Zeitschrift fur Rheumatologie最新文献

{"title":"Multifocal leukoencephalopathy in a patient medicated with etanercept and methotrexate for rheumatoid arthritis.","authors":"Tieer Yu, Chunying Yang","doi":"10.1007/s00393-023-01430-6","DOIUrl":"10.1007/s00393-023-01430-6","url":null,"abstract":"<p><p>Methotrexate (MTX) and etanercept are commonly used in the treatment of rheumatoid arthritis (RA). Several important adverse events, including central nervous system lesions, have been reported during RA treatment. Among them, MTX-induced leukoencephalopathy is a recognized complication that is often observed following intrathecal or intravenous MTX administration. Herein, we report a case of a RA patient who was diagnosed with multifocal leukoencephalopathy during etanercept and MTX therapy. A 77-year-old Chinese woman with a 3-year history of RA had been taking subcutaneous etanercept and low-dose oral MTX since February 2021. Five months after the initial administration, she developed cognitive impairment and experienced a dropped attack. She was then admitted to our hospital in June 2021. T2-weighted magnetic resonance imaging (MRI) images revealed disseminated lesions in the white matter of the brain. Based on these MRI findings and extensive clinical investigation that excluded other possible causes of white matter lesions, she was suspected of having a demyelinating disorder. There was no evidence suggesting other neurological disorders. High-dose corticosteroid was administered, which resulted in improved cognitive impairment. This case report illustrates an important example of multifocal leukoencephalopathy induced by the combined use of etanercept and MTX, which resolved with high-dose corticosteroid. With the recent emphasis on various biologic agents for treatment of RA, our case highlights the importance of identifying leukoencephalopathy that may be induced by various biologics.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41162381","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":"[Changes in the Board of the journal \"Zeitschrift für Rheumatologie\"].","authors":"Ulf Müller-Ladner, Philipp Klemm","doi":"10.1007/s00393-024-01510-1","DOIUrl":"https://doi.org/10.1007/s00393-024-01510-1","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866656","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/s00393-024-01507-w","DOIUrl":"https://doi.org/10.1007/s00393-024-01507-w","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865023","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":"Phalangeal microgeodic syndrome: case report of a young woman treated with pentoxifylline.","authors":"Tiago Borges, Miguel Castro","doi":"10.1007/s00393-023-01470-y","DOIUrl":"10.1007/s00393-023-01470-y","url":null,"abstract":"<p><p>Phalangeal microgeodic syndrome (PMS) is a rare osteolytic disorder of unknown etiology that typically affects children up to 15 years old during colder months. Transient peripheral circulatory impairment probably underlines its pathogenesis. Conservative treatment with eviction of cold exposure is often successful. We report the case of a young woman presenting with joint pain in her feet, along with toe discoloration and redness, where a diagnosis of PMS was established based on magnetic resonance imaging findings and exclusion of other differential diagnostic entities. Pharmacological treatment was deemed necessary for symptomatic relief, but a trial of calcium channel blocker (CCB) was not tolerated by the patient. The patient was then started on pentoxifylline, with significant clinical improvement.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139088712","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":"Magnetic resonance imaging in polymyalgia rheumatica-contrast enhancement is not always needed.","authors":"Martin Fruth, Annika Seggewiss, Jessica Kozik, Philipp Martin-Seidel, Xenofon Baraliakos, Jürgen Braun","doi":"10.1007/s00393-023-01394-7","DOIUrl":"10.1007/s00393-023-01394-7","url":null,"abstract":"<p><strong>Background: </strong>Extracapsular inflammation at entheseal sites in the pelvic girdle as demonstrated by magnetic resonance imaging (MRI) was shown to be useful as an additional tool for diagnosing polymyalgia rheumatica (PMR). However, it is unclear whether MRI needs to be performed with contrast enhancement or whether oedema-sensitive sequences are sufficient.</p><p><strong>Objective: </strong>To evaluate the performance of T2w TIRM (turbo inversion recovery magnitude) imaging compared to fat-saturated contrast-enhanced (ce) T1w at predefined pelvic sites to detect extracapsular inflammation in patients with PMR.</p><p><strong>Methods: </strong>A total of 120 pelvic MRIs of patients with pelvic girdle pain, 40 with clinically diagnosed PMR and 80 controls, were retrospectively scored by three blinded radiologists separately evaluating the MRI with and without contrast enhancement at 19 previously defined pelvic structures. The intra- and interrater reliability and the diagnostic performance of both techniques were statistically analysed and evaluated.</p><p><strong>Results: </strong>The detection of inflammatory MRI signals correlated moderately between both techniques (Cohen's κ 0.583). With ceT1w imaging 20.7% more sites were detected as inflamed compared to T2w TIRM in PMR patients. Inter- and intrareader reliability was superior with ceT1w imaging. If the inflammatory signal was detected at three sites bilaterally including the origin of the rectus femoris muscle or adductor longus muscle, the sensitivity and specificity was 100% and 97.1% by ceT1w imaging vs. 80.8% and 93.3% by T2w TIRM, respectively.</p><p><strong>Conclusion: </strong>Contrast enhancement is superior to oedema-sensitive MRI in the detection of extracapsular inflammation in PMR. However, using T2w TIRM also detects many but not all PMR cases.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11058766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9974888","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 DGRh.","authors":"","doi":"10.1007/s00393-024-01511-0","DOIUrl":"https://doi.org/10.1007/s00393-024-01511-0","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854686","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 DRL.","authors":"","doi":"10.1007/s00393-024-01509-8","DOIUrl":"https://doi.org/10.1007/s00393-024-01509-8","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866621","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":"[Castleman's disease in the rheumatological practice].","authors":"M Schmalzing, O Sander, M Seidl, R Marks, N Blank, I Kötter, M Tiemann, M Backhaus, B Manger, K Hübel, U Müller-Ladner, J Henes","doi":"10.1007/s00393-023-01393-8","DOIUrl":"10.1007/s00393-023-01393-8","url":null,"abstract":"<p><p>The term Castleman's disease encompasses a group of rare lymphoproliferative diseases that show histopathological similarities in lymph node biopsy. Diagnostic criteria and a specific ICD-10 code have been available for a few years. Case studies listed at the beginning illustrate that close cooperation between clinicians and pathologists is required to enable a reliable diagnosis. For an optimal histopathological assessment, the pathologist is also dependent on the removal of a complete lymph node. Before distinguishing a potentially fatal multicentric idiopathic Castleman's disease from the resectable unicentric form, which is important in terms of prognosis and treatment, early diagnosis presupposes that Castleman's disease is considered in the differential diagnosis. Various immune phenomena and overlaps with autoimmune diseases can increase the probability of misdiagnosis or undetected cases in the clinical routine of rheumatologists. The intention of the present overview is therefore to point out the similarities with autoimmune diseases that are relevant for differential diagnoses and to point out situations that justify a review of the previous diagnosis.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11058943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10068510","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":"Real-world experience with filgotinib for rheumatoid arthritis in Germany : A retrospective chart review.","authors":"Olaf Schultz, Christoph Fiehn, Christian Kneitz, Nils Picker, Daniel Kromer, Monia Zignani, Francesco De Leonardis, Hans-Dieter Orzechowski, Margot Gurrath, Klaus Krüger","doi":"10.1007/s00393-024-01506-x","DOIUrl":"https://doi.org/10.1007/s00393-024-01506-x","url":null,"abstract":"<p><strong>Background: </strong>Real-world data for filgotinib, a Janus kinase (JAK)1 inhibitor, are limited in patients with rheumatoid arthritis (RA).</p><p><strong>Objectives: </strong>To explore real-world filgotinib use in patients with RA in Germany.</p><p><strong>Materials and methods: </strong>This retrospective chart review included patients aged ≥ 18 years with confirmed moderate to severe RA who initiated filgotinib before December 1, 2021, with ≥ 6 months of medical records available prior to filgotinib initiation or after initial diagnosis. Patient characteristics, prior treatments, reasons for initiating/discontinuing filgotinib, disease activity, dose adjustments and concomitant treatments were recorded.</p><p><strong>Results: </strong>In total, 301 patients from 20 German rheumatology outpatient units were included. One-third were aged ≥ 65 years and almost half had ≥ 1 cardiovascular (CV) risk factor. Most patients initiated filgotinib as monotherapy (83.7%; 12.7% of whom with glucocorticoids) and at the 200 mg dose (84.7%); higher proportions of those initiating the 100 versus 200 mg dose were aged ≥ 65 years and had renal impairment or ≥ 1 CV risk factor. Oral administration (78.4%), fast onset of action (66.8%) and administration as monotherapy (65.4%) were the most common reasons for initiating filgotinib. At 12 months, 41 (18.4%) patients had discontinued filgotinib, most commonly due to lack of effectiveness. After 6‑months of follow-up, 36.8% of patients had achieved Clinical Disease Activity Index (CDAI) remission and 45.6% had achieved CDAI low disease activity.</p><p><strong>Conclusions: </strong>In clinical practice in Germany, reasons for initiating filgotinib in patients with RA were related to dosing flexibility and general JAK inhibitor attributes. Filgotinib was used predominantly as monotherapy and was effective and generally well tolerated; however, longer-term data in larger, prospective cohorts are needed.</p>","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872292","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":"[Arthritis and osteomyelitis in childhood and adolescence-Bacterial and nonbacterial].","authors":"T. Hospach, T. Kallinich, L. Martin, T. V Kalle, F. Reichert, H. Girschick, C. M. Hedrich","doi":"10.1007/s00393-024-01504-z","DOIUrl":"https://doi.org/10.1007/s00393-024-01504-z","url":null,"abstract":"","PeriodicalId":23834,"journal":{"name":"Zeitschrift fur Rheumatologie","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140671332","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}