Zeitschrift fur Rheumatologie最新文献

{"title":"[Osteology meets rheumatology: frequent and rare conditions in the rheumatological routine].","authors":"Paula Hoff, Frank Buttgereit","doi":"10.1007/s00393-025-01623-1","DOIUrl":"10.1007/s00393-025-01623-1","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"85-87"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459664","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":"[Juvenile idiopathic arthritis-Diagnosis and management].","authors":"Normi Brück, Christiane Reiser, Prasad Thomas Oommen, Tatjana Welzel","doi":"10.1007/s00393-025-01626-y","DOIUrl":"10.1007/s00393-025-01626-y","url":null,"abstract":"<p><p>Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and adolescents. Currently, JIA is classified into seven categories according to the International League of Associations for Rheumatology (ILAR) criteria. Diagnosis is primarily clinical and involves excluding age-specific differential diagnoses, which can be particularly challenging in very young children. Early and effective treatment is crucial to minimize disease burden, chronic morbidity and reduced quality of life. Treatment strategies depend on the JIA category and comorbidities. The treatment should follow consensus treatment plans/strategies published by the German initiative Protocols for Classification, Monitoring and Therapy in Pediatric Rheumatology (ProKind) considering the treat-to-target strategy. Since a significant number of patients continue to have symptoms into adulthood, a well-structured transition from pediatric to adult rheumatology care is essential.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"140-151"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143442196","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":"[Pregnancy and lactation-associated osteoporosis: risk factors and treatment].","authors":"Katja Warnecke, Burkhard Muche, Andreas Krause, Paula Hoff","doi":"10.1007/s00393-025-01619-x","DOIUrl":"10.1007/s00393-025-01619-x","url":null,"abstract":"<p><p>Pregnancy and lactation-associated osteoporosis (PLO) is a rare but serious condition. Multiple fractures often occur, mostly in the form of vertebral fractures, the mother is severely restricted and caring for the infant is barely possible without assistance. The fractures causing the complaints usually occur in the last trimester of the first pregnancy or in the first weeks of lactation. Magnetic resonance imaging (MRI) can be used to detect vertebral fractures and also edematous vertebrae. Bone densitometry is helpful for the diagnostics and assessment of progression. It is extremely important to distinguish PLO from other secondary forms of osteoporosis that can also be manifested during pregnancy and lactation. The mother is advised to stop breastfeeding immediately in order to interrupt calcium mobilization from bone and to achieve a normalization of hormone levels. Calcium and vitamin D should be supplemented and adequate pain treatment and physiotherapy should be initiated. The quality of data is poor due to the rarity of the disease, all available anti-osteoporotic drugs have been used in case reports but overall, in the last decade off-label treatment with teriparatide has been proven to be helpful and safe.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"121-127"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143459667","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":"[Rare osteological diseases in the rheumatological consultation: hypophosphatasia and phosphate loss syndromes].","authors":"Claus-Jürgen Bauer, Valentin S Schäfer, Zhivana Boyadzhieva, Burkhard Muche","doi":"10.1007/s00393-025-01616-0","DOIUrl":"10.1007/s00393-025-01616-0","url":null,"abstract":"<p><p>Metabolic bone diseases cause bone and joint pain and are manifested as rheumatism. Typical for the rare genetic disease hypophosphatasia is a reduced activity of alkaline phosphatase (AP), where the variable residual activity causes the heterogeneous symptoms (e.g., arthralgia, myalgia and fractures). It is indicated by repeatedly low AP measurements. The diagnosis requires a meticulous medical history and laboratory-based clarification in order to rule out other differential diagnoses. Although supportive measures form the basis of treatment, costly enzyme replacement therapy is a possible treatment option for severe forms. Multidisciplinary care under the direction of a rheumatologist experienced in osteology or an osteologist is crucial in order to provide adequate care to affected patients. Phosphate loss syndromes due to overactivity of fibroblast growth factor 23 (FGF-23) lead to deformities of the lower extremities and short stature (in congenital disorders), bone and muscle pain, muscular weakness and pathological fractures, depending on the time of occurrence during life. In genetic forms of the disease (especially X‑linked hypophosphatemia), supplementation with calcitriol and phosphates and, if necessary, complex corrective surgery in adolescence are traditional treatment methods, which are increasingly being replaced by treatment with antibodies against FGF-23. The acquired variant is a paraneoplastic phenomenon from small mostly benign mesenchymal tumors, which clinically shows a relatively acute course with severe bone pain, pathological fractures and muscle weakness in previously healthy patients and can ideally be cured by resection of the tumor. The disease can be suspected by significantly reduced serum phosphate levels and narrowed down with further laboratory diagnostics. In our opinion, the measurement of calcium, phosphate and alkaline phosphatase should be part of the primary laboratory diagnostics performed by rheumatologists and the follow-up of pathological findings is indicated.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"128-137"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469181","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":"[Systemic versus local demineralization in rheumatoid arthritis : Insights into the bone].","authors":"Tobias Hoffmann, Carolin Pflug, Wiebke Schulze, Alexander Pfeil","doi":"10.1007/s00393-025-01624-0","DOIUrl":"10.1007/s00393-025-01624-0","url":null,"abstract":"<p><p>Inflammatory rheumatic diseases, such as rheumatoid arthritis (RA), are characterized by local and systemic bone demineralization. Local demineralization is manifested in the periarticular region of the inflamed joints, particularly at the metacarpophalangeal and metatarsophalangeal joints. Local demineralization shows a significant correlation with inflammatory activity, whereas systemic osteoporosis, predominantly affecting the spine and hip, is typically associated with a prolonged disease duration, glucocorticoid treatment and immobilization. The receptor activator of the nuclear factor-kB ligand (RANKL)/osteoprotegerin (OPG) system and the Wnt signaling pathway play a pivotal role in regulating bone metabolism and are themselves negatively influenced by inflammatory cytokines such as tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-6. The diagnostics include both imaging procedures and procedures for bone mineral density measurement, employing techniques such as high-resolution peripheral quantitative computed tomography (HR-pQCT) and dual energy X‑ray absorptiometry (DXA). These are used for quantification of the bone mineral density. The objective of therapeutic approaches is to reduce disease activity and modulate signaling pathways in order to slow down demineralization and reduce the risk of fractures.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"88-96"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400342","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":"[Quintessence of the new guidelines on physical training and fracture prophylaxis].","authors":"Uwe Lange, Anett Reißhauer, Wolfgang Kemmler","doi":"10.1007/s00393-024-01609-5","DOIUrl":"10.1007/s00393-024-01609-5","url":null,"abstract":"<p><p>The guidelines on physiotherapy and exercise for osteoporosis from 2008 have recently been extensively revised on the basis of new scientific findings and possible applications. The S3 guidelines have not yet been approved by consensus and the planned completion date (Association of the Scientific Medical Societies in Germany, AWMF online, registry number 183-002) is autumn 2024. Based on the publication in Issue 3 Osteology (August 2023), key points of the guidelines on physical training and fracture prophylaxis are summarized in abridged form. These are practice-oriented, evidence-based recommendations for optimal training for fracture prevention.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"97-106"},"PeriodicalIF":0.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980126","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":"[Sequential autoimmunity? The rare case of MDA5 dermatomyositis and sarcoidosis].","authors":"Phillip Kremer, Nikolas Ruffer, Tim Oqueka, Stefan Steurer, Daniel Köhler, Ina Kötter, Martin Krusche","doi":"10.1007/s00393-025-01627-x","DOIUrl":"https://doi.org/10.1007/s00393-025-01627-x","url":null,"abstract":"<p><strong>Background: </strong>Anti-MDA5 positive dermatomyositis is a rare subtype of idiopathic inflammatory myopathies often accompanied by rapidly progressive interstitial lung disease and severe cutaneous ulcerations. It is associated with a high mortality. The simultaneous occurrence of sarcoidosis with multisystemic involvement of myositis has only been described very rarely in the literature to date.</p><p><strong>Case report: </strong>We report the case of a 39-year-old man with a 3-year history of anti-MDA‑5 positive dermatomyositis who developed a worsening of dyspnea and hypercalcemia with acute kidney injury and a marked deterioration in his general condition after successive reductions in immunosuppressive therapy. A bronchoscopy and lymph node biopsy ultimately confirmed the diagnosis of sarcoidosis.</p><p><strong>Conclusion: </strong>This case report illustrates the importance of continuously re-evaluating the diagnosis when new symptoms occur during the course of a rare disease. In the presence of pronounced lymphadenopathy, new hypercalcemia and lung parenchymal changes atypical for dermatomyositis, the differential diagnosis of sarcoidosis should also be considered.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516902","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":"A comparative assessment of rheumatoid arthritis burden: trends in China, the US, India, Europe, and globally from 1990 to 2021 and forecasts to 2030 utilizing GBD data.","authors":"Yi Yang, Xingping Ning, Lu Zhou, Lili Xie, Xiuling Zhang, Le Yu, Jingjing Shang, Xueqin Feng, Jie Ren, Xinwang Duan","doi":"10.1007/s00393-025-01628-w","DOIUrl":"https://doi.org/10.1007/s00393-025-01628-w","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516904","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":"Criteria for the authorisation of specialty training for competence in internal medicine and rheumatology-a position paper of the German Society for Rheumatology and Clinical Immunology.","authors":"Alexander Pfeil, Martin Fleck, Martin Aringer, Xenofon Baraliakos, Diana Ernst, Isabell Haase, Christiana Hillebrecht, Bimba Franziska Hoyer, Gernot Keyßer, Ina Kötter, Andreas Krause, Martin Krusche, Hanns-Martin Lorenz, Fabian Proft, Florian Schuch, Diana Vossen, Anna Voormann, Ulf Wagner, Jürgen Wollenhaupt, Christof Specker","doi":"10.1007/s00393-025-01618-y","DOIUrl":"https://doi.org/10.1007/s00393-025-01618-y","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143516907","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":"[James Joyce. Chronic recurrent iritis resulting from postvenereal reactive arthritis].","authors":"H Zeidler","doi":"10.1007/s00393-024-01614-8","DOIUrl":"https://doi.org/10.1007/s00393-024-01614-8","url":null,"abstract":"<p><p>The Irish author James Joyce (1882-1941) suffered from chronic recurrent iritis with a variety of complications that led to almost complete blindness. Syphilis and a rheumatic disease, such as Reiter's syndrome were discussed as the main causes. The coincidence of a venereal infection, arthritis and the characteristic medically documented features of iritis, including typical complications, together with the chronic recurrent course of the eye disease, are convincing arguments for postvenereal reactive arthritis. A familial predisposition and smoking could have been responsible for the unfavorable course of the iritis. There is no reliable evidence of syphilis and, above all, the multiple recurrences of the iritis are not compatible with a syphilitic infection. Even after the medical publications in which the rheumatic genesis was convincingly discussed and in the knowledge of these, art historians have held on to the diagnosis of syphilis. It is therefore to be hoped that in the future the art historical literature will accurately reflect Joyce's illness in accordance with the medical knowledge.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":""},"PeriodicalIF":0.9,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400341","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}