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Keyßer G. Kein Ergebnis ist auch ein Ergebnis! AKTUEL RHEUMATOL 2023. [DOI: 10.1055/a-2016-2263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Die moderne Genetik hat ermöglicht, dass die Suche nach Assoziationen
zwischen Genen und Autoimmunerkrankungen mittlerweile über das gesamte
menschliche Genom ausgedehnt werden kann. Sogenannte „genome-wide
association studies“ (GWAS) beschreiben dabei eine Vielzahl von genetischen
Markern, die sich mit unterschiedlich starker Signifikanz bei Patienten
häufiger oder seltener finden als bei einem gesunden Vergleichskollektiv.
Die meisten dieser Marker sind „single nucelotide polymorphisms“
(SNPs)- also Varianten im genetischen Code, die sich nur auf ein einziges Nukleotid
beziehen. Derartige GWAS operieren mit sehr großen Datenmengen, deren
Interpretation mitunter schwierig ist. Nicht immer ist die gefundene Abweichung
relevant, und nicht immer ist sie an anderen Patientenkollektiven reproduzierbar.
Die Ursachen dafür können vielfältig sein: Zum einen
können die untersuchten Kollektive tatsächlich genetische
Verschiedenheiten aufweisen, zum anderen können Unterschiede in den
Stichprobengrößen zu Unterschieden im Signifikanzniveau
führen. Außerdem können externe Risikofaktoren für
eine Autoimmunerkrankung geographische Unterschiede aufweisen (Keimspektrum,
chemische Noxen, UV-Strahlung u.a.m.). Daher können genetische
Hintergründe in unterschiedliche Regionen eine andere pathogenetische
Bedeutung aufweisen. Nicht zu vergessen ist außerdem, dass genetische
Unterschiede zwischen Kranken und Gesunden umso schärfer herausgearbeitet
werden können, je besser die Patienten charakterisiert sind. Stützt
man sich bei der Diagnose einer Erkrankung lediglich auf einen ICD-Code, der
irgendwann in die Krankenakte eingetragen wurde, oder wurden die Patienten
tatsächlich von Spezialisten gesehen und für die Analyse rekrutiert?
Deswegen ist es üblich, eine an einer Population gefundene genetische
Assoziation („discovery cohort“) an einer anderen,
unabhängigen Stichprobe zu überprüfen („replication
cohort“).
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Garbe N, Schäfer C, Pilz A, Schmidt F, Raberger K, Wienke A, Keyßer G. The impact of a structured one-day seminar on disease-specific knowledge, lifestyle habits and disease impairment in ANCA-associated vasculitis. Results of a randomized, controlled study. Scand J Rheumatol 2023; 52:69-76. [PMID: 34643169 DOI: 10.1080/03009742.2021.1972534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a complex, chronic autoimmune disease, and its diagnosis triggers considerable anxiety and uncertainty for those affected. There are currently no valid data describing the impact of disease-specific patient education on the disease knowledge, subjective impairment, and changes in lifestyle habits related to AAV. METHOD We designed a one-day educational programme to serve AAV patients with information about their disease and its treatment. Patients were randomized into an intervention group and a waiting list control group. Increase in knowledge was measured with a multiple-choice test. The intervention group completed the questionnaire before, directly after, and 3 months after the seminar, while the waiting list control group was additionally tested 3 months before the seminar to rule out non-specific learning. Furthermore, we investigated the burden of the disease and the impact of our intervention on this burden. RESULTS Compared with the control group, the intervention increased the knowledge (mean ± sd score difference 2.2 ± 1.0, 95% confidence interval 0.1-4.3, p = 0.04). From the patients' point of view, their understanding of the disease had improved and the subjective impairment caused by their rheumatic disease had decreased. There was a tendency to include disease-relevant behaviour, such as nasal care or dietary recommendations, more often in everyday life. CONCLUSION A one-day seminar is suitable to increase the disease-specific knowledge of patients with AAV in a sustainable manner. In addition, our measure positively affected the disease-relevant behaviour.
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Affiliation(s)
- N Garbe
- Department of Internal Medicine II, Rheumatology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - C Schäfer
- Department of Internal Medicine II, Rheumatology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - A Pilz
- Department of Internal Medicine II, Rheumatology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - F Schmidt
- Department of Internal Medicine II, Rheumatology, University Hospital Halle (Saale), Halle (Saale), Germany
| | - K Raberger
- Department of Pediatrics I, University Hospital Halle (Saale), Halle (Saale), Germany
| | - A Wienke
- Institute of Medical Epidemiology, Biometrics, and Informatics, Medical Faculty of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - G Keyßer
- Department of Internal Medicine II, Rheumatology, University Hospital Halle (Saale), Halle (Saale), Germany
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Aringer M, Baerwald C, Bergner R, Feuchtenberger M, Gebhardt C, Hagen M, Keyßer G, Lorenz HM, Witte T. [Rheumatology in German MD curricula]. Z Rheumatol 2020; 80:2-8. [PMID: 33269410 PMCID: PMC7709903 DOI: 10.1007/s00393-020-00933-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Transmitting a substantial amount of basic knowledge in Rheumatology to all medical students is essential for the future medical care of patients with rheumatic diseases for two reasons: on the one hand, future general practitioners will need to master the patterns of rheumatic diseases to recognize them fast enough in new-onset patients and to refer them in time and directly to rheumatologists. On the other hand, the shortage of rheumatologists can only then be relieved in the future when we are able to inspire enthusiasm for our specialty. Adequate rheumatological structures are established only in some of the German faculties of medicine. Structural improvements happen in small steps only but were achieved at several sites. The better the local structures, the higher the chances of committed university teachers in rheumatology to reach all medical students. Probably from 2026 onwards, the learning objectives relevant for examinations will be defined by the national competence-based catalogue of learning objectives in medicine (NKLM), which is currently in the final stages of completion together with the German Federal Institute for Medical and Pharmaceutical Examinations (IMPP). It now appears that systemic autoimmune diseases and inflammatory rheumatic diseases are adequately depicted in this catalogue. If this is achieved, students will know more about these diseases in the future and will diagnose them faster in patients. Work on the NKLM is therefore of highest importance. In addition to the work on the learning objectives, up to date learning materials are required, which have to be available throughout Germany. A Rheumatology script just finished by the committee for medical student education of the German Society of Rheumatology (DGRh) and now available on the DGRh homepage should close this gap.
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Affiliation(s)
- M Aringer
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III und UniversitätsCentrum für Autoimmun- und Rheumatische Erkrankungen (UCARE), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Baerwald
- Rheumatologie, Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - R Bergner
- Sektion Rheumatologie, Medizinische Klinik A, Klinikum der Stadt Ludwigshafen am Rhein, Ludwigshafen am Rhein, Deutschland
| | - M Feuchtenberger
- InnKlinikum Altötting und Mühldorf, Standort Burghausen, Burghausen, Deutschland
| | - C Gebhardt
- Medizinische Klinik IV, Sektion Rheumatologie und klinische Immunologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Hagen
- Medizinische Klinik 3, Klinik für Rheumatologie und Immunologie, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - G Keyßer
- Arbeitsbereich Rheumatologie, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle/Saale, Deutschland
| | - H-M Lorenz
- Sektion Rheumatologie, Med. Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
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Abstract
This article focuses on the training situation of rheumatologists from the perspective of trainers regarding the existing and potentially increasing deficits of specialists for internal medicine and rheumatology. According to the new regulations defining the rheumatologist training, a substantial part of the training schedule is required to be completed in a hospital setting in order to become a specialist rheumatologist. In this context, the increased training capacity necessitates additional hospital training positions. In addition, the rheumatology residents desire a structured training program. Significantly, the work-life balance is an important factor to make working as a specialist for internal medicine and rheumatology more attractive.
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Affiliation(s)
- A Pfeil
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - M Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - G Keyßer
- Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
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Pfeil A, Baerwald CGO, Sieburg M, Boche K, Kupka TA, Linde T, Heldmann F, Unger L, Oelzner P, Aringer M, Keyßer G. [Future of rheumatologists: what are the perspectives? : Survey of resident physicians in rheumatology in middle Germany]. Z Rheumatol 2020; 79:168-174. [PMID: 31570975 DOI: 10.1007/s00393-019-00713-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE The work environment for rheumatologists has significantly changed over the last years. The healthcare of patients with rheumatic diseases is at risk due to the age structure of specialized rheumatologists in middle Germany and the limited availability of training positions for rheumatologists. In this context, it is important to have detailed information on the resident physicians in rheumatology concerning their own visions regarding their future professional career. MATERIAL AND METHODS A questionnaire was sent to resident physicians in 25 rheumatology training hospitals in the middle of Germany (Saxony, Saxony-Anhalt and Thuringia). The questionnaire was completed and returned by 27 participants (17 women and 10 men). RESULTS Most of the participants (60%) aimed to qualify as a specialist in internal medicine followed by a specialization in rheumatology (altogether training for a minimum of 8 years). After finishing training 44% would prefer to work in an outpatient setting while 30% planned to work in a combined outpatient and clinical setting. Of the participants 48% would prefer to work as part-time rheumatologists and 74% (women 94% and men 40%) were interested in employment in an outpatient medical healthcare center. The compatibility of family and work as well as the work-life balance was considered to be highly relevant for the future professional life. CONCLUSION Less than half of the participants intended to work exclusively in an outpatient setting after completing the training in rheumatology. In addition, the participants preferred a part-time employment with compatibility of professional and private life. Consequently, alternative models of employment should be created in rheumatology to be attractive for future physicians. On the other hand, the study revealed that the independent rheumatological practice has a lower priority for the young rheumatologists taking part in this survey.
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Affiliation(s)
- A Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - C G O Baerwald
- Department für Innere Medizin, Neurologie und Dermatologie, Sektion Rheumatologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - M Sieburg
- Rheumatologische Facharztpraxis, Domplatz 11, 39104, Magdeburg, Deutschland
| | - K Boche
- Praxis für Internistische Rheumatologie, Dres. Boche, Hamann, Teich, Käthe-Kollwitz-Straße 9, 04109, Leipzig, Deutschland
| | - T A Kupka
- Rheumazentrum Kupka, Johann-Sebastian-Bach-Str. 2, 04600, Altenburg, Deutschland
| | - T Linde
- Rheumatologische Gemeinschaftspraxis Dr. med. Linde, Dr. med. Wagner, Dr. med. Wilke, Ludwig-Wucherer-Str. 10, 06108, Halle, Deutschland
| | - F Heldmann
- Klinik für Rheumatologie, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstr. 101, 09130, Chemnitz, Deutschland
| | - L Unger
- I. Medizinische Klinik, Städtisches Klinikum Dresden, Friedrichstr. 41, 01067, Dresden, Deutschland
| | - P Oelzner
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland
| | - M Aringer
- Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Medizinische Klinik und Poliklinik III, Rheumatologie, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - G Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
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Zipfel N, Dießel L, Delank KS, Keyßer G, Schäfer C. Langsam progrediente Gelenkzerstörung bei einem älteren Mann als Ausdruck einer Hydroxylapatiterkrankung. Fallbericht und Literaturübersicht. Z Rheumatol 2020; 79:195-199. [DOI: 10.1007/s00393-020-00745-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
ZusammenfassungWir berichten über einen 75-jährigen männlichen Patienten mit seit 10 Jahren bestehenden Arthralgien der großen Gelenke. Klinisch fand sich eine Bursitis des rechten Ellenbogengelenkes. Laborchemisch zeigte sich eine Entzündungskonstellation, und röntgenologisch ergaben sich erosive Gelenkdestruktionen. Es erfolgte eine operative Bursektomie. Histologisch konnten in der Alizarinrotfärbung Hydroxylapatitkristalle nachgewiesen und die Diagnose einer Kristallarthropathie gestellt werden. Die Diagnostik ist schwierig, da die Kristalle nur elektronenmikroskopisch oder mittels Spezialfärbungen nachgewiesen werden können.
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Schlieker R, Keyßer G. [Establishment of the current classification criteria for axial spondylarthritis, rheumatoid arthritis and SLE in routine practice of German rheumatologists]. Z Rheumatol 2019; 78:979-986. [PMID: 31346705 DOI: 10.1007/s00393-019-0677-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In Germany, the numbers of patients with spondylarthritides (SpA) and rheumatoid arthritis (RA) have increased. This rise was possibly promoted by the introduction of new classification criteria (CC) that enable an earlier recognition and the inclusion of less severe cases. The study explores how the new CC for axial SpA (axSpA) are incorporated into the clinical practice, compared with the CC for RA and systemic lupus erythematosus (SLE). In addition, the study investigated whether the new entity of non-radiographic axSpA (nr-axSpA) is accepted and used in Germany. MATERIAL AND METHODS In 2016, an online survey was performed among all rheumatologists registered in the German Society of Rheumatology (DGRh). In addition, 150 rheumatologists were invited to the survey at the national meeting of the DGRh in 2016. RESULTS Among 119 participating rheumatologists, 99% were familiar with the new CC for SpA and 82% applied them in practice (RA 99% and 80%, SLE 50% and 56%). 78% differentiated between radiographic and nr-axSpA and 80% believed that a significant proportion of patients with nr-axSpA will never develop radiographic changes. 91% agreed that the new CC facilitated an earlier treatment start and 58% that the CC enabled more patients to receive biologicals. 50% shared the opinion that the criterion "chronic back pain" could lead to the classification of too many patients as having axSpA. It deemed possible to 65% that patients with nr-axSpA would be treated with biologicals in whom the diagnosis of axSpA could not be confirmed later on. 81% voted against the initiation of TNF inhibitors in nr-axSpA patients with normal CRP levels and normal MRI. 67% interpreted the MRI themselves and 30% stated that the MRI is evaluated according to validated standards by the radiologists. Among all axSpA criteria, HLA B27 and inflammatory back pain received the highest significance and the response to NSAID the lowest. CONCLUSION The new CC and the entity of nr-axSpA are accepted by German rheumatologists. A relevant proportion saw weaknesses of the new CC in the differentiation between nr-axSpA and non-specific chronic back pain. In practise, the interpretation of the CC with respect to the start of biologics is relatively strict, especially in cases with normal CRP and MRI. A ranking of axSpA criteria is commonly applied, although this was not initially intended in the CC.
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Affiliation(s)
- R Schlieker
- Klinik für Innere Medizin II, Arbeitsbereich Rheumatologie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland
| | - G Keyßer
- Klinik für Innere Medizin II, Arbeitsbereich Rheumatologie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle (Saale), Deutschland.
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Zipfel N, Schlüter A, Keyßer G, Schäfer C. Ein 34-jähriger Patient mit retropharyngealer Tendinitis. Z Rheumatol 2019; 78:458-460. [DOI: 10.1007/s00393-019-0620-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kendzierski T, Schneider I, Kraya T, Stoltenburg-Didinger G, Schäfer C, Keyßer G, Zierz S. P16. Overlap Myositis in Felty Syndrome with mitochondrial affection. Clin Neurophysiol 2018. [DOI: 10.1016/j.clinph.2018.04.658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Keyßer G. Erfolg für eine neue Generation von Basistherapeutika. Z Rheumatol 2017; 76:461-462. [DOI: 10.1007/s00393-017-0307-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Keyßer G, Oye S, Feist T, Liebhaber A, Babinsky K, Schobess R, Boldemann RD, Wagner S, Linde T. [Improvement of the diagnostic accuracy in patients with suspected rheumatic disease by preselection in the early arthritis clinic : An alternative to the appointment service point model of the Healthcare Improvement Act]. Z Rheumatol 2017; 75:812-818. [PMID: 27270954 DOI: 10.1007/s00393-016-0099-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The diagnosis and treatment of inflammatory rheumatic diseases can be delayed by a long waiting period for an appointment with a rheumatologist. This study investigated whether preselection of patients in an early arthritis clinic is a suitable tool to improve this situation. In 2006 an early arthritis clinic was founded by the Collaborating Center of Rheumatology in Halle (Saale). General practitioners refer patients by using a special registration form that helps to identify patients with an early joint swelling or inflammatory back pain. Patients are then allocated to a pool of participating rheumatologists and are seen by one of them within 2 weeks. For our scientific evaluation the data of 248 patients from the early arthritis clinic and data of 187 regular patients were gathered by means of an additional questionnaire for rheumatologists and patients. In the early arthritis clinic 40.3 % of patients received the diagnosis of an inflammatory rheumatic disease compared with 19.3 % in the control group. In the latter group 51 % were diagnosed as having degenerative joint or spine disorders compared with 22 % in patients from the early arthritis clinic; however, 61 % of patients who were referred to the early arthritis clinic did not fulfill the criteria of the registration form. On the other hand, patients in this group fulfilling these criteria had an inflammatory rheumatic disease in 68.1 % of the cases. The mean duration of symptoms at the time of first rheumatological consultation was significantly shorter in the early arthritis clinic than in the control group (6 vs. 39 months). Our data demonstrate that the preselection of patients can serve as a useful instrument to guide the referral of patients to rheumatologists. The high percentage of patients who did not fulfil the criteria of the registration form indicates that a further improvement of this form is necessary and stresses the need for intensive communication between rheumatologists and general practitioners. Early arthritis clinics may be an alternative to the current efforts of the legislative authorities to improve specialist care by centralized distribution of specialist appointments.
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Affiliation(s)
- G Keyßer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland.
| | - S Oye
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland
| | - T Feist
- Rheumatologische Facharztpraxis, Kleine Marktstr. 3, 06108, Halle (Saale), Deutschland
| | - A Liebhaber
- Rheumatologische Facharztpraxis, Pestalozzistr. 2a, 06128, Halle (Saale), Deutschland
| | - K Babinsky
- Rheumatologische Facharztpraxis, Pestalozzistr. 2a, 06128, Halle (Saale), Deutschland
| | - R Schobess
- Orthopädische Facharztpraxis, Geiststr. 15, 06108, Halle (Saale), Deutschland
| | - R-D Boldemann
- Rheumatologische Facharztpraxis, Domplatz 11, 39104, Magdeburg, Deutschland
| | - S Wagner
- Rheumatologische Facharztpraxis, Ludwig-Wucherer-Str. 10, 06108, Halle (Saale), Deutschland
| | - T Linde
- Rheumatologische Facharztpraxis, Ludwig-Wucherer-Str. 10, 06108, Halle (Saale), Deutschland
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Keyßer G. Die Auswirkungen der Ernährung auf das Erkrankungsrisiko und den Verlauf der rheumatoiden Arthritis. AKTUEL RHEUMATOL 2015. [DOI: 10.1055/s-0035-1548924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- G. Keyßer
- Department für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle (Saale), Halle (Saale)
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Schmitt M, Müller L, Keyßer G, Lorenz HM, Ho A, Wuchter P. Zelltherapie in der Rheumatologie: Chancen und Risiken der Therapie mit mesenchymalen Stromazellen. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1395611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Schmitt
- Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg
| | - L. Müller
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Innere Medizin IV
| | - G. Keyßer
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Innere Medizin II, Arbeitsbereich Rheumatologie
| | - H.-M. Lorenz
- Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg
| | - A. Ho
- Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg
| | - P. Wuchter
- Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universitätsklinikum Heidelberg, Universität Heidelberg, Heidelberg
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Keyßer G. Klinische Charakteristika und Laborbefunde von Polymyalgia rheumatica (PMR) und Riesenzellarteriitis (RZA). AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1374626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G. Keyßer
- Abteilung für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale)
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Keyßer G, Dejaco C, Fiehn C. Polymyalgia rheumatica, Arteriitis temporalis, Riesenzell-Arteriitis: Aktuelles zur Krankheitsentstehung, Diagnostik und Behandlung. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1377014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Keyßer G. Polymyalgia rheumatica, Arteriitis temporalis, Riesenzell-Arteriitis: Begriffsbestimmung und Epidemiologie. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1374606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G. Keyßer
- Abteilung für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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Keyßer G. Differenzialdiagnose der Polymyalgia rheumatica (PMR) und der Riesenzell-Arteriitis (RZA). AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1374607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G. Keyßer
- Abteilung für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle (Saale)
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Keyßer G, Lupatsch F. Histologische Sicherung der Arteriitis temporalis (AT) mittels Biopsie: Indikation, Durchführung, Interpretation. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1374627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- G. Keyßer
- Abteilung für Innere Medizin, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale)
| | - F. Lupatsch
- Institut für Pathologie, Universitätsklinikum Halle, Halle (Saale)
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Tarner IH, Albrecht K, Fleck M, Gromnica-Ihle E, Keyßer G, Köhler L, Kötter I, Krüger K, Kuipers J, Nüßlein H, Rubbert-Roth A, Wollenhaupt J, Schneider M, Manger B, Müller-Ladner U. [Evidence-based recommendations for the management of undifferentiated peripheral inflammatory arthritis (UPIA). The German perspective on the international 3e initiative]. Z Rheumatol 2014; 73:363-73. [PMID: 24590079 DOI: 10.1007/s00393-013-1249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Peripheral arthritis is the most common presenting complaint in clinical rheumatology. Unequivocal identification of the underlying entity can be difficult, particularly at an early stage. Such cases are commonly referred to as undifferentiated peripheral inflammatory arthritis (UPIA). Since evidence-based recommendations for the clinical management of UPIA are lacking, this international 3e initiative convened 697 rheumatologists from 17 countries to develop appropriate recommendations. METHODS Based on a systematic literature research in Medline, EMBASE, Cochrane Library, and the ACR/EULAR abstracts of 2007/2008, 10 multinational recommendations were developed by 3 rounds of a Delphi process. In Germany, a national group of experts worked on 3 additional recommendations using the same method. The recommendations were discussed among the members of the 3e initiative and the degree of consensus was analyzed as well as the potential impact of the recommendations on clinical practice. RESULTS A total of 39,756 references were identified, of which 250 were systematically reviewed for the development of 10 multinational recommendations concerning differential diagnosis, diagnostic and prognostic value of clinical assessments, laboratory tests and imaging techniques, and monitoring of UPIA. In addition, 3 national recommendations on the diagnostic and prognostic value of a response to anti-inflammatory therapy on the analysis of synovial fluid and on enthesitis were developed by the German experts based on 35 out of 5542 references. CONCLUSIONS The article translates the 2011 published original paper of the international 3e initiative (Machado et al., Ann Rheum Dis 70:15-24, 2011) and reports the methods and results of the national vote and the additional 3 national recommendations.
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Affiliation(s)
- I H Tarner
- Abt. für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin,Kerckhoff-Klinik, Lehrstuhl für Innere Medizin mit Schwerpunkt Rheumatologie, Justus-Liebig-Universität Gießen, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
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Schmitt M, Müller LP, Keyßer G, Lorenz HM, Ho AD, Wuchter P. [Mesenchymal stroma cells (MSCs) for the treatment of rheumatic disease]. Dtsch Med Wochenschr 2013; 138:1852-5. [PMID: 24006170 DOI: 10.1055/s-0033-1343346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- M Schmitt
- Universitätsklinikum Heidelberg, Medizinische Klinik V (Hämatologie, Onkologie, Rheumatologie), Universität Heidelberg, Heidelberg
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Keyßer G. Früher Einsatz von Biologika bei der rheumatoiden Arthritis nach erstem DMARD - contra. Dtsch Med Wochenschr 2013; 138:1851. [DOI: 10.1055/s-0033-1343334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- G. Keyßer
- Arbeitsbereich Rheumatologie, Universitätsklinik und Poliklinik für Innere Medizin II, Halle
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Frenzen K, Schäfer C, Keyßer G, Spielmann RP. Niederfeld-Magnetresonanztomografie zeigt erosive und entzündliche Gelenkveränderungen an der Hand bei Hämochromatose- Arthropathie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Keyßer G. [Conventional basis therapy of rheumatoid arthritis. Effects within and outside cells]. Z Rheumatol 2012; 71:468-72. [PMID: 22802023 DOI: 10.1007/s00393-011-0878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conventional disease-modifying antirheumatic drugs (DMARDs) were formerly introduced into the treatment of rheumatoid arthritis and other rheumatic disorders on an empirical basis. In many cases their mode of action is only partially understood but as a rule of thumb they act on more than one point within the cellular metabolism. Less often they exert biological effects in the extracellular space or on the cell membrane.
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Affiliation(s)
- G Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06097, Halle (Saale), Deutschland.
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Keyßer G. Die Schulter bei internistischen Erkrankungen. AKTUEL RHEUMATOL 2011. [DOI: 10.1055/s-0031-1273780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tarner I, Manger B, Fleck M, Gromnica-Ihle E, Keyßer G, Köhler L, Kötter I, Krüger K, Kuipers J, Lorenz HM, Nüßlein H, Rau R, Rubbert A, Schröder J, Wollenhaupt J, Müller-Ladner U. Evidenzbasierte Empfehlungen einer nationalen Expertenrunde zum Einsatz von Methotrexat bei entzündlich-rheumatischen Erkrankungen. AKTUEL RHEUMATOL 2009. [DOI: 10.1055/s-0028-1119370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rossol M, Pierer M, Arnold S, Keyßer G, Burkhardt H, Baerwald C, Wagner U. Homozygosity for DNASE2 single nucleotide polymorphisms in the 5′-regulatory region is associated with rheumatoid arthritis. Ann Rheum Dis 2008; 68:1498-503. [DOI: 10.1136/ard.2008.092239] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:To analyse the distribution of single nucleotide polymorphisms (SNPs) in the 5′-regulatory region of the DNASE2 gene, in patients with rheumatoid arthritis (RA) and healthy controls.Methods:A total of 906 patients with RA and 878 healthy controls were genotyped. All subjects were of German Caucasian origin. Genotyping was performed by real-time polymerase chain reaction technology, using a TaqMan 5′-allele discrimination assay.Results:In the initial analysis of unrelated case–control samples, three DNASE2 SNP alleles in the 5′-regulatory region were significantly more frequent in patients with RA than in healthy controls. The strongest association was found for the −1066G allele (33.5% vs 27.2%, p = 0.007, odds ratio (OR) = 1.34). Homozygosity for this allele (genotype GG) resulted in an additional increase in disease susceptibility (12.5% vs 6.2%, OR = 2.17). The association was replicated in a second case–control series of 483 patients with RA from two German multicentre studies and 474 controls. The association of DNASE2 −1066 GG homozygosity with RA was limited to rheumatoid factor-positive disease, but was not influenced by the presence of anti-cyclic citrullinated peptide or antinuclear antibodies. Similarly, the presence or absence of the HLA-DRB1 shared epitope or the RA-associated PTPN22 allele had no influence on this association.Conclusions:The association of SNPs in the 5′-regulatory region of the DNA degrading enzyme DNASE2 with RA implies a role for this enzyme in the pathogenesis of this autoimmune disease.
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Keyßer G. Nachweis der Expression von Cathepsin L und D in der Synovialmembran bei Rheumatoider Arthritis und degenerativen Gelenkerkrankungen mittels In-situ-Hybridisation. AKTUEL RHEUMATOL 2008. [DOI: 10.1055/s-2008-1043750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Keyßer G. Klinische Studien entzündlich-rheumatischer Erkrankungen in der Ernährungsmedizin. AKTUEL RHEUMATOL 2007. [DOI: 10.1055/s-2007-963239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Keyßer G. Autoimmunphänomene und Autoimmundiagnostik. AKTUEL RHEUMATOL 2003. [DOI: 10.1055/s-2003-45037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schenk D, Schmeling H, Sauer H, Keyßer G, Horneff G. Diagnose eines Sjögren-Syndroms mit Autoimmunhepatitis und Polyarthritis. AKTUEL RHEUMATOL 2003. [DOI: 10.1055/s-2003-45061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Keyßer G. Virale Infektionen als potenzielle Auslöser rheumatischer Erkrankungen. AKTUEL RHEUMATOL 2002. [DOI: 10.1055/s-2002-33135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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