[COVID-19 in Routine Rheumatologic Care]. / COVID-19 in der rheumatologischen Routineversorgung.

Since the first case of coronavirus infection with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and the associated COVID-19 (corona virus disease 2019) it has become a worldwide pandemic. This leads to persistent and far-reaching consequences for the health system and society as a whole. Our patients with inflammatory rheumatic diseases were initially considered to be at high risk of contracting SARS-CoV­2, especially if they were on immunosuppressive and/or immunomodulatory therapy (DMARD). It was assumed that a severe COVID-19 course could occur in case of infection. Although PCR diagnosis is generally considered the gold standard for early diagnosis of active infection with SARS-CoV­2, it has been shown that it should not always be used to confirm the diagnosis of COVID-19. Therefore, complementary antibody testing for SARS-CoV­2 could be useful in cases of clinical suspicion and negative PCR for diagnostic confirmation of COVID-19, even retrospectively. Apparently, patients with inflammatory rheumatic disease and under DMARD therapy are not particularly at risk in case of SARS-CoV­2 infection. Whether this is due to better hygiene measures or increased contact restrictions of patients with underlying inflammatory rheumatic disease, or whether ongoing DMARD therapy offers some protection against a severe course of COVID-19, is still to be clarified. The important questions about the tolerability and efficacy of COVID-19 vaccination have yet to be answered. In summary, there is still a clear need for research to better advise our patients.

Kineret: efficacy and safety in daily clinical practice: an interim analysis of the Kineret response assessment initiative (kreative) protocol.

Data from 166 patients who had completed 6 months of anakinra (Kineret, r-metHuIL-1Ra) therapy under the conditions of daily clinical practice showed an efficacy and safety profile comparable to the data known from clinical trials. Patients significantly responded as early as 1 month following initiation of therapy. The data suggest that anakinra may also be effective in patients who have failed tumor necrosis factor (TNF)-blocking agents. Injection-site reactions were reported less frequently than in clinical trials, indicating that these reactions seem to require less therapeutic attention under non-clinical trial conditions.

[Patient education--a contribution to improvement of long-term management of patients with rheumatism]. / Patientenschulung--Ein Beitrag zur Verbesserung der Langzeitbetreuung von Rheumapatienten.

Patient education has been recognized as an important tool in the therapy and the rehabilitation of patients with chronic rheumatic diseases. An increasing body of literature refers to favorable effects of patient education. Patient education improves coping with disease, reduces pain and depression and decreases arthritic "helplessness". Therefore, patient education should be a part of the comprehensive care for the rheumatic patient. The patient education group (Arbeitskreis Patientenschulung) of the German Society of Rheumatology (Deutsche Gesellschaft für Rheumatologie) has been initiated to develop a general concept of patient education in rheumatology and to elaborate various patient education programs. The patient education program for rheumatoid arthritis is described as a model for further patient education programs. It consists of six group sessions (modules). The program is conducted by an interdisciplinary team. A group leader is in charge of the program. Train-the-trainer courses should improve the quality of the program. Currently, the patient education group develops education programs for patients with systemic lupus erythematodes and related collagen diseases, spondyarthritis patients, patients with fibromyalgia and rheumatic children and their parents.

[Clinical study on rheumatoid arthritis of the TMJ]. / Klinische Studie zur rheumatischen Arthritis des Kiefergelenkes.

256 individuals with inflammatory rheumatic diseases and 117 individuals of two control groups returned their questionnaires in a survey of subjective symptoms of the masticatory system. Subjective symptoms of the temporomandibular joint (tmj) were reported by 41% of the patients with rheumatoid arthritis, 29% of the patients with psoriatic arthritis, 20% of the patients with ankylosing spondylitis and 23% of the patients with other rheumatic diseases (such as Reiter's syndrome). Statistically significant differences (p less than 0.05) regarding the occurrence of "difficulties in opening the mouth wide" and "crepitus from the tmj" were found between the various types of rheumatic arthritis. In 40 patients with rheumatic diseases and tmj-symptoms the tmj was examined clinically, by orthopantomography and lateral tomography. Radiographic abnormalities were found in 68% of the patients and classified by a new radiographic index, according to the index of Steinbrocker. There were no indications for a relationship between a loss of posterior support and extensive radiographic changes of the tmj. The most common objective symptoms were pain on chewing, crepitus in the tmj and tenderness to palpation of the masticatory muscles and neck.

[Viruses and arthritis]. / Viren und Arthritis.

A number of virus infections can induce acute, non-erosive arthritis. A thorough exploration of the patient's history and serological testing for viral infections are crucial to the diagnosis of virus-induced arthritis. Musculoskeletal involvement in infection with the HIV-virus is not a rare feature and will have to be considered more often in cases of acute arthritis, as the prevalence of HIV-infection is increasing. Whether chronic arthritis, like rheumatoid arthritis, is induced by viral infection, is still a subject of intensive research efforts.

[Practical differential diagnosis in acute arthritis]. / Praktische Differentialdiagnostik bei akuter Arthritis.

The most common cause for acute arthritis are crystal arthropathies, sero-negative spondarthritides and reactive inflammatory arthritis. In any case, the possibility of a purulent-septic arthritis must be excluded because of the prognostic consequences. Precise rheumatological case history and careful examination are relevant tools in providing a differential diagnosis; laboratory findings may be of great help as well. A flow-chart is suggested for rational diagnosis.

[New classification criteria of chronic polyarthritis]. / Die neuen Klassifikationskriterien der chronischen Polyarthritis.

The criteria for the classification of the rheumatoid arthritis were defined more precisely, reduced and simplified in 1987 by the American Rheumatism Association. The more detailed specification was achieved at the cost of sensitivity. We find the revision positive as the classification criteria are supposed to mainly serve the purpose of systematic organisation and as a base for multicentered studies. Only then they can give a little help in diagnostic orientation. Never the criteria can take the place of the individual differential diagnosis and the observation of the development of the disease.

[Long-term drug treatment of chronic polyarthritis: current status and perspectives]. / Medikamentöse Langzeitbehandlung der chronischen Polyarthritis: Aktueller Stand und Perspektiven.

The therapeutic repertoire for the treatment of rheumatoid arthritis has been expanded to new disease-modifying antirheumatic drugs (DMARDs), like Auranofine, Sulfasalazine, and Methotrexate. Rheumatoid arthritis is not only a highly disabling disease but is now recognized to be related with increased mortality. Therefore, the aim of therapeutic strategies is the early induction of remission. The strategy for treatment of rheumatoid arthritis should be based on an analysis of the individual risk of a patient to develop severe illness. A concept of "risk-oriented DMARD-therapy" of rheumatoid arthritis is proposed.

[Progress in therapy of spondylarthritis]. / Fortschritte in der Therapie der Spondarthritiden.

An update of the wide spectrum of therapeutic measures in the spondarthritides is presented with the example of ankylosing spondylitis. Most important is a life style adjusted to the disease with daily exercises and complementary physiotherapy. The most significant measures of physiotherapy, drug treatment, operation, and radiotherapy are discussed. Preliminary results indicate a long-term effect of sulfasalazine in ankylosing spondylitis. Peculiarities in the treatment of psoriatic arthritis and of entheropathic arthritides are pointed out.

[Patient education in rheumatology]. / Patientenschulung in der Rheumatologie.

Most of the patients with rheumatic diseases do not know enough about their disease and its treatment. This may influence patient's satisfaction and compliance. Patient education is a useful approach to reduce the negative consequences of the lack of knowledge and non-compliance. Rheumatologists have recognized patient education as an important part of the long-term management of rheumatic diseases.

[Rheumatologic emergencies]. / Rheumatologische Notfallsituationen.

Contrary to the widely assumed opinion there exist rheumatological emergency situations that affect patients hazardously. These cover complications of the antirheumatic therapy as well as complications of the disease itself. The paper gives an overview of rheumatological emergency situations and tries a systemic approach to a rheumatological emergency medicine.

[Diagnosis of lung function in patients with ankylosing spondylitis]. / Lungenfunktionsdiagnostik bei Patienten mit ankylosierender Spondylitis (SPA).

In a group of 55 men of 18 to 58 years of age who were suffering from ankylosing spondylitis, changes in lung function were analysed by measuring the static parameters and by differentiating between the thoracic and abdominal parts in breathing at rest and under stress, using CO2 rebreathing. In accordance with the reduction in vital capacity, the thoracic share is restricted already at rest. At rest, there is compensation via the abdominal compartment, in contrast to the stress in CO2 rebreathing in which the abdominal part does not compensate.

Reactive fibromatosis in pustulotic arthro-osteitis.

Sterno-costo-hyperostosis is an inflammatory rheumatic disease which is associated to pustulosis palmaris et plantaris. The origin of this disorder is unknown. We described the appearance as a "reactive" fibromatosis in connection with a hyperostosis of a clavicle, which could be demonstrated in a biopsy-probe and by NMR-technique.

[Fever in rheumatic diseases--the spectrum of causes and diagnostic guidelines]. / Fieber bei rheumatischen Erkrankungen--Ursachenspektrum und diagnostische Leitlinien.

The review presents a systematic approach to the diagnostic problem of fever in combination with inflammatory rheumatic symptoms, specifically, in regards to: actual concepts of the pathogenesis of fever in various rheumatic diseases, fever as expression of disease activity, fever as a warning sign of complications in the course of disease and its treatment (infections, drug-induced fever, fever following drug withdrawal, secondary neoplasias), fever and inflammatory rheumatic symptoms as manifestation of non-rheumatic diseases. Based on the literature and information provided by pharmaceutical companies, a survey is given on the frequency of fever as a negative side-effect of the most commonly used drugs in rheumatology.

[Patient education in chronic polyarthritis. 3. Intermediate results of a prospective, controlled study of the effectiveness and side effects of patient seminars for polyarthritis patients]. / Krankheitsaufklärung bei chronischer Polyarthritis. 3. Mittelfristige Ergebnisse einer prospektiven, kontrollierten Studie zu Effizienz und Nebenwirkungen von Patientenseminaren für cP-Kranke.

Efficacy and possible negative side effects of a patient education program for rheumatoid arthritis were evaluated in a controlled, prospective study over 3 months. 34 outpatients were educated over a total of 8 h in three groups within a patient-centred design. Before the program the knowledge of the disease depended only on the formal grade of education but not on disease-related variables such as disease duration or disability. Probably due to its individualizing method, the program improved the knowledge of all patients to the same extent, regardless of their intellectual and social prerequisites. The increased cognitive knowledge did not result in negative side effects like increased pain or depression. The pain score remained unchanged. Depression decreased after the education. The group sessions made us suppose that the participants may have represented a selected group of active, psychologically stable patients, who cope well with rheumatoid arthritis. In contrast, we felt that non-participation was the response of the inactive, fatalistic patients with rheumatoid arthritis, who live in social isolation and especially need our care. Therefore, future efforts must particularly focus on the problem of motivation and on an increase in the rate of participation.

[Patient education in chronic polyarthritis. 2. Organizational and curriculum concept of patient seminars for chronic polyarthritis patients]. / Krankheitsaufklärung bei chronischer Polyarthritis. 2. Organisatorisches und curriculares Konzept von Patientenseminaren für c.P.-Kranke.

In our outpatient rheumatology unit, nearly all patients with rheumatoid arthritis (n = 412, responder rate 89%) were asked for their concepts of patient information and what they thought the aims of a patient education program should be. The patients preferred information about biomedical and practical aspects of their disease more than talking about psychosocial problems. In the same way, from a patient education program they wanted cognitive knowledge and practical help for the daily coping with the disease more than psychological help. Considering the results of the interviews, we developed an educational program for outpatients with rheumatoid arthritis. Its organization and curriculum reflect didactic and methodical aspects of patient information in a chronic rheumatic disease.

Gold colitis induced by auranofin treatment of rheumatoid arthritis: case report and review of the literature.

A case of ulcerative colitis occurred during treatment of rheumatoid arthritis with the new oral gold preparation auranofin after a cumulative dose of 2160 mg. A barium enema showed loss of mucosal pattern and a rectal biopsy disclosed deep erosions, mucosal inflammation, and crypt abscesses. Precipitates of gold were seen in the periglandular stroma. On electron microscopy the gold deposits seemed to be identical to granules described in gold nephropathy. As the extrapolated serum gold level was within the normal range at the onset of the complication, the morphological findings suggested a local toxicity of the drug. The patient recovered within 14 days of withdrawal of auranofin and the start of therapy with sulphasalazine and steroids. A review of the published work shows that the previously reported mortality in gold colitis of 40% has decreased in recent years. The causes of this decrease may be both the earlier diagnosis of gold colitis and the improved intensive care of its severe complications.