A recent review in Arthritis & Rheumatology examined advances in addressing the pathophysiology, genetics and treatment of enthesitis for patients with spondyloarthritis. And author Michael Weisman, MD, notes that challenges remain in understanding the genetics and triggers of enthesitis…
In February, new recommendations were released for the treatment of ankylosing spondylitis and nonradiographic axial spondyloarthritis, noting that NSAIDs may be the best initial treatment for the diseases, with TNF inhibitors as second-line therapies. The guideline was the result of a joint effort by the ACR, the Spondylitis Association of America and the Spondyloarthritis Research and Treatment Network…
Psoriatic arthritis (PsA) is remarkably diverse in presentation and course. To assist clinicians in its management, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) published treatment recommendations in 2009 based on a systematic evidence review. To be clinically relevant, such recommendations must be dynamic, and significant developments in PsA pathophysiology and disease assessment, particularly regarding the important contribution of comorbidities coupled with major therapeutic advances, necessitated an update of the GRAPPA recommendations…
Transitions in medical care can be high-risk periods due to the loss of continuity in care and worsening of medical conditions. Approximately one-quarter of the estimated 18 million adolescents aged 18–21 years in the U.S. have chronic conditions, including rheumatic diseases. Interventions in rheumatology practice can improve transition processes. Transition-readiness assessment tools and transition-satisfaction scales are available for use in rheumatology transition processes…
Although research regarding the increased cardiovascular (CV) morbidity and mortality in rheumatoid arthritis (RA) has burgeoned in recent years, the need remains for a better understanding of the effects of widely used DMARDs on CV risk and risk factors in RA patients. These authors set out to evaluate the long-term changes in cholesterol levels in patients with early RA. Decreases in RA disease activity over long-term follow-up were associated with increases in cholesterol levels in patients with early RA treated with either biologic or nonbiologic therapies…
Enthesitis is a central feature of spondyloarthritis (SpA). This review article summarizes the substantial progress that has been made in addressing the pathophysiology, molecular mechanisms, genetic associations, clinical features, diagnostic modalities and treatment of enthesitis. Further examination into the role of the inflammatory mediators, including IL-17, IL-22, and IL-23 as well as potentially others, in driving enthesitis and bone formation will be important to direct our attention toward future therapeutic targeted pathways in patients with SpA…
“Treat to target regardless of disease activity level” tops the list of recommendations for both early and established RA in the 2015 Guideline for the Treatment of Rheumatoid Arthritis. The guideline addresses six major topics, including DMARDs, glucocorticoids and biologics, and includes 74 recommendations. These recommendations are not prescriptive, and the treatment decisions should be made by physicians and patients together…
Although osteoarthritis (OA) was formerly considered a non-inflammatory joint disease, it’s now well-appreciated that inflammatory mediators, such as PGE2 and IL-1β, are produced by osteoarthritic joint tissues and can be used to identify patients with symptomatic knee OA. A peripheral blood leukocyte inflammatory transcriptome identifies a subset of symptomatic knee OA patients at higher risk for radiographic progression and may reflect persistent low-grade joint inflammation…
A recent study of how medical facilities in three countries meet minimum care standards for patients with childhood-onset systemic lupus erythematosus found a wide variation in quality of care…
Despite new therapeutics, progress for RA patients has virtually stalled over the past 10 years. In this article, the authors discuss many options to advance to a cure and the evidence for them, including the combination of low-dose methotrexate and anti-TNF; targeting angiogenesis and tissue damage pathways directly; antigen-specific therapy; potential combination of TNF and IL17 blockade; and targeting inhibitory receptors and regulatory T cells.