Reviews & Analysis

In this Perspectives article, the authors argue that the cells of the inflammatory infiltrate and the cytokine milieu provide multiple routes to bone destruction in inflammatory arthritis. They first summarize the physiological pathway of osteoclastogenesis, then present emerging evidence of the contribution of various cytokines and cell types to alternative pathways of osteoclast differentiation and activation.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic viral infection of the central nervous system that is associated with several immunosuppressive therapies. In this Opinion article, Calabrese and colleagues propose a ranking of immunosuppressive agents based on their risk of PML to support a better-informed decision-making process.

A screening program for hyperuricaemia and gout would aim to identify those individuals with elevated serum urate and thus enable intervention to prevent the onset of gout. However, the data supporting a role for screening in this setting is far from complete. Stamp and Dalbeth outline the important issues around a screening programme for hyperuricaemia and gout, and highlight areas where further research is required before such a programme could be considered.

Rheumatoid arthritis (RA) and metabolic syndrome share several pathologic characteristics, such as changes in body composition, lipid levels and insulin sensitivity, that may increase cardiovascular mortality. Here, Kerekes and co-authors discuss associations between these components in RA and metabolic syndrome and propose that optimal therapeutic control of RA might attenuate adverse effects of metabolic syndrome in patients with RA.

Active systemic lupus erythematosus (SLE) can manifest in heterogeneous clinical forms, making description of SLE clinical states difficult in patients with high disease activity. In this Opinion article, the authors argue the time has come to change the way SLE is managed by defining a treatment goal based on defining a low disease activity state, and they suggest possible inclusions in, and obstructions to, such a goal.

Strategies to repair damaged intervertebral discs rely on the premise that these structures can be regenerated using cellular-based approaches. Here, Huang and colleagues highlight the importance of nutrient balance for maintenance of disc cell function and question whether disc repair can be successfully achieved in degenerate human discs where nutrient supply is compromised.

With the continued focus on evidence-based medicine, new randomized controlled trials (RCTs) are needed in vasculitis to improve management of these conditions. In this Opinion article, using antineutrophil cytoplasmic antibody-associated and large-vessel vasculitis as examples, Tarzi and colleagues discuss RCTs performed to date and outline important issues in trial design and future directions for the field.

The most common symptom of osteoarthritis is pain, but current treatments do not identify or treat different types of osteoarthritis-associated pain. In this Opinion article the authors argue that some patients with osteoarthritis have neuropathic pain, and that analgesic drugs generally prescribed for neuropathic pain that is unrelated to osteoarthritis should also be used to treat this subset of patients.

The concepts of comorbidity and multimorbidity consider a patient with multiple diseases from different perspectives, which affects how a clinician approaches treatment. In this Perspectives article, Radner and colleagues discuss the concept of multimorbidity and how its integration into daily clinical practice can improve the care of patients with rheumatic conditions.

The transfer of young patients with rheumatic disease from paediatric to adult health-care provision, usually during adolescence, can have adverse effects on disease in individuals who might already be vulnerable. Herein, the authors discuss transitional health-care procedures that support and encourage young patients to take responsibility for their own health-care requirements, which might improve patient coping and disease outcomes in the long term.