Latest Research We observe that the preclinical phase of RA is characterized by an accumulation of multiple autoantibody specificities reflecting the process of epitope spread. Epitope expansion is closely correlated with the appearance of preclinical inflammation, and we identify a biomarker profile including autoantibodies and cytokines. Autoantibody Epitope Spreading in the Pre-Clinical Phase Predicts Progression to Rheumatoid Arthritis. Sokolove J, et al. PLoS One. 2012;7(5):e35296. The aged immune system is prone to autoimmune responses and many autoimmune diseases increase in incidence with age or are even preferentially encountered in the elderly. Why an immune system that suboptimally responds to exogenous antigen fails to maintain tolerance to self-antigens. The Janus Head of T cell aging-Autoimmunity and Immunodeficiency. Goronzy JJ, et al. Front Immunol. 2013;4:131. The distinct associations of PR3-ANCA and MPO-ANCA with different HLA class II antigens, possible role for silica exposure in AAVs and Staphylococcus aureus infection in GPA indicate that GPA and MPA are different diseases. Pathogenesis of ANCA-Associated Vasculitis: New Possibilities for Intervention. Kallenberg CG, et al. Am J Kidney Dis. 2013 Jun 27. [Epub ahead of print] In MTX-naïve RA, up to 2 years of golimumab+MTX yielded sustained improvements in clinical signs/symptoms, physical function, and radiographic progression. Golimumab, a Human Anti-TNF Monoclonal Antibody, Injected Subcutaneously Every 4 Weeks in MTX-Naïve Patients with Active Rheumatoid Arthritis: 1-year and 2-year Clinical, Radiological, and Physical Function Findings of a Phase 3, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study. Emery P, et al. Arthritis Care Res (Hoboken). 2013 Jul 16. [Epub ahead of print] Therapeutic targets have been defined for diseases like diabetes, hypertension or rheumatoid arthritis and adhering to them has improved outcomes. Such targets are just emerging for spondyloarthritis (SpA). Treating Spondyloarthritis, including Ankylosing Spondylitis and Psoriatic Arthritis, to Target: Recommendations of an International Task Force. Smolen JS, et al. Ann Rheum Dis. 2013 Jun 8. [Epub ahead of print] We found similar responses to TNFi in patients with and without concomitant MTX, but drug survival was superior in patients receiving co-medication. The effect of MTX on drug survival was most prominent in patients receiving IFX. The Role of Methotrexate Co-medication in TNF-inhibitor Treatment in Patients with Psoriatic Arthritis: Results from 440 Patients included in the NOR-DMARD Study. Fagerli KM, et al. Ann Rheum Dis. 2013 Jan 3. [Epub ahead of print] We found similar responses to TNFi in patients with and without concomitant MTX, but drug survival was superior in patients receiving co-medication. The effect of MTX on drug survival was most prominent in patients receiving IFX. The Role of Methotrexate Co-medication in TNF-inhibitor Treatment in Patients with Psoriatic Arthritis: Results from 440 Patients included in the NOR-DMARD Study. Fagerli KM, et al. Ann Rheum Dis. 2013 Jan 3. [Epub ahead of print] Parallel occurrence of inflammation and FD at baseline and development of FD without prior inflammation after 2 years were significantly associated with syndesmophyte formation after 5 years of anti-tumor necrosis factor (TNF) therapy. Which Spinal Lesions are Associated with New Bone Formation in Patients with Ankylosing Spondylitis Treated with Anti-TNF Agents? A Long-Term Observational STudy using MRI and Conventional Radiography. Baraliakos X, et al. Ann Rheum Dis. 2013 Jul 14. [Epub ahead of print] TNF-inhibitor treatment was associated with a 50% reduction in the odds of progression. Patients with a delay in starting therapy of more than 10 years were more likely to progress compared to those who started earlier. The Impact of TNF-inhibitors on Radiographic Progression in Ankylosing Spondylitis. Haroon N, et al. Arthritis Rheum. 2013 Jul 1. [Epub ahead of print] Randomized, multicenter, open-label clinical equivalence trial including 137 patients with JIA shows that among children with JIA who had undergone primary immunization, MMR booster vaccination compared with no booster did not result in worse JIA disease activity and was immunogenic. Effects of the Live Attenuated Measles-Mumps-Rubella Booster Vaccination on Disease Activity in Patients with Juvenile Idiopathic Arthritis: A Randomized Trial. Heijstek MW, et al. JAMA. 2013;309(23):2449–2456. Sixty nine children with a median age of 8.5 years were identified. Relapse rate was 34%; mortality was 4%. GI involvement was associated with increased risk of relapse whilst longer time to induce remission and increased cumulative cyclophosphamide dose were associated with lower relapse risk. Systemic Polyarteritis Nodosa in the Young: A Single Centre Experience over 32 Years. Eleftheriou D, et al. Arthritis Rheum. 2013 Jun 10. [Epub ahead of print] 173 individuals were identified with CHIKV, of whom 136 (78.6%) reported persisting musculoskeletal symptoms 27.5 months after infection. We found that 5% of those infected with CHIKV fulfilled a modified version of the American College of Rheumatology criteria for rheumatoid arthritis 27.5 months after infection. Prevalence of and Risk Factors for Chronic Arthralgia and Rheumatoid-Like Polyarthritis more than 2 Years after Infection with Chikungunya Virus. Essackjee K, et al. Postgrad Med J. 2013;89(1054):440–447. Infections accounted for the majority (64/79), the most common being histoplasmosis (37) and non-tuberculous mycobacterial infections (18). Non-infectious diagnoses (15/79) were rheumatoid nodule (5), granulomatosis with polyangiitis (5), sarcoidosis (4), and chronic granulomatous disease (1). Pulmonary Necrotizing Granulomas of Unknown Etiology: Clinical and Pathologic Analysis of 131 Patients with Completely Resected Nodules. Mukhopadhyay S, et al. Chest. 2013 Apr 4. [Epub ahead of print] A total of 149 patients were randomized to bronchoscopy and 155 to endosonography. Significantly more granulomas were detected at endosonography vs. bronchoscopy 74% vs. 48%. Diagnostic yield to detect granulomas for endosonography was 80% for bronchoscopy, 53%. Endosonography vs. Conventional Bronchoscopy for the Diagnosis of Sarcoidosis: The GRANULOMA Randomized Clinical Trial. von Bartheld MB, et al. JAMA. 2013 Jun 19;309(23):2457–2464. Clinical evidence of sustained resolution or improvement was demonstrated in 58.5% of all organs assessed .No clinical change in disease activity was seen in 35.8% of all organs evaluated. Despite infliximab treatment, 5.7% had progressive disease activity. Long Term Follow-up of Infliximab Efficacy in Pulmonary and Extra-pulmonary Sarcoidosis Refractory to Conventional Therapy. Russell E, et al. Semin Arthritis Rheum. 2013 Jan 16. [Epub ahead of print] Significant association was found between myelopathy and low complement (C4) levels and disease activity measured as SLEDAI. We found no relationship between MRI changes and age, time of evolution, or presence of antiphospholipid or anti-dsDNA antibodies. Neuropsychiatric Systemic Lupus Erythematosus: Magnetic Resonance Imaging Findings And Correlation With Clinical And Immunological Features. Toledano P, et al. Autoimmun Rev. 2013 Jul 11. [Epub ahead of print] Our results suggest that frequent consumption of soft drinks may be associated with increased OA progression in men. Replication of these novel findings in other studies demonstrating the reduction in soft drink consumption leads to delay in OA progression is needed. Soft drink intake and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative. Lu B, et al. BMJ Open. 2013;3(7).