Articles in 2012

New data demonstrate that cobalt ions promote immune system activation through Toll-like receptor 4 signalling. This finding adds to our understanding of the adverse innate and adaptive immune reactions evoked by debris released from metal-on-metal total or resurfacing joint replacement implants, which have provoked recommendations against their use.

The emphasis placed on HLA-B27 positivity in classification criteria for axial spondyloarthritis has generated some concern over potential misclassification of patients with chronic back pain. The results of a recent study suggest that these worries could have some foundation, at least in regions with high HLA-B27 prevalence.

Identifying facet joint pathology as the source—as it frequently is—of neck or back pain involves the use of diagnostic blocks, which also aid in selecting patients who will respond to radiofrequency denervation treatment. How best to administer and interpret the results of anaesthetic injection blocks are described in this Review, alongside current shortfalls and future prospects in the clinical management of facetogenic pain.

In the wake of publication of clinical data for new drugs in the management of lupus nephritis, European rheumatology and renal societies have issued new recommendations for management of this condition. Coming hot on the heels of American guidelines, how does this latest advice compare?

Physical activity is paramount in the treatment of juvenile fibromyalgia, although some interventions use indirect methods to increase activity levels rather than address physical dysfunction head-on. New research explores the effects of a psychotherapeutic approach on levels of physical activity in adolescents with fibromyalgia.

Arthropathy is a common manifestation of systemic lupus erythematosus (SLE), but remains poorly understood. Recent ultrasonographic evidence demonstrating high levels of joint and tendon pathology in SLE challenges our previous concepts of arthritis subtypes in this multisystem disease.

Early aggressive immunosuppressive regimens have fundamentally changed the treatment and management of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). However, how to maintain remission in these patients is debated. Here, Raashid Luqmani considers how best to achieve maintenance of clinical remission in patients with AAV.

The association between coagulation and the immune system has been increasingly recognised to have a role in the development of inflammatory rheumatic diseases. The fact that the risk of venous thromboembolism is increased in patients with rheumatoid arthritis (RA) and citrullinated fibrinogen is an early autoantigen in RA indicates an adaptive immune response to coagulation factors in inflammatory rheumatic diseases. In this article, Hoppe and Dörner describes the pathophysiology of an induced procoagulatory state in inflammatory rheumatic diseases, discussing the roles of endothelial cell and platelet activation, and coagulation and fibrinolytic systems, and providing insights into future research for innovative therapeutic interventions.

Fibroblast-like synoviocytes (FLS) are cellular effectors of the inflammatory milieu that characterizes and precedes joint destruction in rheumatoid arthritis (RA). But what role do these cells have in creating the same environment to which they respond? Bottini and Firestein delve into the double life of FLS in RA pathogenesis.

The peripheral nervous system has a complex and important role in regulating the immune system. With a focus on the sympathetic nervous system, the authors of this Review discuss evidence for neuroimmune regulation of the inflammatory response in the context of autoimmune arthritis.