In pharmacoepidemiology, robust data are needed to judge the impact of drug treatment on pregnancy, pregnancy outcomes and breast-fed infants. As pregnant and breastfeeding women are usually excluded from randomised clinical trials, observational studies are required. One of those data sources are pregnancy registers specifically developed to focus on certain diseases or disease groups. The German Rhekiss register investigates pregnancies in women with chronic inflammatory rheumatic diseases (IRD). Rhekiss is a nationwide, multicentre, longitudinal study, in which women aged 18 years or older with an underlying IRD can be enrolled by a rheumatologist either when planning a pregnancy or in the first half of pregnancy. Data are collected prospectively at regular follow-up visits. Rheumatologists and patients provide information in a web-based system before conception (if enrolment was at the time of pregnancy planning), during and after pregnancy. A smartphone app is available for patients. Maternal and clinical information, general laboratory markers, treatment with antirheumatic and other drugs, adverse events, items related to course and outcome of pregnancy and the health of the child are uniformly assessed for all diseases. Individual information on the IRD includes classification criteria, diagnosis-specific laboratory parameters, clinical parameters and validated instruments to measure disease activity or damage. Furthermore, patient-reported outcome measures are captured. A total of 2013 individual patients have been enrolled in the register, and data on 1801 completed pregnancies are available. In summary, Rhekiss is a comprehensive and complex register that can answer various research questions about pregnancy in women with chronic IRDs.

There is an increased prevalence of atherosclerotic cardiovascular disease (ASCVD) in patients with inflammatory rheumatic diseases (IRD) including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and systemic sclerosis. The mechanism for development of ASCVD in these conditions has been linked not only to a higher prevalence and undertreatment of traditional cardiovascular (CV) risk factors, but importantly to chronic inflammation and a dysregulated immune system which contribute to impaired endothelial and microvascular function, factors that may contribute to accelerated atherosclerosis. Accurate ASCVD risk stratification and optimal risk management remains challenging in this population with many barriers that include lack of validated risk calculators, the remitting and relapsing nature of underlying disease, deleterious effect of medications used to manage rheumatic diseases, multimorbidity, decreased mobility due to joint pain, and lack of clarity about who bears the responsibility of performing CV risk assessment and management (rheumatologist vs primary care provider vs cardiologist). Despite recent advances in this field, there remains significant gaps in knowledge regarding the best diagnostic and management approach. The evolving field of Cardio-Rheumatology focuses on optimization of cardiovascular care and research in this patient population through collaboration and coordination of care between rheumatologists, cardiologists, radiologists, and primary care providers. This review aims to provide an overview of current state of knowledge about ASCVD risk stratification in patients with IRD, contributing factors including effect of medications, and review of the current recommendations for cardiovascular risk management in patients with inflammatory disease with a focus on hypertension as a key risk factor.

BACKGROUND: The increased availability of myositis autoantibodies represents new possibilities and challenges in clinical practice (Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis. 2017;76:1955-64. https://doi.org/10.1136/annrheumdis-2017-211468 .). The aim of this study was to perform a retrospective data analysis of patient cases with positive myositis autoantibodies to analyse their significance in routine rheumatology practice.
METHODS: A monocentric analysis of all the orders used to determine myositis autoantibodies from July 2019 to May 2022 in the Department of Rheumatology, Krankenhaus Porz am Rhein, Cologne, Germany, was carried out.
RESULTS: In the defined time interval, a total of 71,597 laboratory values for the antibodies mentioned above were obtained. A total of 238 different positive autoantibodies ​​were detected in 209 patients. Idiopathic inflammatory myopathy was diagnosed in 37 patients (18%), and inflammatory rheumatic diseases other than idiopathic inflammatory myopathy were diagnosed in 90 patients (43%). No inflammatory rheumatic disease was diagnosed in 82 patients (39%). General clusters of clinical manifestations were observed.
CONCLUSIONS: In our cohort, we were able to show that a relevant proportion of patients with positive myositis antibodies did not have idiopathic inflammatory myopathies or inflammatory rheumatic diseases. This finding indicates the importance of myositis autoantibodies in this group of patients. However, further studies on the course of symptoms and examination results in patients without inflammatory rheumatic diseases and with positive myositis antibodies are necessary.

BACKGROUND: The chatbot ChatGPT represents a milestone in the interaction between humans and large databases that are accessible via the internet. It facilitates the answering of complex questions by enabling a communication in everyday language. Therefore, it is a potential source of information for those who are affected by rheumatic diseases. The aim of our investigation was to find out whether ChatGPT (version 3.5) is capable of giving qualified answers regarding the application of specific methods of complementary and alternative medicine (CAM) in three rheumatic diseases: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (GPA). In addition, it was investigated how the answers of the chatbot were influenced by the wording of the question.
METHODS: The questioning of ChatGPT was performed in three parts. Part A consisted of an open question regarding the best way of treatment of the respective disease. In part B, the questions were directed towards possible indications for the application of CAM in general in one of the three disorders. In part C, the chatbot was asked for specific recommendations regarding one of three CAM methods: homeopathy, ayurvedic medicine and herbal medicine. Questions in parts B and C were expressed in two modifications: firstly, it was asked whether the specific CAM was applicable at all in certain rheumatic diseases. The second question asked which procedure of the respective CAM method worked best in the specific disease. The validity of the answers was checked by using the ChatGPT reliability score, a Likert scale ranging from 1 (lowest validity) to 7 (highest validity).
RESULTS: The answers to the open questions of part A had the highest validity. In parts B and C, ChatGPT suggested a variety of CAM applications that lacked scientific evidence. The validity of the answers depended on the wording of the questions. If the question suggested the inclination to apply a certain CAM, the answers often lacked the information of missing evidence and were graded with lower score values.
CONCLUSIONS: The answers of ChatGPT (version 3.5) regarding the applicability of CAM in selected rheumatic diseases are not convincingly based on scientific evidence. In addition, the wording of the questions affects the validity of the information. Currently, an uncritical application of ChatGPT as an instrument for patient information cannot be recommended.
UNASSIGNED: EINFüHRUNG: Der Chatbot ChatGPT stellt einen Meilenstein in der Interaktion zwischen Menschen und großen, über das Internet zugänglichen Datenbanken dar. Er ermöglicht mit einer Kommunikation in Alltagssprache die Beantwortung komplexer Fragen und ist damit potenziell eine Informationsquelle für Betroffene rheumatischer Erkrankungen. Ziel der Untersuchung war es herauszufinden, ob ChatGPT (Version 3.5) in der Lage ist, qualifizierte Antworten zur Anwendbarkeit von Verfahren der Komplementär- und Alternativmedizin (CAM; Homöopathie, Ayurveda, Phytotherapie) bei rheumatoider Arthritis (RA), systemischem Lupus erythematodes (SLE) und Granulomatose mit Polyangiitis (GPA) zu liefern. Außerdem wurde untersucht, welchen Einfluss die Art der Fragestellung auf die erhaltenen Ergebnisse haben könnte.
METHODS: Die Befragung erfolgte in 3 Abschnitten. In Abschnitt A wurde eine offene Frage zu Behandlungsmöglichkeiten bei einem der 3 Krankheitsbilder gestellt. In Abschnitt B wurde allgemein nach möglichen Anwendungen für CAM bei einer der 3 Erkrankungen gefragt. In Abschnitt C wurden Applikationsmöglichkeiten für die 3 genannten Verfahren für jede Diagnose erfragt. In den Abschnitten B und C wurden die Fragen jeweils in 2 Modifikationen gestellt. Die erste fragte danach, ob das Verfahren überhaupt anwendbar ist. Die zweite Frage erkundigte sich nach konkreten Anwendungen aus den genannten Verfahren. Die Validität der Ergebnisse wurde anhand des ChatGPT Reliability Scores, einer 7‑stufigen Likert-Skala, ausgewertet.
UNASSIGNED: Zu den offenen Fragen im Abschnitt A lieferte ChatGPT die validesten Ergebnisse. In B und C wurden zahlreiche CAM-Anwendungen vorgeschlagen, die nicht durch wissenschaftliche Evidenz gestützt sind. In diesen Abschnitten waren die Ergebnisse deutlich von der Art der Fragestellung abhängig. Suggerierte die Frage eine Anwendungsabsicht der CAM, entfielen häufig Hinweise auf die fehlende Evidenz, die Qualität der Antwort wurde in den meisten Fällen schlechter bewertet.
UNASSIGNED: Die Antworten von ChatGPT zur Anwendung von CAM bei definierten rheumatischen Erkrankungen lassen eine ausreichende wissenschaftliche Evidenz vermissen. Zudem beeinflusst die Art der Fragestellung die Qualität der Aussagen erheblich. Eine kritiklose Anwendung von ChatGPT als Instrument der Patientenschulung kann derzeit nicht empfohlen werden.

BACKGROUND: The adaptation of structures and processes in treatment procedures can contribute to increasing patient satisfaction and is the focus of patient-oriented quality assurance.
OBJECTIVE: To identify patient satisfaction as well as needs, expectations and preferences with respect to care and, based on this, to formulate recommendations for action to optimize the quality of care at a large tertiary rheumatology center.
METHODS: As part of a qualitative research approach, semi-structured patient interviews and a focus group interview consisting of physicians in rheumatology training in outpatient specialist care were conducted. The quality dimensions of Donabedian were recorded. The data material was evaluated and analyzed using the content-structuring qualitative content analysis according to Kuckartz with the MAXQDA evaluation software.
RESULTS: Using 12 patient interviews and a focus group of 3 future rheumatologists, recommendations for action to optimize the quality of care were derived on the basis of the structural, process and outcome quality. There was a need for optimization in the areas of personnel management, internal practice processes, practice equipment and treatment processes in the outpatient clinic.
CONCLUSIONS: The results from the patient interviews and the focus group revealed the aspects in need of optimization. The methodology and results of this study can serve as a reference point for analyses of other rheumatology clinics in order to improve the quality of care within the framework of patient-oriented quality management and continuous further development.
UNASSIGNED: HINTERGRUND: Die Anpassung von Strukturen und Prozessen der Behandlungsabläufe kann zur Steigerung der Patientenzufriedenheit beitragen und steht im Fokus einer patientenorientierten Qualitätssicherung. ZIEL: Es erfolgte die Identifizierung der Patientenzufriedenheit sowie der Bedürfnisse, Erwartungen und Präferenzen hinsichtlich der Versorgung und daraus ableitend die Formulierung von Handlungsempfehlungen zur Optimierung der Versorgungsqualität eines großen tertiären rheumatologischen Zentrums.
UNASSIGNED: Im Rahmen eines qualitativen Forschungsansatzes wurden halbstrukturierte Patienteninterviews und ein Fokusgruppeninterview bestehend aus Ärzt:innen in rheumatologischer Weiterbildung (ÄiWB) in der ambulanten spezialfachärztlichen Versorgung (ASV) durchgeführt. Es wurden die Qualitätsdimensionen nach Donabedian erfasst. Das Datenmaterial wurde anhand der inhaltlich-strukturierenden qualitativen Inhaltsanalyse (QIA) nach Kuckartz mit der Auswertungssoftware MAXQDA ausgewertet und analysiert.
UNASSIGNED: Mittels 12 Patienteninterviews und einer Fokusgruppe aus 3 ÄiWB wurden auf Grundlage der Struktur‑, Prozess- und Ergebnisqualität Handlungsempfehlungen zur Optimierung der Versorgungsqualität abgeleitet. Es erwies sich Optimierungsbedarf im Bereich des Personalmanagements, der internen Praxisabläufe, der Praxisausstattung und der Behandlungsabläufe in der ASV-Ambulanz.
UNASSIGNED: Die Ergebnisse aus den Patienteninterviews und der Fokusgruppe zeigten die Aspekte mit Optimierungsbedarf auf. Die Methodik und Ergebnisse dieser Studie können als Anhaltspunkt für Analysen anderer rheumatologischer Kliniken dienen, um im Rahmen des patientenorientierten Qualitätsmanagements und der kontinuierlichen Weiterentwicklung die Versorgungsqualität zu verbessern.

In October 2023, the organization of the German-speaking scientific osteological societies (DVO) published the revised guideline on the \"Prophylaxis, diagnosis and treatment of osteoporosis in postmenopausal women and in men aged over 50.\" This review article reflects the new features of the guideline and their relevance in the care of patients with inflammatory rheumatic diseases.A key innovation is the change from the 10-year fracture risk to the 3‑year fracture risk. Basic diagnostics are currently performed without a defined fracture threshold. Treatment thresholds for specific osteological therapy constitute another key innovation, defined as 3% to < 5%, 5% to < 10%, and from 10% for vertebral body and femoral neck fractures. If the 3‑year fracture risk is > 10%, osteoanabolic therapy should primarily be carried out and antiresorptive therapy is initiated following osteoanabolic therapy. In addition, patients with osteoporosis and prolonged glucocorticoid therapy should primarily be treated osteoanabolically with teriparatide. In summary, the changes to the DVO guideline reflect the latest scientific study findings in osteology and lead to detailed differential therapy for osteoporosis.
UNASSIGNED: Im Oktober 2023 veröffentlichte der Dachverband der deutschsprachigen wissenschaftlichen osteologischen Gesellschaften e. V. (DVO) die überarbeitete Leitlinie zur „Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern ab dem 50. Lebensjahr“. Dieser Übersichtsartikel geht auf die Neuerungen der Leitlinie und deren Relevanz in der Betreuung von Betroffenen mit entzündlich-rheumatischen Erkrankungen ein.Eine zentrale Änderung der Leitlinie stellt die Umstellung des 10-Jahres-Frakturrisikos auf das 3‑Jahres-Frakturrisiko dar. Die Basisdiagnostik wird aktuell ohne definierte Frakturschwelle durchgeführt. Als weitere Schlüsselneuerung sind die Therapieschwellen für die spezifisch osteologische Therapie mit 3 % bis < 5 %, 5 % bis < 10 % und ab 10 % für Wirbelkörper- sowie Schenkelhalsfrakturen zu nennen. Bei einem 3‑Jahres-Frakturrisiko > 10 % ist primär eine osteoanabole Therapie durchzuführen und eine antiresorptive Therapie wird an die osteoanabole Therapie angeschlossen. Weiterführend sollten Patientinnen und Patienten mit einer Osteoporose sowie einer länger andauernden Glukokortikoidtherapie primär osteoanabol mittels Teriparatid behandelt werden. Zusammenfassend reflektieren die Änderungen der DVO-Leitlinie die aktuellen wissenschaftlichen Studienerkenntnisse in der Osteologie und führen zu einer detaillierten Differentialtherapie der Osteoporose.

UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.

OBJECTIVE: Rheumatic diseases may impair reproductive success and pregnancy outcomes, but systematic evaluations across diseases are lacking. We conducted a nationwide cohort study to examine the impact of rheumatic diseases on reproductive health measures, comparing the impacts with those of other immune-mediated diseases (IMDs).
METHODS: Out of all of the 5 339 804 Finnish citizens, individuals born 1964-1984 and diagnosed with any of the 19 IMDs before age 30 (women) or 35 (men) were matched with 20 controls by birth year, sex, and education. We used data from nationwide health registers to study the impact of IMDs on reproductive health measures, such as reproductive success and, for women, ever having experienced adverse maternal and perinatal outcomes.
RESULTS: Several of the rheumatic diseases, particularly SLE, JIA, and seropositive RA, were associated with higher rates of childlessness and fewer children. The risks for pre-eclampsia, newborns being small for gestational age, preterm delivery, non-elective Caesarean sections, and need of neonatal intensive care were increased in many IMDs. Particularly, SLE, SS, type 1 diabetes, and Addison\'s disease showed >2-fold risks for some of these outcomes. In most rheumatic diseases, moderate (1.1-1.5-fold) risk increases were observed for diverse adverse pregnancy outcomes, with similar effects in IBD, celiac disease, asthma, ITP, and psoriasis.
CONCLUSIONS: Rheumatic diseases have a broad impact on reproductive health, with effects comparable with that of several other IMDs. Of the rheumatic diseases, SLE and SS conferred the largest risk increases on perinatal adverse event outcomes.

OBJECTIVE: Tropheryma whipplei infection can manifest as inflammatory joint symptoms, which can lead to misdiagnosis of inflammatory rheumatic disease and the use of disease-modifying antirheumatic drugs. We investigated the impact of diagnosis and treatment of Tropheryma whipplei infection in patients with inflammatory rheumatic disease.
METHODS: We initiated a registry including patients with disease-modifying antirheumatic drugs-treated inflammatory rheumatic disease who were subsequently diagnosed with Tropheryma whipplei infection. We collected clinical, biological, treatment data of the inflammatory rheumatic disease, of Tropheryma whipplei infection, and impact of antibiotics on the evolution of inflammatory rheumatic disease.
RESULTS: Among 73 inflammatory rheumatic disease patients, disease-modifying antirheumatic drugs initiation triggered extra-articular manifestations in 27% and resulted in stabilisation (51%), worsening (34%), or improvement (15%) of inflammatory rheumatic disease. At the diagnosis of Tropheryma whipplei infection, all patients had rheumatological symptoms (mean age 58 years, median inflammatory rheumatic disease duration 79 months), 84% had extra-rheumatological manifestations, 93% had elevated C-reactive protein, and 86% had hypoalbuminemia. Treatment of Tropheryma whipplei infection consisted mainly of doxycycline plus hydroxychloroquine, leading to remission of Tropheryma whipplei infection in 79% of cases. Antibiotic treatment of Tropheryma whipplei infection was associated with remission of inflammatory rheumatic disease in 93% of cases and enabled disease-modifying antirheumatic drugs and glucocorticoid discontinuation in most cases.
CONCLUSIONS: Tropheryma whipplei infection should be considered in inflammatory rheumatic disease patients with extra-articular manifestations, elevated C-reactive protein, and/or hypoalbuminemia before disease-modifying antirheumatic drugs initiation or in inflammatory rheumatic disease patients with an inadequate response to one or more disease-modifying antirheumatic drugs. Positive results of screening and diagnostic tests for Tropheryma whipplei infection involve antibiotic treatment, which is associated with complete recovery of Tropheryma whipplei infection and rapid remission of inflammatory rheumatic disease, allowing disease-modifying antirheumatic drugs and glucocorticoid discontinuation.

This study aimed to compare the health-related quality of life scores among rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis and to evaluate socio-demographic and clinical determinantes of quality of life across diseases.
The sample comprised 490 patients with rheumatoid arthritis, 198 with psoriatic arthritis, and 119 with spondyloarthritis who completed a series of health examinations and self-reported questionnaires. Quality of life was evaluated using the Short-Form 36 Health Survey, disease activity by DAS28-CRP, DAPSA, and ASDAS-CRP (for rheumatoid arthritis, psoriatic arthritis, and spondyloarthritis, respectively), depression and anxiety using the Hospital Anxiety and Depression Scale. ANOVA was used to compare the quality of life dimensions and their physical and mental summary measures among rheumatic diseases, and multivariate analysis was used to explore their potential determinants.
Rheumatoid arthritis had significantly worse scores than spondyloarthritis in the following dimensions: physical functioning, role limitation due to physical health, physical component score, and mental health. Psoriatic arthritis was not significantly different from the other two diseases. Multivariate analysis revealed that physical quality of life was mainly associated with disease activity across rheumatic diseases, rheumatological treatment and depression in rheumatoid arthritis and psoriatic arthritis. Mental quality of life is primarily associated with depression and anxiety across rheumatic diseases.
There were differences in quality of life among patients with inflammatory rheumatic diseases, but overall, approximately uniform factors explained the variance in quality of life across diseases. Clinicians should develop general approaches and strategies for inflammatory rheumatic diseases to improve patients\' quality of life.