Zeitschrift fur Rheumatologie最新文献

Objective: This study aimed to reassess the diagnostic contribution of minor salivary gland biopsy (MSGB) in patients with clinically suspected Sjögren's disease (csSjD) and to assess its association with serological status, clinical features, and fulfillment of classification criteria.

Methods: We retrospectively analyzed 313 patients who underwent MSGB for evaluation of csSjD between 2021 and 2024. All patients were evaluated according to 2016 American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) classification criteria at the end of the diagnostic workup. The MSGB was defined as positive if the focus score was ≥ 1/4 mm². Subgroup analyses were performed according to anti-Ro/SSA antibody status. Predictors of MSGB positivity were examined using logistic regression, and diagnostic performance was evaluated by receiver operating characteristic (ROC) analysis.

Results: The overall MSGB positivity rate was 24.6%. Rates were comparable between anti-Ro-positive (27.8%) and negative (24.2%) patients (p = 0.655). In seronegative patients, older age and longer symptom duration independently predicted biopsy positivity (p < 0.05), although the diagnostic discrimination was limited (AUC: 0.511). Notably, MSGB enabled fulfillment of classification criteria in 22.3% of seronegative cases. No clinical or laboratory variables predicted biopsy outcome in seropositive patients. Across the entire cohort, only CRP showed a weak correlation with histological severity (p = 0.05); MSGB positivity was not associated with systemic manifestations.

Conclusion: Minor salivary gland biopsy provides substantial diagnostic value in seronegative csSjD, where clinical and serological data are insufficient. In contrast, its additional contribution in seropositive patients is limited. While biopsy does not reliably predict systemic disease activity, it remains a cornerstone diagnostic tool, especially in seronegative patients with objective sicca symptoms. Integration of MSGB with salivary ultrasonography and molecular biomarkers may further optimize future diagnostic pathways.

Objective: To evaluate standardized incidence ratios (SIRs) of cancer in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV).

Methods: A systematic review and meta-analysis of studies from Medline, Embase, and Cochrane databases (inception to May 2025) was performed. Pooled SIRs were analyzed overall and by region, sex, age, AAV subtype, and cancer type.

Results: Fourteen studies involving 5553 AAV patients and 883 cancers were included. Overall cancer risk was significantly elevated (SIR: 1.767, 95% confidence interval [CI] 1.514-2.063). Regionally, SIRs were increased in Europe (1.717), Asia (2.193), and Oceania (1.740; all p < 0.001). Age-specific analyses showed elevated risks in patients ≤ 60 years (SIR: 2.217) and > 60 years (SIR: 2.072). Notably increased risks were observed for bladder cancer (SIR: 4.291), leukemia (4.082), kidney cancer (3.202), nonmelanoma skin cancer (3.598), lung cancer (2.082), malignant melanoma (1.701), liver cancer (1.778), oral cavity (1.760), brain (1.912), and colorectal cancer (1.465). No significant increase was found for breast, prostate, stomach cancer, non-Hodgkin lymphoma (NHL), or lymphoma.

Conclusion: Patients with AAV face a significantly increased risk of cancer, particularly bladder, hematologic, kidney, and skin cancers. These findings support the need for tailored cancer surveillance strategies in AAV management.

The model advanced training regulations define the content of advanced training to achieve the qualification of medical specialist in all specialties and sub-specialties of medicine. As rheumatology is one of the ten specialties for internal medicine in Germany, regulations cover basic competencies of general and all other specialties in internal medicine as well as special skills in rheumatology. There are currently no criteria for issuing the authorization in advanced training. This position paper describes the criteria proposed by the German Society for Rheumatology and Clinical Immunology (DGRh), which should be the foundation for the issuance of authorization for advanced training in the field of internal medicine and rheumatology and for the assessment of the duration. The model advanced training regulations 2018 and the advanced training plan recommended by experts function as the basis for this. Based on the criteria, the authorization for advanced training to advanced specialist training in internal medicine and rheumatology can be allocated in a standardized, graded and transparent manner throughout Germany. This enables an optimal quality of advanced training in rheumatology, which can be adapted to the future developments in the discipline.

Background: Fibromyalgia is a chronic pain syndrome associated with a substantial physical and psychological burden. The effectiveness of pharmacological treatment is limited, whereas nonpharmacological self-management strategies, such as exercise, cognitive behavioral therapy (CBT) and mindfulness-based approaches, are recommended. These can increasingly be delivered as online programs and significantly improve access to these forms of treatment.

Objective: Based on the current evidence, the aim of this article is to review how self-management approaches for fibromyalgia are digitally implemented via apps and how these could be further developed using, for example, wearables, artificial intelligence (AI) models and chatbots.

Methods: Existing digital applications for fibromyalgia and novel concepts were evaluated. As an example, the authors' own app, the patient organiser and companion system (POCOS), with and without an AI-based chatbot, was discussed in patient focus groups.

Results: Increasingly available digital apps for fibromyalgia currently focus primarily on psychoeducational content, whereas exercise programs and multimodal concepts are less frequently integrated, despite their evidence base and patient demand. Clinical trials have demonstrated positive effects for certain online programs. Focus groups emphasized the need for personalized, low threshold and user-friendly app designs. The use of AI-powered chatbots in this context is both feasible and desired but requires well-defined content and regulatory frameworks. On a diagnostic level, machine learning can be used to identify distinct fibromyalgia types, which can support personalized treatment.

Discussion: The digital treatment of fibromyalgia is both feasible and effective but requires consistent evidence-based implementation, active participation of people with fibromyalgia, technical interoperability and a sensitive design approach tailored to this heterogeneous patient population.

In April 2025, the European Alliance of Associations for Rheumatology (EULAR) published recommendations on the use of antirheumatic drugs in the reproductive phase, during pregnancy and while breastfeeding. The previous EULAR Points to Consider from 2016 were updated and replaced. The task force formulated five overarching principles and twelve recommendations for the use of antirheumatic drugs before and during pregnancy, while breastfeeding and in male patients. The overarching principles emphasise the great importance of effective control of disease activity during pregnancy and breastfeeding to protect mother and child. In contrast to the 2016 version, biologics, especially tumour necrosis factor inhibitors, are considered safe both during pregnancy and breastfeeding. On the other hand, greater caution is recommended when using nonsteroidal anti-inflammatory drugs and glucocorticoids, especially in higher doses and over longer periods of time. New recommendations have been included for antirheumatic drugs and male fertility as well as for vaccinations in infants after intrauterine exposure to biologics. This "Hot Topic" summarises the EULAR recommendations for German rheumatologists.

Chronic inflammatory diseases such as psoriasis (PsO) and psoriatic arthritis (PsA) are associated with a high disease burden and significant healthcare needs. Given limited specialist resources, the use of medical health apps is increasingly coming into focus as a means of supporting patients in self-management and closing gaps in care. This review highlights digital health applications available in Germany for PsO and PsA. Their functions, objectives, and potential benefits in the context of care are analysed. Six relevant apps were identified based on a systematic literature review and a structured search of the popular app stores. None of the applications are currently approved as digital health applications (German: DiGA). The apps differ in terms of their target groups, range of functions, and scientific evidence. While some primarily deal with dermatological aspects (e.g., Sorea, Psoriasis Monitor), others focus more on rheumatological issues (e.g., Mida Rheuma App, Rheuma-Auszeit). The range is supplemented by educational apps (e.g., PSO Kiosk) and therapy-accompanying apps (e.g., MyTherapy). Such digital apps can promote understanding of the disease, contribute to improving therapy adherence and have a positive effect on mental well-being, especially in patients with PsO and PsA, who often experience stress and mental comorbidities. Even though no app has yet achieved DiGA status, individual applications can be a useful addition to care.

Objective: Enthesitis is a hallmark of axial spondyloarthritis (axSpA) with a notable impact on quality of life. However, information on the prevalence, burden of damage, and associated characteristics of trochanteric enthesitis is lacking. This novel study aimed to explore the prevalence of radiographic trochanteric enthesitis in axSpA patients and analyze its association with disease activity and functional impairments in detail.

Methods: This retrospective cross-sectional observational study included 165 patients diagnosed with axSpA who underwent pelvic radiography. Clinical and demographic data were collected, including disease activity scores, functional status, and spinal mobility. Statistical analyses examined associations with trochanteric enthesitis; binary logistic regression identified independent predictors.

Results: Radiographically, trochanteric enthesitis was observed in 19 patients (11.5%), more commonly bilaterally (89.5%) and more prevalently in radiographic axSpA (17.7% vs. 5.8%, p = 0.032). Patients with trochanteric enthesitis had higher inflammatory markers (erythrocyte sedimentation rate [ESR], C‑reactive protein [CRP]; p = 0.034, p = 0.006), disease activity scores (axial spondyloarthritis disease activity score with CRP [ASDAS-CRP], ASDAS-ESR, Bath Ankylosing Spondylitis Disease Activity Index [BASDAI]; p = 0.004, p = 0.034, p = 0.032), and impaired spinal mobility (Bath Ankylosing Spondylitis Metrology Index [BASMI], p = 0.014). Functional impairments were observed in lumbar lateral flexion, intermalleolar distance, cervical rotation, and chest expansion (p = 0.048, p = 0.009, p = 0.029, p = 0.029). In binary logistic regression, age (p = 0.015) and CRP (p = 0.011) emerged as independent predictors of radiographic trochanteric enthesitis.

Conclusion: Trochanteric enthesitis affects a notable subset of axSpA patients, especially those who are older and have elevated CRP. It is associated with higher disease activity, increased systemic inflammation, and functional impairment.

Objective: This study aims to investigate the feasibility and clinical value of single-photon-emission computed tomography/computed tomography (SPECT/CT) in the quantitative assessment of salivary gland function in patients with Sjögren's syndrome (SS).

Materials and methods: Data were collected from 84 patients diagnosed with SS who underwent dynamic salivary gland scintigraphy at the First Affiliated Hospital of Anhui University of Science and Technology between October 2020 and October 2023. Additionally, a control group of 25 thyroid cancer patients who underwent thyroidectomy was selected. Imaging data from dynamic salivary gland scintigraphy were obtained and analyzed to calculate salivary gland functional parameters, including maximum accumulation rate (MAR), uptake ratio (UR), maximum secretion rate (MSR), Tmin (time from peak to lowest point on the time-activity curve), and average secretion rate (Vmin) following acidic stimulation.

Results: Significant differences in MAR, UR, MSR, Vmin, and Tmin of the parotid and submandibular glands were observed between the SS group and the control group (P < 0.05). In the mild impairment group, significant differences were found in MSR, Tmin, and Vmin of the submandibular gland compared to the control group (P < 0.05). Moderate and severe impairment groups exhibited significant differences in MAR, MSR, Tmin, UR, and Vmin of the parotid gland compared to the control group (P < 0.05).

Conclusion: In SS patients, MAR, UR, MSR, Vmin, and Tmin are important indicators for evaluating salivary gland damage. The qualitative analysis of SPECT/CT salivary gland dynamic imaging and time-activity curves effectively assesses salivary gland function in SS patients, providing vital information for the development of clinical treatment strategies.