Zeitschrift fur Rheumatologie最新文献

Background and objective: Patient education is an integral component of the treatment of axial spondyloarthritis (axSpA). However, the validated tools currently available for assessing disease-related knowledge are outdated and, in the case of axSpA, only available in English. The aims of this work were therefore (1) to develop a German-language tool for assessing disease-specific knowledge among axSpA patients and (2) to assess this tool in a pilot study.

Methods: Available axSpA-specific tools were assessed by a panel of experts and a draft of the current G‑ASKQ7 questionnaire was agreed upon. After evaluation of face validity and subsequent adaptation, consecutive adult axSpA patients of a university hospital (Universitätsklinikum Erlangen) outpatient rheumatology department were asked to complete the questionnaire. Correlation between the patients' overall scores and other collected parameters (age, sex, and disease duration) were investigated.

Results: Patients rated the developed G‑ASKQ7 questionnaire comprising seven questions as easy to understand and completed it within an average of 6.3 ± 2.0 min. The final questionnaire was completed by 65 axSpA patients (36 women; mean age 45.3 ± 12.4 years; mean disease duration 8.6 ± 7.3 years). The average G‑AKSQ7 score was 17.8/25, with significantly higher scores among women (19.0/25) than men (16.3/25; p ≤ 0.05). The question most often answered correctly (79.3 %) was question 7 concerning disease self-management, whereas question 4 on measurement of disease activity received the most incorrect answers (55.8 %). No significant correlation between disease duration (p = 0.57; Pearson's correlation coefficient, r = 0.07) or age (p  = 0.67; r = -0.05) and disease-specific knowledge was found.

Conclusion: The G‑ASKQ7 represents the first German-language instrument for measuring disease-specific knowledge among axSpA patients. Routine application of this questionnaire would enable low-threshold assessment of an individual patient's knowledge requirements and thus provision of appropriate educational information. Continuous updates and further evaluation studies are required.

Background: Patients with rheumatic diseases often enquire about the options for nutritional therapy. Nutritional factors have been empirically described that are associated with the occurrence of inflammatory rheumatic diseases or flare-ups or improved disease states. A growing number of epidemiological and clinical studies deal with the evaluation of nutrition and dietary restriction in rheumatology.

Objective: Narrative presentation of the evidence of nutritional interventions and fasting and its clinical implications.

Results and discussion: Only limited data from smaller clinical studies are available for evidence assessment. A benefit in terms of symptoms and quality of life in rheumatoid arthritis was shown for the Mediterranean and plant-based diet as well as the anti-inflammatory diet. The effect sizes are small to moderate and the effectiveness in the context of complex lifestyle programs is probably sustainable. The evidence for elimination diets is weak. Initial clinical studies indicate a moderate benefit of plant-based nutrition for osteoarthritis in the context of the metabolic syndrome. There is moderate evidence for the benefit of dietary weight normalization in psoriasis. There is clear experimental evidence of a significant anti-inflammatory effect of prolonged fasting. Several clinical studies demonstrated a symptomatic benefit of prolonged modified fasting (therapeutic fasting) in rheumatoid arthritis (RA). If fasting is followed by a vegan and vegetarian diet, lasting effects of up to 1 year have been documented. Cardiometabolic but not antirheumatic effects have been proven for intermittent fasting. Nutrition and fasting can be classified as a possible useful addition to conventional treatment but are currently only rarely taken into account in practice.

The coincidence of an inflammatory rheumatic and a malignant disease causes a physical, cognitive and psychological reduction in performance. The prescription of physical therapy is therefore essential to address safety issues associated with both diseases, as well as side effects associated with antirheumatic and antineoplastic therapy that can impact the treatment. It is important to perform a risk assessment prior to physical therapy to identify potential safety issues and to determine baseline physical and functional status. In this review article descriptive information and the current literature on the safety of physical therapy interventions for people with rheumatic and malignant disease are highlighted, taking the disease process, treatment side effects and associated precautions and contraindications into account.

Background: The effectiveness of additive cognitive training in groups to the standard physical-medical therapy for primary and secondary fibromyalgia syndrome (p/sFMS) and a subsequent home-based self-training phase (STP) was analyzed.

Methods: In the prospective controlled randomized study, 32 people with confirmed p/sFMS were included, whereby 4 patients could not be evaluated. During 2 weeks of acute inpatient therapy, the control group (CG; n = 12) received standard physical-medical therapy and the intervention group (IG, n = 16) also received social-communicative cognitive group training (once/day, 60 min). In the subsequent 3‑months, STP training was continued by both groups.

Results: Outcome parameters at baseline (U1), at discharge (U2), and after a quarter year (U3) were pain, well-being/depressive mood, general health, and cognitive parameters (memory functions, cognitive speed). Both groups showed significant pain relief (U2 vs. U1), which was 10% more in the IG. A significant improvement in mood could be seen in both groups, but only the IG no longer achieved depressive values in the follow-up (U3). An improvement in the general state of health was also detected in both groups, which was only maintained in the IG until the end of the STP. Cognitive performance remained the same in the IG at U2, while there was a reduction in the CG; cognitive speed could only be further improved in the IG during the STP. Adding cognitive training to a standard physical-medical clinical therapy resulted in significant pain relief and improvement of depression in patients during a hospital stay.

Women and men differ in terms of the development and manifestation of inflammatory rheumatic diseases and outcomes as well as with respect to disease perception, health behavior and response to antirheumatic treatment. Sex-specific aspects are increasingly being researched in nearly all medical disciplines to optimize treatment strategies with the aim to improve individual treatment success. This article describes sex differences that can even now be taken into account in rheumatological care.

Numerous reports in recent years have focused on the influence of environmental factors on rheumatoid arthritis. This article provides an overview of the current study situation on the influence of modifiable environmental factors on the development and course of rheumatoid arthritis. Lifestyle factors, such as cigarette smoking, diet, exercise and body weight can be individually influenced. Factors such as air pollution and socioeconomic status can be influenced by environmental and sociopolitical measures at a public level. Epidemiological studies have identified nicotine abuse, an unhealthy diet and obesity as well as a low level of education and social status as risk factors for the development of rheumatoid arthritis. Numerous factors are also associated with a poorer response to treatment and a worse prognosis. As randomized interventional studies on most environmental factors are hardly feasible, the causal relationship of the individual factors to the incidence and progression of rheumatoid arthritis is difficult to quantify. Nevertheless, the current evidence already enables the provision of appropriate counselling to patients with rheumatoid arthritis with respect to a healthy lifestyle including abstaining from cigarette smoking, maintaining a healthy diet, physical activity and avoiding obesity.

Treatment of a rheumatic diseases without physical and occupational therapy is almost incomplete because it cannot be replaced by anything else; however, slightly less than half of all insured persons with inflammatory rheumatic diseases only receive an outpatient prescription and this proportion has hardly changed in the last 15 years. This is even more surprising as those affected persons often have limitations in functional health due to multimorbidity, which are very accessible by physical measures. The article is intended to serve as a basis for a recourse-proof prescription in order to make even greater use of the corresponding possibilities of an outpatient physical prescription in the future.