Nature Reviews Rheumatology 8, 245 (2012). doi:10.1038/nrrheum.2012.57

Author: Katrina Ray

In the treatment of early rheumatoid arthritis (RA), methotrexate is generally considered to be the initial drug of choice. But how to proceed when patients do not respond to methotrexate monotherapy is less clear. Now, updated findings from the multicenter Swedish pharmacotherapy (Swefot) trial, published

Nature Reviews Rheumatology 8, 246 (2012). doi:10.1038/nrrheum.2012.47

In obese patients with knee osteoarthritis (OA), losing weight can alleviate the symptoms of joint pathology; now, a new study indicates that existing joint damage does not preclude such relief. Obese patients aged >50 years had structural damage, muscle strength and knee alignment assessed in

Nature Reviews Rheumatology 8, 246 (2012). doi:10.1038/nrrheum.2012.48

Coronary artery abnormalities frequently affect patients with Kawasaki disease (standard therapy for which is intravenous immunoglobulin, IVIg). In a prospective, open-label, blinded-endpoints trial in Japan, 125 and 123 patients respectively were randomized to receive either IVIg (2 g/kg for 24 h plus aspirin 30 mg/kg

Nature Reviews Rheumatology 8, 246 (2012). doi:10.1038/nrrheum.2012.49

A registry study that linked pregnancies in Norway in 2004–2007 (154,976 pregnancies) with antirheumatic drug prescriptions during pregnancy, and for 3 months pre-conception in either parent, reported that no children were born with major malformations to parents who received methotrexate, adalimumab, leflunomide or etanercept. Taking

Nature Reviews Rheumatology 8, 246 (2012). doi:10.1038/nrrheum.2012.50

Does parathyroid hormone (PTH) increase the risk of gout? A study in 8,316 nationally representative US adults found that serum PTH levels were independently associated with serum uric acid levels and the frequency of hyperuricemia, at the population level.

Nature Reviews Rheumatology 8, 246 (2012). doi:10.1038/nrrheum.2012.51

Author: Emma Leah

Patients with symptomatic knee osteoarthritis (OA) are more sensitive to various pain stimuli, new data confirm, but the good news is that joint replacement can normalize the pain response. The study, by Thomas Graven-Nielsen and colleagues, published in Arthritis & Rheumatism, provides new insight

Nature Reviews Rheumatology 8, 247 (2012). doi:10.1038/nrrheum.2012.38

Author: Jenny Buckland

Vitamin D is undoubtedly important in bone mineralization and health, but the role of its fellow fat-soluble, nutritionists' favorite, vitamin E, remains controversial. Fujita et al. now report in Nature Medicine that vitamin E, in contrast to vitamin D, encourages bone resorption

Nature Reviews Rheumatology 8, 247 (2012). doi:10.1038/nrrheum.2012.45

Author: David Killock

Although highly effective, rheumatoid arthritis (RA) therapeutics concentrate on suppression of the immune system, and thus can cause susceptibility to infection. Inhibition of nonimmune synovial cells by blocking epidermal growth factor receptor (EGFR) signaling, “may synergize with current therapies, and possibly reduce the reliance on

Nature Reviews Rheumatology 8, 247 (2012). doi:10.1038/nrrheum.2012.46

Author: Katherine Smith

Notch receptors are implicated in regulating osteoclastogenesis—an important process in driving bone erosion during rheumatoid arthritis (RA). The role of individual Notch receptors and ligands in osteoclastogenesis, however, are currently undefined. Now, Sekine et al. have identified differential roles for the Notch2 receptor

Nature Reviews Rheumatology 8, 248 (2012). doi:10.1038/nrrheum.2012.52

Author: Sarah Onuora

The results of experiments carried out in mice could provide new insight into the relationship between inflammation and ankylosis in spondyloarthritis (SpA). In a model of spontaneous arthritis, treatment with glucocorticoids inhibited inflammation but did not halt the formation of new bone that leads to

Nature Reviews Rheumatology 8, 248 (2012). doi:10.1038/nrrheum.2012.55

Author: David Killock

Glucocorticosteroids used to treat both adult and pediatric rheumatic diseases are known to have adverse effects on bone, which can impair growth in children and contribute to development of osteoporosis. New data from Farasat Zaman and colleagues, at the Karolinska Institute, Sweden, suggest that the

Nature Reviews Rheumatology 8, 249 (2012). doi:10.1038/nrrheum.2012.43

Authors: James T. Rosenbaum & Holly L. Rosenzweig

Although systemic lupus erythematosus is the prototype multisystem disease, many other inflammatory diseases are also promiscuous, with symptoms manifesting in many organs. Now, new data emphasize the extra-articular involvement in spondyloarthritis, predominantly affecting the eye; however, the factors that account for the observed organ involvement remain unknown.

Nature Reviews Rheumatology 8, 251 (2012). doi:10.1038/nrrheum.2012.56

Author: Philip J. Mease

Although methotrexate is the most widely used medication for psoriatic arthritis (PsA), evidence for its effectiveness is scant. The recent MIPA trial failed to show disease-modifying effects. Was this outcome due to true inefficacy, or to trial issues? Data on symptom-modulating and disease-modifying effects of methotrexate in PsA are explored.

Nature Reviews Rheumatology 8, 253 (2012). doi:10.1038/nrrheum.2012.33

Authors: Astrid van Tubergen & Ulrich Weber

Spondyloarthritis (SpA) defines a group of interrelated diseases, including ankylosing spondylitis (AS), psoriatic arthritis, reactive arthritis, enteropathic-related spondylitis and arthritis, and undifferentiated SpA. The clinical presentation of SpA is heterogeneous, and no single shared distinguishing feature exists for the conditions comprising SpA; in daily practice,

Nature Reviews Rheumatology 8, 262 (2012). doi:10.1038/nrrheum.2012.39

Authors: Martin Rudwaleit & Joachim Sieper

The spectrum of HLA-B27-associated inflammatory spine diseases is referred to as axial spondyloarthritis (axSpA). AxSpA encompasses established ankylosing spondylitis (AS) but also nonradiographic axSpA, and can be classified according to the Assessment of SpondyloArthritis international Society classification criteria for axSpA. Specific and effective therapy

Nature Reviews Rheumatology 8, 269 (2012). doi:10.1038/nrrheum.2012.37

Authors: Shirley M. L. Tse & Ronald M. Laxer

Juvenile spondyloarthritis (SpA) is a distinct disease to adult SpA, and usually manifests as peripheral arthritis and enthesitis. Importantly, many patients with juvenile SpA continue to be at risk of developing ankylosing spondylitis during their disease course. In this Review, the classification and diagnostic criteria,

Nature Reviews Rheumatology 8, 280 (2012). doi:10.1038/nrrheum.2012.40

Author: Joachim Sieper

First-line therapy for spondyloarthritis (SpA) has not yet altered in the wake of new classification criteria; NSAIDs and physical therapy are recommended. Anti-TNF agents can be used when NSAIDs fail, but their efficacy has potentially been limited in previous trials by inclusion criteria requiring the

Nature Reviews Rheumatology 8, 288 (2012). doi:10.1038/nrrheum.2012.42

Authors: Liesbet Van Praet, Peggy Jacques, Filip Van den Bosch & Dirk Elewaut

That gut and joint inflammation are linked in spondyloarthritis (SpA) has been recognized for almost three decades. Intriguingly, microscopic gut inflammation, which occurs frequently in patients with SpA, is an important risk factor for clinically overt Crohn's disease and ankylosing spondylitis. This Review describes current

Nature Reviews Rheumatology 8, 296 (2012). doi:10.1038/nrrheum.2012.41

Author: John D. Reveille

Ankylosing spondylitis (AS), psoriasis and inflammatory bowel disease (IBD) often coexist in the same patient and in their families. In AS, genes within the MHC region, in particular HLA-B27, account for nearly 25% of disease hereditability, with additional small contributions from genes outside of