[Experiences and results from Rheuma-VOR]

[Prioritized appointment allocation in new patients, what is really decisive? : Comparative analysis of manual appointment allocation with automated and AI-assisted approaches]

BACKGROUND

The timely allocation of appointments for new patients is a daily challenge in rheumatological practice, which can be supported by digital solutions. The question is to find the simplest and most effective possible method for prioritization when allocating appointments.

METHODS

Using a registration form for new patients, standardized symptoms and laboratory results were collated. After reviewing this information by a medical specialist the allocation of appointments was carried out in three categories: a) < 6 weeks, b) 6 weeks up to 3 months and c) > 3 months. The waiting time between the time of registration and the presentation appointment was calculated and compared between patients with and without a diagnosis of an inflammatory rheumatic disease (IRD). In addition a decision tree (DT), a method taken from the field of supervised learning within artificial intelligence (AI), was established and the resulting classification was compared with respect to the accuracy and calculated saving in waiting time.

RESULTS

In this study 800 appointments between 2020 and 2023 (including 555 women, 69.4%, median age 53 years, interquartile range, IQR 39-63 years) were analyzed. An IRD could be confirmed in 409 (51.1%) cases with a waiting time of 58 vs. 93 days for non-IRD cases (-38%, p < 0.01). An AI-based stratification resulted in an accuracy of 67% for IRD and a predicted saving of 19% waiting time. The accuracy increased up to 78% with a time saving for IRD cases of up to 31%, when all basic laboratory results were known. Simplified algorithms, e.g., stratification by the use of laboratory findings alone, resulted in a lower accuracy and time savings.

CONCLUSION

Manual allocation of appointments by a medical specialist is effective and significantly reduces the waiting times for patients with IRD. An automated categorization can lead to a reduction in waiting times for appointments when taking complete laboratory results and a lower sensitivity into consideration.

Prioritising Appointments by Telephone Interview: Duration from Symptom Onset to Appointment Request Predicts Likelihood of Inflammatory Rheumatic Disease

Background: This study aims to determine the rate of inflammatory rheumatic diseases (IRDs) in a cohort of initial referrals and the efficacy of prioritising appointments to the early arthritis clinic (EAC) based on symptom duration. Methods: In the present study, we used algorithm-based telephone triage to assign routine care appointments according to the time between symptom onset and request for an appointment (cut-off criterion: 6 months). This retrospective, monocentric analysis evaluated the effectiveness of our triage in identifying patients with IRDs as a function of the assigned appointment category (elective, EAC, or emergency appointment). Results: A total of 1407 patients were included in the study (34.7% male; 65.3% female). Of the 1407 patients evaluated, 361 (25.7%) presented with IRD. There were significant differences in the frequency of inflammatory diagnoses between appointment categories (p < 0.001): elective 13.8%, EAC 32.9%, and emergency 45.9%. The sample without the emergency category included a total of 1222 patients. The classification into "inflammatory" or "non-inflammatory" in this subsample was as follows: Sensitivity was 37.7%, and specificity was 92.6%. The positive predictive value (PPV) was 59.8%, and the negative predictive value (NPV) was 83.6%. Overall, 80.2% of patients were correctly assigned using the appointment category and C-reactive protein (CRP). Conclusions: The algorithm-based triage system presented here, which focuses on the time between symptom onset and request for an appointment, allows for the prioritisation of appointments in favour of patients with IRDs and thus earlier initiation of therapy.

[The subanalysis of Rheuma-VOR demonstrates a considerable need for rheumatological care]

BACKGROUND

Early diagnosis and treatment of inflammatory rheumatic diseases can prevent consequential damage such as permanently limited mobility and joint or organ damage. Simultaneously, there is an increasing deficit in medical care owing to the lack of rheumatological capacity. Rural regions are particularly affected.

OBJECTIVES

The available unconfirmed diagnoses of the study Rheuma-VOR were analysed regarding another definitive inflammatory rheumatic disease.

MATERIALS AND METHODS

The returned questionnaires of the rheumatologists participating in Rheuma-VOR were screened for definitive inflammatory rheumatic diseases other than the required diagnosis of rheumatoid arthritis, psoriatic arthritis or spondyloarthritis.

RESULTS

Of 910 unconfirmed diagnoses, in 245 patients another definitive diagnosis could be confirmed. A total of 29.8% of the diagnoses corresponded to degenerative joint changes or chronic pain syndrome, whereas 26.1% involved different forms of inflammatory arthritis. The majority of diagnoses (40.5%) were collagenosis or vasculitis, DISCUSSION: The available data show that a rheumatological presentation was indicated for the majority of patients. Owing to the increasing deficits in medical care a prior selection of the patients is crucial to make optimal use of restricted rheumatological capacities.

Effects of add-on Celecoxib treatment on patients with schizophrenia spectrum disorders and inflammatory cytokine profile trial (TargetFlame): study design and methodology of a multicentre randomized, placebo-controlled trial

Neuroinflammation has been proposed to impact symptomatology in patients with schizophrenia spectrum disorders. While previous studies have shown equivocal effects of treatments with add-on anti-inflammatory drugs such as Aspirin, N-acetylcysteine and Celecoxib, none have used a subset of prospectively recruited patients exhibiting an inflammatory profile. The aim of the study is to evaluate the efficacy and safety as well as the cost-effectiveness of a treatment with 400 mg Celecoxib added to an ongoing antipsychotic treatment in patients with schizophrenia spectrum disorders exhibiting an inflammatory profile. The “Add-on Celecoxib treatment in patients with schizophrenia spectrum disorders and inflammatory cytokine profile trial (TargetFlame)” is a multicentre randomized, placebo-controlled phase III investigator-initiated clinical trial with the following two arms: patients exhibiting an inflammatory profile receiving either add-on Celecoxib 400 mg/day or add-on placebo. A total of 199 patients will be assessed for eligibility by measuring blood levels of three pro-inflammatory cytokines, and 109 patients with an inflammatory profile, i.e. inflamed, will be randomized, treated for 8 weeks and followed-up for additional four months. The primary endpoint will be changes in symptom severity as assessed by total Positive and Negative Syndrome Scale (PANSS) score changes from baseline to week 8. Secondary endpoints include various other measures of psychopathology and safety. Additional health economic analyses will be performed. TargetFlame is the first study aimed at evaluating the efficacy, safety and cost-effectiveness of the antiphlogistic agent Celecoxib in a subset of patients with schizophrenia spectrum disorders exhibiting an inflammatory profile. With TargetFlame, we intended to investigate a novel precision medicine approach towards anti-inflammatory antipsychotic treatment augmentation using drug repurposing.

Clinical trial registration:http://www.drks.de/DRKS00029044 and https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00029044

[Development of quality standards for patients with rheumatoid arthritis for use in Germany]

Despite a qualitatively and structurally good care of patients with rheumatoid arthritis (RA) in Germany, there are still potentially amendable deficits in the quality of care. For this reason, the German Society for Rheumatology (DGRh) has therefore decided to ask a group of experts including various stakeholders to develop quality standards (QS) for the care of patients with RA in order to improve the quality of care. The QS are used to determine and quantitatively measure the quality of care, subject to relevance and feasibility. The recently published NICE and ASAS standards and a systematic literature search were used as the basis for development. A total of 8 QS, now published for the first time, were approved with the intention to measure and further optimize the quality of care for patients with RA in Germany.

[Further development of regional early care-Many roads lead to Rome : Developmental stages of four established rheumatological early care concepts in different regions of Germany]

In order to shorten the prognostically relevant waiting time until diagnosis and initiation of appropriate treatment in inflammatory rheumatic diseases, rheumatological centers in many regions across Germany have established and continuously developed specific early care concepts. Evaluated models from Altötting·Burghausen, Berlin Buch, Düsseldorf and Heidelberg and their developmental stages as a response to internal and external challenges are presented in this overview. The transparent publication of the developmental steps and the exchange of experiences aim at promoting new early care concepts in other regions and continuing the joint dialogue for improvement of the early detection and quality of care of inflammatory rheumatic diseases in Germany.

Digitalisierung in der Rehabilitation von rheumatischen Erkrankungen: Was ist sinnvoll, was ist bewiesen, welche Perspektiven gibt es?

In Deutschland besteht ein deutlicher Mangel an internistischen Rheumatologen. Um diese Versorgungslücke zu reduzieren, können verschiedene technische Anwendungen genutzt werden. Dies reicht von der Hilfe bei der Früherkennung und Diagnostik für Hausärzte, über Konsilsysteme mit Telemedizin, bis hin zur Videosprechstunde mit den Patienten nach Koordination in einem entsprechenden Netzwerk, das stufenförmig aufgebaut ist, um die vorhandenen Spezialisten möglichst effektiv einzusetzen. Auch Apps für die Nutzung am Smartphone oder Tablet können sowohl Ärzte in Diagnostik und Therapie unterstützen, aber auch vielfältig Patienten bei den jeweiligen Krankheitsbewältigungen helfen. Eine Sonderform sind dabei „Digitale Gesundheitsanwendungen“ (DiGAs), die geprüft wurden und als Medizinprodukte zugelassen und verordnungsfähig sind. Für die Unterstützung von Bewegungsübungen, wie sie bei rheumatischen Erkrankungen so wichtig sind, kommen auch Telemedizinische Assistenzsysteme in Betracht, bei denen über 3D-Kamera und Computeranalyse zu Hause ein individuelles Übungsprogramm angeleitet und kontrolliert wird. Studien zu Anwendungen und Bewertungsoptionen für Apps liegen bereits einige vor, hier besteht aber noch hoher Nachholbedarf.

[Digital diagnostic support in rheumatology]

Only the correct diagnosis enables an effective treatment of rheumatic diseases. Digitalization has already significantly accelerated and simplified our everyday life. An increasing number of digital options are available to patients and medical personnel in rheumatology to accelerate and improve the diagnosis. This work gives an overview of current developments and tools for patients and rheumatologists, regarding digital diagnostic support in rheumatology.

30 Jahre regionale kooperative Rheumazentren – Erfolgreiche Verbesserung der rheumatologischen Versorgung und Versorgungsforschung

Im Rahmen des Modellprogrammes zur besseren Versorgung chronisch Kranker förderte das Bundesgesundheitsministerium (BMG) seit 1992 schwerpunktmäßig den Aufbau von Rheumazentren an 21 Orten der Bundesrepublik. Ziel war neben dem Aufbau formaler Strukturen die Verbesserung der Versorgungsqualität durch Koordination und Kooperation vorhandener Einrichtungen.

[Perspectives for rheumatological health services research at the German Rheumatism Research Center]

In diesem Übersichtsartikel werden aktuelle Projekte und Perspektiven der rheumatologischen Versorgungsforschung am Programmbereich Epidemiologie des DRFZ (Deutsches Rheuma-Forschungszentrum) zusammengefasst. Versorgungsforschung wird mithilfe verschiedener Datenquellen betrieben. Neben den klassischen rheumatologischen Krankheitsregistern werden zunehmend auch Krankenkassendaten und bevölkerungsbezogene Kohorten für Analysen verwendet. Von der Datenerfassung über das Monitoring bis zu Analysealgorithmen verändern digitale Anwendungen die Versorgungsforschung der nächsten Jahre. Kollaborative Analysen mit nationalen und internationalen Kooperationspartnern unter Einbindung von Biomarkern komplettieren die Forschung am Programmbereich Epidemiologie. Die Digitalisierung der Forschungsprojekte ist ein zentraler Baustein, der die Versorgungsforschung im kommenden Jahrzehnt weiter verändern wird.

[Position paper of the commission on digital rheumatology of the German Society of Rheumatology: tasks, targets and perspectives for a modern rheumatology]

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.

Toward Earlier Diagnosis Using Combined eHealth Tools in Rheumatology: The Joint Pain Assessment Scoring Tool (JPAST) Project

Outcomes of patients with inflammatory rheumatic diseases have significantly improved over the last three decades, mainly due to therapeutic innovations, more timely treatment, and a recognition of the need to monitor response to treatment and to titrate treatments accordingly. Diagnostic delay remains a major challenge for all stakeholders. The combination of electronic health (eHealth) and serologic and genetic markers holds great promise to improve the current management of patients with inflammatory rheumatic diseases by speeding up access to appropriate care. The Joint Pain Assessment Scoring Tool (JPAST) project, funded by the European Union (EU) European Institute of Innovation and Technology (EIT) Health program, is a unique European project aiming to enable and accelerate personalized precision medicine for early treatment in rheumatology, ultimately also enabling prevention. The aim of the project is to facilitate these goals while at the same time, reducing cost for society and patients.

[Physical activity, exercise and nutrition in rheumatism : Adjuvant treatment options for inflammatory-rheumatic diseases]

BACKGROUND AND OBJECTIVES

The positive effects of physical activity, physical training and an adaptation of diet on health have been scientifically proven for many diseases. Focusing on inflammatory rheumatic diseases and their potential comorbidities, positive effects are assumed from these two adjuvant treatment opportunities, which are examined in more detail in this review.

MATERIAL AND METHODS

Based on a literature search, randomized controlled trials (RCTs), non-RCT studies, reviews and recommendations from professional societies were included.

RESULTS

Physical activity and training show positive effects on the disease itself and also on its comorbidities with existing certainty. In addition, the exercise and training recommendations of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) provide recommendations, which were adapted by the European League Against Rheumatism (EULAR) to control intensity, duration and training extent. Nutritional medical approaches also provide preventive and rehabilitative beneficial possibilities.

DISCUSSION

The increase of physical activity, regular physical training and the adaptation of diet should be a basic additive component of the treatment of inflammatory rheumatic diseases. In individual sub-aspects, the study situation is very heterogeneous and requires further research.