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B-cell-depletion therapy emerged as a new therapeutic option for systemic lupus erythematosus (SLE) about a decade ago. Promising results from several open-label studies, with respect to efficacy and safety, were marred by the failure of two large, randomized controlled studies of rituximab to meet their endpoints. Rather than writing off B-cell depletion, might we eventually be able to accept it as a useful approach for treating SLE?
Vaccines are vital for protecting us against infectious diseases, but they have also been linked with the development of autoimmunity. In this article, the authors discuss the causal and temporal interactions between vaccines and autoimmune phenomena, and possible mechanisms by which different components of vaccines might induce autoimmune disease.
Clinical guidelines and recommendations, as well as clinicians and patients, consider non-pharmacological modalities to be the mainstay of treatment for osteoarthritis (OA). Despite this consensus in opinion, however, the evidence base for the non-pharmacological management of hand and hip OA continues to lag far behind that for knee OA, which suggests that more research is required to optimize the management of hand and hip OA.
Since the 1970s, rheumatologists have increasingly reported seeing patients with milder onset of rheumatoid arthritis and a less-severe disease course than in preceding decades. Are these improvements attributable to earlier diagnosis, better therapeutic options, or simply a milder natural disease course? Uhlig and Kvien review the evidence for the perceived decrease in disease severity and discuss the potential reasons for this phenomenon.
Owing to the critical role of tumor necrosis factor in host immunity, patients receiving tumor necrosis factor inhibitors for the treatment of autoimmune disorders are at significantly increased risk of infection from a variety of pathogens. The authors review the evidence and provide expert opinion on how best to prevent opportunistic infections in this setting.
Over the past 5 years, there has been considerable interest in the search for new treatments for systemic lupus erythematosus; disappointingly, negative results have now been presented from several large clinical trials. What can we learn from the experience so far to ensure that future opportunities for the development of an effective therapy for this disease are not missed?
Biologic agents are fast becoming a mainstay of treatment for rheumatoid arthritis. The risk of bacterial and opportunistic infections in patients treated with these agents remains unknown, however, in part because of difficulties related to interpretation of relevant trial data.
Evidence is mounting that the cholinergic pathway is involved in the pathogenesis of rheumatoid arthritis and other immune-mediated inflammatory disorders. This timely article provides an overview of the role of the vagus nerve and α7 nicotinic acetylcholine receptor in this pathway, and highlights novel strategies that could exploit these targets in the treatment of rheumatic diseases.
