key: cord-0069279-5yxsmjjs authors: nan title: Jahrestagung der Österreichischen Gesellschaft für Rheumatologie & Rehabilitation: 25.–27. November 2021 date: 2021-11-04 journal: J DOI: 10.1007/s41970-021-00175-5 sha: aeb15c3b8c1d5f1838e5e005086c186971d926cc doc_id: 69279 cord_uid: 5yxsmjjs nan Aim: Imaging guidance gives the opportunity to visualize a needle or other instrument when performing interventions on musculoskeletal sites in patients with rheumatic and musculoskeletal diseases (RMDs). Studies assessing the role of imaging guided procedures have been performed, however, no consensus has been made yet about when and which imaging techniques to use for these interventions. To inform a EULAR taskforce on the current literature on different imaging techniques, procedures and materials to guide interventions on musculoskeletal sites in RMD patients. Methods: Prospective and retrospective studies published in English and comparing either palpation or imaging guided interventions in patients with RMDs were included. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos were searched through October 2021. Risk of bias ( RoB) was assessed using the Cochrane RoB tool for randomized trials version 2 (ROB2), the RoB tool for Non-Randomized Studies of Interventions ( ROBINS-I) and the appraisal tool for cross-sectional studies ( AXIS). Results: Sixty-six studies, with moderate to high RoB, consisting of 49 randomized controlled trials, three prospective cohort studies and 14 retrospective studies were included. Fifty-one studies compared one imaging technique against either another imaging technique, or palpation-guided interventions. Most of the studies were on peripheral joints (47/51), while data on joints of the axial skeleton were scare and heterogeneous (4/51). For peripheral joints, ultrasound ( US) was the most studied imaging technique (49/51), followed by fluoroscopy (10/51). Results revealed a higher accuracy and safety (including procedural pain) of US or fluoroscopy compared to palpation-guided interventions. Data on other imaging techniques was scarce (computed tomography: n = 3, arthroscopy: n = 1) and the results heterogeneous. Results of studies comparing different imaging techniques (12/51) did not favor one imaging method over another. Three studies comparing different materials used for imaging guided interventions were found (e. g. automatic vs manual syringes), showing little evidence for one material being superior to another one. Fifteen studies were found comparing different imaging guided procedures (e. g. intraarticular vs periarticular injections). Overall, studies indicated an advantage of targeted vs. not targeted interventions concerning pain levels, while the comparison of different puncture sites to inject (e. g. ulnar vs midline carpal tunnel injection) was inconclusive. Conclusion: Imaging guidance, especially US, performs favorably for interventions at the peripheral joints compared to palpation-guided interventions, concerning accuracy and safety. Data for the axial skeleton are scarce. Imaging guided targeted interventions may lead to better outcomes than non-targeted interventions. duodenal ulcers at timepoints baseline, and 1, 3, and 6 months after start of naproxen treatment was employed as a surrogate parameter for GI injury. For GI symptom analysis, Severity of Dyspepsia Assessment ( SODA) questionnaire and a list of predefined NSAID-associated adverse events was used. For GI risk factor analysis, the high-risk factors previous GI injury, concomitant selective serotonin reuptake inhibitors or corticosteroids, ulcer history, concomitant low-dose aspirin and age >65 years were employed. Results: Data of 426 naproxen patients were analyzed. Distribution of GI symptoms between patients with and without ulcer was similar; about one third of patients developing an ulcer reported no GI pain symptoms. GI symptoms experienced under naproxen treatment were thus not indicative of GI injury. The proportion of patients developing an ulcer increased with the number of risk factors present, however, about a quarter of patients without any of the analyzed risk factors still developed an ulcer. Conclusion: Solely relying on GI symptoms and the number of risk factors is not a reliable guidance to decide which patient needs gastroprotection and will lead to a large group of patients with GI injuries. A preventive rather than a reactive approach should be taken. IR is 100 times the number of patients experiencing the adverse event divided by the event-specific exposure to treatment (exposure time up to the event for patients with the event and exposure time up to the end of the period including follow up for patients without the event), in years EAIR is expressed as the number of patients experiencing an adverse event per 100 patient years of exposure and is 100 times the number of patients experiencing the adverse event divided by the sum of all patient exposure time (in years) AE adverse event, D/C discontinuation, DVT deep vein thrombosis, EAIR exposure adjusted incidence rate, IR incidence rate per 100 patient-years at risk, NMSC nonmelanoma skin cancer, PE pulmonary embolism Delineation of a proinflammatory cytokine profile targeted by JAK1/2 inhibition using baricitinib in a phase 2 SLE trial were analyzed for: IL-2, IL-3, IL-5, IL-6, IL-10, IL-17A, IL-21, IL-12/23p40, IL-12p70, GM-CSF, IFN-α and IFN-γ using ultrasensitive quantitative assays. IFN gene signature, autoantibodies, C3 and C4 were measured as previously described [1] . Results: At wk 0, serum IL-17A, IL-12/23p40, IL-6, IFN-γ and IFN-α were readily detectable. IL-12/23p40 was detectable in 100 % of pts vs. 100 % of controls, IFN-γ in 89 % of pts vs. 66 % of controls, IL-6 in 53 % of pts vs. 12 % of controls and in IFN-α 41 % of pts vs. 2 % of controls; detection of serum IL-2, GM-CSF, IL-5, IL-10 and IL-17A was variable (. Fig. 1 ). At baseline (wk 0), IL-12/23p40 was positively correlated with SLEDAI and IFN gene signature and negatively correlated with serum C4. IL-6 was positively correlated with joint swelling, joint tenderness, IFN-γ and C3. Serum IFN-α was positively correlated with serum IFN-γ, anti-Sm and anti-RNP, and the IFN gene signature (. Fig. 2) . Treatment with BARI 4 mg (. Fig. 1b ) significantly decreased serum IL12/23p40 and IL-6 cytokine levels at wk 12 (p < 0.05) but not serum IFN-α or IFN-γ levels (. Fig. 1b) . Conclusion: BARI 4 mg treatment was associated with statistically significant decreases of serum IL-12/23p40 and IL-6 at week 12 which continued through week 24. Serum IFN-α or IFN-γ were not reduced with BARI treatment. Thus, BARI 4 mg simultaneously impacted multiple pro-inflammatory cytokines implicated in the pathogenesis of SLE. Table 1 ). Conclusion: If myositis was suspected exclusively or at least as differential diagnosis, about 49 % of the histological finding revealed an inflammatory myopathy. Proportion of myositis was more pronounced, when CK was elevated at time of biopsy (. Fig. 1 ). Sensitivitity and specificity of muscle biopsy was moderate when using start of immunosuppressive therapy as gold standard of IIM diagnosis. mal. Descriptive analyses were performed. In a subset of patients clinical information on initiation of immunosuppressive therapy (including steroids) after muscle biopsy was retrieved form electronical medical records ( EMR). Sensitivity, specificity, pos. and neg. predictive value of histological finding were calculated, using initiation of immunosuppressive therapy as goldstandard. . 1 ). ACR response rates were higher in active controlled trials (. Fig. 2) . The OR for achieving an ACR response when investigating the same treatment was higher in studies with active control group than in corresponding studies with placebo control group: Fig. 3 ). In the presence of many therapeutic options, or after approval of a compound for clinical use, trials often use other active interventions as comparators instead of placebo. In such studies placebo effects are still in place by the mere expectation of a response, but one could hypothesise that the observable effect of each intervention may be higher simply because of knowledge about the certainty to get active treatment (i. e. no risk of placebo). Here we investigate the hypothesis by comparing the effects of active controlled trials versus placebo controlled trials on the efficacy for the same intervention in patients with rheumatoid arthritis ( RA), in a systematic approach using all published trials in the field. Objective: To assess whether there is a systematic difference in response rates when investigating treatments in randomised controlled trials (RCTs) with active control compared to placebo control in RA clinical trials. Methods: A systematic literature search was performed. We identified and matched RCTs that used comparable regimens, patient populations, background therapy and outcome reporting, but were different in terms of control group (active or placebo). Included studies were explored for potential risk of bias and mixed-model logistic regression was used to estimate odds ratios ( OR) for achieving an American College of Rheumatology ( ACR) 20, 50 and 70 % response at week 12 in active-controlled studies compared to corresponding placebo-controlled studies. (68 %), intra-articular effusion in 24 (63 %) and overwarming in 14 (37 %). 32 patients presented with monoarthritis. The knee joint was affected in 89 % of cases. Laboratory findings were leukocytosis in 9 patients and elevated CRP in 27. Infection with B. burgdorferi was detected by ELISAscreening ( IgG+: 37, IgM+: 9) and confirmed by Western Blot ( IgG bands: 29, IgM bands: 10) in all. Radiological imaging was done by ultrasound in 9 patients and MRI in 4 and revealed intraarticular effusion in 12 (32 %) and synovialitis in 5 (13 %) at first visit. Median time interval between first presentation and start of antibiotic therapy was 15 (range 0-320) days. 1° line-antibiotic was ceftriaxone in 15 (39 %), amoxicillin in 10 (26 %), doxycycline in 9 (24 %), cefuroxime and penicillin in 2 (5 %) patients. In 7 (18 %) a 2° course of antibiotics was necessary. 26 (68 %) patients recovered after 1 or 2 cycles of antibiotic therapy. The 12 non-responders underwent therapy with NSAID (4), intra-articular steroid injections (6), or DMARD therapy with sulfasalazine (1). At the end of follow-up, 34 patients were free of symptoms, 3 were subsequently diagnosed with JIA and 1 continued to suffer without diagnosis of a rheumatic disease. Conclusion: Borrelia infection is an important differential diagnosis in children presenting with arthritis, especially in those presenting with monoarthritis of the knee. Early consideration of the diagnosis, confirmation of infection and antibiotic treatment are necessary. Outcome of Lyme arthritis is favourable in children. In children with ongoing symptoms despite antibiotic treatment and intra-articular corticosteroids reevaluation for rheumatic diseases should be done. Universität Salzburg, Salzburg, Austria Aim: Background: The GHG combines several treatment factors such as exposure to low level radon and to high numbers of negative ions, high humidity and mild hyperthermia in a moderate altitude (1280 m) above sea level. Early spa reactions, including short-term worsening of specific (e. g. pain) or general symptoms (e. g. fatigue) or a deterioration of sleep quality within the first week of the interventions, to repeated thermal triggers are clinically well known. Such reactions are hypothetically mediated by autonomous nervous system ( ANS) processes. The GHG treatment factors have a considerable impact on the ANS, a system that adapts rapidly to environmental and internal stressors. Hence, it is plausible that some patients will develop spa reactions in the course of the treatment. In fact, these events are regularly reported by the patients in our clinic. Therefore, our objective was the systematic assessment of frequency, severity and du- Aim: Arthritis is a common late manifestations of Lyme disease in children and an important differential diagnosis in juvenile idiopathic arthritis. Our study aimed to describe the characteristics of the disease in order to carry out the most accurate differential diagnosis possible in clinical practice. The second objective was to evaluate the efficacy of therapy and final outcome. Ziel: Um für Patienten mit rheumatischen Erkrankungen eine möglichst uneingeschränkte Ausübung ihres Berufs sowie der sozialen Partizipation zu erreichen sowie im vorgerückten Alter möglichst lange eine selbständige Lebensführung zu erhalten, bieten die Sozialversicherungen Maßnahmen aus dem Bereich der medizinischen Rehabilitation an. Da sich durch Fortschritte in der medikamentösen Therapie Änderungen in den Schwerpunkten und Zielen der rheumatologischen Rehabilitation ergeben können, war es von Interesse in Umfragen bei Mitgliedern der Österreichischen Gesellschaft für Rheumatologie und Rehabilitation sowie den Expert* innen des Arbeitskreises für Rehabilitation, also zwei kompetenten Fachkreisen, zu erheben, welcher Stellenwert der Rehabilitation bei den Erkrankungen Rheumatoide Arthritis und Spondylarthritiden aktuell zugemessen wird. Die Auswertung dieser Resultate erscheint auch wichtig, um die Zuweisung zur rheumatologischen Rehabilitation und die Qualitätsanforderungen für deren Durchführung den aktuellen Anforderungen anpassen zu können sowie deren Stellenwert im Gesundheitssystem zu stärken. Methoden: In zwei österreichweiten Online-Umfragen (online survey) wurden alle Mitglieder der Österreichischen Gesellschaft für Rheumatologie und Rehabilitation ( ÖGR) aufgefordert zur aktuellen Relevanz einer stationären Rehabilitation bei a) Rheumatoider Arthritis ( RA) und b) axialer Spondylarthritis (axSpA) teilzunehmen. Von den ÖGR-Mitgliedern nahmen n = 117 bei der RA-Befragung und n = 71 bei der axSpA-Befragung teil; die Rehab-Spezialistengruppe umfasste n = 12 ( RA) bzw. n = 13 (axSpA) Experten, im Gesamten also n = 129 ( RA) bzw. n = 84 (axSpA). Die meisten ÖGR-Mitglieder waren FÄ für Innere Medizin, die Mehrheit (ca. 80 %) seit über 5 Jahren auf dem Gebiet der Rheumatologie. Parallel dazu wurden dieselben Fragen von einer Gruppe von Rehabilitationsexperten, den Mitgliedern des Arbeitskreises für Rehabilitation der ÖGR, ration of early spa reactions in patients who attended the GHG for the first time for treatment sessions. Methods: Methods: We conducted an anonymized online survey with patients who attended the GHG for the first time in the year 2020. Fourhundred-forty patients with a variety of diseases who experienced 4 to 13 sessions during their stay were invited to participate. In addition to sociodemographic and disease related variables (i. e. main diagnoses), we assessed the potential spa reactions of night sweats, increased pain and fatigue, lack of strength, and sleeping problems in terms of their occurrence, severity and duration (answer format: yes/no; mild/moderate/severe; lasting 1-2 days/3-4/5-6). Results: Results: In total, 93 patients responded (21 %). The diagnosis of fibromyalgia was indicated in 24 cases (19 % of all diagnoses), ankylosing spondylitis in 19 (15 %), rheumatoid arthritis in 10 (8 %), psoriatic arthritis 9 (7 %), polymyalgia rheumatica 6 (5 %), spine disorders in 14 (11 %), osteoarthritis at different regions in 23 (19 %) and other diagnoses in 18 cases (16 %) (multiple answers were allowed). The mean age was 57 years ( SD 10,4) and 36 % of participants were male. The mean number of sessions was 8,9 ( SD 2,1) and the median was 9 sessions. The results of the spa reaction items are depicted in . Table 1 . In some of them there were significant differences (chi-square test). Conclusion: Conclusions: To our knowledge this is the first time that early spa reactions were assessed systematically, for patients seeking mild radon-hyperthermia treatment. In this diverse sample, early spa reactions were frequent. Fatigue and increased pain occurred in 48 and 31 % of the patients followed by lack of strength in 29 % and sleeping problems in 27 % patients, respectively. In most patients these symptoms were moderate and persisted at least 5 to 6 days. Our results can be used to educate GHG patients in greater detail prior to their treatment about potential spa reactions. Our findings also have implications for future research. For example, some patient reactions are mediated by the ANS and it would be interesting to monitor heart rate variability, a surrogate parameter of the ANS, to assess the physiological processes underlying this phenomenon. There was no significant difference between genders for TNFi used. Conclusion: Gender difference in the response to bDMARDs or tsD-MARDs showed an inconsistent pattern, whereas a statistically better response for TNFi treatment was observed in male RA and PsA patients, this effect did not extend to SpA. In contrast to rituximab and aremilast, which also elicited a statistically better effect in men, Tocilizumab seems to work equally well in both genders. Keeping in mind the small sample number, this differential effect of bDMARDs and tsDMARDs could have potential implications in therapy after testing in a larger cohort. were treated with different cytokines and RNA-sequencing was performed to examine the effect of the synovial cytokine milieu. Fluorescence activated cell sorting ( FACS) purified naïve CD4+ T-cells from patient-derived PBMCs were co-cultured with cytokine pre-treated FLS. Automated fluorescence microscopy and downstream bioinformatic image analysis allowed visualization and quantification of cell-cell interactions. Results: Our data confirmed enhanced T cell-FLS interactions, which was dependent on the cytokine milieu. Consequently, cell-cell interactions lead to enhanced T cell activation, proliferation and differentiation of naïve T cells into CD62L high CD45RO high memory T cells. Ongoing bioinformatic analysis aim to integrate the in vitro generated data into singlecell sequencing data from synovial biopsies from RA patients. Automated high-content microscopy will be used to identify compounds to inhibit cell-cell interactions and consequently the development of pathogenic T cells. Conclusion: Cytokine pre-stimulation of FLS alters their interaction with T-cells, which consequently modifies CD4+ T-cell development. This points towards a role of FLS-T-cell interaction in the pathomechanism of RA. Using our assay system as high-content drug screening tool will allow for identification of interaction-inhibitory compounds. Aim: The aim of our study was to investigate possible gender-dependent differences in response to biologics (bDMARD), apremilast, and ts-DMARD in several inflammatory arthritides in a homogeneous Central European population, using data from the Austrian Registry for Biologics (Bioreg) Methods: Biologics-naïve patients with RA, SpA, and PsA from the BioReg registry with a baseline visit (= V1) and controls at 6 (= V2) and 12 months (= V3) were included. The response rate between genders was examined for all TNFi, rituximab ( RIT), tocilizumab ( TCZ), and apremilast ( APR). The remaining bDMARDs and tsDMARDs were not analyzed due to insufficient numbers. Die Nierenparameter sowie die CK zeigen sich unter Therapie rückläufig (. Tab. 1), sodass auf ein Nierenersatzverfahren letztlich verzichtet werden kann Aufnahme ist ohne die Covid-19-typischen Veränderungen und die beidseitige Nierensonographie zeigt einen Normalbefund. Der Patient kann nach insgesamt 19 Tagen stationären Aufenthalts in gutem Allgemeinzustand und mit leicht erhöhten Nierenfunktionsparametern sowie gering erhöhter, jedoch deutlich rückläufiger CK entlassen werden Während die meisten Fälle viraler Myositis auf Influenza und Enteroviren zurückzuführen sind, wurden seit Beginn der Covid-19-Pandemie auch einzelne SARS-CoV-2 vermittelte Fälle beschrieben Im hier präsentierten Fall wird eine Myositis mit Rhabdomyolyse und ANV nach SARS-CoV-2-Infektion ohne Lungenbeteiligung beschrieben. Das ANV konnte durch forcierte Volumentherapie, die Myositis und Rhabdomyolyse symptomatisch behandelt werden. In der Ursachenforschung konnten weder eine immunologische Grunderkrankung, noch ein sonstiger, typischer Auslöser für Myositis-und Rhabdomyolyse nachgewiesen werden. Die Manifestation einer Post-Covid-19 Erkrankung mit Ganzkörperschmerzen und Rhabdomyolyse ohne Pneumonie ist im vorliegenden Bericht besonders hervorzuheben und soll die Awareness für atypische Phänotypen einer SARS-CoV-2-Infektion verbessern helfen. Ob die ausgelenkte CK als prognostischer Marker Bedeutung haben könnte Das Erheben und Monitieren der CK bei Covid-19-Erkrankten mit Muskelbeschwerden ist aus unserer Sicht notwendig, um potenziell lebensgefährliche Komplikation wie Rhabdomyolyse und ANV zu vermeiden. Schlussendlich ist derzeit unklar, wieso der Patient die offensichtliche Prädisposition zur Entwicklung einer Rhabdomyolyse nach viraler Infektion hat Aufgrund eines nunmehr positiven SARS-CoV-2-PCR Befundes bei Aufnahme ( CT-Wert von 36,70) wird der Patient initial auf die Isolierstation der Zentralen Notaufnahme aufgenommen. Im Verlauf erfolgt bei steigendem CT-Wert die Transferierung auf eine internistische Normalstation Sm-AK EIA Bis 25 U/mL Neg U1-snRNP-AK ql Bis 25 U/mL Neg Scl-70 AK qual AK Bis 25 U/mL Neg Bis 25 U/mL Neg Bis 25 U/mL Neg Scl-70 AK Bis 25 U/mL Neg AK Bis 25 U/mL Neg PL-7-AK qual PL-12-AK qual Mi-2-AK qual TIF1-gamma AK ql SAE-1 AK ql SAE-2 AK ql 2.9 10 Fritsch-Stork 11 12 I Idzko 5.1 22 N Nakhost Lotfi Fallbeschreibung: An eine Grossgefässvaskulitis sollte auch bei jüngeren Patienten, die unter ubiquitären Schmerzen leiden, gedacht werden, um einen langen Leidensweg abkürzen zu helfen und eine effektive zur Verfügung stehende Therapie schnell zu beginnen. Wir berichten über eine 58-jährige als Rechtsanwältin tätige bisher gesunde Patientin, die zur Abklärung generalisierter Schmerzen, die als Fibromyalgiesyndrom gedeutet wurden -bei unklarem Leistungsknick -in unsere rheumatologische Schwerpunktpraxis kam. Bei der Eingangsuntersuchung der Patientin fiel neben der Schmerzsymptomatik an allen 4 Körperquadranten bei der erstmalig erfolgten körperlichen Untersuchung ein erhöhter bisher nicht bekannter Blutdruck von 180/110 rechts und 180/110 li auf. Die veranlassten immunologischen Parameter zeigten bis auf eine CRP Erhöhung von 9,9 mg/l (<5 mg/l) bei ANA, DNS-AK, C-ANCA, P-ANCA, Chromagranin A, Metanephrin-Bestimmung, HLA-B-27 unauffällige Werte, Blutbild-und Blutchemie ob. US-Doppler-Untersuchung der Aa.temporalis, Aa. carotis, Aa.axillaris unauffällig. Echokardiographie bis auf Septumdicke von 12 mm unauffällig. Duplex Nierenarterien unauffällig. Nach 4 Wochen bei Persistenz des Hochdrucks unter medikamentöser Therapie mit Werten bis 220/120 mmHG wurde notfallmässig eine PET-CT18F( FDG)-Untersuchung unter dem Verdacht einer Großgefässvaskulitis ( GCA) veranlasst. PET-CT Ergebnis: Aortitis der Aorta descendens auf 17 cm Länge. Zeichen der peripheren und axialen Spondyloarthritis mit Enthesitiden und Facettengelenksentzündungen ohne Sakroiliitisbefall. Die Therapie mit Steroiden (50 mg absteigend auf 7,5 mg/die innerhalb von 6 Wochen) und Anti IL-6 Rezeptor-AK mit 162,5 mg/Woche führte nach 6 Wochen zu einer anhaltenden Remission, so dass die Therapie nach 12 Monaten abgesetzt werden konnte. Nach 18 Monaten ist die Patientin weiterhin beschwerdefrei. Schlussfolgerung: Bei der rheumatologischen Abklärung eines vordiagnostizierten generalisierten Fibromyalgiesyndroms sollte die beidseitige RR-Kontrolle nicht vergessen werden, um ggf. die richtigen diagnostischen und therapeutischen Schlüsse ziehen zu können. dsDNA-AK Bis 20,0 U/mL 6,0