The use of social media and social networks has increased significantly in recent years. They are becoming progressively more important as information channels in private and professional contexts. Also, in medicine, social media are already being used in a variety of ways. For example, professional societies and patient interest groups are being increasingly represented in social networks. The broad use and wide audience of these networks offer new opportunities for the field of rheumatology. This review article provides an overview of the characteristics of some major social media platforms and systematically analyses the existing publications in the context of rheumatology. Furthermore, advantages, but also potential risks that may arise due to social media use are being addressed.
Rheumatology , Social Media , Humans
The VEXAS syndrome is a recently identified autoinflammatory systemic disease. The acronym VEXAS stands for Vacuoles, E1 enzyme, Xlinked, Autoinflammatory, Somatic. The disease is due to an acquired somatic mutation of the UBA1 gene, which encodes for the E1 enzyme, which in turn is responsible for the ubiquitination of proteins. Due to its location on the X chromosome, the disease predominantly affects men (in the second half of life). The patients present with a plethora of inflammatory clinical symptoms, often with overlap of hematologic, dermatologic, and rheumatologic syndromes. In particular, the presence of cytoplasmic vacuoles in the bone marrow is characteristic. In this article we report the clinical case of a VEXAS patient and give an overview of the pathophysiology, clinical symptoms and diagnostics of the disease.
Syndrome , Male , Humans , Mutation/genetics
Only the correct diagnosis enables an effective treatment of rheumatic diseases. Digitalization has already significantly accelerated and simplified our everyday life. An increasing number of digital options are available to patients and medical personnel in rheumatology to accelerate and improve the diagnosis. This work gives an overview of current developments and tools for patients and rheumatologists, regarding digital diagnostic support in rheumatology.
Rheumatic Diseases , Rheumatology , Humans , Rheumatic Diseases/diagnosis , Rheumatic Diseases/therapy , Rheumatologists
Colchicine, the toxin of the autumn crocus, has various anti-inflammatory effects. For this reason, it is being used for the treatment of several autoinflammatory diseases, such as gout or familial Mediterranean fever (FMF). In addition, some interesting studies have been published which suggest the benefits of colchicine in cardiovascular diseases. Furthermore, various anti-inflammatory therapeutic approaches are currently being tested in clinical trials for the treatment of COVID-19. First publications suggest a potential benefit of colchicine in certain disease phases of the virus infection. This article provides an overview of the mechanisms of action, benefits and side effects as well as the various possible uses of colchicine in rheumatology. Furthermore, a brief preview of potential new areas for use of the drug, which are also of interest to rheumatologists, are presented.
COVID-19 , Familial Mediterranean Fever , Rheumatology , Colchicine/therapeutic use , Humans , SARS-CoV-2
We report the case of a 73-year-old female patient with malignant melanoma who developed rapidly progressive dermatosclerosis of the arms and legs as well as myalgia and flexion contractures during treatment with the immune checkpoint inhibitor nivolumab. The diagnosis of a myofasciitis was confirmed by imaging and biopsy. Following consultation with the treating dermato-oncologists nivolumab treatment was paused and treatment with methotrexate and prednisolone was initiated. Immune checkpoint inhibitors can induce a variety of immune-mediated side effects and can also imitate symptoms of rheumatological diseases. The occurrence of myofasciitis under immune checkpoint inhibition has been reported in the literature only in a few cases. Further oncological and rheumatological treatment management should be carried out in close interdisciplinary coordination.
Drug-Related Side Effects and Adverse Reactions , Melanoma , Myositis , Aged , Female , Humans , Melanoma/drug therapy , Myalgia , Myositis/chemically induced , Myositis/diagnosis , Nivolumab/adverse effects
Pericarditis is the term for inflammatory involvement of the pericardium, which can be associated with pericardial effusion and myocardial involvement (perimyocarditis). Pericarditis can be present in the context of systemic inflammatory rheumatic diseases but can also constitute a distinct disease entity. Idiopathic recurrent pericarditis (IRP) describes relapsing conditions of pericarditis with an unknown cause, which show essential common features with autoinflammatory diseases. This article gives an overview of the frequency of pericarditis in systemic rheumatic diseases. Moreover, the clinical manifestations and pathophysiology of IRP are discussed. Finally, the therapeutic algorithms for acute and idiopathic pericarditis are explained.
Pericarditis , Humans , Inflammation , Pericardial Effusion/diagnosis , Pericardial Effusion/therapy , Pericarditis/diagnosis , Pericarditis/therapy , Pericardium , Rheumatologists
For several years video consultations have been regarded as a new form of medical healthcare infrastructure, in addition to personal doctor-patient contacts and have also been partly promoted. The COVID-19 pandemic brought unexpected topicality and attention to the use of video consultations. The National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung) decided on special regulations in the context of the COVID-19 pandemic, which reduce previous obstacles to the use of telemedicine and video consultations (and also partly of conventional telephony). The present statement of the German Society of Rheumatology (DGRh) on the use of video consultations is intended to give an overview of in which form and with which limitations video consultations can be used in rheumatology in Germany. It sketches an outlook on how video consultations can undertake which functions in rheumatological care in the future.
COVID-19 , Rheumatology , Telemedicine , Germany , Humans , Pandemics , SARS-CoV-2
Due to the outbreak of the COVID-19 pandemic, in recent months we have experienced deep changes in our daily and professional lives. In the context of pandemic containment, routine rheumatological procedures have changed in many areas. To guarantee sufficient protection against the infection for patients and staff, telemedicine (especially telephone and video consultation) has increasingly been used. Due to the Digital Healthcare Act (DiGAV), whereby patients will have a legal claim to specific digital health applications in Germany, medical apps and wearables will offer new opportunities for telemedical monitoring. This article provides an overview of telemedical care options in the field of rheumatology. Furthermore, opportunities and limitations of telemedicine in rheumatology are reviewed.
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Rheumatology/trends , Telemedicine/trends , Betacoronavirus , COVID-19 , Germany , Humans , Mobile Applications , Pandemics , SARS-CoV-2 , Wearable Electronic Devices
Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.
Rheumatology , Telemedicine , Germany , Humans , Rheumatology/methods , Rheumatology/trends , Telemedicine/methods , Telemedicine/trends
Auricular chondritis frequently occurs in relapsing polychondritis. In addition to the primary form of the disease up to 30% of cases of chondritis can be secondary, e.g. due to autoimmune diseases. We describe the case of a 62-year-old male patient with auricular chondritis as the first symptom of granulomatosis with polyangiitis. Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis should always be considered in the differential diagnostics of relapsing polychondritis and antibody testing should be performed accordingly.
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis , Granulomatosis with Polyangiitis , Polychondritis, Relapsing , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/complications , Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/diagnosis , Antibodies, Antineutrophil Cytoplasmic , Diagnosis, Differential , Granulomatosis with Polyangiitis/diagnosis , Humans , Male , Middle Aged , Polychondritis, Relapsing/diagnosis
The increasing use of smartphones is accompanied by a significant increase in the use of mobile applications (apps). Chronically ill patients could permanently profit from this development.This development is fuelled by the Digital Healthcare Act (DVG), whereby patients have a legal claim to certain apps, so-called digital health applications (DiGAs), which are reimbursed by the statutory health insurance companies. Especially in the field of rheumatology, there are various opportunities to implement apps in the management of chronic diseases and their comorbidities. Furthermore, rheumatic patients and rheumatologists are becoming interested in apps and are willing to use them in the daily routine. This article tries to shed light on the chances and risks of apps and gives a first insight into the digital landscape of rheumatology apps in Germany.
Mobile Applications , Rheumatology , Telemedicine , Germany , Humans , Rheumatologists , Rheumatology/methods
BACKGROUND: In May 2018 a revision of the training regulations for German doctors (MWBO) was passed which will significantly impact the medical training for German rheumatologists. The goal of this paper was to create an overview of the status quo in advanced medical training in this field. METHODS: A quantitative and qualitative analysis was conducted to identify the strengths and weaknesses of the current continuous education in the field of rheumatology in Germany. The number of newly trained specialists in rheumatology in the years 2015 to 2017 was determined from the regional medical associations. Furthermore, an online survey assessing the training conditions of assistant physicians was conducted. 71 physicians participated in the nationwide survey. RESULTS: In 2015 (53 specialists), in 2016 (43 specialists) and in 2017 (43 specialists) completed their training in the field of rheumatology. The online survey of assistant physicians found that the medical training was graded 3.1 on a scale of 1 to 6 (SD ± 1.1). 19.4% of respondents reported that they had regular mentoring, and 41.7% had on-the-job evaluations. Deficits were evident concerning practical diagnostic skills: 22.8% of the physicians were not practicing joint ultrasonography and another 20% performed it only once a month. As points of criticism 46.6% mentioned a missing structure in training programme and 33.3% noted a lack of supervision. The majority of respondents wanted more training options, supervision and better practical training in ultrasound diagnostics. CONCLUSION: The nationwide number of newly acquired specialist qualifications (between 2015 and 2017) showed a decreasing trend. It is to be feared that the numbers will continue to stagnate, which increases the importance to invest further in medical education. The online survey also showed that the current medical training in Germany has deficits. Here, the new MWBO could create better guidelines for a structured training, which should be guided by the principle of "Teach to Target".
Education, Medical, Graduate , Rheumatology , Specialization , Germany , Humans , Surveys and Questionnaires
Whipple's disease is a rare infectious disease, which can affect various organ systems. Arthritis is a common symptom and therefore the infection is often misdiagnosed as seronegative rheumatoid arthritis. In rare cases an infection with Tropheryma whipplei can also cause skin lesions, such as subcutaneous nodules, erythema nodosum or vasculitis. This article reports the case of a 77-year-old female patient with erosive joint changes, persistently elevated serological inflammation markers and recurrent ulcerative lesions of the lower extremities, which were initially misdiagnosed as rheumatoid vasculitis. In cases of a clinically suspected infection with Tropheryma whipplei an early biopsy of the affected organ system is essential for the diagnosis.
Arthritis, Rheumatoid , Dermatitis , Whipple Disease , Aged , Anti-Bacterial Agents , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/etiology , Dermatitis/diagnosis , Dermatitis/etiology , Diagnosis, Differential , Female , Humans , Tropheryma , Whipple Disease/complications , Whipple Disease/diagnosis
BACKGROUND: Myalgia is a common but unspecific set of symptoms that may be caused by orthopedic, neurological and internal medical conditions, often resulting in a diagnostic challenge. Muscular polyarteritis nodosa (PAN) is a rare differential diagnosis of myalgia with elevated serological inflammatory markers. OBJECTIVE: Based on three clinical cases and the literature this review describes the essential clinical and diagnostic features of muscular PAN. RESULTS: Muscular PAN typically presents with immobilizing myalgia confined to the lower limbs and elevated serological inflammatory markers but often normal creatine kinase (CK) levels. Contrast-enhanced magnetic resonance imaging of the affected muscles, which can often mimic myositis, and muscle biopsy provide the relevant histological findings that lead to the diagnosis of a vasculitis. CONCLUSION: With respect to own experiences and the reviewed literature, muscular PAN should be considered as a possible diagnosis in cases of myalgia with elevated inflammatory markers but normal CK levels and a lack of further symptoms typical for vasculitis.
Creatine Kinase/blood , Muscle, Skeletal/pathology , Myalgia/diagnosis , Polyarteritis Nodosa , Biopsy , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Muscle, Skeletal/diagnostic imaging , Myalgia/diagnostic imaging , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/diagnostic imaging , Young Adult
BACKGROUND: Apps and online platforms play an ever increasing role in the daily work routine of physicians. The aim of this study was to investigate which medical apps and online platforms are used by German rheumatologists for certain tasks and to identify usage trends. METHODS: Data were collected via a SurveyMonkey survey conducted by members of rheumadocs (Young German Rheumatology Association) at the 2016 and 2018 German Society for Rheumatology (DGRh) conferences. RESULTS: In 2016 and 2018 the survey was completed by 75 and 84 assistant and specialist rheumatologists, respectively. In 2016, 37% of rheumatologists were using medical apps in routine care which changed to 49% in 2018. In 2016, 47% compared to 68% in 2018, planned to integrate medical apps into routine care. In total, 20 different medical apps were recommended for colleagues to use; however only 2 of these apps were specific for rheumatology. In contrast to 52 app recommendations for colleagues, only 8 app recommendations for patients were recorded. Most recommendations to physicians received the app "Arznei aktuell" (21%). "Embryotox" was the app, most recommended to patients (38%). In 2016 the online database PubMed was most popular and 97% of participants were familiar with it. Use of other online platforms showed great age dependency in 2016: Amboss (a digital learning platform) was used by 31% of the age group 21-30 years and was not used at all by the age group 51-60 years. DISCUSSION: Use of medical apps and planned integration of medical apps into routine care is increasing among German rheumatologists. On the other hand, recommendable rheumatological apps for rheumatologists and especially for patients are currently largely unknown to rheumatologists.
Mobile Applications , Practice Patterns, Physicians' , Rheumatologists , Humans , Surveys and Questionnaires
