Patient-reported outcomes in large vessel vasculitis: insights from a retrospective analysis of disease activity and associated factors

BACKGROUND

Patient-reported outcomes (PROs) play a crucial role in assessing rheumatic diseases, offering insights into disease evaluation and treatment efficacy. This study focuses on PRO assessment in large vessel vasculitides, including Takayasu Arteritis and Giant Cell Arteritis (GCA).

METHODS

We retrospectively analyzed routine data from patients treated at our rheumatology clinic over a 10-year span. Patient and physician-rated global disease activity scale (G-DAS) scores, measured on a numeric rating scale (0-10 points), were collected at each visit. Clinical variables like age, sex, body mass index (BMI), disease duration, lab values, pain perception, and questionnaire responses were recorded. Linear regression and generalized additive linear regression (GAM analysis) examined associations between PROs and these factors.

RESULTS

The study included 138 patients, primarily diagnosed with GCA (94.4%). Mean follow-up was 2.5 years (0-7.7). Patient and physician G-DAS exhibited a moderate correlation (Pearson R 0.19, CI 0.14-0.24, p < 0.001). Higher patient G-DAS correlated with younger age (CI -3.4 - -1.5, p < 0.001), increased pain (CI 3.5-4, p < 0.001), functional limitations (HAQ, CI 0.5-0.6, p < 0.001), reduced physical (CI 2.3-2.7, p ≤ 0.001) and psychological well-being (CI 2.1-2.5, p < 0.001), and higher BMI (CI 1.3-2.4, p < 0.001). Physician G-DAS correlated with Birmingham Vasculitis Activity Score (V3.0; R 0.42, p 0.046) and were significantly linked to serum CRP elevations (β = 0.04, CI 0.0-0.08, p 0.028).

CONCLUSIONS

These findings underscore the need to integrate PRO measures into vasculitis disease management strategies, enhancing the understanding of disease activity from the patient's perspective.

POS0378 EVALUATION OF THE USE OF VIDEO CONSULTATION IN GERMAN RHEUMATOLOGY CARE BEFORE AND DURING THE COVID-19 PANDEMIC WAVES

Background

During 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.

Objectives

Evaluation 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.

Methods

Cross-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).

Results

Reported 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 waves

Reasons 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)

Conclusion

Despite 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 Interests

Joana 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

POS0362 FACTORS ASSOCIATED WITH CHANGES IN COPING BEHAVIOUR IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS - A LONGITUDINAL STUDY OF THE LuLa COHORT

Background

Patients with Systemic Lupus Erythematosus (SLE) experience both physical and psychosocial restrictions that negatively impact their quality of life. Coping mechanisms have turned out to be important contributors to health-related outcomes, not only in SLE but also other chronic conditions. However, there is limited understanding of factors that enhance or hamper coping in SLE.

Objectives

To analyse parameters associated with longitudinal changes in coping behaviour in patients with SLE who take part in a long-term SLE patient cohort study.

Methods

Since 2001, the German nationwide SLE patient longitudinal (Lupus Langzeit ‘LuLa’) study annually administers self-reported questionnaires to SLE patients.

In addition to demographic and the annually probed extended clinical data (e.g., medication, disease activity, fatigue, depression), in both 2009 and 2014 we assessed the Pain-related Self Statements Scale (PRSS) to perceive information related to coping behaviour. This includes ‘positive coping’ as well as catastrophizing as a dysfunctional form of coping behaviour.

Statistical analysis was accomplished by a linear regression model adjusting for age, pain, number of comorbidities and net income. The PRSS score difference from 2009 and 2014 was used as the dependent variable. Factors from the i) medical (involvement of the skin, pain, fatigue), ii) activity (basic, leisure, sports), iii) intrinsic (depression, kinesiophobia, perceived health control), and iv) social participation categories were entered as independent variables.

Results

272 patients (96.7% female) provided valid PRSS questionnaires in both 2009 and 2014. In 2009 the mean age in this cohort was 51 years (SD 11.2) with an average disease duration of 16.2 years (SD 8.3). The mean reported lupus activity (VAS 0-10) during the last three months was 3.7 (SD 2.4). During the six-year observation period, the proportion of improvement (46.2%) and deterioration (47.4%) in coping score was almost balanced, while in catastrophizing score more participants improved (50.0%) than deteriorated (37.0%).

A perceived high internal control, thus the belief that health outcomes are contingent on personal behaviour, was associated with an improvement in the coping score [HLC, b=0.061 (95%-CI 0.014; 0.109), p=0.012]. Conversely, high external control convictions, e.g., the belief that doctors and other third parties determine health outcomes, were associated with a worse coping score [HLC, b=-0.090 (95%-CI -0.154; -0.026), p=0.006]. Deterioration in depression [ADS-L, b=0.015, (95%-CI 0.006; 0.025), p=0.002] and impaired social participation [IMET, b=0.043, (95%-CI 0.000; 0.085), p=0.050] were associated with a deterioration of catastrophizing, whereas better internal control [HLC, b=-0.046, (95%-CI -0.080; -0.012), p=0.009] was associated with its improvement.

Mucocutaneous involvement, fatigue and the extent of physical activity were not significantly associated with either coping or catastrophizing scores in the regression analysis.

Conclusion

In line with data from other chronic diseases, our findings in a longitudinal SLE cohort emphasise the role of intrinsic factors, such as mental health status and self-efficacy, improving the quality of life in SLE patients via successful coping behaviour. Affirmative action measures and programs to improve social participation may yield additional benefits.

Acknowledgements

The LuLa study is supported by unrestricted grants from GlaxoSmithKline, UCB Pharma and AstraZeneca.

Disclosure of Interests

Emily Reutemann: None declared, Ralph Brinks: None declared, Jutta G. Richter Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Rebecca Fischer-Betz Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Borgi Winkler-Rohlfing: None declared, Martin Aringer: None declared, Matthias Schneider Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study., Gamal Chehab Grant/research support from: GlaxoSmithKline and UCB Pharma for performing the LuLa-study.

POS0377 ONE YEAR OF DIGITAL HEALTH APPLICATIONS (DiGA) IN GERMANY – RHEUMATOLOGISTS’ PERSPECTIVES

Background

Based 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.

Objectives

To 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.

Methods

Anonymous 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.

Results

75 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.

Conclusion

DiGA 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 Interests

Jutta 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

[Statement of the German Society for Rheumatology (DGRh) on the use of video consultations in rheumatology]

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.

Quality of care predicts outcome in systemic lupus erythematosus: a cross-sectional analysis of a German long-term study (LuLa cohort)

Objective

Our aim was to study the quality of medical care in patients with systemic lupus erythematosus (SLE) to understand gaps and to analyze the association with outcome of the disease.

Methods

Information on demographics and medical care was assessed by self-reported questionnaires among SLE patients (LuLa cohort, 2011, n = 580). In total, 21 aspects of medical care were analyzed. Univariate analysis selected 10 predictor variables for further analysis: (1) urine examination and (2) blood test in the previous year, (3) taking antimalarials, (4) taking vitamin D and calcium if the dosage of prednisolone was greater than 7.5 mg/day, counseling regarding (5) lipid metabolism, (6) vaccination, and (7) blood pressure, and treatment of the comorbidities (8) hypertension, (9) osteoporosis and (10) lipid metabolism disorder. The association of these 10 items with the outcome of the disease, assessed in 2015, was analyzed by linear regression analysis, adjusted for age, disease duration and sex.

Results

On average six of the 10 items were met (±1.7). Receiving more clinical care in 2013 was predictive for low disease activity (SLAQ, p = 0.024, β = –0.104, corr. R²= 0.048), low progress in disease-related damage (Delta Brief Index of Lupus Questionnaire, p = 0.048, β = –0.132, corr. R²= 0.036) and high health-related quality of life (SF-12 physical, p = 0.035, β = 0.100, corr. R²= 0.091) in 2015.

Conclusion

Our study illustrates a link between the quality of care and the SLE outcome parameters disease activity, disease-related damage and quality of life. Consistent considerations of these care parameters, which are recommended in several management guidelines, could therefore be a good approach to improve the outcome of patients with SLE.

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

Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.

AB1189 PICASO - THE PLATFORM FOR IMPROVED PERSONAL AND COORDINATED CARE OF CHRONICALLY ILL – SIX MONTHS RESULTS FROM A PROOF-OF-CONCEPT STUDY

Background:

Cross-sectoral coordination of treatment plans and efficient management of patients with chronic diseases and co-morbidities are of great importance. In rheumatoid arthritis (RA) it is essential to orchestrate information available for a patient at various locations, to allow (cost) efficient data use, to optimize management processes and to avoid redundant diagnostics. The information and communication platform developed in the Horizon2020 funded PICASO project (www.picaso-project.eu) supports the management of patients and their data along the continuum of care, consisting of hospitals, outpatient departments, practices, other health service providers via remote health monitoring. The platform might empower patients to improve their self-management of their illnesses.

Objectives:

What technological expertise and resources do RA patients and physicians have, who are willing to participate in a proof-of-concept study using a modern ICT platform? What is the user satisfaction? What are platform`s clinical implications?

Methods:

PICASO pursued a user-centered design approach. Platform`s user requirements were determined through workshops and interviews with physicians from various disciplines, patients and other stakeholders in the health care system (e.g. data protection officers). The development was accompanied by so-called “expert walkthroughs” to ensure a user-friendly design. An evaluation concept assessing the usability of the applications, user satisfaction and clinical relevance of the platform was part of the 6-month proof-of-concept study with RA patients and their physicians (rheumatologists and family doctors). A positive ethics vote was obtained.

Results:

111 user requirements were identified and used to develop the platform. Conformity with the GDPR as well as national regulations were precisely adhered to. All developments are based on the new ‘Fast Healthcare Interoperability Resources’ standard enabling data exchange with other software systems in the healthcare sector. This offers many advantages, e.g. a semantic model for describing the smallest units in the health care system (e.g. medication intake times, diagnostic procedures). Thus information can be linked and made available across sectors. Data can remain with the data owner and role-specific data access is ensured.

30 RA patients (80% female) participated, mean age was 58.6±10.8 years, disease duration 12.6±8.5 years, DAS28 2.6±0.9, average number of comorbidities 3.0±1.6. Patients’ IT-experience was heterogeneous. After 6 months evaluations showed a good platform acceptance with an overall rating of 2.3±1.1 (n=27, Likert scale (LS) 1-6) and evaluation of ‘ease of use’ at 2.3±1.2 (n=27, LS 1-6). Usability tests showed that for patients the presentation of (1) tasks to be performed for the management of their disease, (2) results from their remote health monitoring, and (3) patient-reported outcome instruments in a dashboard was clear and easy to understand. Time required for documentation and daily tasks was rated as appropriate by 75.9% of the patients. No major technical problems or impairments due to RA where experienced when using the dashboard. 8 physicians (37.5 % female) participated in the evaluation; overall the platform was rated at 2.2±0.5 (LS 1-6).

Conclusion:

The platform offers cross-sectoral orchestration of patient data and thus innovative capabilities for modern management processes (e.g. treat-to-target, tele-monitoring). The PICASO platform is available for RA patients as well as for other chronic diseases.

Acknowledgments:

This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 689209.

Disclosure of Interests:

None declared

Medical adherence in patients with systemic lupus erythematosus in Germany: predictors and reasons for non-adherence – a cross-sectional analysis of the LuLa-cohort

Objective

Adherence to medication has a major impact on treatment control and success especially in chronic diseases but often remains unrecognized. Besides clinical, socioeconomic, disease-related and treatment-related parameters, general and personal health beliefs, as well as perception of health, can affect adherence. Our aim was to investigate the adherence to lupus-specific medications in German lupus patients and to assess influencing factors including detrimental or beneficial effects of health perceptions and beliefs.

Methods

The Lupus Erythematosus (LE) Long-Term Study (LuLa-study) is a nationwide longitudinal study among German Caucasian patients with systemic lupus erythematosus who have been assessed annually using a self-reported questionnaire since 2001. In 2013, we included questions concerning medical adherence (Morisky Medication Adherence Scale; MMAS-4), beliefs about medication prescribed (BMQ), illness perception and about the patients’ health locus of control (HLC). We present a cross-sectional analysis to assess predictors of adherence using a multivariable stepwise logistic regression.

Results

Five hundred and seventy-nine patients participated, 81 of whom did not take any lupus-specific medication and 40 of whom did not complete the MMAS-4 and were therefore omitted. Only 62.7% reported high adherence. Unintentional behaviour for low medical adherence exceeded the intentional behaviour by far. The use of azathioprine (OR: 1.85; 95% CI: 1.02–3.34), prednisone <7.5 mg (OR: 1.56; 95% CI: 0.97–2.49), a higher age (OR: 1.06; 95% CI: 1.03–1.08) and higher external HLC (OR: 1.15; 95% CI: 1.01–1.30) proved conducive for high adherence in our multivariable model. On the contrary, the general perception of medication being harmful or addictive (OR: 0.89; 95% CI: 0.82–0.97) was detrimental.

Conclusion

A low belief that one's own health is determined by healthcare providers (external HLC) and the belief of the harmfulness of medication were independent predictors of low adherence besides age and the choice of the medical agent. The recognition of these potential obstacles in physician–patient relationships is essential to ameliorate adherence. Provision of sufficient information and education might help to reach the best possible outcome.

[Self-monitoring in inflammatory rheumatic diseases]

BACKGROUND

Active involvement of patients in their care has led to better treatment and outcomes. Tight control concepts emphasize the need for regular assessments including patients' active involvement by self-monitoring.

METHODS

The literature was screened with respect to published experiences of self-monitoring of rheumatoid arthritis and spondyloarthritides. The use of "patient-reported outcome" (PRO) instruments can facilitate self-monitoring. Potentially applicable PROs and their correlations to clinical parameters as well as modern data acquisition modes are presented.

RESULTS

Some experiences for self-monitoring have been reported. Recommendations from national and international professional rheumatology societies do not yet consider self-monitoring; however, PROs might be used for self-monitoring but instructions for patients on "how to deal with self-monitored PRO values" are missing.

CONCLUSION

Self-monitoring of inflammatory rheumatic diseases seems feasible. Further evaluation studies are warranted to guarantee an optimized direct patient involvement in their management beyond outpatient care in hospitals and private practices so that they can thus contribute to a better outcome.

Age-specific prevalence of diagnosed systemic lupus erythematosus in Germany 2002 and projection to 2030

Objective

The objective of this report is to estimate the prevalence and future number of cases of systemic lupus erythematosus (SLE) in Germany.

Methods

Data from a representative sample of all insurants from the statutory health insurance in Germany comprising more than 2.3 million individuals have been screened for SLE diagnoses. The gender- and age-specific prevalence of SLE is calculated. The case definition is based on at least one recorded diagnosis of SLE during 2002. The stratum-specific prevalence is applied to the current and the future population of Germany in order to estimate and predict the number of people with SLE until 2030.

Results

The overall prevalence of diagnosed SLE in 2002 was 15.4 (95% CI: 13.1–17.9) and 55.4 (51.4, 59.8) per 100,000 in the male and female German population. This corresponds to an estimated 30,000 and 31,000 people with diagnosed SLE in 2002 and 2010, respectively. This number will slightly increase until 2020 and decrease thereafter.

Conclusions

Compared with health insurance data from France, the prevalence in our data is similar. Under the assumption that the gender- and age-specific prevalence of SLE in Germany will not change considerably, the number of cases in the next two decades will change only slightly.

[What factors determine the direct medical costs of patients with systemic lupus erythematosus in Germany? Subanalysis of the LUCIE study]

OBJECTIVES

The aim of this study was to evaluate annual direct medical costs of adult SLE patients with active autoantibody positive disease on medication in Germany.

METHODS

A multicentre, observational, retrospective European study with German sub-analysis was performed. Costs were assessed according to national tariffs.

RESULTS

10 German centres included 77 patients. The mean (SD) annual direct medical costs of patients were € 3 452.21 (3 777.07), and were 3.4 times higher in severe than non-severe patients (€ 5 291.07 vs. 1 564.97; p<0.001). Cost of medication (€ 2 349.40) represented 68.1% of the total cost. Flares, especially severe flares, were identified as cost predictors. Each flare increased the annual total cost by € 2 164,01 (p<0,001).

CONCLUSION

The annual direct medical cost of SLE patients in Germany is linked to disease severity. Medical treatments and severe flares were identified as the cost predictors and drivers, respectively.

Diagnostic algorithm for Raynaud’s phenomenon and vascular skin lesions in systemic lupus erythematosus

Skin discolorations and skin lesions due to vascular pathologies are common clinical features in systemic lupus erythematosus. A variety of clinical manifestations such as Raynaud’s phenomenon, acrocyanosis, livedo patterns, erythematous or violaceous macules and papules or necrosis are triggered by heterogeneous pathophysiological mechanisms such as vasospasm, vasculitis or thromboembolism. A standardized macro- and microvascular assessment is necessary to establish the correct diagnosis. We describe and illustrate common clinical features of vascular skin manifestations in systemic lupus erythematosus and present a diagnostic algorithm. Lupus (2010) 19, 1087—1095.

Internet use in rheumatology outpatients in 2006: gender less important

OBJECTIVE

Exploring patients' Internet use, their online needs and requirements, expectations and attitudes towards the Internet is mandatory to effectively provide interactive online applications and information.

METHODS

Within a prospective study, 153 consecutive outpatients with rheumatoid arthritis, systemic lupus erythematosus or spondyloarthritis answered a paper-based questionnaire investigating their Internet use, interests, pattern and degree of utilization. Sociodemographic and functional disability data were collected. The data were compared with our survey of 2001 and to the normal German population.

RESULTS

Patients were predominantly female (69.3%; n.s.). Mean age was 45.7+/-14.4 years (n.s.). 68.6% (+18.6%, p=0.0027) reported regular Internet use for 5.0+/-2.6 yrs. Internet use in 2006 is still age- and education-dependent (p<0.001, p=0.003). Differences by gender observed in 2001 no longer existed as women increased their Internet use from 2.9 to 6.1 hours/week (p=0.001, p=0.0006). Searching for health-related information remained an important topic. Interest in e-communication and interactive applications strongly increased. Independently of gender and functional disability, patients' future online interests focussed on information on diseases, medications, health care providers and patient education. Confidence in the Internet and reliability of information were rated unchanged since 2001.

CONCLUSION

Gender no longer has significant impact on Internet use. The great potentials of Internet services-well accepted by patients and contributing substantially to more effective and improved disease (self-) management strategies-should encourage rheumatologists to provide interactive applications and high-quality information on Internet platforms and in routine patient care. Continuous research to explore the effects of Internet-delivered information on patients' attitudes,expectations, behaviour and outcome is required.

Hypogonadism in Wegener's granulomatosis

OBJECTIVE

Current developments in the management of Wegener's granulomatosis (WG) focus on adoption of therapeutic strategies to avoid complications of both the disease and its therapy. Systematic analyses with respect to the reproductive system in WG are missing.

METHODS

Data of a cross-sectional study of sexual hormones in 19 male WG patients were analysed. Disease extension was classified according to the ears, nose, and throat (E), lungs (L), and kidneys (K) classification (ELK classification) and to the disease extent index (DEI). Laboratory investigation included measurement of gonadotrophins, oestradiol, and total serum testosterone. Hypogonadism was defined by an increase in follicle-stimulating hormone (FSH) beyond twice the upper reference range in the presence of low serum testosterone. Thirty-eight age-matched men served as controls.

RESULTS

Hypogonadism was found in 52.6% of the patients but was not detectable in any of the controls (p<0.0001). No significant correlation to any clinical factor of systemic vasculitis, current or past medication was detected. In particular, testosterone or FSH levels were not correlated with current or cumulative use of cyclophosphamide or corticosteroids (p = 0.417, p = 0.293; p = 0.893, p = 0.317).

CONCLUSION

Data of our study revealed an unexpected high rate of hypogonadism irrespective of cyclophosphamide use, and subclinical involvement of the testes by the vasculitis itself might be an alternative explanation. Screening during the course of the disease is reasonable as hypogonadism might severely affect patients' quality of life. Further prospective studies with respect to gender-specific changes in the reproductive system are warranted.

Self-assessments of patients via Tablet PC in routine patient care: comparison with standardised paper questionnaires

OBJECTIVE

We evaluated the feasibility of electronic data capture of self-administered patient questionnaires using a Tablet PC for integration in routine patient management; we also compared these data with results received from corresponding paper-pencil versions.

METHODS

Standardised patient questionnaires (FFbH/HAQ, BASDAI, SF-36) were implemented in our documentation software. 153 outpatients (rheumatoid arthritis, systemic lupus erythematosus, spondyloarthritis) completed sets of questionnaires as paper-pencil and electronic versions using a Tablet PC. The quality and validity of data obtained using a Tablet PC and the capability of disabled patients to handle it were assigned; patients' experiences, preferences and computer/internet use were also assessed.

RESULTS

Scores obtained by direct data entry on the Tablet PC did not differ from the scores obtained by the paper-pencil questionnaires in the complete group and disease subgroups. No major difficulties using the Tablet PC occurred. 62.1% preferred remote data entry in the future. Seven (4.6%) patients felt uncomfortable with the Tablet PC due to their rheumatic disease.

CONCLUSIONS

Self-administered questionnaires via Tablet PC are a facile and capable option in patients with rheumatic diseases to monitor disease activity, efficacy and safety assessments continuously. Tablet PC applications offers directly available data for clinical decision-making improves quality of care by effective patient monitoring, and contributes to patients' empowerment.

Krankheitsbezogene Internetnutzung bei Patienten mit entz�ndlich-rheumatischen Systemerkrankungen

OBJECTIVE

On behalf of the "systemic inflammatory rheumatic diseases network" comprehensive, nationwide horizontal and vertical cross-linking of research and care is to be developed for the first time. The quality of scientific work and patient care is to be increased in the medium term through this improved communication and co-operation. Our objective was to determine what hardware and software are available to the patients involved, with a view to the Internet being used as a basis for communication. The ultimate aim was to provide patients with an adequate source of information on care.

METHODS

A survey was carried out among 400 patients attending our outpatient clinics. Data on the hardware and software used and on Internet access and patterns and degree of utilization were collected using a unilateral questionnaire.

RESULTS

326 patients filled in the questionnaire. 163 of those responding had Internet access, with younger and better educated patients using the Internet significantly more frequently. No dependency was noted on gender or marital status. Mean time duration for Internet use was longer in men. 55.8% of the internet users searched for medical questions. Major search topics included up to date therapeutic options (46.6%) and information on specific diseases (28.8%).

CONCLUSION

Internet is an important information medium for patients. Technical requirements and high motivation make communication practicable for about 50% of patients. To ensure acceptance, the Internet platform of the systemic inflammatory rheumatic diseases network needs to be aligned to patients' requirements, bearing in mind the need for extensive high-value, reliable scientific information to be offered on the website.