Zeitschrift fur Rheumatologie最新文献

{"title":"[Arthroplastic borderline cases in pediatric and adolescent rheumatology].","authors":"Kathrin Ritter, Martin Arbogast","doi":"10.1007/s00393-025-01639-7","DOIUrl":"https://doi.org/10.1007/s00393-025-01639-7","url":null,"abstract":"<p><p>Shoulder joint involvement in juvenile idiopathic arthritis (JIA) is common; however, it is first clinically manifested only after a delay. Initially, the aim should be to preserve the joint for as long as possible by means of adequate drug treatment and arthroscopic synovectomy. If definitive joint destruction nevertheless occurs hemiarthroplasty, anatomical and reverse shoulder arthroplasty are available. Hemiarthroplasty can result in pain amelioration and was the gold standard for a long time but it remains inferior to total shoulder arthroplasty in terms of pain reduction, improvement of the range of motion and durability. Reverse shoulder arthroplasty can also be used even in young patients with JIA, particularly when rotator cuffs are also involved. A metaphyseal fixation of the short stem and a modular design of the prosthesis make these attractive, even with respect to the inevitable necessity for revisions.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Infections during joint replacement under immunomodulatory treatment].","authors":"Stefan Rehart, Ole Schickedanz, Benedikt Wickler","doi":"10.1007/s00393-025-01643-x","DOIUrl":"https://doi.org/10.1007/s00393-025-01643-x","url":null,"abstract":"<p><p>Artificial joint replacement, particularly of the hip and knee joints, has become an established treatment option for degenerative and systemic inflammatory joint diseases in Germany; however, with the increasing number of endoprosthetic procedures, the risk of postoperative complications, particularly periprosthetic infections (PPI), also increases. These infections can lead to severe consequences, such as prolonged healing times, redo surgery and functional impairments. Patients with rheumatic diseases and immunosuppressive treatment have a particularly high risk for PPI, as the immune response is severely impaired by medications, such as corticosteroids, disease-modifying antirheumatic drugs (DMARD) and biologics. Preoperative measures, such as a thorough anamnesis and adjustment of the immunosuppressive treatment, are crucial to minimize the risk of infections. Diagnosing a PPI in immunosuppressed patients can be challenging as typical symptoms are often less pronounced. In cases of a suspected infection, an early diagnostic work-up and individualized treatment are required, which may include both antibiotic treatment and surgical interventions. An interdisciplinary management involving rheumatologists, orthopedic (rheumatologic) surgeons and infectious disease specialists is essential for successful treatment. Preventive strategies and targeted perioperative risk management can help to reduce the occurrence of PPI and ensure the long-term health of patients.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Shoulder pain in inflammatory rheumatic diseases : Importance of musculoskeletal ultrasound].","authors":"Annika Franziska Podewski, Marina Backhaus, Sarah Ohrndorf","doi":"10.1007/s00393-025-01640-0","DOIUrl":"https://doi.org/10.1007/s00393-025-01640-0","url":null,"abstract":"<p><p>Shoulder pain is a frequent reason for presentation in medical practices; however, it can sometimes be challenging to differentiate between an inflammatory versus mechanical or degenerative cause of shoulder pain. A swelling of the shoulder joint is only palpable in cases of pronounced clinical findings. In rheumatoid arthritis (RA) and psoriatic arthritis (PsA) the shoulder joints can be involved, which is early and frequent, particularly in the case of RA and is associated with a more severe course of the disease. Polymyalgia rheumatica (PMR) is typically manifested with shoulder and hip girdle pain. In all three diseases inflammatory changes, such as effusion/synovitis in the glenohumeral joint and subdeltoid bursitis are present in the sonographic examination. Specific ultrasound findings, such as peritendinitis and, in particular, bilateral involvement of the shoulder joints (inflammation of the long biceps tendon as well as the supraspinatus or subscapularis tendons) are associated with a definitive PMR. In addition, crystal arthropathies, such as calcium pyrophosphate deposition (CPPD) disease and gout should be included in the differential diagnostic considerations with respect to rheumatological diseases.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143773588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitteilungen der DGRh.","authors":"","doi":"10.1007/s00393-025-01645-9","DOIUrl":"https://doi.org/10.1007/s00393-025-01645-9","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":"84 3","pages":"252-253"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Influence of the treatment setting on the treatment of patients with rheumatoid arthritis or psoriatic arthritis within the delegation to rheumatological specialist assistants - A post hoc analysis of the StärkeR study].","authors":"Rilind Shabani, Anna Mai, Robin Denz, Nina Timmesfeld, Jürgen Braun, Dietmar Krause","doi":"10.1007/s00393-024-01606-8","DOIUrl":"10.1007/s00393-024-01606-8","url":null,"abstract":"<p><strong>Background: </strong>The StärkeR study has shown the non-inferiority of a team-based form of care with delegation to rheumatological specialist assistants (RFA) compared to standard care in patients with rheumatoid arthritis (RA) or psoriatic arthritis (PsA).</p><p><strong>Objective: </strong>Exploratory analyses regarding a possible influence of the treatment setting (specialist practice/outpatient clinic) on various outcome parameters in patients with RA or PsA in the context of delegation to RFA.</p><p><strong>Material and methods: </strong>Patients with RA or PsA and stable adjustment with low disease activity from 3 outpatient clinics and 14 rheumatological specialist practices that participated in the StärkeR study were included in this post hoc analysis. The effectiveness of the team-based form of care depending on the treatment setting was investigated using interaction analyses in linear regression models with respect to disease activity, functional capacity, pain and fatigue, among others.</p><p><strong>Results: </strong>Out of 588 patients 466 were treated in specialized practices and 92 in hospital outpatient clinics. The analyses showed a significant interaction for one of nine outcomes examined: functional capacity (scale 0-1) had slightly lower values in the hospital outpatient clinics compared to standard care (-0.07 [-0.12; -0.02]), while no such difference was found in the practices. For other outcomes, the team-based form of care in the practice setting tended to show an advantage.</p><p><strong>Discussion: </strong>These exploratory analyses point to the potential benefits of evaluating different forms of care, such as the delegation of medical services to qualified RFA, in terms of benchmarking.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"188-197"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"History of antineutrophil cytoplasmic autoantibodies : Milestones in rheumatology.","authors":"Kirsten de Groot, Elena Csernok, Diane van der Woude","doi":"10.1007/s00393-024-01599-4","DOIUrl":"10.1007/s00393-024-01599-4","url":null,"abstract":"<p><p>Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are autoimmune inflammatory small-vessel disorders with potentially life-threatening organ manifestations. Recent disease definitions and classification criteria allow distinction between granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA), and non-granulomatous microscopic polyangiitis (MPA). The discovery of ANCA-autoantibodies directed against proteolytic enzymes of neutrophil granules-has enabled earlier diagnosis of AAV and paved the way to stage-adapted treatments. ANCA testing initially relied on different immunofluorescence patterns, i.e., cytoplasmic ANCA (C-ANCA) vs. perinuclear ANCA (P-ANCA), in ethanol-fixed neutrophils. This is nowadays outperformed by well-standardized immunoassays against the ANCA target antigens proteinase 3 (PR3) and myeloperoxidase (MPO) for the diagnosis of small-vessel vasculitides. The discovery of ANCA has contributed substantially to unravelling the pathogenesis of AAV, which comprises neutrophil degranulation, NETosis with concurrently amplified ANCA antigen presentation, and intra- and transmural vascular inflammation involving the alternative complement system in susceptible individuals. There is a genetic disposition concerning certain HLA alleles and polymorphisms of the proteinase 3 gene. Furthermore, epigenetic modifications impact on disease activity and relapse. During follow-up, the ANCA titer is not a reliable mirror of disease activity; however, PR3-ANCA positivity is associated with a greater likelihood of relapse and a better treatment response to rituximab as compared to cyclophosphamide/azathioprine. Within the past 60 years, the discovery of ANCA has revolutionized the ability to diagnose, understand, classify, and treat AAV in a targeted manner.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"219-224"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965146/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitteilungen der DRL.","authors":"","doi":"10.1007/s00393-025-01644-w","DOIUrl":"https://doi.org/10.1007/s00393-025-01644-w","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":"84 3","pages":"255-256"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Prioritized appointment allocation in new patients, what is really decisive? : Comparative analysis of manual appointment allocation with automated and AI-assisted approaches].","authors":"Stefan Krämer, A Flöge, S Handt, F Juzek-Küpper, K Vogt, J Ullmann, T Rauen","doi":"10.1007/s00393-024-01550-7","DOIUrl":"10.1007/s00393-024-01550-7","url":null,"abstract":"<p><strong>Background: </strong>The timely allocation of appointments for new patients is a daily challenge in rheumatological practice, which can be supported by digital solutions. The question is to find the simplest and most effective possible method for prioritization when allocating appointments.</p><p><strong>Methods: </strong>Using a registration form for new patients, standardized symptoms and laboratory results were collated. After reviewing this information by a medical specialist the allocation of appointments was carried out in three categories: a) < 6 weeks, b) 6 weeks up to 3 months and c) > 3 months. The waiting time between the time of registration and the presentation appointment was calculated and compared between patients with and without a diagnosis of an inflammatory rheumatic disease (IRD). In addition a decision tree (DT), a method taken from the field of supervised learning within artificial intelligence (AI), was established and the resulting classification was compared with respect to the accuracy and calculated saving in waiting time.</p><p><strong>Results: </strong>In this study 800 appointments between 2020 and 2023 (including 555 women, 69.4%, median age 53 years, interquartile range, IQR 39-63 years) were analyzed. An IRD could be confirmed in 409 (51.1%) cases with a waiting time of 58 vs. 93 days for non-IRD cases (-38%, p < 0.01). An AI-based stratification resulted in an accuracy of 67% for IRD and a predicted saving of 19% waiting time. The accuracy increased up to 78% with a time saving for IRD cases of up to 31%, when all basic laboratory results were known. Simplified algorithms, e.g., stratification by the use of laboratory findings alone, resulted in a lower accuracy and time savings.</p><p><strong>Conclusion: </strong>Manual allocation of appointments by a medical specialist is effective and significantly reduces the waiting times for patients with IRD. An automated categorization can lead to a reduction in waiting times for appointments when taking complete laboratory results and a lower sensitivity into consideration.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"169-178"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141989018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[What is the potential of ChatGPT for qualified patient information? : Attempt of a structured analysis on the basis of a survey regarding complementary and alternative medicine (CAM) in rheumatology].","authors":"Gernot Keyßer, Alexander Pfeil, Monika Reuß-Borst, Inna Frohne, Olaf Schultz, Oliver Sander","doi":"10.1007/s00393-024-01535-6","DOIUrl":"10.1007/s00393-024-01535-6","url":null,"abstract":"<p><strong>Introduction: </strong>The chatbot ChatGPT represents a milestone in the interaction between humans and large databases that are accessible via the internet. It facilitates the answering of complex questions by enabling a communication in everyday language. Therefore, it is a potential source of information for those who are affected by rheumatic diseases. The aim of our investigation was to find out whether ChatGPT (version 3.5) is capable of giving qualified answers regarding the application of specific methods of complementary and alternative medicine (CAM) in three rheumatic diseases: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (GPA). In addition, it was investigated how the answers of the chatbot were influenced by the wording of the question.</p><p><strong>Methods: </strong>The questioning of ChatGPT was performed in three parts. Part A consisted of an open question regarding the best way of treatment of the respective disease. In part B, the questions were directed towards possible indications for the application of CAM in general in one of the three disorders. In part C, the chatbot was asked for specific recommendations regarding one of three CAM methods: homeopathy, ayurvedic medicine and herbal medicine. Questions in parts B and C were expressed in two modifications: firstly, it was asked whether the specific CAM was applicable at all in certain rheumatic diseases. The second question asked which procedure of the respective CAM method worked best in the specific disease. The validity of the answers was checked by using the ChatGPT reliability score, a Likert scale ranging from 1 (lowest validity) to 7 (highest validity).</p><p><strong>Results: </strong>The answers to the open questions of part A had the highest validity. In parts B and C, ChatGPT suggested a variety of CAM applications that lacked scientific evidence. The validity of the answers depended on the wording of the questions. If the question suggested the inclination to apply a certain CAM, the answers often lacked the information of missing evidence and were graded with lower score values.</p><p><strong>Conclusion: </strong>The answers of ChatGPT (version 3.5) regarding the applicability of CAM in selected rheumatic diseases are not convincingly based on scientific evidence. In addition, the wording of the questions affects the validity of the information. Currently, an uncritical application of ChatGPT as an instrument for patient information cannot be recommended.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"179-187"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141564539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vasculitic involvement of the skeletal muscle and the peripheral nervous system: clinical and neuropathologic perspective].","authors":"Nikolas Ruffer, Felix Kleefeld, Marie-Therese Holzer, Martin Krusche, Ina Kötter, Udo Schneider, Werner Stenzel","doi":"10.1007/s00393-024-01567-y","DOIUrl":"10.1007/s00393-024-01567-y","url":null,"abstract":"<p><p>The peripheral nervous system is a classic target organ in systemic vasculitis. In addition, the skeletal muscle can also be affected. Myalgia, muscle weakness and sensory deficits are typical signs, which can lead to severe functional limitations and impaired of quality of life. Vasculitic involvement of the skeletal muscle (vasculitic myopathy [VM]) and peripheral nerves (vasculitic neuropathy [VN]) occurs predominantly in polyarteritis nodosa and small-vessel vasculitis. VM presents with elevated markers of inflammation and is typically characterized by immobilizing myalgia with normal creatine kinase activity and diffuse or patchy areas of hyperintensity on T2-weighted MRI (\"MRI myositis without myositis\"). In VN, sensor motor deficits predominantly affect the lower extremity in the area supplied by several peripheral nerves (e.g., mononeuritis multiplex) with acute to subacute history. The histopathological examination of nerve and muscle biopsies is the gold standard for the diagnosis of vasculitic manifestations and has a significant impact on the therapeutic approach.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"210-218"},"PeriodicalIF":0.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}