lupus erythematosus, and juvenile dermatomyositis.Recent FindingsA rational management of patients with pediatric rheumatic diseases requires the regular assessment of the level of disease activity and damage, as well as the evaluation of therapeutic response through validated and standardized outcome measures. Ideally, such tools should be simple, feasible, and easily applicable in routine care. Recently, there has been a great deal of effort to refine existing tools and devis...
Source: Current Rheumatology Reports - March 8, 2021 Category: Rheumatology Source Type: research
Checkpoint Molecules in Rheumatology —or the Benefits of Being Exhausted
AbstractPurpose of ReviewThis review will focus on the most common co-inhibitory molecules, emphasizing the importance of these in relation to rheumatic disease.Recent FindingsCheckpoint molecules are pivotal in determining the outcome of antigen activation. Checkpoint molecules consist of co-stimulatory and co-inhibitory molecules, where the first activates and the latter inhibits the antigen presentation process. Studies show that increased activity of co-inhibitory molecules is associated with a good prognosis in rheumatic diseases. Opposite, when cancer patients are treated with antibodies blocking the inhibitory pathw...
Source: Current Rheumatology Reports - March 2, 2021 Category: Rheumatology Source Type: research
Etiologies of Rheumatoid Arthritis: Update on Mucosal, Genetic, and Cellular Pathogenesis
AbstractPurpose of ReviewOver the last few years, the scientific community has made significant progress in understanding the etiology of rheumatoid arthritis (RA). In this review, we summarize those key findings and trends.Recent FindingsNew data strongly implicates respiratory exposures, obesity, diet and microbiome, genetics, and their interactions in the etiology of RA. Furthermore, anti-posttranslationally modified protein antibodies (AMPAs) and abnormal glycosylation may be additional biomarkers for RA. Finally, functional genomics techniques implicate loss of certain macrophage populations and proliferation of synov...
Source: Current Rheumatology Reports - March 1, 2021 Category: Rheumatology Source Type: research
