1
|
Arnold S, Wallmeier P, Tais A, Ihorst G, Janoschke M, Schubach F, Aries P, Bergner R, Bremer JP, Görl N, Gutdeutsch E, Hellmich B, Henes J, Hoyer BF, Kangowski A, Kötter I, Krusche M, Magnus T, Metzler C, Müller-Ladner U, Petersen J, Reichelt de Tenorio A, Schaier M, Schirmer JH, Schönermarck U, Thiel J, Unger L, Venhoff N, Weinmann-Menke J, Iking-Konert C, Lamprecht P. The Joint Vasculitis Registry in German-speaking countries (GeVas): subgroup analysis of 266 AAV patients. Clin Exp Rheumatol 2024; 42:852-858. [PMID: 38607682 DOI: 10.55563/clinexprheumatol/suxkyq] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVES Prospective long-term observational data on the disease course of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) were missing in Germany to date. Therefore, the Joint Vasculitis Registry in German-speaking countries (GeVas) has been established to follow the course of patients with AAV. The aim of this study is to present baseline data of patients with newly diagnosed and relapsing AAV enrolled in the GeVas registry. METHODS GeVas is a prospective, web-based, multicentre, clinician-driven registry for the documentation of organ manifestations, damage, long-term outcomes, and therapy regimens in various types of vasculitis. Recruitment started in June 2019. RESULTS Between June 2019 and October 2022, 266 patients with AAV were included in the GeVas registry: 173 (65%) with new-onset and 93 (35%) with relapsing AAV. One hundred and sixty-two (61%) patients were classified as granulomatosis with polyangiitis (GPA), 66 (25%) as microscopic polyangiitis (MPA), 36 (13%) as eosinophilic granulomatosis with polyangiitis (EGPA), and 2 (1%) as renal limited AAV. The median age was 59 years (51-70 years, IQR), 130 (51%) patients were female. Most patients were ANCA positive (177; 67%) and affected by general symptoms, pulmonary, ear nose throat (ENT), renal and neurological involvement. For induction of remission, the majority of patients received glucocorticoids (247, 93%) in combination with either rituximab (118, 45%) or cyclophosphamide (112, 42%). CONCLUSIONS Demographic characteristics are comparable to those in other European countries. Differences were found regarding ANCA status, frequencies of organ manifestations, and therapeutic regimens. The GeVas registry will allow longitudinal observations and prospective outcome measures in AAV.
Collapse
Affiliation(s)
- Sabrina Arnold
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany.
| | - Pia Wallmeier
- Department of Nephrology, Asklepios Klinikum Barmbek, Hamburg; and III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arlette Tais
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Marco Janoschke
- Clinical Trials Unit, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Fabian Schubach
- Interdisciplinary Medical Intensive Care, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Peer Aries
- Immunologikum, Department of Rheumatology, Hamburg, Germany
| | - Raoul Bergner
- Klinikum Ludwigshafen, Department of Internal Medicine, Haemato-oncology, Nephrology, Infectiology and Rheumatology, Ludwigshafen am Rhein, Germany
| | | | - Norman Görl
- Klinikum Südstadt Rostock, Department of Internal Medicine, Rheumatology and Immunology, Rostock, Germany
| | - Eva Gutdeutsch
- Department of Rheumatology, Barmherzige Brüder Regensburg, Germany
| | - Bernhard Hellmich
- Vasculitis Centre South, Medius Kliniken, Teaching Hospital University of Tübingen, Department of Internal Medicine, Rheumatology, Pulmonology, Nephrology and Diabetology, Kirchheim unter Teck, Germany
| | - Jörg Henes
- University Medical CentreTübingen, Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II, Tübingen, Germany
| | | | - Antje Kangowski
- Klinikum Südstadt Rostock, Department of Internal Medicine, Rheumatology and Immunology, Rostock, Germany
| | - Ina Kötter
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg; and Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, Germany
| | - Martin Krusche
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim Magnus
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany
| | - Claudia Metzler
- Immunologikum, Department of Rheumatology, Hamburg, and Department of Internal Medicine and Rheumatology, Klinikum Bielefeld, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Jana Petersen
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt, and MEDIZINICUM, Hamburg, Germany
| | - Anke Reichelt de Tenorio
- Vasculitis Centre South, Medius Kliniken, Teaching Hospital University of Tübingen, Department of Internal Medicine, Rheumatology, Pulmonology, Nephrology and Diabetology, Kirchheim unter Teck, Germany
| | - Matthias Schaier
- Department of Nephrology, University Medical Centre Heidelberg, Germany
| | | | - Ulf Schönermarck
- Department of Medicine IV, Nephrology Division, LMU University Hospital, LMU Munich, Germany
| | - Jens Thiel
- Clinical Department of Rheumatology and Immunology, University Medical Centre Graz, Austria
| | - Leonore Unger
- Medical Department 1, Städtisches Klinikum Dresden, Germany
| | - Nils Venhoff
- Department of Rheumatology and Clinical Immunology, Medical Centre, Faculty of Medicine, University of Freiburg, Germany
| | - Julia Weinmann-Menke
- Department of Nephrology, University Medical Centre of the Johannes Gutenberg University, Mainz, Germany
| | - Christof Iking-Konert
- III Department of Medicine, Division of Rheumatology and Systemic Inflammatory Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and Department of Rheumatology, Stadtspital Zürich, Switzerland
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Germany
| |
Collapse
|
2
|
Schirmer JH, Sanchez-Alamo B, Hellmich B, Jayne D, Monti S, Luqmani RA, Tomasson G. Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): part 1-treatment of granulomatosis with polyangiitis and microscopic polyangiitis. RMD Open 2023; 9:e003082. [PMID: 37479496 PMCID: PMC10364171 DOI: 10.1136/rmdopen-2023-003082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/16/2023] [Indexed: 07/23/2023] Open
Abstract
OBJECTIVE To summarise and update evidence to inform the 2022 update of the EULAR recommendations for the management of antineutrophil cytoplasm antibody-associated vasculitis (AAV). METHODS A systematic literature review (SLR) was performed to identify current evidence regarding treatment of AAV. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented here is focused on the treatment of granulomatosis with polyangiitis and microscopic polyangiitis. RESULTS 3517 articles were screened and 175 assessed by full-text review. Ninety articles were included in the final evidence synthesis. Cyclophosphamide and rituximab (RTX) show similar efficacy for remission induction (level of evidence (LoE) 1a) but RTX is more effective in relapsing disease (LoE 1b). Glucocorticoid (GC) protocols with faster tapering result in similar remission rates but lower rates of serious infections (LoE 1b). Avacopan can be used to rapidly taper and replace GC (LoE 1b). Data on plasma exchange are inconsistent depending on the analysed trial populations but meta-analyses based on randomised controlled trials demonstrate a reduction of the risk of end-stage kidney disease at 1 year but not during long-term follow-up (LoE 1a). Use of RTX for maintenance of remission is associated with lower relapse rates compared with azathioprine (AZA, LoE 1b). Prolonged maintenance treatment results in lower relapse rates for both, AZA (LoE 1b) and RTX (LoE 1b). CONCLUSION This SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.
Collapse
Affiliation(s)
- Jan Henrik Schirmer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Beatriz Sanchez-Alamo
- Nephrology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
- Nephrology, Skåne University Hospital, Lund, Sweden
| | - Bernhard Hellmich
- Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, University of Pavia; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Raashid Ahmed Luqmani
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gunnar Tomasson
- Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| |
Collapse
|
3
|
Sanchez-Alamo B, Schirmer JH, Hellmich B, Jayne D, Monti S, Tomasson G, Luqmani RA. Systematic literature review informing the 2022 update of the EULAR recommendations for the management of ANCA-associated vasculitis (AAV): Part 2 - Treatment of eosinophilic granulomatosis with polyangiitis and diagnosis and general management of AAV. RMD Open 2023; 9:e003083. [PMID: 37349121 DOI: 10.1136/rmdopen-2023-003083] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/14/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To summarise and update evidence to inform the 2022 update of the European Alliance of Associations of Rheumatology (EULAR) recommendations for the management of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). METHODS Three systematic literature reviews (SLR) were performed. PubMed, EMBASE and the Cochrane library were searched from 1 February 2015 to 25 February 2022. The evidence presented herein covers the treatment of eosinophilic granulomatosis with polyangiitis (EGPA) as well as diagnostic testing and general management of all AAV syndromes. RESULTS For the treatment of EGPA, diagnostic procedures and general management 3517, 4137 and 4215 articles were screened and 26, 110 and 63 articles were included in the final evidence syntheses, respectively. For EGPA patients with newly diagnosed disease without unfavourable prognostic factors, azathioprine (AZA) combined with glucocorticoids (GC) is not superior to GC monotherapy to induce remission (LoE 2b). In patients with active EGPA and unfavourable prognostic factors, cyclophosphamide or rituximab can be used for remission induction (LoE 2b). Treatment with Mepolizumab added to standard treatment results in higher rates of sustained remission in patients with relapsing or refractory EGPA without active organ-threatening or life-threatening manifestations (LoE 1b) and reduces GC use. Kidney biopsies have prognostic value in AAV patients with renal involvement (LoE 2a). In the context of suspected AAV, immunoassays for proteinase 3 and myeloperoxidase-ANCA have higher diagnostic accuracy compared with indirect immunofluorescent testing (LoE 1a). CONCLUSION This SLR provides current evidence to inform the 2022 update of the EULAR recommendations for the management of AAV.
Collapse
Affiliation(s)
- Beatriz Sanchez-Alamo
- Nephrology, Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain
- Nephrology, Skåne University Hospital, Lund, Sweden
| | - Jan Henrik Schirmer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Bernhard Hellmich
- Department of Internal Medicine, Rheumatology and Immunology, Medius Kliniken Kirchheim/Teck, University Tübingen, Kirchheim-Teck, Germany
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, University of Pavia; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gunnar Tomasson
- Faculty of Medicine, University of Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Raashid Ahmed Luqmani
- Oxford NIHR Biomedical Research Centre, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Schirmer JH, Both M, Müller O. Vaskulitis mimics. AKTUEL RHEUMATOL 2023. [DOI: 10.1055/a-1949-8509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
ZusammenfassungIdiopathische Vaskulitiden sind seltene entzündliche Systemerkrankungen,
die nach der Chapel-Hill Konsensus-Nomenklatur nach der Größe
der prädominant betroffenen Gebiete von Blutgefäßen
(große, mittelgroße, kleine Gefäße und
Gefäße variabler Größe) eingeteilt werden.
Vaskulitis mimics sind Syndrome, die ein ähnliches klinisches Bild
hervorrufen oder leicht mit einer idiopathischen Vaskulitis verwechselt werden
und teils sogar ein Krankheitsbild, das klinisch und histologisch einer
Vaskulitis gleicht, auslösen können. Die Zahl der Vaskulitis
mimics ist groß, je nach betroffenem Gefäßgebiet kommen
hereditäre Erkrankungen des Bindegewebes, genetisch bedingte
Immundefekt- und Autoinflammationssyndrome, infektiöse Erkrankungen,
seltene entzündliche Systemerkrankungen, Tumorerkrankungen,
medikamenteninduzierte Syndrome und zahlreiche weitere infrage. In diesem Review
wird eine Auswahl klassischer Imitatoren von Vaskulitiden, orientiert an der
Größe der betroffenen Blutgefäße
präsentiert und Konstellationen, die typische
„Fallstricke“ in der klinischen Abklärung darstellen
können, diskutiert.
Collapse
Affiliation(s)
- Jan Henrik Schirmer
- Klinik für Innere Medizin I, Sektion Rheumatologie,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel,
Germany
| | - Marcus Both
- Klinik für Radiologie und Neuroradiologie,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel,
Germany
| | - OliverJ Müller
- Klinik für Innere Medizin III (Kardiologie, Angiologie und
internistische Intensivmedizin), Universitätsklinikum Schleswig-Holstein
Campus Kiel, Kiel, Germany
| |
Collapse
|
5
|
Geisen UM, Rose R, Neumann F, Ciripoi M, Vullriede L, Reid HM, Berner DK, Bertoglio F, Hoff P, Hust M, Longardt AC, Lorentz T, Martini GR, Saggau C, Schirmer JH, Schubert M, Sümbül M, Tran F, Voß M, Zeuner R, Morrison PJ, Bacher P, Fickenscher H, Gerdes S, Peipp M, Schreiber S, Krumbholz A, Hoyer BF. The long term vaccine-induced anti-SARS-CoV-2 immune response is impaired in quantity and quality under TNFα blockade. J Med Virol 2022; 94:5780-5789. [PMID: 35945627 PMCID: PMC9538219 DOI: 10.1002/jmv.28063] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/03/2022] [Accepted: 08/06/2022] [Indexed: 01/06/2023]
Abstract
The humoral immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in patients with chronic inflammatory disease (CID) declines more rapidly with tumor necrosis factor-α (TNF-α) inhibition. Furthermore, the efficacy of current vaccines against Omicron variants of concern (VOC) including BA.2 is limited. Alterations within immune cell populations, changes in IgG affinity, and the ability to neutralize a pre-VOC strain and the BA.2 virus were investigated in these at-risk patients. Serum levels of anti-SARS-CoV-2 IgG, IgG avidity, and neutralizing antibodies (NA) were determined in anti-TNF-α patients (n = 10) and controls (n = 24 healthy individuals; n = 12 patients under other disease-modifying antirheumatic drugs, oDMARD) before and after the second and third vaccination by ELISA, immunoblot and live virus neutralization assay. SARS-CoV-2-specific B- and T cell subsets were analysed by multicolor flow cytometry. Six months after the second vaccination, anti-SARS-CoV-2 IgG levels, IgG avidity and anti-pre-VOC NA titres were significantly reduced in anti-TNF-α recipients compared to controls (healthy individuals: avidity: p ≤ 0.0001; NA: p = 0.0347; oDMARDs: avidity: p = 0.0012; NA: p = 0.0293). The number of plasma cells was increased in anti-TNF-α patients (Healthy individuals: p = 0.0344; oDMARDs: p = 0.0254), while the absolute number of SARS-CoV-2-specific plasma cells 7 days after 2nd vaccination were comparable. Even after a third vaccination, these patients had lower anti-BA.2 NA titres compared to both other groups. We show a reduced SARS-CoV-2 neutralizing capacity in patients under TNF-α blockade. In this cohort, the plasma cell response appears to be less specific and shows stronger bystander activation. While these effects were observable after the first two vaccinations and with older VOC, the differences in responses to BA.2 were enhanced.
Collapse
Affiliation(s)
- Ulf Martin Geisen
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Ruben Rose
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | | | - Maria Ciripoi
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Lena Vullriede
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Hayley M. Reid
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Dennis Kristopher Berner
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Federico Bertoglio
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | - Paula Hoff
- Department of Rheumatology, Endokrinologikum‐GruppeBerlinGermany
| | - Michael Hust
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | | | | | - Gabriela Rios Martini
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany,Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Carina Saggau
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Jan Henrik Schirmer
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Maren Schubert
- Department of BiotechnologyInstitute of Biochemistry, Biotechnology, and Bioinformatics, Technische Universität BraunschweigBraunschweigGermany
| | - Melike Sümbül
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Florian Tran
- Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany,Department for Internal Medicine IUniversity Medical Center Schleswig‐HolsteinKiel
| | - Mathias Voß
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | - Rainald Zeuner
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| | - Peter J. Morrison
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Petra Bacher
- Institute of ImmunologyUniversity Medical Center Schleswig‐HolsteinKielGermany,Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany
| | - Helmut Fickenscher
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany
| | - Sascha Gerdes
- Department for DermatologyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Matthias Peipp
- Department of Internal Medicine II, Division of Antibody‐Based ImmunotherapyUniversity Medical Center Schleswig‐HolsteinKielGermany
| | - Stefan Schreiber
- Institute of Clinical Molecular BiologyChristian‐Albrecht University of KielKielGermany,Department for Internal Medicine IUniversity Medical Center Schleswig‐HolsteinKiel
| | - Andi Krumbholz
- Institute for Infection Medicine, Christian‐Albrecht University of Kiel and University Medical Center Schleswig‐HolsteinKielGermany,Labor Dr. Krause und Kollegen MVZ GmbHKielGermany
| | - Bimba Franziska Hoyer
- Medical Department I, Rheumatology and Clinical ImmunologyUniversity Medical Center Schleswig‐Holstein Campus KielKielGermany
| |
Collapse
|
6
|
Tran F, Schirmer JH, Ratjen I, Lieb W, Helliwell P, Burisch J, Schulz J, Schrinner F, Jaeckel C, Müller-Ladner U, Schreiber S, Hoyer BF. Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives. Front Immunol 2021; 12:614653. [PMID: 33815372 PMCID: PMC8012677 DOI: 10.3389/fimmu.2021.614653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/02/2021] [Indexed: 01/20/2023] Open
Abstract
Chronic inflammatory diseases (CID) are emerging disorders which do not only affect specific organs with respective clinical symptoms but can also affect various aspects of life, such as emotional distress, anxiety, fatigue and quality of life. These facets of chronic disease are often not recognized in the therapy of CID patients. Furthermore, the symptoms and patient-reported outcomes often do not correlate well with the actual inflammatory burden. The discrepancy between patient-reported symptoms and objectively assessed disease activity can indeed be instructive for the treating physician to draw an integrative picture of an individual's disease course. This poses a challenge for the design of novel, more comprehensive disease assessments. In this mini-review, we report on the currently available patient-reported outcomes, the unmet needs in the field of chronic inflammatory diseases and the challenges of addressing these.
Collapse
Affiliation(s)
- Florian Tran
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Jan Henrik Schirmer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Ilka Ratjen
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology and Biobank PopGen, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Philip Helliwell
- UK and Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
| | - Johan Burisch
- Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
| | - Juliane Schulz
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
- Department of Oral and Maxillofacial Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Florian Schrinner
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Charlot Jaeckel
- Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig-University Giessen, Kerckhoff-Klinik GmbH, Giessen, Germany
| | - Stefan Schreiber
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Bimba F. Hoyer
- Department of Internal Medicine I, University Medical Center Schleswig-Holstein, Kiel, Germany
| |
Collapse
|
7
|
Schirmer JH, Aries PM, Balzer K, Berlit P, Bley TA, Buttgereit F, Czihal M, Dechant C, Dejaco C, Garske U, Henes J, Holle JU, Holl-Ulrich K, Lamprecht P, Nölle B, Moosig F, Rech J, Scheuermann K, Schmalzing M, Schmidt WA, Schneider M, Schulze-Koops H, Venhoff N, Villiger PM, Witte T, Zänker M, Hellmich B. [S2k guidelines (executive summary): management of large-vessel vasculitis]. Z Rheumatol 2021; 79:937-942. [PMID: 33156418 DOI: 10.1007/s00393-020-00894-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- J H Schirmer
- Klinik für Innere Medizin I, Sektion Rheumatologie, Exzellenzzentrum Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - P M Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - K Balzer
- Abteilung für Gefäß- und Endovaskulärchirurgie, St. Marien Hospital, GFO Kliniken Bonn, Bonn, Deutschland
| | - P Berlit
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
| | - T A Bley
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - F Buttgereit
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie (CCM), Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - M Czihal
- Sektion Angiologie - Gefäßzentrum, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - C Dechant
- Sektion Rheumatologie und klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - C Dejaco
- Klinische Abteilung für Rheumatologie und Immunologie, Medizinische Universität Graz, Landesweiter Dienst für Rheumatologie, Südtiroler Sanitätsbetrieb, Graz, Österreich
| | - U Garske
- Deutsche Rheuma-Liga Bundesverband e. V., Bonn, Deutschland
| | - J Henes
- Medizinische Klinik II, Rheumatologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - J U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - K Holl-Ulrich
- Pathologie - Hamburg, Labor Lademannbogen MVZ, Hamburg, Deutschland
| | - P Lamprecht
- Klinik für Rheumatologie und klinische Immunologie, Universität zu Lübeck, Lübeck, Deutschland
| | - B Nölle
- Klinik für Ophthalmologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - F Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - J Rech
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - K Scheuermann
- Deutsche Rheuma-Liga Bundesverband e. V., Bonn, Deutschland
| | - M Schmalzing
- Medizinische Klinik II, Rheumatologie/Klinische Immunologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - W A Schmidt
- Rheumatologie und klinische Immunologie, Immanuel Krankenhaus Berlin-Buch, Berlin, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - N Venhoff
- Klinik für Rheumatologie und klinische Immunologie, Vaskulitis-Zentrum Freiburg, Department Innere Medizin, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - P M Villiger
- Universitätsklinik für Rheumatologie, Immunologie und Allergologie, Inselspital, Bern, Schweiz
| | - T Witte
- Klinik für Immunologie und Rheumatologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Zänker
- Abteilung für Innere Medizin, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - B Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum Süd, Medius Klinik, Eugenstr. 3, 73230, Kirchheim unter Teck, Deutschland.
| |
Collapse
|
8
|
Schirmer JH, Aries PM, de Groot K, Hellmich B, Holle JU, Kneitz C, Kötter I, Lamprecht P, Müller-Ladner U, Reinhold-Keller E, Specker C, Zänker M, Moosig F. [S1 guidelines Diagnostics and treatment of ANCA-associated vasculitis]. Z Rheumatol 2019; 76:77-104. [PMID: 29204681 DOI: 10.1007/s00393-017-0394-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jan Henrik Schirmer
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105, Kiel, Deutschland.
| | - Peer M Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Kirsten de Groot
- Medizinische Klinik III, Sana Klinikum Offenbach, Offenbach, Deutschland
- KfH Nierenzentrum Offenbach, Offenbach, Deutschland
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum Süd, Medius Klinik Kirchheim, Kirchheim, Deutschland
| | - Julia U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Christian Kneitz
- Klinik für Innere Medizin II, Rheumatologie, klinische Immunologie und Geriatrie, Klinikum Südstadt, Rostock, Deutschland
| | - Ina Kötter
- Abteilung für Rheumatologie, klinische Immunologie und Nephrologie, Asklepios Klinikum Altona, Hamburg, Deutschland
| | - Peter Lamprecht
- Klinik für Rheumatologie und klinische Immunologie, Universität zu Lübeck, Lübeck, Deutschland
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie und Klinische Immunologie, Campus Kerckhoff, Justus-Liebig Universität Giessen, Bad Nauheim, Deutschland
| | - Eva Reinhold-Keller
- Klinik für Rheumatologie und klinische Immunologie, Klinikum Bad Bramstedt, Bad Bramstedt, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie und klinische Immunologie, Universitätsmedizin Essen, St. Josef Krankenhaus Werden, Essen, Deutschland
| | - Michael Zänker
- Abteilung für Innere Medizin, Immanuel Klinikum Bernau Herzzentrum Brandenburg, Bernau, Deutschland
- Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| |
Collapse
|
9
|
Moosig F, Schirmer JH, Lamprecht P, Holle JU. [Clinical spectrum of IgG4-related diseases and the connection to rheumatology]. Z Rheumatol 2016; 75:675-80. [PMID: 27418057 DOI: 10.1007/s00393-016-0138-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Rheumatologist should be familiar with the concept of IgG4-related disease (IgG4-RD). Due to the clinical spectrum IgG4-RD can fall directly within the scope of rheumatology and are often diagnosed primarily by rheumatologists. Furthermore, IgG4RD are relevant differential diagnoses for many other rheumatic conditions. Finally, there are an increasing amount of data suggesting an important role of immunological processes observed in IgG4-RD for other rheumatic diseases.
Collapse
Affiliation(s)
- F Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, 24534, Neumünster, Deutschland.
| | - J H Schirmer
- 1. Medizinische Universitätsklinik der Christian-Albrechts-Universität zu Kiel, Schittenhelmstr., 24105, Kiel, Deutschland
| | - P Lamprecht
- Klinik für Rheumatologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - J U Holle
- Rheumazentrum Schleswig-Holstein Mitte, Kuhberg 5a-7, 24534, Neumünster, Deutschland
| |
Collapse
|
10
|
Schirmer JH, Bremer JP, Moosig F, Holle JU, Lamprecht P, Wieczorek S, Haenisch S, Cascorbi I. Cyclophosphamide treatment-induced leukopenia rates in ANCA-associated vasculitis are influenced by variant CYP450 2C9 genotypes. Pharmacogenomics 2016; 17:367-74. [PMID: 26894931 DOI: 10.2217/pgs.15.176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM Correlation of outcomes of cyclophosphamide (CP) therapy in antineutrophil cytoplasmic antibody-associated vasculitis with genotype polymorphisms in prodrug activating cytochrome P450 enzyme genes CYP2C9 and CYP2C19. PATIENTS & METHODS One hundred and ninety six patients with antineutrophil cytoplasmic antibody-associated vasculitis treated with CP, either as intravenous pulse or as daily oral medication, were included. Genotypes of CYP2C9 and CYP2C19 were correlated with clinical outcomes (leukopenia, infection, urotoxicity and treatment response). RESULTS Sixty five (33.2%) patients had variant CYP2C9 and 55 (28.1%) had variant CYP2C19 genotype. In patients bearing variant CYP2C9, leukopenia was documented significantly more frequent than in carriers of wild-type CYP2C9 (55.4 vs 37.4%; odds ratio: 2.08; 95% CI: 1.14-3.80; p = 0.017). The impact of the CYP2C9 genotype was stronger in patients treated with oral CP (69.6 vs 45.6%; odds ratio: 2.73; 95% CI: 1.27-5.89; p = 0.009), but was not present in patients treated with intravenous pulsed CP. We observed less refractory disease courses in patients with variant CYP2C9, not reaching statistical significance. CONCLUSION Patients with variant CYP2C9 are at increased risk for cyclophosphamide-induced leukopenia but may have a better chance to respond to treatment.
Collapse
Affiliation(s)
- Jan Henrik Schirmer
- Department of Rheumatology & Clinical Immunology, Vasculitis Center, University Hospital Schleswig-Holstein & Klinkum Bad Bramstedt, Bad Bramstedt, Germany.,Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jan Phillip Bremer
- Department of Rheumatology & Clinical Immunology, Vasculitis Center, University Hospital Schleswig-Holstein & Klinkum Bad Bramstedt, Bad Bramstedt, Germany
| | - Frank Moosig
- Department of Rheumatology & Clinical Immunology, Vasculitis Center, University Hospital Schleswig-Holstein & Klinkum Bad Bramstedt, Bad Bramstedt, Germany
| | - Julia Ulrike Holle
- Department of Rheumatology & Clinical Immunology, Vasculitis Center, University Hospital Schleswig-Holstein & Klinkum Bad Bramstedt, Bad Bramstedt, Germany
| | - Peter Lamprecht
- Department of Rheumatology & Comprehensive Center for Inflammation Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | | | - Sierk Haenisch
- Institute for Experimental & Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Ingolf Cascorbi
- Institute for Experimental & Clinical Pharmacology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| |
Collapse
|