Pub Date : 2024-11-06DOI: 10.1038/s41584-024-01181-x
Sarah L. N. Clarke, Panagiotis Maghsoudlou, Catherine M. Guly, Andrew D. Dick, Athimalaipet V. Ramanan
Uveitis encompasses multiple different conditions that are all characterized by intra-ocular inflammation. Uveitis occurs in the context of many different rheumatological conditions and carries a substantial risk to vision. Uveitis can develop both at the early stages of rheumatic diseases, sometimes even preceding other clinical features, and at later stages of disease. Uveitis can also occur as either a direct or an indirect complication of therapies used to treat patients with rheumatic disease. Conversely, patients with uveitis of non-rheumatic aetiology sometimes require immunosuppression, a treatment option that is not readily accessible to ophthalmologists. Thus, collaborative working between rheumatologists and ophthalmologists is critical for optimal management of patients with uveitis. This Review is written with rheumatologists in mind, to assist in the care of patients with uveitis. We collate and summarize the latest evidence and best practice in the diagnosis, management and prognostication of uveitis, including future trends and research priorities. This Review provides an overview of the pathogenesis, classification and diagnosis of and treatment strategies for adult and paediatric rheumatology patients with uveitis. The authors highlight the importance of collaborations between ophthalmologists and rheumatologists to provide optimal treatment of uveitis, improve patient care and enhance future research.
{"title":"The management of adult and paediatric uveitis for rheumatologists","authors":"Sarah L. N. Clarke, Panagiotis Maghsoudlou, Catherine M. Guly, Andrew D. Dick, Athimalaipet V. Ramanan","doi":"10.1038/s41584-024-01181-x","DOIUrl":"10.1038/s41584-024-01181-x","url":null,"abstract":"Uveitis encompasses multiple different conditions that are all characterized by intra-ocular inflammation. Uveitis occurs in the context of many different rheumatological conditions and carries a substantial risk to vision. Uveitis can develop both at the early stages of rheumatic diseases, sometimes even preceding other clinical features, and at later stages of disease. Uveitis can also occur as either a direct or an indirect complication of therapies used to treat patients with rheumatic disease. Conversely, patients with uveitis of non-rheumatic aetiology sometimes require immunosuppression, a treatment option that is not readily accessible to ophthalmologists. Thus, collaborative working between rheumatologists and ophthalmologists is critical for optimal management of patients with uveitis. This Review is written with rheumatologists in mind, to assist in the care of patients with uveitis. We collate and summarize the latest evidence and best practice in the diagnosis, management and prognostication of uveitis, including future trends and research priorities. This Review provides an overview of the pathogenesis, classification and diagnosis of and treatment strategies for adult and paediatric rheumatology patients with uveitis. The authors highlight the importance of collaborations between ophthalmologists and rheumatologists to provide optimal treatment of uveitis, improve patient care and enhance future research.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"795-808"},"PeriodicalIF":29.4,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142588532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1038/s41584-024-01186-6
Sarah Onuora
In an open-label clinical trial, collagenase injection was not noninferior to limited fasciectomy for the treatment of Dupuytren contracture.
在一项开放标签临床试验中，胶原酶注射治疗杜普伊特伦挛缩症的效果并不优于有限筋膜切除术。
{"title":"Dupuytren contracture treatments compared","authors":"Sarah Onuora","doi":"10.1038/s41584-024-01186-6","DOIUrl":"10.1038/s41584-024-01186-6","url":null,"abstract":"In an open-label clinical trial, collagenase injection was not noninferior to limited fasciectomy for the treatment of Dupuytren contracture.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"742-742"},"PeriodicalIF":29.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-04DOI: 10.1038/s41584-024-01187-5
Maria Papatriantafyllou
The presence of anti-IFI16 autoantibodies in patients with idiopathic interstitial pneumonia is linked to poor prognosis and could inform treatment.
特发性间质性肺炎患者出现抗IFI16自身抗体与预后不良有关，可为治疗提供参考。
{"title":"Novel autoantigen in idiopathic lung disease","authors":"Maria Papatriantafyllou","doi":"10.1038/s41584-024-01187-5","DOIUrl":"10.1038/s41584-024-01187-5","url":null,"abstract":"The presence of anti-IFI16 autoantibodies in patients with idiopathic interstitial pneumonia is linked to poor prognosis and could inform treatment.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"742-742"},"PeriodicalIF":29.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142574406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1038/s41584-024-01177-7
Johannes Knitza, Latika Gupta, Thomas Hügle
Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient–provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care. Digital health has the potential to improve patient care in rheumatology and alleviate strain on the health-care system. This Review explores the current status of the transition from traditional health care to a model that harnesses the potential of digital health technologies, including discussion of the main benefits and barriers.
{"title":"Rheumatology in the digital health era: status quo and quo vadis?","authors":"Johannes Knitza, Latika Gupta, Thomas Hügle","doi":"10.1038/s41584-024-01177-7","DOIUrl":"10.1038/s41584-024-01177-7","url":null,"abstract":"Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient–provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care. Digital health has the potential to improve patient care in rheumatology and alleviate strain on the health-care system. This Review explores the current status of the transition from traditional health care to a model that harnesses the potential of digital health technologies, including discussion of the main benefits and barriers.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"747-759"},"PeriodicalIF":29.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-31DOI: 10.1038/s41584-024-01185-7
Sarah Onuora
Findings from an observational study suggest that the frequency of uveitis in patients with spondyloarthritis has declined since the introduction of biologic DMARDs.
一项观察性研究结果表明，自生物 DMARDs 问世以来，脊柱关节炎患者发生葡萄膜炎的频率有所下降。
{"title":"Risk of uveitis in SpA is changing","authors":"Sarah Onuora","doi":"10.1038/s41584-024-01185-7","DOIUrl":"10.1038/s41584-024-01185-7","url":null,"abstract":"Findings from an observational study suggest that the frequency of uveitis in patients with spondyloarthritis has declined since the introduction of biologic DMARDs.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"741-741"},"PeriodicalIF":29.4,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1038/s41584-024-01178-6
Miguel López, Oreste Gualillo
Over the past few decades, the connection between metabolism and various inflammatory and rheumatic diseases has been an area of active investigation. Nonetheless, the precise mechanisms underlying these relationships remain a topic of ongoing debate, owing in part to conflicting data. This discrepancy can be attributed to the predominant focus on peripheral mechanisms in research into the metabolic consequences of rheumatic diseases. However, a wealth of evidence supports the notion that the central nervous system, specifically the hypothalamus, has an important influence on metabolic homeostasis. Notably, links have been established between crucial hypothalamic mechanisms responsible for regulating energy balance (including food intake, thermogenesis, and glucose and lipid metabolism), such as AMP-activated protein kinase, and the pathophysiology of rheumatoid arthritis. This Review aims to comprehensively examine the current understanding of central metabolic control in rheumatic diseases and explore potential therapeutic options that target this pathophysiological mechanism. In this Review, López and Gualillo discuss the complex interrelationships between rheumatic diseases and the hypothalamic and autonomic mechanisms that regulate metabolism, and explore the therapeutic potential of targeting central regulators of energy balance.
{"title":"Rheumatic diseases and metabolism: where centre and periphery meet","authors":"Miguel López, Oreste Gualillo","doi":"10.1038/s41584-024-01178-6","DOIUrl":"10.1038/s41584-024-01178-6","url":null,"abstract":"Over the past few decades, the connection between metabolism and various inflammatory and rheumatic diseases has been an area of active investigation. Nonetheless, the precise mechanisms underlying these relationships remain a topic of ongoing debate, owing in part to conflicting data. This discrepancy can be attributed to the predominant focus on peripheral mechanisms in research into the metabolic consequences of rheumatic diseases. However, a wealth of evidence supports the notion that the central nervous system, specifically the hypothalamus, has an important influence on metabolic homeostasis. Notably, links have been established between crucial hypothalamic mechanisms responsible for regulating energy balance (including food intake, thermogenesis, and glucose and lipid metabolism), such as AMP-activated protein kinase, and the pathophysiology of rheumatoid arthritis. This Review aims to comprehensively examine the current understanding of central metabolic control in rheumatic diseases and explore potential therapeutic options that target this pathophysiological mechanism. In this Review, López and Gualillo discuss the complex interrelationships between rheumatic diseases and the hypothalamic and autonomic mechanisms that regulate metabolism, and explore the therapeutic potential of targeting central regulators of energy balance.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"783-794"},"PeriodicalIF":29.4,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142541697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1038/s41584-024-01169-7
Victoria Konzett, Daniel Aletaha
Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the ‘maximum’ level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as ‘difficult to treat’. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient’s multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives. Despite the availability of numerous treatment options, the management of rheumatoid arthritis remains suboptimal. In this Review, Konzett and Aletaha discuss strategies to advance clinical decision-making from trial-and-error to an informed process that considers more than just drug efficacy, and appropriately balances effort and success.
类风湿性关节炎（RA）的管理已从简单地将药物疗效结果从临床试验直接转化为患者护理，发展为一个更为复杂的纵向过程，不仅要考虑药物疗效，还要考虑治疗的安全性、患者情况和偏好以及健康经济因素。由于治疗 RA 的 DMARDs 种类繁多，有关试验疗效的知识已变得不那么重要，重要的是能为最佳选择和使用这些药物的适当临床策略提供依据的数据。例如，过于雄心勃勃地追求 "最大 "成功率的方法很容易导致失败和挫败感，并导致大量患者被视为 "难以治疗"。对于精准医疗方法而言，安全性分析可能比疗效分析更有参考价值。因此，当代的 RA 管理策略可能会采取一种更全面的方法，而不仅仅是疗效，以设定可提高依从性的目标，而不是期望的成功，同时考虑到每位患者的多病情况和偏好，以及每种治疗方法的安全性。归根结底，我们的目标始终不变：最大限度地提高与健康相关的生活质量；然而，我们关注的是最佳平衡，而不是夸夸其谈。
{"title":"Management strategies in rheumatoid arthritis","authors":"Victoria Konzett, Daniel Aletaha","doi":"10.1038/s41584-024-01169-7","DOIUrl":"10.1038/s41584-024-01169-7","url":null,"abstract":"Management of rheumatoid arthritis (RA) has evolved from simply the direct translation of drug efficacy results from clinical trials to patient care, to a more complex longitudinal process that considers not only drug efficacy but also the safety gestalt of a treatment and patient profiles and preferences, as well as health-economic factors. With numerous DMARDs available to treat RA, knowledge about trial efficacy becomes less important than data that inform an appropriate clinical strategy for their optimal selection and use. Overly ambitious approaches targeting the ‘maximum’ level of success could, for example, be prone to failure and create frustration, and lead to a large number of patients then being considered as ‘difficult to treat’. Safety profiles might be more informative than efficacy profiles for precision medicine approaches. Contemporary RA management strategies might therefore take a more holistic approach, beyond merely efficacy, to the setting of targets that lead to improved compliance rather than aspirational successes, with consideration of each patient’s multimorbidity profile and preferences, as well as the safety profile of each treatment. Ultimately, the goal remains unchanged: maximizing health-related quality of life; however, with a focus on optimal balance rather than superlatives. Despite the availability of numerous treatment options, the management of rheumatoid arthritis remains suboptimal. In this Review, Konzett and Aletaha discuss strategies to advance clinical decision-making from trial-and-error to an informed process that considers more than just drug efficacy, and appropriately balances effort and success.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"760-769"},"PeriodicalIF":29.4,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1038/s41584-024-01183-9
Holly Webster
In a subset of monocytes in systemic lupus erythematosus, internalization of mitochondria-retaining red blood cells leads to type I interferon-mediated IL-1β release.
在系统性红斑狼疮的单核细胞亚群中，线粒体保留红细胞的内化会导致 I 型干扰素介导的 IL-1β 释放。
{"title":"Mito+ RBCs prompt IFN and IL-1β release by SLE monocytes","authors":"Holly Webster","doi":"10.1038/s41584-024-01183-9","DOIUrl":"10.1038/s41584-024-01183-9","url":null,"abstract":"In a subset of monocytes in systemic lupus erythematosus, internalization of mitochondria-retaining red blood cells leads to type I interferon-mediated IL-1β release.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"742-742"},"PeriodicalIF":29.4,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142487842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1038/s41584-024-01182-w
Holly Webster
New research demonstrates a key role for osmo-sensitive LRRC8 anion channels in crystal-induced inflammation.
新研究表明，对渗透敏感的 LRRC8 阴离子通道在晶体诱发的炎症中发挥着关键作用。
{"title":"Osmo-sensitive anion channels reduce crystal-induced inflammation","authors":"Holly Webster","doi":"10.1038/s41584-024-01182-w","DOIUrl":"10.1038/s41584-024-01182-w","url":null,"abstract":"New research demonstrates a key role for osmo-sensitive LRRC8 anion channels in crystal-induced inflammation.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"741-741"},"PeriodicalIF":29.4,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-15DOI: 10.1038/s41584-024-01180-y
Maria Papatriantafyllou
Synovial fibroblasts from individuals with OA release small extracellular vesicles with potentially pathogenic miRNA cargo.
患有 OA 的滑膜成纤维细胞会释放出含有潜在致病 miRNA 的小细胞外囊泡。
{"title":"Erosive cargo from synovial fibroblasts","authors":"Maria Papatriantafyllou","doi":"10.1038/s41584-024-01180-y","DOIUrl":"10.1038/s41584-024-01180-y","url":null,"abstract":"Synovial fibroblasts from individuals with OA release small extracellular vesicles with potentially pathogenic miRNA cargo.","PeriodicalId":18810,"journal":{"name":"Nature Reviews Rheumatology","volume":"20 12","pages":"741-741"},"PeriodicalIF":29.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142439169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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