Wie viele Patienten mit entzündlich rheumatischen Erkrankungen haben die technischen Voraussetzungen für Videosprechstunden und sind bereit, fachärztliche Visiten so durchzuführen?

$\bf Hintergrund$ Die aktuell grassierende SARS-CoV-2-Pandemie und begrenzte Kapazitäten in der ambulanten rheumatologischen Versorgung werfen, auch angesichts der digitalen Revolution, Fragen nach möglichen Alternativen zu klinischen Visiten auf. Ob und inwieweit Patienten mit entzündlich rheumatischen Erkrankungen bereit und in der Lage sind, mit den neuen Medien wie etwa Videosprechstunden (VSS) umzugehen, ist unklar. $\bf Methoden$ Mitten in der Pandemie wurden im Mai 2020 ambulante Patienten mit einem standardisierten Fragebogen systematisch befragt, um ihre Möglichkeiten und die Bereitschaft für die Teilnahme an VSS zu ermitteln. Der behandelnde Arzt gab an, ob er die Durchführung einer VSS für möglich und auch für sinnvoll hielt. $\bf Ergebnisse$ Insgesamt wurden 232 Patienten mit entzündlich rheumatischen Erkrankungen befragt (64,7 % weiblich, mittleres Alter 54,0 $\pm$ 15,2 Jahre), seropositive ($\it n$ = 58) und seronegative ($\it n$ = 51) rheumatoide Arthritis (RA), Spondyloarthritis (SpA) ($\it n$ = 77) inklusive der axialen SpA (axSpA) und der Psoriasisarthritis (PsA) sowie Kollagenosen und Vaskulitiden (KoV) ($\it n$ = 46). Die mittlere Krankheitsdauer betrug 5,5 $\pm$ 8,2 Jahre, bei 75 Patienten (32,3 %) handelte es sich um eine Erstdiagnose. Die mittlere Krankheitsaktivität (0–10, subjektive Patienteneinschätzung) lag bei 4,7 $\pm$ 2,5. Insgesamt wussten 176 Patienten grundsätzlich über die Möglichkeit der Durchführung von VSS Bescheid (75,9 %), und 166 sahen sich technisch in der Lage, daran teilzunehmen (71,6 %), aber nur 131 waren grundsätzlich auch bereit dazu (56,5 %). Die logistische Regressionsanalyse zeigte, dass die Bereitschaft zur Teilnahme an VSS mit zunehmendem Alter abnahm ($\beta$ = 0,28, $\it p$ = 0,01). Nach ärztlicher Einschätzung wurden VSS bei 161 Patienten aus technischen (69,4 %) und bei 127 aus medizinischen Gründen (54,7 %) prinzipiell für möglich gehalten. Die Durchführung von VSS im Rahmen der Versorgung wurde vom Arzt aber nur bei 76 Patienten (32,8 %) für sinnvoll gehalten. $\bf Zusammenfassung$ Nicht alle Patienten können oder wollen an VSS teilnehmen, mit zunehmendem Alter nimmt die Bereitschaft dazu ab. Auch die ärztliche Einschätzung der Sinnhaftigkeit von VSS beschränkte sich auf etwa ein Drittel der befragten Patienten. Dies ist für zukünftige Planungen von VSS zu berücksichtigen.$\bf Background$ The currently disseminating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and limited capacities in outpatient rheumatological care, pose questions about possible alternatives to clinical visits, also in view of the digital revolution. It is unclear whether and to what extent patients with inflammatory rheumatic diseases are willing and in a position to deal with the new media, such as video consultation. $\bf Methods$ In the middle of the pandemic in May 2020 outpatients were surveyed using a standardized questionnaire in order to document their possibilities and willingness to participate in a video consultation. The treating physicians were asked whether carrying out a video consultation was considered to be a possible and meaningful option. $\bf Results$ Overall, 232 patients with inflammatory rheumatic diseases were surveyed (64.7% female, average age 54.0 $\pm$ 15.2 years), seropositive ($\it n$ = 58) and seronegative ($\it n$ = 51) rheumatoid arthritis (RA), spondyloarthritis (SpA, $\it n$ = 77) including axial SpA (axSpA) and psoriatic arthropathy (PsA) as well as collagenosis and vasculitis (CoV, $\it n$ = 46). The mean duration of disease was 5.5 $\pm$8.2 years, whereby in 75 patients (32.3%) it was the first diagnosis. The mean disease activity (0–10, subjective patient self-estimation) was 4.7 $\pm$ 2.5. Overall, 176 patients were basically aware of the possibility to carry out video consultations (75.9%) and 166 considered that they were technically capable to participate (71.6%) but only 131 were principally willing to participate (56.5%). Logistic regression analyses showed that the willingness to participate in video consultations decreased with increasing age ($\beta$ = 0.28, $\it p$ = 0.01). According to the medical estimation video consultations were thought to be principally possible for 161 patients for technical reasons (69.4%) and for 127 for medical reasons (54.7%); however, a video consultation within the framework of treatment was only considered to be meaningful by the physician for 76 patients (32.8%). $\bf Conclusion$ Not all patients can or want to participate in video consultations and the willingness declines with increasing age. The estimation of the meaningfulness of video consultations by physicians was also limited to approximately one third of the patients surveyed. This must be taken into consideration for the future planning of video consultations

Drohende Corona-Endemie in einer rheumatologischen Spezialklinik

Die SARS-CoV-2-Pandemie hält die meisten Länder der Welt anhaltend in Atem. In Deutschland liegt die Prävalenz von SARS-CoV-2-Infektionen zwar noch unter 2 %, die Zahlen steigen aber seit Wochen auch in Deutschland wieder an. Die rheumatologische Versorgung wurde durch die 1. Welle der Pandemie vorübergehend beeinträchtigt. Wir berichten über die Infektionssituation in der größten deutschen Rheumaspezialklinik, dem Rheumazentrum Ruhrgebiet, weil es hier vor Kurzem während der 2. Welle erstmals zum Auftreten von mehreren SARS-CoV-2-Infektionen an einem Wochenende gekommen ist, was zu einer erheblichen Unruhe bei vielen Beteiligten führte. Die Situation konnte durch konsequentes Testen von Patienten und Mitarbeitern mit dem Antigenschnelltest aufgeklärt und die Lage beruhigt werden. Letztlich waren nur wenige Getestete positiv, und die Verläufe bei den Patienten blieben bis jetzt blande. Dies zeigt auch die Effektivität der seit April konsequent durchgeführten hygienischen Schutzmaßnahmen.The severe acute respiratory coronavirus type 2 (SARS-CoV-2) pandemic is keeping most countries of the world in suspense. In Germany the prevalence of SARS-CoV‑2 infections is under 2% but for weeks the numbers in Germany have also been increasing. The care in rheumatology was temporarily impaired by the first wave of the pandemic. This article reports the infection situation in the largest specialized rheumatology clinic in Germany, the Rheumatism Center Ruhrgebiet, because recently during the second wave for the first time several SARS-CoV‑2 infections occurred here over one weekend, which led to considerable anxiety in many of those involved. The situation could be clarified by consistent testing of patients and personnel with the rapid antigen test and the situation could be mollified. Ultimately, only a few persons were tested positive and the courses by the patients have so far remained bland. This shows the effectiveness of the protective hygiene measures consistently implemented since April

SARS-CoV-2 vaccination willingness and predictors in patients with chronic inflammatory rheumatic diseases (CIRD) and without CIRD

$\bf Background:$ Recent surveys in chronic inflammatory rheumatic diseases (CIRD) showed a high degree of vaccine hesitancy. Current knowledge about patients' attitudes toward vaccination against SARS-CoV-2 is limited. $\bf Objectives:$ To assess the willingness of CIRD patients to be vaccinated against SARS-CoV-2 and to identify the influencing factors compared with non-CIRD patients. $\bf Methods:$ In this cross-sectional study, two cohorts of consecutive patients with and without CIRD were recruited in parallel when presenting to our tertiary hospital and asked to answer questions of a structured interview to assess vaccination willingness to SARS-CoV-2 their experience with SARS-CoV-2 and their personal history of infections and vaccinations. Vaccination willingness was assessed using a numerical rating scale (0: fully disagree; 10: fully agree). Arbitrarily defined cut-offs were used to define definite (score $\geq$7) and probable willingness (score of 5 or 6) to be vaccinated. Factors associated with willingness were assessed using Kendall's tau-$\it b$ correlation measure and linear regression analysis. $\bf Results:$ A total of 514 CIRD and 100 non-CIRD patients, mean age of 54.7 $\pm$ 12.8 and 55.6 $\pm$ 9.8 years, respectively, were included. Definite and probable willingness to be vaccinated against SARS-CoV-2 was declared by 79.6% and 90.7% $\it versus$ 76.0% and 85.0% of CIRD and non-CIRD patients, respectively. Only 60% of CIRD patients believed that the vaccines against SARS-CoV-2 were safe, and 42% indicated to be afraid of side effects. Vaccination willingness was significantly correlated with being in a risk group for COVID-19 (tau-$\it b$ = −0.149), hypertension (tau-$\it b$ = 0.14), and information about disease prevention (tau-$\it b$ = 0.19), while a history of infections or immunosuppressive therapy was not. Vaccination willingness was significantly associated with higher education ($\it b$ = 0.65) and age ($\it b$ = 0.06). $\bf Conclusion:$ This survey highlights several predictors of relevance for the vaccination willingness of patients with CIRD and controls including appropriate information about its relevance. The good news, however, is that the vast majority of CIRD patients indicated their willingness to be vaccinated. However, there was some uncertainty regarding the safety and efficacy of the vaccines. Since the major influencing factors were education and information about SARS-CoV-2 Vaccine and COVID-19 Disease, patient education should be improved soon

Facilitators and barriers for vaccination in patients with inflammatory rheumatic musculoskeletal diseases

$\bf Introduction$ To identify facilitators and barriers towards vaccination in general and specifically against pneumococci, influenza and SARS-CoV-2 in patients with rheumatic musculoskeletal diseases (RMD). $\bf Methods$ Between February and April 2021, consecutive patients with RMD were asked to complete a structured questionnaire on general knowledge about vaccination, personal attitudes and perceived facilitators and barriers towards vaccination. General facilitators (n=12) and barriers (n=15) and more specific ones for vaccination against pneumococci, influenza and SARS-CoV-2 were assessed. Likert scales had four response options: from 1 (completely disagree) to 4 (completely agree). Patient and disease characteristics, their vaccination records and attitudes towards vaccination against SARS-CoV-2 were assessed. $\bf Results$ 441 patients responded to the questionnaire. Knowledge about vaccination was decent in $\geq$70% of patients, but <10% of patients doubted its effectiveness. Statements on facilitators were generally more favourable than on barriers. Facilitators for SARS-CoV-2 vaccination were not different from vaccination in general. Societal and organisational facilitators were more often named than interpersonal or intrapersonal facilitators. Most patients indicated that recommendations of their healthcare professional would encourage them to be vaccinated - without preference for general practitioner or rheumatologists. There were more barriers towards SARS-CoV-2 vaccination than to vaccination in general. Intrapersonal issues were most frequently reported as a barrier. Statistically significant differences in response patterns to nearly all barriers between patients classified as definitely willing, probably willing and unwilling to receive SARS-CoV-2 vaccines were noted. $\bf Discussion$ Facilitators towards vaccination were more important than barriers. Most barriers against vaccination were intrapersonal issues. Societal facilitators identified support strategies in that direction

Treatment with adalimumab in patients with chronic inflammatory rheumatic diseases

$\bf Background:$ Previous experiences with non-medical switching of adalimumab (ADA) in patients with chronic inflammatory rheumatic diseases (CIRD) come mainly from phase III extension of randomised clinical trials and little from routine care. $\bf Objectives:$ To analyse treatment trajectories over 2 years in patients with CIRD conducting a non-medical switch from originator to biosimilar ADA. $\bf Design:$ A retrospective observational cohort study was conducted with data from a third-level rheumatology centre in Germany. CIRD patients on originator ADA who switched to ADA biosimilar from October 2018 onwards were identified and followed until September 2020. $\bf Methods:$ Patients’ characteristics were compared between the four $\textit {a priori}$ defined treatment trajectories "continued biosimilar ADA therapy", "back-switch to originator ADA therapy", "switch to another biological disease-modifying anti-rheumatic drug (bDMARD) therapy" and "stopped bDMARD therapy/death/drop out". Factors associated with continuing biosimilar ADA therapy were analysed using Cox proportional hazards regression analyses. $\bf Results:$ A total of 121 CIRD patients were included. Most patients (66.9%) continued therapy with biosimilar ADA over 2 years, with a treatment retention rate of 73.1%. Whereas 21 patients (17.4%) switched back to originator ADA, mainly due to adverse events, and 8 patients (6.6%) switched to a different bDMARD, mainly due to lack of effect. The estimated risk of withdrawal was lower for longer prior duration on originator ADA [hazard ratio (HR): 0.82; 95% CI: 0.69–0.97] and higher for higher C-reactive protein levels at baseline (HR: 1.18; 95% CI: 1.00–1.39). Male patients, older patients and those for whom originator ADA was their first bDMARD tended to have a lower risk of withdrawal. $\bf Conclusion:$ Our results indicated that three of four patients continue biosimilar ADA over 2 years with lower risks of withdrawal for male sex, older age, longer prior duration on originator ADA and originator ADA as first bDMARD

Wie gut sind Patienten mit entzündlich rheumatischen Erkrankungen gegen Masern geschützt?

$\bf Hintergrund$ Patienten mit entzündlich rheumatischen Erkrankungen haben aufgrund ihrer Autoimmunerkrankung, aber auch bedingt durch die immunsuppressive Medikation ein erhöhtes Infektrisiko. Obwohl Impfungen in der Primärprophylaxe von Infektionen bekanntermaßen effektiv sind, ist die Impfrate in Deutschland generell zu niedrig. Wegen des zuletzt zunehmenden, teils epidemieartigen Auftretens von Masern ist die Lebendimpfung gegen Masern in Deutschland seit Kurzem gesetzlich vorgeschrieben. $\bf Fragestellung$ Wie viele Patienten mit entzündlich rheumatischen Erkrankungen sind aktuell ausreichend gegen Masern geschützt? $\bf Methode$ Patienten mit entzündlich rheumatischen Erkrankungen des Rheumazentrums Ruhrgebiet wurden zwischen Dezember 2017 und Oktober 2018 prospektiv und konsekutiv eingeschlossen. Dabei wurden Daten zu Erkrankung und Therapie auf Ebene von Substanzklassen sowie die Impf- und Infektanamnese erhoben. Alle Angaben zu Impfungen wurden im Impfpass kontrolliert. Antikörpertiter gegen Masern wurden mit ELISA bestimmt. Als Schwellenwert für einen ausreichenden Schutz gegen Masern wurden 150 mIU/ml festgelegt. $\bf Ergebnis$ Von 975 Patienten konnten 540 (55,4 %) einen Impfausweis vorlegen. Bei 201 Patienten mit Ausweis (37,2 %) lagen dokumentierte Impfungen seit Geburt vor. Insgesamt hatten 45 von 267 nach 1970 geborene Patienten (16,9 %) einen suffizienten Impfschutz gegen Masern. Die anamnestischen Angaben zu einer Masernerkrankung in der Kindheit differenzierten nicht zwischen Patienten mit und ohne protektiven Masern-IgG-Antikörpern. Protektive Masern-IgG-Antikörper wurden bei 901 Patienten von 928 Patienten mit Messung der Masern-IgG-Antikörperspiegel (97,1 %) nachgewiesen. Die unterschiedlichen Wirkprinzipien der aktuellen immunsuppressiven Therapie hatten darauf keinen Einfluss. $\bf Diskussion$ Diese Daten zeigen, dass mindestens 2,9 % der Patienten keinen ausreichenden Schutz gegen Masern haben. Interessanterweise hatte die Mehrheit der nach 1970 geborenen Patienten protektive Antikörper trotz fehlenden Impfschutzes gegen Masern. Die Anstrengungen sowohl im primär- als auch im fachärztlichen Bereich sollten dringend verstärkt werden, um eine adäquate Infektionsprophylaxe bei besonders gefährdeten Patienten gewährleisten zu können.$\bf Background$ Patients with inflammatory rheumatic diseases have an increased risk of infections due to the autoimmune disease but also due to the immunosuppressive medication. Although vaccinations are known to be effective in the primary prophylaxis of infections, the vaccination rate in Germany is generally too low. Due to the recently increasing, sometimes epidemic-like occurrence of measles, the administration of live vaccine against measles has recently become required by law. $\bf Objective$ How many patients with inflammatory rheumatic diseases are currently sufficiently protected against measles? $\bf Method$ Between December 2017 and October 2018 patients with inflammatory rheumatic diseases at the Ruhrgebiet Rheumatism Center were prospectively and consecutively included. Data on the disease and treatment at the level of substance classes, patient history of vaccination and infections were collated. All information on vaccinations were controlled in the vaccination certificate. Antibodies against measles were determined using ELISA. The threshold for sufficient protection against measles was set at 150 mIU/ml. $\bf Results$ Out of 975 patients 540 (55.4%) could present a vaccination certificate. In 201 patients with a certificate (37.2%) vaccination had been documented since birth. Overall, 45 out of 267 patients born after 1970 (16.9%) had sufficient protection against measles. The patient history of measles in childhood showed no differences between patients with and without protective measles IgG antibodies. Protective measles IgG antibodies were detected in 901 out of 928 patients with measurement of the measles IgG antibody level (97.1%). The different principles of action of the current immunosuppressive treatments had no influence on this. $\bf Conclusion$ These data show that at least 2.9% of the patients did not have sufficient protection against measles. Interestingly, the majority of patients born after 1970 had protective antibodies despite the lack of vaccination against measles. The efforts in primary and also in the specialist medical care should be urgently strengthened in order to be able to guarantee an adequate infection prophylaxis in particularly endangered patients

Standardisierte Erfassung der gesundheitsbezogenen Lebensqualität bei Patienten mit Psoriasisarthritis

$\bf Einleitung$ Die standardisierte Beurteilung der gesundheitsbezogenen Lebensqualität gewinnt in der Rheumatologie zunehmend an Bedeutung. Der englische Fragebogen "Psoriasis Arthritis Quality of Life Questionnaire (PsAQoL)" ist ein krankheitsspezifisches Instrument zur Messung der Lebensqualität von Patienten mit Psoriasisarthritis (PsA). Ziel der vorliegenden Arbeit ist die Übersetzung des PsAQoL ins Deutsche und die Validierung der deutschen Version in einer aus der Routineversorgung rekrutierten Kohorte von PsA-Patienten. $\bf Methode$ Die Übersetzung und Validierung des Fragebogens PsAQoL wurde in einem mehrstufigen Verfahren unter Beteiligung von betroffenen Patienten mit PsA durchgeführt. Nach Übersetzung des englischsprachigen Fragebogens wurde die deutsche Version in einem Feldtest überprüft. Die psychometrischen Merkmale des Fragebogens wurden anschließend in einer PsA-Kohorte aus der Routineversorgung untersucht. Neben der Konstrukt- und Gruppenvalidität wurden die Zuverlässigkeit des Fragebogens mittels Test/Retest-Reliabilität sowie die interne Konsistenz getestet. Die körperliche Funktionsfähigkeit wurde mit dem Health Assessment Questionnaire (HAQ) und Domänen der Lebensqualität mit dem Nottingham Health Profile (NHP) gemessen. $\bf Ergebnis$ In einem Feldtest mit 10 Patienten erwies sich die deutsche Version des PsAQoL-Fragebogens als relevant, gut verständlich und durchführbar (Bearbeitungszeit: 4,7 $\pm$ 2,1 min). Insgesamt 126 Patienten (37,3 % männlich, Alter 55,6 $\pm$ 11,3 Jahre) wurden in die Validierungskohorte eingeschlossen. Der PsAQoL korrelierte moderat mit dem HAQ (r = 0,65) sowie moderat bis gut mit dem NHP (Subdomänen r = 0,58–0,75). Die interne Konsistenz war hoch (Cronbach's α 0,92), und die Zuverlässigkeit bei Patienten mit stabilem Krankheitsverlauf war sehr gut (Spearman-Korrelationskoeffizient 0,94). Der PsAQoL kann zwischen unterschiedlichen Patientengruppen differenzieren. $\bf Zusammenfassung$ Mit der deutschen Übersetzung des PsAQoLs steht ein valides und krankheitsspezifisches Messinstrument zur standardisierten Erfassung der gesundheitsbezogenen Lebensqualität bei Patienten mit PsA zur Verfügung. Die psychometrischen Eigenschaften der englischsprachigen Originalversion sind vergleichbar. Der deutsche PsAQoL kann damit für die klinische und wissenschaftliche Verwendung empfohlen werden.$\bf Background$ The standardized assessment of health-related quality of life is becoming increasingly more important. The English questionnaire on psoriatic arthritis quality of life (PsAQoL) is a disease-specific instrument for measuring the quality of life of patients with psoriatic arthritis (PsA). The aim of the present study was to translate the PsAQoL into German and to validate the German version in a cohort of PsA patients recruited from routine care. $\bf Method$ The translation and validation of the PsAQoL questionnaire was carried out in a stepwise procedure involving affected patients with PsA. After translation of the original English questionnaire the German version was evaluated in a field test. The psychometric features of the questionnaire were then examined in a PsA cohort from routine care. In addition to the construct and group validity, the reliability of the questionnaire was tested using test-retest reliability and internal consistency. The physical functioning was measured with the health assessment questionnaire (HAQ) and domains of the quality of life with the Nottingham health profile (NHP). $\bf Results$ In a field test with 10 patients the German version of the PsAQoL questionnaire proved to be relevant, easily understandable and feasible (processing time 4.7 $\pm$ 2.1 min). A total of 126 patients (37.3% male, age 55.6 $\pm$ 11.3 years) were included in the validation cohort. The PsAQoL showed moderate correlation with the HAQ (r = 0.65) and moderate to good correlation with the NHP (subdomains r = 0.58–0.75). The internal consistency was high (Cronbach's α 0.92) and reliability in patients with stable disease course was very good (Spearman correlation coefficient 0.94). The PsAQoL can differentiate between different patient groups. $\bf Conclusion$ The German translation of the PsAQoL provides a valid disease-specific instrument for the standardized assessment of health-related quality of life in patients with PsA. The psychometric characteristics of this questionnaire are comparable with the original English version. The German PsAQoL can therefore be recommended for clinical and scientific application

Different humoral but similar cellular responses of patients with autoimmune inflammatory rheumatic diseases under disease-modifying antirheumatic drugs after COVID-19 vaccination

$\bf Objectives$ The effect of different modes of immunosuppressive therapy in autoimmune inflammatory rheumatic diseases (AIRDs) remains unclear. We investigated the impact of immunosuppressive therapies on humoral and cellular responses after two-dose vaccination. $\bf Methods$ Patients with rheumatoid arthritis, axial spondyloarthritis or psoriatic arthritis treated with TNFi, IL-17i (biological disease-modifying antirheumatic drugs, b-DMARDs), Janus-kinase inhibitors (JAKi) (targeted synthetic, ts-DMARD) or methotrexate (MTX) (conventional synthetic DMARD, csDMARD) alone or in combination were included. Almost all patients received mRNA-based vaccine, four patients had a heterologous scheme. Neutralising capacity and levels of IgG against SARS-CoV-2 spike-protein were evaluated together with quantification of activation markers on T-cells and their production of key cytokines 4 weeks after first and second vaccination. $\bf Results$ 92 patients were included, median age 50 years, 50% female, 33.7% receiving TNFi, 26.1% IL-17i, 26.1% JAKi (all alone or in combination with MTX), 14.1% received MTX only. Although after first vaccination only 37.8% patients presented neutralising antibodies, the majority (94.5%) developed these after the second vaccination. Patients on IL17i developed the highest titres compared with the other modes of action. Co-administration of MTX led to lower, even if not significant, titres compared with b/tsDMARD monotherapy. Neutralising antibodies correlated well with IgG titres against SARS-CoV-2 spike-protein. T-cell immunity revealed similar frequencies of activated T-cells and cytokine profiles across therapies. $\bf Conclusions$ Even after insufficient seroconversion for neutralising antibodies and IgG against SARS-CoV-2 spike-protein in patients with AIRDs on different medications, a second vaccination covered almost all patients regardless of DMARDs therapy, with better outcomes in those on IL-17i. However, no difference of bDMARD/tsDMARD or csDMARD therapy was found on the cellular immune response

Facilitators and barriers of vaccine uptake in patients with autoimune inflammatory rheumatic disease

$\bf Objectives$ Patients with autoimmune inflammatory rheumatic diseases (AIRD) often have lower vaccination coverage rates compared with the general population, despite being disproportionately affected by infectious complications. We aim to systematically review the literature regarding vaccination willingness and hesitancy in AIRD. $\bf Methods$ A scoping review was conducted in PubMed, EMBASE and the Cochrane Library in June 2021. Study selection was performed by two independent reviewers and data were extracted using a standardised form. Risk of bias was assessed using instruments from McMaster University. Identified barriers were categorised into the WHO’s measuring behavioural and social drivers (BeSD) of vaccination conceptual model. $\bf Results$ The search yielded 1644 hits of which 30 publications were included (cross-sectional studies based on interviews (n=27) and intervention studies (n=3)). The majority of studies reported barriers to influenza and pneumococcal vaccination only (n=9) or in combination with another vaccination (n=8) from the patients’ perspective. Only one study assessed the view of rheumatologists. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians. Patients mainly mentioned behavioural and social factors that negatively influenced their willingness to be vaccinated while physicians mentioned organisational deficits as major barriers. $\bf Conclusions$ The view on vaccination in patients with AIRD diverges between patients and rheumatologists. Our results show that in-depth counselling on vaccines is important for patients, whereas physicians need support in implementing specific immunisation recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in patients with AIRD