Perspectives

A working group including authors of the latest OARSI and ESCEO recommendations for the management of knee osteoarthritis and independent experts compare and contrast these guidelines, and provide insights into their differences that could help inform application of the recommendations.

In this article, the authors discuss how the use of innovative clinical trial designs could facilitate the efficient evaluation of new and existing drugs in specific subgroups of patients, in order to optimize therapy allocation and address unmet clinical needs.

A subset of patients with coronavirus disease 19 (COVID-19) develop a thrombotic disorder that resembles a virally induced, complement-mediated thrombotic microangiopathy. Here, the authors present the theory and evidence for this disease model and discuss important considerations for treatment.

This Perspective article explores similarities in the inflammatory processes underlying coronavirus disease 2019 (COVID-19) and rheumatoid arthritis, including the role of pro-inflammatory cytokines and the potential of anti-cytokine therapies to treat COVID-19, as well as the effect of the COVID-19 pandemic on rheumatology.

In this Perspective article, the authors recount the earliest stages of translational research into IL-6 biology and the subsequent development of therapeutic IL-6 pathway inhibitors for the treatment of autoimmune rheumatic diseases and potentially numerous other indications.

Glucocorticoids have been used to treat patients with rheumatic diseases for more than 70 years, but have been controversial owing to their safety record. Are we now entering an age when opinions about their use in rheumatology clinics are converging?

Breakthroughs in the field of rheumatology have transformed the management of rheumatic diseases and improved patient outcomes, but clinical challenges remain. Looking back at ‘older’ drugs could provide new lessons for future drug strategies and development.

Behavioural economics uses psychological and economical insights to explain decision making by individuals to understand the predictable way in which individuals behave irrationally. Concepts from this field can be applied to promote healthy behaviours and could be applicable to rheumatology.

In this Perspectives article, the authors present how various types of anti-citrullinated protein antibodies (ACPAs) differ based on the structural interactions of these antibodies with their citrullinated antigens, and examine the potential consequences for ACPA-mediated effector functions.

Establishing suitable outcome measures is an important goal for the classification and monitoring of patients with early knee osteoarthritis. This Perspectives article highlights various outcome measures that have potential use in clinical and/or research settings for early knee osteoarthritis.

Treat-to-target has been a guiding principle for treatment in rheumatology for almost 10 years. This Perspectives article evaluates how well the idea of treat-to-target has translated into clinical practice.

Dactylitis is diffuse inflammation of the digits and is so closely associated with psoriatic arthritis that it can be used as an outcome measure of it. In this Opinion article, the authors describe how imaging modalities and scoring systems combined with data from animal models can be used to understand the underlying anatomy and immunopathogenesis of dactylitis.

In osteoarthritis, identifying those patients at most risk of disease progression and/or who might benefit the most from therapy is an important step. Incorporating machine-learning into the development of prediction models has great potential for moving towards precision medicine

Environmental changes can sometimes be too rapid for genetic adaptation and result in a mismatch between our genetics and the environment. Osteoarthritis should be considered a mismatch disease owing to a rapid increase in prevalence that is associated with the modern lifestyle, diet and patterns of physical activity.

In this Perspectives article, Roemer et al. argue that the time has come to use MRI, rather than radiography, as the primary imaging modality for defining eligibility criteria for clinical trials of potential disease-modifying osteoarthritis drugs (DMOADs).

Symptoms associated with chronic inflammatory diseases such as fatigue, depression and muscle loss are often overlooked during treatment. This Perspectives article provides a framework for understanding many of these symptoms that is based on the concepts of evolutionary medicine, energy regulation and neuroendocrine–immune crosstalk.