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Topic Review
Treatment Approach of Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE), the prototype of systemic autoimmune diseases is characterized by extreme heterogeneity with a variable clinical course. Renal involvement may be observed and affects the outcome. Hydroxychloroquine should be administered to every lupus patient irrespective of organ involvement. Conventional immunosuppressive therapy includes corticosteroids, methotrexate, cyclophosphamide, mycophenolate mofetil, azathioprine, cyclosporine and tacrolimus. However, despite conventional immunosuppressive treatment, flares occur and broad immunosuppression is accompanied by multiple side effects. Flare occurrence, target organ involvement, side effects of broad immunosuppression and increased knowledge of the pathogenetic mechanisms involved in SLE pathogenesis as well as the availability of biologic agents has led to the application of biologic agents in SLE management. Biologic agents targeting various pathogenetic paths have been applied. B cell targeting agents have been used successfully. Belimumab, a B cell targeting agent, has been approved for the treatment of SLE. Rituximab, an anti-CD20 targeting agent is also used in SLE. Anifrolumab, an interferon I receptor-targeting agent has beneficial effects on SLE. In conclusion, biologic treatment is applied in SLE and should be further evaluated with the aim of a good treatment response and a significant improvement in quality of life.
  • 167
  • 10 Jul 2023
Topic Review
Treat-to-Target in Systemic Lupus Erythematosus
Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic lupus erythematosus (SLE), defining the most meaningful treatment targets has been challenging, due to disease complexity and heterogeneity. Control of disease activity, the reduction of damage accrual and the patient’s quality of life should be considered as the main targets in SLE, and several new drugs are emerging to achieve these targets. 
  • 163
  • 13 Jun 2023
Topic Review
Therapy of the Rheumatic Knee
In rheumatoid arthritis, the joints of the lower extremities are almost always affected. This is most conspicuous in the knee joint. In rheumatics, inflammatory osteoarthritis manifests itself comparably earlier than in patients with osteoarthritis. The focus of attention was primarily on the synovia with its destruction process and secondary changes. Now, driven by experimental research, dendritic cells and fibroblasts and molecular features are moving into the clinician’s field of vision. Even in joints that appear to be in remission with no swelling or pain, the activity of these cells leads to changes in the capsule-ligaments. The complex deformities and instabilities caused by this, in conjunction with atrophy of the inter-articular musculature, have an impact on the activities of daily life (ADL). If these biomechanical aspects of the knee joint are not taken into account early on in therapy, the frequency of primary and secondary surgical treatment increases. The timely recognition of biomechanical pathologies and consistent treatment can contribute to improving the patient situation in addition to adequate medication therapy. 
  • 570
  • 07 Apr 2021
Topic Review
The Treatment of Enthesitis-Related Arthritis
Enthesitis-related arthritis (ERA) represents 5–30% of all cases of juvenile idiopathic arthritis (JIA) and belongs to the spectrum of the disorders included in the group of juvenile spondyloarthritis. In the last decade, there have been considerable advances in the classification, diagnosis, monitoring, and treatment of ERA. New provisional criteria for ERA have been recently proposed by the Paediatric Rheumatology INternational Trials Organisation, as part of a wider revision of the International League of Associations for Rheumatology criteria for JIA. The therapeutic recommendations for ERA are comparable to those applied to other non-systemic JIA categories, unless axial disease and/or enthesitis are present. In such cases, the early use of a TNF-alpha inhibitor is recommended. Novel treatment agents are promising, including IL-17/IL-23 or JAK/STAT pathways blockers.
  • 169
  • 24 Oct 2023
Topic Review
The Role of T Cells in Systemic Sclerosis
Systemic sclerosis (SSc) is a chronic disease characterized by microvasculopathy, autoantibodies (autoAbs), and fibrosis. The pathogenesis of the disease is incompletely understood. Microvasculopathy and autoAbs appear very early in the disease process. AutoAbs, such as those directed against DNA topoisomerase I (Topo I), are disease specific and associated with disease manifestations, and indicate activation of the adaptive immune system. B cells are involved in fibrosis in SSc. T cells are also involved in disease pathogenesis. T cells show signs of antigen-induced activation; T cells of TH2 type are increased and produce profibrotic cytokines interleukin (IL)-4, IL-13, and IL-31; CD4+ cytotoxic T lymphocytes are increased in skin lesions, and cause fibrosis and endothelial cell apoptosis; circulating T follicular helper (TFH) cells are increased in SSc produce IL-21 and promote plasmablast antibody production. On the other hand, regulatory T cells are impaired in SSc. These findings provide strong circumstantial evidence for T cell implication in SSc pathogenesis and encourage new T cell-directed therapeutic strategies for the disease.
  • 335
  • 26 Sep 2022
Topic Review
The Role of Interleukin-17 in Juvenile Idiopathic Arthritis
Interleukin-17 (IL-17) is a cytokine family consisting of six members and five specific receptors. IL-17A was the first member to be identified in 1993. Since then, several studies have elucidated that IL-17 has predominantly pro-inflammatory activity and that its production is involved in both the defense against pathogens and the genesis of autoimmune processes.
  • 371
  • 03 Jan 2023
Topic Review
The Role of Alarmins in Osteoarthritis Pathogenesis
Osteoarthritis (OA) is a multifactorial disease in which genetics, aging, obesity, and trauma are well-known risk factors. It is the most prevalent joint disease and the largest disability problem worldwide. Findings have described the role of damage-associated molecular patterns (DAMPs) in the course of the disease. In particular, alarmins such as HMGB1, IL-33, and S100B, appear implicated in enhancing articular inflammation and favouring a catabolic switch in OA chondrocytes.
  • 159
  • 07 Sep 2023
Topic Review
The Neuropathic Pain
A consensus definition of neuropathic pain is ‘pain resulting from a lesion of the somatosensory system, which results in faulty pain signaling’
  • 423
  • 12 Jul 2022
Topic Review
The Contribution of Innate Immunity in Large-Vessel Vasculitis
Large-vessel vasculitis (LVV) are granulomatous vasculitis affecting medium- and large-sized arteries, especially the aorta and its main branches. They are mainly represented by giant cell arteritis (GCA) and Takayasu arteritis (TAK), both marked by vessel wall inflammation and remodeling, accounting for arterial stenosis and subsequent ischemic manifestations or aortic aneurysms and dissection.
  • 64
  • 18 Feb 2024
Topic Review
Tendinopathies
Tendinopathy is an umbrella term used to identify a complex clinical condition characterized by molecular, cellular, and histological changes occurring in affected tendons that leads to persistent pain, swelling, and impaired physical performance. Several pathogenic mechanisms are involved in the occurrence of this condition. High load demands and repetitive mechanical exposure during exercise act as primum movens of tendinopathy.
  • 528
  • 08 Nov 2021
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