[German Guideline for Idiopathic Pulmonary Fibrosis]

Idiopathic pulmonary fibrosis (IPF) is a severe and often fatal disease. Diagnosis of IPF requires considerable expertise and experience. Since publication of the international IPF guideline in the year 2011 and Update 2018 several studies and technical advances occurred, which made a new assessment of the diagnostic process mandatory. In view of the antifibrotic drugs which have been approved for the treatment of IPF patients, the goal of this guideline is to foster early, confident and effective diagnosis of IPF. The guideline focusses on the typical clinical setting of an IPF patient and provides tools to exclude known causes of interstitial lung disease including standardised questionnaires, serologic testing and cellular analysis of bronchoalveolar lavage. High resolution computed tomography remains crucial in the diagnostic work-up. If it is necessary to obtain specimen for histology transbronchial lung cryobiopsy is the primary approach, while surgical lung biopsy is reserved for patients who are fit for it and in whom bronchoscopic diagnosis did not provide the information needed. Despite considerable progress, IPF remains a diagnosis of exclusion and multidisciplinary discussion remains the golden standard of diagnosis.

[What rheumatologists can learn from pneumologists]

BACKGROUND

Pulmonary involvement in patients with underlying autoimmune diseases poses a major diagnostic and therapeutic challenge to the treating physician. Due to the associated increased mortality risk, early diagnosis is crucial.

OBJECTIVE

The incidence and mortality rate of connective tissue disease-related interstitial lung diseases (CTD-ILD) and pulmonary hypertension (PH) were evaluated in patients with rheumatic disease including clinical aspects, diagnostic procedure, prognosis and treatment recommendations.

MATERIAL AND METHODS

An analysis of remarkable publications was carried out and guidelines are presented.

RESULTS

The CTD-ILD and PH are frequent comorbidities with significantly increased mortality risk, especially in patients with systemic sclerosis (SSc). In primary fibrotic and non-inflammatory CTD-ILD, as occurs especially in patients with rheumatoid arthritis, immunosuppressive therapy is only partially effective. Currently, in some eligible patients only lung transplantation remains as a definitive therapy.

CONCLUSION

The diagnostics and treatment of CTD-ILD and PH in patients with an underlying autoimmune disease requires an interdisciplinary approach. The effectiveness of antifibrotic treatment needs to be evaluated in the future.

[Psycho-rheumatic problems in patients with soft tissue rheumatism]

Patients with non-articular rheumatism syndrome demand a multidimensional judgment and an interdisciplinary care in a biopsychosocial understanding of the disease. In the psychosomatic consideration factors from the person-environment interaction of the patient gains increasedly importance. Thereby the communication of pain in the doctor-patient relationship and the valuation of pain in the family play a particular role. These regions of psychorheumatological problems are shown and discussed.

[Significance of occupational, health and life satisfaction in coping with rheumatic complaints]

In a pilot study with a prospective study design we analyzed the interaction between disease modifying drugs and coping styles. We examined 45 inpatients with definite or classical rheumatoid arthritis at the beginning of disease modifying drug treatment and eight months later. In this paper we evaluate the role of health satisfaction in relation to an effective therapy. The results of the discriminant analyses between sufficient and non-sufficient persons show that a differential discrimination can be achieved with psychosocial variables, for example diseasecompetency and self-mobility. Finally, our results show that a disease modifying drug treatment in rheumatic diseases must be completed with psychosocial treatments.

[The personality of the teacher as a patient type in psychological diagnosis]

The report concerns the questioning of 200 pedagogues using the questionnaire concerning introversion, neuroticism, rigidity and autonomic instability. All the patients are teachers and pupils in working relationships who were chosen from medical dispensary care with present symptoms of exhaustion and conflicting reactions, and who were transferred to psychological supervision. From the resulting data in the scales investigated, a configuration frequency analysis of the symptoms of introversion, neuroticism, rigidity and autonomic instability is given. Three oft-occurring typical configurations of scale can be found. From this a configuration type (with stikingly rigid behaviour and an otherwise unobtrusive scale constellation) can be interpreted as the "typical tacher" product of lengthy pedagogic activity.