Zeitschrift fur Rheumatologie最新文献

Background: Demographic change and a growing shortage of healthcare professionals pose significant challenges to the German healthcare system. Rheumatology is particularly affected due to increasing patient demand and evolving societal expectations regarding work-life balance, family compatibility, and gender equity. As a result, flexible working time models are gaining importance.

Objective: This study aimed to assess existing and desired working time models in rheumatology, their feasibility, and perceived barriers from the perspectives of both employees and leadership.

Methods: The Commission of Equal Opportunities of the German Society for Rheumatology (DGRh) developed two online questionnaires targeting rheumatology healthcare professionals in employee and leadership roles asking about their current employment situation, existing flexible working time models, and preferences and feasibility of various working time models. The survey was distributed between September 2024 and March 2025 via the mailing lists of the DGRh and the Association of Rheumatological Acute Clinics (VRA), and via personal contacts by email, and subsequently evaluated descriptively.

Results: A total of 151 individuals participated (111 employees, 40 leaders). Part-time work, especially in outpatient care, was common and frequently desired. The 4‑day workweek and hybrid models (e.g., home office) were considered attractive but posed organizational challenges. Of the employees, 24% reported having changed jobs due to a lack of flexible options; 30% of leaders had lost staff for the same reason. Most respondents prioritized flexibility over reduced working hours.

Conclusion: Flexible working time models are generally desired and often feasible in rheumatology but require tailored implementation and structural support. They are essential for improving job satisfaction and staff retention and should be strategically promoted to ensure sustainable rheumatologic care.

Objective: Belimumab and anifrolumab are two biologic therapies currently employed in the management of systemic lupus erythematosus (SLE). Belimumab is approved for both SLE and lupus nephritis (LN), whereas anifrolumab is not currently approved for LN and has only been evaluated for LN in one published phase II trial. Direct head-to-head comparative data are lacking. This meta-analysis aims to indirectly compare the efficacy and safety of belimumab and anifrolumab using evidence from randomized controlled trials (RCTs).

Methods: We performed a comprehensive search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Indirect comparative analyses were conducted using odds ratios (ORs) and hazard ratios (HRs) derived from clinical trial data comparing both belimumab and anifrolumab with placebo for SLE and LN. Primary endpoints included SRI‑4 response, SELENA-SLEDAI ≥ 4 reduction, corticosteroid dose reduction, incidence of severe flares, normalization of anti-dsDNA, and normalization of C3/C4 in SLE as well as complete renal response (CRR), renal event-free survival, and immunologic biomarkers in LN. Safety was evaluated based on the incidence of herpes zoster, serious infections, and mortality.

Results: Seven RCTs comprising 4332 patients treated with either belimumab or anifrolumab for SLE or LN were included in this meta-analysis. For SLE, belimumab demonstrated superior SRI‑4 response rates (OR = 1.99, 95% CI: 1.25-3.16) relative to anifrolumab, whereas anifrolumab yielded greater benefit in steroid tapering (OR = 0.31, 95% CI: 0.19-0.51) and immunologic normalization (anti-dsDNA: OR = 0.69, 95% CI: 0.43-1.10; C3/C4: OR = 0.69, 95% CI: 0.42-1.13). In LN, both agents improved CRR rates compared to placebo; however, indirect comparisons between the two agents were not definitive due to wide confidence intervals (CRR: OR = 0.83, 95% CI: 0.22-3.10). Safety profiles were similar in terms of serious infections and mortality, although anifrolumab was linked to higher rates of herpes zoster (7.2% vs. 3.2-4.6% for belimumab).

Conclusion: Belimumab confers greater benefit in terms of SRI‑4 response for SLE, while anifrolumab is more effective for corticosteroid tapering and immunologic parameter normalization. In LN, the comparative efficacy remains uncertain. Both agents exhibit similar safety profiles, but anifrolumab is associated with an increased risk of herpes zoster. Differences in study design, inclusion criteria, and assessment protocols among included trials may limit direct comparability.

Digital health applications (DHA) can provide exercise therapy, behavioral interventions or patient education. These interventions are of high relevance in axial spondyloarthritis (axSpA). Therefore, axSpA represents a potentially promising area of DHA usage; however, no DHA has yet been officially approved for axSpA. Currently, the medical apps Axia and RheCORD Plus are in the DiGA approval track. So far, published study results are only available for Axia and appear promising. In addition to these apps, DHAs such as ViViRA or HelloBetter Chronic Pain are being tested in axSpA, and initial study results also show positive effects in this context. The use of DHAs in axSpA thus shows promising potential, although further research is needed to evaluate long-term effectiveness, cost-effectiveness and user acceptance.

Dual-energy X‑ray absorptiometry (DXA) assessing the lumbar spine and bilateral proximal femurs is the current guideline-recommended standard method for quantitative measurement of bone density. The output of DXA-the T score-reflects the number of standard deviations by which the measured bone density differs from the average of a healthy young reference population. The operational World Health Organization (WHO) definition of osteoporosis is based on a T score ≤-2.5 at the femoral neck, although other measurement locations are interpreted analogously in clinical routine. Numerous studies have shown that a decrease in bone density is associated with an exponential increase in the fracture risk. However, consideration of the bone density in isolation is inadequate to predict the real fracture risk. Therefore, DXA results must always be interpreted within the context of other clinical risk factors. Additional DXA methods and further analyses can significantly improve the diagnostic accuracy.

Background: Gastrointestinal involvement is common in eosinophilic granulomatosis with polyangiitis (EGPA) and has a poor prognosis.

Objectives: The aim of our study was to determine the density of eosinophils in the gastrointestinal tract that should be considered pathological in patients with EGPA, and how clinically and prognostically relevant intramucosal eosinophil accumulation is in patients with EGPA.

Methods: Forty-nine subjects were included in the study: 18 with EGPA (9 women) and as a control group 31 with other rheumatological inflammatory diseases. Two hundred and forty-four biopsies from the gastrointestinal tract of the study participants were analyzed.

Results: Histologically, there was no significant difference in eosinophil counts between patients with EGPA and the control group; however, there was an increased density when macroscopic gastrointestinal inflammation was already present.

Conclusions: Biopsies from macroscopically unremarkable mucosa appear to have limited diagnostic utility.

Introduction: Demographic change is expected to further aggravate the existing shortage of rheumatological care in Germany, particularly in rural regions. Increased involvement of general practitioners (GPs) and more digitalization are therefore considered promising strategies to improve care of rheumatological patients.

Objectives: Assessment of the current state of GP-based care for patients with rheumatic diseases, with a particular focus on the role of digitalization.

Materials and methods: To answer these questions, a cross-sectional study was conducted among GPs in the region of the Rheumatology Centre Würzburg using a questionnaire with 10 domains and 13 question items.

Results: In all, 92 GPs participated in the survey, representing approximately 10% of the GPs working in Lower Franconia. On average, 3.9 patients with suspected rheumatic disease are seen per quarter and 22 patients with confirmed inflammatory rheumatic disease are medically cared for. Furthermore, 62% are confident that they can take responsibility for the care of stable rheumatological patients without rheumatological guidance. The majority of them (94.6 %) already obtain their information from digital sources. Only 30.4 % are familiar with digital training for rheumatology, and only 3% uses screening tools for rheumatism. Digital health applications (DiGAs) have already been prescribed by 61%.

Conclusion: GPs are already making a significant contribution to the care of rheumatological patients and they are willing to provide care for rheumatological patients with stable pharmacotherapy. Digitalization is already being used by GPs in the care of rheumatology patients, but there is still considerable potential for use of digital tools/applications.