Schadet die „Muckibude“ Patienten mit entzündlich-rheumatischen Erkrankungen?

The present article discusses the topic of “inflammatory rheumatic disease and commercial sports activities in fitness studios” with particular emphasis on joint protection.     

Krankheitsbezogene Internetnutzung bei Patienten mit entzündlich-rheumatischen Systemerkrankungen

OBJECTIVE: On behalf of the "systemic inflammatory rheumatic diseases network" comprehensive, nationwide horizontal and vertical cross-linking of research and care is to be developed for the first time. The quality of scientific work and patient care is to be increased in the medium term through this improved communication and co-operation. Our objective was to determine what hardware and software are available to the patients involved, with a view to the Internet being used as a basis for communication. The ultimate aim was to provide patients with an adequate source of information on care. METHODS: A survey was carried out among 400 patients attending our outpatient clinics. Data on the hardware and software used and on Internet access and patterns and degree of utilization were collected using a unilateral questionnaire. RESULTS: 326 patients filled in the questionnaire. 163 of those responding had Internet access, with younger and better educated patients using the Internet significantly more frequently. No dependency was noted on gender or marital status. Mean time duration for Internet use was longer in men. 55.8% of the internet users searched for medical questions. Major search topics included up to date therapeutic options (46.6%) and information on specific diseases (28.8%). CONCLUSION: Internet is an important information medium for patients. Technical requirements and high motivation make communication practicable for about 50% of patients. To ensure acceptance, the Internet platform of the systemic inflammatory rheumatic diseases network needs to be aligned to patients' requirements, bearing in mind the need for extensive high-value, reliable scientific information to be offered on the website.     

Soziale Teilhabe und Alltagsaktivitäten von Patienten mit entzündlich-rheumatischen Erkrankungen

Rheumatic patients are at risk of social isolation and physical inactivity which can have a significant impact on physical and mental health. Only every seventh patient is organized in a self-help group (SHG), most of them in the German League Against Rheumatism (GLAR). Members of a SHG are socially and physically more active and take part in exercise therapy (ET) more often. Depending on the study, the utilization of ET ranges from 25 % to 71?%. The functional training as the most attended offer of the GLAR showed positive effects at the physical and psychological levels. To motivate difficult to reach patients to engage in self-help and regular exercise, further development of exercise programs with individually tailored intensive strength and endurance elements as well as the increased use of new media seems promising. The Internet provides various opportunities for networking and social participation especially for severely impaired and temporally less flexible patients.     

Kernsatz von Verhaltensempfehlungen für Patienten mit ankylosierender Spondylitis

Objectives

Patients with ankylosing spondylitis (AS) can contribute to a favorable disease course by their own behaviour and environmental adaptations. However, no standardized consensus recommendations on patient behavior and adaptations exist, neither internationally nor nationally. The aim of this study was to establish a core set of recommendations concerning favorable patient behavior to be given to patients with AS by rheumatologists.

Methods

An extended literature research in the scientific and patient-oriented literature revealed 70 recommendations. These recommendations were evaluated and ranked by importance at a meeting of the Ankylosing Spondylitis International Federation (ASIF, 26 participants from 13 countries) in November 2011. The remaining 59 recommendations were extensively discussed, supplemented, partially reworded, condensed and those with the highest priority were selected by consensus at a seminar of local branch leaders of the AS patient organization in Germany (Deutsche Vereinigung Morbus Bechterew) in March 2012 (80 participants, 95?% patients with AS).

Results

The core set encompasses 1) a general statement on living with AS and 2) recommendations in the areas of sitting position, walking, sleeping, at work, exercising, sports and recreational activities, diet and life style, sexuality and pregnancy, fall prevention, car driving and membership in an AS-specific patient organization. The selected recommendations received agreement by 80–100?% of the patients. Some recommendations (e.g. fall prevention and car driving) are more relevant to patients with advanced and usually longstanding disease, i.e. with advanced ankylosis or osteoporosis.

Conclusions

For the first time a core set of recommendations for the behavior of patients with AS was created in collaboration with many persons affected by the disease. Patients with AS should receive these recommendations from their rheumatologists, ideally early in the disease course. The German version of this core set is presented in this article.     

Arrhythmien bei Patienten mit angeborenen Herzfehlern und Bedeutung für die Prognose

Patients with congenital heart disease have an increased chance to suffer from brady- as well as tachyarrhythmias. The impact of these on quality of life, morbidity and mortality is more often imperative as compared to heart-healthy individuals. The substrate for these may be either congenital or acquired. Improvements of the surgical management of these patients have led, on the one hand, to improved survival rates with prolonged life expectancy within the last 2 decades, which on the other hand provided the basis for a higher rate of acquired cardiac arrhythmias. Together, this not only challenges diagnostics and therapy but also the prognostic relevance of these arrhythmias. The therapeutic strategies and prognostic markers have until now mostly been based on retrospective studies limited by the low number of patients and inhomogeneous patient selection. Despite these limitations, an increased risk of sudden cardiac death has been substantiated for certain patient groups, e.g., those operated on by the Mustard- or Senning procedures in patients with transposition of the great arteries and patients operated on with correction of the tetralogy of Fallot. However, until now it has not been possible to identify reliable markers for establishing the risk on an individual basis within these patient cohorts. For achieving reliable data on the symptomatic and prognostic effects of present-day--as well as new-coming--therapeutic strategies, it is mandatory to perform prospectively based, randomized multicenter studies. Furthermore, the well-appreciated synergism of hemodynamically and primarily of arrhythmia-based effects on prognosis could potentially be divided into their relative weight to better guide appropriate, substrate-related therapy. In addition, this should help to get better estimates of the risk for sudden cardiac death in different, etiologically homogeneous, groups of patients with congenital heart disease.     

EULAR-Empfehlungen für die Behandlung des Morbus Beh?et

Objectives

The aim of the EULAR/ESCISIT initiative was to develop evidence-based recommendations for the management of Behçet’s disease (BD), supplemented where necessary by expert opinions and taking already published data into consideration. The current article briefly summarises the results in German and comments on them.

Methods

The multidisciplinary expert committee consisted of nine rheumatologists, three ophthalmologists, one internist, one dermatologist, and one neurologist, representing six European countries, Tunisia and Korea. One patient representative was also present. Problem areas and related keywords for a systematic literature search were identified. A systematic literature research was performed using MedLine and the Cochrane library up to December 2006. Consequently, 40 initial statements were generated based on the literature research. These yielded the final recommendations which resulted from two blind Delphi rounds of voting.

Results

Nine recommendations were developed for the management of different aspects of BD. The strength of each recommendation was determined by the level of evidence and the expert‘s opinions. The level of agreement for each recommendation was determined using a visual analogue scale for both the whole committee and for each individual viewpoint of the subgroup, who considered themselves experts in that field of BD. There was excellent concordance between the level of agreement of the whole group and the “experts in the field”.

Conclusion

Recommendations relating to eye, skin, and mucosal disease, as well as arthritis are mainly evidence-based, while recommendations on vascular disease and neurological and gastrointestinal involvement are based largely on expert opinions and uncontrolled evidence from open trials and observational studies. The need for further properly designed controlled clinical trials is apparent.     

Neue Versorgungsstrukturen für Patienten mit chronischer Herzinsuffizienz

Frequency of chronic heart failure still increases. More and more resources have been required for the diagnosis and therapy of this disease. This burden for health-care systems will grow in the near future. In particular, clinical treatment has a major impact. New approaches are essential to ensure an efficient supply of patients with chronic heart failure in the next years.Models to improve the supply give the opportunity to optimize the medical workflow and involve the patient into the concept of care. Therefore, a variety of models have been developed and up to now tested concerning benefit and applicability in western industrial countries. The present article focuses on the fundamental models to improve the supply of patients with chronic heart failure.     

Selbst-Monitoring bei entzündlich-rheumatischen Erkrankungen

Background

Active involvement of patients in their care has led to better treatment and outcomes. Tight control concepts emphasize the need for regular assessments including patients’ active involvement by self-monitoring.

Methods

The literature was screened with respect to published experiences of self-monitoring of rheumatoid arthritis and spondyloarthritides. The use of “patient-reported outcome” (PRO) instruments can facilitate self-monitoring. Potentially applicable PROs and their correlations to clinical parameters as well as modern data acquisition modes are presented.

Results

Some experiences for self-monitoring have been reported. Recommendations from national and international professional rheumatology societies do not yet consider self-monitoring; however, PROs might be used for self-monitoring but instructions for patients on “how to deal with self-monitored PRO values” are missing.

Conclusion

Self-monitoring of inflammatory rheumatic diseases seems feasible. Further evaluation studies are warranted to guarantee an optimized direct patient involvement in their management beyond outpatient care in hospitals and private practices so that they can thus contribute to a better outcome.     

Schwangerschaft bei entzündlich-rheumatischen Erkrankungen

Inflammatory rheumatic diseases often affect females of childbearing age and pregnancy remains a challenge for this group of patients and their physicians. However, the majority of patients can now have successful pregnancies and deliver healthy babies as a result of our improved knowledge of the risks encountered during pregnancy, better preventive and therapeutic measures, and in particular close rheumatological, obstetric and neonatal monitoring. To ensure a favorable outcome, pregnancy should be planned to take place during a period of disease stability, monitored closely (physical examination, laboratory tests, and Doppler ultrasound), and treated appropriately.     

Knochendichtemessungen bei entzündlich-rheumatischen Erkrankungen

Bone densitometry should be performed earlier in patients with inflammatory arthritis, since factors such as inflammation and drug therapy, in particular treatment with glucocorticoids, have an important impact on the development of osteoporosis. DXA (Dual energy X-ray Absorptiometry) is considered the gold standard for bone densitometry. According to the German guidelines for osteoporosis, bone densitometry plays a crucial role in the choice of therapy. In patients with rheumatoid arthritis, measurement of peripheral bone (forearm) density in addition to lumbar spine and hip is recommended, since local bone loss is pathognomonic for this disease. DXA measurements of the hand enable the diagnosis of juxtaarticular osteoporosis at an earlier stage; however, this has not yet been established in routine practise. Bone measurement in patients with ankylosing spondylitis can be performed in the lumbar spine and the hip at disease onset. In systemic lupus erythematosus, bone loss is more frequent in patients with high inflammatory activity. Patients with psoriasis arthritis frequently have osteoporosis in the case of a destructive development of the joints.     

Empfehlungen der Deutschen Gesellschaft für Rheumatologie zur perioperativen Vorgehensweise unter Therapie mit DMARD und Biologicals bei entzündlich-rheumatischen Erkrankungen

Background

The perioperative administration of antirheumatic medication can lead to an increased risk of infection and to a malfunction in wound healing up to a manifest infection; however, the termination of antirheumatic therapy can result in a flare up of the disease. Both situations can endanger the success of the operation, particularly in arthroplasty.

Method

The recommendations have been developed and approved by the Pharmacotherapy Commission of the German Society for Rheumatology following a systematic literature search (as of 30 April 2013) and a consensus process.

Results

As very little data with sufficiently high evidence are available, the present recommendations should be considered as having an advisory quality and an individual risk assessment should always be carried out. Classical disease-modifying antirheumatic drugs (DMARD), such as methotrexate can be continued in normal cases but whether this is also true for leflunomide is still undecided. For biologicals a break of two half-life periods before the operation is recommended. The therapy can be continued after wound healing has been completed and when there are no signs of infection.     

Neue diagnostische Methoden für Patienten mit Diabetes und Fettleber

Die Diabetologie - Die nichtalkoholische Fettlebererkrankung (NAFLD) hat eine hohe Prävalenz bei Patienten, die mit Typ-2-Diabetes leben. In der Pathophysiologie spielen Leberentzündungen...