Articles in 2010

The natural history of untreated Lyme arthritis is rarely observed as most cases are successfully treated with antibiotics. This Case Study discusses a patient with Lyme disease who refused antibiotic therapy during the first 4 years of her illness and demonstrates that antibiotic therapy is still likely to be effective, even following a long-term infection withBorrelia burgdorferi.

The effect of biological therapies on cancer risk in JIA is controversial owing to confounding factors such as the use of concomitant immunosuppressants. A study has shed new light on this association, but questions still remain on the effect of the disease itself and biological therapies on cancer risk.

Osteoarthritis (OA) is a disease of the whole joint, at the centre of which lies the interface between cartilage and bone. Altered transfer of mechanical stress across this boundary is thought to result from, and to exacerbate, OA, but molecular crosstalk was presumed to be minimal. Accumulating data challenge this assumption, and this Review explores the biology and pathology of the bone–cartilage functional unit.

Despite preclinical evidence of the safety and efficacy of gene therapy for arthritis, few clinical trials have been undertaken. What are the constraints on the development of this therapeutic strategy, and are these barriers likely to be overcome?

Tissue engineering to repair diseased or injured cartilage could be revolutionized by the development of a novel cell-homing strategy that overcomes several barriers inherent in the use of existing techniques.

The link between glucocorticoid use and bone loss, with increased fracture risk, necessitates care in prescribing these potent anti-inflammatory drugs. What impact will new ACR recommendations—incorporating new clinical trial data and modern methodology for guideline development—have on ensuring that patients receive proper management to reduce the negative impact of glucocorticoids on bone health?

Macrophages have important roles in the induction and resolution of inflammation, but the intracellular pathways from inflammatory signals to pain response remain unclear. A recent study demonstrates that the P2X4 receptor mediates inflammatory pain by inducing formation of the potent lipid mediator prostaglandin E₂.

Genome-wide association studies of human diseases have uncovered large numbers of common genetic variants with small effect sizes; however, rare genetic variants with large effect sizes might have greater relevance with respect to disease heritability. The identification and characterization of rare variants—such as those recently discovered in SIAE—is, therefore, likely to be a major endeavor in the field in the coming years.

Glucocorticoids are widely used anti-inflammatory and immunosuppressive drugs for rheumatoid arthritis. This Review outlines the indications for and benefits of glucocorticoids as co-therapy with other DMARDs, describes the adverse effects that are predominantly associated with high-dose or long-term therapy, and considers the impact of patients' and doctors' perceptions of glucocorticoid therapy on prescribing and adherence to treatment.

Digital ulcers in patients with systemic sclerosis (SSc) can cause considerable disability; however, clinical trials addressing the treatment and prevention of digital ulcers in SSc are rare. A study has evaluated the potential benefit of the endothelin receptor antagonist bosentan in the treatment of SSc-related digital ulcers.

The etiology and pathogenesis of osteoarthritis (OA) are poorly understood, although proinflammatory cytokines are known to be critically implicated in the disease. In this Review, the authors discuss the current knowledge regarding the role of proinflammatory cytokines, particularly interleukin (IL) 1β, tumor necrosis factor and IL 6 in the pathophysiology of OA, and give an overview of efforts to develop adequate and specific anticytokine therapies.