[Current guidance of the German Society of Rheumatology for the care of patients with rheumatic diseases during the SARS-CoV-2/Covid 19 pandemic]

[The German Society for Rheumatology and Clinical Immunology (DGRh) and the COVID-19 pandemic]

The pandemic led to a global disruption of public life unprecedented in modern times due to an infectious disease, which certainly caused additional special burdens for patients with chronic diseases as well as for personnel in the healthcare system. The German Society of Rheumatology and Clinical Immunology (DGRh), with its Executive Board and two ad hoc commissions, responded promptly to the complex challenges posed by the pandemic for rheumatological care in Germany with provision of a comprehensive and professionally sound range of information and provided concrete assistance in many situations. The diverse activities of the DGRh in the context of the pandemic led to national and international attention and consideration of its committees and recommendations in national committees and guidelines.

COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey

Objective

To analyze the impact of the COVID-19 pandemic on medical care and vaccination acceptance of vasculitis patients in Germany.

Methods

A web-based national survey was developed by rheumatology centers and vasculitis patient advocacy groups. The survey was distributed nationwide by mail and flyers and could be accessed via a QR-code or weblink from December 2021 to April 2022. Descriptive statistics [mean, median, standard derivation (SD), 25%, 75% quantile] were calculated. 95% confidence intervals were presented for responses that were directly related to the impact of COVID-19 on parameters associated with vasculitis patient care.

Results

The online survey was completed by 117 patients with small and large vessel vasculitis [granulomatosis with polyangiitis (n = 69), eosinophilic granulomatosis with polyangiitis (n = 16), microscopic polyangiitis (n = 12), giant cell arteritis (n = 17) and Takayasu's arteritis (n = 3)]. Prescheduled rheumatological appointments had been canceled due to the COVID-19 pandemic in 12.6% of the respondents [95% confidence interval (CI), 7.3-20.0%); in 9% (95% CI, 4.5-15.6%)] appointments had been replaced by digital services. Therapeutic regimens were changed (shifted, reduced, or discontinued) due to the pandemic in 15.5% (95% CI 9.5-22.2%). Vaccination coverages were generally high compared to patients with other rheumatic diseases and the general population. Highest vaccination coverage was observed against COVID-19 (98.1% 95% CI 93.9-99.6%).

Conclusion

Vasculitis patients experienced changes in medical care during COVID-19 pandemic such as cancelation of prescheduled rheumatology appointments and modifications in therapeutic regimens. The overall acceptance rate for vaccination was comparatively high, particularly for vaccination against COVID-19.

[COVID-19 in Routine Rheumatologic Care]

Seit dem ersten Fall einer Infektion mit SARS‐CoV‐2 („severe acute respiratory syndrome coronavirus 2“) und der damit assoziierten COVID-19-Erkrankung („corona virus disease 19“) existiert eine weltweite Pandemie. Diese führt zu anhaltenden, weitreichenden Folgen für das Gesundheitssystem und die Gesellschaft insgesamt. Unsere Patienten mit entzündlich-rheumatischen Erkrankungen galten initial, insbesondere bei bestehender immunsuppressiver und/oder immunmodulatorischer Therapie (DMARD), als hochgefährdet, sich mit SARS‐CoV‐2 zu infizieren. Man nahm an, dass es im Fall einer Infektion zu einem schweren COVID‐19-Verlauf kommen könnte. Die PCR-Diagnostik gilt zwar gemeinhin als Goldstandard zur Frühdiagnose einer aktiven Infektion mit SARS-CoV‑2, es zeigt sich jedoch, dass sie nicht immer zur Diagnosesicherung von COVID-19 als solches gewertet werden sollte. Eine ergänzende Antikörpertestung scheint empfehlenswert und kann bei typischer Symptomatologie auch noch rückwirkend zur Diagnosesicherung Abhilfe schaffen. Dem Anschein nach sind Patienten mit einer entzündlich-rheumatischen Erkrankung und unter einer DMARD-Therapie im Fall einer SARS-CoV-2-Infektion nicht grundsätzlich besonders gefährdet. Ob dies an besseren Hygienemaßnahmen oder verstärkten Kontaktbeschränkungen der Patienten mit entzündlich-rheumatischer Grunderkrankung liegt oder ob die laufende DMARD-Therapie einen gewissen Schutz vor einem schweren Verlauf von COVID-19 bietet, lässt sich aus den vorliegenden Daten nicht sagen. Die wichtigen Fragen zur Verträglichkeit und Wirksamkeit der COVID-19-Impfung sind noch nicht zu beantworten. Zusammenfassend besteht weiterhin ein deutlicher Forschungsbedarf, um unsere Patienten besser beraten zu können.

Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in times of SARS-CoV-2-methodology, key messages and justifying information

A few days after the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled the first group of recommendations for the care of patients with inflammatory rheumatic diseases in light of SARS-CoV-2/coronavirus disease 2019 (COVID-19). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registries, cross-sectional studies, case reports and case series are available, the DGRh has developed a timely update. This update is based on a literature search of publications available through 15 June 2020 and addresses preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. Driven by the commitment to let patients benefit from these new evidence-based recommendations as quickly as possible, the DGRh published the update in German on its homepage and in the Zeitschrift für Rheumatologie immediately after completion. Here we report the key recommendations to make them available to the international community, provide the scientific methodology used to develop the recommendations, give additional thoughts and advice for the management of patients with rheumatic diseases during the COVID-19 pandemic and discuss our recommendations in the context of other international recommendations.

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

BACKGROUND

The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain.

OBJECTIVE

The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available.

METHODS

Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process.

RESULTS

The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions.

CONCLUSIONS

The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Analysis of the Effect of Health Management of Chronic Diseases and Metabolic Disorders under the Guidance of B-Ultrasound

Chronic diseases are diseases with insidious onset, prolonged duration, and intractability and are associated with complex etiology and multiple morbidities, including hypertension, obesity, liver disease, kidney disease, cancer, cardiovascular disease, and chronic lung disease. For patients with chronic diseases, although the cause of the disease is not in the spleen and stomach, medication or further development of the disease will affect the function of the spleen and stomach disorders, leading to worsening of the disease. In this article, ultrasound is used to detect health disorders of the spleen and stomach. Patients should eat a light diet and exercise more. Elderly patients can increase abdominal massage and other health care. It should be emphasized that the prevalence of chronic diseases is not lower in people with high education or high economic income but is closely related to people's daily living habits; secondly, we should enhance physical exercise and advocate annual physical examination. Finally, we need to develop different measures according to different regions to prevent and treat chronic diseases and give timely feedback to the interventions. New preventive and curative measures are given in time to improve public health.

[Regional cooperative rheumatology centers : Networking of rheumatology in Germany for over 25 years]

Over the last 25 years the regional collaborative rheumatology centers have become established throughout Germany as "catalysts" for improving rheumatological care at many different levels. With campaigns and a multitude of activities they have promoted the visibility of rheumatology in Germany together with rheumatological alliance partners and, on the scientific side, together with the German Rheumatism Research Center have contributed to the improvement of rheumatological care research in Germany. The regional cooperative rheumatology centers have become an important partner in the rheumatology network in their association as a working group of the German Society for Rheumatology and they will continue to face new tasks in the future to further improve rheumatological care in Germany.

[Prospective monitoring of a university rheumatology outpatient clinic throughout the first wave of the COVID-19 pandemic : What lessons can be learned?]

Hintergrund

Im März 2020 breitete sich die SARS-CoV-2-Pandemie initial v. a. in Bayern aus. Zu diesem Zeitpunkt war weitgehend unklar, wie mit der immunmodulatorischen Therapie bei Rheumapatienten umzugehen ist.

Ziel der Arbeit

Das Ziel war es, den Einfluss der Pandemie auf klinische Entscheidungen zu erfassen.

Material und Methoden

Es wurden zwischen dem 16.03. und 31.07.2020 Patienten eingeschlossen, die sich in der Rheumaambulanz des Klinikums rechts der Isar vorstellten. Anpassungen der Therapie erfolgten nach klinischem Ermessen und in Anlehnung an die Handlungsempfehlungen der DGRh.

Ergebnisse

Es wurden 322 Patienten eingeschlossen. Die häufigsten Diagnosen waren die rheumatoide Arthritis mit 17 %, die ANCA-assoziierte Vaskulitis (AAV) mit 14 % sowie der SLE mit 12 %; 262 Patienten erhielten eine DMARD-Therapie und 77 Patienten orale Glukokortikoide. Es lagen 5 SARS-CoV-2-Verdachtsfälle vor. Kein Patient erkrankte nachweislich an COVID-19. Eine Therapieänderung erfolgte aufgrund der Pandemie bei 40 Patienten. Dabei kam es bei 3 Patienten zu einem Flare der Grunderkrankung. Eine Therapiedeeskalation erfolgte am häufigsten bei AAV, IgG4-assoziierter Erkrankung sowie bei gleichzeitig bestehenden Malignomen und beim Einsatz von Rituximab.

Diskussion

In dieser Single-Center-Kohorte legt das gänzliche Fehlen von nachweislichen SARS-CoV-2-Infektionen in einer sonst relativ stark betroffenen Region den Schluss nahe, dass kein überproportional erhöhtes Infektionsrisiko für Patienten mit entzündlich rheumatischen Erkrankungen zu bestehen scheint. Eine Fortführung der meisten immunsuppressiven Therapien erscheint daher sinnvoll.

[Recommendations of the German Society for Rheumatology for management of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic - Update July 2020]

A few days after the SARS-CoV-2 infection was declared a pandemic, the German Society for Rheumatology (DGRh) compiled first recommendations for the care of patients with inflammatory rheumatic diseases (IRD). These first recommendations were based on an expert consensus and were largely non-evidence-based. Now that the first scientific data from registers, cross-sectional studies, case reports and case series are available, the present update is intended to update the previous recommendations and to add new findings. The current recommendations are based on a literature search of publications available up to 15 June 2020 and address preventive measures (such as hygiene measures or vaccinations) and the use of immunomodulatory/immunosuppressive drugs. An important goal of the current recommendations is also to prevent harm to patients with IRD through unjustified restriction of care. The DGRh will continue to update its recommendations in the case of new aspects and will publish them as well as further information on the COVID-19 pandemic on its homepage ( www.dgrh.de ) in an ongoing process.

[SARS-CoV-2 & rheumatic disease : Consequences of the SARS-CoV-2 pandemic for patients with inflammatory rheumatic diseases. A comparison of the recommendations for action of rheumatological societies and risk assessment of different antirheumatic treatments]

The recommendations of the German Society of Rheumatology (DGRh) update, which update and expand the guidance on the management of patients with inflammatory rheumatic diseases in view of SARS-CoV‑2 created at the beginning of the COVID-19 pandemic, correspond in many points with the recommendations for action of the American (ACR) and European (EULAR) societies, but also differ in some points. Therefore, this article discusses the core recommendations of the DGRh update on the prevention of SARS-CoV-2/COVID-19, the risk assessment for inflammatory rheumatic diseases and the use of antirheumatic treatments in the context and in comparison to the ACR and EULAR recommendations, and provides an overview of the risk assessment of individual antirheumatic drugs.

[Biological therapy after COVID-19 infection : No reactivation of a COVID-19 infection with positive SARS-CoV-2 antibody status under biological therapy]

Berichtet wird über einen Fall mit rheumatoider Arthritis und unzureichender Kompensation unter einer Kombinationslangzeittherapie mit Methotrexat und Leflunomid. Nach durchgemachter COVID-19-Infektion erfolgte eine Neueinstellung auf einen Tumornekrosefaktor(TNF)-Blocker. Hierunter zeigte sich bisher keine Reaktivierung der COVID-19-Infektion bei positivem Antikörperstatus SARS-CoV‑2.

Covid-19: Was Rheumapatienten jetzt wissen sollten

Rheumapatienten gelten als Risikogruppe bei der Coronavirus-Krankheit COVID-19. Nicht nur die Erkrankung, auch die Therapien greifen in das Immunsystem ein. Die Deutsche Gesellschaft für Rheumatologie (DGRh) hat nun für betreuende Ärzte Empfehlungen auf Basis eines Expertenkonsens vorgelegt.