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1.
Z Rheumatol ; 2024 Jul 10.
Artículo en Alemán | MEDLINE | ID: mdl-38985176

RESUMEN

INTRODUCTION: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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.

2.
Z Rheumatol ; 2024 Jun 27.
Artículo en Alemán | MEDLINE | ID: mdl-38935116

RESUMEN

Patients with diseases of the musculoskeletal system are confronted with a large quantity of treatment offers based on methods of complementary medicine. Despite a considerable number of publications on this topic, the scientific evidence is still poor. This article focuses on Ayurvedic medicine (AM), traditional Chinese medicine (TCM), mind-body medicine and homeopathy. These procedures have a longstanding tradition of practice and each claims to have its own theoretical concept; however, the application in the field of rheumatology can only be recommended either for specific entities or, in the case of homeopathy, not at all. In addition, this article summarizes the evidence for dietary recommendations, nutritional supplements and herbal medicine in rheumatology. The latter topics are frequently discussed in the popular press and are a much-debated issue between physicians and patients; however, clear-cut recommendations for the application on a scientific basis are the exception and mainly consist of the endorsement to adhere to the principles of a Mediterranean diet.

3.
Z Rheumatol ; 2024 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-38689038

RESUMEN

BACKGROUND: Real-world data for filgotinib, a Janus kinase (JAK)1 inhibitor, are limited in patients with rheumatoid arthritis (RA). OBJECTIVES: To explore real-world filgotinib use in patients with RA in Germany. MATERIALS AND METHODS: 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. RESULTS: 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 6­months of follow-up, 36.8% of patients had achieved Clinical Disease Activity Index (CDAI) remission and 45.6% had achieved CDAI low disease activity. CONCLUSIONS: 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.

4.
Z Rheumatol ; 82(6): 517-531, 2023 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-37212842

RESUMEN

Methods of complementary and alternative medicine (CAM) are appealing for many patients with rheumatic diseases. The scientific data are currently characterized by a large number of publications that stand in contrast to a remarkable shortage of valid clinical studies. The applications of CAM procedures are situated in an area of conflict between efforts for an evidence-based medicine and high-quality therapeutic concepts on the one hand and ill-founded or even dubious offers on the other hand. In 2021 the German Society of Rheumatology (DGRh) launched a committee for CAM and nutrition, which aims to collect and to evaluate the current evidence for CAM applications and nutritional medical interventions in rheumatology, in order to elaborate recommendations for the clinical practice. The current article presents recommendations for nutritional interventions in the rheumatological routine for four areas: nutrition, Mediterranean diet, ayurvedic medicine and homeopathy.


Asunto(s)
Terapias Complementarias , Dieta Mediterránea , Homeopatía , Enfermedades Reumáticas , Enfermedades Reumáticas/terapia , Humanos , Medicina Ayurvédica
5.
EFSA J ; 16(8): e05351, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32626012

RESUMEN

EFSA was asked for a partial risk assessment of Spodoptera frugiperda for the territory of the EU focussing on the main pathways for entry, factors affecting establishment, risk reduction options and pest management. As a polyphagous pest, five commodity pathways were examined in detail. Aggregating across these and other pathways, we estimate that tens of thousands to over a million individual larvae could enter the EU annually on host commodities. Instigating risk reduction options on sweetcorn, a principal host, reduces entry on that pathway 100-fold. However, sweetcorn imports are a small proportion of all S. frugiperda host imports, several of which are already regulated and further regulation is estimated to reduce the median number entering over all pathways by approximately 10%. Low temperatures limit the area for establishment but small areas of Spain, Italy and Greece can provide climatic conditions suitable for establishment. If infested imported commodities are distributed across the EU in proportion to consumer population, a few hundreds to a few thousands of individuals would reach NUTS 2 regions within which suitable conditions for establishment exist. Although S. frugiperda is a known migrant, entry directly into the EU from extant populations in sub-Saharan Africa is judged not feasible. However, if S. frugiperda were to establish in North Africa, in the range of thousands to over two million adults could seasonally migrate into the southern EU. Entry into suitable NUTS2 areas via migration will be greater than via commercial trade but is contingent on the establishment of S. frugiperda in North Africa. The likelihood of entry of the pest via natural dispersal could only be mitigated via control of the pest in Africa. If S. frugiperda were to arrive and become a pest of maize in the EU, Integrated Pest Management (IPM) or broad spectrum insecticides currently used against existing pests could be applied.

6.
PLoS One ; 5(12): e14328, 2010 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-21179199

RESUMEN

BACKGROUND: Interleukin-6 (IL-6) is a pro-inflammatory cytokine that has been found to be increased in type 2 diabetic subjects. However, it still remains unclear if these elevated IL-6 levels are co-incidental or if this cytokine is causally related to the development of insulin resistance and type 2 diabetes in humans. Therefore, in the present study we examined insulin sensitivity, serum adipokine levels and lipid parameters in human subjects before and after treatment with the IL-6 receptor antibody Tocilizumab. METHODOLOGY/PRINCIPAL FINDINGS: 11 non-diabetic patients with rheumatoid disease were included in the study. HOMA-IR was calculated and serum levels for leptin, adiponectin, triglycerides, LDL-cholesterol, HDL-cholesterol and lipoprotein (a) (Lp (a)) were measured before as well as one and three months after Tocilizumab treatment. The HOMA index for insulin resistance decreased significantly. While leptin concentrations were not altered by inhibition of IL-6 signalling, adiponectin concentrations significantly increased. Thus the leptin to adiponectin ratio, a novel marker for insulin resistance, exhibited a significant decrease. Serum triglycerides, LDL-cholesterol and HDL-cholesterol tended to be increased whereas Lp (a) levels significantly decreased. CONCLUSIONS/SIGNIFICANCE: Inhibition of IL-6 signalling improves insulin sensitivity in humans with immunological disease suggesting that elevated IL-6 levels in type 2 diabetic subjects might be causally involved in the pathogenesis of insulin resistance. Furthermore, our data indicate that inhibition of IL-6 signalling decreases Lp (a) serum levels, which might reduce the cardiovascular risk of human subjects.


Asunto(s)
Artritis Reumatoide/metabolismo , Insulina/metabolismo , Interleucina-6/metabolismo , Lipoproteína(a)/metabolismo , Adipoquinas/sangre , Adulto , Anciano , Anticuerpos Monoclonales/farmacología , Anticuerpos Monoclonales Humanizados , Citocinas/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Femenino , Humanos , Resistencia a la Insulina , Masculino , Persona de Mediana Edad , Transducción de Señal
7.
Cell Tissue Res ; 307(3): 321-7, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11904768

RESUMEN

The potential of mesenchymal stem and progenitor cells (MSC) to replicate undifferentiated and to mature into distinct mesenchymal tissues suggests these cells as an attractive source for tissue engineering. The objective was to establish a protocol for the isolation of porcine MSC from bone marrow and to demonstrate their ex vivo differentiation into various mesenchymal tissue cells. MSC from passage 2 were selected for differentiation analysis. Differentiation along the osteogenic lineage was documented by deposition of calcium, visualization of alkaline phosphatase activity, and by analysis of osteogenic marker genes. Adipocytes were identified morphologically and by gene-expression analysis. Deposition of type II collagen and histological staining of proteoglycan indicated chondrogenic differentiation. Therefore, porcine MSC may be introduced as a valuable model system with which to study the mesenchymal lineages for basic research and tissue engineering.


Asunto(s)
Linaje de la Célula , Separación Celular/métodos , Mesodermo/citología , Células Madre , Porcinos , Adipocitos/fisiología , Animales , Biomarcadores , Células de la Médula Ósea/citología , Células de la Médula Ósea/metabolismo , Técnicas de Cultivo de Célula/métodos , Diferenciación Celular/fisiología , Tamaño de la Célula , Células Cultivadas , Condrogénesis/fisiología , Humanos , Osteogénesis/fisiología , Fenotipo , Células Madre/metabolismo , Ingeniería de Tejidos
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