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Eine adäquate Versorgung von alten Rheumapatienten sollte multimodal, interdisziplinär und patientenorientiert erfolgen. Bei Patienten mit rheumatoider Arthritis (RA) ist die kardiovaskuläre Mortalität im Vergleich zur Allgemeinbevölkerung 5fach erhöht. Geriatrische Patienten können als Folge des Abbaus fettfreier Körpermasse eine „rheumatoide Kachexie“ erleiden. Ein Body-Mass-Index von unter 20 kg/mDie „late onset rheumatoid arthritis“ (LORA) in höherem Lebensalter ( 60) manifestiert sich häufiger mit einem oligoartikulären Muster mit Bevorzugung größerer Gelenke. Die Therapie der LORA hat sich entscheidend gewandelt: Die Langzeittherapie mit Glukokortikoiden wurde durch eine altersadaptierte Basistherapie verdrängt. In über 90 % der Fälle sind Patienten mit Polymyalgia rheumatica (PMR) älter als 60 Jahre. Sonografisch nachweisbare Bursitiden werden mittlerweile als wichtigste Ursache angenommen. Prednisolon ist zwar weiter der Goldstandard der Therapie der PMR, aber initiale Dosen7,5 oder30 mg/Tag gelten nun als obsolet. Durch den Einsatz der hochauflösenden Farbdopplersonografie kann bei der Riesenzellarteriitis mittlerweile fast die Aussagekraft einer Biopsie der A. temporalis erreicht werden. Als wichtige Ursache einer gesteigerten Toxizität pharmakologischer Wirkstoffe im Alter gilt mittlerweile ein Abfall der Eiweißbindungskapazität. Bei älteren Rheumapatienten wird dieser durch einen Albuminmangel bedingt. Die früher häufig praktizierte „Low-dose“-Glukokortikoidtherapie der RA Älterer wird nicht mehr empfohlen. Die Kombination mehrerer Basistherapeutika ist bei älteren Rheumapatienten risikoreich, sodass der Übergang auf Biologika oft der sicherere Weg ist.

Burgen und Schlösser - Zeitschrift für Burgenforschung und Denkmalpflege, Bd. 14, Nr. 1 (1973): Burgen und Schlösser. Zeitschrift für Burgenforschung und Denkmalpflege

Burgen und Schlösser - Zeitschrift für Burgenforschung und Denkmalpflege, Bd. 17, Nr. 2 (1976): Burgen und Schlösser. Zeitschrift für Burgenforschung und Denkmalpflege

Reproducible climate reconstructions of the Common Era (1 CE to present) are key to placing industrial-era warming into the context of natural climatic variability. Here we present a community-sourced database of temperature-sensitive proxy records from the PAGES2k initiative. The database gathers 692 records from 648 locations, including all continental regions and major ocean basins. The records are from trees, ice, sediment, corals, speleothems, documentary evidence, and other archives. They range in length from 50 to 2000 years, with a median of 547 years, while temporal resolution ranges from biweekly to centennial. Nearly half of the proxy time series are significantly correlated with HadCRUT4.2 surface temperature over the period 1850-2014. Global temperature composites show a remarkable degree of coherence between high-and low-resolution archives, with broadly similar patterns across archive types, terrestrial versus marine locations, and screening criteria. The database is suited to investigations of global and regional temperature variability over the Common Era, and is shared in the Linked Paleo Data (LiPD) format, including serializations in Matlab, R and Python.(TABLE)Since the pioneering work of D'Arrigo and Jacoby1-3, as well as Mann et al. 4,5, temperature reconstructions of the Common Era have become a key component of climate assessments6-9. Such reconstructions depend strongly on the composition of the underlying network of climate proxies10, and it is therefore critical for the climate community to have access to a community-vetted, quality-controlled database of temperature-sensitive records stored in a self-describing format. The Past Global Changes (PAGES) 2k consortium, a self-organized, international group of experts, recently assembled such a database, and used it to reconstruct surface temperature over continental-scale regions11 (hereafter, ` PAGES2k-2013').This data descriptor presents version 2.0.0 of the PAGES2k proxy temperature database (Data Citation 1). It augments the PAGES2k-2013 collection of terrestrial records with marine records assembled by the Ocean2k working group at centennial12 and annual13 time scales. In addition to these previously published data compilations, this version includes substantially more records, extensive new metadata, and validation. Furthermore, the selection criteria for records included in this version are applied more uniformly and transparently across regions, resulting in a more cohesive data product.This data descriptor describes the contents of the database, the criteria for inclusion, and quantifies the relation of each record with instrumental temperature. In addition, the paleotemperature time series are summarized as composites to highlight the most salient decadal-to centennial-scale behaviour of the dataset and check mutual consistency between paleoclimate archives. We provide extensive Matlab code to probe the database-processing, filtering and aggregating it in various ways to investigate temperature variability over the Common Era. The unique approach to data stewardship and code-sharing employed here is designed to enable an unprecedented scale of investigation of the temperature history of the Common Era, by the scientific community and citizen-scientists alike.

Protecting different kinds of information has become an important area of research. One aspect is to provide effective means to avoid that secrets can be deduced from the answers of legitimate queries. In the context of atomic propositional databases several methods have been developed to achieve this goal. However in those databases it is not possible to formalize structural information. Also they are quite restrictive with respect to the specification of secrets. In this paper we extend those methods to match the much greater expressive power of Boolean description logics. In addition to the formal framework we provide a discussion of various kinds of censors and establish different levels of security they can provide.

The spatial context is critical when assessing present-day climate anomalies, attributing them to potential forcings and making statements regarding their frequency and severity in a long-term perspective. Recent international initiatives have expanded the number of high-quality proxy-records and developed new statistical reconstruction methods. These advances allow more rigorous regional past temperature reconstructions and, in turn, the possibility of evaluating climate models on policy-relevant, spatio-temporal scales. Here we provide a new proxy-based, annually-resolved, spatial reconstruction of the European summer (June-August) temperature fields back to 755 CE based on Bayesian hierarchical modelling (BHM), together with estimates of the European mean temperature variation since 138 BCE based on BHM and composite-plus-scaling (CPS). Our reconstructions compare well with independent instrumental and proxy-based temperature estimates, but suggest a larger amplitude in summer temperature variability than previously reported. Both CPS and BHM reconstructions indicate that the mean 20th century European summer temperature was not significantly different from some earlier centuries, including the 1st, 2nd, 8th and 10th centuries CE. The 1st century (in BHM also the 10th century) may even have been slightly warmer than the 20th century, but the difference is not statistically significant. Comparing each 50 yr period with the 1951-2000 period reveals a similar pattern. Recent summers, however, have been unusually warm in the context of the last two millennia and there are no 30 yr periods in either reconstruction that exceed the mean average European summer temperature of the last 3 decades (1986-2015 CE). A comparison with an ensemble of climate model simulations suggests that the reconstructed European summer temperature variability over the period 850-2000 CE reflects changes in both internal variability and external forcing on multi-decadal time-scales. For pan-European temperatures we find slightly better agreement between the reconstruction and the model simulations with high-end estimates for total solar irradiance. Temperature differences between the medieval period, the recent period and the Little Ice Age are larger in the reconstructions than the simulations. This may indicate inflated variability of the reconstructions, a lack of sensitivity and processes to changes in external forcing on the simulated European climate and/or an underestimation of internal variability on centennial and longer time scales

Im Verlauf einer gastroenterologischen Erkrankung konnen rheumatologische Symptome auftreten. Diese sind manchmal sogar fuhrend. Wichtige Beispiele sind der Morbus Crohn, die Colitis ulcerosa, der Morbus Whipple und die glutensensitive Enteropathie. Neben Gelenkschmerzen konnen zum Teil schwere, gelenkzerstorende Entzundungen auftreten. Auch bei hepatologischen Erkrankungen zeigen sich rheumatische Beschwerden. Umgekehrt kommt es bei rheumatologischen Erkrankungen haufig zu einer Leberbeteiligung. Virale Hepatitiden konnen Beschwerdebilder verursachen, die der klassischen rheumatoiden Arthritis ahneln. In den meisten Fallen ist die Therapie der gastroenterologischen Grundkrankheit entscheidend fur den Verlauf der rheumatologischen Symptomatik.

The immunologic basis of inflammatory bowel disease has been the focus of interest of a series of studies on Crohn's disease and the process of immune sensitization at the gastrointestinal mucosal level is functionally poorly understood. To date only few contradictory reports concerning the incidence of autoantibodies in patients with this disease exist. The aim of this study was to investigate the sera drawn from 60 patients suffering from biopsy-proven Crohn's disease to evaluate the prevalence of autoantibodies against nuclear antigens and cytoskeletal proteins. Using standard methods, no anti-nuclear antibodies or antibodies to extractable nuclear antigens could be detected. All sera were also negative for antibodies to double-stranded DNA, anti-mitochondrial antibodies, and antibodies to gastric parietal cells. Using sensitive enzyme-linked immunosorbent assays with purified antigens and Western blotting with cytoskeletal proteins of human intestinal cells, the following antibodies could be demonstrated: cytokeratin 18 autoantibodies (IgG 20.0%; IgM 6.7%; IgA 13.3%), actin antibodies (IgG 36.7%; IgM 48.3%, IgA 26.7%), desmin antibodies (IgG 6.7%; IgM 15.08%; IgA 50%), vimentin antibodies (IgG 3.3%; IgM 16.7%; IgA 10.0%) and tropomyosin antibodies (IgG 3.3%; IgM 3.3%, IgA 5.0%). Statistically significant correlations could be found for levels of cytokeratin 18 antibodies (IgM-type) and the BEST index of activity, and for levels of desmin antibodies (IgM-type) and the van HEES index of activity. Highest levels could be measured for actin antibodies (IgG-type) in patients with isolated disease manifestation in the colon. The mechanism of induction of autoantibodies against cytoskeletal components in Crohn's disease still remains obscure. Unmasking of hidden antigens after cell injury during the inflammatory process of disease might lead to sensitization and antibody production. The pattern of antibodies in patients with Crohn's disease seems to be different compared with that of connective tissue diseases.

A lambda-light chain-IgA plasmocytoma, accompanied by a changing clinical picture of fever, nocturnal perspirations and weight loss, developed in a 46-year-old homosexual male with AIDS, stage IV (classification according to the Centers for Disease Control). He had been suffering from recurrent Salmonella septicaemia. Serum protein electrophoresis demonstrated marked elevation of the beta- and gamma-fractions (44% and 24%, respectively). There were 15% plasma cells in the differential blood count and in the bone marrow smear. Immunoelectrophoresis demonstrated free lambda-light chains. The IgA concentration in cerebrospinal fluid was raised to 202 mg/l, and there was an IgA paraproteinaemia. The patient died during a recurrence of the Salmonella septicaemia from septic cardiovascular failure.

During a nine-year treatment by haemodialysis for renal failure a now 57-year-old woman developed multiple complications of the skeletal system. Acute calcific periarthritis of the right shoulder became manifest one year after the start of the haemodialysis, followed the next years by progressive arthropathy with subchondral amyloid cysts of both shoulders, effusions in the knee-joint and destructive spondylarthropathy of the middle vertebrae. Carpal-tunnel syndrome also occurred, caused by a beta 2-microglobulin amyloidosis (beta 2-microglobulin concentration in serum 42.6 ng/l) and an aluminium osteopathy. These multiple complications, observed here in one patient, are each of them typical long-term complications of chronic haemodialysis.

Ankle oedema and abdominal swelling suddenly developed in a 55-year-old woman who also had lymphadenopathy in the neck, axillae and groin. Ultrasonography demonstrated hepatosplenomegaly, ascites and pleural effusions. Histological examination of some lymph-nodes from the axilla and groin revealed angioimmunoblastic lymphadenopathy (low-malignant peripheral T cell lymphoma). Bone-marrow biopsy was undertaken because of a normocytic anaemia (haemoglobin 4.9 g/dl) requiring blood transfusion, thrombocytopenia (5000/microliters) and monoclonal IgG gammopathy. This showed lymphoma-associated secondary myelofibrosis. Treatment with prednisone (2 mg/kg daily for 8 weeks) and vincristine (1 mg/m2 once weekly for 4 weeks) brought about partial remission of the angioimmunoblastic lymphadenopathy with normalization of the clinical and laboratory findings, the splenohepatomegaly regressed, and there was only a small amount of ascites. Four months after onset of the illness bone-marrow biopsy also showed regression of the myelofibrosis.