COMMENTARY

Rheumatology Advances to Know From 2015

Kevin Deane, MD, PhD

Disclosures

December 23, 2015

In This Article

Biosimilars and the Biome

As of 2015, biosimilars for rheumatic diseases have not been approved in the United States. However, they are in use in Canada, Europe, and Asia, and some agents are expected in the United States in the near future.[9] The issues of the efficacy, safety, affordability, and approved indications of these agents compared with their parent agents will be major areas of consideration.

The Microbiome and Mucosal Inflammation

In 2015, several advances were made in understanding the relationship between microbes and mucosa and rheumatic diseases. In particular, a deeper relationship between periodontal inflammation and RA was found, although it is still not clear whether periodontal disease is a trigger for RA, a propagating factor, a target of circulating autoimmunity, or all three of these.[10]

Zhang and colleagues[11] found an association between the microbiome of the gut (and other mucosal areas) and RA activity in Chinese patients; specifically, certain organisms were associated with changes in disease activity. There has been also been a growing awareness of relationships between microbes, mucosal inflammation and lupus, antiphospholipid antibody syndrome and other rheumatic diseases.[12,13]

Finally, in a case/control study, Horton and colleagues[14] found a significant association between the use of antibiotics and a future diagnosis of juvenile idiopathic arthritis. Although specific causal factors were not identified, the authors speculated that antibiotics may have altered the microbioal constituents of the gut or other sites and triggered disease.

It is of high interest to identify microbial factors that, if modified, could treat or prevent rheumatic disease. Much still needs to be learned about microbes and their relationship with their human hosts before clinical practice for rheumatic diseases will substantially change. But as the ability to identify microbes as well as their effects on mucosal surfaces and systemic immunity increases, in the near future, there may be more direct roles for manipulation of the microbiome and mucosal surfaces in the treatment of rheumatic disease.

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