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1.
Orthopade ; 48(11): 936-941, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31686154

RESUMO

BACKGROUND: Gastroenterological and rheumatological diseases often have a systemic character, with disease manifestations beyond the area affected by the disease. Common disease-relevant pathophysiological pathways, e.g. chronic inflammation, may present primarily as rheumatological or gastroenterological disease. Knowledge of disease-specific symptoms and signs beyond one's own area of expertise my lead to an earlier and more precise diagnosis, with the chance of a more focused therapy. AIM: The aim of this overview is to sensitize orthopedists as well as rheumatologists to gastroenterological signs and symptoms and give them a clinical guide to approaching an interdisciplinary patient. Targeted, clinically relevant questions are discussed and common disease entities are presented.


Assuntos
Doenças do Sistema Digestório , Gastroenterologia , Inflamação , Doenças Reumáticas , Reumatologia , Humanos
3.
Z Rheumatol ; 78(8): 775-788, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31535201

RESUMO

Glucocorticoids (GC) have been proven drug substances in rheumatology for more than 70 years. They act very rapidly in high doses through membrane stabilizing effects. Genomic therapeutic effects of GC even in very low doses are mainly due to inhibition of the functions of the transcription factor nuclear factor kappa B (NFkB), which promotes the synthesis of proinflammatory mediators, adhesion molecules and other regulatory proteins. Indications for the use of GC in high doses in rheumatology are always given when a life-threatening, dangerous or treatment-resistant situation is involved. Lower doses of GC, usually administered orally, are particularly used in rheumatoid arthritis, vasculitis and collagenosis. In clinical practice the general principle is to use the smallest possible effective dose of GC for the shortest possible time in order to achieve the therapeutic effect of GC without running the risk of unacceptably severe side effects.


Assuntos
Glucocorticoides/uso terapêutico , Doenças Reumáticas , Reumatologia , Artrite Reumatoide , Relação Dose-Resposta a Droga , Glucocorticoides/efeitos adversos , Humanos , Doenças Reumáticas/tratamento farmacológico , Febre Reumática , Fatores de Transcrição
4.
J Assoc Physicians India ; 67(7): 38-43, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31559767

RESUMO

Objective: To assess physicians' perception and their felt competence in dealing with patients with rheumatic complaints. Methods: We assessed the quantum of rheumatological disorders seen by physicians in India, their felt competency in dealing with such patients, and their perceived adequacy of undergraduate and postgraduate medical training in Rheumatology by means of an anonymized questionnaire conducted at the annual national conference of internal medicine specialists. Results: Our analysis of 333 respondents revealed that while they saw an average of 10 patients with rheumatic complaints every month, the felt competence in dealing with such cases was only a median of 6/10 (interquartile range 5-7). About 75% professed little or no exposure to Rheumatology as undergraduates, whereas only 20% perceived adequacy of training during internal medicine residency to treat such diseases confidently. 78.37% and 67.7% perceived an inadequacy of rheumatology training at undergraduate and postgraduate level respectively, and 83% felt the need for further training or sensitization in Rheumatology. Conclusion: There remains an unmet need to enhance existing undergraduate and postgraduate internal medicine curricula in India to impart greater skills in the diagnosis and management of rheumatic diseases. Initiatives and government funding to establish short-term training courses in Rheumatology for established internal medicine faculty, to enable them to provide basic Rheumatology services at their respective hospitals, are urgently needed.


Assuntos
Médicos , Doenças Reumáticas , Reumatologia/educação , Humanos , Índia , Medicina Interna
6.
Internist (Berl) ; 60(10): 1036-1042, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31485714

RESUMO

BACKGROUND: Monoclonal antibodies and fusion proteins were introduced into clinical rheumatology 20 years ago. Nowadays they are an established component of modern internal medical practice. OBJECTIVE: This article gives an overview of the breadth of biologics currently in clinical use. MATERIAL AND METHODS: Evaluation of published approval studies and guideline recommendations, discussion of the immunological principles and targets in the treatment with biologics. RESULTS: Monoclonal antibodies and fusion proteins for influencing cytokine signals, T­cell costimulation and B­cell function are the most important innovations in the treatment of rheumatological diseases. Nowadays they are indispensible for the treatment of moderate and severe disease courses of rheumatoid arthritis, spondylarthropathies and vasculitides. CONCLUSION: Although a cure or permanent freedom from symptoms in rheumatological autoimmune diseases is still not possible, much more favorable disease courses with less long-term limitations can be achieved by the early administration of biologics.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Humanos , Infliximab/uso terapêutico , Reumatologia , Rituximab/uso terapêutico
7.
Harefuah ; 158(9): 559-562, 2019 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-31507103

RESUMO

INTRODUCTION: For years patients with rheumatic diseases were managed by internists, orthopedics and rehabilitation clinics. The first rheumatology clinic in Israel was opened in 1965. The founders of rheumatology were rheumatologists who were trained in Europe and North America. Only in 1988, rheumatology was recognized as a subspecialty of internal medicine, and in 2012 pediatric rheumatology was recognized as a separate sub-specialty. There are 166 certified rheumatologists in Israel who are members of the Israeli Society of Rheumatology (ISR). The goal of the ISR is to provide an organized platform for education and scientific exchange in rheumatology through the provision of high quality education for all health care providers in the field of rheumatology, bi-annual scientific meetings dedicated to the advancement of clinical and basic science research, and the promotion of best clinical practice in the delivery of care for patients with rheumatologic disorders. In addition, the ISR promotes the introduction of new drugs and technologies, representing the rheumatology patients' best interests as well as collaboration with rheumatology patients' advocacy groups.


Assuntos
Doenças Reumáticas , Reumatologia , Criança , Europa (Continente) , Humanos , Israel , Platina
8.
Harefuah ; 158(9): 589-594, 2019 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-31507111

RESUMO

BACKGROUND: The field of pediatric rheumatology was only recently recognized in Israel as a sub-specialty. To enable a fellowship program in this field comprising mainly uncommon diseases, the Meir and Shaare Zedek medical centers were authorized to implement a joint fellowship program, in which the trainees split their time between the two medical centers. OBJECTIVES: This article presents the unique experience as a trainee in the joint fellowship program in pediatric rheumatology, while relating to the different characteristics of these centers, patient populations and variable disease exposure. METHODS: Assessment of the extent of clinical and procedural exposure was achieved by comparing the exposure data of the fellow during the first two years of the joint fellowship to the published data derived from questionnaires answered by 44 fellows in the United States. RESULTS: All requirements for successfully completing the Israeli fellowship program were fulfilled, but also those of the North American and European programs. We have shown that the extent of both clinical and procedural exposure is high in the joint fellowship program. We also show the differences in the variety of diseases seen in both centers. DISCUSSION: Possible explanations for these observations are provided in this article. The experience of this joint fellowship can set an example for other fellowship programs in medical areas dealing with uncommon diseases.


Assuntos
Bolsas de Estudo , Pediatria , Reumatologia , Criança , Humanos , Israel , Inquéritos e Questionários , Estados Unidos
10.
Z Rheumatol ; 78(8): 692-697, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468164

RESUMO

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".


Assuntos
Educação de Pós-Graduação em Medicina , Reumatologia , Especialização , Alemanha , Humanos , Inquéritos e Questionários
11.
Z Rheumatol ; 78(8): 743-752, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468168

RESUMO

Rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis are the most common chronic autoimmune rheumatic diseases. For all three diseases an early diagnosis and initiation of treatment is crucial. The proof of concept network study "Rheuma-VOR" is a further developed version of the predecessor project ADAPTHERA and was extended to several federal states. The aim of this prospective study is to improve the early diagnosis of rheumatoid arthritis, psoriatic arthritis and axial spondylarthritis and thus positively impact the quality of care for patients with the help of multidisciplinary coordinating centers. To date 3710 disease-specific questionnaires from patients with the suspected diagnosis of rheumatoid arthritis, psoriatic arthritis or axial spondylarthritis from 1298 different primary care providers were registered in the multidisciplinary coordination centers. A total of 1958 appointments were made with 1 of the 53 participating rheumatology specialists. In 876 patients, 1 of the 3 rheumatic diseases was diagnosed in an early stage. The waiting period was on average 42.5 days depending on the federal state, which is well below the nationwide average. It should also be noted that the coordinated cooperation and risk stratification of the Rheuma-VOR coordination centers relieved the capacity of rheumatology specialists by 1281 appointments (34.5%). In addition, the 2­week Rheuma Bus Tour and the accompanying initiatives in Rhineland-Palatinate (Rheuma-VOR screening app and the triage consultation) are showing first promising positive results.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Doenças Reumáticas/diagnóstico , Reumatologia , Artrite Psoriásica/diagnóstico , Artrite Reumatoide/diagnóstico , Prestação Integrada de Cuidados de Saúde/normas , Diagnóstico Precoce , Humanos , Programas Nacionais de Saúde , Estudos Prospectivos , Reumatologia/organização & administração , Espondilartrite/diagnóstico
12.
Z Rheumatol ; 78(8): 722-742, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31468170

RESUMO

In order to reduce the prognostically relevant time interval between the initial manifestation of a rheumatic and musculoskeletal disease and diagnosis as well as the consecutive initiation of an appropriate treatment, several rheumatological centers in Germany have improved the access to initial rheumatologic evaluation by establishing early recognition/screening clinics at their respective sites. Corresponding models located at Altoetting·Burghausen, Bad Pyrmont, Berlin Buch, Duesseldorf, Heidelberg, Herne, Mannheim as well as supraregional/multicenter initiatives Rheuma Rapid, RhePort and Rheuma-VOR are presented in this overview along with the respective characteristics, potential advantages and disadvantages, but also first evaluation results of several models. The aim of this publication is to promote early detection of rheumatic and musculoskeletal diseases as one of the most important challenges in current rheumatology by encouraging further rheumatologic centers and practices to launch their own early recognition/screening consultation model on the basis of aspects presented herein.


Assuntos
Doenças Musculoesqueléticas , Doenças Reumáticas , Reumatologia , Diagnóstico Precoce , Alemanha , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/terapia , Encaminhamento e Consulta , Doenças Reumáticas/diagnóstico , Doenças Reumáticas/terapia , Reumatologia/métodos
13.
Harefuah ; 158(8): 529-533, 2019 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-31407543

RESUMO

INTRODUCTION: Rheumatology is an ancient field in medicine which deals with inflammatory diseases affecting the joints, muscles and skeleton. Rheumatic diseases challenge patients and care providers coping with chronic pain, fatigue, depression, low self-esteem and agony. The hallmark of rheumatic diseases is rheumatoid arthritis. In this review, we will present the variety of treatments that are available today. Some of them, created a revolution in the patient's prognosis and quality of life.


Assuntos
Artrite Reumatoide/terapia , Fadiga , Humanos , Qualidade de Vida , Doenças Reumáticas , Reumatologia
14.
Z Rheumatol ; 78(8): 765-773, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31456005

RESUMO

Since April 2018, the new third level care model of outpatient specialist care (ASV) according to §116b of the Social Code Book V (SGBV) has been available for patients with chronic inflammatory rheumatic diseases in Germany. Not only is a multiprofessional cooperation between the disciplines involved in treating rheumatic diseases promoted but also the cooperation between specialized rheumatologists and other specialists in private practice and in hospitals is encouraged. As budget capping limiting services and number of cases do not apply in ASV, a significant improvement of patient care in rheumatology is expected due to an increase in provider capacity. At the end of May 2019, 72 rheumatologists in the first 9 newly approved ASV teams had qualified for this new care concept. Bureaucratic obstacles have so far delayed the implementation of ASV. Difficulties arose in building a team with different specialties, in the process of registration of the teams and the assessment of the registration by certain regional boards responsible for access control. The national associations of rheumatologists, the Professional Association of German Rheumatologists (BDRh), the VRA (Verband der Rheumatologischen Akutkliniken e. V.) and the German Society of Rheumatology (DGRh) campaign for an easier admission of providers to the ASV and for adequate financing of all specialties involved in the ASV. The aim is to realize the chance of the ASV for better rheumatological care nationwide with shorter waiting times for a medical appointment and a better cooperation between specialists.


Assuntos
Assistência Ambulatorial/normas , Reumatologia , Especialização , Assistência Ambulatorial/organização & administração , Alemanha , Humanos , Pacientes Ambulatoriais , Reumatologia/organização & administração , Reumatologia/normas , Resultado do Tratamento
15.
Autoimmun Rev ; 18(9): 102351, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31323361

RESUMO

OBJECTIVE: Uveitis is the most common ophthalmological finding in the practice of rheumatology and clinical immunology. The condition is frequently idiopathic but about 60 causes of uveitis have been described. Our aim was to analyze the clinical patterns and etiologies of uveitis in a tertiary referral center. METHODS: The records of 912 consecutive patients referred to the department of internal medicine (Lyon University Hospital, Lyon, France) for the diagnostic work-up of uveitis were examined. Demographic, clinical, anatomical, and etiological features of uveitis were analyzed. RESULTS: The mean age at onset was 48.8 years; 59.8% of the patients were women and 78.2% were Caucasians. Anterior uveitis was the most common type of uveitis (40.6%), followed by panuveitis (31.7%), posterior (18.75%) and intermediate uveitis (9%). 46.9% of the patients had idiopathic uveitis. The most common etiologies were systemic diseases (37.3%), such as sarcoidosis (17.1%), HLA-B27-related uveitis and/or spondyloarthritis (12.5%), and tuberculosis (7.5%). CONCLUSION: We describe one of the largest cohorts of consecutive uveitis patients referred to a department of internal medicine. The high percentage of uveitis associated with underlying (systemic) diseases highlights the need for a multidisciplinary approach, in order to reduce the diagnostic delay.


Assuntos
Autoimunidade/fisiologia , Uveíte/epidemiologia , Uveíte/imunologia , Doença Aguda , Adulto , Idoso , Diagnóstico Tardio , Feminino , França/epidemiologia , Antígeno HLA-B27/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reumatologia , Sarcoidose/complicações , Sarcoidose/epidemiologia , Espondilartrite/complicações , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Uveíte/complicações , Uveíte/genética
16.
Z Rheumatol ; 78(8): 753-764, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31286192

RESUMO

The Ruhrgebiet Rheumatism Center, which is highly specialized for rheumatic diseases, is the largest of its kind in Germany. For many years it has fulfilled all the requirements for structural quality required by the Association of Rheumatological Acute Clinics (VRA) including regular participation in the KOBRA benchmarking project. Therefore, the center regularly receives the VRA seal for quality of care. In 2018 more than 7500 patients were treated as inpatients. Within the framework of care according to §116b (ASV since May 2019) there were nearly 25,000 outpatient patient contacts. Furthermore, an early screening program (triage) was established 5 years ago in order to be able to identify patients with musculoskeletal complaints on a potentially inflammatory rheumatic basis. This functions in the sense of an early diagnosis and treatment in accordance with the treat-to-target concept within less than 4 weeks (initially) on an outpatient basis with respect to the required urgency, in order to subsequently provide sound diagnostic support. In the last 2 years 2017 and 2018, this deadline was met in more than 90% of cases. Within the scope of inpatient care approximately one third of patients were treated in recent years with a defined rheumatological complex therapy and 10% with pain complex therapy. Approximately 3% were treated with geriatric complex therapy and 65% were short-stay patients (<4 days), i.e. patients who received the necessary diagnostics and treatment on an inpatient basis at short notice. The overall structure of the rheumatism center, the cooperation with rheumatologists in private practice, many cooperation partners, referring physicians and patients represents a model for rheumatological care in large conurbations. The care of large numbers of patients also enables the further training of many assistants and this is essential for the future of good rheumatological medicine.


Assuntos
Garantia da Qualidade dos Cuidados de Saúde , Doenças Reumáticas , Reumatologia , Diagnóstico Precoce , Alemanha , Humanos , Doenças Reumáticas/terapia , Reumatologistas
17.
Z Rheumatol ; 78(8): 703-712, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31297603

RESUMO

BACKGROUND: Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE: In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS: Between 15 and 17 rheumatological institutions take part in the core documentation and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS: The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION: The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.


Assuntos
Produtos Biológicos/uso terapêutico , Qualidade da Assistência à Saúde , Doenças Reumáticas , Reumatologia , Artrite Reumatoide , Humanos , Qualidade de Vida , Doenças Reumáticas/terapia , Reumatologia/tendências , Espondilite Anquilosante
19.
Praxis (Bern 1994) ; 108(9): 609-614, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31288660

RESUMO

Rheumatology from A to Z - a Web-Based Information Tool Abstract. Online health information is consulted frequently. However, appropriately examining this data for its quality, trustworthiness, and clinical relevance presents a challenge even for medical professionals. This project offers contents in the area of the musculoskeletal system that has been compiled and verified by experts. Overall, 222 terms are defined, explained and equipped with clinically relevant details in order to provide interested professionals with quick and encompassing access to high-quality, subject-specific information. In addition, these terms are supplemented with a total of 2150 links to websites of verified quality with further information. All content is provided in English and German and can be retrieved either by website or by app.


Assuntos
Internet , Reumatologia , Sistemas de Informação
20.
Lancet ; 393(10188): 2344-2358, 2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31180031

RESUMO

The heterogeneity of systemic lupus erythematosus (SLE), long recognised by clinicians, is now challenging the entire lupus community, from geneticists to clinical investigators. Although the outlook for patients with SLE has greatly improved, many unmet needs remain, chief of which is the development of safer and more efficacious therapies. To develop innovative therapies, a far better understanding of SLE pathogenesis as it relates to the array of clinical phenotypes is needed. Additionally, to efficiently achieve these goals, the lupus community needs to refine existing clinical research tools and better adapt them to overcome the obstacles created by the heterogeneity of manifestations. Here, we review progress towards the ultimate goal of safely reducing disease activity and preventing damage accrual and death. We discuss the new classification criteria from the European League Against Rheumatism and American College of Rheumatology, novel definitions of remission and low lupus disease activity, and new proposals for the histological classification of lupus nephritis. Recommendations for the treatment of SLE and novel approaches to drug development hold much promise to further enhance SLE outcomes.


Assuntos
Lúpus Eritematoso Sistêmico/tratamento farmacológico , Feminino , Humanos , Lúpus Eritematoso Sistêmico/classificação , Lúpus Eritematoso Sistêmico/fisiopatologia , Masculino , Indução de Remissão , Reumatologia/métodos , Reumatologia/tendências , Índice de Gravidade de Doença
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