[The regional network ADAPTHERA : Rheumatology care through coordinated cooperation: comprehensive, trans-sectoral, covering all health insurance. Initial results]. / Das landesweite Netzwerk ADAPTHERA : Erste Ergebnisse einer flächendeckenden, krankenkassenübergreifenden und transsektoralen rheumatologischen Versorgung.

The aim of the rheumatology network ADAPTHERA ("risk-adapted rheumatology therapy") is to achieve a comprehensive improvement in rheumatology care by coordinating treatment in a regional, trans-sectoral network. Accompanying biomedical research projects, training concepts, and the construction of a rheumatology register (gathering data and biomaterials) should furthermore ensure the stable and sustainable optimisation of care. In the pilot phase (2012-2015) the focus of the ADAPTHERA network, required as a "regional key project" within the framework of the Initiative on Health Economy of Rheinland-Palatinate (RL-P), Germany, was placed on the optimisation of the early diagnosis of rheumatoid arthritis, where it is well-known that there is a significant care deficit.Through the intensive, stable, and coordinated cooperation of all health care partners in the field of rheumatology (registered general practitioners and orthopaedic specialists, registered core rheumatologists as well as the Association of Rheumatology of RL-P) a unique regional, comprehensive offer with verifiable care optimisation has been established in RL-P. The network is supported by outstanding collaboration with the Association of Statutory Health Insurance Physicians and the self-help organisation Rheumatology League.The aims that were established at the start of the project will be achieved by the end of the pilot phase:- significant improvement in the early diagnosis of rheumatoid arthritis (an average of 23.7 days until diagnosis by rheumatologists)- access covering all health insurance (regardless of the particular scheme the patients belong to)- comprehensive (verifiable participation of general practitioners from all over RL-P)- data and biomaterials collection, established as a basis for biomarker research, and a rheumatology register for RL-P.

[Routine report on the medical rehabilitation of patients with musculoskeletal diseases]. / Routineberichterstattung zur medizinischen Rehabilitation bei muskuloskelettalen Krankheiten.

The commission "Rehabilitation" of the German Society of Rheumatology compiled a data set for a routine report of the rehabilitation system for muskuloskeletal diseases. More than 250 rehabilitation hospitals offer inpatient rehabilitation for patients with musculoskeletal diseases. The prevalence of inpatient rehabilitation decreased due to new legislative rules in 1997, increased again thereafter but has not reached the former level. The prevalence of inpatient rehabilitation during the preceding year in patients with inflammatory rheumatic diseases treated by rheumatologists amounts to 12% with higher figures in men than in women and lower figures in the area of the former German Democratic Republic. The prevalence of outpatient rehabilitation increased during the last few years but, currently, does not exceed 5% of the entire rehabilitation procedures.

[Sulfasalazine in ankylosing spondylitis: a prospective, randomized, double-blind placebo-controlled study and comparison with other controlled studies]. / Sulfasalazin bei Spondylitis ankylosans: eine prospektive, randomisierte, doppelblinde, placebo-kontrollierte Studie und Vergleich mit anderen kontrollierten Studien.

OBJECTIVE: To assess the efficacy and tolerability of sulfasalazine in ankylosing spondylitis including a meta-analysis of comparable trials. METHODS: In a prospective, randomized, double-blind, placebo-controlled trial 70 patients with established diagnosis of ankylosing spondylitis and a mean disease duration of 16.7 years were investigated in two centers for 26 weeks comparing 3 g/d sulfasalazine to placebo. RESULTS: The main outcome parameters, pain score, fingers-to-floor test, and CRP, did not improve significantly in the sulfasalazine group compared to the placebo group. Altogether sulfasalazine was significantly superior to placebo only concerning the IgA levels. The dropout rate was 47% for the sulfasalazine group and 19% for the placebo group. Due to side effects, 38% and 11%, respectively, stopped treatment. Ten other prospective, double-blind, controlled studies were analyzed. Altogether 959 patients with a mean disease duration of 13.9 years were evaluated. Most parameters did not improve significantly in the sulfasalazine groups compared to the placebo groups. Spinal motility remained nearly unchanged (0.3-3.5% improvement). Pain, morning stiffness, functional index, and global assessment were slightly influenced (1.9-11.7%). Reduction of ESR, CRP, IgA, IgG, and IgM was more distinct (12.6-20.3%). In 4 studies SSZ had greater efficacy in patients with peripheral joint involvement. CONCLUSION: Sulfasalazine has no clinically relevant benefit in patients with ankylosing spondylitis. The dropout-rate due to adverse effects is high with a daily dose of 3 g. Sulfasalazine may be beneficial in peripheral joint involvement. Only few data exist about patients with a disease duration of less than 10 years.

[Outcome measurement in musculoskeletal diseases: recommendation for a core set of scales for use in rehabilitation]. / Outcome-Messung bei muskuloskelettalen Krankheiten: Vorschlag für ein Core-Set von Instrumenten zum Einsatz in der Rehabilitation.

By application of a standardized core set of outcome measurement instruments, comparison between studies as well as meta-analyses in rehabilitation research can be facilitated. The German Society for Rheumatology has commissioned its working group on rehabilitation with the development of a proposal for such a core set of outcome measurement instruments. In a first step, dimensions for outcome measurement in rehabilitation were defined by a group of experts which represented rehabilitation hospitals, acute care hospitals, and research groups specialized in outcome measurement. The Delphi method was used in a multiple step consensus process. In a second step, instruments and procedures to operationalize the relevant dimensions were chosen. Reliability, validity, sensitivity to change, and practicability were used as criteria for selecting measurement instruments. The main intention of the proposed core set of outcome measurement instruments is to facilitate the processes of planning and carrying out rehabilitation research studies. Furthermore, the proposed instruments can be used for clinical documentation systems as well as for internal or external quality assurance programs.

Topometry for locally changing materials.

Three-dimensional topometry is supplemented with ellipsometric measurements on the same pixel raster for calculation of the phase of the reflected waves and correction of the height fields. Lateral resolution is <1mum . The ellipsometric angles are determined by phase shifting and contrast evaluation. Three-dimensional fields of the ellipsometric angles, the real and the imaginary parts of the refractive index, and the corrected topography of the heights are presented.

Klebsiella pneumoniae-reactive T cells in blood and synovial fluid of patients with ankylosing spondylitis. Comparison with HLA-B27+ healthy control subjects in a limiting dilution study and determination of the specificity of synovial fluid T cell clones.

OBJECTIVE: To study the frequency of Klebsiella pneumoniae-responsive T cells in the peripheral blood (PB) of ankylosing spondylitis (AS) patients compared with that in healthy HLA-B27+ donors, and to examine T lymphocyte clones (TLC) derived from AS patient synovial fluid (SF) for the presence of Klebsiella reactivity. METHODS: Limiting dilution analysis of PB T cells in 8 patients with active AS and in 8 HLA-B27+ healthy subjects was used to determine the frequency of PB T cells responsive to K pneumoniae and Escherichia coli GroEL. SF T cells from a patient with active AS were cloned, and 125 TLC were characterized in proliferation assays. RESULTS: There were fewer T cells in the PB of AS patients that reacted with K pneumoniae than in the PB of healthy HLA-B27+ subjects. The frequencies of E coli GroEL-responsive T cells were approximately 5-10 times lower in all subjects tested (healthy donors and AS patients), but without significant differences between the 2 groups. Two CD4+ TLC that recognized K pneumoniae (1 cross-reactive with E coli) as well as 3 TLC that recognized GroEL (2 CD4+, 1 T cell receptor gamma/delta+) were isolated from the SF of a patient with actige AS. CONCLUSION: Our results indicate that there is a quantitative reduction of K pneumoniae-responsive T cells in the PB of AS patients as compared with healthy controls. This may reflect a defective peripheral T cell defense in the immune response to Klebsiella and may allow bacterial antigens to reach the synovium, where they initiate specific T cell responses.

Microshape and rough-surface analysis by fringe projection.

A fringe-projection system for microscopic applications, fringe-projecting microscopy, is developed and analyzed. Projection of the grating and imaging of the fringe system, modulated by the surface, are accomplished by the same high-aperture objective. The spectrum of the grating is spatially filtered and projected into the aperture with a lateral shift, which leads to a telecentric projection under oblique incidence and telecentric imaging. Topographies of specularly as well as diffusely reflecting surfaces can be obtained. The measurement of highly rough surfaces is described together with preprocessing steps. The resulting intensity distribution of the fringes is analyzed. Formulas for vertical and lateral resolution, measuring range, and dynamic range, based on noise considerations, are presented and verified by topographies of technical surfaces.

[Graphic presentation of visual analog scales for pain evaluation in rheumatology]. / Grafische Darstellung visueller Analogskalen zur Schmerzbeurteilung in der Rheumatologie.

The scores of visual analog scales, used for rating of rheumatological pains, are scarcely normal distributed. The presentation of these findings by mean and standard deviation can be evidently distorted. Furthermore range and extreme values are missing. The new grafical method-box and whisker plot-is more adequate to those data. Comparing both methods in a clinical trial the possible gain of information is illustrated.

[Treatment of ankylosing spondylitis with slow-release diclofenac sodium in a single daily dose]. / Behandlung der Spondylitis ankylosans mit der Retardform von Diclofenac-Natrium in einmal täglicher Dosierung.

The efficacy and tolerability of slow-release diclofenac sodium were investigated in 40 patients with ankylosing spondylitis. The patients received one coated tablet of 100 mg daily in the morning for 21 days in addition to standard physiotherapy. The efficacy of the trial treatment was evaluated by measuring the chin-to-manubrium sterni and fingertips-to-floor distances, Schober's sign, and chest expansion. Every morning and evening the severity of pain and the degree of spinal stiffness were recorded by the patients on visual analogue scales. A significant improvement of the symptoms was found in 35 of the patients as compared to the initial findings. The slow-release formulation of diclofenac Na was very well tolerated. The necessity of balneophysical therapy in ankylosing spondylitis is emphasized, which in most cases will only be possible in combination with adequate drug therapy.

[ECG changes in chronic polyarthritis compared to a healthy control group]. / Ekg-Veränderungen bei chronischer Polyarthritis im Vergleich mit einer gesunden Kontrollgruppe.

ECG from 200 patients with radiologically and clinically definite rheumatoid arthritis were compared with those from a healthy group with the same age and sex distribution. The frequency of pathological changes of the ECG was found to be the same in both groups. Therefore doubt remains whether the pathological changes of the ECG can be attributed to rheumatoid arthritis.

[ECG changes in spondylarthritis ankylopoietica in comparison with a healthy control group]. / Ekg-Veränderungen bei Spondylarthritis ankylopoetica im Vergleich zu einer gesunden Kontrollgruppe

ECG from 150 patients with clinically and radiologically established ankylosing spondylitis were compared with those from a healthy age and sex matched group. The reported frequency of atrioventricular conduction defects (3-15%) was confirmed (4.6%). These and other pathological ECG changes were also found in the control group. No significant statistical difference in frequency was found. The refore doubt remains whether the pathological changes of the ECG can be attributed to ankylosing spondylitis.