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Klemm P, Schulz N, Boettger P, Lange U. Heat therapy in rheumatic and musculoskeletal diseases - an overview of clinical and molecular effects. Int J Hyperthermia 2024; 41:2322667. [PMID: 38439192 DOI: 10.1080/02656736.2024.2322667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/20/2024] [Indexed: 03/06/2024] Open
Abstract
Rheumatic and musculoskeletal diseases (RMDs) usually lead to morphological and functional deficits of various extend, increased morbidity and a considerable loss of quality of life. Modern pharmacological treatment has become effective and can stop disease progression. Nonetheless, disease progression is often only slowed down. Moreover, pharmacological treatment does not improve functionality per se. Therefore, multimodal treatment of rheumatic disorders with physical therapy being a key element is of central importance for best outcomes. In recent years, research into physical medicine shifted from a sole investigation of its clinical effects to a combined investigation of clinical effects and potential changes in the molecular level (e.g., inflammatory cytokines and the cellular autoimmune system), thus offering new explanations of clinical effects of physical therapy. In this review we provide an overview of studies investigating different heat applications in RMDs, their effect on disease activity, pain and their influence on the molecular level.
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Affiliation(s)
- Philipp Klemm
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Nils Schulz
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Priyanka Boettger
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
| | - Uwe Lange
- Department of Rheumatology, Clinical Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig-University Gießen, Bad Nauheim, Germany
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Freudenberg LS, Baraliakos X, Kampen WU, Vereb M, Fischer M, Toenshoff G, Boddenberg-Pätzold B, Czech N, Klett R. [Pain reduction by radiosynoviorthesis in rheumatism-induced synovitis of the elbow : Results of a retrospective multicenter data analysis]. Z Rheumatol 2023; 82:892-897. [PMID: 35066630 DOI: 10.1007/s00393-022-01158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Radiosynoviorthesis (RSO) is a nuclear medical local treatment modality for inflammatory joint diseases. It is indicated in patients with rheumatoid arthritis (RA) in joints with persistent synovitis despite adequate pharmacotherapy. Arthritis of the elbow joint occurs in up to 2/3 of patients with RA. Intra-articular radiotherapy using the beta emitter [186Re] rhenium sulfide leads to sclerosis of the inflamed synovial membrane with subsequent pain alleviation. The clinical efficacy in cubital arthritis, however, has so far only been described in small monocentric studies. OBJECTIVE The degree of pain alleviation by RSO was analyzed in patients with rheumatoid cubital arthritis, treated in several nuclear medical practices specialized in RSO. MATERIAL AND METHODS The subjective pain intensity before and after RSO was documented in a total of 107 patients with rheumatic cubital arthritis using a 10-step numeric rating scale (NRS). A difference of ≥ -2 is rated as a significant improvement. Follow-up examinations were done after a mean interval of 14 months after RSO (at least 3 months, maximum 50 months). RESULTS The mean NRS value was 7.3 ± 2.1 before RSO and 2.8 ± 2.2 after RSO. A significant pain alleviation was seen in 78.5% of all patients treated. The subgroup analysis also showed a significant improvement in the pain symptoms in all groups depending on the time interval between the RSO and the control examination. A significant pain progression was not observed. The degree of pain relief was independent of the time of follow-up. CONCLUSION Using RSO for local treatment of rheumatoid cubital arthritis leads to a significant and long-lasting pain relief in more than ¾ of the treated patients.
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Affiliation(s)
- Lutz S Freudenberg
- ZRN Rheinland und ZRN MVZ GmbH, Überseite 88, 41352, Korschenbroich, Deutschland.
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428.
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - Willm Uwe Kampen
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstr. 8, 20095, Hamburg, Deutschland
| | - Marika Vereb
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Manfred Fischer
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis für Radiologie, Nuklearmedizin und Strahlentherapie, Fr.-Ebert-Str. 50, 34117, Kassel, Deutschland
| | - Gregor Toenshoff
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Radiologie und Nuklearmedizin, Röntgenpraxis Georgstraße, Georgstr. 16, 30159, Hannover, Deutschland
| | - Barbara Boddenberg-Pätzold
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Praxis Nuramed Köln-West, Max-Planck-Str. 27A, 50858, Köln, Deutschland
| | - Norbert Czech
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- Zentrum für Nuklearmedizin und PET/CT Bremen im St. Joseph Stift, Schwachhauser Heerstr. 54, 28209, Bremen, Deutschland
| | - Rigobert Klett
- ExzellenznetzRSO e. V., Langgöns, Deutschland, 53428
- ÜBAG für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Deutschland
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Long-term trends in rheumatology care : Achievements and deficits in 25 years of the German national rheumatology database. Z Rheumatol 2019; 78:65-72. [PMID: 31407089 DOI: 10.1007/s00393-019-0680-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Since 1993, data on the care and quality of life of patients with inflammatory rheumatic diseases have been collected in the German National Database (NDB) of the regional collaborative rheumatology centers. OBJECTIVE In this review long-term trends on treatment, disease activity and gainful employment of the most common inflammatory rheumatic diseases are presented and the most important analyses from 25 years of the NDB are summarized. METHODS Between 15 and 17 rheumatological institutions take part in the NDB and once a year collect data from a total of more than 10,000 patients. The rheumatologists document the disease status and care, the patients report on their state of health and the effects of the disease. RESULTS The biologics era at the beginning of the twenty-first century has led to changes in the therapeutic spectrum of most inflammatory rheumatic diseases, especially in rheumatoid arthritis and ankylosing spondylitis. Some basic therapies formerly used are hardly used anymore and glucocorticoids are used less frequently. Methotrexate has remained the standard therapy for rheumatoid arthritis over the years. Nowadays, nearly 30% of patients with rheumatoid arthritis receive treatment with biologics. Disease activity, functional and social restrictions have decreased across all diseases. CONCLUSION The improved health status of many patients with rheumatic diseases confirms the high level of care provided by the rheumatism centers involved in the NDB. The increasing specification of measuring instruments and the standardization of documentation systems are major challenges that the NDB will have to face in the coming years if it is to remain in the digital age.
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Abstract
Rheumatic diseases usually progress towards morphological and functional deficits and thus cause impairment of physical health and function. Based on this fact, physiotherapeutic options are elementary and indispensable. This article focuses on the significance and importance of physiotherapy in inflammatory and degenerative rheumatic diseases. Furthermore, an overview is presented on the consequences of rheumatic diseases, the reality of supply of physiotherapy, the principles and therapeutic options, and the evidence.
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Zink A, Braun J, Gromnica-Ihle E, Krause D, Lakomek HJ, Mau W, Müller-Ladner U, Rautenstrauch J, Specker C, Schneider M. [Memorandum of the German Society for Rheumatology on the quality of treatment in rheumatology - Update 2016]. Z Rheumatol 2017; 76:195-207. [PMID: 28364218 DOI: 10.1007/s00393-017-0297-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
On behalf of the Steering Committee of the German Society for Rheumatology, in 2016 the Interdisciplinary Commission on Healthcare Quality updated the 2008 memorandum on rheumatological healthcare in Germany. The update considers changes in therapeutic strategies, treatment targets as well as current structures in healthcare and the political framework. It concentrates on examination of the need for rheumatologists with a background in internal medicine and determines the gap between needs and supply. The internist rheumatologist is responsible for the care of patients with inflammatory rheumatic diseases and contributes to the care of patients with severe forms of other musculoskeletal diseases. At least 2 internist rheumatologists are needed for the outpatient care of 100,000 adult inhabitants, equivalent to 1350 rheumatologists in Germany. With currently 776 rheumatologists, we have little more than half of what we need. The German Society for Rheumatology calls for specific requirements planning for rheumatologists in outpatient care in order to decrease the deficit. In acute inpatient care we need specialized hospitals and wards that ensure a high quality of treatment for patients with complex diseases. We need up to 50 beds per 1 million inhabitants. At least 2 full-time internist rheumatologists and 3 further physicians are needed per 30 beds. In inpatient and outpatient rehabilitation we need 40 beds or outpatient places per 1 million inhabitants with at least 1 full-time rheumatologist and 1 further physician. In order to reduce the existing deficits and to cover the increasing future need for rheumatologists, more emphasis has to be laid on primary and secondary education. Chairs for internal rheumatology are needed at each medical university and more positions for postgraduate training in rheumatology should be provided. In all segments of healthcare the treatment aims should be jointly defined between patients and physicians. The patients should be treated in an interdisciplinary network, comprising other medical specialties, health professionals as well as patient organizations.
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Affiliation(s)
- A Zink
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie und Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Deutschland
| | | | - D Krause
- Internistische und rheumatologische Gemeinschaftspraxis, Gladbeck, Deutschland
| | - H J Lakomek
- Klinik für Rheumatologie und Interdisziplinäre Geriatrie, Universitätszentrum Innere Medizin, Johannes Wesling Klinikum Minden, Minden, Deutschland
| | - W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - U Müller-Ladner
- Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
- Abteilung Rheumatologie und klinische Immunologie, Kerckhoff-Klinik GmbH, Bad Nauheim, Deutschland
| | - J Rautenstrauch
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Rheumazentrum Rhein-Ruhr e.V., St. Josef Krankenhaus (Universitätsklinikum Essen), Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich für Rheumatologie, Hiller Forschungszentrum Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Mau W, Beyer W, Ehlebracht-König I, Engel JM, Genth E, Lange U. [Treat to participation : Position paper of the German Society for Rheumatology on sustained improvement of functional health of patients with rheumatic and musculoskeletal diseases]. Z Rheumatol 2016; 74:553-7. [PMID: 26238709 DOI: 10.1007/s00393-015-1640-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.
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Affiliation(s)
- W Mau
- Institut für Rehabilitationsmedizin, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, 06097, Halle (Saale), Deutschland,
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Huscher D, Thiele K, Rudwaleit M, Albrecht KC, Bischoff S, Krause A, Karberg K, Wassenberg S, Zink A. Trends in treatment and outcomes of ankylosing spondylitis in outpatient rheumatological care in Germany between 2000 and 2012. RMD Open 2015; 1:e000033. [PMID: 26535133 PMCID: PMC4612682 DOI: 10.1136/rmdopen-2014-000033] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/17/2015] [Accepted: 04/29/2015] [Indexed: 12/17/2022] Open
Abstract
Objectives To describe changes in drug treatment and clinical outcomes of ankylosing spondylitis (AS) during the past decade. Methods The national database of the German collaborative arthritis centres collects clinical and patient-derived data from unselected outpatients with inflammatory rheumatic diseases. Cross-sectional data from 2000 to 2012 of around 1000 patients with AS per year were compared with regard to clinical presentation and quality of life indicators. Results Non-steroidal anti-inflammatory drugs (NSAIDs) have been the predominant treatment choice in AS over the years with a prescription rate of 67% of patients in 2012. Currently, almost half of the patients with AS in German rheumatology centres are treated with tumour necrosis factor inhibitors (TNFi). Often, both treatments are used in combination (33%), followed by combinations of NSAIDs and synthetic disease modifying antirheumatic drugs (sDMARDs) with 23% or TNFi alone (21%). In 2012, 10% of patients each received NSAID or sDMARD monotherapy. Methotrexate, sulfasalazine, glucocorticoids and analgaesics alone or in combination with other treatments were given to 10% of patients, respectively. Over the years, we have seen remarkable improvements in disease control and patient reported outcomes. These developments are consistent with enhanced functional status, increasing employment rates and decreasing sick leave, hospitalisation and work disability. Conclusions In the German rheumatology secondary/tertiary care setting, routine care of patients with AS has changed tremendously during the past decade. Increasingly, more efficacious treatment options are reflected in improved clinical outcomes, quality of life and participation in the labour force.
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Affiliation(s)
- Dörte Huscher
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany
| | - Katja Thiele
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany
| | | | | | - Sascha Bischoff
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany
| | - Andreas Krause
- Department of Rheumatology and Clinical Immunology , Immanuel Krankenhaus Berlin , Berlin , Germany
| | | | | | - Angela Zink
- Epidemiology Unit , German Rheumatism Research Centre, A Leibniz Institute , Berlin , Germany ; Department of Rheumatology and Clinical Immunology , Charité University Hospital Berlin , Berlin , Germany
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Neue Entwicklungen bei sozialmedizinischen Konsequenzen und rehabilitativen Interventionen. Z Rheumatol 2014; 73:8-10. [DOI: 10.1007/s00393-013-1204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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