Kernspintomographische Untersuchungen des Achsenskeletts bei Patienten mit ankylosierender Spondylitis vor und nach Therapie mit monoklonalen Antikörpern gegen den Tumor-Nekrose-Faktor- α\alpha

$\bf {Problem:}$ Ziel dieser Arbeit war, ein Score-System zur Erfassung von Wirbelsäulenläsionen bei Patienten mit AS anhand von MRT-Untersuchungen zu entwickeln und zu evaluieren. $\bf {Methoden:}$ Zwanzig AS-Patienten wurden MRTs (T1-Sequenz vor und nach Gadoliniumgabe sowie STIR Sequen) vor und drei Monate nach Infliximab-Therapie untersucht und mittels des neuen ASspiMRI-Scores evaluiert. $\bf {Ergebnisse:}$ Der ASspiMRI Score war zuverlässig, mit signifikanten Korrelationen zwischen MRT-Scores und klinischen Parametern. Die Therapie mit Infliximab zeigte eine 60% Besserung der entzündlichen MRT-Läsionen, verglichen mit 21% Verschlechterung unter Placebo-Behandlung (p=0,02). $\bf {Diskussion:}$ Der ASspiMRI-Score ist zuverlässig für die Evaluierung von akuten Wirbelsäulenläsionen bei Patienten mit AS. Gleichzeitig zeigt er gute Korrelationen zu den klinischen Parametern der Krankheitsaktivität und stellt somit ein geeignetes Instrument zur Erfassung von AS-bezogenen Wirbelsäulenläsionen mittels MRT dar

High prevalence of chondrocalcinosis and frequent comorbidity with calcium pyrophosphate deposition disease in patients with seronegative rheumatoid arthritis

$\bf Background$ The crystal-induced calcium pyrophosphate deposition disease (CPPD) clinically appearing as pseudogout differs from the mere radiographic finding of chondrocalcinosis (CC) but may cause symptoms resembling rheumatoid arthritis (RA). $\bf Objective$ To study the prevalence of CPPD and CC in rheumatic diseases focusing on differences between seropositive and seronegative RA. $\textbf {Patients and methods}$ In a retrospective study design, we analysed records and radiographs of consecutive new patients presenting to our centre between January 2017 and May 2020. 503 patients were identified based on expert diagnoses: 181 with CPPD, 262 with RA, 142 seropositive (54.2%) and 120 seronegative RA, gout (n=30) and polymyalgia rheumatica (n=30), mean symptom duration <1 year in almost all patients. $\bf Results$ The majority of patients had only one rheumatological diagnosis (86.9%). Most patients with CPPD (92.6%) had radiographic CC, primarily in the wrists. The prevalence of CC was higher in seronegative (32.3%) than in seropositive RA (16.6%), respectively (p<0.001). Patients with CPPD were older (p<0.001) and had acute attacks more frequently than patients with RA (p<0.001), who had symmetric arthritis more often (p=0.007). The distribution pattern of osteoarthritic changes in radiographs of hands and wrists differs between patients with RA and CPPD. CC was present in more than one joint in 73.3% of patients with CPPD, 9.6% with seropositive and 18.7% with seronegative RA. $\bf Discussion$ CPPD and CC were more frequent in seronegative versus seropositive RA. Symmetry of arthritis and acuteness of attacks differentiated best between CPPD and RA but localisation of joint involvement did not. Co-occurrence of both diseases was frequently observed

Peripheral spondyloarthritis and psoriatic arthritis sine psoriase\textit {sine psoriase}

Diagnosing peripheral spondyloarthritis (pSpA) remains a significant challenge due to the lack of specific disease biomarkers and the overlap with other SpA subtypes, mainly psoriatic arthritis (PsA), which represents a diagnostic challenge particularly in the absence of skin psoriasis (PsA $\textit {sine psoriase}$). This narrative review aimed to compare the epidemiology, genetic susceptibility, pathophysiology, classification criteria, disease phenotype and burden, and therapeutic guidelines between patients diagnosed with pSpA and those with PsA $\textit {sine psoriase}$, to determine if the two entities should be considered jointly or distinctly. Globally, pSpA appears to be more inclusive compared with PsA $\textit {sine psoriase}$. Areas of similarities include age of onset, number of joints involved and prevalence of axial involvement. However, patients with pSpA have a male gender predominance, a higher prevalence of HLA-B27, enthesitis and involvement of large joints of the lower limbs, whereas patients with PsA $\textit {sine psoriase}$ have a higher prevalence HLA-Cw6, dactylitis and involvement of hand distal interphalangeal joints. Therefore, the difference between pSpA and PsA $\textit {sine psoriase}$ goes beyond semantics. The few dissimilarities should drive scientific efforts to reach a better characterisation of pSpA as an individual disease. Accordingly, randomised clinical trials should target patients with well-defined pSpA to identify effective therapies in this population

Serum granulocyte-macrophage colony-stimulating factor (GM-CSF) is increased in patients with active radiographic axial spondyloarthritis and persists despite anti-TNF treatment

$\bf Background:$ Accumulating evidence supports the role of monocytes and neutrophils in radiographic axSpA (r-axSpA). Granulocyte-macrophage colony-stimulating factor (GM-CSF) is a growth factor for both leukocyte lineages and a pro-inflammatory cytokine activating myeloid cells and promoting osteoclastogenesis. It acts through the JAK-STAT pathway. We measured serum GM-CSF and markers of bone metabolism in patients with r-axSpA before and after anti-TNF treatment. $\bf Methods:$ Patients with active r-axSpA despite treatment with NSAIDs, all eligible for treatment with a biologic agent, were recruited. Healthy donors were sampled as controls. Serum was collected before (baseline) and after 4–6 months (follow-up) of anti-TNF treatment and the following molecules were measured with ELISA: GM-CSF, sclerostin (SOST), and dickkopf-1 (Dkk-1). $\bf Results:$ Twelve r-axSpA patients (7 males, 5 females, median age 37 years) with a median disease duration of 1 year and 16 age- and sex-matched controls were included. At baseline, patients had mean BASDAI 6.3$\pm$2 and ASDAS 3.2$\pm$0.7, which decreased to 4.1$\pm$1.7 and 2.2$\pm$0.6 at follow-up, respectively. At baseline, r-axSpA patients had significantly higher mean serum levels of GM-CSF (150 vs 62pg/ml, $\it p$=0.049), significantly lower Dkk-1 (1228 vs 3052pg/ml, $\it p$=0.001), but similar levels of SOST (369 vs 544pg/ml, $\it p$=0.144) compared to controls. Anti-TNF treatment did not affect GM-CSF, Dkk-1, or SOST levels. Spearman correlation analysis showed that GM-CSF correlated positively with ASDAS at baseline ($\it r$=0.61, $\it p$=0.039), while no correlations were identified between bone markers (Dkk-1, SOST) on one hand and GM-CSF or disease activity indices on the other. $\bf Conclusions:$ GM-CSF is increased in patients with active AS and strongly correlates with disease activity. TNF inhibition does not affect GM-SCF levels, despite improving disease activity. GM-CSF may represent an important pathway responsible for residual inflammation during TNF blockade, but also a potential target of JAK inhibitors, explaining their efficacy in r-axSpA

Addressing the spread of health-related misinformation on social networks

This article deals with the spread of misinformation in a general context and specifically in the health sector. It presents a theoretical view of the problem and analyzes its characteristics with a focus on medicine and mainly rheumatology. Finally, conclusions from the previous analysis are formulated as well as suggestions for reducing the dimensions of the problem in the health sector

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

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

Answering epidemiologic rheumatologic questions by cooperation with the large population-based SHIP cohort

In diesem Artikel wird dargestellt, wie sich Fragestellungen hinsichtlich der rheumatischen Erkrankung axiale Spondyloarthritis (axSpA) in Zusammenhang mit der Verfügbarkeit neuer bildgebender Verfahren und neuer Medikamente über mehr als zwei Jahrzehnte in einer rheumatologischen Forschungsgruppe entwickelt haben. Insbesondere in den letzten Jahren ergaben sich durch die Kooperation mit der SHIP ("Study of Health in Pomerania")-Kohorte neue grundlegende Aspekte. Dabei bestand eine intensive Kooperation zwischen der Ruhr-Universität Bochum (Rheumazentrum Ruhrgebiet) und der Universitätsmedizin Greifswald (Forschungsverbund "Community Medicine"). Das Design der SHIP-Kohorte ist schon vor 10 Jahren veröffentlicht worden und der Kohortenansatz wurde im Bundesgesundheitsblatt dargestellt, wobei zentrale methodische Fragen ausführlich erörtert wurden. Im Jahr 2014 wurde ein Kooperationsprojekt des Rheumazentrums Ruhrgebiet/Ruhr-Universität Bochum mit der Abteilung Klinisch-Epidemiologische Forschung (KEF) von SHIP vereinbart, aus dem bereits interessante Ergebnisse hochrangig publiziert wurden. Um das Potenzial solcher Kooperationen zu betonen, werden wesentliche Inhalte mit Fokus auf die Magnetresonanztomographie (MRT) im Folgenden, auch unter historischen Aspekten, dargestellt.This article presents how, based on the availability of new imaging methods and medications, objectives regarding the rheumatic disease axial spondyloarthritis (axSpA) have developed over the course of more than two decades into a rheumatologic research group. During recent years, cooperation with the Study of Health in Pomerania (SHIP) cohort has given rise to new fundamental aspects. This involved intensive cooperation between the Ruhr University Bochum ($\textit {Rheumazentrum Ruhrgebiet}$) and the Greifswald University Hospital (Community Medicine research collective). The design of the SHIP cohort was published 10 years ago and the cohort approach presented in the Bundesgesundheitsblatt, which also described central methodologic questions in detail. In 2014, a cooperation project between the Ruhr Rheumatology Center/Ruhr University Bochum and the SHIP Department of Clinical and Epidemiologic Research (Klinisch-Epidemiologische Forschung, KEF; SHIP-KEF) was established, which has already resulted in publication of interesting results in high-ranking journals. In order to stress the potential of such corporations, important contents thereof are presented herein, with a focus on MRI and consideration of historical aspects

Evaluation des Trabecular Bone Score (TBS) in der täglichen Praxis bei Patienten mit entzündlich rheumatischen und nichtentzündlichen Erkrankungen

$\bf Hintergrund$ Osteoporosebedingte Frakturen sind bei Patienten mit rheumatoider Arthritis (RA) häufig. Die Messung der Knochenmineraldichte (KDM) mit der Dual-Energie-Röntgenabsorptionsmessung (DXA) allein sagt das Frakturrisiko nur begrenzt voraus. Der Trabecular Bone Score (TBS) ist ein Surrogatmarker für die trabekuläre Mikroarchitektur des Knochens, der das Frakturrisiko unabhängig von der KDM vorhersagen kann. $\bf Ziel$ Ermittlung der Prävalenz von KDM, TBS und osteoporotisch bedingten Wirbelkörperbrüchen ("vertebral fractures" [VF]) bei Patienten mit RA im Vergleich zu Kontrollen mit nichtentzündlichen Muskel-Skelett-Erkrankungen (MSK). $\bf Methoden$ Die Daten von Patienten mit von Rheumatologen diagnostizierter RA und verfügbaren TBS- und DXA-Messungen, die in unserem Krankenhaus von 2006 bis 2014 erhoben wurden, wurden retrospektiv analysiert. Den RA-Patienten wurden Kontrollen mit nichtentzündlichen MSK zugeordnet. Eine "reduzierte Knochengesundheit" wurde definiert als ein T‑Score <−1,0 und/oder ein TBS-Wert <−1,31. Statistische Vergleiche wurden mit dem Mann-Whitney- und dem Wilcoxon-Test durchgeführt. \ud $\bf Ergebnisse$ Es wurden 143 Patienten mit RA (Alter 72,1 $\pm$ 11,1 Jahre, 72 % weiblich) und 106 Kontrollen (Alter 69,6 $\pm$ 12,6 Jahre, 75 % weiblich) eingeschlossen. RA-Patienten hatten häufiger eine erniedrigte KDM ($\it n$ = 102; 71,3 %) und einen erniedrigen TBS-Wert ($\it n$ = 125; 87,4 %) als die Kontrollen ($\it n$ = 63; 59,4 % und $\it n$ = 79; 74,5 %, $\it p$ = 0,049 und $\it p$ = 0,009). RA-Patienten hatten mehr VF ($\it n$ = 52, 36,4 %) als Kontrollen ($\it n$ = 24, 22,6 %, $\it p$ = 0,02). Insgesamt hatten 20 Patienten mit VF (26,3 %) eine normale Wirbelsäulen-KDM und 9 (11,8 %) auch eine normale Hüft-KDM. Bei Patienten mit VF war die Kombination eines niedrigen TBS bei normaler WS-KDM häufiger als ein normaler TBS bei niedriger WS-KDM ($\it p$ = 0,008 für RA, $\it p$ = 0,025 für Kontrollen). $\bf Diskussion$ VF treten bei Patienten mit normaler KDM auf. Bei Patienten mit VF wurde eine niedrige TBS bei normaler Wirbelsäulen-KDM häufiger gefunden als eine normale TBS bei niedriger Wirbelsäulen-KDM. Die Messung des TBS scheint für die Erkennung eines erhöhten Frakturrisikos bei RA-Patienten mit normaler WS-KDM nützlich zu sein.$\bf Background$ Osteoporosis-related fractures are common in patients with rheumatoid arthritis (RA). Bone mineral density (BMD) measurements using dual-energy x‑ray absorptiometry (DXA) alone has only a limited value for predicting the risk of fractures. The trabecular bone score (TBS) is a surrogate parameter for trabecular microarchitecture of bone and a predictor of fracture risk independent of BMD. $\bf Aim$ To examine the prevalence of BMD, TBS and osteoporosis-related vertebral fractures (VF) in patients with RA in comparison to controls with non-inflammatory musculoskeletal diseases. $\bf Methods$ Data from patients with RA diagnosed by a rheumatologist and with TBS and DXA measurements, who were assessed in this hospital between 2006 and 2014 were retrospectively analyzed. The RA patients were matched with controls with non-inflammatory musculoskeletal diseases. "Reduced bone health" was defined as a T‑score <−1.0 and/or a TBS value <−1.31. Statistical analyses were carried out using the Mann-Whitney test and the Wilcoxon test. $\bf Results$ Data from 143 patients with RA (age 72.1 $\pm$ 11.1 years, 72% female) and 106 controls (age 69.6 $\pm$ 12.6 years, 75% female) were included. The RA patients more frequently had low BMD ($\it n$ = 102, 71.3%) and low TBS values ($\it n$ = 125, 87.4%) compared to controls ($\it n$ = 63, 59.4% and $\it n$ = 79, 74.5%, $\it p$ = 0.049 and $\it p$ = 0.009, respectively). The RA patients had more VF ($\it n$ = 52, 36.4%) than controls ($\it n$ = 24, 22.6%, $\it p$ = 0.02). A total of 20 patients with VF (26.3%) had normal lumbar spine BMD and 9 (11.8%) also had a normal hip BMD. In patients with VF the combination of low TBS with normal spine BMD was more common than a normal TBS and low spine BMD ($\it p$ = 0.008 for patients with RA, $\it p$ = 0.025 for controls). $\bf Discussion$ It is known that VF can occur in patients with normal BMD. In patients with VF, a low TBS with normal spine BMD is found more frequently than normal TBS and low spine BMD. These results suggest that measurement of the TBS has the potential to be a useful tool to detect increased fracture risk in patients with RA and normal spine BMD