[Novel revision of the training regulations for German physicians-Consequences for trainees and trainers in rheumatology]. / Neue Musterweiterbildungsordnung ­ Konsequenzen für die Weiterzubildenden und die Weiterbilder in der Rheumatologie.

Rheumatology training is reorganized with the implementation of the revision of the training regulations for German physicians (MWBO) to become a specialist in internal medicine and rheumatology. This article focusses on novel aspects including far-reaching waiver of reference numbers, the professionally recommended training plan, the e­logbook, the regulation of specific training periods and the requirement of reapplication for the training authorization in addition to the contents of training. These aspects involve direct consequences for trainees and trainers.

[Compliance--(no) topic in pain therapy?]. / Compliance--(k)ein Thema in der Schmerztherapie?

Patients' compliance or adherence to medical therapy recommendations has been identified to be a pivotal element in achievement of treatment success. Nonadherence is a commonly-found phenomenon among patients suffering chronic pain. Its negative impact on the individual health status and on health systems has put forth strategies to improve adherence in the therapy of chronicpain. These include the use of medications with reliable and high efficacy combined with low rate and severity of side effects, limited need of medication to manage breakthrough pain as well as the reduction of application frequency.

Vitamin D receptor genotypes are not associated with rheumatoid arthritis or biochemical parameters of bone turnover in German RA patients.

OBJECTIVE: Vitamin D is known to exert immunomodulatory effects. An overrepresentation of the b allele of the vitamin D receptor (VDR) has been detected in autoimmune diseases as type-1-diabetes and multiple sclerosis. VDR polymorphisms have been shown to influence bone metabolism and bone density. The aim of the present study was to examine the distribution of VDR alleles in German rheumatoid arthritis (RA) patients and their relation to bone turnover parameters. METHODS: 62 German RA patients were included and compared to 40 controls. Three VDR alleles were examined (Bsm I, Taq I and Fok I). In addition, serum intact osteocalcin (OC), parathyroid hormone, bone specific alkaline phosphatase (B-ALP), the carboxyterminal extension peptide of type I procollagen, 25-OH-vitamin D and urinary deoxypyridinoline (DPD) excretion were measured. Furthermore, C-reactive protein, erythrocyte sedimentation rate and rheumatoid factor were measured. RESULTS: We found a slightly higher frequency of the bB and tT-genotype in RA patients compared to controls, which was not statistically significant. OC and B-ALP were found to be significantly higher in RA patients with positive correlations between bone formation and resorption parameters indicating higher bone turnover in RA patients with maintained coupling. CRP in RA patients correlated with DPD and inversely with PTH. VDR genotype showed no association with bone turnover, family history or the presence of rheumatoid factor. CONCLUSIONS: Our results suggest that VDR polymorphisms do not play a major role in RA predisposition in Germans.

[Thermotherapy in rheumatic diseases]. / Thermotherapie bei rheumatischen Erkrankungen.

Heat and cold treatment are often used in the physical therapy of rheumatic diseases. Thermotherapy influences perfusion, muscular tone, pain, and inflamed arthritic joints. Cold applications are preferable in treating active arthritis. Heat treatment is advantageous in the management of less active arthritis and non-inflammatory rheumatic disorders. Current investigations demonstrate that thermotherapy influences the endocrine--an immune systems.

Skin microcirculation during tapwater iontophoresis in humans: cathode stimulates more than anode.

The aim of this controlled study was to evaluate the influence of anode and cathode on skin blood flow by using direct current. Skin microcirculation and skin temperature of 26 healthy subjects (17 men and 9 women, 20-64 years of age) without any vascular diseases were registered when a tapwater iontophoresis was applied. Thermoindifferent water temperature was used to prevent thermic effects on microcirculation. The blood flow measurement was conducted by laser-Doppler flowmetry on the proximal forearm and on the back of the wrist. The skin temperature was measured before and after treatment by an infrared thermometer. In 19 persons there was an intense erythema on the side of the cathode and an only modest one on the side of the anode, while 7 persons showed meager reactions on both sides. The erythema rose strongly from the distal (back of the hand) to the proximal forearm. The comparison of the microcirculation of the arms showed an increase of 120% at the anode and of 700% at the cathode. The differences between the two sides were significant (P < 0.001). After the end of tapwater iontophoresis the skin temperature increased more on the side of the cathode than on the anode side (P < 0.001). The frequency of vasomotion did not change. The vasomotion amplitude increased 67% at the anode (P < 0.05) and 175% at the cathode (P < 0.001). The increased blood flow effect was not age or sex dependent. Although the increased blood flow effect was six times larger on the cathode side, the subjects did not perceive any subjective difference.

Reduced skin hyperemia during tap water iontophoresis after intake of acetylsalicylic acid.

Skin microcirculation and skin temperature of 10 healthy subjects (6 men and 4 women, 20-44 yr of age) without any vascular diseases were registered when a thermoindifferent tap water iontophoresis was applied. The aim of this controlled study was to evaluate the development of skin hyperemia after the intake of 500 mg of acetylsalicylic acid (ASA). The measurement was conducted by laser-Doppler flowmetry on the proximal forearm. The skin temperature was measured before and after the treatment by an infrared thermometer. In all persons there was an intense erythema on the side of the cathode and only a modest one on the side of the anode. Without ASA preliminary treatment, the cutaneous flow showed an increase of 106% at the anodal side and that of 834% at the cathodal side (P < 0.001). After ending tap water iontophoresis, the skin temperature increased more on the cathode side than on the anode side (P < 0.001). After the intake of 500 mg ASA, the increase of the flow was 78% at the anode and 88% at the cathode. The comparison of the skin microcirculation did not show any differences at the anodal side when acetylsalicylic acid was taken before, but a strong suppression of the galvanic erythema at the cathodal side was observed after the intake of ASA. There is a direct influence of acetylsalicylic acid on the induction of the neurogenic inflammation caused by a galvanic erythema. The intensity of the induced erythema correlates with the analgesic effects of constant current treatment. An attenuation of the electrotherapeutic analgesia is possible.