Volume 12 Issue 10, October 2016

A new study of 'symptom-free' volunteers reports a surprisingly high prevalence of MRI features usually associated with rheumatoid arthritis (particularly bone marrow oedema), but the interpretation of these findings highlights several methodological issues. MRI assessment of healthy joints is clearly essential but should be carried out in a stringent fashion.

Changes in DNA methylation patterns are emerging as an important feature in the development and progression of primary Sjögren syndrome. However, questions remain regarding the contribution of epigenetic (and genetic) factors to the recruitment and activation of autoreactive lymphocytes in the glandular tissues primarily affected by the disease.

New research shows that an extended autoantibody repertoire is associated with adverse clinical outcomes in patients with rheumatoid arthritis. Testing for rheumatoid factor and antibodies against citrullinated proteins is now routine in the evaluation of patients with rheumatoid arthritis; should this testing be extended to include other classes of autoantibody?

Revised recommendations for the management of fibromyalgia have been published by a multinational EULAR working group. Applying these guidelines to clinical practice will require good clinical judgement and flexibility.

The type of anti-neutrophil cytoplasmic antibody (ANCA) seems to be a major determinant of clinical presentation in ANCA-associated vasculitides (AAV). The authors of this Review argue that ANCA specificity for PR3 or MPO provides clinically useful information and should be used in the classification of AAV.

Emerging evidence indicates that the inflammatory mechanisms involved in the pathophysiology of osteoarthritis (OA) differ from those in rheumatoid arthritis. This Review explores the mechanisms of chronic, low-grade inflammation in OA, discusses the evidence of their central role in its pathogenesis, and explores how they might be targeted to prevent or treat OA.

Cancer can be successfully treated by blocking inhibitory immune checkpoint receptors, but in some patients these treatments cause immune-related adverse effects that can resemble autoimmune responses. This Review discusses what rheumatologists can learn from these observations and summarizes progress in therapeutically targeting inhibitory receptors in autoimmune diseases.

Understanding the global burden of SLE, and the factors that contribute to the considerable variation in its worldwide incidence and prevalence (particularly health disparities, costs, and socioeconomic status), is expected to inform future efforts to improve patient outcomes while optimizing resource allocation and decreasing associated health-care costs.