Zeitschrift fur Rheumatologie最新文献

Since the 1980s, various terms have been used to describe diseases with the primary finding of sterile bone inflammation (osteitis), which is attributed to the rheumatological spectrum. Various terms, such as SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, SCCH (sternocostoclavicular hyperostosis), and ACW (anterior chest wall syndrome), are in use to describe overlapping clinical phenomena with the leading finding of sterile, nonbacterial osteitis that have not yet been classified as a uniform entity. Against this background, an international panel of experts developed statements and recommendations in 2023 and 2024 as part of a consensus process using a standardized procedure. These establish adult chronic nonbacterial osteitis (CNO) as the uniform name for the disease. In addition, 16 recommendations for diagnosis and therapy were formulated and discussed. On this basis, the clinical implementation of the consensus recommendations has the potential to significantly improve the quality of treatment for adult CNO. This is described in detail below. It is important to emphasize the independence of adult CNO as an entity, which is not a subgroup of axial spondyloarthritis (axSpA) or psoriasis arthritis (PsA), but nevertheless occurs as an overlapping disease in 20-30% of cases. Diagnosis focuses on clinical activity parameters for quantifying symptoms and targeted radiological imaging of osteitis in the affected region (preferably with magnetic resonance imaging). The consensus recommendations provide relatively specific treatment recommendations, starting with NSAIDs (for 4-12 weeks, depending on therapy response), alternatively or subsequently coxibs, then intravenous bisphosphonates (for 3-12 months, depending on therapy response), alternatively or subsequently TNFi (also for 3-12 months), whereas no specific recommendations are formulated for long-term therapies. There are specific features for the use of these therapeutic modalities in Germany that must be taken into account, particularly with regard to off-label use. Conventional DMARDs are not used for adult CNO, unless there is an indication for this in patients with overlapping PsA or axSpA.

Background: The satisfaction of patients with rheumatoid arthritis (RA) influences disease control, treatment adherence and both physical and psychological well-being, which are key factors for long-term treatment success. However, due to limited physician resources, guideline-based patient-centered care cannot be universally implemented. As a response, the integration of trained rheumatological specialist assistants (RFA) into the care is evaluated as a complementary approach.

Objective: This study aimed to assess the impact of team-based care on patient satisfaction among individuals with seropositive RA during flares.

Material and methods: In this 12-month multicenter, pragmatic randomized controlled trial, 224 patients were enrolled. Following baseline assessment, five follow-up visits were scheduled. In the intervention group (IG), three of these visits were conducted by RFAs, while the control group (CG) received standard rheumatologist-led care. After 12 months participants were stratified by disease activity (DAS28 < 2.6 vs. ≥ 2.6). A secondary outcome was patient satisfaction, assessed using the ZAP questionnaire.

Results: After 12 months the IG reported significantly higher satisfaction in the domains of interaction (p = 0.023), information (p = 0.014), cooperation (p = 0.021), quality of care (p = 0.005) and trust in the healthcare provider (p = 0.028). No significant differences were found for practice organization (p = 0.515) or overall satisfaction (p = 0.084). Similar patterns were observed in the subgroup with active disease but not in patients in remission.

Conclusion: Team-based care showed a positive impact on multiple dimensions of patient satisfaction in active RA.

Background: Rheumatoid arthritis (RA) is a pervasive chronic inflammatory condition exerting a substantial impact on global morbidity and mortality. This study provides an in-depth analysis of the epidemiological trends of RA across China, America, India, and Europe as well as at a global level from 1990 to 2021, with forward-looking projections extending to 2030.

Methods: Leveraging data from the Global Burden of Disease (GBD) database, a comparative assessment of the age-standardized (AS) incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life years (DALYs) rate (ASDR) for RA was performed. Trends were evaluated and future burdens forecasted using Joinpoint regression and autoregressive integrated moving average (ARIMA) models.

Results: Between 1990 and 2021, a global upsurge in RA incidence was observed, with India experiencing the most rapid growth and America consistently recording the highest ASIR, albeit with a diminishing increment rate. The prevalence escalated across all regions, with America exhibiting the highest ASPR. Mortality rates generally trended downward, with India registering the highest ASMR by 2021, contrasting with the lowest rates in America and Europe. Disability trends, quantified by ASDR, exhibited relative stability, yet a notable increase was observed in India. ARIMA model-based projections anticipate a continued rise in RA incidence and prevalence by 2030, with mortality and disability rates anticipated to exhibit minor oscillations.

Conclusion: The escalating burden of RA, particularly in developing nations, underscores an urgent need for enhanced healthcare policies focused on early diagnosis, intervention, and disability mitigation. The projections indicate enduring public health challenges attributed to RA in the forthcoming decade.

Background: Sjögren's syndrome (SjS) is a systemic autoimmune disease classified among the group of connective tissue diseases that is characterized not only by classical sicca symptoms but also by extraglandular manifestations. Muscular involvement is rare; however, several case reports and studies have described an association between SjS and inclusion body myositis (IBM). Polymyositis with mitochondrial pathology (PM-Mito) is another myositis subtype linked to SjS, featuring mitochondrial changes and often considered part of the IBM spectrum.

Case report: We report the case of a 90-year-old female patient who presented with progressive dysphagia, weight loss and ultimately a progressive limitation in walking. During the diagnostic work-up, a primary SjS was diagnosed and a muscle biopsy enabled the diagnosis of PM-Mito.

Conclusion: This case report highlights the importance of considering neuromuscular involvement as a differential diagnosis in patients with SjS. The comorbid occurrence of myositis with mitochondrial pathology (PM-Mito or IBM) and SjS supports ongoing discussions about similar pathomechanistic aspects. Additionally, the report underlines the crucial role of a histopathological evaluation in cases of initially unclear myopathy as the key element for a correct diagnosis.

The effects of the current hospital reform as well as the increasing shift from inpatient care to outpatient care in Germany will lead to a decline in inpatient training capacities, with the threat of current and future shortages of specialists in outpatient care. This scenario could also affect rheumatology, although the prevalence and complexity of inflammatory rheumatic diseases with systemic organ involvement make comprehensive acute inpatient rheumatology care urgently necessary. The medical, structural and training-related need for inpatient rheumatological care arises not only from the introduction of innovative treatment concepts but also in particular due to highly inflammatory and severe systemic rheumatic diseases with multiorgan involvement as well as from a wide range of comorbidities or the treatment of older people with polypharmacy multimorbidity. The planned amendment of the model advanced training regulations for rheumatism should therefore continue to take an appropriate proportion of inpatient training into account and targeted funding of specialist education is planned as part of the flat-rate payments under the Hospital Care Improvement Act (KHVVG).

Background: Data of patients with inflammatory rheumatic diseases are annually recorded within the National Database of the German Collaborative Rheumatology Centers.

Methods: For rheumatoid arthritis (RA), psoriatic arthritis (PsA), axial spondylarthritis (axSpA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), Sjögren's syndrome (SjS), idiopathic inflammatory myositis (IIM), polymyalgia rheumatica (PMR), giant cell arteritis (GCA), ANCA-associated vasculitis (AAV), Behçet's disease (BD), adult onset Still's disease (AOSD) and autoinflammatory diseases (AID) data are reported from 2023. Information includes physician-reported disease activity on a numeric rating scale (NRS) of 0-10, treatment and patient-reported outcomes. For selected diagnoses, developments from 2010 to 2023 are presented regarding physicians' assessments of disease activity and treatment.

Results: A total of 13,884 patients were documented from 14 rheumatology centers, most frequently with RA (5734), PsA (1741) and axSpA (1494). The mean age ranged from 45 years (BD) to 73 years (GCA) and the median disease duration ranged from 3 years (PMR) to 16 years (axSpA). Disease activity was predominantly low, with 6% (BD) to 15% (axSpA) rated moderate to high (> 4 on the NMR) by rheumatologists. Biological disease-modifying antirheumatic drugs (bDMARD) were most frequently prescribed for axSpA (65%), AOSD (58%), PsA (53%) and GCA (41%). Tumor necrosis factor (TNF) inhibitors were frequently used in axSpA (53%), BD (30%) and PsA (28%), interleukin (IL)-1 inhibitors in AOSD (51%) and AID (50%), IL-6Ri in GCA (38%), IL17i in PsA (17%) and rituximab in AAV (29%). Higher levels of pain, fatigue, sleep disturbances and reduced well-being were reported by patients with IIM, SSc, axSpA and AID. Among those younger than 65 years, 58% (SSc) to 77% (axSpA) were employed. The percentage of early retirement due to rheumatic diseases was 5% (AOSD) to 18% (AAV). Since 2010 the development in the proportion of patients in remission or with very low disease activity (NRS 0-1) has increased across all diagnoses. In terms of treatment there has been an increase in b/tsDMARDs and a decrease in glucocorticoids for various diagnoses.

Conclusion: The results show the diversity of inflammatory rheumatic diagnoses and the continuously growing range of treatment in rheumatology along with good disease control in many patients.