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Hasseli R, Hanses F, Stecher M, Specker C, Weise T, Borgmann S, Hasselberger M, Hertenstein B, Hower M, Hoyer BF, Koll C, Krause A, von Lilienfeld-Toal M, Lorenz HM, Merle U, Nunes de Miranda SM, Pletz MW, Regierer AC, Richter JG, Rieg S, Roemmele C, Ruethrich MM, Schmeiser T, Schulze-Koops H, Strangfeld A, Vehreschild MJ, Voit F, Voll RE, Vehreschild JJ, Müller-Ladner U, Pfeil A. The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population-A comparison of two German registries. Front Med (Lausanne) 2024; 11:1332716. [PMID: 38510457 PMCID: PMC10953502 DOI: 10.3389/fmed.2024.1332716] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Objectives To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) infected patients covering inpatients from the general population with SARS-CoV-2 infections were compared. Methods 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: n = 366 and IRD registry: n = 366) were included for analyses in total. Results Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65°years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19. Conclusion Inflammatory rheumatic diseases (IRD) patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.
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Affiliation(s)
- Rebecca Hasseli
- Section of Rheumatology and Clinical Immunology, Department of Internal Medicine D, University Hospital Münster, Münster, Germany
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Frank Hanses
- Emergency Department and Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | | | | | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, Dortmund, Germany
| | - Bimba F. Hoyer
- Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein, Kiel, Germany
| | - Carolin Koll
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Anne C. Regierer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Jutta G. Richter
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria M. Ruethrich
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Maria J.G.T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Henes J, Richter JG, Thiele K, Kiltz U, Callhoff J, Albrecht K. Trends in health care of patients with vasculitides, including giant cell arteritis, Takayasu arteritis, ANCA-associated vasculitis and Behçet's disease: cross-sectional data of the German National Database 2007-2021. Rheumatol Int 2024; 44:497-507. [PMID: 38180499 PMCID: PMC10866751 DOI: 10.1007/s00296-023-05508-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 01/06/2024]
Abstract
The aim of this study is to present the current care situation of patients with giant cell arteritis (GCA), Takayasu arteritis (TAK), ANCA-associated vasculitis (AAV) and Behçet's disease (BD). Trends over the last 15 years will reflect improvements and remaining deficits in the management of vasculitides. Consecutive cross-sectional data from patients with vasculitides from the German National Database (NDB) of the Collaborative Arthritis Centres between 2007 and 2021 were included. Medication, physician- and patient-reported outcomes on disease activity and disease burden, inpatient stays and occupational participation are compared for different vasculitis entities and over time. Employment rates were compared to German population rates. Between 502 and 854 vasculitis patients were annually documented. GCA and AAV were the most common vasculitides. Median disease duration ranged from 2 to 16 years. Over the years, glucocorticoids decreased in proportion and dose, most markedly in GCA and TAK, while biologic therapies increased up to 27%. Physicians rated disease activity as low for the vast majority of patients, while patients-reported moderate outcomes in many dimensions. PROs remained largely unchanged. The proportion of employed patients (< 65 years) increased from 47 to 57%. In recent years, biologics are increasingly used in patients with vasculitides, while glucocorticoids decreased significantly. PRO's have not improved. Work participation increased but remains lower than that in the German population.
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Affiliation(s)
- Jörg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoimmune Diseases and Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Jutta G Richter
- Department of Rheumatology, Faculty of Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Faculty of Medicine, Hiller Research Centre Rheumatology, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Katja Thiele
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Uta Kiltz
- Ruhr Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Germany
| | - Johanna Callhoff
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Katinka Albrecht
- Programme Area Epidemiology and Health Services Research, German Rheumatism Research Centre Berlin, Berlin, Germany.
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Kernder A, Rohde M, Acar H, Düsing C, Fischer-Betz R, Haase I, Mucke J, Sander O, Richter JG, Filla T, Schneider M, Chehab G. Patient-reported outcomes in large vessel vasculitis: insights from a retrospective analysis of disease activity and associated factors. J Patient Rep Outcomes 2024; 8:4. [PMID: 38285076 PMCID: PMC10825095 DOI: 10.1186/s41687-023-00681-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Patient-reported outcomes (PROs) play a crucial role in assessing rheumatic diseases, offering insights into disease evaluation and treatment efficacy. This study focuses on PRO assessment in large vessel vasculitides, including Takayasu Arteritis and Giant Cell Arteritis (GCA). METHODS We retrospectively analyzed routine data from patients treated at our rheumatology clinic over a 10-year span. Patient and physician-rated global disease activity scale (G-DAS) scores, measured on a numeric rating scale (0-10 points), were collected at each visit. Clinical variables like age, sex, body mass index (BMI), disease duration, lab values, pain perception, and questionnaire responses were recorded. Linear regression and generalized additive linear regression (GAM analysis) examined associations between PROs and these factors. RESULTS The study included 138 patients, primarily diagnosed with GCA (94.4%). Mean follow-up was 2.5 years (0-7.7). Patient and physician G-DAS exhibited a moderate correlation (Pearson R 0.19, CI 0.14-0.24, p < 0.001). Higher patient G-DAS correlated with younger age (CI -3.4 - -1.5, p < 0.001), increased pain (CI 3.5-4, p < 0.001), functional limitations (HAQ, CI 0.5-0.6, p < 0.001), reduced physical (CI 2.3-2.7, p ≤ 0.001) and psychological well-being (CI 2.1-2.5, p < 0.001), and higher BMI (CI 1.3-2.4, p < 0.001). Physician G-DAS correlated with Birmingham Vasculitis Activity Score (V3.0; R 0.42, p 0.046) and were significantly linked to serum CRP elevations (β = 0.04, CI 0.0-0.08, p 0.028). CONCLUSIONS These findings underscore the need to integrate PRO measures into vasculitis disease management strategies, enhancing the understanding of disease activity from the patient's perspective.
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Affiliation(s)
- A Kernder
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany.
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany.
| | - M Rohde
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - H Acar
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - C Düsing
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - R Fischer-Betz
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - I Haase
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - J Mucke
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - O Sander
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - J G Richter
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - T Filla
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - M Schneider
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - G Chehab
- Department of Rheumatology, Medical Faculty of Heinrich, University Hospital Düsseldorf, Heine University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
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Giulini M, Brinks R, Vordenbäumen S, Acar H, Richter JG, Baraliakos X, Ostendorf B, Schneider M, Sander O, Sewerin P. High Frequency of Osteophytes Detected by High-Resolution Ultrasound at the Finger Joints of Asymptomatic Factory Workers. J Pers Med 2023; 13:1343. [PMID: 37763111 PMCID: PMC10532985 DOI: 10.3390/jpm13091343] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/28/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Hand Osteoarthritis (HOA) is a frequently occurring musculoskeletal disease that impacts health. Diagnostic criteria often incorporate osteophytes documented through imaging procedures. Radiographic imaging is considered the gold standard; however, more sensitive and safer methods like ultrasound imaging are becoming increasingly important. We conducted a population-based cross-sectional study to examine the prevalence, grade, and pattern of osteophytes using high-resolution ultrasound investigation. Factory workers were recruited on-site for the study. Each participant had 26 finger joints examined using ultrasonography to grade the occurrence of osteophytes on a semi-quantitative scale ranging from 0-3, where higher scores indicate larger osteophytes. A total of 427 participants (mean age 53.5 years, range 20-79 years) were included, resulting in 11,000 joints scored. At least one osteophyte was found in 4546 out of 11,000 (41.3%) joints or in 426 out of 427 (99.8%) participants, but only 5.0% (553) of the joints showed grade 2 or 3 osteophytes. The total osteophyte sum score increased by 0.18 per year as age increased (p < 0.001). The distal interphalangeal joints were the most commonly affected, with 61%, followed by the proximal interphalangeal joints with 48%, carpometacarpal joint 1 with 39%, and metacarpophalangeal joints with 16%. There was no observed impact of gender or workload. In conclusion, ultrasound imaging proves to be a practical screening tool for osteophytes and HOA. Grade 1 osteophytes are often detected in the working population through ultrasound assessments and their incidence increases with age. The occurrence of grade 2 or 3 osteophytes is less frequent and indicates the clinical presence of HOA. Subsequent evaluations are imperative to ascertain the predictive significance of early osteophytes.
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Affiliation(s)
- Mario Giulini
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ralph Brinks
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Hasan Acar
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Jutta G. Richter
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Claudiusstrasse 45, 44649 Herne, Germany
| | - Benedikt Ostendorf
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Matthias Schneider
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Oliver Sander
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller-Research-Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Claudiusstrasse 45, 44649 Herne, Germany
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Richter JG, Filla T, Acar H, Bleck E, Kernder A, Düsing C, Vordenbäumen S, Schröder M, Hansen R, Distler JHW, Schneider M. Sustained agreement rates in the longitudinal assessment of lupus patients to a Broad Consent for personal data and specimen usage in the RHINEVIT biobank. Front Med (Lausanne) 2023; 10:1208006. [PMID: 37415767 PMCID: PMC10321663 DOI: 10.3389/fmed.2023.1208006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Background Biobanks are essential structures for scientific research. The RHINEVIT biobank is used to recruit biomaterials from rheumatology patients in outpatient care and to conduct clinical research studies (e.g., cohort studies) and basic research. RHINEVIT established Broad Consents (BC) to allow extensive and relevant usage of data and biospecimens without the need for specific project restrictions. For quality assurance, we compared the consent rate of individual items of the BC versions in patients with systemic lupus erythematosus (SLE) in the longitudinal study. Methods BCs were used for biomaterial donation. Informed consent data from RHINEVIT were analyzed. Due to the content restructuring of the BC items due to changes from the templates of the working group of the Medical Ethics Commissions in the Federal Republic of Germany and GDPR requirements, content mapping of the items was performed for the analysis. Results From September 2015 to March 2022, 291 SLE outpatients donated biomaterials. In 119 patients, the BC was renewed at least once in a subsequent biomaterial donation. Three biomaterial donations were obtained from 21 patients and four from six patients using the respective BC. However, one consent was later revoked. Consent to the BC topics showed consistently high rates of agreement (range 97.5%-100%), with only some patients disagreeing with individual topics. This remained stable over time (median 526 days [Q1 400, Q3 844]). None of the patients disagreed with a certain topic in two consecutive visits. Conclusion Modifications to the BC did not result in any relevant changes in the approval rates for SLE patients. RHINEVIT's BC is successfully used for the quality-assured handling of excellently annotated biomaterial. The long-term use of these highly valuable biospecimens for unrestricted research, also in an international context, remains assured.
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Affiliation(s)
- Jutta G. Richter
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Tim Filla
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Hasan Acar
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Ellen Bleck
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Kernder
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Düsing
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
| | | | | | - Jörg H. W. Distler
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Matthias Schneider
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
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Callhoff J, Feuchtenberger M, Karberg K, Kiltz U, Aringer M, Baraliakos X, Muth T, Regierer AC, Richter JG, Thiele K, Zinke S, Albrecht K. [With RheMIT rheumatology centers can participate in the German national database-Expansion of the long-term rheumatological documentation]. Z Rheumatol 2023:10.1007/s00393-023-01373-y. [PMID: 37280334 PMCID: PMC10382348 DOI: 10.1007/s00393-023-01373-y] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 06/08/2023]
Abstract
The national database (NDB) of the German regional collaborative rheumatology centers was switched to the RheMIT documentation software last year. Rheumatology centers that already use RheMIT for care contracts or other research projects can therefore use the software to also participate in the NDB. Experiences from a hospital, a medical care center and a specialist practice show how the changeover to RheMIT from an existing documentation system or a new participation in the NDB with RheMIT can be implemented. The NDB team at the German Rheumatism Research Center in Berlin (DRFZ) welcomes new participating rheumatology centers.
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Affiliation(s)
- Johanna Callhoff
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Institut für Sozialmedizin, Epidemiologie und Gesundheitsökonomie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
| | - Martin Feuchtenberger
- Med. Versorgungszentren Burghausen - Altötting, MED BAYERN OST GmbH, Burghausen, Deutschland
| | | | - Uta Kiltz
- Ruhr-Universität Bochum, Rheumazentrum Ruhrgebiet, Herne, Deutschland
| | - Martin Aringer
- Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | | | - Theresia Muth
- BDRh Service-GmbH, Grünwald bei München, Deutschland
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Jutta G Richter
- Klinik für Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
- Hiller Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Katja Thiele
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Silke Zinke
- Rheumatologische Praxis Berlin, Berlin, Deutschland
| | - Katinka Albrecht
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Vordenbäumen S, Kleefisch M, Sokolowski A, Düsing C, Richter JG, Brinks R, Schneider M, Chehab G. Beneficial effects associated to a healthy lifestyle in systemic lupus erythematosus: A cross-sectional study. Lupus 2023:9612033231175289. [PMID: 37169766 DOI: 10.1177/09612033231175289] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE To assess whether a healthy lifestyle is associated to beneficial effects on various systemic lupus erythematosus (SLE) health domains. METHODS In a cross-sectional study, Mediterranean Diet Adherence Score (MEDAS), physical activity energy expenditure (PAEE), and smoking status were assessed by questionnaires, along with clinical parameters and various health domains including Systemic Lupus Disease Activity Score (SLEDAI), Depression Scale (CES-D), Fatigue Severity (FSS), functional status (FFbH), physical and mental quality of life (PCS, MCS). Lifestyle choices were assessed with respect to health domains by linear regression modeling. Additionally, SLE patients with a healthy lifestyle (MEDAS ≥ 4, ≥ 1 h sport per week, no smoking) were compared to those without by Wilcoxon's signed-rank test. RESULTS 49 of 145 SLE patients (44.3 ± 31.7 years, 87.6% female) followed a healthy lifestyle and showed a higher physical quality of life (β = 4.5 (95%-CI 1.5-7.9) p = 0.01), lower depression (β = -5.0 (-8.2 to -0.2) p = 0.02) and lower fatigue (β = -0.8 (-1.5 to -0.2) p = 0.01) independently of SLE disease activity. Furthermore, dsDNA-antibodies were lower (146 ± 540 vs 266 ± 146 U/mL, p = 0.049). In a more detailed analysis, physical activity had the highest impact on the various health domains when compared to smoking or diet adherence, which was consistent even after adjusting for multiple potential confounders. Each 1,000 kcal of weekly PAEE was associated to a 1.8 (0.9-2.6) point increase in the PCS (p = 0.0001), a 0.2 (0.03-0.4) point decrease in the CES-D (p = 0.01) and a 2.8 (1.2-4.4) point increase in the FFbH (p = 0.0006). CONCLUSION A healthy lifestyle, especially physical activity is associated with beneficial effects including quality of life, depression and fatigue in SLE.
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Affiliation(s)
- Stefan Vordenbäumen
- St. Elisabeth-Hospital Meerbusch-Lank, Dept. Rheumatology, Meerbusch, Germany
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Martin Kleefisch
- St. Elisabeth-Hospital Meerbusch-Lank, Dept. Rheumatology, Meerbusch, Germany
| | - Alexander Sokolowski
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Christina Düsing
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Jutta G Richter
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Ralph Brinks
- Medical Biometry and Epidemiology, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Matthias Schneider
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Gamal Chehab
- Clinic for Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
- Hiller Research Unit, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
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Hasseli R, Richter JG, Hoyer BF, Lorenz HM, Pfeil A, Regierer AC, Schmeiser T, Strangfeld A, Voll RE, Krause A, Reckert S, Gräßler A, Saar P, Kapelle A, Backhaus M, Blank N, Henes J, Osiek S, Knothe A, Hoese G, Brandt-Jürgens J, Maltzahn A, Specker C, Müller-Ladner U, Schulze-Koops H. Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases. RMD Open 2023; 9:rmdopen-2023-002998. [PMID: 37068915 PMCID: PMC10111193 DOI: 10.1136/rmdopen-2023-002998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs). METHODS Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients' vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression. RESULTS In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14-347) days in patients being double-vaccinated, and after 88 (range 14-270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p<0.001). Mortality was 2% in unvaccinated, 1.8% in the double-vaccinated and 0.6% in triple-vaccinated patients. Compared with unvaccinated patients, double-vaccinated (OR 0.43, 95% CI 0.29 to 0.62) and triple-vaccinated (OR 0.13, 95% CI 0.08 to 0.21) patients showed a significant lower risk of COVID-19-related hospitalisation. Using multivariable analysis, the third vaccination was significantly associated with a lower risk for COVID-19-related death (OR 0.26; 95% CI 0.01 to 0.73). CONCLUSIONS Our cross-sectional data of COVID-19 infections in patients with IRD showed a significant reduction of hospitalisation due to infection in double-vaccinated or triple-vaccinated patients compared with those without vaccination and even a significant reduction of COVID-19-related deaths in triple-vaccinated patients. These data strongly support the beneficial effect of COVID-19 vaccination in patients with IRD. TRIAL REGISTRATION NUMBER EuDRACT 2020-001958-21.
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Affiliation(s)
- Rebecca Hasseli
- Department of Internal Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Munster, Munster, Germany
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Jutta G Richter
- Clinic for Rheumatology, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Hiller Research Center, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bimba Franziska Hoyer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | | | - Tim Schmeiser
- Rheumatology, Private Practice "Rheumatologie im Veedel" Cologne, Cologne, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Centre of Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | | | | | - Petra Saar
- Rheumatology, Private Practice Endokrinologikum, Frankfurt, Germany
| | | | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Academic Hospital of the Charité Berlin, Berlin, Germany
| | - Norbert Blank
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases (INDIRA) and Department of Internal Medicine II (Oncology, Haematology, Rheumatology and Clinical Immunology), University Hospital Tuebingen, Tuebingen, Germany
| | - Silke Osiek
- Rheumatology, Private Practice Dialysezentrum, Schweinfurt, Germany
| | - Anna Knothe
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Guido Hoese
- Rheumatology, Private Practice, Stadthagen, Germany
| | | | | | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University, Munich, Germany
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König IR, Mittermaier M, Sina C, Raspe M, Stais P, Gamstätter T, Stachwitz P, Wolfrum S, Richter JG, Möckel M. [Evidence of positive care effects by digital health apps-methodological challenges and approaches]. Inn Med (Heidelb) 2022; 63:1298-1306. [PMID: 36279007 DOI: 10.1007/s00108-022-01429-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Since 2020, digital health applications (DiGA) can be prescribed at the expense of the German statutory health insurance (SHI) system after undergoing an approval procedure by the Federal Institute for Drugs and Medical Devices (BfArM). DiGA can be approved provisionally for 1 year (with the option of extension) or permanently. The latter is dependent on scientific evidence of a positive effect on care, which can be a medical benefit or a patient-relevant structural and procedural improvement in care. However, it is apparent that the investigation of DiGA in scientific studies is challenging, as they are often complex interventions whose success also includes user and prescriber factors. In addition, health services research data underpinning the benefits of DiGA are lacking to date. In the current article, methodological considerations for DiGA research are presented, and a selection of internal medicine DiGAs is used to critically discuss current research practice.
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Affiliation(s)
- Inke R König
- Institut für Medizinische Biometrie und Statistik, Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Mirja Mittermaier
- Medizinische Klinik m.S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christian Sina
- Institut für Ernährungsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Matthias Raspe
- Medizinische Klinik m.S. Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Patrick Stais
- Medizinische Klinik 3, Lungen- und Bronchialheilkunde, Lungen-Thorax-Zentrum Nordrhein, Moers, Deutschland
| | - Thomas Gamstätter
- Deutsche Gesellschaft für Innere Medizin e. V., Wiesbaden, Deutschland
| | - Philipp Stachwitz
- Deutsche Gesellschaft für Innere Medizin e. V., Wiesbaden, Deutschland
| | - Sebastian Wolfrum
- Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - Jutta G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Martin Möckel
- Notfall- und Akutmedizin, Zentrale Notaufnahmen und Chest Pain Units, Campus Mitte und Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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10
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Richter JG, Chehab G, Reiter J, Aries P, Muehlensiepen F, Welcker M, Acar H, Voormann A, Schneider M, Specker C. Evaluation of the use of video consultation in German rheumatology care before and during the COVID-19 pandemic. Front Med (Lausanne) 2022; 9:1052055. [PMID: 36507506 PMCID: PMC9732003 DOI: 10.3389/fmed.2022.1052055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background The COVID-19 pandemic led to transformations in healthcare infrastructures and increased use of (innovative) telemedicine (TM) tools. Comparison of the use of video consultation (VC) in rheumatology in the pre-pandemic period and during the pandemic might allow for evaluating this new form of consultancy in healthcare due to changing conditions and possibilities. Materials and methods Cross-sectional nationwide online survey among German rheumatologists and rheumatologists in training between March and May 2021 promoted by newsletters and Twitter posts. Results Results refer to 205 participants. The majority was male (59%), older than 40 years (90%). Thirty-eight percent stated to have employed TM before ("digital users"), 27% were using VC as part of their TM expertise ("VC-users"), 10% stated to have experience with TM but not VC ("TM-users"). Those negating the use of any TM (62%) were designated as "digital non-users." TM-Knowledge was self-rated as 4 [median on a Likert Scale 1 (very high) to 6 (very low)] with a significant difference between digital users (VC-user 2.7 ± 1.2, TM-user 3.2 ± 1.1) and digital non-users (4.4 ± 1.3). The reported significant increase of VC use during the lockdown periods and between the lockdowns compared to the pre-pandemic phase was regarded as a proxy for VC acceptance in the pandemic. Reasons for VC non-use were administrative/technical efforts (21%), lack of technical equipment (15%), time constraints (12%), time required for individual VC sessions (12%), inadequate reimbursement (11%), lack of demand from patients (11%), data security concerns (9%), poor internet connection (8%), and lack of scientific evaluation/evidence (5%). Physicians considered the following clinical situations to be particularly suitable for VC: follow-up visits (VC-user 79%, TM-user 62%, digital non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, digital non-user 20%), and patients presenting for the first time (VC-user 11%, TM-user 19%, digital non-user 8%). Conclusion Even though the pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms as VC, its use and acceptance remained comparatively low due to multiple reasons. This analysis may help identify hurdles in employing innovative digital care models for rheumatologic healthcare.
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Affiliation(s)
- Jutta G. Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany,*Correspondence: Jutta G. Richter,
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Joana Reiter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Welcker
- MVZ für Rheumatologie Dr. Martin Welcker GmbH and RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Hasan Acar
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
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11
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Richter JG, Chehab G, Stachwitz P, Hagen J, Larsen D, Knitza J, Schneider M, Voormann A, Specker C. One year of digital health applications (DiGA) in Germany - Rheumatologists' perspectives. Front Med (Lausanne) 2022; 9:1000668. [PMID: 36388899 PMCID: PMC9640713 DOI: 10.3389/fmed.2022.1000668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Based on given legislation the German approach to digital health applications (DiGA) allows reimbursed prescription of approved therapeutic software products since October 2020. For the first time, we evaluated DiGA-related acceptance, usage, and level of knowledge among members of the German Society for Rheumatology (DGRh) 1 year after its legal implementation. MATERIALS AND METHODS An anonymous cross-sectional online survey, initially designed by the health innovation hub (think tank and sparring partner of the German Federal Ministry of Health) and the German Pain Society was adapted to the field of rheumatology. The survey was promoted by DGRh newsletters and Twitter-posts. Ethical approval was obtained. RESULTS In total, 75 valid response-sets. 80% reported to care ≥ 70% of their working time for patients with rheumatic diseases. Most were working in outpatient clinics/offices (54%) and older than 40 years (84%). Gender distribution was balanced (50%). 70% knew the possibility to prescribe DiGA. Most were informed of this for the first time via trade press (63%), and only 8% via the scientific/professional society. 46% expect information on DiGA from the scientific societies/medical chambers (35%) but rarely from the manufacturer (10%) and the responsible ministry (4%). Respondents would like to be informed about DiGA via continuing education events (face-to-face 76%, online 84%), trade press (86%), and manufacturers' test-accounts (64%). Only 7% have already prescribed a DiGA, 46% planned to do so, and 47% did not intend DiGA prescriptions. Relevant aspects for prescription are provided. 86% believe that using DiGA/medical apps would at least partially be feasible and understandable to their patients. 83% thought that data collected by the patients using DiGA or other digital solutions could at least partially influence health care positively. 51% appreciated to get DiGA data directly into their patient documentation system/electronic health record (EHR) and 29% into patient-owned EHR. CONCLUSION Digital health applications awareness was high whereas prescription rate was low. Mostly, physician-desired aspects for DiGA prescriptions were proven efficacy and efficiency for physicians and patients, risk of adverse effects and health care costs were less important. Evaluation of patients' barriers and needs is warranted. Our results might contribute to the implementation and dissemination of DiGA.
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Affiliation(s)
- Jutta G. Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Philipp Stachwitz
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Julia Hagen
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Denitza Larsen
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Johannes Knitza
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
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Izadi Z, Gianfrancesco MA, Aguirre A, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson‐Tovey S, Kearsley‐Fleet L, Schaefer M, Seet AM, Schmajuk G, Jacobsohn L, Katz P, Rush S, Al‐Emadi S, Sparks JA, Hsu TY, Patel NJ, Wise L, Gilbert E, Duarte‐García A, Valenzuela‐Almada MO, Ugarte‐Gil MF, Ribeiro SLE, de Oliveira Marinho A, de Azevedo Valadares LD, Giuseppe DD, Hasseli R, Richter JG, Pfeil A, Schmeiser T, Isnardi CA, Reyes Torres AA, Alle G, Saurit V, Zanetti A, Carrara G, Labreuche J, Barnetche T, Herasse M, Plassart S, Santos MJ, Rodrigues AM, Robinson PC, Machado PM, Sirotich E, Liew JW, Hausmann JS, Sufka P, Grainger R, Bhana S, Costello W, Wallace ZS, Yazdany J. Development of a Prediction Model for COVID-19 Acute Respiratory Distress Syndrome in Patients With Rheumatic Diseases: Results From the Global Rheumatology Alliance Registry. ACR Open Rheumatol 2022; 4:872-882. [PMID: 35869686 PMCID: PMC9350083 DOI: 10.1002/acr2.11481] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Some patients with rheumatic diseases might be at higher risk for coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS). We aimed to develop a prediction model for COVID-19 ARDS in this population and to create a simple risk score calculator for use in clinical settings. METHODS Data were derived from the COVID-19 Global Rheumatology Alliance Registry from March 24, 2020, to May 12, 2021. Seven machine learning classifiers were trained on ARDS outcomes using 83 variables obtained at COVID-19 diagnosis. Predictive performance was assessed in a US test set and was validated in patients from four countries with independent registries using area under the curve (AUC), accuracy, sensitivity, and specificity. A simple risk score calculator was developed using a regression model incorporating the most influential predictors from the best performing classifier. RESULTS The study included 8633 patients from 74 countries, of whom 523 (6%) had ARDS. Gradient boosting had the highest mean AUC (0.78; 95% confidence interval [CI]: 0.67-0.88) and was considered the top performing classifier. Ten predictors were identified as key risk factors and were included in a regression model. The regression model that predicted ARDS with 71% (95% CI: 61%-83%) sensitivity in the test set, and with sensitivities ranging from 61% to 80% in countries with independent registries, was used to develop the risk score calculator. CONCLUSION We were able to predict ARDS with good sensitivity using information readily available at COVID-19 diagnosis. The proposed risk score calculator has the potential to guide risk stratification for treatments, such as monoclonal antibodies, that have potential to reduce COVID-19 disease progression.
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Affiliation(s)
| | | | | | | | - Elsa F. Mateus
- Portuguese League Against Rheumatic DiseasesLisbonPortugal
| | - Kimme L. Hyrich
- The University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University and NHS Foundation TrustManchesterUK
| | - Laure Gossec
- INSERM, Sorbonne Universite and Hopital Universitaire Pitie Salpetriere, AP‐HPParisFrance
| | | | - Saskia Lawson‐Tovey
- The University of Manchester and National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust and Manchester Academic Health Science CentreManchesterUK
| | - Lianne Kearsley‐Fleet
- The University of Manchester and Manchester Academic Health Science CentreManchesterUK
| | | | | | - Gabriela Schmajuk
- University of CaliforniaSan Francisco and San Francisco Department of Veterans Affairs Medical Center
| | | | | | | | | | - Jeffrey A. Sparks
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Tiffany Y‐T Hsu
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Naomi J. Patel
- Massachusetts General Hospital and Harvard Medical SchoolBoston
| | - Leanna Wise
- University of Southern CaliforniaLos Angeles
| | | | | | | | - Manuel F. Ugarte‐Gil
- Universidad Científica del Sur and Hospital Nacional Guillermo Almenara IrigoyenEsSalud, LimaPeru
| | | | | | | | | | - Rebecca Hasseli
- Justus‐Liebig University Giessen, Campus KerckhoffGiessenGermany
| | | | - Alexander Pfeil
- Jena University Hospital and Friedrich Schiller University JenaJenaGermany
| | - Tim Schmeiser
- Rheumatology im Veedel (Private Practice)CologneGermany
| | | | | | | | | | - Anna Zanetti
- Italian Society for Rheumatology and University of Milano‐BicoccaMilanItaly
| | - Greta Carrara
- Italian Society for Rheumatology and University of Milano‐BicoccaMilanItaly
| | | | - Thomas Barnetche
- FHU ACRONIM, Centre for Autoimmune Systemic Rare Diseases, Bordeaux University HospitalBordeauxFrance
| | - Muriel Herasse
- Filière des Maladies Autoimmunes et Autoinflammatoires Rares, Hôpital Huriez, Centre Hospitalier Universitaire de LilleLilleFrance
| | - Samira Plassart
- Filière des Maladies Autoimmunes et Autoinflammatoires Rares, Hôpital Huriez, Centre Hospitalier Universitaire de LilleLilleFrance
| | - Maria José Santos
- Hospital Garcia de Orta, Almada, Portugal, and Instituto de Medicina Molecular Faculdade Medicina and Rheumatic Diseases Portuguese RegisterLisbonPortugal
| | - Ana Maria Rodrigues
- Rheumatic Diseases Portuguese Register, Sociedade Portuguesa de Reumatologia, Nova Medical School, and Hospital dos LusiadasLisbonPortugal
| | - Philip C. Robinson
- The University of Queensland, Brisbane, Queensland, Australia, and Royal Brisbane and Women's Hospital, Metro North Hospital and Health ServiceHerstonQueenslandAustralia
| | - Pedro M. Machado
- University College London, University College London Hospitals NHS Foundation Trust and Northwick Park Hospital, London North West University Healthcare NHS TrustLondonUK
| | - Emily Sirotich
- McMaster University, Hamilton, Ontario, Canada, and Canadian Arthritis Patient AllianceTorontoOntarioCanada
| | - Jean W. Liew
- Boston University School of MedicineBostonMassachusetts
| | - Jonathan S. Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School and Boston Children's HospitalBostonMassachusetts
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Kempin R, Richter JG, Schlegel A, Baraliakos X, Tsiami S, Buehring B, Kiefer D, Braun J, Kiltz U. Monitoring of Disease Activity With a Smartphone App in Routine Clinical Care in Patients With Axial Spondyloarthritis. J Rheumatol 2022; 49:878-884. [PMID: 35428719 DOI: 10.3899/jrheum.211116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the performance of a health app with respect to usability, adherence, and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA). METHODS Consecutive patients with axSpA were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by 2 further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit; they also completed the Mobile App Rating Scale and the System Usability Scale after 3 and 6 months. RESULTS Of 103 patients with axSpA, 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 4.3 (2.0), and 76.8% treated with biologic disease-modifying antirheumatic drugs. Patients' adherence to regular app exports was 29.0% and 28.4% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity (P = 0.02) and older age (P = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (intraclass correlation coefficients 0.99 [95% CI 0.98-0.99]). Performance of the app was rated as good. CONCLUSION Collection of digital PROs by AxSpA Live App may be successfully used in patients with axSpA with high disease activity. Our study showed equivalence of digital data, but adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients.
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Affiliation(s)
- Robin Kempin
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Jutta G Richter
- J.G. Richter, MD, Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Anna Schlegel
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Xenofon Baraliakos
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Styliani Tsiami
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Bjoern Buehring
- B. Buehring, MD, Bergisches Rheumazentrum Wuppertal, Wuppertal, and Ruhr-Universität Bochum Germany, Bochum, Germany
| | - David Kiefer
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Juergen Braun
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum
| | - Uta Kiltz
- R. Kempin, MD, A. Schlegel, X. Baraliakos, MD, S. Tsiami, MD, D. Kiefer, MD, J. Braun, MD, U. Kiltz, MD, Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Bochum;
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Vollmar HC, Lemmen C, Kramer U, Richter JG, Fiebig M, Hoffmann F, Redaèlli M. [Digital Transformation of Healthcare: A Delphi Study of the Working Groups Digital Health and Validation and Linkage of Secondary Data of the German Network for Health Services Research (DNVF)]. Gesundheitswesen 2022; 84:581-596. [PMID: 35679867 DOI: 10.1055/a-1821-8429] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM OF THE STUDY The digital transformation in healthcare is also of fundamental importance for healthcare research. For this reason, experts should agree on, prioritize and identify key topics for a medium-term strategy of the German Network for Health Services Research and classify the general development of digital health in the context of health services research. METHODS Between April and September 2018, the working groups "Digital Health" and "Validation and Linkage of Secondary Data" of the German Network for Health Services Research were asked to submit their expertise online using the methodological approach of a Delphi study. For this purpose, a multi-stage modified Delphi method with quantitative and qualitative approaches was chosen. Initially, a list of theses was drawn from the network's published position papers on digital health applications and medical apps. A total of 131 statements were formulated. The final survey instrument included questions on the biographical background of the participants, 42 developed items (33 statements and 8 open-ended questions), and one free-text field to add further aspects. Items were evaluated with a five-point Likert scale. A statement was accepted if the agreement rate was 75% or higher. RESULTS Of the 110 potential participants, 50 (46%) took part in the first round and 39 (36%) in the second round of the Delphi survey. In the first round, there was a clear result for 24 of 33 statements. There were 20 statements "agreed with" and four "disagreed with." Nine statements were between 60 and 75% and were presented to the participants again for evaluation in the second round. In round two, of these nine statements, four statements were "agreed with" and five statements were "disagreed with." Digital Health Literacy" emerged as a particular focus in this Delphi study. CONCLUSION In this Delphi study, experts were involved in selecting and prioritizing possible topics for the Digital Health working group and assessing future developments in digital health in the context of health services research. The results reflect both the expectations and interests of the members and are largely consistent with the recommendations of the report "Digitalization for Health" made by the expert council for assessing developments in the health sector.
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Affiliation(s)
| | - Clarissa Lemmen
- Institut für Gesundheitsökonomie und Klinische Epidemiologie (IGKE) , Universität zu Köln Medizinische Fakultät, Koln, Germany
| | - Ursula Kramer
- Gesundheitskommunikation, Sanawork, Freiburg im Breisgau, Germany
| | - Jutta G Richter
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Madlen Fiebig
- Competence in Nursing and Healthcare, ePA-CC GmbH, Wiesbaden, Germany
| | - Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Marcus Redaèlli
- Institut für Gesundheitsökonomie und Klinische Epidemiologie (IGKE) , Universität zu Köln Medizinische Fakultät, Koln, Germany
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Klein-Weigel P, Ruttloff A, König D, Nielitz J, Steindl J, Sander O, Richter JG. [Functional vascular acrosyndromes]. Inn Med (Heidelb) 2022; 63:591-600. [PMID: 35925129] [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] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
Vascular acrosyndromes are characterized by sparse, uniform clinical manifestations and a variety of possible pathomechanisms. The present article focuses on the functional entities. Raynaud phenomenon is based on cold- or stress-induced vasospasms of acral arteries. It is defined by the color changes of the skin, in the typical case white-blue-red (tricolore). The long fingers are most commonly affected. The etiology is unknown, and the pathophysiology is poorly understood. A distinction is made between primary and a secondary Raynaud phenomenon. The most important underlying diseases include collagenosis, primarily systemic sclerosis, and malignancies; furthermore, medications and drugs may promote vasospasm. Treatment is aimed at preventing or breaking the vasospasm, but has been only partially effective in doing so. Acrocyanosis is a vasospastic dystonic acral disorder that results in permanent reddish-livid discoloration, especially of the hands and feet. Secondary forms occur in collagenosis, malignancies, and myelodysplastic syndromes. The etiology and pathophysiology are virtually unknown. Targeted pharmacological intervention is not possible. Unlike all other vascular acrosyndromes, erythromelalgia is characterized by hyperemia. The primary form is a genetic sodium channelopathy, while secondary forms include malignancies, connective tissue diseases, and myelodysplastic syndromes. The symptoms are often distressing and disabling. Therapy requires a multimodal approach that includes both nonpharmacological and pharmacological strategies. Close interdisciplinary collaboration is essential for the management of this disease.
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Affiliation(s)
- Peter Klein-Weigel
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland.
| | - Andreas Ruttloff
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Dana König
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Jessica Nielitz
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Julia Steindl
- Klinik für Angiologie, Klinikum Ernst von Bergmann, Charlottenstr. 72, 14467, Potsdam, Deutschland
| | - Oliver Sander
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller-Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Jutta G Richter
- Poliklinik und Funktionsbereich für Rheumatologie & Hiller-Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
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Richter P, Richter JG, Lieb E, Steimann F, Chehab G, Becker A, Thielscher C. Digitalization and disruptive change in rheumatology. Z Rheumatol 2022:10.1007/s00393-022-01222-4. [PMID: 35639150 DOI: 10.1007/s00393-022-01222-4] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recently, many sectors have seen disruptive changes due to the rapid progress in information and communication technology (ICT). The aim of this systematic literature review was to develop a first understanding of what is known about new ICTs in rheumatology and their disruptive potential. METHODS PubMed, LIVIVO, and EBSCO Discovery Service (EDS) databases were searched for relevant literature. Use of new ICTs was identified, categorized, and disruptive potential was discussed. Articles from 2008 to 2021 in German and English were considered. RESULTS A total of 3539 articles were identified. After application of inclusion/exclusion criteria, 55 articles were included in the analyses. The majority of articles (48) used a non-experimental design or detailed expert opinion. The new ICTs mentioned in these articles could be allocated to four main categories: technologies that prepare for the development of new knowledge by data collection (n = 32); technologies that develop new knowledge by evaluation of data (e.g., by inventing better treatment; n = 11); technologies that improve communication of existing knowledge (n = 32); and technologies that improve the care process (n = 29). Further assessment classified the ICTs into different functional subcategories. Based on these categories it is possible to estimate the disruptive potential of new ICTs. CONCLUSION ICTs are becoming increasingly important in rheumatology and may impact patients' lives and professional conduct. The properties and disruptive potential of technologies identified in the articles differ widely. When looking into ICTs, doctors have focused on new diagnostic and therapeutic procedures but rarely on their disruptive potential. We recommend putting more effort into investigation of whether ICTs change the way rheumatology is performed and who is in control of it. Especially technologies that potentially replace physicians with machines, take control over the definition of quality in medicine, and/or create proprietary knowledge that is not accessible for doctors need more research.
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Affiliation(s)
- Pia Richter
- Competence Center for Medical Economics, FOM University, Sigsfeldstr. 5, 45141, Essen, Germany
| | - Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Elke Lieb
- FOM University, Am Kieselhumes 15, 66123, Saarbrücken, Germany
| | - Friedrich Steimann
- Department for Programming Systems, FernUniversität Hagen, Universitätsstraße 11, 58097, Hagen, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Arnd Becker
- Ortenau Klinikum Offenburg-Kehl, Offenburg, Germany
| | - Christian Thielscher
- Competence Center for Medical Economics, FOM University, Sigsfeldstr. 5, 45141, Essen, Germany.
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Lautwein A, Ostendorf B, Vordenbäumen S, Liedmann A, Brinks R, Giulini M, Ohrndorf S, Backhaus M, Acar H, Sander O, Richter JG, Schneider M, Sewerin P. Musculoskeletal ultrasound as a screening-tool for rheumatoid arthritis: results of the "Rheuma-Truck" screening and awareness initiative. Adv Rheumatol 2022; 62:1. [PMID: 34983698 DOI: 10.1186/s42358-021-00233-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/20/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate musculoskeletal ultrasound (MSUS) as a screening tool for rheumatoid arthritis (RA) and osteoarthritis (OA) patients in a rheumatology-screening program. PATIENTS AND METHODS To raise awareness for rheumatic diseases, a mobile rheumatology office was deployed in different cities of Germany ("Rheuma-Truck"). Standardized questionnaire assessment, testing for rheumatoid factor and citrullinated peptide antibodies and medical student driven MSUS of the clinically dominant hand/foot including wrist, MCP-II, -III, -V, PIP-II, -III, MTP-II and -V were offered free of charge to the population. In case of suspicious results, a rheumatologist was consulted. RESULTS In MSUS, 192 of 560 selected volunteers (aged 18-89, mean 52.7 years; 72.9% female) had suspicious findings including synovitis or erosions primarily affecting the MTP-II (11.8%), dorsal wrist (8.9%), and MCP-II (7%). 354 of the 560 volunteers further visited a rheumatologist of whom 76 were diagnosed with RA. According to the 'US7 Score', a sum scores ≥ 5 was significantly predictive for RA (odds ratio (OR) 5.06; confidence interval (CI) 0.83-35.32). 313 volunteers displayed signs of OA including osteophytes, while MCP-II (36.2%), MCP-III (14.8%), and the wrist (10.5%) were mostly affected. Diagnosis of RA was favoured over OA if the wrist (OR 4.2; CI 1.28-13.95), MTP-II (OR 1.62; CI 1.0-2.6), and MCP-V (OR 2.0; CI 1.0-3.8) were involved. CONCLUSION Medical student driven MSUS by the 'US7 Score' can facilitate diagnosis of RA in rheumatology-screening programs due to the level of the score and the affected joints. A high rate of unknown OA signs was detected by MSUS. A mobile rheumatology office displays an opportunity to screen patients for RA and OA.
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Affiliation(s)
- Alexander Lautwein
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Benedikt Ostendorf
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Stefan Vordenbäumen
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Aiko Liedmann
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Ralph Brinks
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Mario Giulini
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Academic Hospital of the Charité Berlin, Park-Klinik Weissensee Berlin, Berlin, Germany
| | - Hasan Acar
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Oliver Sander
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Jutta G Richter
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Matthias Schneider
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany
| | - Philipp Sewerin
- Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf Medical Faculty, Moorenstrasse 5, 40225, Duesseldorf, Germany.
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Richter JG, Weiß A, Bungartz C, Fischer-Betz R, Zink A, Schneider M, Strangfeld A. Mobile Responsive App-A Useful Additional Tool for Data Collection in the German Pregnancy Register Rhekiss? Front Med (Lausanne) 2022; 8:773836. [PMID: 34977074 PMCID: PMC8718637 DOI: 10.3389/fmed.2021.773836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/10/2021] [Accepted: 11/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: The German pregnancy register Rhekiss is designed as a nationwide, web-based longitudinal observational cohort established in 2015. The register follows women with inflammatory rheumatic disease prospectively from child wish or early pregnancy until 2 years post-partum. Information on clinical and laboratory parameters, drug treatment, and (adverse) pregnancy outcomes are documented in pre-specified intervals. Physicians and patients report data for the same time periods via separated accounts and forms into a web-based application (app). As data entry on mobile devices might improve response rates of patients, a responsive app as a further convenient documentation option was developed. Methods: The Rhekiss-app is available for self-reported data retrieval since August 2017 from the App stores. For the current analysis, Rhekiss register data were used from the start of the register until 30 September 2020. The analyses were performed for forms containing information on devices. Outcome parameters were compared for mobile and desktop users for the quantity and quality of filled forms. Results: In total, 5,048 forms were received and submitted by 966 patients. About 57% of forms were sent from mobile devices with the highest numbers in patients with child wishes (63%). Users of mobile devices were slightly younger and often had less high-education level (62 vs. 79%) compared with desktop users. The proportion of forms submitted via mobile devices increased steadily from 48% in the fourth quarter of 2018 to 64% in the third quarter of 2020. The proportion of forms received before and after the Rhekiss-app implementation increased with the highest increase of 12% for forms filled at time point 12 months post-partum. Mobile users submitted significantly more forms than desktop users (2.9 vs. 2.1), data sent via desktops were more often complete (88 vs. 86%). Conclusion: The responsive app is a valuable additional tool for data collection and is well-accepted by patients as indicated by its increasing use in Rhekiss. Apart from desktop/browser developments, the technological adoptions within observational cohorts and registries should take smartphone requirements and developments into account, especially when patient-reported data in young, mobile patients are collected, bearing in mind that data quality could be compromised and concepts for improving data quality should be implemented.
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Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Christina Bungartz
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Rebecca Fischer-Betz
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Düsseldorf, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center (DRFZ), Berlin, Germany
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Richter JG, Becker A, Schneider M, Chehab G. Activity tracker in Rheumatology - 'new' data for improved patient management in routine care? Rheumatology (Oxford) 2021; 61:2712-2713. [PMID: 34888641 DOI: 10.1093/rheumatology/keab919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf (HHUD), University Clinic, Germany
| | - Arnd Becker
- Ortenau Klinikum Offenburg-Kehl, Offenburg, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf (HHUD), University Clinic, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf (HHUD), University Clinic, Germany
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Hasseli R, Pfeil A, Hoyer BF, Lorenz HM, Regierer AC, Richter JG, Schmeiser T, Strangfeld A, Voll RE, Krause A, Schulze-Koops H, Müller-Ladner U, Specker C. [German registry www.Covid19-Rheuma.de : Status report after 1 year of the pandemic]. Z Rheumatol 2021; 80:641-646. [PMID: 34196793 PMCID: PMC8246125 DOI: 10.1007/s00393-021-01034-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 registry ( www.covid19-rheuma.de ) of the German Society of Rheumatology was the first registry for the acquisition and systemic evaluation of viral infections in patients with inflammatory rheumatic diseases (IRD). This has enabled rapid generation of scientific data that will help to improve the care of patients with IRD in the context of the pandemic. In addition to confirming general risk factors, such as patient age and comorbidities (e.g. cardiovascular, chronic lung and kidney diseases), the use of glucocorticoids and the disease activity of the rheumatic disease could be identified as disease-specific independent risk factors for the need of hospitalization due to COVID-19. Evaluations of the continuously growing cohort of patients with IRD and COVID-19 enable recommendations for patient care to be based on better evidence. Cooperation with international rheumatology registries (e.g. European COVID-19 registry for IRD) enables analyses of aggregated cohorts of patients with IRD and COVID-19 for international comparisons and statistically even more reliable statements.
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Affiliation(s)
- Rebecca Hasseli
- Abteilung für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Alexander Pfeil
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Bimba Franziska Hoyer
- Sektion für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Hanns-Martin Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Jutta G Richter
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | | | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Reinhard E Voll
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Andreas Krause
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hendrik Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
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Vordenbäumen S, Sokolowski A, Rosenbaum A, Gebhard C, Raithel J, Düsing C, Chehab G, Richter JG, Brinks R, Rehli M, Schneider M. Methyl donor micronutrients, CD40-ligand methylation and disease activity in systemic lupus erythematosus: A cross-sectional association study. Lupus 2021; 30:1773-1780. [PMID: 34284675 PMCID: PMC8564257 DOI: 10.1177/09612033211034559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 01/07/2023]
Abstract
Objective Hypomethylation of CD40-ligand (CD40L) in T-cells is associated with
increased disease activity in systemic lupus erythematosus (SLE). We
therefore investigated possible associations of dietary methyl donors and
products with CD40L methylation status in SLE. Methods Food frequency questionnaires were employed to calculate methyl donor
micronutrients in 61 female SLE patients (age 45.7 ± 12.0 years, disease
duration 16.2 ± 8.4 years) and compared to methylation levels of previously
identified key DNA methylation sites (CpG17 and CpG22) within CD40L promotor
of T-cells using quantitative DNA methylation analysis on the EpiTYPER mass
spectrometry platform. Disease activity was assessed by SLE Disease Activity
Index (SLEDAI). Linear regression modelling was used. P values were adjusted
according to Benjamini & Hochberg. Results Amongst the micronutrients assessed (g per day), methionine and cysteine were
associated with methylation of CpG17 (β = 5.0 (95%CI: 0.6-9.4), p = 0.04;
and β = 2.4 (0.6-4.1), p = 0.02, respectively). Methionine, choline, and
cysteine were additionally associated with the mean methylation of the
entire CD40L (β = 9.5 (1.0-18.0), p = 0.04; β = 1.6
(0.4-3.0), p = 0.04; and β = 4.3 (0.9-7.7), p = 0.02, respectively).
Associations of the SLEDAI with hypomethylation were confirmed for CpG17
(β=-32.6 (-60.6 to -4.6), p = 0.04) and CpG22 (β=-38.3 (-61.2 to -15.4),
p = 0.004), but not the mean methylation of CD40L. Dietary
products with the highest impact on methylation included meat, ice cream,
white bread, and cooked potatoes. Conclusions Dietary methyl donors may influence DNA methylation levels and thereby
disease activity in SLE.
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Affiliation(s)
- Stefan Vordenbäumen
- Department of Rheumatology, Rheinisches Rheuma-Zentrum St. Elisabeth-Hospital, Meerbusch-Lank, Germany.,Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alexander Sokolowski
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Anna Rosenbaum
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Claudia Gebhard
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Department of Internal Medicine III, Hematology and Oncology, Regensburg Center for Interventional Immunology (RCI), University Hopital Regensburg, Regensburg, Germany
| | - Johanna Raithel
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Department of Internal Medicine III, Hematology and Oncology, Regensburg Center for Interventional Immunology (RCI), University Hopital Regensburg, Regensburg, Germany
| | - Christina Düsing
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gamal Chehab
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jutta G Richter
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ralph Brinks
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany.,Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Michael Rehli
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Department of Internal Medicine III, Hematology and Oncology, Regensburg Center for Interventional Immunology (RCI), University Hopital Regensburg, Regensburg, Germany
| | - Matthias Schneider
- Medical Faculty, Dept. & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
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Richter JG, Chehab G, Schwartz C, Ricken E, Tomczak M, Acar H, Gappa H, Velasco CA, Rosengren P, Povilionis A, Schneider M, Thestrup J. The PICASO cloud platform for improved holistic care in rheumatoid arthritis treatment-experiences of patients and clinicians. Arthritis Res Ther 2021; 23:151. [PMID: 34044850 PMCID: PMC8157758 DOI: 10.1186/s13075-021-02526-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/15/2021] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background Multimorbidity raises the number of essential information needed for delivery of high-quality care in patients with chronic diseases like rheumatoid arthritis (RA). We evaluated an innovative ICT platform for integrated care which orchestrates data from various health care providers to optimize care management processes. Methods The Horizon2020-funded research project PICASO (picaso-project.eu) established an ICT platform that offers integration of care services across providers and supports patients’ management along the continuum of care, leaving the data with the owner. Strict conformity with ethical and legal legislations was augmented with a usability-driven engineering process, user requirements gathering from relevant stakeholders, and expert walkthroughs guided developments. Developments based on the HL7/FHIR standard granting interoperability. Platform’s applicability in clinical routine was an essential aim. Thus, we evaluated the platform according to an evaluation framework in an observational 6-month proof-of-concept study with RA patients affected by cardiovascular comorbidities using questionnaires, interviews, and platform data. Results Thirty RA patients (80% female) participated, mean age 59 years, disease duration 13 years, average number of comorbidities 2.9. Home monitoring data demonstrated high platform adherence. Evaluations yielded predominantly positive feedback: The innovative dashboard-like design offering time-efficient data visualization, comprehension, and personalization was well accepted, i.e., patients rated the platform “overall” as 2.3 (1.1) (mean (SD), Likert scales 1–6) and clinicians recommended further platform use for 93% of their patients. They managed 86% of patients’ visits using the clinician dashboard. Dashboards were valued for a broader view of health status and patient-physician interactions. Platform use contributed to improved disease and comorbidity management (i.e., in 70% physicians reported usefulness to assess patients’ diseases and in 33% potential influence on treatment decisions; risk manager was used in 59%) and empowered patients (i.e., 48% set themselves new health-related goals, 92% stated easier patient-physician communications). Conclusion Comprehensive aggregation of clinical data from distributed sources in a modern, GDPR-compliant cloud platform can improve physicians’ and patients’ knowledge of the disease status and comorbidities as well as patients’ management. It empowers patients to monitor and positively contribute to their disease management. Effects on patients’ outcome, behavior, and changes in the health care systems should be explored by implementing ICT-based platforms enriched by upcoming Artificial Intelligence features where possible. Trial registration DRKS—German Clinical Trials Register, DRKS00013637, prospectively registered. 17 January 2018.
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Affiliation(s)
- Jutta G Richter
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany.
| | - Gamal Chehab
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Catarina Schwartz
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Elisabeth Ricken
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Monika Tomczak
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Hasan Acar
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Henrike Gappa
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | - Carlos A Velasco
- Fraunhofer Institute for Applied Information Technology FIT, St. Augustin, Germany
| | | | | | - Matthias Schneider
- Department Rheumatology & Hiller-Research Unit Rheumatology, Heinrich-Heine-University Düsseldorf, Medical Faculty, Moorenstr. 5, 40225, Duesseldorf, Germany
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23
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Mucke J, Brinks R, Dimitriou A, Richter JG, Schneider M. Treatment expectations as a possible prognostic factor for DMARD response in rheumatoid arthritis: a prospective cohort study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211015829. [PMID: 34093746 PMCID: PMC8142018 DOI: 10.1177/1759720x211015829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/31/2020] [Accepted: 04/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background: The prediction of the individual’s response to disease modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis (RA) is challenging and often limited. Here we evaluated the influence of patients’ expectations towards a change in treatment with DMARD on clinical outcome in RA. Methods: One hundred patients (74 female) with RA (2010 ACR/EULAR classification criteria) and an upcoming change in DMARD treatment due to non-response or adverse effects were included. Patients’ treatment beliefs, health-related quality of life and treatment expectations were measured using the Beliefs about Medicines Questionnaire (BMQ), the Short Form 36, and self-designed questions about expectations before treatment initiation (T0), and DAS28-CRP was calculated at T0 and after 4 months (T4). Associations between patients’ beliefs and expectations and changes in DAS28-CRP (T0 to T4, ΔDAS28-CRP) were explored by regression analyses after multiple imputation. Results: A total of 99 patients were included, of whom 84 completed all questionnaires. Thirty-six percent of all variability in treatment response (ΔDAS28-CRP) was explained by expectations assessed with the questionnaires and the C-reactive protein (CRP)-value at T0. Among these, the expected improvement rate, with 10.5%, as well as the CRP-value at T0, with 10.6%, had the greatest positive effect whereas the fear of adverse effects, with 11.4%, and the BMQ.concern scale, with 9.0%, had the greatest negative impact on ΔDAS28. Conclusion: Patients’ expectations towards newly induced DMARD therapies influence clinical response and may serve as possible explanatory factors for treatment response affecting subjective and objective outcome parameters. Clinical trial registration number: DRKS00017005
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Affiliation(s)
- Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Moorenstrasse 5, Duesseldorf, 40225, Germany
| | - Ralph Brinks
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Germany
| | - Argyri Dimitriou
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Germany
| | - Jutta G Richter
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Germany
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Germany
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Hasseli R, Pfeil A, Hoyer BF, Krause A, Lorenz HM, Richter JG, Schmeiser T, Voll RE, Schulze-Koops H, Specker C, Müller-Ladner U. Do patients with rheumatoid arthritis show a different course of COVID-19 compared to patients with spondyloarthritis? Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/1bq5pl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany.
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Germany
| | - Bimba F. Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel-Hospital Berlin, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Rheumatology, Medicine V, University Hospital of Heidelberg, Germany
| | - Jutta G. Richter
- Department of Rheumatology and Hiller Research Unit, Heinrich-Heine-University, Medical Faculty, Duesseldorf, Germany
| | | | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
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25
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Richter JG, Chehab G, Knitza J, Krotova A, Schneider M, Voormann AJ, Schulze-Koops H, Specker C. [Annual meeting of the German Society for Rheumatology going virtual-successfully defying the pandemic]. Z Rheumatol 2021; 80:399-407. [PMID: 33877456 PMCID: PMC8055747 DOI: 10.1007/s00393-021-00997-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Die COVID-19-Pandemie führte im Jahr 2020 dazu, dass der Jahreskongress der Deutschen Gesellschaft für Rheumatologie (DGRh) als „Deutscher Rheumatologiekongress virtuell“ durchgeführt wurde. Fragestellung Wie wird der „Deutsche Rheumatologiekongress virtuell“ angenommen und welche Optimierungsmöglichkeiten bieten sich für die Zukunft? Material und Methode Die registrierten Teilnehmer wurden gebeten, an einer Online-Kongressevaluation teilzunehmen. Ergebnisse Von 2566 Kongressteilnehmern nahmen 721 an der Evaluation teil. Die Mehrheit (80,2 %) war mit der Veranstaltung insgesamt zufrieden oder sehr zufrieden. Das Format wurde als für den kollegialen Austausch weniger geeignet angesehen. Die verwendete Technik wurde überwiegend als leicht bedienbar und problemlos zugänglich beschrieben. Die ausgewählten Themen des Kongresses entsprachen den Erwartungen von 89 % der Teilnehmer. Die präsentierten Inhalte wurden von 85,2 % der Teilnehmer als für ihre Tätigkeit relevant eingestuft. Eine deutliche Mehrheit der Teilnehmer (85,3 %) würde es begrüßen, die Kongressinhalte dauerhaft und flexibel „on demand“ abrufen zu können. Diskussion Insgesamt konnte ein gut akzeptiertes Format für die Durchführung des „Deutschen Rheumatologiekongresses virtuell“ gefunden werden. Optimierungsaspekte konnten aufgezeigt werden, diese können bei der Umsetzung weiterer (digitaler) Kongresse Berücksichtigung finden. Die Ergebnisse dieser Arbeit geben Aufschluss darüber, wie die DGRh virtuelle und/oder hybride Konferenzen in der Zukunft gestalten kann, um den Interessen und Wünschen der Teilnehmer zu entsprechen.
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Affiliation(s)
- Jutta G Richter
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Gamal Chehab
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Johannes Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Anna Krotova
- Rheumatologische Fortbildungsakademie, Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Anna Julia Voormann
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum, Universität München, München, Deutschland
| | - Hendrik Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum, Universität München, München, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
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26
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Richter JG, Nannen C, Chehab G, Acar H, Becker A, Willers R, Huscher D, Schneider M. Mobile App-based documentation of patient-reported outcomes - 3-months results from a proof-of-concept study on modern rheumatology patient management. Arthritis Res Ther 2021; 23:121. [PMID: 33874994 PMCID: PMC8054360 DOI: 10.1186/s13075-021-02500-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/31/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Mobile medical applications (Apps) offer innovative solutions for patients' self-monitoring and new patient management opportunities. Prior to routine clinical application feasibility and acceptance of disease surveillance using an App that includes electronic (e) patient-reported outcome measures (PROMs) warrant evaluation. Therefore, we performed a proof-of-concept study in which rheumatoid arthritis (RA) patients used an App (RheumaLive) to document their disease. METHODS Accurate PROM reporting via an App in comparison to paper-based versions was investigated to exclude media bias. Sixty participants recruited from 268 consecutive RA outpatients completed paper-based and electronic PROMs (Hannover Functional Questionnaire/derived HAQ; modified RA disease activity index) using the App at baseline and follow-up visits. Between visits, patients used their App on their own smartphone according to their preferences. The equivalence of PROM data and user experiences from patients and physicians were evaluated. RESULTS Patients' (78.3% female) mean (SD) age was 50.1 (13.1) years, disease duration 10.5 (9.1) years, and paper-based HAQ 0.78 (0.59). Mean confidence in Apps scored 3.5 (1.1, Likert scale 1 to 6). ePROMs' scores obtained by patients' data entry in the App were equivalent to paper-based ones and preferred by the patients. After 3 months, the App retention rate was 71.7%. Patients' overall satisfaction with the App was 2.2 (0.9, Likert scale 1 to 6). Patients and physicians valued the App, i.e., for patient-physician interaction: 87% reported that it was easier for them to document the course of the disease using the App than "only" answering questions about their current health during routine outpatient visits. Further App use was recommended in 77.3% of the patients, and according to physicians, in seven patients, the App use contributed to an increased adherence to therapy. CONCLUSION Our study provides an essential basis for the broader implementation of medical Apps in routine care. We demonstrated the feasibility and acceptance of disease surveillance using a smartphone App in RA. App use was convincing as a reliable option to perform continuous, remote monitoring of disease activity and treatment efficacy. TRIAL REGISTRATION ClinicalTrials.gov, NCT02565225 . Registered on September 16, 2015 (retrospectively registered).
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Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany.
| | - Christina Nannen
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Hasan Acar
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Arnd Becker
- Ortenau Klinikum Offenburg-Kehl, Offenburg, Germany
| | - Reinhart Willers
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Institute of Health, Charité - Universitaetsmedizin, Berlin, Germany
- German Rheumatism Research Center Berlin, Berlin, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology & Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Duesseldorf, University Clinic, Moorenstr, 5, 40225, Duesseldorf, Germany
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Klein-Weigel P, Sander O, Reinhold S, Nielitz J, Steindl J, G. Richter J. Raynaud's Phenomenon: A Vascular Acrosyndrome That Requires Long-Term Care. Dtsch Arztebl Int 2021; 118:arztebl.m2021.0023. [PMID: 33632387 PMCID: PMC8287761 DOI: 10.3238/arztebl.m2021.0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Some 5-10% of the German population are affected by Raynaud's phenomenon (RP). In around 10-20% of cases RP arises from an underlying disease, most commonly a connective tissue disease. This review encompasses the diagnosis and differential diagnosis of RP and examines the efficacy of the currently available pharmaceutical and non-pharmaceutical treatment options. METHODS We conducted a selective literature search in PubMed using the search terms "Raynaud's phenomenon", "Raynaud's syndrome," "vasospasm," "vascular acrosyndrome," and "systemic sclerosis," together with a search of the Cochrane Database of Systematic Reviews up to April 2020. RESULTS Raynaud's phenomenon mainly affects the fingers or toes and is typically triggered by cold or emotional stressors. The most important diagnostic steps are demonstration of a tendency towards digital vasospasm, exclusion of occlusions in the afferent arteries and acral vessels, nail-fold capillaroscopy, and determination of autoantibody status. Tumor screening should be arranged in the presence of B symptoms or first manifestation of RP in old age. The onset of RP in childhood is a rare occurrence and points to a secondary origin. The principal options for treatment are protection against cold and administration of calcium antagonists, which reduces the occurrence of RP by around 20-40 %. The treatment of RP in patients with systemic sclerosis is described in the recommendations of the European League Against Rheumatism (EULAR). CONCLUSION At onset or after years of latency, patients with Raynaud phenomenon may have an underlying disease (most commonly a connective tissue disease). Long-term specialist care is necessary for asymptomatic patients with risk factors and for those with clinically manifest symptoms of an underlying condition alike.
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Affiliation(s)
- Peter Klein-Weigel
- Department of Angiology, Klinikum Ernst von Bergmann, Potsdam: Dr. med Peter Klein-Weigel, Dr. med Simone Reinhold, Jessica Nielitz, Dr. med. Julia Steindl
| | - Oliver Sander
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Düsseldorf University Hospital, Faculty of Medicinet, Heinrich Heine University Düsseldorf: Dr. med. Oliver Sander, Prof. Dr. med. Jutta G. Richter
| | - Simone Reinhold
- Department of Angiology, Klinikum Ernst von Bergmann, Potsdam: Dr. med Peter Klein-Weigel, Dr. med Simone Reinhold, Jessica Nielitz, Dr. med. Julia Steindl
| | - Jessica Nielitz
- Department of Angiology, Klinikum Ernst von Bergmann, Potsdam: Dr. med Peter Klein-Weigel, Dr. med Simone Reinhold, Jessica Nielitz, Dr. med. Julia Steindl
| | - Julia Steindl
- Department of Angiology, Klinikum Ernst von Bergmann, Potsdam: Dr. med Peter Klein-Weigel, Dr. med Simone Reinhold, Jessica Nielitz, Dr. med. Julia Steindl
| | - Jutta G. Richter
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Düsseldorf University Hospital, Faculty of Medicinet, Heinrich Heine University Düsseldorf: Dr. med. Oliver Sander, Prof. Dr. med. Jutta G. Richter
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28
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Kernder A, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Brinks R, Aringer M, Schneider M, Chehab G. Delayed diagnosis adversely affects outcome in systemic lupus erythematosus: Cross sectional analysis of the LuLa cohort. Lupus 2021; 30:431-438. [PMID: 33402036 PMCID: PMC7933718 DOI: 10.1177/0961203320983445] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Indexed: 02/02/2023]
Abstract
Objective Despite increased physician’s awareness and improved diagnostic and
serological testing in the recent years, the interval between the initial
symptoms and the diagnosis of Systemic lupus erythematosus (SLE) is still
very long. Our aim was to study this delay and its association to the
outcome of the disease. Methods Information on demographics, onset of first symptoms, first physicians visit
and time of diagnosis was assessed by self-reported questionnaires among SLE
patients in Germany (LuLa cohort, n = 585) in the year 2012. Disease
activity (Systemic Lupus Activity Questionnaire; SLAQ), disease related
damage (Brief Index of Lupus Damage; BILD), health related quality of life
(Short Form 12) and fatigue (FSS) were chosen as proxies for outcome. Linear
regression analysis was used to analyze the association of the delay in
diagnosis to the outcome, adjusted for age, disease duration and sex. Results Mean duration between the onset of symptoms and the diagnosis of SLE was 47
months (SD 73). The longer the time to diagnosis, the higher the disease
activity (β = 0.199, p < 0.0001), the disease-related damage (β = 0.137,
p = 0.002) and fatigue (β 0.145, p = 0.003) and the lower the health-related
quality of life (physical β = −0.136, p = 0.004, mental β = −0.143,
p = 0.004). Conclusion In systemic lupus erythematosus, longer time to diagnosis was associated with
worse outcome. Concepts in care with the intention to shorten the time to
diagnosis are needed to improve the long-term outcome of the disease.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jutta G Richter
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rebecca Fischer-Betz
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Ralph Brinks
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Martin Aringer
- Department of Medicine III, Division of Rheumatology, TU Dresden, Germany
| | - Matthias Schneider
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gamal Chehab
- Department of Rheumatology and Hiller-Research Unit Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
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Aries P, Welcker M, Callhoff J, Chehab G, Krusche M, Schneider M, Specker C, Richter JG. [Statement of the German Society for Rheumatology (DGRh) on the use of video consultations in rheumatology]. Z Rheumatol 2020; 79:1078-1085. [PMID: 33201305 PMCID: PMC7670291 DOI: 10.1007/s00393-020-00932-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
Die Durchführung von Videosprechstunden wird seit mehreren Jahren als ergänzende Form der medizinischen Versorgung in Ergänzung zu einem persönlichen Arzt-Patienten-Kontakt angesehen und teilweise auch gefördert. Die COVID-19-Pandemie hat der Nutzung von Videosprechstunden ungeahnte Aktualität und Aufmerksamkeit verschafft. Die Kassenärztliche Bundesvereinigung beschloss Sonderregelungen im Rahmen der COVID-19-Pandemie, die bisherige Hindernisse für den Einsatz von Telemedizin und Videosprechstunden (und auch teilweise der herkömmlichen Telefonie) reduziert. Die vorliegende Stellungnahme der DGRh zum Einsatz von Videosprechstunden soll einen Überblick darüber geben, in welcher Form und mit welchen Limitierungen die Videosprechstunde in der Rheumatologie in Deutschland anwendbar ist. Die Stellungnahme skizziert einen Ausblick, wie die Videosprechstunde welche Funktionen zukünftig in der rheumatologischen Versorgung übernehmen kann.
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Affiliation(s)
- P Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - M Welcker
- Geschäftsführung, MVZ für Rheumatologie Dr. Martin Welcker GmbH & RheumaDatenRhePort (RhaDaR), Planegg, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - G Chehab
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
| | - J G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Vordenbäumen S, Rosenbaum A, Gebhard C, Raithel J, Sokolowski A, Düsing C, Chehab G, Richter JG, Brinks R, Rehli M, Schneider M. Associations of site-specific CD4 +-T-cell hypomethylation within CD40-ligand promotor and enhancer regions with disease activity of women with systemic lupus erythematosus. Lupus 2020; 30:45-51. [PMID: 33081589 DOI: 10.1177/0961203320965690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/18/2022]
Abstract
OBJECTIVE To comprehensively assess associations of site-specific CD4+-T-cell hypomethylation of the CD40-Ligand gene (CD40L) with disease activity of women with systemic lupus erythematosus (SLE). METHODS CpG-sites within the DNA of the promotor and two enhancer regions (n = 22) of CD40L were identified and numbered consecutively. The rate of methylated DNA in isolated CD4+-T-cells of women with SLE were quantified for each methylation site by MALDI-TOF. Disease activity was assessed by SLE Disease Activity Index (SLEDAI). Associations of site-specific methylation rates with the SLEDAI scores were assessed by linear regression modelling. P values were adjusted according to Bonferroni-Holm as indicated. RESULTS 60 female SLE patients participated in the study (age 45.7 ± 11.1 years, disease duration 17.0 ± 8.3 years). Significant associations to the SLEDAI were noted for CpG22 hypomethylation of the promotor (β = -40.1, p = 0.017, adjusted p = 0.027), trends were noted for CpG17 hypomethylation of the promotor (β = -30.5, p = 0.032, adjusted p = 0.6), and for CpG11 hypermethylation of the second enhancer (β = 15.0, p = 0.046, adjusted p = 0.8). CONCLUSION Site-specific hypomethylation of the CD40L promotor in CD4+-T-cells show associations with disease activity in female SLE patients.
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Affiliation(s)
- Stefan Vordenbäumen
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany.,Rheinisches Rheuma-Zentrum St. Elisabeth-Hospital, Meerbusch-Lank, Germany
| | - Anna Rosenbaum
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Claudia Gebhard
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
| | - Johanna Raithel
- Rheinisches Rheuma-Zentrum St. Elisabeth-Hospital, Meerbusch-Lank, Germany.,Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Alexander Sokolowski
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Christina Düsing
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Gamal Chehab
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jutta G Richter
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ralph Brinks
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Rehli
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.,Regensburg Center for Interventional Immunology (RCI), Regensburg, Germany
| | - Matthias Schneider
- Medical Faculty, Department & Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Düsseldorf, Germany
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Kernder A, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Brinks R, Schneider M, Chehab G. Quality of care predicts outcome in systemic lupus erythematosus: a cross-sectional analysis of a German long-term study (LuLa cohort). Lupus 2020; 29:136-143. [PMID: 31992161 PMCID: PMC6993135 DOI: 10.1177/0961203319896626] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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] [Indexed: 12/17/2022]
Abstract
Objective Our aim was to study the quality of medical care in patients with systemic lupus erythematosus (SLE) to understand gaps and to analyze the association with outcome of the disease. Methods Information on demographics and medical care was assessed by self-reported questionnaires among SLE patients (LuLa cohort, 2011, n = 580). In total, 21 aspects of medical care were analyzed. Univariate analysis selected 10 predictor variables for further analysis: (1) urine examination and (2) blood test in the previous year, (3) taking antimalarials, (4) taking vitamin D and calcium if the dosage of prednisolone was greater than 7.5 mg/day, counseling regarding (5) lipid metabolism, (6) vaccination, and (7) blood pressure, and treatment of the comorbidities (8) hypertension, (9) osteoporosis and (10) lipid metabolism disorder. The association of these 10 items with the outcome of the disease, assessed in 2015, was analyzed by linear regression analysis, adjusted for age, disease duration and sex. Results On average six of the 10 items were met (±1.7). Receiving more clinical care in 2013 was predictive for low disease activity (SLAQ, p = 0.024, β = –0.104, corr. R2 = 0.048), low progress in disease-related damage (Delta Brief Index of Lupus Questionnaire, p = 0.048, β = –0.132, corr. R2 = 0.036) and high health-related quality of life (SF-12 physical, p = 0.035, β = 0.100, corr. R2 = 0.091) in 2015. Conclusion Our study illustrates a link between the quality of care and the SLE outcome parameters disease activity, disease-related damage and quality of life. Consistent considerations of these care parameters, which are recommended in several management guidelines, could therefore be a good approach to improve the outcome of patients with SLE.
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Affiliation(s)
- A Kernder
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - J G Richter
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - R Fischer-Betz
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | | | - R Brinks
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - M Schneider
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
| | - G Chehab
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Department Rheumatology & Hiller-Research Unit Rheumatology, Düsseldorf, Germany
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Hasseli R, Mueller-Ladner U, Schmeiser T, Hoyer BF, Krause A, Lorenz HM, Regierer AC, Richter JG, Strangfeld A, Voll RE, Pfeil A, Schulze-Koops H, Specker C. National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD. RMD Open 2020; 6:rmdopen-2020-001332. [PMID: 32878994 PMCID: PMC7507994 DOI: 10.1136/rmdopen-2020-001332] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. Methods Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters—for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection—are documented. Results Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. Conclusions In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.
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Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | | | - Jutta G Richter
- Department of Rheumatology and Hiller Research Unit, Heinrich-Heine-University, Medical Faculty, Duesseldorf, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte,Essen, Germany
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Knitza J, Callhoff J, Chehab G, Hueber A, Kiltz U, Kleyer A, Krusche M, Simon D, Specker C, Schneider M, Voormann A, Welcker M, Richter JG. [Position paper of the commission on digital rheumatology of the German Society of Rheumatology: tasks, targets and perspectives for a modern rheumatology]. Z Rheumatol 2020; 79:562-569. [PMID: 32651681 DOI: 10.1007/s00393-020-00834-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/28/2022]
Abstract
Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.
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Affiliation(s)
- J Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - G Chehab
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Hueber
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.,Sektion Rheumatologie, Sozialstiftung Bamberg, Klinikum Bamberg, Bamberg, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - D Simon
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - M Welcker
- Geschäftsführung, MVZ für Rheumatologie Dr. Martin Welcker GmbH & RheumaDatenRhePort (rhadar), Planegg, Deutschland
| | - J G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Vordenbäumen S, Brinks R, Schriek P, Lueking A, Richter JG, Budde P, Schulz-Knappe P, Zucht HD, Callhoff J, Schneider M. Profiling of IgG antibodies targeting unmodified and corresponding citrullinated autoantigens in a multicenter national cohort of early arthritis in Germany. Arthritis Res Ther 2020; 22:167. [PMID: 32631453 PMCID: PMC7336616 DOI: 10.1186/s13075-020-02252-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 06/17/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To assess the diagnostic potential of IgG antibodies to citrullinated and corresponding native autoantigens in early arthritis. METHODS IgG autoantibodies to 390 distinct unmodified and corresponding in vitro citrullinated recombinant proteins were measured by a multiplex assay in baseline blood samples from a German multicenter national cohort of 411 early arthritis patients (56.5 ± 14.6 years, 62.8% female). The cohort was randomly split into a training cohort (n = 329, 28.6% ACPA positive) and a validation cohort (n = 82, 32.9% ACPA pos.). The diagnostic properties of candidate antibodies to predict a subsequent diagnosis of rheumatoid arthritis (RA) as opposed to a non-RA diagnosis were assessed by receiver operating characteristics analysis and generalized linear modeling (GLM) with Bonferroni correction in comparison to clinically determined IgM rheumatoid factor (RF) and citrullinated peptide antibody (ACPA) status. RESULTS Of 411 patients, 309 (75.2%) were classified as RA. Detection rates of antibody responses to citrullinated and uncitrullinated forms of the proteins were weakly correlated (Spearman's r = 0.13 (95% CI 0.029-0.22), p = 0.01). The concentration of 34 autoantibodies (32 to citrullinated and 2 to uncitrullinated antigens) was increased at least 2-fold in RA patients and further assessed. In the training cohort, a significant association of citrullinated "transformer 2 beta homolog" (cTRA2B)-IgG with RA was observed (OR 5.3 × 103, 95% CI 0.8 × 103-3.0 × 106, p = 0.047). Sensitivity and specificity of cTRA2B-IgG (51.0%/82.9%) were comparable to RF (30.8%/91.6%) or ACPA (32.1%/94.7%). Similar results were obtained in the validation cohort. The addition of cTRA2B-IgG to ACPA improved the diagnostic performance over ACPA alone (p = 0.026 by likelihood ratio test). CONCLUSIONS cTRA2B-IgG has the potential to improve RA diagnosis in conjunction with RF and ACPA in early arthritis.
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Affiliation(s)
- Stefan Vordenbäumen
- Department Rheumatology & Hiller Research Unit, UKD, Heinrich-Heine-University Düsseldorf, Merowingerplatz 1a, 40225, Düsseldorf, Germany.
| | - Ralph Brinks
- Department Rheumatology & Hiller Research Unit, UKD, Heinrich-Heine-University Düsseldorf, Merowingerplatz 1a, 40225, Düsseldorf, Germany
| | - Patrick Schriek
- Protagen AG (now Oncimmune Germany GmbH), Otto-Hahn-Str. 15, 44227, Dortmund, Germany
- Bio21 Molecular Science & Biotechnology Institute, Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria, Australia
| | - Angelika Lueking
- Protagen AG (now Oncimmune Germany GmbH), Otto-Hahn-Str. 15, 44227, Dortmund, Germany
- SensID GmbH, Schillingallee 68, 18057, Rostock, Germany
| | - Jutta G Richter
- Department Rheumatology & Hiller Research Unit, UKD, Heinrich-Heine-University Düsseldorf, Merowingerplatz 1a, 40225, Düsseldorf, Germany
| | - Petra Budde
- Oncimmune Germany GmbH, Otto-Hahn-Str. 15, 44227, Dortmund, Germany
| | - Peter Schulz-Knappe
- Protagen AG (now Oncimmune Germany GmbH), Otto-Hahn-Str. 15, 44227, Dortmund, Germany
- Immunovia AB, Medicon Village, Scheelevägen, 22381, Lund, Sweden
| | | | - Johanna Callhoff
- Department of Epidemiology, German Rheumatism Research Center DRFZ, Charitéplatz 1, 10117, Berlin, Germany
| | - Matthias Schneider
- Department Rheumatology & Hiller Research Unit, UKD, Heinrich-Heine-University Düsseldorf, Merowingerplatz 1a, 40225, Düsseldorf, Germany
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Vordenbäumen S, Sokolowski A, Kutzner L, Rund KM, Düsing C, Chehab G, Richter JG, Brinks R, Schneider M, Schebb NH. Erythrocyte membrane polyunsaturated fatty acid profiles are associated with systemic inflammation and fish consumption in systemic lupus erythematosus: a cross-sectional study. Lupus 2020; 29:554-559. [PMID: 32188303 DOI: 10.1177/0961203320912326] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/16/2023]
Abstract
Objective This study aimed to assess polyunsaturated fatty acid (PUFA) status and association with systemic inflammation and fish consumption in systemic lupus erythematosus (SLE). Methods Parameters of PUFA status including the proportion of omega-6 and -3 fatty acids in highly unsaturated fatty acids (omega-6%, omega-3%), essential fatty acids linoleic acid (LA) and alpha-linolenic acid (ALA), the omega-6 PUFA arachidonic acid (ARA) and the sum of key omega-3 PUFA eicosapentaenoic acid+docosahexaenoic acid (omega-3 status) were measured by gas chromatography in 68 SLE patients (88.2% female, aged 45.7±12.5 years). Associations with serum CRP, disease activity, damage and fish consumption were assessed by linear regression modelling adjusted for age, sex and body mass index. Associations are reported in terms of regression coefficients (β). Results Omega-6 PUFA were associated with higher CRP: omega-6% (β = 0.052, p = 0.02), the ratio of LA/ALA (β = 0.007, p = 0.02) and ARA (β = 0.308, p = 0.001). Conversely, omega-3% was associated with lower CRP (β = −0.051, p = 0.02). Increased dietary PUFA consumption from fish (g/day) was linked to a higher omega-3 status (β = 2.21, p = 0.02) and lower self-reported damage (Brief Index of Lupus Damage; β = −3.22, p = 0.02). Conclusions Omega-3 and omega-6 fatty acid status differentially reflect systemic inflammation in SLE and are linked to fish consumption.
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Affiliation(s)
- Stefan Vordenbäumen
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Alexander Sokolowski
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Laura Kutzner
- University of Wuppertal, Faculty of Mathematics and Natural Sciences, Wuppertal, Germany
| | - Katharina M Rund
- University of Wuppertal, Faculty of Mathematics and Natural Sciences, Wuppertal, Germany
| | - Christina Düsing
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Gamal Chehab
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Jutta G Richter
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Ralph Brinks
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Matthias Schneider
- Heinrich-Heine-University Düsseldorf, Medical Faculty, Rheumatology and Hiller Research Unit, Düsseldorf, Germany
| | - Nils H Schebb
- University of Wuppertal, Faculty of Mathematics and Natural Sciences, Wuppertal, Germany
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Richter JG, Chehab G, Kiltz U, Callhoff J, Voormann A, Lorenz HM, Schneider M, Specker C. [Digital Health in Rheumatology - Status 2018/19]. Dtsch Med Wochenschr 2019; 144:e3. [PMID: 31284312 DOI: 10.1055/a-0900-6124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jutta G Richter
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Gamal Chehab
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, und Ruhr-Universität Bochum
| | | | | | | | - Matthias Schneider
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen
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Vordenbäumen S, Brinks R, Richter JG, Albrecht K, Schneider M. Response to 'What rheumatologist should know about Fabry disease' by Moiseev et al. Ann Rheum Dis 2019; 79:e72. [PMID: 31040121 DOI: 10.1136/annrheumdis-2019-215516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Stefan Vordenbäumen
- Rheumatology and Hiller Research Unit, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Ralph Brinks
- Rheumatology and Hiller Research Unit, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Jutta G Richter
- Rheumatology and Hiller Research Unit, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | | | - Matthias Schneider
- Rheumatology and Hiller Research Unit, Heinrich-Heine-University Düsseldorf, Medical Faculty, Düsseldorf, Germany
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Callhoff J, Thiele K, Dörner T, Zink A, Richter JG, Henes J, Albrecht K. Trends in employment and hospitalisation in patients with Sjögren's syndrome 1996-2016: results from the German National database. Clin Exp Rheumatol 2019; 37 Suppl 118:83-89. [PMID: 31287413] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/29/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess trends in treatments and outcomes in patients with primary Sjögren's syndrome (pSS), focusing on employment, hospitalisation and medical treatment in the past two decades. METHODS From 1996 to 2016, approximately 300 patients with pSS were annually documented in the National Database of the German Collaborative Arthritis Centres. Data on treatment, physicians' assessments of disease activity, patient-reported outcomes, hospitalisation and employment were collected and compared to patients with rheumatoid arthritis (RA), matched 1:1 for age, sex and disease duration for each calendar year. RESULTS Patients with pSS (>90% female, age 44 years at disease onset, disease duration 10 years) were more frequently assessed to be in low disease activity in 2016 (93%) than in 1996 (62%), p<0.01. Treatment with antimalarials increased from 1996 to 2016 (31 to 50%, p<0.01) and less patients were on glucocorticosteroids (50 to 34%, p<0.01) but <5% were treated with biologics. Employment (<65 years) increased by 21 percentage points (43 to 64%, p<0.001), exceeding the increase observed for RA patients (+15 percentage points). Early retirement (22 to 10%, p=0.01), hospitalisation/year (13 to 7%, p=0.08) and sick leave (39% in 1997 to 27%, p=0.09) decreased comparably to RA patients. CONCLUSIONS Overall, similar trends were observed for RA and pSS cohorts despite minor changes in pSS therapy. Work participation has improved significantly over two decades in pSS. A greater perception of pSS without systemic manifestations may have caused a shift towards less severely affected patient cohorts today.
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Affiliation(s)
- Johanna Callhoff
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany.
| | - Katja Thiele
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | | | - Angela Zink
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, and Charité University Medicine Berlin, Germany
| | - Jutta G Richter
- Heinrich-Heine-University Duesseldorf, Medical Faculty, Policlinic for Rheumatology & Hiller Research Centre for Rheumatology, Duesseldorf, Germany
| | - Joerg Henes
- Eberhard Karls-University Tuebingen, Department of Rheumatology and Clinical Immunology, Tuebingen, Germany
| | - Katinka Albrecht
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
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Richter JG, Chehab G, Kiltz U, Callhoff J, Voormann A, Lorenz HM, Schneider M, Specker C. [Digital Health in Rheumatology - Status 2018/19]. Dtsch Med Wochenschr 2019; 144:464-469. [PMID: 30925601 DOI: 10.1055/a-0740-8773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STATE OF THE ART Innovations in information and communication technology have been used in rheumatology for many years. In 2018 the German Society for Rheumatology established the Commission "Digital Rheumatology". DIGITAL APPLICATIONS IN GERMAN RHEUMATOLOGY Mobile data acquisition in rheumatological patients is feasible. It offers innovative possibilities in the implementation of modern treatment strategies. Digital applications such as the "Rheuma Check" and the "Bechterew Check" are available to the public at any time to screen for inflammatory rheumatic diseases. Other digital services and modern networks allow a triage of patients. Rhekiss and RABBIT SpA are the first fully digitalised registries to provide short-term data on issues that are not covered by clinical trials of pharmaceutical companies. OUTLOOK Digitalization in Rheumatology will provide much faster answers to important questions in healthcare research in the future.
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Affiliation(s)
- Jutta G Richter
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Gamal Chehab
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, und Ruhr-Universität Bochum
| | | | | | | | - Matthias Schneider
- Poliklinik, Funktionsbereich & Hiller Forschungszentrum für Rheumatologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Universitätsklinikum Düsseldorf
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen
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Vordenbäumen S, Brinks R, Richter JG, Albrecht K, Schneider M. Clinical characteristics of patients with alpha-galactosidase A gene variants in a German multicentre cohort of early undifferentiated arthritis. Ann Rheum Dis 2019; 78:1286-1287. [DOI: 10.1136/annrheumdis-2019-215223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 01/31/2023]
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Mucke J, Brinks R, Fischer-Betz R, Richter JG, Sander O, Schneider M, Chehab G. Patient Satisfaction And Disease Control In Patients With Systemic Lupus Erythematosus Is Not Affected By Switching From Intravenous Belimumab To Subcutaneous Injections. Patient Prefer Adherence 2019; 13:1889-1894. [PMID: 31806937 PMCID: PMC6839583 DOI: 10.2147/ppa.s227208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/19/2019] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Since the launch of belimumab in 2011, the BLyS antibody has been increasingly used in the therapy of systemic Lupus erythematosus (SLE). Comparative studies showed that the intravenous (i.v.) and subcutaneous (s.c.) administration forms do not differ in their efficacy. Since the approval of the s.c. therapy, many patients have been switched from i.v. to s.c. administration. The clinical course of these patients and their satisfaction regarding the drug have not yet been investigated. METHODS A total of 9 patients with SLE were switched from i.v. to s.c. belimumab between 12/2017 and 03/2018. We assessed a self-developed questionnaire on drug satisfaction, disease activity (SLEDAI-2k), serological activity (leukocytes, DNA antibodies, complement), disease damage (SLICC/ACR damage index) and functional status (health-assessment questionnaire) at switching (T0) and after 6 months (T1). Association of the questionnaires with the form of administration (i.v. vs s.c.) was analyzed for each variable separately by linear regression analyses, adjusted for age, gender and disease duration. RESULTS At switching, disease activity of all patients was well controlled (median SLEDAI-2k = 2 [Interquartile range 0-4]) and the patients were mainly satisfied with their therapy. No evidence for any difference in disease activity, disease damage or patient satisfaction 6 months after switching was found. In tendency, patients were more satisfied with the s.c. administration. CONCLUSION The switch from i.v. to s.c. belimumab was successful in all cases and had no effect on disease activity or patient satisfaction. Despite the small sample size, s.c. belimumab seems to offer a good alternative to i.v. application.
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Affiliation(s)
- Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
- Correspondence: Johanna Mucke Policlinic and Hiller Research Unit for Rheumatology, Heinrich-Heine-University, Moorenstrasse 5, Duesseldorf40225, GermanyTel +49 211 811 7817Fax +49 211 811 9206 Email
| | - Ralph Brinks
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Rebecca Fischer-Betz
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Jutta G Richter
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Oliver Sander
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Gamal Chehab
- Policlinic and Hiller Research Unit for Rheumatology, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
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Chehab G, Richter JG, Brinks R, Fischer-Betz R, Winkler-Rohlfing B, Schneider M. Vaccination coverage in systemic lupus erythematosus-a cross-sectional analysis of the German long-term study (LuLa cohort). Rheumatology (Oxford) 2018; 57:1439-1447. [PMID: 29757414 DOI: 10.1093/rheumatology/key120] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 02/02/2023] Open
Abstract
Objectives Vaccinations are an important measure to prevent infections in immunocompromised patients. The knowledge of vaccination coverage and reasons for non-vaccination in patients with SLE is scarce. The aim of this study was to assess coverage rates of selected vaccinations in a representative sample of SLE patients and to identify predictors for non-vaccination. Methods In 2013, information on selected vaccinations (coverage, application and reservations) and on demographics, clinical parameters and health beliefs was assessed by means of a self-reported questionnaire among a representative sample of SLE patients in Germany (LuLa cohort). Results Five hundred and seventy-nine patients participated. Vaccination status was primarily checked by their general practitioner (57.3%). Of all the patients, 24.9% did not get their vaccination status checked at all, 16.1% had generally been advised against the use of vaccinations by a physician, and 37.5% stated that they had rejected vaccinations themselves. Their main reasons were fears of developing a lupus flare (21.8%) or adverse events (13.5%). A greater belief by patients in the doctor controlling one's health and the general benefit of medication prevented the rejection of vaccines. Vaccination coverage was low for all recorded vaccinations (tetanus 65.8%, influenza 45.2%, pneumococcus 32.2% and meningococcus 6.1%). Older age was predictive of receiving influenza and pneumococcal vaccination. The same applies for CSs >7.5 mg for receiving influenza vaccination. Conclusion Vaccination coverage in SLE patients is poor and reflects insufficient implementation of national and international recommendations. Rheumatologists need to recognize patients' reservations against vaccinations, to communicate their importance and safety and to give individual recommendations to patients and their health-care providers. Trial registration German Clinical Trials Register, www.germanctr.de, DRKS00011052.
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Affiliation(s)
- Gamal Chehab
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jutta G Richter
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ralph Brinks
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Rebecca Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Matthias Schneider
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Chehab G, Sauer GM, Richter JG, Brinks R, Willers R, Fischer-Betz R, Winkler-Rohlfing B, Schneider M. Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort. Lupus 2018; 27:1652-1660. [DOI: 10.1177/0961203318785245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs. Methods The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients’ health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression. Results Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02–3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97–2.49), a higher age (OR: 1.06; 95% CI: 1.03–1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01–1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82–0.97) was detrimental. Conclusion A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician–patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.
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Affiliation(s)
- G Chehab
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - G M Sauer
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - J G Richter
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Brinks
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Willers
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - R Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - M Schneider
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
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Richter JG, Muth T, Li J, Brinks R, Chehab G, Koch T, Siegrist J, Angerer P, Huscher D, Schneider M. Elevated Psychosocial Stress at Work in Patients with Systemic Lupus Erythematosus and Rheumatoid Arthritis. J Rheumatol 2017; 45:227-234. [DOI: 10.3899/jrheum.170233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2017] [Indexed: 01/03/2023]
Abstract
Objective.Psychosocial stress at work not only affects the healthy working population, but also workers with chronic diseases. We aimed to investigate the psychosocial work stress levels in patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA).Methods.A cross-sectional study applied the Effort-Reward Imbalance (ERI) questionnaire — an internationally established instrument that measures work stress — to patients with SLE and RA who were capable of work and to a group of controls without these diseases. Participants were recruited through rheumatologists in private practices, hospitals, and from self-help groups by personal communication, paper-based flyers, and online advertisements. Because very few studies tested the ERI’s applicability in patient groups, with a lack of evidence in patients with inflammatory rheumatic diseases, internal consistency and construct validity of the ERI measure were evaluated.Results.Data came from 270 patients with RA and 247 with SLE, and 178 controls. Patients showed elevated psychosocial stress at work compared to controls. Across the total sample and all groups, satisfactory internal consistencies of the scales effort, reward, and overcommitment were obtained (Cronbach’s alpha coefficients > 0.70), and confirmatory factor analysis replicated the theoretical structure of the ERI model (goodness-of-fit index > 0.80).Conclusion.We found elevated psychosocial stress at work in patients with SLE and RA compared to controls by applying the ERI model. Despite some heterogeneity in the sample, we achieved satisfactory psychometric properties of the ERI questionnaire. Our results suggest that the ERI questionnaire is a psychometrically useful tool to be implemented in epidemiological studies of employed patients with SLE and RA.
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Richter JG, Sander O, Schneider M. Causes of Cardiovascular Ischemic Events in Giant Cell Arteritis. J Rheumatol 2016; 43:2092-2093. [PMID: 27909138 DOI: 10.3899/jrheum.161237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf;
| | - Oliver Sander
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Brinks R, Hoyer A, Weber S, Fischer-Betz R, Sander O, Richter JG, Chehab G, Schneider M. Age-specific and sex-specific incidence of systemic lupus erythematosus: an estimate from cross-sectional claims data of 2.3 million people in the German statutory health insurance 2002. Lupus Sci Med 2016; 3:e000181. [PMID: 27933200 PMCID: PMC5133401 DOI: 10.1136/lupus-2016-000181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 10/28/2016] [Accepted: 11/05/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To provide an estimate of age-specific incidence rate of physician-diagnosed systemic lupus erythematosus (SLE) for German men and women. METHODS The age-specific and sex-specific prevalence of diagnosed SLE in claims data is used to estimate the incidence in the German male and female population. The claims data set stems from a representative sample of the statutory health insurance in 2002 and comprises 2.3 million people. The statutory health insurance covers >85% of the German population. RESULTS The estimated incidence rates are 0.9 (95% CI 0.7 to 1.1) per 100 000 person-years for men and 1.9 (95% CI 1.7 to 2.2) per 100 000 person-years for women. The age-specific incidence rate of SLE in the male population has a maximum of 2.2 (95% CI 1.0 to 3.4) per 100 000 person-years at the age of 65-70 years. In women, the incidence is peaking at the rate of 3.6 (95% CI 2.9 to 4.3) cases per 100 000 person-years at the age of 20-25 years, but has a second local maximum (2.6, 95% CI 1.5 to 3.8) at menopausal age. CONCLUSIONS For the first time, representative data on the incidence of SLE in Germany are provided. The estimated incidence rates of SLE for men and women in Germany are at the lower end of other estimates from comparable European countries.
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Affiliation(s)
- Ralph Brinks
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; German Diabetes Center, Institute for Biometry and Epidemiology, Duesseldorf, Germany
| | - Annika Hoyer
- German Diabetes Center, Institute for Biometry and Epidemiology , Duesseldorf , Germany
| | - Sergej Weber
- Hiller Research Unit for Rheumatology , University Hospital Duesseldorf , Duesseldorf , Germany
| | - Rebecca Fischer-Betz
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Oliver Sander
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Jutta G Richter
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Gamal Chehab
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Matthias Schneider
- Hiller Research Unit for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany; Policlinics for Rheumatology, University Hospital Duesseldorf, Duesseldorf, Germany
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Richter JG, Chehab G, Schneider M. Electronic health records in rheumatology: emphasis on automated scoring and additional use. Clin Exp Rheumatol 2016; 34:S62-S68. [PMID: 27762191] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
Electronic health records are increasingly used and frequently required from various regulatory authorities. Apart from their day-to-day use by health care professionals for routine clinical practice and/or the improvement of quality of care processes, patients with chronic inflammatory disease may become increasingly involved in the data retrieval process by self-monitoring and providing patient-reported (outcome) data. Among key features of electronic health records are automated scoring, visualisation of validated measures, and long-term systematic patient-centered data collection in a structured and standardised manner. Data derived from electronic health records are increasingly incorporated into patient-centered research, registries, and other secondary uses. Thus, electronic health records offer opportunities to improve knowledge and to create new process flows in rheumatology health care. The article summarises some of these opportunities in patient care, as well as an overview of secondary use scenarios. In addition, the article focuses on patients' active involvement in the disease management process via health information applications, reports on patients' perspectives, as well as some legal and regulatory matters concerning electronic health records.
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Affiliation(s)
- Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Kiltz U, Boonen A, Braun J, Richter JG. Electronic assessment of disease activity and functioning in patients with axial spondyloarthritis: challenges and unmet needs. Clin Exp Rheumatol 2016; 34:S57-S61. [PMID: 27762203] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 06/06/2023]
Abstract
The dynamic clinical course of rheumatic conditions indicates a need for regular collection of information on health status to monitor disease activity and functional status. Patient-reported outcomes measures (PROMs) are playing a key role in the evaluation of symptoms and functioning and health, and are crucial in the initiation of treatment in those patients. In recent years, electronic assessments of PROMs (so called ePROMs) have been introduced. This report summarises some of the rationale, opportunities, and results using ePROMs in patients with spondyloarthritis (SpA).
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Affiliation(s)
- Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany.
| | - Annelies Boonen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Jutta G Richter
- Policlinic for Rheumatology and Hiller Research Centre for Rheumatology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany
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Fischin J, Chehab G, Richter JG, Fischer-Betz R, Winkler-Rohlfing B, Willers R, Schneider M. Factors associated with pain coping and catastrophising in patients with systemic lupus erythematosus: a cross-sectional study of the LuLa-cohort. Lupus Sci Med 2015; 2:e000113. [PMID: 26629351 PMCID: PMC4654099 DOI: 10.1136/lupus-2015-000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/12/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to identify factors associated with pain coping and catastrophising in patients with systemic lupus erythematosus. Methods All patients were participants of the lupus erythematosus long-term study, which is based on patient-reported data assessed among members of the German Lupus Erythematosus Self-Help Organization. Assessments were performed by means of a questionnaire. Among self-reported clinical data the Pain-Related Self Statements Scale (PRSS) was included. To depict significant differences univariable analyses were carried out using non-parametrical rank tests. To examine factors influencing our outcome variables, we performed a multivariable stepwise regression model including variables that presented significantly in the univariable analysis. Results 447 cases (94.9% female) were analysed showing a mean catastrophising score of 1.1 (SD 0.8) and a mean coping score of 2.8 (SD 0.9) in the PRSS subscales. Higher catastrophising quartiles went along with higher experienced pain, lupus activity, fatigue, damage and decreased health related quality of life, whereas they presented inversely for coping. In our multivariable model, factors associated with catastrophising were: number of lupus-specific drugs (p value 0.004), pain in the last 7 days (p value 0.034), the Short Form 12 Health Survey Mental Component Summary (p value <0.001) and disease activity measured by the Systemic Lupus Activity Questionnaire (p value 0.042). Social participation reflected by performed leisure activities such as dancing or bowling had a positive association with coping (p value 0.006). In contrast, other health related physical activities and their extent had no impact on coping. A direct association between the amount of pain coping and catastrophising, as well as a great impact of the catastrophising, respectively, coping level on physical and mental functioning could be shown. Conclusions Reduction or increase of detected factors might lead to a modification of pain coping and catastrophising and offer an approach to more effective care in patients with SLE.
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Affiliation(s)
- Julia Fischin
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
| | - Gamal Chehab
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
| | - Jutta G Richter
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
| | - Rebecca Fischer-Betz
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
| | | | - Reinhart Willers
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
| | - Matthias Schneider
- Policlinic of Rheumatology and Hiller Research Unit Rheumatology , Heinrich-Heine-University , Düsseldorf , Germany
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Abstract
Thromboangiitis obliterans (TAO, Buerger's disease) is an inflammatory vascular disease affecting small and medium sized arteries and veins. It is characterized by segmental thrombotic occlusions by highly mononuclear cellular thrombi. Its occurrence and re-occurrence is closely related to tobacco use. Immunohistological examinations and the detections of various autoantibodies led to the new paradigm of an immunopathogenesis of TAO. Clinically it is characterized by distal ischemia syndromes in young people and high amputation rates. This article summarizes the disease characteristics, clinical features, and diagnostic and therapeutic approaches and focuses on new therapeutic options, i.e. stem cell derived therapies, immunoadsorption, and the endothelin-receptor-blocking agent bosentan.
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Affiliation(s)
| | - Jutta G Richter
- Poliklinik und Funktionsbereich Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität, Düsseldorf, Deutschland
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