RESUMEN
The city and casino of Wiesbaden, capital of the German state Hessen, have endowed the Carol Nachman Prize to promote research work in the field of rheumatology since 1972. The prize, endowed with 37,500â¯, is the second highest medical award in Germany and serves to promote clinical, therapeutic, and experimental research work in the field of rheumatology. In June 2022, the 50-year anniversary was celebrated. In the symposium preceding the award ceremony, an overview was given on the significance of spondyloarthritis for the work of the awardees in the past 30 years. This overview has now been put together to inform the interested community of the work performed, including the opinion of the awardees regarding what they consider to be their most important contribution.
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Polyarteritis nodosa (PAN) and Kawasaki syndrome (KS) are rare forms of primary vasculitis with heterogeneous manifestations and courses of the disease. According to the Chapel Hill Consensus Conference 2012 they belong to the vasculitis of medium size vessels. In contrast to microscopic polyangiitis (MPA), PAN and KS do not affect microscopic vessels such as arterioles, venules or capillaries and are not associated with antineutrophil cytoplasmic antibodies (ANCA). The diagnostics are based on the typical constellation of clinical symptoms, on angiographic findings, the exclusion of other differential diagnoses and, in the case of PAN, in the histopathological confirmation. The therapeutic options of KS in childhood and PAN in adults and children, which are dependent on the severity and the prognosis, are presented.
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Poliangitis Microscópica , Síndrome Mucocutáneo Linfonodular , Poliarteritis Nudosa , Adulto , Niño , Humanos , Poliarteritis Nudosa/diagnóstico , Síndrome Mucocutáneo Linfonodular/complicaciones , Anticuerpos Anticitoplasma de Neutrófilos , PronósticoAsunto(s)
Refugiados , Migrantes , Humanos , Accesibilidad a los Servicios de Salud , Instituciones de SaludRESUMEN
As systemic diseases it is not uncommon for inflammatory rheumatic diseases to exhibit renal involvement. In contrast to connective tissue diseases and vasculitis, in rheumatoid arthritis and spondylarthritis direct inflammatory manifestations in the sense of glomerulonephritis (GN) and autoimmune interstitial nephritis are rare. In these groups of diseases renal biopsies usually show mesangial proliferative GN and IgA nephropathy or less commonly membranous GN. These and secondary amyloid A (AA) amyloidosis are regularly associated with longer lasting disease activity and a poor prognosis; however, clinically more frequent and more relevant are other sequelae of chronic systemic inflammation, namely endothelial function disorder and the premature development of atherosclerosis, resulting in progressive kidney failure. This is accompanied by the undesired effects of antirheumatic treatment and renal complications of comorbidities.
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Artritis Reumatoide , Humanos , Artritis Reumatoide/complicaciones , Artritis Reumatoide/diagnósticoRESUMEN
Spondylarthritis (SpA) is one of the most frequent extraintestinal manifestations of chronic inflammatory bowel disease (IBD). Several arthritogenic enterobacterial infections can induce sequelae such as reactive SpA. Studies on the gut-synovium axis in view of genetic, immunological, clinical and therapeutic aspects has made enterogenic SpA a model disease of all forms of SpA. The same applies for investigating IBD, as subclinical gut inflammation seen in SpA patients has provided significant evidence for a better understanding of mucosa-associated early immune events in Crohn's disease (CD). This article summarizes the pathognomonic clinical features, diagnostic steps, differential diagnosis and current pathogenetic models of enterogenic SpA. Knowledge of pathogenetic contexts leads to concrete treatment recommendations. These vary individually depending on the underlying IBD, on the inflammatory intestinal or rheumatic activity and on the rheumatological manifestation pattern.
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Enfermedad de Crohn , Enfermedades Inflamatorias del Intestino , Espondiloartritis , Humanos , Inflamación , Enfermedades Inflamatorias del Intestino/diagnóstico , Enfermedades Inflamatorias del Intestino/terapia , Espondiloartritis/diagnóstico , Espondiloartritis/terapiaRESUMEN
Interstitial lung disease (ILD) is the most frequent organ manifestation in rheumatic autoimmune disease. Depending on the underlying autoimmune disease, differently pronounced affections of small airways, interstitial parenchyma, and vessels are found. The group of rheumatic autoimmune diseases mainly includes connective tissue diseases (CTDs), also known as collagen vascular diseases, such as rheumatoid arthritis (RA), systemic sclerosis, (SSc), systemic lupus erythematosus, primary Sjögren's syndrome, idiopathic inflammatory myositis (IIM), and interstitial pneumonia with autoimmune features (IPAF). Frequency and manifestations of parenchymal lung disorders are described clinically, radiologically, and morphologically in these entities. For the precise diagnosis and for the differentiation between the wide range of parenchymal disorders with known possible cause or with unknown origin, also called unclassifiable or idiopathic interstitial pneumonias (IIPs), high resolution computed tomography (HRCT) findings represent the diagnostic gold standard. A transbronchial biopsy, surgical biopsy, or cryobiopsy will be used in unclassifiable findings to confirm a definitive histological confirmation. A precise diagnosis of these ILDs is crucial since the different pathologies that encompass ILD have different therapeutic options. In this sense, the participation of a pneumologist, rheumatologist, radiologist, and pathologist become essential in the multidisciplinary evolution of ILD.
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Enfermedades Autoinmunes , Enfermedades del Tejido Conjuntivo , Enfermedades Pulmonares Intersticiales , Lupus Eritematoso Sistémico , Humanos , Pulmón/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Reactive arthritis (ReA) is an aseptic, immune mediated arthritis with typical manifestations following urogenital, gastrointestinal or respiratory tract infections. The interval between the antecedent infection and arthritis is ranging from several days to 4-6 weeks. ReA is classified as member of the group of spondyloarthritides. The triggering microorganisms are not culturable by routine methods from the affected joints. In the pathogenesis of ReA, bacterial and immunological as well as genetic factors (HLA-B27) play an important role. Post-streptococcal arthritis, Lyme arthritis (Borreliosis) and viral arthritis are not classified as ReA within the spondyloarthritis group.âIn the treatment of ReA, antibiotics are not used. Acute ReA is treated by nonsteroidal anti-inflammatory drugs, and refractory (chronic) arthritis by steroids, sulfasalazine and TNF inhibitors. Notably, only a few original papers on ReA have been published within the last years.
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Artritis Reactiva , Antiinflamatorios no Esteroideos/uso terapéutico , Infecciones Bacterianas , Antígeno HLA-B27 , Humanos , Prohibitinas , Esteroides/uso terapéutico , Sulfasalazina/uso terapéutico , Inhibidores del Factor de Necrosis Tumoral/uso terapéuticoRESUMEN
In the case of acute back pain, the indication for inpatient diagnosis and therapy is rarely given. The indication is provided if a potentially dangerous disease situation is suspected and if the pain is immobilizing or cannot be controlled on an outpatient basis. The high treatment numbers in German hospitals indicate that there is overuse in the treatment of back pain. Back pain, especially acute low back pain, is a frequent consultative activity of general practitioners. Serious diseases of the spine occur in only about 1â% of cases in GP practices. Identifying potentially dangerous disease outcomes requires a detailed history and thorough physical examination of the unclothed patient. "Red flags", together with the overall clinical impression of the patient, provide decisive warnings for urgently needed back pain. Common non-specific low back pain can be treated on an outpatient basis by prescribing painkillers and instructions for exercise by GPs.