Zeitschrift fur Rheumatologie最新文献

{"title":"[Acute diagnostics-focus on septic arthritis].","authors":"Lukas Bönnen, Christian Heiß, Markus Rupp, Christoph Biehl","doi":"10.1007/s00393-026-01848-8","DOIUrl":"10.1007/s00393-026-01848-8","url":null,"abstract":"<p><p>Septic arthritis represents a medical emergency in daily clinical practice due to its high mortality. It requires time-critical diagnostic evaluation and treatment. Patients with inflammatory arthritis (IA) are at particularly high risk. The current article is based on a literature search on septic arthritis, with a focus on the diagnostic value of systemic and synovial laboratory parameters in patients with IA. The results show that in patients with IA, any isolated arthritis should initially be considered septic until proven otherwise. Simple laboratory cut-off values are insufficient for reliable diagnosis. Early joint aspiration with microbiological diagnostics and prompt escalation of therapy in cases of suspected septic arthritis are critical determinants of treatment success.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"458-468"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413079","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":"[Autoimmunity and ageing : How immune ageing shapes disease phenotype, infection risk and treatment safety in rheumatic diseases].","authors":"Jan Leipe, Jan Henrik Schirmer, Sorwe Mojtaheed-Poor","doi":"10.1007/s00393-026-01852-y","DOIUrl":"10.1007/s00393-026-01852-y","url":null,"abstract":"<p><strong>Background: </strong>Immune ageing alters tolerance mechanisms, the chronic low-grade inflammatory environment and host infection defence. This is clinically relevant in rheumatology because the number of older patients with inflammatory rheumatic diseases is increasing and age modifies disease phenotype, vaccination responses and treatment safety.</p><p><strong>Objective: </strong>To summarize the interfaces between ageing, autoimmunity and chronic inflammation and to derive consequences for prevention and treatment.</p><p><strong>Material and methods: </strong>Narrative review of recent reviews and key studies on immunosenescence, geroscience, autoimmunity, infection risk, vaccination responses and translational biomarkers.</p><p><strong>Results: </strong>Key features include loss of naïve lymphocytes, repertoire contraction, inflammaging, myeloid dysregulation and disorders of cellular homeostasis. Classical autoimmune diseases such as rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) show features of premature immune ageing, whereas giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) illustrate age-restricted inflammatory disease. Clinically, immune ageing translates into altered susceptibility to infection, weaker responses to vaccination and a narrower safety margin during immunosuppression.</p><p><strong>Conclusion: </strong>Age should be regarded as a biological modifier in rheumatic diseases. Clinical implications include early vaccination and infection prevention, glucocorticoid-sparing treatment strategies and biomarker-guided approaches that capture immunological rather than chronological age.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"424-429"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424711","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":"[Immune cell populations in rheumatoid arthritis and giant cell arteritis].","authors":"Laurin Braune, Caroline Schmidt","doi":"10.1007/s00393-026-01849-7","DOIUrl":"10.1007/s00393-026-01849-7","url":null,"abstract":"<p><strong>Background: </strong>Rheumatoid arthritis (RA) and giant cell arteritis (GCA) are systemic autoimmune diseases with distinct clinical manifestations that are driven by dysregulation of multiple cell populations of the innate and adaptive immune systems.</p><p><strong>Objective: </strong>The aim of this work is to describe and compare the role of central immune cell populations in RA and GCA.</p><p><strong>Material and methods: </strong>This review is based on a comprehensive literature search in PubMed. Recent publications on immune cell populations in RA and GCA were assessed for their pathogenic significance and therapeutic implications.</p><p><strong>Results: </strong>Both diseases show complex interactions between T cells, B cells, and cells of the innate immune system. A common feature is an imbalance between pro-inflammatory and regulatory mechanisms, ultimately leading to chronic inflammation and tissue damage. Key differences include a dominant role of autoreactive lymphocytes and autoantibodies in RA, whereas dendritic cells and T cell-mediated vascular inflammation are the main drivers in GCA.</p><p><strong>Conclusion: </strong>A deeper understanding of these immune cell populations enables new treatment strategies and could be particularly relevant for patients who do not adequately respond to current forms of treatment.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"450-457"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148398070","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":"Pathogenese, Lebensalter und neue Therapieansätze in der Rheumatologie.","authors":"Ulf Wagner","doi":"10.1007/s00393-026-01854-w","DOIUrl":"https://doi.org/10.1007/s00393-026-01854-w","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":"85 6","pages":"421-423"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680046","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 potpourri of diagnoses-Unusual manifestations of a chronic inflammatory bowel disease : Case report].","authors":"Helga Merwald-Fraenk, Franziska Wiesent, Gerd Burmester, Paula Hoff","doi":"10.1007/s00393-026-01842-0","DOIUrl":"10.1007/s00393-026-01842-0","url":null,"abstract":"<p><strong>Background: </strong>Inflammatory bowel diseases (IBD) are frequently associated with extraintestinal manifestations, which usually occur concomitantly with or following onset of an intestinal disease. The presence of multiple autoimmune manifestations preceding the diagnosis of IBD is rare and unusual.</p><p><strong>Case report: </strong>We report the case of a 22-year-old woman referred for rheumatological evaluation due to bilateral anterior uveitis. Her medical history included type 2 autoimmune pancreatitis and persistently elevated liver enzyme parameters. Further diagnostic work-up revealed primary sclerosing cholangitis. A few weeks later she developed bloody diarrhea and Crohn's disease was confirmed histologically. A retrospective review of previous imaging studies showed findings consistent with small bowel inflammation prior to clinical manifestation.</p><p><strong>Conclusion: </strong>This case highlights the importance of interdisciplinary diagnostics in young patients presenting with multiple autoimmune manifestations. An underlying chronic inflammatory bowel disease should be considered even in the absence of gastrointestinal symptoms.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"473-475"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148273266","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":"Patient:innen sollten über die Nutzen-Risiko-Abwägung zu ihrer JAKi-Therapie informiert werden, besonders bei ausgeprägterem Risikoprofil.","authors":"Martin Schäfer, Anja Strangfeld","doi":"10.1007/s00393-026-01823-3","DOIUrl":"10.1007/s00393-026-01823-3","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"493-496"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148043857","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 - Veranstaltungen der Rheumaakademie.","authors":"","doi":"10.1007/s00393-026-01851-z","DOIUrl":"https://doi.org/10.1007/s00393-026-01851-z","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":"85 6","pages":"500"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680025","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":"[Prevention strategies in rheumatoid arthritis : From primary prevention to targeted drug interception].","authors":"Jürgen Rech","doi":"10.1007/s00393-026-01844-y","DOIUrl":"10.1007/s00393-026-01844-y","url":null,"abstract":"<p><p>The development of rheumatoid arthritis (RA) is a multistage process that often begins decades before the first joint symptoms appear. The first critical turning point is the loss of immunological tolerance [1]. Under the influence of chronic stimuli on the mucous membranes increased citrullination of proteins can occur [1]. Particularly in carriers of the shared epitope, the immune system recognizes these altered proteins as \"foreign\" and thereby produces anticitrullinated protein antibodies (ACPA), marking the onset of systemic autoimmunity [1, 2]. This primordial phase thus represents a potential therapeutic window of opportunity for preventive interventions [3]. In particular, smoking in conjunction with the presence of the shared epitope is associated with an up to 21-fold increased risk for ACPA-positive individuals [4, 5]. Other modifiable environmental factors such as smoking, obesity, diet and periodontitis also contribute to an increased risk of RA development, and thus represent the first key initial focus of primary prevention. In secondary prevention, recent interventional studies in high-risk individuals (ACPA/RF-positive with arthralgia) have shown mixed results: While hydroxychloroquine (STOP-RA) [8] remained ineffective, methotrexate (TREAT EARLIER) [9] was able to delay disease progression, particularly in ACPA-positive patients [9, 10]. Abatacept has so far proven to be the most promising approach (APIPPRA and ARIAA), with a significant reduction in the progression rate and lasting effects well beyond the treatment period. [11, 12].. The ARIAA long-term data also demonstrate that just 6 months of abatacept treatment delays the development of RA for up to 5 years, with IgA-ACPA-positive patients benefiting particularly [14]. Modern imaging using magnetic resonance imaging (MRI) and ultrasound enables the detection of subclinical inflammation, with tenosynovitis considered a highly sensitive early marker [15, 17]. The new EULAR/ACR risk stratification criteria enable the precise identification of high-risk individuals for prevention studies [18, 21]. The combination of lifestyle modifications and targeted drug intervention in high-risk patients could already be revolutionizing RA prevention today.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"440-449"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148362430","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":"[First approved rheumatological digital health application for axial spondyloarthritis].","authors":"Martin Krusche","doi":"10.1007/s00393-026-01826-0","DOIUrl":"10.1007/s00393-026-01826-0","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"469-472"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13442311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843468","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":"How ultrasound changed the practice of rheumatology: echoes of a 30-year collaboration.","authors":"George A Bruyn, Richard J Wakefield, Marina Backhaus, Peter V Balint, Mario Chavez-Lopez, Emilio Filippucci, Sandrine Jousse-Joulin, Gurjit S Kaeley, David Kane, Eugene Kissin, Giorgio Lorenzon, Silvia Magni-Manzoni, Ingrid Moller, Esperanza Naredo, Carlos Pineda, Wolfgang A Schmidt, Alen Zabotti, Nanno Swen","doi":"10.1007/s00393-026-01804-6","DOIUrl":"10.1007/s00393-026-01804-6","url":null,"abstract":"<p><p>Ultrasound in medicine has a history arbitrarily going back to the days when a modified custom-built metal flaw detector was used in post-War Glasgow to diagnose abdominal masses. Spanning a period of 30 years, the article describes the coming of age of ultrasound within the field of rheumatology. This historical paper highlights collaborative research focusing on validation and standardization of the imaging modality. In addition, the work of several persons who have played a key role in the development of ultrasound in the field of rheumatology is emphasized. In real time and at the point of care, ultrasound can demonstrate where inflammation is present, thereby giving doctors and patients a better idea of why and where pain and stiffness originate. In retrospect, we may conclude that ultrasound has profoundly changed the practice of clinical rheumatology.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":" ","pages":"479-486"},"PeriodicalIF":1.2,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147491857","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}