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The author discusses the article "Genome-wide Investigation of Persistence of Treatment With Methotrexate in Early Rheumatoid Arthritis" by Öberg Sysoeve and colleagues, published in the issue. She talks about the use of methotrexate (MTX), the clinical practice issues that can influence tolerance and effectiveness of MTX, and studies from the U.S. about the underutilization and underdosing of MTX.

The author reflects on the challenges and issues in the treatment of systemic juvenile idiopathic arthritis (SJIA) and macrophage activation syndrome (MAS). SJIA is a distinct subtype of childhood arthritis, while MAS is a prototypical cytokine storm syndrome. Also cited is the study which examined the association of interleukin-18 (IL-18)/IFNγ axis in SJIA with MAS and treatment responses.

The author reflects on the accomplishments in efforts to treat autoimmune disorders like systemic lupus erythematosus (SLE) and lupus nephritis (LN) as of December 2020. Topics include the neuropsychiatric (NP) and renal manifestations of SLE and LN, the importance of biomarkers in diagnosis, and the key role played by B cell activating factor (BAFF) in SLE and LN.

The authors discuss a study published in the issue which analysed the prevalence and clinicopathological associations of autoantibodies in a large cohort of inflammatory myopathy patients from Australia and a comparator group of patients with systemic sclerosis (SSc). Topics include the role of the autoantibody as a diagnostic marker of myositis subtype, boundaries between myositis and dystrophies, and antibody that could be the missing link between inflammation and muscle tissue degeneration.

The author discusses a study on the mechanisms that lead to local antibody production by CD4+ T cells in systemic lupus erythematosus (SLE). Highlights include the reason why T cells infiltrate the peripheral tissue in SLE, a subset of circulating peripheral helper T cells that show similarities to follicular helper T cells, and serological changes that occur in patients following B-cell depletion therapy.

The author discusses a range of biomarkers that have been studied to determine whether there is potential to improve the prediction of radiographic spinal progression in axial spondyloarthritis (axSpA). Highlights include HLA-B27 as the only biomarker with clinical utility for diagnostic purposes, an incomplete list of biomarkers that have been studied in axSpA, and the link between inflammation and bone formation in axSpA.

The authors discuss a study that gives some insights into the typical vasculopathy in the context of systemic sclerosis (SSc). Highlights include the role of lysyl oxidases (LOXs) in several crucial physiological functions, the role of LOXs in multiple pathological fibrotic conditions, and the potential origin of serum LOX in SSc.

The author reflects on the approved biomarkers for the early diagnosis of systemic juvenile idiopathic arthritis (sJIA), which is a rare childhood polygenic autoinflammatory disease. Other topics include the sJIA symptoms like arthralgia, fever and rashes, the study which assessed the performance of myeloid-related protein 8/14 (MRP8/14) as diagnostic biomarker of sJIA, and the effectiveness of the interleukin 1 (IL-1) and IL-6 inhibitors in managing patients with sJIA.

The author discusses the facts and fictions of precision medicine in autoimmune diseases. Topics include why autoimmune diseases provide an excellent field for precision medicine model application, the application of cellular, molecular and transcriptional profiling and single-cell RNA sequencing of synovial tissue in the identification of rheumatoid arthritis patient clusters and the value of the integration of large molecular and clinical data from patients with autoimmune diseases.

Early differentiation between infection and aseptic inflammation is difficult and is a challenge often faced in the rheumatology practice. Procalcitonin (PCT) is a biomarker that is preferentially induced in patients with bacterial infections, and a growing body of evidence supports its use for improving diagnosis of bacterial infections and guiding antibiotic therapy. In this article, we review the evidence for the use of PCT measurement in rheumatology practice. Several studies have examined the use of PCT to assist in the differentiation between septic and non-septic arthritis in patients with an inflamed joint and found it to be a sensitive and specific marker of infection. A number of studies in patients with diverse inflammatory rheumatic diseases have provided useful information regarding the usefulness of PCT in these patients. In summary, PCT when used in the appropriate clinical setting can be a useful adjunct to currently available laboratory infection markers, though further studies are warranted. Furthermore, PCT results should be interpreted in parallel with the clinical assessment. [ABSTRACT FROM PUBLISHER]

The article discusses a study on the immunologic heterogeneity within the overall group of patients classified as having psoriatic arthritis. The authors examined the efficacy of steering the choice of biologic on a per-patient immunologic basis in the strategic arm as compared with a standard-of-care approach. The authors have addressed recent calls for novel trial design. Slight caution is warranted as the strategic arm and standard-of-care arm were different in some key factors.

The authors discuss advances in the field of epigenetics that helps for understanding how environmental factors may trigger the development of complex diseases. They said that failure of cell processes can cause disease or increase susceptibility to future conditions. It is noted that environmental interactions encountered by ancestors have contributed to the shape of current epigenetic marks. It is said that there is a thorough removal of parental epigenetic marks during embryogenesis.

The authors convey their views on a collaboration of academically-interested clinicians and patients in Great Britain that acts as a focus for disease education. Topics mentioned include the strategy of patients playing an equal part within the consortium, efforts of patient and professional groups to raise awareness of rheumatological conditions for patients, health professionals, and decision makers, and the research-related ties between the pharmaceutical industry and clinical academics.