1
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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. [Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST]. Z Rheumatol 2024; 83:257-268. [PMID: 37566120 PMCID: PMC11058970 DOI: 10.1007/s00393-023-01395-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | | | - Michael N Berliner
- Rheumatologie und Geriatrie, Helios Klinikum Berlin-Buch, Berlin, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum Bad Abbach, Bad Abbach, Deutschland
| | - Gernot Keyßer
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Andreas Krause
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bernhard Manger
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Florian Schuch
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Deutschland
| | | | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - Matthias Raspe
- Klinik für Pneumologie, Beatmungsmedizin und Intensivmedizin mit dem Arbeitsbereich Schlafmedizin Charité - Campus Virchow-Klinikum, Charité - Universitätsmedizin, Berlin, Deutschland
| | - Martin Krusche
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Alexander Pfeil
- Klinik für Innere Medizin III, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Am Klinikum 1, 07747, Jena, Deutschland.
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Hasseli R, Hanses F, Stecher M, Specker C, Weise T, Borgmann S, Hasselberger M, Hertenstein B, Hower M, Hoyer BF, Koll C, Krause A, von Lilienfeld-Toal M, Lorenz HM, Merle U, Nunes de Miranda SM, Pletz MW, Regierer AC, Richter JG, Rieg S, Roemmele C, Ruethrich MM, Schmeiser T, Schulze-Koops H, Strangfeld A, Vehreschild MJ, Voit F, Voll RE, Vehreschild JJ, Müller-Ladner U, Pfeil A. The protective effect of tumor necrosis factor-alpha inhibitors in COVID-19 in patients with inflammatory rheumatic diseases compared to the general population-A comparison of two German registries. Front Med (Lausanne) 2024; 11:1332716. [PMID: 38510457 PMCID: PMC10953502 DOI: 10.3389/fmed.2024.1332716] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/22/2024] Open
Abstract
Objectives To investigate, whether inflammatory rheumatic diseases (IRD) inpatients are at higher risk to develop a severe course of SARS-CoV-2 infections compared to the general population, data from the German COVID-19 registry for IRD patients and data from the Lean European Survey on SARS-CoV-2 (LEOSS) infected patients covering inpatients from the general population with SARS-CoV-2 infections were compared. Methods 4310 (LEOSS registry) and 1139 cases (IRD registry) were collected in general. Data were matched for age and gender. From both registries, 732 matched inpatients (LEOSS registry: n = 366 and IRD registry: n = 366) were included for analyses in total. Results Regarding the COVID-19 associated lethality, no significant difference between both registries was observed. Age > 65°years, chronic obstructive pulmonary disease, diabetes mellitus, rheumatoid arthritis, spondyloarthritis and the use of rituximab were associated with more severe courses of COVID-19. Female gender and the use of tumor necrosis factor-alpha inhibitors (TNF-I) were associated with a better outcome of COVID-19. Conclusion Inflammatory rheumatic diseases (IRD) patients have the same risk factors for severe COVID-19 regarding comorbidities compared to the general population without any immune-mediated disease or immunomodulation. The use of rituximab was associated with an increased risk for severe COVID-19. On the other hand, the use of TNF-I was associated with less severe COVID-19 compared to the general population, which might indicate a protective effect of TNF-I against severe COVID-19 disease.
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Affiliation(s)
- Rebecca Hasseli
- Section of Rheumatology and Clinical Immunology, Department of Internal Medicine D, University Hospital Münster, Münster, Germany
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Frank Hanses
- Emergency Department and Department for Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | | | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | | | | | - Martin Hower
- Department of Pneumology, Infectious Diseases, Internal Medicine and Intensive Care, Klinikum Dortmund GmbH, Dortmund, Germany
| | - Bimba F. Hoyer
- Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein, Kiel, Germany
| | - Carolin Koll
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Department of Internal Medicine V, University of Heidelberg, Heidelberg, Germany
| | - Uta Merle
- Department of Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Anne C. Regierer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Jutta G. Richter
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
- Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich-Heine-University, Düsseldorf, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg, Freiburg, Germany
| | - Christoph Roemmele
- Department of Gastroenterology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Maria M. Ruethrich
- Department of Hematology and Medical Oncology, University Hospital Jena, Jena, Germany
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Maria J.G.T. Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Voit
- Department of Internal Medicine II, School of Medicine, University Hospital Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Jörg Janne Vehreschild
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Department II of Internal Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Giessen, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
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Yazdany J, Ware A, Wallace ZS, Bhana S, Grainger R, Hachulla E, Richez C, Cacoub P, Hausmann JS, Liew JW, Sirotich E, Jacobsohn L, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Ribeiro SLE, Al-Emadi S, Hasseli R, Müller-Ladner U, Specker C, Schulze-Koops H, Bernardes M, Fraga VM, Rodrigues AM, Sparks JA, Ljung L, Di Giuseppe D, Tidblad L, Wise L, Duarte-García A, Ugarte-Gil MF, Colunga-Pedraza IJ, Martínez-Martínez MU, Alpizar-Rodriguez D, Xavier RM, Isnardi CA, Pera M, Pons-Estel G, Izadi Z, Gianfrancesco MA, Carrara G, Scirè CA, Zanetti A, Machado PM. Impact of Risk Factors on COVID-19 Outcomes in Unvaccinated People With Rheumatic Diseases: A Comparative Analysis of Pandemic Epochs Using the COVID-19 Global Rheumatology Alliance Registry. Arthritis Care Res (Hoboken) 2024; 76:274-287. [PMID: 37643903 DOI: 10.1002/acr.25220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/03/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Approximately one third of individuals worldwide have not received a COVID-19 vaccine. Although studies have investigated risk factors linked to severe COVID-19 among unvaccinated people with rheumatic diseases (RDs), we know less about whether these factors changed as the pandemic progressed. We aimed to identify risk factors associated with severe COVID-19 in unvaccinated individuals in different pandemic epochs corresponding to major variants of concern. METHODS Patients with RDs and COVID-19 were entered into the COVID-19 Global Rheumatology Alliance Registry between March 2020 and June 2022. An ordinal logistic regression model (not hospitalized, hospitalized, and death) was used with date of COVID-19 diagnosis, age, sex, race and/or ethnicity, comorbidities, RD activity, medications, and the human development index (HDI) as covariates. The main analysis included all unvaccinated patients across COVID-19 pandemic epochs; subanalyses stratified patients according to RD types. RESULTS Among 19,256 unvaccinated people with RDs and COVID-19, those who were older, male, had more comorbidities, used glucocorticoids, had higher disease activity, or lived in lower HDI regions had worse outcomes across epochs. For those with rheumatoid arthritis, sulfasalazine and B-cell-depleting therapy were associated with worse outcomes, and tumor necrosis factor inhibitors were associated with improved outcomes. In those with connective tissue disease or vasculitis, B-cell-depleting therapy was associated with worse outcomes. CONCLUSION Risk factors for severe COVID-19 outcomes were similar throughout pandemic epochs in unvaccinated people with RDs. Ongoing efforts, including vaccination, are needed to reduce COVID-19 severity in this population, particularly in those with medical and social vulnerabilities identified in this study.
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Affiliation(s)
| | - Anna Ware
- National Center for Collaborative Healthcare Innovation, Palo Alto Department of Veterans Affairs Healthcare System, Palo Alto, California
| | | | | | - Rebecca Grainger
- University of Otago Wellington and Te Whatu Ora, Health New Zealand Capital, Coast and Hutt Valley, Wellington, New Zealand
| | - Eric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre Hospitalier Universitaire (CHU) de Lille, pour la Filière des maladies Auto-Immunes et Autoinflammatoires Rares, Lille, France
| | - Christophe Richez
- Service de Rhumatologie, Centre de référence des maladies autoimmunes systémiques rares de l'Est et du Sud-Ouest de France, CHU de Bordeaux, pour la Société Française de Rhumatologie, Bordeaux, France
| | - Patrice Cacoub
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Société Nationale Française de Médecine Interne, Paris, France
| | - Jonathan S Hausmann
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jean W Liew
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | | | - Anja Strangfeld
- German Rheumatism Research Center and Charité University Hospital, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal, and European Alliance of Associations for Rheumatology, Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique and AP-HP, Pitié-Salpêtrière hospital, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | | | | | - Rebecca Hasseli
- University Hospital Munster, Munster, Germany, and Justus Liebig University Giessen, Kerckhoff, Germany
| | | | | | | | - Miguel Bernardes
- University of Porto and Centro Hospitalar e Universitário de São João, Porto, Portugal
| | | | - Ana Maria Rodrigues
- Sociedade Portuguesa de Reumatologia and Comprehensive Health Research Centre, Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jeffrey A Sparks
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lotta Ljung
- Karolinska Institutet and Academic Specialist Centre, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | | | | | - Leanna Wise
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Manuel F Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémica, Universidad Científica del Sur and Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Peru
| | | | | | | | - Ricardo Machado Xavier
- Universidade Federal do Rio Grande do Sul, Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Mariana Pera
- Hospital Angel C. Padilla, San Miguel de Tucuman, Tucuman, Argentina
| | - Guillermo Pons-Estel
- Universidad Nacional de Rosario, Rosario, Argentina, and College of Physicians of the Province of Santa Fe 2nd, Santa Fe, Argentina
| | | | | | | | - Carlo Alberto Scirè
- Italian Society for Rheumatology and School of Medicine, University of Milano-Bicocca, Milan, Italy
| | | | - Pedro M Machado
- University College London, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, and Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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4
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Proft F, Vossen D, Baraliakos X, Berliner MN, Fleck M, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Raspe M, Krusche M, Pfeil A. Survey on the working, training, and research conditions of resident physicians in internistic and rheumatological continuing education-BEWUSST. Z Rheumatol 2024; 83:31-39. [PMID: 37847298 PMCID: PMC10879383 DOI: 10.1007/s00393-023-01433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Data on the training and continuing education situation of residents in the field of internal medicine and rheumatology are not available for Germany. For this reason, the Commission for Education and Training of the German Society of Rheumatology (DGRh) initiated the BEWUSST survey on the working, training and research conditions of residents in rheumatology. METHODS A total of 102 questions on the topics of working conditions in everyday professional life, continuing medical education and training, compatibility of career and family, compatibility of work and research, perspectives as a rheumatologist and practical activities were included in an online questionnaire. RESULTS A total of 102 participants took part in the survey. Of the respondents 48.1% were satisfied with their professional situation, 40.2% of the participants were supervised by a specialist mentor and 54.9% were working as scientists during their work as a physician. A compatibility of family and career was possible for 34.7%. After completion of the residency 52.9% of the respondents aspired to a combined clinical and outpatient activity. CONCLUSION Half of the trainee rheumatologists are satisfied with their professional activities, although mentoring of the assistants in training should be further improved. With respect to the desired combined clinical and outpatient activity, the existing options should be expanded or new professional fields of activity should be established, so that the specialty remains attractive for the upcoming generations.
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Affiliation(s)
- Fabian Proft
- Department of Gastroenterology, Infectiology and Rheumatology (including Nutrition Medicine), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Diana Vossen
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Germany
| | | | - Michael N Berliner
- Rheumatology and Geriatrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Martin Fleck
- Clinic and Polyclinic for Internal Medicine I, University Hospital Regensburg, Regenburg, Germany
- Clinic and Polyclinic for Rheumatology/Clinical Immunology, Asklepios Klinikum Bad Abbach, Bad Abbach, Germany
| | - Gernot Keyßer
- Department of Internal Medicine, Clinic for Internal Medicine II, University Hospital Halle, Halle (Saale), Germany
| | - Andreas Krause
- Clinic for Internal Medicine, Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Bernhard Manger
- Medical Clinic 3, Rheumatology and Immunology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Florian Schuch
- Internal Practice Group Rheumatology-Nephrology, Erlangen, Germany
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Germany
| | | | | | - Matthias Raspe
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Krusche
- Section for Rheumatology and Inflammatory Systemic Diseases, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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5
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Braun J, Krause A, Schulze-Koops H, Haase I, Kötter I, Hoyer BF, Aringer M, Krusche M, Voormann AJ, Wagner U, Schwarting A, Specker C. [Discipline-specific assessment of the report of the German Society of Internal Medicine e.V. (DGIM) on depiction of the treatment landscape in the field of internal medicine in Germany by the German Society for Rheumatology e.V. (DGRh)]. Z Rheumatol 2023; 82:798-813. [PMID: 37493709 DOI: 10.1007/s00393-023-01375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Affiliation(s)
- Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - Isabell Haase
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Ina Kötter
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin des Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Kiel, Deutschland
| | - Martin Aringer
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - Anna Julia Voormann
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Andreas Schwarting
- Abteilung Rheumatologie und klinische Immunologie, I. Medizinische Klinik der Universität Mainz, Mainz, Deutschland
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie, Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
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6
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Braun J, Specker C, Schulze-Koops H, Haase I, Kötter I, Hoyer B, Aringer M, Krusche M, Voormann A, Wagner U, Krause A. [Position paper of the German Society of Rheumatology e.V. (DGRh) regarding the situation of advanced training in the discipline of rheumatology in Germany]. Z Rheumatol 2023; 82:615-620. [PMID: 37335384 DOI: 10.1007/s00393-023-01349-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 06/21/2023]
Affiliation(s)
- J Braun
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- c/o Praxis Dr. Karberg, Schlossstr. 110, 12163, Berlin, Deutschland
- Ruhr Universität Bochum, Bochum, Deutschland
| | - C Specker
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, KEM | Evangelische Kliniken Essen-Mitte gGmbH, Essen, Deutschland
| | - H Schulze-Koops
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, LMU München, München, Deutschland
| | - I Haase
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Hiller Forschungszentrum, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - I Kötter
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - B Hoyer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Sektion Rheumatologie und Exzellenzzentrum für Entzündungsmedizin, Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität, Kiel, Deutschland
| | - M Aringer
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, Dresden, Deutschland
| | - M Krusche
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Klinik für Rheumatologie und Immunologie am Klinikum Bad Bramstedt und Sektion für Rheumatologie und Entzündliche Systemerkrankungen in der III. Medizin des Universitätsklinikum Eppendorf (UKE), Hamburg, Deutschland
| | - A Voormann
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland.
| | - U Wagner
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Bereich Rheumatologie an der Klinik für Endokrinologie, Nephrologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Krause
- Deutschen Gesellschaft für Rheumatologie e. V., Wilhelmine-Gemberg-Weg 6, 10179, Berlin, Deutschland
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
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7
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Pfeil A, Krusche M, Proft F, Vossen D, Braun J, Baraliakos X, Berliner MN, Keyßer G, Krause A, Lorenz HM, Manger B, Schuch F, Specker C, Wollenhaupt J, Voormann A, Fleck M. [Rheumatology training positions in Germany]. Z Rheumatol 2023; 82:539-551. [PMID: 36264331 PMCID: PMC10495514 DOI: 10.1007/s00393-022-01284-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 10/24/2022]
Abstract
BACKGROUND In the next few years many general practitioners and specialists will retire. As in other disciplines the question arises in rheumatology whether sufficient training positions are available to maintain or expand the supply of care according to demand. Therefore, the German Society of Rheumatology (DGRh) has assigned its committee for education and training to review the currently available training opportunities in Germany. The aim of this work is the quantitative survey of the training capacity to become a specialist in internal medicine and rheumatology. METHODS Within the framework of this study, a survey was conducted via the homepages of the 17 state medical associations to determine the postgraduate medical officers, their place of work and the duration of their postgraduate training capabilities. Based on the data, a nationwide survey of training positions was conducted. RESULTS Specialized rheumatology training is established at 229 training centers in Germany, whereby data from 187 training sites were available for analysis. The training locations are distributed as followed: 52.4% clinical sector and 47.6% outpatient sector. In total, 478.4 training positions are available in Germany (clinical sector: 391.4 and outpatient sector: 87) and 17.2% of the positions (clinical sector: 11.4% and outpatient sector: 43.1%) are not occupied. CONCLUSION Based on this study, it can be shown that most of the continuing education positions are available in the clinical sector. In contrast, half of the training positions in the outpatient area are not filled. In order to improve the training situation, it is essential to integrate outpatient colleagues into the training program. This presupposes that further training is supported or financed by the healthcare system. In this context, optimal rheumatological care must be permanently guaranteed throughout Germany in order to provide sufficient care for the approximately 2 million patients with inflammatory rheumatic diseases.
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Affiliation(s)
- Alexander Pfeil
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland.
- Klinik für Innere Medizin III, Funktionsbereich Rheumatologie und Osteologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Deutschland.
| | - Martin Krusche
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg, Deutschland
| | - Fabian Proft
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland
| | - Diana Vossen
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheinisches Rheumazentrum Meerbusch-Lank, St. Elisabeth Hospital, Meerbusch, Deutschland
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - Xenofon Baraliakos
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - Michael N Berliner
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Rheumatologie und Geriatrie, Helios Klinikum Berlin-Buch, Berlin, Deutschland
| | - Gernot Keyßer
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Department für Innere Medizin, Klinik für Innere Medizin II, Universitätsklinikum Halle, Halle (Saale), Deutschland
| | - Andreas Krause
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik für Innere Medizin, Abteilung Rheumatologie, klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Bernhard Manger
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Medizinische Klinik 3, Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Florian Schuch
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Internistische Praxisgemeinschaft Rheumatologie - Nephrologie, Erlangen, Deutschland
| | - Christof Specker
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Deutschland
| | - Jürgen Wollenhaupt
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Immunologikum Hamburg, Hamburg, Deutschland
| | - Anna Voormann
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - Martin Fleck
- Kommission Fort- und Weiterbildung der Deutschen Gesellschaft für Rheumatologie, Berlin, Deutschland
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, Regenburg, Deutschland
- Asklepios Klinikum Bad Abbach, Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Bad Abbach, Deutschland
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8
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Hasseli R, Richter JG, Hoyer BF, Lorenz HM, Pfeil A, Regierer AC, Schmeiser T, Strangfeld A, Voll RE, Krause A, Reckert S, Gräßler A, Saar P, Kapelle A, Backhaus M, Blank N, Henes J, Osiek S, Knothe A, Hoese G, Brandt-Jürgens J, Maltzahn A, Specker C, Müller-Ladner U, Schulze-Koops H. Characteristics and outcomes of SARS-CoV-2 breakthrough infections among double-vaccinated and triple-vaccinated patients with inflammatory rheumatic diseases. RMD Open 2023; 9:rmdopen-2023-002998. [PMID: 37068915 PMCID: PMC10111193 DOI: 10.1136/rmdopen-2023-002998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/22/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE To analyse the clinical profile of SARS-CoV-2 breakthrough infections in at least double-vaccinated patients with inflammatory rheumatic diseases (IRDs). METHODS Data from the physician-reported German COVID-19-IRD registry collected between February 2021 and July 2022 were analysed. SARS-CoV-2 cases were stratified according to patients' vaccination status as being not vaccinated, double-vaccinated or triple-vaccinated prior to SARS-CoV-2 infection and descriptively compared. Independent associations between demographic and disease features and outcome of breakthrough infections were estimated by multivariable logistic regression. RESULTS In total, 2314 cases were included in the analysis (unvaccinated n=923, double-vaccinated n=551, triple-vaccinated n=803, quadruple-vaccinated n=37). SARS-CoV-2 infections occurred after a median of 151 (range 14-347) days in patients being double-vaccinated, and after 88 (range 14-270) days in those with a third vaccination. Hospitalisation was required in 15% of unvaccinated, 8% of double-vaccinated and 3% of triple-vaccinated/quadruple-vaccinated patients (p<0.001). Mortality was 2% in unvaccinated, 1.8% in the double-vaccinated and 0.6% in triple-vaccinated patients. Compared with unvaccinated patients, double-vaccinated (OR 0.43, 95% CI 0.29 to 0.62) and triple-vaccinated (OR 0.13, 95% CI 0.08 to 0.21) patients showed a significant lower risk of COVID-19-related hospitalisation. Using multivariable analysis, the third vaccination was significantly associated with a lower risk for COVID-19-related death (OR 0.26; 95% CI 0.01 to 0.73). CONCLUSIONS Our cross-sectional data of COVID-19 infections in patients with IRD showed a significant reduction of hospitalisation due to infection in double-vaccinated or triple-vaccinated patients compared with those without vaccination and even a significant reduction of COVID-19-related deaths in triple-vaccinated patients. These data strongly support the beneficial effect of COVID-19 vaccination in patients with IRD. TRIAL REGISTRATION NUMBER EuDRACT 2020-001958-21.
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Affiliation(s)
- Rebecca Hasseli
- Department of Internal Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Munster, Munster, Germany
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Jutta G Richter
- Clinic for Rheumatology, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
- Hiller Research Center, University Hospital Duesseldorf, Medical Faculty of Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bimba Franziska Hoyer
- Clinic for Internal Medicine I, Rheumatology and Clinical Immunology, University Medical Center Schleswig-Holstein Campus, Kiel, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | | | - Tim Schmeiser
- Rheumatology, Private Practice "Rheumatologie im Veedel" Cologne, Cologne, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
- Centre of Chronic Immunodeficiency, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | | | | | - Petra Saar
- Rheumatology, Private Practice Endokrinologikum, Frankfurt, Germany
| | | | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Academic Hospital of the Charité Berlin, Berlin, Germany
| | - Norbert Blank
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases (INDIRA) and Department of Internal Medicine II (Oncology, Haematology, Rheumatology and Clinical Immunology), University Hospital Tuebingen, Tuebingen, Germany
| | - Silke Osiek
- Rheumatology, Private Practice Dialysezentrum, Schweinfurt, Germany
| | - Anna Knothe
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Guido Hoese
- Rheumatology, Private Practice, Stadthagen, Germany
| | | | | | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Giessen, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig-Maximilians-University, Munich, Germany
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9
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Kernder A, Filla T, de Groot K, Hellmich B, Holle J, Lamprecht P, Moosig F, Ruffer N, Specker C, Vordenbäumen S, Schneider M, Chehab G. COVID-19 pandemic impairs medical care of vasculitis patients in Germany: Results of a national patient survey. Front Med (Lausanne) 2023; 9:1103694. [PMID: 36698843 PMCID: PMC9868561 DOI: 10.3389/fmed.2022.1103694] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,*Correspondence: Anna Kernder ✉
| | - Tim Filla
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Kirsten de Groot
- Medical Clinic III, Sana Klinikum Offenbach GmbH, Offenbach, Germany
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatolgie und Immunologie, Medius Klinik Kirchheim, University Tübingen, Kirchheim unter Teck, Germany
| | - Julia Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Nikolas Ruffer
- Department of Rheumatology and Immunology, Klinikum Bad Bramstedt GmbH, Bad Bramstedt, Germany,III Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Stefan Vordenbäumen
- Department of Rheumatology, St. Elisabeth-Hospital Meerbusch-Lank, Meerbusch, Germany
| | - Matthias Schneider
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
| | - Gamal Chehab
- Department of Rheumatology, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany,Hiller Research Center, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University, Düsseldorf, Germany
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10
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Schulze-Koops H, Skapenko A, Krause A, Krueger K, Lorenz HM, Sewerin P, Specker C, Wagner UG, Voormann A, Mueller-Ladner U, Voll RE. Correspondence to 'Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases'. Ann Rheum Dis 2023; 82:e1. [PMID: 33127664 DOI: 10.1136/annrheumdis-2020-218997] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alla Skapenko
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | | | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Philipp Sewerin
- Department and Hiller-Research-Unit fpr Rheumatology, University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte-KEM, Essen, Germany
| | - Ulf G Wagner
- Division of Rheumatology, Department for Endocrinology, Nephrology, Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie eV, Berlin, Germany
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.,Centre for Chronic Immunodeficiency, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany
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11
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Richter JG, Chehab G, Reiter J, Aries P, Muehlensiepen F, Welcker M, Acar H, Voormann A, Schneider M, Specker C. Evaluation of the use of video consultation in German rheumatology care before and during the COVID-19 pandemic. Front Med (Lausanne) 2022; 9:1052055. [PMID: 36507506 PMCID: PMC9732003 DOI: 10.3389/fmed.2022.1052055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background The COVID-19 pandemic led to transformations in healthcare infrastructures and increased use of (innovative) telemedicine (TM) tools. Comparison of the use of video consultation (VC) in rheumatology in the pre-pandemic period and during the pandemic might allow for evaluating this new form of consultancy in healthcare due to changing conditions and possibilities. Materials and methods Cross-sectional nationwide online survey among German rheumatologists and rheumatologists in training between March and May 2021 promoted by newsletters and Twitter posts. Results Results refer to 205 participants. The majority was male (59%), older than 40 years (90%). Thirty-eight percent stated to have employed TM before ("digital users"), 27% were using VC as part of their TM expertise ("VC-users"), 10% stated to have experience with TM but not VC ("TM-users"). Those negating the use of any TM (62%) were designated as "digital non-users." TM-Knowledge was self-rated as 4 [median on a Likert Scale 1 (very high) to 6 (very low)] with a significant difference between digital users (VC-user 2.7 ± 1.2, TM-user 3.2 ± 1.1) and digital non-users (4.4 ± 1.3). The reported significant increase of VC use during the lockdown periods and between the lockdowns compared to the pre-pandemic phase was regarded as a proxy for VC acceptance in the pandemic. Reasons for VC non-use were administrative/technical efforts (21%), lack of technical equipment (15%), time constraints (12%), time required for individual VC sessions (12%), inadequate reimbursement (11%), lack of demand from patients (11%), data security concerns (9%), poor internet connection (8%), and lack of scientific evaluation/evidence (5%). Physicians considered the following clinical situations to be particularly suitable for VC: follow-up visits (VC-user 79%, TM-user 62%, digital non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, digital non-user 20%), and patients presenting for the first time (VC-user 11%, TM-user 19%, digital non-user 8%). Conclusion Even though the pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms as VC, its use and acceptance remained comparatively low due to multiple reasons. This analysis may help identify hurdles in employing innovative digital care models for rheumatologic healthcare.
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Affiliation(s)
- Jutta G. Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany,*Correspondence: Jutta G. Richter,
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Joana Reiter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Welcker
- MVZ für Rheumatologie Dr. Martin Welcker GmbH and RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Hasan Acar
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
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12
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Specker C. Therapeutische Aspekte beim Antiphospholipidsyndrom. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1927-0834] [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: 11/06/2022]
Abstract
ZusammenfassungDas Antiphospholipidsyndrom (APS) wird klinisch durch venöse oder
arterielle Thrombosen sowie Schwangerschaftskomplikationen gekennzeichnet und
serologisch durch den Nachweis von Antiphospholipidantikörpern (aPL)
bzw. eines Lupusantikoagulans (LA). In den letzten Jahren wurde evident, dass
insbesondere bei Vorliegen aller drei serologischen Kriterien,
Antikörper gegen Cardiolipin (aCL), gegen ß2-Glykoprotein-1
(aß2-GP1) und ein positives Lupusantikoagulans, die sog.
Triple-Positivität, das Risiko für (weitere) thromboembolische
und geburtshilfliche Komplikationen deutlich erhöht ist. Therapeutisch
werden Thrombozytenaggregationshemmer (ASS), Heparin und Vitamin K Antagonisten
eingesetzt. Von der Verwendung direkter oraler Antikoagulantien beim APS wird
abgeraten. Eine Immunsuppression ist für die Vermeidung weiterer
thromboembolischer Komplikationen eines APS nicht wirksam.
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Affiliation(s)
- Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie,
Evangelische Kliniken Essen-Mitte, Essen, Germany
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13
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Richter JG, Chehab G, Stachwitz P, Hagen J, Larsen D, Knitza J, Schneider M, Voormann A, Specker C. One year of digital health applications (DiGA) in Germany - Rheumatologists' perspectives. Front Med (Lausanne) 2022; 9:1000668. [PMID: 36388899 PMCID: PMC9640713 DOI: 10.3389/fmed.2022.1000668] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Based on given legislation the German approach to digital health applications (DiGA) allows reimbursed prescription of approved therapeutic software products since October 2020. For the first time, we evaluated DiGA-related acceptance, usage, and level of knowledge among members of the German Society for Rheumatology (DGRh) 1 year after its legal implementation. MATERIALS AND METHODS An anonymous cross-sectional online survey, initially designed by the health innovation hub (think tank and sparring partner of the German Federal Ministry of Health) and the German Pain Society was adapted to the field of rheumatology. The survey was promoted by DGRh newsletters and Twitter-posts. Ethical approval was obtained. RESULTS In total, 75 valid response-sets. 80% reported to care ≥ 70% of their working time for patients with rheumatic diseases. Most were working in outpatient clinics/offices (54%) and older than 40 years (84%). Gender distribution was balanced (50%). 70% knew the possibility to prescribe DiGA. Most were informed of this for the first time via trade press (63%), and only 8% via the scientific/professional society. 46% expect information on DiGA from the scientific societies/medical chambers (35%) but rarely from the manufacturer (10%) and the responsible ministry (4%). Respondents would like to be informed about DiGA via continuing education events (face-to-face 76%, online 84%), trade press (86%), and manufacturers' test-accounts (64%). Only 7% have already prescribed a DiGA, 46% planned to do so, and 47% did not intend DiGA prescriptions. Relevant aspects for prescription are provided. 86% believe that using DiGA/medical apps would at least partially be feasible and understandable to their patients. 83% thought that data collected by the patients using DiGA or other digital solutions could at least partially influence health care positively. 51% appreciated to get DiGA data directly into their patient documentation system/electronic health record (EHR) and 29% into patient-owned EHR. CONCLUSION Digital health applications awareness was high whereas prescription rate was low. Mostly, physician-desired aspects for DiGA prescriptions were proven efficacy and efficiency for physicians and patients, risk of adverse effects and health care costs were less important. Evaluation of patients' barriers and needs is warranted. Our results might contribute to the implementation and dissemination of DiGA.
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Affiliation(s)
- Jutta G. Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Philipp Stachwitz
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Julia Hagen
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Denitza Larsen
- Health Innovation Hub of the Federal Ministry of Health (hih), Berlin, Germany
| | - Johannes Knitza
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich-Heine-University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
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Reiter J, Chehab G, Aries P, Muehlensiepen F, Welcker M, Voormann A, Schneider M, Specker C, Richter JG. POS0378 EVALUATION OF THE USE OF VIDEO CONSULTATION IN GERMAN RHEUMATOLOGY CARE BEFORE AND DURING THE COVID-19 PANDEMIC WAVES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1474] [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: 11/03/2022]
Abstract
BackgroundDuring the COVID-19 pandemic telemedicine tools rapidly and widely gained acceptance as indispensable management tools for the continuum of clinical care in rheumatic diseases. They have been adopted in position papers and guidelines for the management of rheumatic diseases in adult patients.ObjectivesEvaluation of the use of video consultation as one form of telemedicine before and during the COVID-19 pandemic and associated lockdowns among Rheumatology physicians in Germany. The survey results are expected to support the optimization and implementation of video consultation (VC) into routine clinical practice in rheumatology, providing long-term benefits for both parties, patients and their treating rheumatologists.MethodsCross-sectional nationwide online survey among German rheumatologists and rheumatologists in training. The survey was promoted by newsletters sent by means of mail and Twitter posts to members of the German Society for Rheumatology (n=1,650) and German Professional Society for Rheumatology (n=527).ResultsReported data refer to 205 participants. The majority of respondents was male (59%), older than 40 years (90%) and specialized in internal medicine/rheumatology (85%).They were divided into two groups: ‘digital users’ (38%) and ‘digital non-users’ (62%). Users employing telemedicine (TM) but never VC were defined as ‘TM-users’ (10%). Those using TM and VC were classified as ‘VC-users’ (27%). ‘Non-users’ negated the use of VC and TM respectively.Knowledge on telemedicine was self-rated as 4 (median on a Likert Scale 1 (very high) to 6 (very low)) with a significant difference between user (VC-user 2.7±1.2, TM-user 3.2±1.1) and non-user (4.4±1.3).The Figure 1 shows a significant increase in the use of VC during the lockdown periods. Even between the lockdown phases, VC use was higher than in the pre-pandemic phase.Figure 1.Grouped patient numbers seen via VC during the pandemic wavesReasons for VC non-use in TM-user and non-user were administrative/technical efforts (21%), lack of technical equipment (15%), time constraints (12%), time required for individual VC sessions (12%), inadequate reimbursement (11%), lack of demand from patients (11%), data security concerns (9%), poor internet connection (8%), and lack of scientific evaluation/evidence (5%).Based on the experience gained, physicians considered the following clinical situations to be particularly suitable for VC: follow-up visits (VC-user 79%, TM-user 62%, non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, non-user 20%), and patients presenting for the first time (VC-user 11%, TM-user 19%, non-user 8%).Table 1.Evaluation of the VC in comparison to other patient interaction (VC-user) on a Likert Scale with 1 (I agree completely) to 6 (I do not agree at all)VC isMean ± standard deviation (median)… comparable to a face to face meeting (n=52)4.3 ± 1.3 (4.5)… comparable to a telephone consultation (n=51)3.3 ± 1.3 (3.0)… suitable as an additional means of communication with the patient (n=51)2.3 ± 1.5 (2.0)ConclusionDespite the fact that the current pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms such as VC, their use and acceptance remained below expectations. Given the reported decline in physician face-to-face consultations during the pandemic, these findings are even more concerning. The identified reasons for non-utilization should be addressed by policy makers, payers and medical societies to provide better foundations for future innovative care models.Disclosure of InterestsJoana Reiter: None declared, Gamal Chehab: None declared, Peer Aries: None declared, Felix Muehlensiepen Speakers bureau: Novartis Pharma GmbH, Grant/research support from: Novartis Pharma GmbH & AbbVie Deutschland GmbH & Co. KG, Martin Welcker: None declared, Anna Voormann: None declared, Matthias Schneider Speakers bureau: Astra-Zeneca; Biogen; BMS; Celgene; Chugai; GSK; Janssen-Cilag; Lilly; Pfizer; UCB, Paid instructor for: Lilly, Consultant of: Abbvie; Astra-Zeneca; Boehringer-Ingelheim; GSK; Lilly; Novartis; Pfizer; Protagen; Roche; Sanofi-Aventis; UCB, Grant/research support from: Abbvie; Astra-Zeneca; GSK; UCB, Christof Specker: None declared, Jutta G. Richter: None declared
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Hasseli R, Hoyer BF, Lorenz HM, Pfeil A, Regierer A, Richter J, Schmeiser T, Strangfeld A, Voll R, Schulze-Koops H, Krause A, Specker C, Müller-Ladner U. POS1246 COVID-19 IN RITUXIMAB TREATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3381] [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: 11/04/2022]
Abstract
BackgroundAt the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic, the influence of anti-inflammatory therapy on the course of SARS-CoV-2 infection in patients with inflammatory rheumatic diseases (IRD) was unknown. In the meantime, several data indicate an association of severe courses of COVID-19 with the use of rituximab (RTX).ObjectivesTo gather further knowledge about SARS-CoV-2 infections in RTX-treated IRD patients, data from the German COVID-19-IRD-registry were analysed.MethodsHospitalisation was used as a surrogate of COVID-19 severity. Baseline characteristics, disease features, medication and outcome of COVID-19 were compared in RTX-treated inpatients and outpatients.ResultsIn total, 3592 cases were reported in the registry, which included 130 RTX patients (3.6%) for our analysis. RTX-treated inpatients were older than RTX-treated outpatients (median age 63 y vs 56 y, p=0.007). Patients with granulomatosis with polyangiitis treated with RTX (n=32) showed a significant higher COVID-19 related hospitalisation rate (33% vs 11%, p=0.005), which was not the case for patients with rheumatoid arthritis (49% vs 50%). Cardiovascular comorbidities were reported more frequently in hospitalised RTX-treated patients (20% vs. 6%, p=0.032). More than 50% of the RTX-treated inpatients developed COVID-19 related complications, e.g. acute respiratory distress syndrome. The median time period between the last RTX treatment and SARS-CoV-2 infection was shorter in inpatients than in non-hospitalised patients (3 (range 0-17) vs. 4 months (range -29), p=0.039). The COVID-19 related mortality rate was 14% (n=19) in RTX-treated IRD patients. In RTX-treated inpatients and outpatients, there were no relevant differences with respect to the use of concomitant glucocorticoids or other disease modifying anti-rheumatic drugs, disease activity, median last RTX dose or median number of immunomodulatory drugs prior to RTX treatment.ConclusionIn addition to general risk factors, such as age and comorbidities, it is already known that IRD patients treated with RTX show a higher rate of severe COVID-19. In our registry, RTX-treated patients with granulomatosis with polyangiitis appear to be at even higher risk to develop severe COVID-19 compared to other IRD. Moreover, the shorter the time since the last RTX treatment, the higher seems to be the risk of developing severe COVID-19. This might be explained by a more profound B-cell depletion in the first weeks after RTX treatment warranting further studies.Disclosure of InterestsNone declared
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Richter JG, Chehab G, Stachwitz P, Hagen J, Larsen D, Knitza J, Schneider M, Voormann A, Specker C. POS0377 ONE YEAR OF DIGITAL HEALTH APPLICATIONS (DiGA) IN GERMANY – RHEUMATOLOGISTS’ PERSPECTIVES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.510] [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: 11/03/2022]
Abstract
BackgroundBased on given legislation (§§ 33a and 139e SGB V, Social Code Book V) the German approach to digital health applications (Digitale Gesundheitsanwendungen, DiGA) allows reimbursed prescription of approved therapeutic software products (listed in the DIGA directory https://diga.bfarm.de/de/verzeichnis) for patients since October 6th, 2020.ObjectivesTo evaluate the level of knowledge on DiGA among members of the German Society for Rheumatology (DGRh) after one year of DiGA under the conditions of the COVID-19 pandemic using the DiGA Toolbox of the ‘health innovation hub’ (hih), a think tank and sparrings partner of the German Federal Ministry of Health.MethodsAnonymous cross-sectional online survey using LimeSurvey (https://limesurvey.org). The survey was promoted by newsletters sent out to DGRh newsletter recipients and Twitter posts. Ethical approval was obtained.Results75 valid participants reported that they care more than 80% of their working time for patients with rheumatic diseases. Most were working in outpatient clinics (54%) and older than 40 years of age (84%). Gender distribution was balanced (50%).70% were aware of the possibility to prescribe DiGA. Most were informed on this for the first time via trade press (63%), and only 8% via the professional society. 46% expect information on DiGA from professional societies and the medical chambers (36%) but rarely from the manufacturer (10%) and the responsible ministry (4%). Respondents would like to be informed about DIGA via continuing education events (face-to-face 76%, online 84%), trade press (86%), and manufacturers test accounts (64%).Only 7% have already prescribed a DiGA, 46% planned to do so, and 47% did not intend DiGA prescriptions. Relevant aspects for prescription are given in Figure 1.Figure 1.Aspects relevant for DiGA prescriptions; sorted by importance/number of mentions (participants needed to pick their three most relevant aspects from a pre-given list)86% believe that using DiGA / medical apps would at least partially be feasible and understandable to their patients.83% thought that data collected by the patients using DiGA or other digital solutions could at least partially influence health care positively.51% appreciated to get DiGA data directly into their patient documentation system resp. clinical electronic health record (EHR) and 29% into patients’ owned EHR.ConclusionDiGA awareness was high whereas prescription rate was low. Mostly, physician-desired aspects for DiGA prescriptions were proven efficacy and efficiency for physicians and patients, risk of adverse effects and health care costs were less important. Evaluation of patients’ barriers and needs are warranted. Our results will contribute to the implementation and dissemination of DIGA.Disclosure of InterestsJutta G. Richter: None declared, Gamal Chehab: None declared, Philipp Stachwitz: None declared, Julia Hagen: None declared, Denitza Larsen: None declared, Johannes Knitza Consultant of: Vila Health, ABATON, Medac, Matthias Schneider: None declared, Anna Voormann: None declared, Christof Specker: None declared
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Hasseli R, Hoyer BF, Lorenz HM, Pfeil A, Regierer A, Richter J, Schmeiser T, Strangfeld A, Krause A, Voll R, Schulze-Koops H, Müller-Ladner U, Specker C. OP0179 CHARACTERISTICS AND OUTCOMES OF SARS-CoV-2 BREAKTHROUGH INFECTIONS AMONG DOUBLE AND TRIPLE VACCINATED PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3386] [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: 11/04/2022]
Abstract
BackgroundSARS-CoV-2 vaccines offer the most effective way to reduce the risk of severe COVID-19. Recent data indicate sufficient immune response after vaccination in most patients with inflammatory rheumatic diseases (IRD) on immunomodulatory treatments.ObjectivesTo investigate the clinical profile of SARS-CoV-2 breakthrough infections among double and triple vaccinated patients with IRD.MethodsData from the German COVID-19-IRD registry, collected by treating rheumatologists between February 2021 and January 2022 were analysed. Patients double or triple vaccinated against COVID-19 ≥14 days prior to proven SARS-CoV-2 infection were identified, and type of IRD, vaccine, immunomodulation, comorbidities and outcome of the infection were compared with 737 unvaccinated IRD-patients with COVID-19.ResultsIn total, 271 cases of breakthrough infections were reported, 250 patients (91%) had received two doses of vaccines, 21 (9%) patients three. More than 70% of the patients received Pfizer/Biontech vaccine for the first, second and third vaccination. The median time from second/third vaccine dose to infection was 148 days (range 14-302) days. Most of the patients were diagnosed with inflammatory joint diseases (Table 1). Most of the patients were treated with methotrexate (Table 1). The use of Januskinase inhibitors(i) was more frequently reported in double vaccinated patients (10.4% vs 4.8%), whereas tumor necrosis (TNF)i were reported more often in triple vaccinated patients (33.3% vs. 22.8). Hospitalisation rate was higher in unvaccinated IRD-patients than in vaccinated ones, while fatality rate was similar in unvaccinated and double vaccinated patients. Although the rate of comorbidities and median age were higher in triple-vaccinated patients, infected patients showed a lower rate of hospitalisation, neither COVID-19 related complications, nor the need of oxygen treatment or death.Table 1.Profile of vaccinated IRD patientsunvaccinated2ndvaccination3rdvaccinationNumber (737)%Number (250)%Number (21)%Age56 (18-93)57 (22-90)63 (35-88)Female47864.915863.21361.9BMI26.8 (17-53)26.7 (17-55)25.4 (18-41)Inflammatory rheumatic disease (multiple selections possible)Inflammatory joint diseases56175.918674.41676.2Connective tissue diseases10112.8301229.6Vasculitis719.6228.8314.3Other IRD638.52911.614.8Immunomodulation (multiple selections possible)Glucocorticoid21228.86726.8523.8Methotrexate27036.69036838.1Azathioprine192.672.8//Cyclosporine30.410.4//Leflunomide506.872.8//Hydroxychloroquine7910.7239.214.8Sulfasalazine202.793.6//JAKi547.32610.414.8TNFi15821.45722.8733.3Abatacept91.231.2//Rituximab212.8114.414.8Other biologics597.93212.829.6Mycophenolate15241.6//Immunoglobulines20.310.4//Apremilast40.5////Cyclophosphamide10.110.4//No immunomodulation7410228.814.8No/low disease activity62584.822389.21885.7Moderate/high disease activity10213.82710.8314.3ComorbiditiesCardiovascular diseases32944.6130521361.9Diabetes mellitus7610.32510//Osteoporosis435.8218.429.5Chronic renal failure405.4166.4419Cancer/history of cancer152.0104314.3COPD253.4104//ILD162.272.8//Bronchial asthma344.6166.4//Pregnancy70.910.414.8No comorbidity25434.59738.8523.8Complications due to COVID-19Hospitalisation13518.32911.629.5Oxygen treatment11415.5249.6//Invasive ventilation253.493.6//Death162.272.8//ConclusionIn this cohort of triple-vaccinated IRD patients no fatal courses and no COVID-19 related complications were reported, although median age and rate of comorbidities were higher compared to double-vaccinated and unvaccinated patients. These results support the general recommendations to reduce the risk of severe COVID-19 disease by administering three doses of vaccine, especially in patients with older age, presence of comorbidities, and on immunomodulatory treatment.Disclosure of InterestsNone declared
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Abstract
Cryoglobulinemic vasculitis (CV) is a rare immune complex disease of small vessels (capillaries, venules or arterioles) with detection of cryoglobulins (CG). These are serum proteins that precipitate at temperatures below the normal body temperature. The laboratory diagnostics are logistically challenging because the temperature of the blood sample must be maintained continuously at 37 °C until arrival in the laboratory to prevent early precipitation of the proteins with adsorption to corpuscular blood components. Cryoglobulins can be divided into three classes (types I-III), with each class associated with specific underlying diseases and symptom complexes. Cryoglobulinemia can be caused by hematological, virological or autoimmune diseases and mixed forms also occur. The most common cause to date is a hepatitis C infection. Treatment of the underlying disease is obligatory, with antiviral treatment of hepatitis C offering the rare possibility of causal treatment. Depending on the severity of cryoglobulinemia, immunosuppressive therapy is indicated to prevent permanent damage caused by the inflammation.
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Affiliation(s)
- Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Pattbergstr. 1-3, 45239, Essen, Deutschland.
| | - Denise Passens
- Klinik für Innere Medizin & Hepatologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - Jörg Schlaak
- Klinik für Innere Medizin - Hepatologie, Gastroenterologie, Infektiologie & Diabetologie, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Deutschland
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Ugarte-Gil MF, Alarcón GS, Izadi Z, Duarte-García A, Reátegui-Sokolova C, Clarke AE, Wise L, Pons-Estel GJ, Santos MJ, Bernatsky S, Ribeiro SLE, Al Emadi S, Sparks JA, Hsu TYT, Patel NJ, Gilbert EL, Valenzuela-Almada MO, Jönsen A, Landolfi G, Fredi M, Goulenok T, Devaux M, Mariette X, Queyrel V, Romão VC, Sequeira G, Hasseli R, Hoyer B, Voll RE, Specker C, Baez R, Castro-Coello V, Maldonado Ficco H, Reis Neto ET, Ferreira GAA, Monticielo OAA, Sirotich E, Liew J, Hausmann J, Sufka P, Grainger R, Bhana S, Costello W, Wallace ZS, Jacobsohn L, Taylor T, Ja C, Strangfeld A, Mateus EF, Hyrich KL, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schäfer M, Machado PM, Robinson PC, Gianfrancesco M, Yazdany J. Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance. Ann Rheum Dis 2022; 81:970-978. [PMID: 35172961 PMCID: PMC8882632 DOI: 10.1136/annrheumdis-2021-221636] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/15/2022]
Abstract
Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab. Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.
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Affiliation(s)
- Manuel Francisco Ugarte-Gil
- Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Cientifica del Sur, Lima, Peru .,Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Graciela S Alarcón
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.,School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Zara Izadi
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA.,Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Ali Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Cristina Reátegui-Sokolova
- Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen, EsSalud, Lima, Peru.,Unidad de Investigación Para La Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, LimaPeru
| | - Ann Elaine Clarke
- Division of Rheumatology Department of Medicine. Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leanna Wise
- Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
| | - Guillermo J Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina.,Research Unit, Argentine Society of Rheumatology, Buenos Aires, Argentina
| | - Maria Jose Santos
- Rheumatology, Hospital Garcia de Orta, Almada, Portugal.,Rheumatology Research Unit. Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Sasha Bernatsky
- Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, Québec, Canada
| | | | - Samar Al Emadi
- Rheumatology Department, Hamad Medical Corp, Doha, Qatar
| | - Jeffrey A Sparks
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tiffany Y-T Hsu
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naomi J Patel
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital. Harvard Medical School, Boston, Massachusetts, USA
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Gianpiero Landolfi
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Micaela Fredi
- Rheumatology and Clinical Immunology, ASST Spedali Civili, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Tiphaine Goulenok
- Internal Medicine Department, Bichat Claude Bernard Hospital, APHP, Paris, France.,Université de Paris, Paris, France
| | - Mathilde Devaux
- Internal Medicine Department, Poissy Saint-Germain-en-Laye Hospital, Poissy, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Viviane Queyrel
- Department of Rheumatology, Pasteur 2 Hospital, University of Nice -Sophia- Antipolis, Nice, France
| | - Vasco C Romão
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Graca Sequeira
- Centro Hospitalar Universitário do Algarve, Unidade de Faro, Faro, Portugal
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology. Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Bimba Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
| | - Roberto Baez
- Hospital Francisco Lopez Lima, General Roca, Argentina
| | | | | | | | | | - Odirlei Andre André Monticielo
- Hospital de Clinicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Jean Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan Hausmann
- Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center. Harvard Medical School, Boston, Massachusetts, USA
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Wellington, New Zealand
| | | | - Wendy Costello
- Irish Children's Arthritis Network (iCAN), Tipperary, Ireland
| | - Zachary S Wallace
- Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital. Harvard Medical School, Boston, Massachusetts, USA
| | - Lindsay Jacobsohn
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Tiffany Taylor
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Clairissa Ja
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Anja Strangfeld
- Epidemiology and Health Services, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases (LPCDR), Lisbon, Portugal.,European League Against Rheumatism (EULAR) Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Kilchberg, Switzerland
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Saskia Lawson-Tovey
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Martin Schäfer
- Epidemiology and Health Care Research, German Rheumatism Research Center (DRFZ Berlin), Berlin, Germany
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR), University College London Hospitals, London, UK.,Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Philip C Robinson
- School of Clinical Medicine, The University of Queensland, Herston, Queensland, Australia.,Department of Rheumatology. Metro North Hospital & Health Service, Royal Brisbane and Woman's Hospital, Herston, Queensland, Australia
| | - Milena Gianfrancesco
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV-2/COVID-19 pandemic, including recommendations for COVID-19 vaccination. Z Rheumatol 2021; 80:33-48. [PMID: 34491403 PMCID: PMC8422376 DOI: 10.1007/s00393-021-01055-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Christof Specker
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Germany.
| | - Peer Aries
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologie im Struenseehaus, Hamburg, Germany
| | - Jürgen Braun
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Germany
| | - Gerd Burmester
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Rebecca Fischer-Betz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Rebecca Hasseli
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Julia Holle
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Bimba Franziska Hoyer
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Iking-Konert
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Andreas Krause
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Klaus Krüger
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumatologisches Praxiszentrum München, Munich, Germany
| | - Martin Krusche
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Germany
| | - Jan Leipe
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Germany
| | - Hanns-Martin Lorenz
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Moosig
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | | | - Matthias Schneider
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Anja Strangfeld
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Germany
| | - Reinhard Voll
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Germany
| | - Anna Voormann
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
| | - Ulf Wagner
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Hendrik Schulze-Koops
- German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie e. V., DGRh), Berlin, Germany.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstraße 8a, Munich, Germany.
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21
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Sondermann W, Hadaschik E, Specker C. Successful therapy of disseminated patch-type granuloma annulare with upadacitinib in a patient with rheumatoid arthritis. Dermatol Ther 2021; 35:e15211. [PMID: 34791765 DOI: 10.1111/dth.15211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Evangelisches Krankenhaus Kliniken Essen-Mitte, Essen, Germany
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22
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Regierer AC, Hasseli R, Schäfer M, Hoyer BF, Krause A, Lorenz HM, Pfeil A, Richter J, Schmeiser T, Schulze-Koops H, Strangfeld A, Voll RE, Specker C, Mueller-Ladner U. TNFi is associated with positive outcome, but JAKi and rituximab are associated with negative outcome of SARS-CoV-2 infection in patients with RMD. RMD Open 2021; 7:rmdopen-2021-001896. [PMID: 34670840 PMCID: PMC8529615 DOI: 10.1136/rmdopen-2021-001896] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Several risk factors for severe COVID-19 specific for patients with inflammatory rheumatic and musculoskeletal diseases (RMDs) have been identified so far. Evidence regarding the influence of different RMD treatments on outcomes of SARS-CoV-2 infection is still poor. Methods Data from the German COVID-19-RMD registry collected between 30 March 2020 and 9 April 2021 were analysed. Ordinal outcome of COVID-19 severity was defined: (1) not hospitalised, (2) hospitalised/not invasively ventilated and (3) invasively ventilated/deceased. Independent associations between demographic and disease features and outcome of COVID-19 were estimated by multivariable ordinal logistic regression using proportional odds model. Results 2274 patients were included. 83 (3.6%) patients died. Age, male sex, cardiovascular disease, hypertension, chronic lung diseases and chronic kidney disease were independently associated with worse outcome of SARS-CoV-2 infection. Compared with rheumatoid arthritis, patients with psoriatic arthritis showed a better outcome. Disease activity and glucocorticoids were associated with worse outcome. Compared with methotrexate (MTX), TNF inhibitors (TNFi) showed a significant association with better outcome of SARS-CoV-2 infection (OR 0.6, 95% CI0.4 to 0.9). Immunosuppressants (mycophenolate mofetil, azathioprine, cyclophosphamide and ciclosporin) (OR 2.2, 95% CI 1.3 to 3.9), Janus kinase inhibitor (JAKi) (OR 1.8, 95% CI 1.1 to 2.7) and rituximab (OR 5.4, 95% CI 3.3 to 8.8) were independently associated with worse outcome. Conclusion General risk factors for severity of COVID-19 play a similar role in patients with RMDs as in the normal population. Influence of disease activity on COVID-19 outcome is of great importance as patients with high disease activity—even without glucocorticoids—have a worse outcome. Patients on TNFi show a better outcome of SARS-CoV-2 infection than patients on MTX. Immunosuppressants, rituximab and JAKi are associated with more severe course.
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Affiliation(s)
| | - Rebecca Hasseli
- Department of Rheumatology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Martin Schäfer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Bimba F Hoyer
- Department for Rheumatology and Clinical Immunology, University of Schleswig-Holstein at Kiel, Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin-Wannsee Branch, Berlin, Germany
| | | | | | - Jutta Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Centre of Chronic Immunodeficiency, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany.,Rheumatology, Heinrich Heine University Düsseldorf, Dusseldorf, Germany
| | - Ulf Mueller-Ladner
- Rheumatology and Clinical Immunology, Giessen University, Bad Nauheim, Germany
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23
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Hasseli R, Müller-Ladner U, Keil F, Broll M, Dormann A, Fräbel C, Hermann W, Heinmüller CJ, Hoyer BF, Löffler F, Özden F, Pfeiffer U, Saech J, Schneidereit T, Schlesinger A, Schwarting A, Specker C, Stapfer G, Steinmüller M, Storck-Müller K, Strunk J, Thiele A, Triantafyllias K, Vagedes D, Wassenberg S, Wilden E, Zeglam S, Schmeiser T. The influence of the SARS-CoV-2 lockdown on patients with inflammatory rheumatic diseases on their adherence to immunomodulatory medication: a cross sectional study over 3 months in Germany. Rheumatology (Oxford) 2021; 60:SI51-SI58. [PMID: 33704418 PMCID: PMC7989169 DOI: 10.1093/rheumatology/keab230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/23/2021] [Indexed: 01/06/2023] Open
Abstract
Objectives To evaluate the influence of the SARS-CoV-2 pandemic on the adherence of patients with inflammatory rheumatic diseases (IRD) to their immunomodulatory medication during the three-months lockdown in Germany. Methods From March 16th until June 15th 2020, IRD patients from private practices and rheumatology departments were asked to answer a questionnaire addressing their behaviour with respect to their immunomodulating therapy. Eight private practices and nine rheumatology departments which included rheumatology primary care centres and university hospitals participated. 4252 questionnaires were collected and evaluated. Results The majority of patients (54%) were diagnosed with rheumatoid arthritis, followed by psoriatic arthritis (14%), ankylosing spondylitis (10%), connective tissue diseases (12%) and vasculitides (6%). The majority of patients (84%) reported to continue their immunomodulatory therapy. Termination of therapy was reported by only 3% of the patients. The results were independent from the type of IRD, the respective immunomodulatory therapy and by whom the patients were treated (private practices vs rheumatology departments). Younger patients (<60 years) reported just as often as older patients to discontinue their therapy. Conclusion The data show that most of the patients continued their therapy in spite of the pandemic. A significant change in behavior with regard to their immunomodulatory therapy was not observed during the three months of observation. The results support the idea that the immediate release of recommendation of the German Society of Rheumatology were well received, supporting the well-established physician-patient-relationship in times of a crisis.
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Affiliation(s)
- R Hasseli
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - U Müller-Ladner
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - F Keil
- Department of Electrical Engineering and Information Technology, Technical University Darmstadt, Darmstadt, Germany
| | - M Broll
- Private Practice, Wetzlar, Germany
| | - A Dormann
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - C Fräbel
- Department of Cardiology, University Hospital Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - W Hermann
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - B F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus, Kiel, Germany
| | - F Löffler
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - F Özden
- Private Practice, Nienburg, Germany
| | - U Pfeiffer
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - J Saech
- Private Practice 'Rheumatologie-Centrum', Leverkusen, Germany
| | - T Schneidereit
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - A Schlesinger
- Department of Internal Medicine, Pulmonology and Rheumatology, Marienhospital, Cologne, Germany
| | - A Schwarting
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - C Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
| | - G Stapfer
- Department of Rheumatology and Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | | | | | - J Strunk
- Department of Rheumatology, Hospital Porz am Rhein, Cologne, Germany
| | - A Thiele
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - K Triantafyllias
- Acura Rheumatology Center Rhineland Palatinate, Bad Kreuznach, Germany
| | - D Vagedes
- Medical Care Centre Barmherzige Brüder, Straubing, Germany
| | - S Wassenberg
- Private Practice 'Rheumazentrum Ratingen', Ratingen, Germany
| | - E Wilden
- Private Practice, Cologne, Germany
| | - S Zeglam
- Department of Internal Medicine, Pulmonology and Rheumatology, Marienhospital, Cologne, Germany
| | - T Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
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24
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Hasseli R, Pfeil A, Krause A, Schulze-Koops H, Müller-Ladner U, Specker C. A survey to evaluate knowledge, perceptions and attitudes toward COVID-19 vaccinations among rheumatologists in Germany. Rheumatol Int 2021; 41:1949-1956. [PMID: 34498112 PMCID: PMC8425463 DOI: 10.1007/s00296-021-04986-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/30/2021] [Indexed: 12/12/2022]
Abstract
The objective is to evaluate the attitude of rheumatologists regarding the use of COVID-19 vaccination in patients with inflammatory rheumatic diseases (IRDs). From February 2nd until March 15th, 2021, rheumatologists from Germany were asked to participate anonymously in a survey addressing their attitude with respect to COVID-19 vaccinations of IRD patients. The survey was completed by 214 participants (107 men, 103 women, 4 unspecified). More than half of the physicians (61%) were working in rheumatologic private practices and 62% had more than 20 years of experience in rheumatology. 90% reported to be at least confidential in handling issues of COVID-19 vaccination and 99% would recommend COVID-19 vaccination for IRD patients. The majority would not recommend to stop or reduce immunomodulatory drugs for vaccination except for rituximab. More than 70% would prefer vaccination with a mRNA vaccine for their IRD patients. This study shows that almost all rheumatologists in Germany support the COVID-19 vaccination for their IRD patients without reducing or terminating the actual immunomodulatory medication to potentially improve the response to the vaccine. This attitude is in accordance with the current recommendations of the German Society of Rheumatology regarding COVID-19 vaccination in IRD patients, and indicates that these have been well accepted and work in everyday clinical practice.
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Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim, Germany.
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Bad Nauheim, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
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25
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Hasseli R, Pfeil A, Hoyer BF, Lorenz HM, Regierer AC, Richter JG, Schmeiser T, Strangfeld A, Voll RE, Krause A, Schulze-Koops H, Müller-Ladner U, Specker C. [German registry www.Covid19-Rheuma.de : Status report after 1 year of the pandemic]. Z Rheumatol 2021; 80:641-646. [PMID: 34196793 PMCID: PMC8246125 DOI: 10.1007/s00393-021-01034-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
The COVID-19 registry ( www.covid19-rheuma.de ) of the German Society of Rheumatology was the first registry for the acquisition and systemic evaluation of viral infections in patients with inflammatory rheumatic diseases (IRD). This has enabled rapid generation of scientific data that will help to improve the care of patients with IRD in the context of the pandemic. In addition to confirming general risk factors, such as patient age and comorbidities (e.g. cardiovascular, chronic lung and kidney diseases), the use of glucocorticoids and the disease activity of the rheumatic disease could be identified as disease-specific independent risk factors for the need of hospitalization due to COVID-19. Evaluations of the continuously growing cohort of patients with IRD and COVID-19 enable recommendations for patient care to be based on better evidence. Cooperation with international rheumatology registries (e.g. European COVID-19 registry for IRD) enables analyses of aggregated cohorts of patients with IRD and COVID-19 for international comparisons and statistically even more reliable statements.
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Affiliation(s)
- Rebecca Hasseli
- Abteilung für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
| | - Alexander Pfeil
- Funktionsbereich Rheumatologie und Osteologie, Klinik für Innere Medizin III, Universitätsklinikum Jena, Jena, Deutschland
| | - Bimba Franziska Hoyer
- Sektion für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Hanns-Martin Lorenz
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Anne C Regierer
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Jutta G Richter
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | | | - Anja Strangfeld
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheuma-Forschungszentrum, Berlin, Deutschland
| | - Reinhard E Voll
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Andreas Krause
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hendrik Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Ulf Müller-Ladner
- Abteilung für Rheumatologie, Klinische Immunologie, Osteologie und Physikalische Medizin, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
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26
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Specker C, Aries P, Braun J, Burmester G, Fischer-Betz R, Hasseli R, Holle J, Hoyer BF, Iking-Konert C, Krause A, Krüger K, Krusche M, Leipe J, Lorenz HM, Moosig F, Schmale-Grede R, Schneider M, Strangfeld A, Voll R, Voormann A, Wagner U, Schulze-Koops H. [Updated recommendations of the German Society for Rheumatology for the care of patients with inflammatory rheumatic diseases in the context of the SARS-CoV‑2/COVID‑19 pandemic, including recommendations for COVID‑19 vaccination]. Z Rheumatol 2021; 80:570-587. [PMID: 34309739 PMCID: PMC8311067 DOI: 10.1007/s00393-021-01056-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Pattbergstr. 2, 45239, Essen, Deutschland.
| | - Peer Aries
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Jürgen Braun
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Ruhrgebiet, Ruhr Universität Bochum, Bochum, Deutschland
| | - Gerd Burmester
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Rebecca Fischer-Betz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Rebecca Hasseli
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Bad Nauheim, Deutschland
| | - Julia Holle
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Bimba Franziska Hoyer
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Christof Iking-Konert
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg-Eppendorf, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Klaus Krüger
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumatologisches Praxiszentrum München, München, Deutschland
| | - Martin Krusche
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität zu Berlin, Berlin, Deutschland
| | - Jan Leipe
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Frank Moosig
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | | | - Matthias Schneider
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, , Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anja Strangfeld
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Programmbereich Epidemiologie und Versorgungsforschung, Deutsches Rheumaforschungszentrum Berlin, Berlin, Deutschland
| | - Reinhard Voll
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Universität Freiburg, Freiburg, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
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Specker C, Aringer M, Burmester GR, Peters M, Hofmann MW, Kellner H, Moosig F, Tony HP, Fliedner G. POS0615 TOCILIZUMAB IS SAFE AND EFFECTIVE IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1711] [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: 11/04/2022]
Abstract
Background:Average life spans of patients with rheumatoid arthritis (RA) are approaching those of the general population. This results in a large proportion of RA patients being elderly at some point and underlines effective RA treatments needed for this population. Pivotal clinical trials have demonstrated the efficacy of tocilizumab (TCZ) for the treatment of RA. However, real-world studies that explore the effectiveness of TCZ especially in the elderly are lacking. ICHIBAN was a large, observational study that followed patients with RA treated with TCZ under real-world conditions in Germany for up to 2 years.Objectives:In this analysis of ICHIBAN, we examined the safety and effectiveness of long-term TCZ treatment according to patient baseline (BL) age (<50, 50–65, >65 years).Methods:ICHIBAN (NCT01194401) was a prospective, non-interventional study that observed adult patients with active moderate to severe RA in German rheumatology clinics and practices. Patients were treated with TCZ according to the local label. The safety analyses set (SAF) included all patients who received at least one dose of TCZ. The effectiveness set (EFF) included all patients from the SAF who had no prior TCZ therapy. Patient-reported outcomes (PROs) were assessed using the visual analogue scale. Last observation carried forward was used to substitute for missing values.Results:At baseline (BL), 3,164 patients were included in the SAF: 29.2% <50 years, 47.3% 50–65 years, and 23.5% >65 years old (1.2% ≥80 years). Patients >65 years old were not only the most likely to have comorbidities such as hypertension, anaemia, renal insufficiency, osteoporosis, diabetes, and coronary heart disease, but also had the highest BL disease activity according to Disease Activity Score-28 erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI) (Table 1).Proportions of patients with adverse events (AEs) considered related to treatment were similar in patients <50 (22.3%), 50–65 (21.9%) and >65 years (22.2%). More patients >65 years (20.2%) and 50–65 years (14.4%) experienced serious AEs (SAEs) than patients <50 years (11.5%). Slightly more patients >65 years old experienced infectious SAEs (4.8%) than younger patients (<50 years, 3.2% and 50–65 years, 3.1%). Yet, similar proportions of patients across all age groups discontinued TCZ due to AE (7.0% <50 years; 9.6% 50–65 years; 7.8% >65 years).2,902 patients were included in the EFF. Patients <50 years experienced DAS28-ESR remission at least once during the treatment period (65.4%) more often than patients aged 50–65 years (59.8%) or >65 years (59.5%). However, patients >65 years had numerically greater improvements in DAS28-ESR (Table 1). Patients <50 years had the best physical functioning at BL and the greatest reduction in Health Assessment Questionnaire Disease Index (HAQ-DI) score (Figure 1A). All age groups had similar improvements in PROs such as fatigue, strength of pain, and sleep disturbances (Figure 1B).Table 1.Model summary for prediction of DAS28CRP using time and etanercept originator (relative to biosimilar)<50 years50–65 years>65 yearsDAS28-ESR, mean ± SDn*7771237617BL4.9 ± 1.45.3 ± 1.35.4 ± 1.3Last visit2.8 ± 1.73.1 ± 1.73.2 ± 1.7Change from BL-2.0 ± 1.7-2.2 ± 1.7-2.2 ± 1.8CDAI, mean ± SDn*7681217590BL25.7 ± 12.828.4 ± 13.328.8 ± 12.8Last visit13.3 ± 12.814.6 ± 13.214.5 ± 12.8Change from BL-12.5 ± 13.6-13.8 ± 14.0-14.3 ± 13.8*271 patients with missing data at BL**327 patients with missing data at BLConclusion:Although elderly patients experienced a higher rate of infections, the proportion of patients withdrawing due to AE was not higher than in the other age groups. Starting with higher baseline disease activity, patients >65 years had similar benefits to disease activity and PROs when compared with younger patients. Overall, these results indicate that long-term TCZ treatment of elderly patients is effective and has an acceptable safety profile.Disclosure of Interests:Christof Specker Speakers bureau: AbbVie, Celgene, Chugai, Janssen-Cilag, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Boehringer Ingelheim, Chugai, Lilly, Novartis, Sobi, and UCB, Grant/research support from: Boehringer, Chugai, GSK, and Roche, Martin Aringer Speakers bureau: Roche and Chugai, Consultant of: Roche and Chugai, Grant/research support from: Roche, Gerd Rüdiger Burmester Consultant of: Lilly, Pfizer, Sanofi, and Roche, Grant/research support from: Roche, Marvin Peters Employee of: Roche Pharma AG, Michael W. Hofmann Employee of: Chugai Pharma Germany GmbH, Herbert Kellner Consultant of: Roche, Grant/research support from: Roche, Frank Moosig Grant/research support from: Roche, Hans-Peter Tony Speakers bureau: Roche, Abbvie, BMS, Chugai, Janssen, Novartis, Sanofi, and Lilly, Consultant of: Roche, Abbvie, BMS, Chugai, Janssen, Novartis, Sanofi, and Lilly, Grant/research support from: Roche, Gerhard Fliedner Grant/research support from: Roche, Chugai, Abbvie, and Lilly
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Hasseli R, Hoyer BF, Krause A, Lorenz HM, Pfeil A, Regierer A, Richter J, Schmeiser T, Strangfeld A, Schulze-Koops H, Voll R, Specker C, Müller-Ladner U. OP0283 DOES TNF-INHIBITION DECREASE THE RISK OF SEVERE COVID-19 IN RMD-PATIENTS? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4027] [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: 11/04/2022]
Abstract
Background:Patients with rheumatic and musculoskeletal diseases (RMD) might have an increased risk for infection due to their immunomodulatory treatment, secondary to their disease and comorbidities. Recent studies suggest a decreased risk of severe COVID-19 in RMD-patients treated with biologics.Objectives:The aim of this study was to assess courses of RMD patients treated with TNF-inhibitors (TNF-I) included in the German COVID-19 registry.Methods:In the German physician-reported COVID-19-RMD registry, patients with an RMD and confirmed SARS-CoV-2-infection were documented (data entered between March 30, 2020 and January 30, 2021). We analysed TNF-I treated patients, their course and outcome of the infection. Data were compared to RMD-patients treated with other immunomodulatory drugs (OID) than TNF-I.Results:A total of 269 patients were treated with a TNF-I (57% female) compared to 874 patients who were treated with OID (68% female). Median age was 52 years (range: 19-87) in the TNF-I-group versus 58 years (range: 18-91) in the OID-group. Rheumatoid arthritis was the most common diagnosis (38% in TNF-I-group vs. 52% in the OID-group), followed by ankylosing spondylitis (32% vs. 6%), psoriatic arthritis (22% vs. 11%) and other RMD (9% vs. 31%). Adalimumab (35%) and etanercept (35%) were the most frequently used TNF-I (tab. 1). Glucocorticoids (GC) were used in 22% of TNF-I-treated patients and in 42% of the OID-group.Under TNF-I, stable disease was reported prior to the SARS-CoV-2-infection in 53% of the patients (OID-group: 47%), followed by low disease activity in 35% (OID: 34%), moderate disease activity in 6% (OID: 12%) and high disease activity in 4% (OID: 3%). Most frequent comorbidities were arterial hypertension (29% under TNF-I vs. 35% under OID), diabetes (8% vs. 11%) and cardiovascular diseases (7% vs. 12%).The most common reported COVID-19 symptoms were dry cough (57% vs. 55%), fever (53% vs. 61%) and fatigue (50% vs. 49%). Hospitalization due to SARS-CoV infection was required in only 12% of the TNF-I-treated cases vs. in 29% in the OID-group. Oxygen treatment was necessary in 5% of the patients under TNF-I compared to 22% under OID and invasive ventilation in 2% in the TNF-I-group compared to 6% under OID. Most notably, no fatal courses of COVID-19 were reported among the 269 RMD-patients treated with TNF-I versus 49 deaths in the 874 cases (5.6%) treated with OID. Focussing on the hospitalizated TNF-I patients, the rate of concomitant GC use (p<0.001) and higher disease activity (p=0.005) was significant higher (tab.1).Conclusion:High or moderate RMD-disease activity is an important factor associated with severity of COVID-19 including mortality. In this large cohort RMD patients treated with TNF-I show a low hospitalisation rate and no fatal course. This is reassuring for patients and treating rheumatologists to use TNF-I to control RMD disease activity. The use of glucocorticoids and high disease activity seem to counteract possible protective effects of TNF-I.Table 1.TNF inhibition (269)Other immunomodulation (874)Total patientsRate (%)Total patientsRate (%)Disease activitystable1415340847low933529934Moderate15610812High104293Comorbiditiescardiovascular diseases18710412arterial hypertension772930335bronchial asthma124657COPD/interstitial lung disease1148610chronic renal failure93779Osteoporosis135678Diabetes2289211COVID-19 related symptomsFever1425347855dry cough1525753061Expectoration3112839muscular pain973628032Fatigue1355042449Headache1013823727shortness of breath491824528no symptoms239566COVID-19 outcomeOutpatients2378861971Inpatients321225529need of oxygen treatment18718922invasive ventilation52496fatal course00496TNF inhibitorsAdalimumab9535Infliximab239Certolizumab3312Golimumab249Etanercept9435GC and disease activity in TNF-I treated patientsTNF-I inpatients treated with GC18/3256p< 0.001TNF-I outpatients treated with GC42/23718TNF-I inpatients with high disease activity4/3213TNF-I outpatients with high disease activity6/2376p= 0.005Acknowledgements:The authors would like to thank all physicians and personnel involved in the documentation of the cases in our registry.Disclosure of Interests:None declared
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Schulze-Koops H, Krueger K, Specker C. Response to: ‘Treatment adherence behaviours in rheumatic diseases during pandemic
COVID-19: a Latin American experience’ by Pineda-Sic et al. Ann Rheum Dis 2021; 80:e86. [DOI: 10.1136/annrheumdis-2020-218223] [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] [Received: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/04/2022]
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Hasseli R, Müller-Ladner U, Schmeiser T, Lorenz HM, Krause A, Schulze-Koops H, Pfeil A, Regierer A, Richter J, Strangfeld A, Voll R, Specker C, Hoyer BF. POS1261 DISEASE ACTIVITY AND PAIN LEVELS ARE NOT INFLUENCED BY THE CURRENT COVID19 PANDEMIC IN PATIENTS WITH RHEUMATIC DISEASES IN GERMANY – DATA FROM THE GERMAN COVID-19 PATIENT SURVEY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Background:The current pandemic constitutes an entirely new situation for patients as well as physicians. The insecurity of the early phase, shutdowns, increasing infection rate and appearing SARS-CoV2 mutations have created a situation that makes live difficult especially for chronic diseases i.e. patients with rheumatic and musculoskeletal diseases (RMD) and their treating physicians. The psychosocial burden that is created by this special situation is completely unknown and is estimated to be higher in patients than in the general population.Objectives:In order to measure the impact on our patients, the German COVID19-Rheuma patient survey was set up in April 2020, during Germany’s first shut down.Methods:The German COVID19-Rheuma patient survey is a patient reported longitudinal online survey where patients with RMD who registered between April and July 2020 are asked on a monthly base using an online survey on social, personal, medical factors, whether a COVID19 infection occurred, isolation measures were changed and scores regarding stress and anxiety are recorded. Between April and July 2020, 637 patients registered and completed a first survey. Up to January 2021, about 400 patients are still enrolled.Here we present an interim analysis of the first 6 months regarding patients that were enrolled in April and May during the first shut-down. This first analysis compares the situation in the first lockdown to July, a phase with very low infection numbers in Germany, and to November, the beginning of the second lockdown.Results:150 patients (87% female) were enrolled in April/early May 2020. Mean age was 48 years (range 11-89). The majority of patients suffered from rheumatoid arthritis (51%), followed by psoriatic arthritis (17%), other spondyloarthropathies (10%) and connective tissue diseases (10%).The majority of patients received antirheumatic therapies: 32% glucocorticoids (GC), 31% cDMARDs, 21% TNF inhibitors, 7% Jak inhibitors, and 9% other biologicals. Of the patients treated with GC, 25% were on GC monotherapy.In the first lockdown, 26% of patients were working remotely and 24% were self-isolating (doubles included). Additionally, 48% were using masks that were not mandatory at that time and 41% were using disinfection in a regular manner. The rates for remote work and self-isolation did not change significantly over time while the mask use increased to 98% with the official obligation to do so. The use of disinfectants increased to 88% in November.Regarding disease activity, no change in patient global assessment could be observed over time (4.3 ± 2.5 vs. 4.0 ±2.6 and 4.0 ± 2.5). Self-reported pain was also stable over time as were sleep disturbances. While 48.2% of patients who were receiving physiotherapy paused in April, only 10 and 14% did so in July and November, respectively. 11% of the patients paused their medication in the first lockdown, whereas only 2.75% did so in July and 3.4% in November. Contact with the treating rheumatologist was maintained over time in the majority of cases.Conclusion:While in the beginning of the pandemic the insecurity was considerable and the concern that the fear for infection would lead to inadequately treated patients with RMDs, we here show for the first time that on the one hand our patients were timely in taking adequate measures to keep themselves safe (e.g. self-isolating, mask use) and adapted to the clinical situation in not pausing their medication. Altogether, in this alert cohort, the pandemic did not lead to an increase of patient-reported disease activity in the first six months.Acknowledgements:Thanks goes to all patients who participated in the study.Disclosure of Interests:None declared
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Sparks JA, Wallace ZS, Seet AM, Gianfrancesco MA, Izadi Z, Hyrich KL, Strangfeld A, Gossec L, Carmona L, Mateus EF, Lawson-Tovey S, Trupin L, Rush S, Katz P, Schmajuk G, Jacobsohn L, Wise L, Gilbert EL, Duarte-García A, Valenzuela-Almada MO, Pons-Estel GJ, Isnardi CA, Berbotto GA, Hsu TYT, D'Silva KM, Patel NJ, Kearsley-Fleet L, Schäfer M, Ribeiro SLE, Al Emadi S, Tidblad L, Scirè CA, Raffeiner B, Thomas T, Flipo RM, Avouac J, Seror R, Bernardes M, Cunha MM, Hasseli R, Schulze-Koops H, Müller-Ladner U, Specker C, Souza VAD, Mota LMHD, Gomides APM, Dieudé P, Nikiphorou E, Kronzer VL, Singh N, Ugarte-Gil MF, Wallace B, Akpabio A, Thomas R, Bhana S, Costello W, Grainger R, Hausmann JS, Liew JW, Sirotich E, Sufka P, Robinson PC, Machado PM, Yazdany J. Associations of baseline use of biologic or targeted synthetic DMARDs with COVID-19 severity in rheumatoid arthritis: Results from the COVID-19 Global Rheumatology Alliance physician registry. Ann Rheum Dis 2021; 80:1137-1146. [PMID: 34049860 PMCID: PMC8172266 DOI: 10.1136/annrheumdis-2021-220418] [Citation(s) in RCA: 126] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022]
Abstract
Objective To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). Methods We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders. Results Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity. Conclusions People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.
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Affiliation(s)
- Jeffrey A Sparks
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA .,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Zachary S Wallace
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA .,Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea M Seet
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Milena A Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Zara Izadi
- Division of Rheumatology, Department of Medicine, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Anja Strangfeld
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universite, Paris, France.,APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal.,Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), European League Against Rheumatism, Kilchberg, Switzerland
| | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, The University of Manchester, Manchester, UK.,National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Laura Trupin
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Stephanie Rush
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Patricia Katz
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Gabriela Schmajuk
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA.,San Francisco VA Health Care System, San Francisco, California, USA
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Leanna Wise
- Department of Internal Medicine, Division of Rheumatology, University of Southern California, Los Angeles, California, USA
| | - Emily L Gilbert
- Division of Rheumatology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Ali Duarte-García
- Division of Rheumatology, Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | | | | | | | - Tiffany Y-T Hsu
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristin M D'Silva
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naomi J Patel
- Clinical Epidemiology Program and Rheumatology Unit, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Martin Schäfer
- Epidemiology and Health Care Research, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Sandra Lúcia Euzébio Ribeiro
- Hospital Universitário Getúlio Vargas, Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas, Brazil
| | - Samar Al Emadi
- Rheumatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Liselotte Tidblad
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Bernd Raffeiner
- Department of Rheumatology, Central Hospital of Bolzano, Padua, Italy
| | - Thierry Thomas
- Société Française de Rhumatologie (SFR), Department of Rheumatology, Hôpital Nord, Universite de Lyon, Lyon, France
| | - René-Marc Flipo
- Department of Rheumatology, University of Lille, Lille, France
| | - Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, AP-HP.CUP, Universite de Paris, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Assistance Publique, Hopitaux de Paris, Universite Paris-Saclay, Saint-Aubin, France
| | - Miguel Bernardes
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal.,Rheumatology Department, Centro Hospitalar de Sao Joao EPE, Porto, Portugal
| | | | - Rebecca Hasseli
- Division of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig Universitat Giessen, Giessen, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Internal Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany
| | - Ulf Müller-Ladner
- Division of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig Universitat Giessen, Giessen, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | | | | | | | - Philippe Dieudé
- Rheumatology Department, Bichat-Claude Bernard Hospital, Paris University, Paris, France
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College Hospital, King's College London, London, UK
| | | | - Namrata Singh
- Division of Rheumatology, University of Washington, Seattle, Washington, USA
| | - Manuel F Ugarte-Gil
- School of Medicine, Universidad Cientifica del Sur, Lima, Peru.,Rheumatology Department, Level IV Hospital Guillermo Almenara Irigoyen, La Victoria, Peru
| | - Beth Wallace
- Department of Internal Medicine/Rheumatology, University of Michigan, Ann Arbor, Michigan, USA.,VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Akpabio Akpabio
- Rheumatology Department, Royal Hallamshire Hospital, Sheffield, UK
| | - Ranjeny Thomas
- UQ Diamantina Institute, The University of Queensland, Saint Lucia, Queensland, Australia
| | | | - Wendy Costello
- Irish Children's Arthritis Network (iCan), Tipperary, Ireland
| | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Jonathan S Hausmann
- Program in Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA.,Division of Rheumatology and Clinical Immunology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jean W Liew
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Emily Sirotich
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.,Canadian Arthritis Patient Alliance, Toronto, Ontario, Canada
| | - Paul Sufka
- HealthPartners, St. Paul, Minnesota, USA
| | - Philip C Robinson
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia.,Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital Health Service District, Herston, Queensland, Australia
| | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California San Francisco, San Francisco, California, USA
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Hasseli R, Pfeil A, Hoyer BF, Krause A, Lorenz HM, Richter JG, Schmeiser T, Voll RE, Schulze-Koops H, Specker C, Müller-Ladner U. Do patients with rheumatoid arthritis show a different course of COVID-19 compared to patients with spondyloarthritis? Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/1bq5pl] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany.
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Germany
| | - Bimba F. Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel-Hospital Berlin, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Department of Rheumatology, Medicine V, University Hospital of Heidelberg, Germany
| | - Jutta G. Richter
- Department of Rheumatology and Hiller Research Unit, Heinrich-Heine-University, Medical Faculty, Duesseldorf, Germany
| | | | - Reinhard E. Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
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Schulze-Koops H, Krüger K, Hoyer BF, Leipe J, Iking-Konert C, Specker C. 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. Rheumatology (Oxford) 2021; 60:2128-2133. [PMID: 33502500 PMCID: PMC7928544 DOI: 10.1093/rheumatology/keab072] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/13/2020] [Accepted: 12/29/2020] [Indexed: 12/14/2022] Open
Abstract
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.
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Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universität München
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, München
| | - Bimba Franziska Hoyer
- Division of Rheumatology, Department of Medicine 1, University Hospital Schleswig-Holstein Campus Kiel, Kiel
| | - Jan Leipe
- Division of Rheumatology, Department of Medicine V, University Hospital Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg
| | - Christof Iking-Konert
- Department of Medicine III and Section Rheumatology, University Hospital Hamburg-Eppendorf, Hamburg
| | - Christof Specker
- Clinic for Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
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Schwarze M, Fieguth V, Schuch F, Sandner P, Edelmann E, Händel A, Kettler M, Hanke A, Kück M, Stein L, Stille C, Fellner M, De Angelis V, Touissant S, Specker C. [Disease-related knowledge acquisition through structured patient information in rheumatoid arthritis (StruPI-RA) : First results of the StruPI-RA study in Germany]. Z Rheumatol 2021; 80:364-372. [PMID: 32926219 PMCID: PMC8096752 DOI: 10.1007/s00393-020-00871-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVE The structured patient information for rheumatoid arthritis (StruPi-RA) program was the first standardized outpatient education program in rheumatoid arthritis (RA) in Germany. The main objective of the study was to determine the efficacy of the StruPi-RA program concerning disease-specific knowledge acquisition in patients with early stage RA or after changing the treatment regimen. METHODS A total of 61 patients were included in a control group design, 32 in the intervention group (IG) and 29 in the control group (CG). Patients of the IG attended 3 modules of 90 min in a structured patient information program (StruPI-RA) including the topics of diagnostics, treatment and living with RA. Patients in the CG only received information material from the German Rheumatism League. The primary target criterion was the disease-related acquisition of knowledge, measured with the patient knowledge questionnaire (PKQ). Data were collected before and after participation in StruPI-RA. RESULTS The improvement in knowledge in the IG attending the StruPI-RA compared to the CG was significant in time and group comparisons. No influence of disease duration or educational level was observed. The subscale treatment alone showed a significant difference in the group and time comparison. CONCLUSION Participation in the StruPI-RA program in early RA was associated with a significant increase in disease-specific knowledge compared to the control group of patients. This leads to better decision-making in terms of treatment, a more beneficial doctor-patient communication and better self-management. In the long term an improvement in treatment adherence and quality of life is expected.
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Affiliation(s)
- M Schwarze
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - V Fieguth
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - F Schuch
- Rheumatologische Schwerpunktpraxis, Erlangen, Deutschland
| | - P Sandner
- Rheumatologische Schwerpunktpraxis, Erlangen, Deutschland
| | - E Edelmann
- Rheumazentrum Bad Aibling-Erding, Bad Aibling, Deutschland
| | - A Händel
- Rheumazentrum Bad Aibling-Erding, Bad Aibling, Deutschland
| | - M Kettler
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - A Hanke
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M Kück
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - L Stein
- Institut für Sportmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - C Stille
- Rheumatologie-Praxis, Hannover, Deutschland
| | - M Fellner
- Rheumatologie-Praxis, Hannover, Deutschland
| | | | - S Touissant
- Rheumatologie Centrum, Leverkusen, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
- Arbeitsgemeinschaft Regionaler Kooperativer Rheumazentren in der Deutschen Gesellschaft für Rheumatologie e. V. (DGRh), Berlin, Deutschland
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Richter JG, Chehab G, Knitza J, Krotova A, Schneider M, Voormann AJ, Schulze-Koops H, Specker C. [Annual meeting of the German Society for Rheumatology going virtual-successfully defying the pandemic]. Z Rheumatol 2021; 80:399-407. [PMID: 33877456 PMCID: PMC8055747 DOI: 10.1007/s00393-021-00997-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Die COVID-19-Pandemie führte im Jahr 2020 dazu, dass der Jahreskongress der Deutschen Gesellschaft für Rheumatologie (DGRh) als „Deutscher Rheumatologiekongress virtuell“ durchgeführt wurde. Fragestellung Wie wird der „Deutsche Rheumatologiekongress virtuell“ angenommen und welche Optimierungsmöglichkeiten bieten sich für die Zukunft? Material und Methode Die registrierten Teilnehmer wurden gebeten, an einer Online-Kongressevaluation teilzunehmen. Ergebnisse Von 2566 Kongressteilnehmern nahmen 721 an der Evaluation teil. Die Mehrheit (80,2 %) war mit der Veranstaltung insgesamt zufrieden oder sehr zufrieden. Das Format wurde als für den kollegialen Austausch weniger geeignet angesehen. Die verwendete Technik wurde überwiegend als leicht bedienbar und problemlos zugänglich beschrieben. Die ausgewählten Themen des Kongresses entsprachen den Erwartungen von 89 % der Teilnehmer. Die präsentierten Inhalte wurden von 85,2 % der Teilnehmer als für ihre Tätigkeit relevant eingestuft. Eine deutliche Mehrheit der Teilnehmer (85,3 %) würde es begrüßen, die Kongressinhalte dauerhaft und flexibel „on demand“ abrufen zu können. Diskussion Insgesamt konnte ein gut akzeptiertes Format für die Durchführung des „Deutschen Rheumatologiekongresses virtuell“ gefunden werden. Optimierungsaspekte konnten aufgezeigt werden, diese können bei der Umsetzung weiterer (digitaler) Kongresse Berücksichtigung finden. Die Ergebnisse dieser Arbeit geben Aufschluss darüber, wie die DGRh virtuelle und/oder hybride Konferenzen in der Zukunft gestalten kann, um den Interessen und Wünschen der Teilnehmer zu entsprechen.
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Affiliation(s)
- Jutta G Richter
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Gamal Chehab
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Johannes Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Deutschland
| | - Anna Krotova
- Rheumatologische Fortbildungsakademie, Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Anna Julia Voormann
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum, Universität München, München, Deutschland
| | - Hendrik Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Klinikum, Universität München, München, Deutschland
| | - Christof Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
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36
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Specker C, Alberding A, Aringer M, Burmester GR, Flacke JP, Hofmann MW, Kästner P, Kellner H, Moosig F, Sieburg M, Tony HP, Fliedner G. ICHIBAN, a non-interventional study evaluating tocilizumab long-term effectiveness and safety in patients with active rheumatoid arthritis. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/3qdgi1] [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: 11/13/2022]
Affiliation(s)
- Christof Specker
- Clinic of Rheumatology and Clinical Immunology, Evangelical Hospital, Clinic Essen-Mitte, Essen, Germany.
| | | | - Martin Aringer
- Department of Medicine III, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin, Free University and Humboldt University Berlin, Germany
| | | | | | | | - Herbert Kellner
- Rheumatology and Gastroenterology Specialty Practice, Munich, Germany
| | - Frank Moosig
- Rheumatology Center Schleswig-Holstein Middle, Neumünster, Germany
| | | | - Hans-Peter Tony
- Medical Clinic II, Department of Rheumatology and Clinical Immunology, University Clinic Würzburg, Germany
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37
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Specker C, Aringer M, Burmester GR, Killy B, Hofmann MW, Kellner H, Moosig F, Tony HP, Fliedner G. The safety and effectiveness of tocilizumab in elderly patients with rheumatoid arthritis and in patients with comorbidities associated with age. Clin Exp Rheumatol 2021; 40:1657-1665. [DOI: 10.55563/clinexprheumatol/f7ff6q] [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] [Received: 03/30/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Christof Specker
- Clinic of Rheumatology and Clinical Immunology, Clinic Essen-Mitte, Essen, Germany.
| | - Martin Aringer
- Department of Medicine III, University Medical Center Carl Gustav Carus, Dresden University of Technology, Dresden, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology Charité - Universitätsmedizin Berlin, Free University and Humboldt University Berlin, Germany
| | - Barbara Killy
- Rheumatology, Roche Pharma AG, Grenzach-Wyhlen, Germany
| | | | - Herbert Kellner
- Rheumatology and Gastroenterology Specialty Practice, Munich, Germany
| | - Frank Moosig
- Rheumatology Center Schleswig-Holstein Middle, Neumünster, Germany
| | - Hans-Peter Tony
- Medical Clinic II, Department of Rheumatology and Clinical Immunology, University Clinic Würzburg, Germany
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38
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Schulze-Koops H, Specker C, Skapenko A. Vaccination of patients with inflammatory rheumatic diseases against SARS-CoV-2: considerations before widespread availability of the vaccines. RMD Open 2021; 7:rmdopen-2020-001553. [PMID: 33627439 PMCID: PMC7907835 DOI: 10.1136/rmdopen-2020-001553] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 01/20/2021] [Accepted: 02/03/2021] [Indexed: 01/18/2023] Open
Abstract
Vaccination against SARS-CoV-2 has become available and will hopefully end the current pandemic. Understandably, patients with inflammatory rheumatic diseases (iRMDs) and their physicians are feverishly preoccupied with questions about vaccination and the vaccines against SARS-CoV-2. However, as it will take months before all patients with iRMDs will have access to the vaccines, measures that are taken now in order to increase potential safety and efficacy of the vaccines may impose a risk for the patients with regard to reactivation of their underlying iRMD. The ad hoc commission ‘Covid-19’ and the board of directors of the German Society for Rheumatology have addressed this topic and have developed considerations, which are intended to answer urgent questions, to take away concerns and fears and to make initial recommendations for patients with iRMDs.
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Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Alla Skapenko
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig Maximilians University of Munich, Munich, Germany
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39
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Hasseli R, Mueller-Ladner U, Hoyer BF, Krause A, Lorenz HM, Pfeil A, Richter J, Schäfer M, Schmeiser T, Strangfeld A, Schulze-Koops H, Voll RE, Specker C, Regierer AC. Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2021; 7:rmdopen-2020-001464. [PMID: 33479021 PMCID: PMC7823432 DOI: 10.1136/rmdopen-2020-001464] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Whether patients with inflammatory rheumatic and musculoskeletal diseases (RMD) are at higher risk to develop severe courses of COVID-19 has not been fully elucidated. Aim of this analysis was to describe patients with RMD according to their COVID-19 severity and to identify risk factors for hospitalisation. Methods Patients with RMD with PCR confirmed SARS-CoV-2 infection reported to the German COVID-19 registry from 30 March to 1 November 2020 were evaluated. Multivariable logistic regression was used to estimate ORs for hospitalisation due to COVID-19. Results Data from 468 patients with RMD with SARS-CoV-2 infection were reported. Most frequent diagnosis was rheumatoid arthritis, RA (48%). 29% of the patients were hospitalised, 5.5% needed ventilation. 19 patients died. Multivariable analysis showed that age >65 years (OR 2.24; 95% CI 1.12 to 4.47), but even more>75 years (OR 3.94; 95% CI 1.86 to 8.32), cardiovascular disease (CVD; OR 3.36; 95% CI 1.5 to 7.55), interstitial lung disease/chronic obstructive pulmonary disease (ILD/COPD) (OR 2.79; 95% CI 1.2 to 6.49), chronic kidney disease (OR 2.96; 95% CI 1.16 to 7.5), moderate/high RMD disease activity (OR 1.96; 95% CI 1.02 to 3.76) and treatment with glucocorticoids (GCs) in dosages >5 mg/day (OR 3.67; 95% CI 1.49 to 9.05) were associated with higher odds of hospitalisation. Spondyloarthritis patients showed a smaller risk of hospitalisation compared with RA (OR 0.46; 95% CI 0.23 to 0.91). Conclusion Age was a major risk factor for hospitalisation as well as comorbidities such as CVD, ILD/COPD, chronic kidney disease and current or prior treatment with GCs. Moderate to high RMD disease activity was also an independent risk factor for hospitalisation, underlining the importance of continuing adequate RMD treatment during the pandemic.
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Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerkhoff, Justus-Liebig-University, Giessen, Giessen, Germany
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerkhoff, Justus-Liebig-University, Giessen, Giessen, Germany
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University of Schleswig-Holstein at Kiel, Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital, Berlin, Germany
| | | | - Alexander Pfeil
- Department of Internal Medicine III, Universitatsklinikum Jena, Jena, Germany
| | - Jutta Richter
- Department of Rheumatology and Hiller Research Unit, Medical Faculty, Heinrich-Heine-Universitat Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Martin Schäfer
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Center Berlin, Berlin, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Reinhard E Voll
- Dep. of Rheumatology and Clinical Immunology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, Kliniken Essen-Mitte, Essen, Germany
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40
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Lakomek HJ, Krause A, Braun J, Hellmich B, Klass M, Lorenz H, Schneider M, Schulze-Koops H, Specker C. [Future of acute inpatient rheumatology in Germany : Statement of the Boards of the German Society for Rheumatology and the Association of Rheumatological Acute Clinics on hospital planning North-Rhine/Westphalia 2019 for the discipline rheumatology]. Z Rheumatol 2020; 80:103-106. [PMID: 33313964 PMCID: PMC7872996 DOI: 10.1007/s00393-020-00939-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 12/03/2022]
Abstract
Im September 2019 wurde vom Ministerium für Arbeit, Gesundheit und Soziales (MAGS) in NRW ein Gutachten zur Krankenhausplanung veröffentlicht. Hierin wurde eine grundlegende Reform der Krankenhausplanung empfohlen, indem zukünftig eine Bedarfsplanung auf der Grundlage einer detaillierten Ausweisung von Leistungsbereichen und Leistungsgruppen erfolgen soll. Nach Aufforderung durch das MAGS NRW hat auch die Deutsche Gesellschaft für Rheumatologie (DGRh) mit Unterstützung des Verbandes Rheumatologischer Akutkliniken (VRA) hierzu Stellung genommen.
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Affiliation(s)
- H-J Lakomek
- Universitätsklinik für Geriatrie, Mühlenkreiskliniken, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Deutschland.
| | - A Krause
- Abteilung Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet und Ruhr-Universität Bochum, Herne, Deutschland
| | - B Hellmich
- Vaskulitiszentrum Süd, Klinik für Innere Medizin, Rheumatologie und Immunologie, Medius Kliniken - Akademisches Lehrkrankenhaus der Universität Tübingen, Kirchheim u. Teck, Deutschland
| | - M Klass
- Klinik für Rheumatologie und Physikalische Therapie, Helios St. Johannes Klinik, Duisburg, Deutschland
| | - H Lorenz
- Sektion Rheumatologie, Med. Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.,ACURA-Rheumazentrum Baden-Baden, Baden-Baden, Deutschland
| | - M Schneider
- Poliklinik, Funktionsbereich und Hiller-Forschungszentrum für Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Evang. Krankenhaus Essen-Werden, Kliniken Essen-Mitte, Essen, Deutschland
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41
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Lorenz HM, Aringer M, Braun J, Hoyer BF, Krause A, Meyer-Olson D, Mucke J, Rudwaleit M, Schneider M, Sewerin P, Späthling-Mestekemper S, Specker C, Voormann A, Wagner U, Wendler J, Schulze-Koops H. [Mission statement from rheumatologists in the German Society of Rheumatology (DGRh e. V.) : We live rheumatology. German version]. Z Rheumatol 2020; 79:1018-1021. [PMID: 33216190 DOI: 10.1007/s00393-020-00919-8] [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] [Accepted: 10/09/2020] [Indexed: 11/24/2022]
Abstract
Systemic disease demands systemic thinkers. In this mission statement we define rheumatology, describe the role of the German Society of Rheumatology and the rheumatologist's spirit to their discipline. Rheumatologists are dedicated to improving the quality of life of their acute, chronic, and rehabilitative patients on the basis of up to date evidence and strong physician-patient relations. We think, act and interact systemically, scientifically, consistently, transparently, reliably, inclusively, innovatively and enthusiastically.
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Affiliation(s)
- H-M Lorenz
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland. .,Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland. .,Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - M Aringer
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Bereich Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - J Braun
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Rheumazentrum Ruhrgebiet, Lehrstuhl für Rheumatologie, Ruhr Universität Bochum, Herne, Deutschland
| | - B F Hoyer
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie und klin. Immunologie, 1. Medizinische Klinik, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - A Krause
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Klinische Immunologie und Osteologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - D Meyer-Olson
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung Rheumatologie/Innere Medizin, m&i Fachklinik Bad Pyrmont und MVZ Weserbergland, Bad Pyrmont, Deutschland.,Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - J Mucke
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Rudwaleit
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Klinik für Innere Medizin und Rheumatologie, Klinikum Bielefeld, Bielefeld, Deutschland
| | - M Schneider
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - P Sewerin
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - S Späthling-Mestekemper
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Rheumapraxis München Pasing, München, Deutschland
| | - C Specker
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - A Voormann
- Ad-hoc-Kommission der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Geschäftsstelle der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - U Wagner
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Wendler
- Rheumatologische Schwerpunktpraxis Erlangen, Erlangen, Deutschland
| | - H Schulze-Koops
- Vorstand der Deutschen Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
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Aries P, Welcker M, Callhoff J, Chehab G, Krusche M, Schneider M, Specker C, Richter JG. [Statement of the German Society for Rheumatology (DGRh) on the use of video consultations in rheumatology]. Z Rheumatol 2020; 79:1078-1085. [PMID: 33201305 PMCID: PMC7670291 DOI: 10.1007/s00393-020-00932-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
Die Durchführung von Videosprechstunden wird seit mehreren Jahren als ergänzende Form der medizinischen Versorgung in Ergänzung zu einem persönlichen Arzt-Patienten-Kontakt angesehen und teilweise auch gefördert. Die COVID-19-Pandemie hat der Nutzung von Videosprechstunden ungeahnte Aktualität und Aufmerksamkeit verschafft. Die Kassenärztliche Bundesvereinigung beschloss Sonderregelungen im Rahmen der COVID-19-Pandemie, die bisherige Hindernisse für den Einsatz von Telemedizin und Videosprechstunden (und auch teilweise der herkömmlichen Telefonie) reduziert. Die vorliegende Stellungnahme der DGRh zum Einsatz von Videosprechstunden soll einen Überblick darüber geben, in welcher Form und mit welchen Limitierungen die Videosprechstunde in der Rheumatologie in Deutschland anwendbar ist. Die Stellungnahme skizziert einen Ausblick, wie die Videosprechstunde welche Funktionen zukünftig in der rheumatologischen Versorgung übernehmen kann.
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Affiliation(s)
- P Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - M Welcker
- Geschäftsführung, MVZ für Rheumatologie Dr. Martin Welcker GmbH & RheumaDatenRhePort (RhaDaR), Planegg, Deutschland
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - G Chehab
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
| | - J G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Hasseli R, Mueller-Ladner U, Schmeiser T, Hoyer BF, Krause A, Lorenz HM, Regierer AC, Richter JG, Strangfeld A, Voll RE, Pfeil A, Schulze-Koops H, Specker C. National registry for patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 in Germany (ReCoVery): a valuable mean to gain rapid and reliable knowledge of the clinical course of SARS-CoV-2 infections in patients with IRD. RMD Open 2020; 6:rmdopen-2020-001332. [PMID: 32878994 PMCID: PMC7507994 DOI: 10.1136/rmdopen-2020-001332] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/09/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives Patients with inflammatory rheumatic diseases (IRD) infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be at risk to develop a severe course of COVID-19. The influence of immunomodulating drugs on the course of COVID-19 is unknown. To gather knowledge about SARS-CoV-2 infections in patients with IRD, we established a registry shortly after the beginning of the pandemic in Germany. Methods Using an online questionnaire (www.COVID19-rheuma.de), a nationwide database was launched on 30 March 2020, with appropriate ethical and data protection approval to collect data of patients with IRD infected with SARS-CoV-2. In this registry, key clinical and epidemiological parameters—for example, diagnosis of IRD, antirheumatic therapies, comorbidities and course of the infection—are documented. Results Until 25 April 2020, data from 104 patients with IRD infected with SARS-CoV-2 were reported (40 males; 63 females; 1 diverse). Most of them (45%) were diagnosed with rheumatoid arthritis, 59% had one or more comorbidities and 42% were treated with biological disease-modifying antirheumatic drugs. Hospitalisation was reported in 32% of the patients. Two-thirds of the patients already recovered. Unfortunately, 6 patients had a fatal course. Conclusions In a short time, a national registry for SARS-CoV2-infected patients with IRD was established. Within 4 weeks, 104 cases were documented. The registry enables to generate data rapidly in this emerging situation and to gain a better understanding of the course of SARS-CoV2-infection in patients with IRD, with a distinct focus on their immunomodulatory therapies. This knowledge is valuable for timely information of physicians and patients with IRD, and shall also serve for the development of guidance for the management of patients with IRD during this pandemic.
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Affiliation(s)
- Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
| | - Tim Schmeiser
- Department of Rheumatology and Immunology, Saint Josef Hospital, Wuppertal, Germany
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Krause
- Department of Rheumatology, Clinical Immunology and Osteology, Immanuel Hospital Berlin, Berlin, Germany
| | | | | | - Jutta G Richter
- Department of Rheumatology and Hiller Research Unit, Heinrich-Heine-University, Medical Faculty, Duesseldorf, Germany
| | - Anja Strangfeld
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Freiburg, Germany
| | - Alexander Pfeil
- Department of Internal Medicine III, University Hospital Jena, Jena, Germany
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte,Essen, Germany
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Abstract
Even early on thromboembolic events were observed in patients with systemic lupus erythematosus (SLE) until the antiphospholipid syndrome (APS) was described in the 1980s as an independent disorder. The APS is a systemic autoimmune disease often overlapping with SLE in which antiphospholipid autoantibodies, including lupus anticoagulant, can cause a hypercoagulation state, which clinically by definition is manifested as arterial and venous occlusions or pregnancy complications. The pathophysiology has not yet been entirely delineated and the clinical spectrum of associated concomitant manifestations is large. As the mortality is increased with SLE and simultaneous APS, focused diagnostics and risk assessment are indispensable. According to the recently published recommendations of the European League Against Rheumatism the therapeutic strategy comprises individualized secondary prevention of thromboembolic complications by means of anticoagulation (with unaltered importance of vitamin K antagonists) and thrombocyte aggregation inhibition, usually lifelong. Statins and antimalarial drugs are recommended for vascular protection while immunosuppressive treatment has not so far been sufficiently proven for APS but remains the subject of current research.
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Affiliation(s)
- M Lettau
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.,Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), 10117, Berlin, Deutschland
| | - E V Schrezenmeier
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.,Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), 10117, Berlin, Deutschland.,Medizinische Klinik mit Schwerpunkt Nephrologie und Internistische Intensivmedizin, Charité - Universitätsmedizin Berlin, 10117, Berlin, Deutschland
| | - C Specker
- Kliniken Essen-Mitte, Klinik für Rheumatologie und Klinische Immunologie, 45239, Essen, Deutschland
| | - T Dörner
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland. .,Deutsches Rheuma-Forschungszentrum Berlin (DRFZ), 10117, Berlin, Deutschland.
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Knitza J, Callhoff J, Chehab G, Hueber A, Kiltz U, Kleyer A, Krusche M, Simon D, Specker C, Schneider M, Voormann A, Welcker M, Richter JG. [Position paper of the commission on digital rheumatology of the German Society of Rheumatology: tasks, targets and perspectives for a modern rheumatology]. Z Rheumatol 2020; 79:562-569. [PMID: 32651681 DOI: 10.1007/s00393-020-00834-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/28/2022]
Abstract
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.
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Affiliation(s)
- J Knitza
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
| | - J Callhoff
- Programmbereich Epidemiologie, Deutsches Rheuma-Forschungszentrum (DRFZ), Berlin, Deutschland
| | - G Chehab
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Hueber
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.,Sektion Rheumatologie, Sozialstiftung Bamberg, Klinikum Bamberg, Bamberg, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr-Universität Bochum, Herne, Deutschland
| | - A Kleyer
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - M Krusche
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Berlin, Deutschland
| | - D Simon
- Medizinische Klinik 3 - Rheumatologie und Immunologie, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland
| | - C Specker
- Klinik für Rheumatologie & Klinische Immunologie, Evangelisches Krankenhaus, Kliniken Essen-Mitte, Essen, Deutschland
| | - M Schneider
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - A Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - M Welcker
- Geschäftsführung, MVZ für Rheumatologie Dr. Martin Welcker GmbH & RheumaDatenRhePort (rhadar), Planegg, Deutschland
| | - J G Richter
- Poliklinik und Funktionsbereich Rheumatologie & Hiller-Forschungszentrum Rheumatologie, Medizinische Fakultät, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Fiehn C, Ness T, Weseloh C, Specker C, Hadjiski D, Detert J, Krüger K. [Safety management of the treatment with antimalarial drugs in rheumatology. Interdisciplinary recommendations based on a systematic literature search]. Z Rheumatol 2020; 79:186-194. [PMID: 32095892 DOI: 10.1007/s00393-020-00751-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Antimalarial medication (AM) plays an important role in the treatment of rheumatic diseases. OBJECTIVE Updated evidence-based recommendations on the safety management of rheumatological treatment with AM are presented. METHODS A systematic literature search in the databases Medline (PubMed) and Cochrane identified 1160 studies on the safety of treatment with AM in rheumatology. In addition, a manual search was carried out and 67 publications considered to be particularly relevant by the authors were analyzed in more detail. These publications served as a basis for consensus-based recommendations. RESULTS Treatment with AM in rheumatology should be carried out with hydroxychloroquine (HCQ) with a dosage not exceeding 5 mg/kg body weight/day. Patients should undergo a basic ophthalmological examination within the first 6 months of AM treatment. Pre-existing maculopathy, renal insufficiency (glomerular filtration rate, GFR <60 ml/min), tamoxifen comedication, a daily dose of >5 mg/kg HCQ or treatment with chloroquine (CQ) show an increased risk for AM-induced retinopathy. These patients should undergo an annual ophthalmological check from the beginning of the treatment, whereas patients with no risk factors are recommended to start this only after 5 years of taking the medication. The ophthalmological examination should comprise at least both an appropriate subjective and an objective method and these are usually an automated visual field test and optical coherence tomography (OCT). A visual field test revealing a parafoveal sensitivity loss and an OCT showing a parafoveal circumscribed loss of the photoreceptor layer or focal interruptions of the structural line of the outer segment are signs of a possible AM retinopathy. Determination of creatine kinase (CK) and lactate dehydrogenase (LDH) in blood is appropriate to screen for cardiomyopathy and myopathy and should be checked before starting the treatment and then ca. every 3 months. The use of cardiac biomarkers, such as brain natriuretic peptide (BNP) or troponin in serum, electrocardiograph (ECG) or cardiac imaging should be considered depending on the situation. An intake of HCQ is safe during pregnancy and breastfeeding according to the current state of knowledge and is protective for mother and child in patients with systemic lupus erythematosus. CONCLUSION The updated recommendations on AM treatment in rheumatology in particular include a more rigorous measuring of doses, risk stratification in monitoring and defined ophthalmological examination methods to detect a possible retinopathy.
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Affiliation(s)
- C Fiehn
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland.
| | - T Ness
- Klinik für Augenheilkunde, Universitätsklinik Freiburg, Freiburg, Deutschland
| | - C Weseloh
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - D Hadjiski
- Rheumatologie Baden-Baden GbR, Tätigkeitsschwerpunkt Klinische Immunologie und Belegarzteinheit der ViDia-Kliniken Karlsruhe, Medical Center Baden-Baden, Beethovenstr. 2, 76530, Baden-Baden, Deutschland
| | - J Detert
- Rheumatologisch-immunologische Arztpraxis, Templin, Deutschland
| | - K Krüger
- Praxiszentrum St. Bonifatius, München, Deutschland
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Schulze-Koops H, Iking-Konert C, Leipe J, Hoyer BF, Holle J, Moosig F, Aries P, Burmester G, Fiehn C, Krause A, Lorenz HM, Schneider M, Sewerin P, Voormann A, Wagner U, Krüger K, Specker C. [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]. Z Rheumatol 2020; 79:679-685. [PMID: 32757030 PMCID: PMC7403789 DOI: 10.1007/s00393-020-00851-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Hendrik Schulze-Koops
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland.
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - Christof Iking-Konert
- III. Medizinische Klinik und Poliklinik, Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Jan Leipe
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätskrankenhaus Mannheim, Mannheim, Deutschland
| | - Bimba Franziska Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Julia Holle
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Deutschland
| | - Peer Aries
- Rheumatologie im Struenseehaus, Hamburg, Deutschland
| | - Gerd Burmester
- Klinik für Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität und Humboldt Universität Berlin, Berlin, Deutschland
| | - Christoph Fiehn
- Praxis für Rheumatologie und Klinische Immunologie, Medical Center Baden-Baden und ViDia-Kliniken Karlsruhe, Baden-Baden, Deutschland
| | - Andreas Krause
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Osteologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Berlin, Deutschland
| | - Hanns-Martin Lorenz
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Medizinische Klinik V, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Matthias Schneider
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Philipp Sewerin
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Anna Voormann
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
| | - Ulf Wagner
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Abteilung für Rheumatologie, Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Klaus Krüger
- Rheumatologisches Praxiszentrum München, St. Bonifatius-Str. 5, 81541, München, Deutschland.
- Kommission Pharmakotherapie, DGRh e. V., Berlin, Deutschland.
| | - Christof Specker
- Deutsche Gesellschaft für Rheumatologie e. V., Berlin, Deutschland
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
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48
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Leipe J, Hoyer BF, Iking-Konert C, Schulze-Koops H, Specker C, Krüger K. [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]. Z Rheumatol 2020; 79:686-691. [PMID: 32845393 PMCID: PMC7448266 DOI: 10.1007/s00393-020-00878-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- J Leipe
- Sektion Rheumatologie, Medizinische Klinik V, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland. .,Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland.
| | - B F Hoyer
- Abteilung für Rheumatologie, 1. Medizinische Klinik, Universitätskrankenhaus Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - C Iking-Konert
- III. Medizinische Klinik und Poliklinik Sektion Rheumatologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H Schulze-Koops
- Sektion Rheumatologie und Klinische Immunologie, Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, München, Deutschland
| | - C Specker
- Klinik für Rheumatologie und Klinische Immunologie, Kliniken Essen-Mitte, Essen, Deutschland
| | - K Krüger
- Rheumatologisches Praxiszentrum München, München, Deutschland
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Kedor C, Listing J, Zernicke J, Weiß A, Behrens F, Blank N, Henes JC, Kekow J, Rubbert-Roth A, Schulze-Koops H, Seipelt E, Specker C, Feist E. Canakinumab for Treatment of Adult-Onset Still's Disease to Achieve Reduction of Arthritic Manifestation (CONSIDER): phase II, randomised, double-blind, placebo-controlled, multicentre, investigator-initiated trial. Ann Rheum Dis 2020; 79:1090-1097. [PMID: 32404342 PMCID: PMC7392486 DOI: 10.1136/annrheumdis-2020-217155] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inhibition of interleukin (IL)-1 represents a promising treatment option in adult-onset Still's disease (AOSD). OBJECTIVE To investigate the efficacy and safety of canakinumab in patients with AOSD and active joint involvement by means of a multicentre, double-blind, randomised, placebo-controlled trial. METHODS Patients with AOSD and active joint involvement (tender and swollen joint counts of ≥4 each) were treated with canakinumab (4 mg/kg, maximum 300 mg subcutaneous every 4 weeks) or placebo. The primary endpoint was the proportion of patients with a clinically relevant reduction in disease activity at week 12 as determined by the change in disease activity score (ΔDAS28>1.2). RESULTS At enrolment, patients had high active disease with a mean DAS28(ESR) of 5.4 in the canakinumab and 5.3 in the placebo group, respectively. In the intention-to-treat analysis, 12 patients (67%) in the canakinumab group and 7 patients (41%) in the placebo group fulfilled the primary outcome criterion (p=0.18). In the per-protocol analysis, significantly higher American College of Rheumatology (ACR) 30% (61% vs 20%, p=0.033), ACR 50% (50% vs 6.7%, p=0.009) and ACR 70% (28% vs 0%, p=0.049) response rates were observed in the canakinumab group compared with the placebo group. Two patients in the canakinumab group experienced a serious adverse event. CONCLUSION Although the study was terminated prematurely and the primary endpoint was not achieved, treatment with canakinumab led to an improvement of several outcome measures in AOSD. The overall safety findings were consistent with the known profile of canakinumab. Thus, our data support indication for IL-1 inhibition with canakinumab in AOSD.
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Affiliation(s)
- Claudia Kedor
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Listing
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Jan Zernicke
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Anja Weiß
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Frank Behrens
- CIRI/Rheumatology and Fraunhofer TMP, Goethe-University, Frankfurt, Germany
| | - Norbert Blank
- Internal Medicine 5, University of Heidelberg, Heidelberg, Germany
| | - Joerg Christoph Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany
| | - Joern Kekow
- Clinic of Rheumatology and Orthopaedics, Otto-von-Guericke University Magdeburg, Vogelsang-Gommern, Germany
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Eva Seipelt
- Abteilung Rheumatologie und Klinische Immunologie, Immanuel Krankenhaus Berlin, Standort Berlin-Buch, Berlin, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, KEM Kliniken Essen-Mitte, Essen, Germany
| | - Eugen Feist
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Schulze-Koops H, Specker C, Krueger K. Telemedicine holds many promises but needs to be developed to be accepted by patients as an alternative to a visit to the doctor. Response to: 'Patient acceptance of using telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak' by So et al. Ann Rheum Dis 2020; 80:e98. [PMID: 32581084 DOI: 10.1136/annrheumdis-2020-218235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Medicine IV, Ludwig-Maximilians-Universitat Munchen, Munich, Germany
| | - Christof Specker
- Klinik für Rheumatologie und Klinische Immunologie, KEM Kliniken Essen-Mitte, Essen, Germany
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