94 results on '"B. Buehring"'
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2. Häufigkeit und Schweregrad von Sarkopenie bei Patient*innen mit entzündlichen und nichtentzündlichen muskuloskeletalen Erkrankungen
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B. Buehring, C. Mueller, R. Parvaee, I. Andreica, D. Kiefer, U. Kiltz, S. Tsiami, M. Pourhassan, T. Westhoff, R. Wirth, X. Baraliakos, N. Babel, and J. Braun
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Rheumatology - Published
- 2023
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3. Osteoporosis and Rheumatoid Arthritis-Diagnosis, Diagnostics and Therapy
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Katharina Schultz, Friederike Thomasius, B. Buehring, and Uwe Maus
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medicine.medical_specialty ,business.industry ,Osteoporosis ,Context (language use) ,General Medicine ,Disease ,medicine.disease ,Review article ,Joint pain ,Rheumatoid arthritis ,medicine ,Vitamin D and neurology ,medicine.symptom ,Risk factor ,Intensive care medicine ,business - Abstract
Many inflammatory rheumatic diseases are associated with an increased fracture risk. Causes include the pro-inflammatory cytokines which are elevated in these diseases, reduced mobility and physical activity often caused by joint pain, and medications that negatively affect bone quality. Osteoporosis, the loss of bone mass and structure is the result. This review article summarizes the current diagnostic and therapeutic osteoporosis recommendations for patients with rheumatoid arthritis. It should be emphasized that early measures for the detection and treatment of osteoporosis are particularly important, since the risk factor constellation often present in this patient population leads to a relatively high imminent fracture risk at the beginning of the disease and the start of glucocorticoid therapy. Treatment initiations as early as possible with effective control of inflammatory activity is therefore essential to reduce the risk of osteoporosis. The administration of glucocorticoids should be reduced as far as the clinical context allows. Fracture risk should be assessed when the RA diagnosis is made and in regular intervals thereafter. Osteoporosis medication should be initiated based on the overall fracture risk. The choice of medication is based on the particular risk and indication. The basis of therapy is an adequate intake of vitamin D and calcium and adapted physical activity
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- 2021
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4. Evaluation des Trabecular Bone Score (TBS) in der täglichen Praxis bei Patienten mit entzündlich rheumatischen und nichtentzündlichen Erkrankungen
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J. Thomas, J. Braun, B. Buehring, X. Baraliakos, and T. Wittkämper
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030203 arthritis & rheumatology ,Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Rheumatology ,business.industry ,Medicine ,030209 endocrinology & metabolism ,business - Abstract
Zusammenfassung Hintergrund Osteoporosebedingte Frakturen sind bei Patienten mit rheumatoider Arthritis (RA) häufig. Die Messung der Knochenmineraldichte (KDM) mit der Dual-Energie-Röntgenabsorptionsmessung (DXA) allein sagt das Frakturrisiko nur begrenzt voraus. Der Trabecular Bone Score (TBS) ist ein Surrogatmarker für die trabekuläre Mikroarchitektur des Knochens, der das Frakturrisiko unabhängig von der KDM vorhersagen kann. Ziel Ermittlung der Prävalenz von KDM, TBS und osteoporotisch bedingten Wirbelkörperbrüchen („vertebral fractures“ [VF]) bei Patienten mit RA im Vergleich zu Kontrollen mit nichtentzündlichen Muskel-Skelett-Erkrankungen (MSK). Methoden Die Daten von Patienten mit von Rheumatologen diagnostizierter RA und verfügbaren TBS- und DXA-Messungen, die in unserem Krankenhaus von 2006 bis 2014 erhoben wurden, wurden retrospektiv analysiert. Den RA-Patienten wurden Kontrollen mit nichtentzündlichen MSK zugeordnet. Eine „reduzierte Knochengesundheit“ wurde definiert als ein T‑Score Ergebnisse Es wurden 143 Patienten mit RA (Alter 72,1 ± 11,1 Jahre, 72 % weiblich) und 106 Kontrollen (Alter 69,6 ± 12,6 Jahre, 75 % weiblich) eingeschlossen. RA-Patienten hatten häufiger eine erniedrigte KDM (n = 102; 71,3 %) und einen erniedrigen TBS-Wert (n = 125; 87,4 %) als die Kontrollen (n = 63; 59,4 % und n = 79; 74,5 %, p = 0,049 und p = 0,009). RA-Patienten hatten mehr VF (n = 52, 36,4 %) als Kontrollen (n = 24, 22,6 %, p = 0,02). Insgesamt hatten 20 Patienten mit VF (26,3 %) eine normale Wirbelsäulen-KDM und 9 (11,8 %) auch eine normale Hüft-KDM. Bei Patienten mit VF war die Kombination eines niedrigen TBS bei normaler WS-KDM häufiger als ein normaler TBS bei niedriger WS-KDM (p = 0,008 für RA, p = 0,025 für Kontrollen). Diskussion VF treten bei Patienten mit normaler KDM auf. Bei Patienten mit VF wurde eine niedrige TBS bei normaler Wirbelsäulen-KDM häufiger gefunden als eine normale TBS bei niedriger Wirbelsäulen-KDM. Die Messung des TBS scheint für die Erkennung eines erhöhten Frakturrisikos bei RA-Patienten mit normaler WS-KDM nützlich zu sein.
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- 2020
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5. Biosimilars und der Nocebo-Effekt
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D. Kiefer, Uta Kiltz, S. Tsiami, B. Buehring, I. Andreica, Xenofon Baraliakos, and J. Braun
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030203 arthritis & rheumatology ,Gynecology ,Nocebo Effect ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Rheumatology ,business.industry ,medicine ,Building and Construction ,030212 general & internal medicine ,business - Abstract
In Deutschland sind seit vielen Jahren Biosimilars zugelassen, seit wenigen Jahren auch in der Rheumatologie. Zwar haben die Biosimilars, die wie die Referenzbiologika biotechnologisch hergestellten Produkte sind, inzwischen in einigen Regionen schon erheblich Marktanteile erreicht, es gibt aber bei Patienten und Arzten immer noch viele Zweifler, die einen Qualitatsverlust befurchten – auch, wenn es dafur keinen Anhalt gibt. Ein Teil dieses Problems ist durch den Nocebo-Effekt zu erklaren, der aber auch daruber hinaus eine erhebliche medizinische Bedeutung hat. Dieser Effekt wird in diesem Artikel beschrieben und erlautert. Psychosoziale und kontextbezogene Faktoren wie die Beziehung zwischen Patient und Arzt, fruhere Behandlungserfahrungen und Behandlungserwartungen konnen die Wirksamkeit einer therapeutischen Intervention entweder verbessern oder beeintrachtigen. Diese Phanomene werden ublicherweise als Placebo- und Nocebo-Effekte bezeichnet. Da Placebo- und Nocebo-Effekte die Symptomentwicklung, die Haufigkeit unerwunschter Ereignisse und die Wirksamkeit der Behandlung beeinflussen konnen, ist es entscheidend, diese Effekte zu kennen und Strategien zur Pravention zu entwickeln, um die Behandlungsergebnisse zu optimieren. Wahrend experimentelle Studien in den letzten Jahren wesentliche Fortschritte bei der Aufklarung der psychosozialen und neurobiologischen Mechanismen von Placebo-Effekten erzielt haben, sind die detaillierten Mechanismen von Nocebo-Effekten noch weitgehend unerforscht. Ein besseres Verstandnis dieser Mechanismen verspricht die Entwicklung benutzerfreundlicher Strategien fur die klinische Versorgung zur Verbesserung der Behandlungsergebnisse und der Patientenzufriedenheit.
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- 2019
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6. Rheumatologische Versorgung im Rheumazentrum Ruhrgebiet – ein Modell für Ballungszentren
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I. Andreica, B. Mintrop, Xenofon Baraliakos, U. Häusler, H Kavruk, J. Braun, D. Kiefer, R Lochowski, B. Guminski, Uta Kiltz, and B. Buehring
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Gynecology ,medicine.medical_specialty ,Rheumatology ,business.industry ,Medicine ,Treat to target ,business - Abstract
Das Rheumazentrum Ruhrgebiet ist die groste deutsche Rheumaspezialklinik, die seit vielen Jahren alle Voraussetzungen fur die vom Verband der rheumatologischen Akutkliniken (VRA) geforderte Strukturqualitat erfullt und – auch wegen der regelmasigen Teilnahme am Benchmarkingprojekt KOBRA – regelmasig das VRA-Gutesiegel erhalt. Im Rheumazentrum Ruhrgebiet wurden im Jahr 2018 mehr als 7500 Patienten stationar versorgt, und im Rahmen der Versorgung uber § 116b (zukunftig ASV [ambulante spezialfacharztliche Versorgung]) gab es nahezu 25.000 ambulante Patientenkontakte. Daruber hinaus wurde vor 5 Jahren ein Fruhsichtungsprogramm (Triage) etabliert, um Patienten mit muskuloskeletalen Beschwerden und potenziell entzundlich rheumatischer Grundlage im Sinne einer Fruhdiagnose und -therapie gemas dem Treat-to-target-Konzept innerhalb von weniger als 4 Wochen (zunachst) ambulant hinsichtlich der erforderlichen Dringlichkeit sichten zu konnen, um sie anschliesend einer fundierten Diagnosesicherung zuzufuhren. Diese Frist konnte in den letzten beiden Jahren 2017 und 2018 in mehr als 90 % der Falle realisiert werden. Im Rahmen der stationaren Versorgung wurden in den letzten Jahren etwa ein Drittel der Patienten im Rahmen einer rheumatologischen Komplextherapie und ca. 10 % mit einer Schmerzkomplextherapie behandelt, etwa 3 % werden mit einer geriatrischen Komplextherapie versorgt, und ca. 65 % waren Kurzlieger (
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- 2019
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7. Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study
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Juergen Braun, S. Tsiami, D. Kiefer, Uta Kiltz, B. Buehring, Xenofon Baraliakos, I. Andreica, and Aylin Celik
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medicine.medical_specialty ,Cross-sectional study ,Immunology ,Infections ,Measles ,Rheumatology ,Internal medicine ,Rheumatic Diseases ,medicine ,Immunology and Allergy ,Humans ,Hepatitis B Vaccines ,Latent tuberculosis ,business.industry ,Vaccination ,Lamivudine ,Hepatitis B ,medicine.disease ,Cross-Sectional Studies ,arthritis ,inflammation ,Cohort ,Medicine ,business ,Cohort study ,medicine.drug - Abstract
ObjectiveTo evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD).MethodsConsecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0–26) categorising patients into four immunisation states: low (0–6), moderate (7–13), good (14–20), high (21–26).ResultsAll patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score.ConclusionsThe majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result.
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- 2021
8. Comment on ‘Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 global rheumatology alliance physician-reported registry’ by Gianfrancesco M et al
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D. Kiefer, Juergen Braun, I. Andreica, Uta Kiltz, B. Buehring, Robert Jast, Xenofon Baraliakos, and Guenther A. Rezniczek
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030203 arthritis & rheumatology ,0301 basic medicine ,medicine.medical_specialty ,Systemic lupus erythematosus ,Anti-nuclear antibody ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Immunology ,Rheumatic disease ,medicine.disease ,Rheumatology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,Psoriatic arthritis ,030104 developmental biology ,0302 clinical medicine ,Internal medicine ,Rheumatoid arthritis ,medicine ,Rheumatoid factor ,Immunology and Allergy ,business - Abstract
We read with interest the publication on COVID-19 outcomes related to hospitalisation of people with chronic inflammatory rheumatic diseases (CIRD) by Gianfrancesco et al .1 In our centre, we have taken a different approach by contacting 1495 patients with CIRD by telephone to ask for COVID-19 tests and symptoms. A total of 917 patients who agreed to participate (61%) was interviewed between 15 April and 15 June 2020: about 60% women, mean age 54, mean disease duration 12 years. Most had spondyloarthritis (SpA) including psoriatic arthritis (51%), 41% rheumatoid arthritis (RA) and 7% connective tissue diseases (CTD), mainly lupus. In RA, rheumatoid factor was found in 88%, anti-citrullinated protein antibodies (ACPA) in 77% and human leukocyte antigen (HLA) B27 in 73% of patients with axSpA, while 92% with CTD had antinuclear antibodies. Less than half of patients were vaccinated against pneumococci (43%) and influenca (47%). The German government started a national shutdown on 22 March 2020. To give some guidance to rheumatologists, the German Society of Rheumatology (DGRh) released recommendations on 29 April 2020.2 Our survey started about 2 weeks earlier. The care of our patients with CIRD is largely based on the ‘treat to …
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- 2020
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9. AB1400 ARE COMORBIDITIES IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES ASSOCIATED WITH TREATMENT NON-ADHERENCE TO BIOSIMILARS IN A NON-MEDICAL SWITCH SCENARIO?
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I. Redeker, S. Moustakis, S. Tsiami, X. Baraliakos, I. Andreica, B. Buehring, J. Braun, and U. Kiltz
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Rheumatology ,Immunology ,Immunology and Allergy ,General Biochemistry, Genetics and Molecular Biology - Abstract
BackgroundThe availability of biosimilars has created a financial incentive to encourage non-medical switching if cheaper products are on the market. In patients with chronic inflammatory rheumatic diseases (CIRD), we have previously reported a relatively high retention rate after switching from originator etanercept to its biosimilar. However, this has been different in other studies and the reasons for non-adherence are poorly understood. Comorbidity has recently gained much attention in patients with CIRD and might be a reason for non-adherence.ObjectivesThe aim of this study was to analyse the effectiveness and safety of systematic non-medical switching from originator adalimumab (ADA) to ADA ABP501 biosimilar (ABP) over 6 months in patients with CIRD and to investigate the influence of comorbidities on retention rates.MethodsPatients with CIRD on originator ADA who switched to ABP subsequently from October 2018 onwards were identified from a large routine database and then followed for 6 months. The presence of comorbidities and disease characteristics as well as measures of disease activity, physical function and changes in treatment were documented at baseline (the time of switching from originator ADA to ABP), and at months 3 and 6. Longitudinal data including information on the clinical efficacy and safety of ABP, and the reasons for discontinuation were documented.ResultsA total of 111 CIRD patients on treatment with originator ADA were switched to the biosimilar ABP (Table 1). More than half of the patients (62%) had a Charlson comorbidity score of 0, though there were differences between disease subtypes. RA patients were comparatively older (mean age 65 years) and had the highest mean Charlson score (1.8). Treatment retention varied only slightly between patients with a Charlson score of 0 and those with ≥0 (Figure 1). In both groups, the majority of patients (90% vs 95%) continued therapy with ABP, while only a small proportion either switched back to originator ADA (6% vs 5%), switched to a different biologic (3% vs 0%), or dropped out (1% vs 0%). The main reason for back switch was the occurrence of adverse events, mostly subjective complaints, most frequently pain. Patients with a Charlson comorbidity score > 0 tended to have poorer scores in trajectories of scores for disease activity and physical function stratified by disease subtype.Figure 1.Treatment retention after 6 months stratified by the Charlson comorbidity scoreTable 1.Patients and disease characteristicsRAaxSpAPsAOtherN=23N=68N=15N=5Age (years), mean (SD)65.1 (12.0)47.3 (13.1)51.1 (11.2)41.8 (14.2)Women60.9% (14)32.4% (22)53.3% (8)40.0% (2)Disease duration (years), median (IQR)4.0 (3.0-8.0)5.0 (2.0-8.0)4.0 (2.0-13.0)7.0 (4.0-7.0)Duration originator ADA therapy (month), mean (SD)43.8 (28.6)39.4 (26.9)34.7 (29.0)60.9 (27.7)Charlson score, mean (SD)1.8 (2.1)0.6 (1.1)0.7 (1.2)0.2 (0.4)Gastroenterological comorbidities26.1% (6)22.1% (15)6.7% (1)0Hepatic comorbidities17.4% (4)2.9% (2)13.3% (2)0Hematological conditions8.7% (2)2.9% (2)13.3% (2)0Cardiovascular comorbidities60.9% (14)32.4% (22)33.3% (5)60.0% (3)Neurological and psychological comorbidities8.7% (2)17.6% (12)33.3% (5)0Metabolic comorbidities21.7% (5)7.4% (5)26.7% (4)40.0% (2)Osteoporosis43.5% (10)11.9% (8)6.7% (1)20.0% (1)Lung diseases21.7% (5)8.8% (6)040.0% (2)Skin diseases26.1% (6)26.5% (18)80.0% (12)20.0% (1)Eye diseases8.7% (2)23.5% (16)6.7% (1)60.0% (3)Kidney diseases13.0% (3)10.3% (7)040.0% (2)ConclusionComorbidity had no influence on the biosimilar retention rate after 6 months in this study but the majority of patients did not have Charlson scores > 0. However, disease activity and physical function tended to be worse among CIRD patients with comorbidity. Cardiovascular disease and osteoporosis were more often present in RA patients than in axSpA or PsA patients, while neurological and psychological comorbidities were more often observed in the latter.Disclosure of InterestsImke Redeker: None declared, Stefan Moustakis: None declared, Styliani Tsiami: None declared, Xenofon Baraliakos Speakers bureau: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Paid instructor for: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Consultant of: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Grant/research support from: Abbvie, Pfizer, MSD, UCB, Novartis, Lilly, Galapagos, Hexal, Ioana Andreica Speakers bureau: UCB, MSD, Novartis, Abbvie, Lilly, Janssen, SOBI, Consultant of: Lilly, Novartis, Galapagos, Amgen, Takkeda, SOBI, Grant/research support from: Lilly, Bjoern Buehring Speakers bureau: UCB, Amgen, Gilad/Galapagos, Biogen, Sanofi/Genzyme, Consultant of: UCB, Theramex, Gilead/Galapagos, Amgen, Abbvie, Juergen Braun Speakers bureau: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Consultant of: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Grant/research support from: Abbvie, Amgen, Biogen, BMS, Boehringer, Celltrion, Chugai, Fresenius, Hexal, Janssen, Lilly, Medac, MSD, Mylan, Mundipharma, Novartis, Pfizer und UCB, Uta Kiltz Speakers bureau: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Consultant of: AbbVie, Biocad, Biogen, Chugai, Eli Lilly, Fresenius, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, UCB, Grant/research support from: AbbVie, Amgen, Biogen, Fresenius, GSK, Hexal, Novartis, Pfizer.
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- 2022
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10. Differenzialdiagnose axiale Spondyloarthritis – 'axSpA mimics'
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J. Braun, Uta Kiltz, M. Fruth, B. Buehring, and X. Baraliakos
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030203 arthritis & rheumatology ,Gynecology ,medicine.medical_specialty ,Ankylosing spondylitis ,business.industry ,Sacroiliitis ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,medicine ,030212 general & internal medicine ,Axial spondyloarthritis ,Differential diagnosis ,business - Abstract
Die Klassifikation axiale Spondyloarthritis (axSpA) umfasst die klassische Spondylitis ankylosans (AS), die durch bereits bestehende Strukturveranderungen in den Sakroiliakalgelenken charakterisiert ist, und die sog. nicht-rontgenologische axSpA (nr-axSpA), bei der solche Veranderungen definitionsgemas nicht vorhanden sind. Die Grundlage dieser Unterscheidung sind die ASAS(Assessment of SpondyloArthritis international Society)-Klassifikationskriterien fur axSpA, die fur die Diagnosestellung aber nicht geeignet sind. Der heute gangigen Einteilung zufolge umfassen die Spondyloarthritiden (SpA) die axiale SpA, die mit Psoriasis, Morbus Crohn und Colitis ulcerosa assoziiert sein kann, und die periphere SpA, die sich weiter unterteilt in die SpA bei Psoriasis, partiell synonym Psoriasisarthritis (PsA), die reaktive SpA, partiell synonym reaktive Arthritis (ReA), und die SpA bei chronisch entzundlichen Darmerkrankungen (CED), partiell synonym mit Arthritiden, die mit chronisch entzundlichen Darmerkrankungen assoziiert sind (wie Morbus Crohn, Colitis ulcerosa), und die periphere undifferenzierte SpA, bei der definitionsgemas keine der oben aufgefuhrten Assoziationen vorliegt. In der vorliegenden Arbeit werden nur die wichtigsten Differenzialdiagnosen behandelt – d. h. die diffuse idiopathische skeletale Hyperostose (DISH), Frakturen und Infektionen im Achsenskelett. Daruber hinaus geht es um die Haufigkeit von bestimmten muskuloskeletalen Befunden in der mit Magnetresonanztomographie (MRT) untersuchten Normalbevolkerung.
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- 2018
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11. Älter werden mit axialer Spondyloarthritis
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J. Braun, X. Baraliakos, Uta Kiltz, and B. Buehring
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030203 arthritis & rheumatology ,Gynecology ,03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Rheumatology ,business.industry ,Medicine ,030212 general & internal medicine ,Axial spondyloarthritis ,business - Abstract
Die physiologischen Altersveranderungen wie Verlust von Muskelmasse und -funktion, Reduzierung von Organfunktionen und degenerative Gelenkveranderungen treffen bei Patienten mit ankylosierender Spondylitis (AS) auf krankheitsspezifische Veranderungen, die altere AS-Patienten vulnerabel fur andere Erkrankungen machen. Verschiedene Prozesse fuhren bei solchen Patienten zu einer reduzierten korperlichen Funktionsfahigkeit, zu einer veranderten Korperhaltung, zu verminderter Knochendichte und Sarkopenie, was zu vermehrter Fallneigung und Wirbelkorperfrakturen fuhren kann. Die Mortalitat ist bei Patienten mit AS v. a. bei Mannern insbesondere aufgrund der erhohten kardiovaskularen Mortalitat erhoht. Die standardisierte Erfassung kardiovaskularer Risikofaktoren bei Patienten mit entzundlich rheumatischen Erkrankungen wird zwar seit Jahren empfohlen (unabhangig vom Alter der Patienten), dies wird jedoch kaum umgesetzt. Insgesamt liegen hinsichtlich Komorbiditaten und Risikofaktoren fast ausschlieslich Untersuchungen bei AS-Patienten und nicht anderen Spondyloarthritiden vor.
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- 2018
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12. [Biosimilars and the nocebo effect]
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J, Braun, S, Tsiami, B, Buehring, D, Kiefer, I, Andreica, X, Baraliakos, and U, Kiltz
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Treatment Outcome ,Germany ,Rheumatic Diseases ,Humans ,Nocebo Effect ,Placebo Effect ,Biosimilar Pharmaceuticals - Abstract
Biosimilars have been approved for use in Germany for many years and in the meantime also in rheumatology but only a few years ago. Biosimilars, which are biotechnologically manufactured products the same as reference biologicals, have actually now achieved a substantial proportion of the market in some regions but there are still doubters among patients and physicians who fear a loss of quality even if there is no evidence for this. A part of this problem can be explained by the nocebo effect but which furthermore also has a substantial medical importance. This effect is described and explained in this article. Psychosocial and context-related factors, such as the relationship between patient and physician, previous experience with treatment and treatment expectations can either improve or impair the efficacy of treatment interventions. These phenomena are commonly known as placebo and nocebo effects. As placebo and nocebo effects can influence the development of symptoms, the frequency of undesired events and the efficacy of treatment, it is decisive to know these effects and to develop strategies for prevention in order to optimize the treatment results. Although in recent years experimental studies have achieved substantial progress in the clarification of the psychosocial and neurobiological mechanisms of placebo effects, detailed mechanisms of nocebo effects are still widely unexplored. An improved understanding of these mechanisms promises the development of user-friendly strategies for the clinical care to improve treatment results and patient satisfaction.
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- 2019
13. [Rheumatological care in the Rheumazentrum Ruhrgebiet Rheumatism Center-a model for conurbations]
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J, Braun, U, Kiltz, I, Andreica, B, Buehring, B, Guminski, U, Häusler, H, Kavruk, D, Kiefer, R, Lochowski, B, Mintrop, and X, Baraliakos
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Early Diagnosis ,Quality Assurance, Health Care ,Rheumatology ,Germany ,Rheumatic Diseases ,Humans ,Rheumatologists - Abstract
The Ruhrgebiet Rheumatism Center, which is highly specialized for rheumatic diseases, is the largest of its kind in Germany. For many years it has fulfilled all the requirements for structural quality required by the Association of Rheumatological Acute Clinics (VRA) including regular participation in the KOBRA benchmarking project. Therefore, the center regularly receives the VRA seal for quality of care. In 2018 more than 7500 patients were treated as inpatients. Within the framework of care according to §116b (ASV since May 2019) there were nearly 25,000 outpatient patient contacts. Furthermore, an early screening program (triage) was established 5 years ago in order to be able to identify patients with musculoskeletal complaints on a potentially inflammatory rheumatic basis. This functions in the sense of an early diagnosis and treatment in accordance with the treat-to-target concept within less than 4 weeks (initially) on an outpatient basis with respect to the required urgency, in order to subsequently provide sound diagnostic support. In the last 2 years 2017 and 2018, this deadline was met in more than 90% of cases. Within the scope of inpatient care approximately one third of patients were treated in recent years with a defined rheumatological complex therapy and 10% with pain complex therapy. Approximately 3% were treated with geriatric complex therapy and 65% were short-stay patients (4 days), i.e. patients who received the necessary diagnostics and treatment on an inpatient basis at short notice. The overall structure of the rheumatism center, the cooperation with rheumatologists in private practice, many cooperation partners, referring physicians and patients represents a model for rheumatological care in large conurbations. The care of large numbers of patients also enables the further training of many assistants and this is essential for the future of good rheumatological medicine.
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- 2019
14. POS0973 CONTEXTUAL FACTORS SHOULD COMPLETE THE ASSESSMENT OF FUNCTIONING IN PATIENTS WITH AXIAL SPONDYLOARTHRITIS (axSpA)
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J. Braun, Uta Kiltz, J. D. Leicht, D. Kiefer, X. Baraliakos, Eerik Ahomaa, and B. Buehring
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medicine.medical_specialty ,Rheumatology ,business.industry ,Immunology ,Physical therapy ,medicine ,Immunology and Allergy ,In patient ,Axial spondyloarthritis ,business ,General Biochemistry, Genetics and Molecular Biology - Abstract
Background:Functioning of patients (pts.) with axial spondyloarthritis (axSpA) is influenced by a variety of factors. In contrast to clinical factors, the influence of contextual factors on functioning has not been well studied. According to the According to the International Classification of Functioning, Disability and Health (ICF), functioning is a complex interaction between health status and contextual factors such as social support, relationships and attitudes.Objectives:The aim of this study is to understand limitations in participation and to investigate barriers and facilitators of contextual factors in pts. with axSpA.Methods:Consecutive axSpA pts. underwent a standardized assessment with collection of patient and disease characteristics, patient-reported outcomes (ASDAS, BASFI, BASMI, PHQ-9, ICF Measure of Participation and ACTivities questionnaire (IMPACT-S (0-100%)), ASAS Health Index (ASAS HI and environment factor item set (EFIS) (1). The EFIS contains 9 dichotomous questions addressing ICF categories of products and technologies (e1), support and relationship (e3), attitudes (e4) and health services (e5). Validated cut-offs of ASAS HI were used to categorize global functioning.Results:A total of 200 axSpA pts. were included: 69% males, 44.3±12.5 years, symptom duration 17.9±12.6 years, ASDAS 2.5±1.1, BASFI 4.0±2.7, BASMI 3.5±1.8, ASAS HI 7.0±4.1. Pts. reported limitations in the IMPACT-S activity and participation domain (82.3% (15.2) and 83.5% (16.8), respectively. The majority of pts. reported as barrier that treatment of axSpA requires time (e4, 58.5%). A minority of pts. but quite a few reported as barrier the need for support by family members (e3, 43.5%), the need to modify home and work environment (e1, 39.5%) and that they cannot rely on family members for help (e3, 22%). Some pts. (< 20%) reported that they have problems to be understood by health care professionals when experiencing a flare (e5, 18.5%), that pts. at home are not adequately taken care of (e4, 18.5%), disliking friends’ behavior toward them (e4, 13.5%), and that friends are too demanding (e4, 13%). The majority of pts. (e4, 75.9%) identified attitudes of friends as the only and major facilitator. All pts. reporting at least one barrier had significantly worse global functioning (ASAS HI, IMPACT-S), and depression (PHQ-9) compared to patients who reported no barriers in the respective ICF categories (p< 0.01). Similarly, pts. with poor functioning are more likely to report barriers in contextual factors compared to pts. with good functioning (Table 1). Pts. having to ask for more support from their families expressed the feeling that they cannot rely on that.Conclusion:Barriers more than facilitators of contextual factors are present in pts. with axSpA. This study shows that barriers in contextual factors are more common in pts. with impairments in self-reported and performed functioning as in those without impairments. This underlines the importance of contextual factors in the management of axSpA pts.References:[1]Kiltz et al. Ann Rheum Dis 2013;72(s3):572Table 1.Presence of contextual factors, stratified for global functioning categoriesICF categoryEFIS ItemGlobal Functioning (ASAS HI 0-17)Good ≤ 5(n= 69)Moderate (n= 106Poor ≥ 12(n= 25)e3EFIS 1: As a result of my rheumatic disease, the children take more responsibility for household tasks.11 (15.9)55 (51.9)21 (84)e3EFIS 2: I don’t like the way my friends acts around me.0 (0)15 (14,2)12 (48,0)e3EFIS 3: I can’t count on my relatives to help me with my problems11 (15,9)24 (22,6)9 (36)e1EFIS 4: I modify my home and work environments.16 (23,2)47 (44,3)9 (36)e5EFIS 5: I have difficulties getting worsening of my disease acknowledged by a health care professional3 (4,3)21 (19,8)16 (64)e5EFIS 6: Treatment of my rheumatic disease is taking up time22 (31,9)73 (68,9)22 (88)e4,EFIS 7: My friends expect too much of1 (1,4)18 (17,0)7 (28)e4EFIS 8: No one pays much attention to me at home10 (14,5)20 (18,9)7 (28)e4EFIS 9: My friends understand me56 (17,4)83 (78,3)12 (48)values given as number (%)Disclosure of Interests:None declared.
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15. AB0823 TREATMENT WITH ADALIMUMAB IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASES: A STUDY OF TREATMENT TRAJECTORIES ON A PATIENT LEVEL IN CLINICAL PRACTICE
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Imke Redeker, Uta Kiltz, S. Moustakis, S. Tsiami, Xenofon Baraliakos, B. Buehring, I. Andreica, and J. Braun
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medicine.medical_specialty ,business.industry ,Immunology ,Biosimilar ,Disease ,General Biochemistry, Genetics and Molecular Biology ,Clinical Practice ,Rheumatology ,Drop out ,Internal medicine ,medicine ,Adalimumab ,Immunology and Allergy ,In patient ,Adverse effect ,BASFI ,business ,medicine.drug - Abstract
Background:There is evidence that drug retention rates to adalimumab (ADA) in patients (pts.) with chronic inflammatory rheumatic diseases (CIRD) are impaired by loss of efficacy and adverse events, and that about 50% of users had discontinued ADA within 5 years (1). With the introduction of ADA biosimilars in October 2018, non-medical switching from originator to ADA biosimilars is now increasingly part of daily practice in rheumatologic care.Objectives:The aim was to study treatment trajectories over two years in pts. with CIRD receiving originator ADA.Methods:Pts. with CIRD on originator ADA who switched to ADA biosimilar from October 2018 onwards were identified and followed until 2020. Disease activity (ASDAS), physical function (HAQ, BASFI), and changes in treatment were documented every 3 months. The four predefined treatment trajectories “continued ADA biosimilar therapy”, “back-switch to originator ADA therapy”, “switch to other biological (b) disease modifying anti-rheumatic drug (DMARD) therapy”, and “stopped bDMARD therapy /death /drop out” were used to compare characteristics of pts. with different trajectories.Results:A total of 111 CIRD pts. on treatment with originator ADA were switched to ADA biosimilar (Table 1). The majority of pts. 75 continued therapy with ADA biosimilar (Figure 1 next page) while 16% switched back to originator ADA, 7% switched to a different bDMARD, and 9% either stopped treatment (n=9) or died (n=1). Pts. who continued ADA biosimilar were more frequently male, older or with a longer disease duration than those who switched therapy back to originator ADA and those who switched to a different bDMARD (Table 1). The previous duration on originator ADA treatment was increased in patients who continued ADA biosimilar compared to those who switched therapy back to originator ADA and those who switched to a different bDMARD. There was more functional impairment (HAQ, BASFI) and higher disease activity (ASDAS) in pts. who switched compared to those who continued ADA biosimilar therapy (Table 1). Treatment with csDMARDs and glucocorticoids was increased in pts. who continued ADA biosimilar therapy, while pts. who switched therapy had more previous bDMARD therapies (Table 1).Table 1.Characteristics of patients at baseline for the entire group and stratified by treatment trajectoryTotal groupN=111 (100%)Treatment trajectorycontinued ADA biosimilar therapyN=75 (67.6%)back-switch to originator ADA therapyN=18 (16.2%)switch to different bDMARD therapyN=8 (7.2%)no bDMARD therapy /death /drop outN=10 (9.0%)Age, y51.2 (14.5)51.5 (13.6)50.6 (16.8)43.5 (9.5)56.4 (19.0)Women, No. (%)46 (41.4)27 (36.0)9 (50.0)6 (75.0)4 (40.0)RA23 (20.7)17 (22.7)2 (11.1)1 (12.5)3 (30.0)axSpA68 (61.3)47 (62.7)11 (61.1)6 (75.0)4 (40.0)PsA15 (13.5)7 (9.3)4 (22.2)1 (12.5)3 (30.0)Other diagnoses5 (4.5)4 (5.3)1 (5.6)0 (0.0)0 (0.0)Disease duration, median (IQR), y5.0 (2.0-8.0)5.0 (2.0-9.0)3.5 (2.0-6.0)2.0 (1.0-5.5)4.5 (2.0-8.0)Duration previous originator ADA therapy40.7 (27.7)45.3 (27.8)35.0 (25.2)20.3 (24.7)32.3 (25.1)DAS283.0 (1.0)2.9 (1.0)3.4 (1.0)-3.3 (1.2)CRP, median (IQR), mg/L0.2 (0.1-0.3)0.1 (0.1-0.2)0.2 (0.0-0.5)0.2 (0.2-1.3)0.3 (0.2-0.4)HAQ score1.3 (0.8)1.1 (0.7)1.7 (0.8)-1.8 (1.0)ASDAS2.2 (1.1)2.0 (1.0)3.0 (1.2)2.7 (0.9)2.3 (0.2)BASFI3.5 (2.6)3.0 (2.5)5.4 (2.4)3.4 (1.6)5.4 (1.6)+values are given as mean (SD)Conclusion:Two thirds of pts. who switched to ADA biosimilar remained on this therapy for 2 years. As many as 16% of pts. switched back to ADA originator. Whether or to what degree this was influenced by nocebo effects needs further study. The same is true for the effect of functional impairment – it would be interesting to know whether this was due to inflammation or structural damage.References:[1]Neovius M et al. Ann Rheum Dis 2015; 74:354-360[2]The study was funded by Hexal Germany.Figure 1.Treatment trajectories of ADA therapy in patients with CIRD during two years ADA: adalimumab; bDMARD: biological disease modifying anti-rheumatic drug.Disclosure of Interests:None declared
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- 2021
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16. AB0684 LESS THAN 20% OF PATIENTS WITH A CHRONIC INFLAMMATORY RHEUMATIC DISEASE CHANGED THEIR IMMUNOSUPPRESSIVE MEDICATION BECAUSE OF THE COVID 19 PANDEMIC
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D. Kiefer, J. Braun, R. Jast, Xenofon Baraliakos, Guenther A. Rezniczek, I. Andreica, Uta Kiltz, and B. Buehring
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medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Immunology ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Psoriatic arthritis ,Rheumatology ,Internal medicine ,Rheumatoid arthritis ,Pandemic ,medicine ,Immunology and Allergy ,Anxiety ,Methotrexate ,medicine.symptom ,business ,BASDAI ,Depression (differential diagnoses) ,medicine.drug - Abstract
Background:The best treatment options of patients with chronic inflammatory rheumatic diseases (CIRD) in the pandemic have not been completely clear, especially in the beginning of the lockdown. Whether and to which degree pandemic-related therapy changes have occurred, has not been studied in detail.Objectives:To study the behaviour of patients with CIRD initially facing the COVID 19 pandemic related to their disease status and medication.Methods:Patients with CIRD were contacted by telephone to assess their health status and ask for changes in medication. Standardized assessment tools were used to assess disease activity, depression and anxiety. High disease activity was assumed if RADAI-5 ≥ 3.2 and BASDAI ≥ 4. Anxiety (HADS-A) and depression (HADS-D) of patients were assessed using HADS. A score < 8 was taken as indication of no major problem in this regard.Results:A total of 886 patients was interviewed between April 15 and June 15 of 2020. Here we report on 550 patients with complete information on standard assessments (62%). About 60% were female, mean age 54.4±13.7, mean disease duration 12.2±10.5 years. Most had spondyloarthritis (SpA, n=287) including axial SpA (axSpA, n=172) and psoriatic arthritis (PsA, n=116), in total 52.2%, while 40.2% had rheumatoid arthritis (RA, n=221), and 7.6% connective tissue diseases (CTD, n=42). Most RA patients were on methotrexate (48.8%), while 43.8% took glucocorticoids. In addition, 61.0% of patients were on bDMARDs, mostly on TNF inhibitors (59.6%). More SpA than RA patients were on bDMARDs: 71.0% vs 49.7% respectively. A recent change in medication was reported by 182 patients (33.1%): 89 with RA (40.2%), 88 with SpA (30.6%) and 5 with CTD (11.9%). Half of those who changed (n=92; 50.5%) admitted that the change was mainly made due to fear of the pandemic (16.7% of all patients). Altogether, significantly more patients changed bDMARDs (68.5%) than csDMARDs (57.3%). The data of patients who changed vs patients who didn’t change is shown in the Table 1, including subgroup analyses. The median HADS scores were < 8.Table 1.RA and SpA patients who changed and who did not change their medicationGroup (N) / ReasonNActive disease (%)HADS-D≥ 8 (%)HADS-A≥ 8 (%)bDMARD therapy (%)Rheumatoid arthritis221134 (60.6)76 (35.0) [4]94 (43.3) [4]110 (50.9) [5]Spondyloarthritis287130 (45.4)83 (29.5) [6]109 (38.8) [6]204 (72.6) [6] Pa (RA vs SpA)0.2280.354Patients did not change their medication Rheumatoid arthritis (%)132 (59.7)84 (63.6)46 (35.9) [4]58 (45.3) [4]62 (48.4) [4] Spondyloarthritis (%)199 (69.3)88 (44.2)58 (30.1) [6]69 (35.8) [6]137 (71.0) [6] P (RA vs SpA)0.0310.3580.101Patients changed their medication Rheumatoid arthritis89 (40.3)50 (56.2)30 (33.7)36 (40.4)48 (54.5) [1] P (vs no change)0.3310.8460.5670.457 Reason[9] Pandemic41 (51.3)15 (36.6)11 (26.8)14 (34.1)24 (60.0) [1] Inactive disease23 (28.8)12 (52.2)6 (26.1)10 (43.5)12 (52.2) Active disease b16 (20.0)14 (87.5)6 (37.5)7 (43.8)7 (43.8) P (reasons)0.0030.6870.6870.526 Spondyloarthritis88 (30.7)42 (47.7)25 (28.4)40 (45.5)67 (76.1) P (vs no change)0.6730.8890.1570.451 Reason[6] Pandemic50 (61.0)22 (44.0)13 (26.0)22 (44.0)42 (84.0) Inactive disease15 (18.3) 7 (46.7)4 (26.7)7 (46.7)10 (66.7) Active disease b17 (20.7)11 (64.7)6 (35.3)6 (35.3)11 (64.7) P (reasons)0.3310.7560.7740.156 P (RA vs SpA)0.0310.2940.9500.6030.004Data are presented as numbers (percentage proportions; across rows except for column N) or medians (interquartile ranges). Missing values are in square brackets.a P values calculated using χ2 test or Mann-Whitney rank sum test.b Self-reported claim of disease activity.Conclusion:Two thirds of patients did not change medication but one third changed. A relatively high number of patients did so due to fear of the pandemic, mostly those on biologics. There were no major differences between RA and SpA. Anxiety and depression do not seem to play an important role for the decision to change medication (Table 1 below).Disclosure of Interests:None declared
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17. AB1245 DAILY MANAGEMENT OF PATIENTS WITH AXIAL SPONDYLOARTHRITIS: SELF-MONITORING OF DISEASE ACTIVITY WITH A SMARTPHONE APP IS FEASIBLE – A PROOF OF CONCEPT STUDY
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B. Buehring, D. Kiefer, S. Tsiami, R. Kempin, Xenofon Baraliakos, Uta Kiltz, J. Braun, and A. Schlegel
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medicine.medical_specialty ,business.industry ,Immunology ,Economic shortage ,Schering-Plough ,General Biochemistry, Genetics and Molecular Biology ,Disease activity ,Rheumatology ,Family medicine ,Smartphone app ,Immunology and Allergy ,Medicine ,Ready to use ,Axial spondyloarthritis ,business ,BASDAI ,Daily routine - Abstract
Background:Assessment and monitoring of disease activity and functioning is of major importance for the course of axial spondyloarthritis (axSpA). This is equally important for patient monitoring in daily routine as also for tight control strategies. Even though there is evidence that a closer monitoring of patients is better than routine care, more intensive treatment schedules are often not realized in daily practice for several reasons including shortage of time and personal resources. Using application software devices (apps) in clinical routine for the recording of disease-specific patient reported outcomes (PRO) may facilitate monitoring and improve clinical decision processes but there is a lack of data on the use of apps.Objectives:To investigate the use of such App technology in respect to usability, feasibility and equivalence of data in daily care of patients with axSpA. In more detail, it will be first determined how many patients are capable and ready to use the technology in a routine setting. Furthermore, the usage and behavior of patients using the app will be studied, the usability of the app and the equivalence of the collected parameters as well as the adherence to the documentation of disease activity over time.Methods:Patients diagnosed with axSpA were consecutively included in this ongoing monocentric prospective cohort study. In addition to patient and disease characteristics, information on previous experience with digital health apps was collected. Patients were asked to submit BASDAI and BASFI scores regularly every 2 weeks. The free to use AxSpA Live App is available for Android and iOS as a Class I certified medical device.Results:Out of 103 axSpA patients asked, 69 patients with axSpA (mean age 41.5 ± 11.3, 58% male, 76.8% use of bDMARDs, BASDAI 4.3 ± 2.0, BASFI 3.8 ± 2.5) out of 103 patients (67%) agreed to use participate, while 5 did not have a smartphone, 1 was unable to download the app for technical reasons, 28 reported other personal reasons). Of the 69, 62 patients (89.9%) reported using electronic media frequently and had used digital health apps (mean apps used 1.0 ± 1.3) in everyday life before. There were no systematic differences between pain levels documented on paper or by app at baseline (ICC 0.9 (95%CI 0.82 – 0.93). Out of 55 patients who completed week 2, only 33 patients (60%) used the App regularly to transmit their BASDAI/BASFI responses within the first two weeks (60%). Patients who started a new drug treatment because of high disease activity, reported BASDAI values more often than patients without a treatment change within a follow-up period of 5.5± 2.4 weeks (Table).Conclusion:The majority of patients with axSpA were able to use the AxSpA Live App. Most patients report scores regularly. The current disease activity seems to influence the adherence to reporting.Patients without change in their medication (n=53)Patients with change in their medication (n=16)Age, years42.0 (11.9)39.8 (9.3)Sex, male (%)62.343.8BASDAI, baseline4.1 (2.1)4.9 (1.7)BASFI, baseline3.8 (2.6)3.8 (2.3)Time of follow-up, in weeks5.4 (2.4)5.6 (2.5)Number of transmitted BASDAI values at week 222 (41%)11 (69%)Median number of transmitted BASDAI values during follow up1.0(3.6)1.5 (1.4)This work was supported by an unrestricted Grant by Novartis Pharma GmbH, GermanyAcknowledgments:n/aDisclosure of Interests:Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Robin Kempin: None declared, Anna Schlegel: None declared, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Styliani Tsiami: None declared, Bjoern Buehring Grant/research support from: GE/Lunar, Kinemed, Consultant of: Gilead, Abbvie, Lilly, GE/Lunar, Janssen, Amgen, Speakers bureau: UCB, David Kiefer Grant/research support from: Novartis, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma
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18. SAT0579 SYSTEMATIC GERIATRIC ASSESSMENT IN OLDER PATIENTS WITH RHEUMATIC DISEASES - THE RheuMAGIC PILOT STUDY
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D. Kiefer, I. Andreica, S. Tsiami, Uta Kiltz, J. Braun, A. Berrisch, B. Buehring, and Xenofon Baraliakos
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Ankylosing spondylitis ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Inflammatory arthritis ,Immunology ,Population ,Overweight ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Psoriatic arthritis ,Rheumatology ,Internal medicine ,Diabetes mellitus ,Rheumatoid arthritis ,medicine ,Immunology and Allergy ,medicine.symptom ,education ,business ,Dyslipidemia - Abstract
Background:Current demographic data predict that the number of older adults with rheumatic diseases will considerably increase in the coming years. Geriatric patients differ from younger adults in many ways including their clinical presentation, co-morbidities and response to medication. The management of such patients is often challenging due to the presence of multi-morbidity, polypharmacy and geriatric syndromes (i.e. conditions in which symptoms result from impairments in multiple systems rather than a discrete disease). To systematically assess geriatric patients, specific tools have been developed; however, they are not routinely utilized by rheumatologists. Using these tools could improve patient management and satisfaction in rheumatologic care.Objectives:To examine the prevalence of 17 common geriatric health problems using validated geriatric assessment tools in older patients with rheumatic and musculoskeletal diseases.Methods:Adults 65 years and older who presented to a tertiary rheumatologic hospital were included after informed consent. All patients recruited were assessed using theMAngableGeriatrICAssessment (MAGIC) which addresses 14 common geriatric health problems. In addition, polypharmacy (≥ 5 medication), muscle function using the Short Physical Performance Battery and frailty applying the Fried definition were assessed. Disability was quantified with the “Funktionsfragebogen Hannover” (FFbH), a validated tool for patients with rheumatologic diseases that can be easily converted to Health Assessment Questionnaire (HAQ) scores. Primary outcome was the frequency of the selected 17 geriatric health problems; the correlation of the total number of problems with HAQ scores was a secondary outcome.Results:Of the 300 individuals included 67% were female with a mean age of 73±6.6 years; 85% (> 50% with rheumatoid arthritis) had a rheumatologic diagnosis. The remaining participants had either a chronic pain syndrome or degenerative joint/spine disease. On average participants had 7 out of 17 assessed geriatric problems. Females had more such problems than males (8 vs. 6, p2= 0.44, pConclusion:A systematic geriatric assessment can be successfully used to discover and quantify geriatric health problems in older patients with rheumatic and musculoskeletal diseases. These problems appear to be very common and importantly, patients with more problems had poorer functional status. Frailty, depression, incomplete vaccination status, cognitive impairment or polypharmacy are all known to negatively impact patient care. Recognizing and addressing geriatric problems has the potential to lead to health care improvements including adherence and medication side effects and might increase patient satisfaction and functional status independent of disease activity.References:[1]Buehring, B. and S. Barczi, Assessing the Aging Patient, in Spine Surgery in an Aging Population, N. Brooks and A. Strayer, Editors. 2019, Thieme: New York. p. 208.[2]Cleutjens F, Boonen A, van Onna MGB. Geriatric syndromes in patients with rheumatoid arthritis: a literature overview. Clin Exp Rheumatol 2019;37(3):496-501Geriatric Problem% presentProblems with Daily Activities67Problems with Vision28Problems with Hearing38Problems with Falls11Problems with Urinary Incontinence38Problems with Depression57Lack of Social Support10Incomplete Vaccinations53Problems with Cognition31Problems with Chronic Pain90Problems with Dizziness44Problems with Mobility41Problems with Unintentional Weight Loss30Inappropriate Medications present17Polypharmacy present81Frailty present46Short Physical Performance Battery low57Acknowledgments:NoneDisclosure of Interests:Anna Berrisch: None declared, Ioana Andreica: None declared, Styliani Tsiami: None declared, David Kiefer Grant/research support from: Novartis, Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Xenofon Baraliakos Grant/research support from: Grant/research support from: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Consultant of: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Speakers bureau: AbbVie, BMS, Celgene, Chugai, Merck, Novartis, Pfizer, UCB and Werfen, Juergen Braun Grant/research support from: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Eli Lilly and Company, Medac, MSD (Schering Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi- Aventis, and UCB Pharma, Consultant of: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Speakers bureau: Abbvie (Abbott), Amgen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, EBEWE Pharma, Eli Lilly and Company, Medac, MSD (Schering-Plough), Mundipharma, Novartis, Pfizer (Wyeth), Roche, Sanofi-Aventis, and UCB Pharma, Bjoern Buehring Grant/research support from: GE/Lunar, Kinemed, Consultant of: Gilead, Abbvie, Lilly, GE/Lunar, Janssen, Amgen, Speakers bureau: UCB
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19. AB1203 Use of magnetic resonance imaging of the pelvis to describe inflammatory changes at different anatomic sites in the pelvis which are potentially specific findings in patients with polymyalgia rheumatica
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Martin Fruth, M. Franklin, J. Braun, B. Buehring, and X. Baraliakos
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musculoskeletal diseases ,medicine.medical_specialty ,Greater trochanter ,medicine.diagnostic_test ,business.industry ,Enthesitis ,Pubic symphysis ,Magnetic resonance imaging ,Pelvic girdle pain ,medicine.disease ,Polymyalgia rheumatica ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Erythrocyte sedimentation rate ,medicine ,030212 general & internal medicine ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Pelvis - Abstract
Background Pelvic girdle pain is a common clinical symptom of patients with polymyalgia rheumatica (PMR). It also occurs in patients with rheumatoid arthritis (RA). The origin of this characteristic pain is not really clear, even though some imaging findings have been reported. However, this has neither changed pathophysiologic thinking nor clinical practice related to diagnosis. Objectives To describe pelvic structures in PMR patients in detail which show signs of inflammation by magnetic resonance imaging (MRI) in order to find a disease specific pattern. Methods In a retrospective study we used MRIs of patients who had presented with clinical symptoms suggestive of PMR in our centre between 2015 and 2017. Only patients with complete MRI examinations, including contrast enhanced scans in coronal and transversal planes were included to be carefully examined by an experienced musculoskeletal radiologist (MF). After having first described all findings in much detail we developed a preliminary semiquantitative scoring system that assesses a total of 12 sites which appeared to be frequently involved. A total of 40 patients with pelvic girdle pain and complete data were identified from the hospital records. The median (25th/75th percentiles) age of the patients was 67 (55/73) years, the median symptom duration was 13 (6/22) weeks, 55% were female, the median C-reactive protein measured close to the day of the MRI examination was 1.9 (0.7/4) mg/dl, and the median erythrocyte sedimentation rate was 30 (17/43) after the 1st hour. Only 3 patients were rheumatoid factor positive, and 2 patients had anti-CCP antibodies. Ten patients had a diagnosis of RA (25%) in addition to the leading PMR like symptom. Results The MRI signal of interest for PMR is a post-gadolinium signal in T1 weighted pelvic images. The most frequently involved anatomic sites were: the hamstring tendon and the M.gluteus medius and minimus tendon near the greater trochanter in all cases, which were found to be bilaterally involved as was the proximal M.rectus femoris in all cases, and the insertion of the adductor muscles, especially the M.adductor longus at the inferomedial pubic symphysis in 90% of cases. Other sites were also, but less frequently, involved. We think that the involvement of 4 sites including either the M.rectus femoris or the M.adductor longus is rather specific for PMR, see examplary images below. There was no major difference between patients with and without RA. Conclusions This study suggests that there may be a MRI pattern specific for PMR. The target structure of the characteristically inflamed anatomic site seems to be the paratenon which implies that the pattern observed in PMR differs from the enthesitis seen in patients with spondyloarthritis. Prospective randomised trials are needed to further test and prove the clinical usefulness of this approach. Disclosure of Interest None declared
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- 2018
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20. [Becoming older with axial spondyloarthritis]
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U, Kiltz, X, Baraliakos, B, Buehring, and J, Braun
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Male ,Aging ,Fractures, Bone ,Spondylarthritis ,Humans ,Osteoporosis ,Spinal Fractures ,Spondylitis, Ankylosing ,Aged - Abstract
The combination of physiological age-related changes (e. g. reduction in muscle mass and function, reduction in organ function and degenerative changes in joints) and disease-specific changes of ankylosing spondylitis (AS), make older AS patients vulnerable for additional diseases. In this patient population various processes lead to a reduction in physical function, changes in posture, osteoporosis and sarcopenia, which then can result in falls and fractures, especially vertebral fractures. Mortality is increased in patients with AS, particularly in men due to an increase in cardiovascular mortality. Although the standardized assessment of cardiovascular risk factors in patients with inflammatory rheumatic diseases (independent of age) has been recommended for years, it is rarely done in clinical practice. Overall, data on comorbidities and risk factors are only available for AS patients and are lacking for other forms of spondyloarthritides.
- Published
- 2018
21. FRI0528 Successful implementation of a pharmacist-led fracture liaison service at a us veteran affairs (VA) hospital
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T Holobyn, B Buehring, Karen E. Hansen, B Glynn-Servedio, J Kotek, A Bridges, and S Wright
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musculoskeletal diseases ,Service (business) ,medicine.medical_specialty ,Op management ,business.industry ,Osteoporosis ,Psychological intervention ,Pharmacist ,medicine.disease ,Clinical pharmacy ,Family medicine ,Intervention (counseling) ,medicine ,business ,Veterans Affairs ,health care economics and organizations - Abstract
Background Worldwide, an osteoporosis (OP) care gap exists for individuals with a fragility fracture (FF). Published data shows that US veterans are no exception. To address the OP care gap, fracture liaison services (FLS) are being implemented with the goal to prevent additional FF. Objectives Here we report the patient outcomes after initiating a FLS at a US Veterans Affairs (VA) hospital. Methods We identified veterans with a pelvic, hip and/or femur shaft fracture by querying a central database. Veterans with traumatic fractures, active OP medication, recent dual-energy X-ray absorptiometry (DXA) and/or hospice status were excluded. The remaining veterans were contacted via letter and the responsible primary health care team was sent a template letter with OP management recommendations via the electronic medical record. Recommendations included DXA, laboratory evaluation, and pharmacologic and non-pharmacologic interventions. In most cases, trained clinical pharmacists serving as FLS coordinators performed all tasks with an expert physician available for questions. Presented data are based on a review 4 months after recommendations were sent. Results The initial query revealed 149 veterans with pelvic, femoral, and/or hip fractures without a recent DXA and/or active OP therapy. Of those, 32 (31 males, 1 female) patients suffered a FF and were included in the FLS intervention. Our review showed that 59% of these had a DXA scan, 35% had their calcium/vitamin D intake reviewed, and 40% had started OP therapy or were referred to an OP specialist. When the primary care team9s clinical pharmacist instead of the primary care provider implemented the FLS recommendations (10/32), 100% of the recommendations were addressed. Furthermore, 70% of patients had a bisphosphonate ordered, whereas it was 9% when no pharmacist was involved (p=0.0004). Conclusions Our study suggests that a pharmacist-led FLS improves post-FF care in US veterans. We found a high percentage of OP care goals met when patients interacted with clinical pharmacists. This observation might be due to the fact that most pharmacists had dedicated training in OP management and their interaction with the patient focused on their FF. In summary, our data suggests that clinical pharmacists trained in OP management can very effectively implement a FLS intervention. Disclosure of Interest None declared
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- 2017
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22. FRI0525 Association of dysmobility syndrome with fracture risk in the mros cohort
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Steve Cummings, Karen E. Hansen, Nancy E Lane, K E Ensrud, B Buehring, Peggy M. Cawthon, BL Lewis, and Neil Binkley
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0301 basic medicine ,medicine.medical_specialty ,Hip fracture ,business.industry ,Incidence (epidemiology) ,Osteoporosis ,030209 endocrinology & metabolism ,medicine.disease ,03 medical and health sciences ,Grip strength ,0302 clinical medicine ,Quartile ,Sarcopenia ,Internal medicine ,Cohort ,medicine ,Lean body mass ,030101 anatomy & morphology ,business - Abstract
Background Osteoporosis, obesity and sarcopenia are risk factors for fractures and their combination has a negative effect on musculoskeletal health (MSKH). We proposed a score-based approach to define this combination as “dysmobility syndrome (DS)”. DS increases mortality in the NHANES cohort but no data exist on fracture risk. The most widely used fracture risk calculator, the WHO FRAX® tool, does not include several measures of MSKH such as physical function, muscle mass or falls. In this analysis of the Osteoporotic Fractures in Men (MrOS) cohort, we examine whether individuals with impaired MSKH/DS have a higher incidence of fragility fractures and whether this composite score confers additional risk for fracture, beyond risk estimates provided by FRAX®. Objectives In this analysis of the Osteoporotic Fractures in Men (MrOS) cohort, we examine whether individuals with impaired MSKH/DS have a higher incidence of fragility fractures and whether this composite score confers additional risk for fracture, beyond risk estimates provided by FRAX®. Methods The MrOS cohort was utilized in this study. The score-based approach to define DS includes six factors with one point assigned to each: appendicular lean mass/height2 30%, T-score ≤-2.5, grip strength Results 5827 men ages 74±6 years with a mean BMI of 27.4±3.8 kg/m2 had complete data necessary for this analysis. 391 males (6.7%) met criteria for DS. 571 (10%) experienced a MOF including 245 (4%) hip fractures. DS increased the hazards of major osteoporotic (HR 3.31, 95% CI, 2.58, 4.23) and hip (HR 3.48, 95% CI 2.41, 5.03) fractures. In adjusted models, DS and elevated FRAX® risk each increased the hazards of major osteoporotic and hip fracture. Interaction models showed no significant interaction between the presence of DS and FRAX® score for major osteoporotic (p=0.184) or hip (p=0.177) fractures. Conclusions DS was associated with increased MOF fracture incidence even after adjusting for quartiles of FRAX® risk in this cohort of older men. Our study suggests that using a composite assessment of MSKH in addition to already available tools such as FRAX® may improve identification of individuals at high fracture risk. Additional analyses are necessary to examine whether this approach can better distinguish between those who will fracture and who will not and whether the results can be reproduced in women. Disclosure of Interest None declared
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- 2017
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23. Effects of various gases on handgear insulation
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W B Buehring, W W Strobl, and J F Hall
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Materials science ,Hydrocarbons, Halogenated ,Physiology ,business.industry ,chemistry.chemical_element ,Carbon Dioxide ,Space Flight ,Conductivity ,Cold Climate ,Helium ,Copper ,Clothing ,chemistry.chemical_compound ,Thermal conductivity ,chemistry ,Thermal insulation ,Physiology (medical) ,Thermal ,Carbon dioxide ,Room air distribution ,Humans ,Gases ,Composite material ,business - Abstract
The effect of gases having different thermal conductivities on the thermal insulation of handgear was investigated. Experimental mittens with special plastic spacer interliners of various thicknesses were sealed between gas impermeable outer and inner shells and filled first with room air (as control), then various experimental gases, and thermal insulation measured on a copper hand. Experimental gases included carbon dioxide, Freon-12, and helium. Comparative results are presented in terms of percentage insulation change; clo per inch; conductivity (K) values; and the measured thermal insulation (clo) values. Before all tests each mitten was evacuated (13 cm Hg) to remove all entrapped air, then filled without contamination with the control, or experimental gas. Gas within the handgear was maintained at a constant positive pressure (7.6 mm water) throughout each experiment. Mean measurements showed significant increases (13-32%) of thermal insulation for Freon-12 and carbon dioxide, with decreased insulation observed with helium. Significance and some practical application of these results for protective clothing design are shown.
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- 1966
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24. Prevalence and associations of kinesiophobia with patient-reported outcomes and mobility measures in axial spondyloarthritis.
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Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Redeker I, Tsiami S, Herbold S, and Baraliakos X
- Abstract
Objective: To investigate prevalence and associations of kinesiophobia on patients with axSpA, and its relation to global functioning and health, disease activity, function, spinal mobility and physical activity in comparison to healthy controls (HC)., Methods: Cross-sectional, observational study in which consecutive axSpA-patients with axSpA (n=100) and 20 healthy controls (HC) were examined by the Tampa scale of kinesiophobia (TSK), and the Fear avoidance belief questionnaire (FABQ). Patient reported outcomes and objective assessments of disease activity physical function, global health and functioning as well as the BASMI, the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and Epionics SPINE (ES) measurements, including range of motion (RoM) and kinematics (RoK) were collected., Results: AxSpA-patients showed higher TSK (25.5±6.8 vs 14.0±5.1) and FABQ scores (40.1±22. vs 3.1±6.9) compared to HC, all p≤0.001. Categorical analyses of kinesio-phobia levels revealed that patients with higher levels performed significantly worse in ASPI and SPPB tasks, and they also showed impairments in BASMI and ES measures. TSK and FABQ scores correlated with ASAS HI (r=0.45 and r=0.52) and BASFI (r=0.38 and r=0.44), but not with ASPI, SPPB and RoK. Weak correlations were found for BASMI (r=0.24 and r=0.38) and BASDAI (both r=0.35)., Conclusion: Kinesiophobia seems to be a clinically relevant problem of axSpA-patients, since the mobility of patients with moderate to high TSK and FABQ scores was much more impaired in this study. Of interest, the level of kinesiophobia showed stronger correlations with physical function, global functioning and health than with mobility and PA., (Copyright © 2025 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)
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- 2025
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25. Sustained IFN Signature Suppression with Anifrolumab in a SAVI patient Refractory to JAK Inhibitor and Dazukibart Therapy.
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Alehashemi S, Buehring B, de Jesus AA, Gaurav S, Rastegar A, Baumgardner A, Friend K, Arisa OT, Figg WD, Fink D, Kuhns DB, Colton B, Peer CJ, and Goldbach-Mansky R
- Abstract
Objective: To report the efficacy and safety of interferon-β (IFNβ) neutralizing monoclonal antibody (dazukibart), followed by treatment with anti-IFNAR1 antibody (anifrolumab), in a patient with STING-associated vasculopathy with onset in infancy (SAVI) who had vasculitic ulcers and systemic inflammation refractory to Janus kinase inhibition (JAKi)., Methods: A SAVI patient with a de novo STING1 p.(Asn154Ser) mutation, a known pathogenic variant, and uncontrolled disease received twenty-one doses of dazukibart under a compassionate use investigational new drug (IND) protocol, followed by treatment with the anti-IFNAR1 antibody anifrolumab. Clinical and laboratory parameters, including wound healing, whole-blood type I interferon (IFN I) signature, and safety markers were closely monitored throughout both treatment periods., Results: Despite initial reductions in C-reactive protein (CRP) levels and IFN I scores following dazukibart administration, the patient experienced rebound inflammation and recurrent vasculitic lesions. Dazukibart dose adjustments failed to sustainably control IFN I signaling. Subsequent combination therapy of baricitinib and tocilizumab proved partially effective. Treatment with anifrolumab, an IFNα/β receptor (IFNAR1) blocker, in conjunction with tocilizumab, led to sustained suppression of IFN I scores, allowed discontinuation of JAKi, and resulted in significant improvement in vasculitic wounds., Conclusion: This case underscores the challenges in treating SAVI patients and highlights the utility of IFN I scores as a theragnostic biomarker. While high-dose JAKi, and dazukibart failed to achieve sustained control of IFN I signaling, treatment with anifrolumab durably suppressed IFN scores and demonstrated promising efficacy, allowing investigation of the role of IFN I signaling in the disease pathogenesis of SAVI and other interferonopathies in future clinical trials., (This article is protected by copyright. All rights reserved.)
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- 2025
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26. Understanding the multiple dimensions of ageing: 5Ms for the rheumatologist.
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Buehring B, van Onna M, Myasoedova E, Lee J, and Makris UE
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- Aged, Humans, Geriatrics methods, Geriatrics trends, Multimorbidity, Polypharmacy, Rheumatic Diseases drug therapy, Rheumatologists, Rheumatology trends, Aging
- Abstract
The global population is ageing and the rheumatology workforce should be prepared to take care of the inevitable complexities of ageing patients. We can learn from our colleagues and experts in geriatrics about how best to manage multimorbidity, polypharmacy, geriatric syndromes, and shifting priorities of older patients in the context of delivering care for rheumatic diseases. One approach to learning and adopting key ageing constructs within rheumatology practice is to incorporate the established Geriatric 5Ms-principles fundamental to caring for older adults. In this Series paper we discuss the 5Ms in the context of rheumatology practice (1) multicomplexity: assessing and managing multimorbidity and challenging biopsychosocial situations, (2) medications: ensuring that medications do not interfere with the other Ms, (3) mind: managing neurocognitive disorders and comorbid mental health conditions, (4) mobility: ensuring older adults can move independently and safely, and (5) what matters most: aligning care with an older adult's specific goals., Competing Interests: Declaration of interests Within the last 3 years, BB received honoraria for consulting or speaking engagements, travel support, or research funding from AbbVie, Alexion, Amgen, AstraZeneca, Biogen, Boehringer–Ingelheim, Gilead/Galapagos, Janssen, Merck Sharpe Dohme, Sanofi Genzyme, Theramex, and UCB. MvO received consultancy fees from Galapagos, Eli Lilly, Novartis, and Pfizer; and a research grant to her department from Pfizer. EM is supported by the National Institutes of Health (NIH), National Institute on Aging (NIA; R01 AG068192 and K24 AG078179). JL is supported by the NIH, NIA (R03 AG067975 and K23 AG082727). UEM is supported in part by a grant from Veteran Affairs Health Services Research and Development (HX003350) and NIH, NIA (P30 AG022845). All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)
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- 2024
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27. Ageism and rheumatic diseases.
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Misra D, Buehring B, Yung R, and Makris UE
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Competing Interests: RY receives grants from the National Institute on Aging–National Institutes of Health, the Claude D. Pepper Older Americans Independence Center, and the Veterans Affairs Ann Arbor Geriatrics Research, Education and Clinical Center. UEM is supported in part by a grant from Veterans Affairs Health Services Research and Development (HX003350, IIR 20–256) and National Institutes of Health (NIA P30 AG022845). All other authors declare no competing interests.
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- 2024
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28. [Geriatric traumatological management of osteoporosis : "Let the first fracture be the last"].
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Buehring B and Maus U
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- Humans, Aged, Aged, 80 and over, Female, Male, Germany, Bone Density Conservation Agents therapeutic use, Traumatology, Evidence-Based Medicine, Geriatrics, Geriatric Assessment, Osteoporotic Fractures therapy, Osteoporotic Fractures diagnosis, Osteoporosis therapy, Osteoporosis diagnosis, Osteoporosis complications
- Abstract
In Germany more than 800,000 osteoporotic fractures occur every year, with severe medical, social and health economic consequences. Nevertheless, as in many other countries there is a large gap in care. Fractures frequently occur in older geriatric patients, who are increasingly being (or should be) treated in geriatric trauma centers. This multidisciplinary approach offers the opportunity not only to restore the patient's mobility and independence but also to set the course for preventing further fractures. Diagnosing osteoporosis and initiating treatment early after a fracture is particularly important as there is an imminently high risk of further fractures in the months and years following a fracture. This review article describes a pragmatic, guideline-based approach to osteoporosis management for geriatric trauma patients. It discusses fracture risk assessment, current treatment thresholds and treatment strategies as well as the individual osteoporosis drugs, the indications and contraindications. This review aims to show that the treatment of osteoporosis within the framework of a geriatric traumatology team is feasible in the majority of cases. It is suggested that a treatment decision can be systematically made based on a few questions or a flow chart., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: B. Buehring und U. Maus sind beide Vorstandsmitglieder des Dachverbandes Osteologie (DVO) und in der DVO-Leitlinienkommission. B. Bühring hat Honorare für Referenten- und Advisory Board-Tätigkeiten von AbbVie, Alexion, Amgen, AstraZeneca, Biogen, Gilead/Galapagos, MSD, Sanofi Genzyme, Theramex und UCB erhalten. U. Maus hat Honorare für Referenten- und Advisory Board-Tätigkeiten von Ag Novos, Lilly, Amgen, UCB, Theramex, Alexion, Kyowa Kirin und Medi erhalten. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)
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- 2024
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29. Palliative care in patients with rheumatic diseases.
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Buehring B, Tay SH, Manu E, and Yung R
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Competing Interests: RY is supported by research grants from the National Institute of Health/National Institute on Aging Claude D. Pepper Older Americans Independence Center and the VA Ann Arbor Geriatrics Research, Education and Clinical Center. All other authors declare no competing interests.
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- 2024
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30. Pitfalls and pearls in diagnosing inflammatory arthritis in older patients.
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Levinson J and Buehring B
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- Humans, Aged, Diagnosis, Differential, Female, Arthritis diagnosis, Arthritis physiopathology, Arthritis epidemiology, Male, Aged, 80 and over, Aging physiology, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid epidemiology, Arthritis, Rheumatoid physiopathology, Age Factors, Geriatric Assessment methods
- Abstract
Given current demographic shifts, the number of older adults continues to grow, with almost half of patients over 65 being diagnosed with some form of arthritis. Rheumatic diseases pose unique diagnostic challenges in older patients due to the convergence of physiologic changes of aging, confounding difficulties to care, and atypical disease manifestations. This review summarizes the current published evidence to guide clinicians in evaluating geriatric patients with rheumatologic concerns, focusing on inflammatory arthritis. Using the background of epidemiologic data on various musculoskeletal diseases, clinical presentations, current diagnostic tests, and known physiologic changes of aging, this review highlights five diagnostic pitfalls in inflammatory polyarthritis among older patients. The pitfalls include: 1) broader differential diagnosis; 2) atypical presentations; 3) communication, cognitive, and social impairments; 4) the role of chronological vs. biological age; and 5) anchoring bias by assuming older adults are simply "older young adults". These pitfalls are discussed in the context of geriatric principles such as the "hallmarks of aging" and the expected pathophysiologic changes of organ systems. Furthermore, the review discusses the strengths and weaknesses of diagnostic tests used in arthritis and introduces some of the geriatric assessment tools that systematically evaluate multimorbidity and geriatric syndromes. With familiarity of the potential diagnostic pitfalls, knowledge of both normal and pathologic aging processes, awareness of the difference between biological and chronological age, and the ability to use geriatric assessment tools to better characterize older patients, clinicians will be better able to diagnose and manage rheumatic conditions in this population., (Copyright © 2024. Published by Elsevier Masson SAS.)
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- 2024
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31. A Bayesian model to analyse the association of comorbidities with biosimilar treatment retention in a non-medical switch scenario in patients with inflammatory rheumatic musculoskeletal diseases.
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Redeker I, Moustakis S, Tsiami S, Baraliakos X, Kiefer D, Andreica I, Buehring B, Braun J, and Kiltz U
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- Humans, Female, Male, Middle Aged, Adult, Drug Substitution statistics & numerical data, Rheumatic Diseases drug therapy, Rheumatic Diseases epidemiology, Aged, Musculoskeletal Diseases epidemiology, Musculoskeletal Diseases drug therapy, Treatment Outcome, Bayes Theorem, Biosimilar Pharmaceuticals therapeutic use, Antirheumatic Agents therapeutic use, Comorbidity, Adalimumab therapeutic use
- Abstract
Objectives: To analyse clinical outcomes of a non-medical switch from originator adalimumab (ADA) to its ABP501 biosimilar (ABP) over 6 months in patients with inflammatory rheumatic musculoskeletal diseases (RMD) in relation to comorbidity as a risk factor for therapy discontinuation., Methods: RMD patients switching from originator ADA to ABP were identified from a large routine database from October 2018 onwards. Documented clinical data at the time of non-medical switching (baseline), and at 3 and 6 months were collected. Comorbidities were represented by the Charlson Comorbidity Index (CCI) at baseline and patients were categorized based on CCI > 0. Differences in the ABP retention rate over 6 months between patients with CCI = 0 and patients with CCI > 0 were analysed using Bayesian exponential regression., Results: A total of 111 patients with axial spondyloarthritis (n = 68), rheumatoid arthritis (n = 23) and psoriatic arthritis (n = 15), were identified, 74.8% of whom had continued treatment with ABP after 6 months, while a smaller proportion had either switched to another ADA biosimilar (10.8%), switched back to originator ADA (7.2%), switched to a different biologic (3.6%), or dropped out (3.6%). At baseline, a CCI > 0 was found in 38% of patients. Cardiovascular comorbidities (40%) were most prevalent followed by diseases of the skin (33%), the gastrointestinal tract (20%) and the eye (20%). ABP treatment was continued after 6 months in 74% of patients with CCI = 0 and in 76% with CCI > 0. Bayesian analysis showed only a small difference (months) in the APB continuation rate between groups (estimate 0.0012, 95% credible interval (CrI) -0.0337 to 0.0361). Adjusting for age, sex, and disease subtype revealed somewhat shorter retention rates for patients with CCI > 0, but the distribution of the difference included 0 (estimate -0.0689, 95% CrI -0.2246 to 0.0234)., Conclusion: In a non-medical switch scenario of RMD patients, there was no evidence for a considerable difference in ABP retention rates over 6 months between comorbidity groups., (© 2024. The Author(s).)
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- 2024
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32. Prevalence and location of inflammatory and structural lesions in patients with rheumatoid arthritis and radiographic axial spondyloarthritis with chronic neck pain evaluated by magnetic resonance imaging.
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Kiefer D, Soltani M, Damirchi P, Kiltz U, Buehring B, Andreica I, Sewerin P, and Baraliakos X
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- Humans, Female, Male, Middle Aged, Prevalence, Adult, Cervical Vertebrae diagnostic imaging, Radiography methods, Aged, Inflammation diagnostic imaging, Spondylarthritis diagnostic imaging, Spondylarthritis complications, Arthritis, Rheumatoid diagnostic imaging, Arthritis, Rheumatoid complications, Magnetic Resonance Imaging methods, Neck Pain diagnostic imaging, Neck Pain epidemiology, Neck Pain etiology, Chronic Pain diagnostic imaging, Chronic Pain etiology, Chronic Pain epidemiology, Axial Spondyloarthritis diagnostic imaging, Axial Spondyloarthritis epidemiology
- Abstract
Objective: Define the prevalence and location of inflammatory and structural lesions on magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA) and radiographic axial spondyloarthritis (r-axSpA) with neck pain as leading clinical symptom., Methods: Patients with diagnosis of RA and r-axSpA were consecutively included if they had chronic (> 3 months) neck pain. Clinical assessment, neck pain questionnaires and MRIs of the cervical spine (CS) were performed., Results: 107 patients (59 RA and 48 r-axSpA) were included. While there was no difference in the Northwick-Park-Neck-Pain-questionnaire, patients with RA reported higher neck pain compared to r-axSpA on a numeric rating scale (5.0 ± 3.6 vs. 3.0 ± 3.1; p = 0.003). Inflammatory lesions occurred predominantly in the craniocervical area in RA and in the lower CS segments in r-axSpA. Bone marrow edema (BME) was more frequent in axSpA (BME-score axSpA/RA: 0.35vs0.17; p < 0.001) while synovitis was visible in both but was more prevalent in RA (synovitis-score axSpA/RA: 0.02vs0.1; p < 0.001). BME was found in 8 (13.6%) vertebral corner vs. 9 (18.8%), in 2 (3.4%) facet joints vs. 7 (14.6%) and in 1 (1.7%) spinous processes vs. 9 (18.8%) in patients with RA/r-axSpA. In contrast, more patients with RA (30.5% vs6.3%) showed erosive osteochondrosis with endplate BME (p = 0.002)., Conclusion: While involvement of upper cervical inflammation was typically present in RA, r-axSpA patients showed more BME in lower CS segments, vertebral corners, facet joints and spinous processes. Neck pain is linked to upper and lower inflammatory and structural lesions of the CS in both diseases., (© 2024. The Author(s).)
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- 2024
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33. Prevalence of remission in patients with rheumatoid arthritis in daily clinical practice: long-term data from a tertiary care centre.
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Gildemeister N, Redeker I, Buehring B, Andreica I, Kiefer D, Baraliakos X, Braun J, and Kiltz U
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- Humans, Female, Male, Middle Aged, Retrospective Studies, Aged, Treatment Outcome, Adult, Prospective Studies, Time Factors, Severity of Illness Index, Logistic Models, Remission Induction, Tertiary Care Centers, Arthritis, Rheumatoid drug therapy, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid physiopathology, Antirheumatic Agents therapeutic use
- Abstract
Objectives: We aimed to study remission rates in patients with RA in a tertiary care centre over a long-term observation period., Methods: In a monocentric cohort study with a prospective and a retrospective part, adult RA patients were included. Patient's characteristics and outcome parameters were documented prospectively (clinical visit). Data of the initial visit (index visit) and date of first occurrence of remission were taken retrospectively from the hospital information system. Remission was defined as DAS28 <2.6 and sustained remission (SR) was defined as remission lasting >6 months. Logistic regression analysis was used to analyse factors associated with remission and SR., Results: A total of 136 RA patients were included with retrospective data available over a period of 47.9 (18.9) months. One third already had erosions and severe limitations in physical function at baseline. The vast majority (n=109) of patients achieved a state of remission at least once over time (80.1%). At the clinical visit, 40 patients (29.4%) were in remission. Remission was achieved 14.9 months (13.8) after the index visit and by 54.1%, 23.9%, 13.8%, and 8.3% of patients within the first, second, third, and fourth year, respectively. SR was achieved by 65 patients (47.8%) within the observation period., Conclusions: Most patients achieved remission at least once within the observation period and almost 50% of patients also achieved SR. This study shows that the target of achieving remission should be constantly pursued, as we were able to show that even in the fourth year of treatment, patients still achieved remission.
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- 2024
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34. Three-Year Mortality of Older Hospitalized Patients with Osteosarcopenia: Data from the OsteoSys Study.
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Pourhassan M, Buehring B, Stervbo U, Rahmann S, Mölder F, Rütten S, Neuendorff NR, Westhoff TH, Babel N, and Wirth R
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- Humans, Female, Aged, Male, Aged, 80 and over, Prospective Studies, Longitudinal Studies, Absorptiometry, Photon, Risk Factors, Sarcopenia mortality, Sarcopenia complications, Sarcopenia epidemiology, Hospitalization statistics & numerical data, Bone Density, Osteoporosis mortality, Osteoporosis complications, Bone Diseases, Metabolic mortality
- Abstract
Osteosarcopenia, the concurrent presence of sarcopenia and osteopenia/osteoporosis, poses a significant health risk to older adults, yet its impact on clinical outcomes is not fully understood. The aim of this prospective, longitudinal multicentre study was to examine the impact of osteosarcopenia on 3-year mortality and unplanned hospitalizations among 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% female). Sarcopenia and low bone mineral density (BMD) were evaluated using Dual Energy X-ray Absorptiometry and the European Working Group on Sarcopenia in Older People (EWGSOP2) and WHO criteria, respectively. Among participants, 76% had low BMD, 9% were sarcopenic, and 8% had osteosarcopenia. Individuals with osteosarcopenia experienced a significantly higher rate of mortality (46%, p < 001) and unplanned hospitalization (86%, p < 001) compared to those without this condition. Moreover, "healthy" subjects-those without sarcopenia or low BMD-showed markedly lower 3-year mortality (9%, p < 001) and less unplanned hospitalization (53%, p < 001). The presence of osteosarcopenia ( p = 0.009) increased the 3-year mortality risk by 30% over sarcopenia alone and by 8% over low BMD alone, underscoring the severe health implications of concurrent muscle and bone deterioration. This study highlights the substantial impact of osteosarcopenia on mortality among older adults, emphasizing the need for targeted diagnostic and therapeutic strategies.
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- 2024
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35. Impact of daily physical therapy over 2 weeks on spinal mobility including objective electronic measurements and function in patients with axial spondyloarthritis.
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Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, and Baraliakos X
- Abstract
Background: Patients with axial spondyloarthritis (axSpA) are often compromised by impaired function and mobility. The standardized 2-week inpatient program 'multimodal rheumatologic complex treatment' (MRCT) was designed for patients with axSpA. The Epionics SPINE (ES) is an objective tool validated to assess mobility., Objective: To investigate the impact of MRCT on physical function and mobility including range of motion (RoM) and kinematics (RoK)., Design: Single-center interventional, observational trial., Methods: Patients with axSpA presenting with high disease activity and impaired physical function were consecutively recruited to undergo MRCT. Assessments performed before (V1) and after (V2) the intervention included Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis functional index (BASFI), Bath Ankylosing Spondylitis Metrology Index (BASMI), the ankylosing spondylitis physical performance index (ASPI), the Short Physical Performance Battery (SPPB), and ES measurements., Results: At baseline, the 80 patients included had: BASDAI 5.5 ± 1.5, BASFI 5.6 ± 2.0, BASMI 4.2 ± 1.8, SPPB 13.8 ± 1.8, and ASPI 37.3 ± 18.1 s. Clinically relevant improvements between V1 versus V2 were noted for BASFI, BASMI, and all other assessments ( p < 0.001), and also for ES measures of RoK (all p < 0.003) and RoM (all p < 0.04), while a positive trend was seen for flexion and extension (RoM). There was no significant effect of changes in medication (all p > 0.05)., Conclusion: The 2-weeks MRCT was associated with definite improvements of function and mobility. Importantly, the effect of this extensive physical activity was confirmed by using the ES as an objective tool to assess spinal mobility. The ES demonstrated for the first time that the RoK of spinal mobility can significantly improve related to an exercise intervention., Trial Registration: Ethical Committee: Ruhr-Universität (reference-number: 19-6735-BR)., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DK has received grant and research support and consultancy fees from AbbVie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche, and UCB. JB has received honoraria for talks, advisory boards, paid consultancies, and rants for studies from Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi Aventis, and UCB. UK has received grant and research support and consultancy fees from AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Fresenius, Grünenthal, GSK, Hexal, Janssen, MSD, Novartis, Pfizer, Roche, and UCB. NK: None. LS: None. IA has received research support, consultancy fees, and honoraria from Abbvie, Amgen, BMS, Chugai, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Sobi, Takkeda, and UCB. ST: None. BB has received honoraria for talks, advisory boards, paid consultancies, and/or travel support from Abbvie, Alexion, Amgen, Biogen, Boehringer Ingelheim, Gilead/Galapagos, Janssen, MSD, Theramex, Sanofi-Genzyme, and UCB. PS has received grant and research support and consultancy fees from AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing Ltd/Chugai Europe, Deutscher Psoriasis-Bund, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medi-login, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Spirit Medical Communication, Swedish Orphan Biovitrum, UCB Pharma. SH: Has received consultancy fees of AbbVie and Novartis. XB has received grant and research support and consultancy fees from AbbVie, Amgen, Chugai, Galapagos, Hexal, Lilly, MSD, Novartis, Pfizer, and UCB., (© The Author(s), 2024.)
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- 2024
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36. Clinically relevant differences in spinal mobility related to daytime performance in patients with axial spondyloarthritis.
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Kiefer D, Schneider L, Braun J, Kiltz U, Kolle N, Andreica I, Tsiami S, Buehring B, Sewerin P, Herbold S, and Baraliakos X
- Subjects
- Humans, Spine, Inpatients, Axial Spondyloarthritis, Spondylitis, Ankylosing complications, Spondylitis, Ankylosing diagnosis
- Abstract
Objective: Patients with axial spondyloarthritis (axSpA) suffer from clinical symptoms like morning stiffness and back pain. Mobility of patients with axSpA is often impaired. The aim of this study is to compare the performance of patients with axSpA regarding mobility measures including performance-based tests and objective electronic assessments with the Epionics SPINE device (ES) at different times of the day compared with healthy controls (HC)., Methods: Observational trial, consecutive inpatients with axSpA (n=100) and 20 HCs were examined in the morning (V1: before 10:00 am) and in the afternoon (V2: after 02:00 pm) by the Bath Ankylosing Spondylitis Metrology Index (BASMI), the AS physical performance index (ASPI), the Short Physical Performance Battery (SPPB) and ES measurements, including range of motion (RoM) and range of kinematics (RoK)., Results: The assessments of patients with axSpA performed in the morning clearly differed from those in the afternoon, especially regarding performance-based tests. Significant improvements were seen for BASMI (4.0±3.8 to 3.8±1.9; p<0.001), ASPI (36.2±18.3 to 28.8±11.9 s; p<0.001), SPPB (10.1±1.5 to 10.7±1.4 points; p<0.001) and for ES measures of speed (RoK; p<0.018) but not for RoM, except for lateral flexion (13.3±7.4 to 14.7±8.2°; p=0.002). This time of assessment-related variability was not observed in HC., Conclusion: The spinal mobility of patients with axSpA was worse in the morning but significantly improved in the afternoon. This was captured best by performance-based measures and was not seen in HC. The diurnal variation of mobility has implications for clinical studies, suggesting that the time of assessments needs to be standardised., Competing Interests: Competing interests: The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: Dr DK has received grant and research support and consultancy fees from AbbVie, BMS, Boehringer Ingelheim, Chugai, Eli Lilly, Galapagos, Janssen, MSD, Novartis, Pfizer, Roche and UCB. Dr JB has received honoraria for talks, advisory boards, paid consultancies and rants for studies from Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi Aventis and UCB. Dr UK has received grant and research support and consultancy fees from AbbVie, Amgen, Biogen, Chugai, Eli Lilly, Grünenthal, GSK, Hexal, Janssen, MSD, Novartis, Pfizer, Roche and UCB. NK, LS and ST: none. Dr IA has received research support, consultancy fees and honoraria from Abbvie, Amgen, BMS, Chugai, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Sobi, Takkeda and UCB. Dr BB has received honoraria for talks, advisory boards, paid consultancies and/or travel support from Abbvie, Alexion, Amgen, Biogen, Boehringer Ingelheim, Gilead/Galapagos, Janssen, MSD, Theramex, Sanofi-Genzyme and UCB. Dr PS has received grant and research support and consultancy fees from AXIOM Health, AMGEN, AbbVie, Biogen, Bristol-Myers Squibb, Celgene, Chugai Pharma Marketing/Chugai Europe, Deutscher Psoriasis-Bund, Gilead Sciences, Hexal Pharma, Janssen-Cilag, Johnson & Johnson, Lilly/Lilly Europe/Lilly Global, medi-login, Mediri GmbH, Novartis Pharma, Onkowissen GmbH, Pfizer, Roche Pharma, Rheumazentrum Rhein-Ruhr, Sanofi-Genzyme, Spirit Medical Communication, Swedish Orphan Biovitrum, UCB Pharma. SH has received consultancy fees of AbbVie and Novartis. Dr XB has received grant and research support and consultancy fees from AbbVie, Amgen, Chugai, Galapagos, Hexal, Lilly, MSD, Novartis, Pfizer and UCB., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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37. Does adding exercise or physical activity to pharmacological osteoporosis therapy in patients with increased fracture risk improve bone mineral density and lower fracture risk? A systematic review and meta-analysis.
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Schumm AK, Craige EA, Arora NK, Owen PJ, Mundell NL, Buehring B, Maus U, and Belavy DL
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- Humans, Bone Density, Exercise, Lumbar Vertebrae, Osteoporosis drug therapy, Fractures, Bone
- Abstract
This prospectively registered systematic review and meta-analysis examines whether exercise (EX) training has an additive effect to osteoanabolic and/or antiresorptive pharmacological therapy (PT) in people with osteoporosis on bone mineral density (BMD), bone turnover markers (BTMs), fracture healing, and fractures. Four databases (inception to 6 May 2022), 5 trial registries, and reference lists were searched. Included were randomized controlled trials comparing the effect of EX + PT vs. PT with regard to BMD, BTM, fracture healing, and fractures. Risk of bias was assessed using the Cochrane RoB2 and certainty of evidence by the GRADE approach. Random-effects meta-analysis with Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate standardized mean differences and 95% confidence intervals. Out of 2593 records, five RCTs with 530 participants were included. Meta-analysis showed with very low certainty evidence and wide confidence intervals that EX + PT compared to PT had larger effect sizes for BMD at 12 months at the hip (SMD [95%CI]: 0.18 [- 1.71; 2.06], n = 3 studies), tibia (0.25 [- 4.85; 5.34], n = 2), lumbar spine (0.20 [- 1.15; 1.55], n = 4), and forearm (0.05 [- 0.35; 0.46], n = 3), but not femoral neck (- 0.03 [- 1.80; 1.75], n = 3). Furthermore, no improvement was revealed for BTM such as bone ALP (- 0.68 [- 5.88; 4.53], n = 3), PINP (- 0.74 [- 10.42; 8.93], n = 2), and CTX-I (- 0.69 [- 9.61; 8.23], n = 2), but with very wide confidence intervals. Three potentially relevant ongoing trials were identified via registries. No data were found for fracture healing or fracture outcomes. It remains unclear whether EX has an additive impact to PT in people with osteoporosis. High-quality, adequately powered, targetted RCTs are required. PROTOCOL REGISTRATION: PROSPERO CRD42022336132., (© 2023. The Author(s).)
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- 2023
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38. Treatment with adalimumab in patients with chronic inflammatory rheumatic diseases: a study of treatment trajectories on a patient level in routine care.
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Redeker I, Moustakis S, Tsiami S, Baraliakos X, Andreica I, Buehring B, Braun J, and Kiltz U
- Abstract
Background: Previous experiences with non-medical switching of adalimumab (ADA) in patients with chronic inflammatory rheumatic diseases (CIRD) come mainly from phase III extension of randomised clinical trials and little from routine care., Objectives: To analyse treatment trajectories over 2 years in patients with CIRD conducting a non-medical switch from originator to biosimilar ADA., Design: A retrospective observational cohort study was conducted with data from a third-level rheumatology centre in Germany. CIRD patients on originator ADA who switched to ADA biosimilar from October 2018 onwards were identified and followed until September 2020., Methods: Patients' characteristics were compared between the four a priori defined treatment trajectories 'continued biosimilar ADA therapy', 'back-switch to originator ADA therapy', 'switch to another biological disease-modifying anti-rheumatic drug (bDMARD) therapy' and 'stopped bDMARD therapy/death/drop out'. Factors associated with continuing biosimilar ADA therapy were analysed using Cox proportional hazards regression analyses., Results: A total of 121 CIRD patients were included. Most patients (66.9%) continued therapy with biosimilar ADA over 2 years, with a treatment retention rate of 73.1%. Whereas 21 patients (17.4%) switched back to originator ADA, mainly due to adverse events, and 8 patients (6.6%) switched to a different bDMARD, mainly due to lack of effect. The estimated risk of withdrawal was lower for longer prior duration on originator ADA [hazard ratio (HR): 0.82; 95% CI: 0.69-0.97] and higher for higher C-reactive protein levels at baseline (HR: 1.18; 95% CI: 1.00-1.39). Male patients, older patients and those for whom originator ADA was their first bDMARD tended to have a lower risk of withdrawal., Conclusion: Our results indicated that three of four patients continue biosimilar ADA over 2 years with lower risks of withdrawal for male sex, older age, longer prior duration on originator ADA and originator ADA as first bDMARD., Competing Interests: IR, SM and ST: none. XB has received grant and research support and consultancy fees from AbbVie (Abbot), Amgen, Centocor, Chugai, MSD, Novartis, Pfizer, UCB and Wyeth. IA has received research support, consultancy fees and honoraria from AbbVie, Amgen, AstraZeneca, Chugai, Galapagos, Janssen, Eli Lilly, MSD, Novartis, Pfizer, Sobi, Takeda and UCB. BB has received research support, consultancy fees and honoraria from GE/Lunar, Kinemed, Janssen, UCB, Lilly, AbbVie and Gilead. JB has received honoraria for talks, advisory boards, paid consultancies and grants for studies from Abbvie (Abbott), Amgen, Baxter, Biogen, BMS, Boehringer, Celgene, Celltrion, Centocor, Chugai, Fresenius, GlaxoSmithKline, Gilead, Hexal, Janssen, Lilly, Medac, MSD (Schering-Plough), Mylan, Mundipharma, Novartis, Pfizer (Wyeth, Hospira), Roche, Sanofi-Aventis and UCB. UK has received grant and research support and consultancy fees from AbbVie, Amgen, Biocad, Biogen, Chugai, Eli Lilly, Fresenius, Gilead, Grünenthal, GSK, Hexal, Janssen, MSD, Novartis, onkowissen.de, Pfizer, Roche, UCB and Viatris., (© The Author(s), 2023.)
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- 2023
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39. Patients' awareness towards physical activity in the treatment of axial spondyloarthritis.
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Kiefer D, Braun J, Kiltz U, Kolle N, Schneider L, Andreica I, Buehring B, Sewerin P, Herbold S, and Baraliakos X
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- Humans, Cohort Studies, Exercise, Spondylitis, Ankylosing drug therapy, Spondylarthritis diagnosis, Axial Spondyloarthritis
- Abstract
Introduction: The course of axial spondyloarthritis (axSpA) is often characterized by impairments in physical function and mobility. Regular physical activity (PA) is a cornerstone of axSpA management. Recent European League Against Rheumatism (EULAR) recommendations for PA have stressed the importance of their implementation., Objective: Cohort study to investigate the awareness on and individual implementation of axSpA patients towards PA., Methods: Patients with axSpA and impaired physical function (Bath AS Functional Index [BASFI] score≥2.0) were recruited consecutively. All patients underwent a clinical examination including assessments of disease activity, physical function, mobility and global functioning. Patients also had to fill out structured questionnaires on knowledge, awareness and individual attitudes to PA., Results: Out of a total of 100 patients enrolled, 96 were included. Most respondents (n=82, 85.4%) were aware that PA has significant health benefits for patients with axSpA. Even though less than half of the patients (n=44, 42.7%) were aware that actual EULAR recommendations do exist, 45 patients (46.9%) did already fulfill these in terms of frequency/week. The majority of patients (n=61, 67.7%) had been informed about the benefits of PA by their physician, and physiotherapy had often been prescribed (n=61, 63.3%). Many patients (n=51, 53.1%) reported to perform individual exercise programs, and some (n=22, 22.9) supervised PA., Conclusion: Even though the majority of axSpA patients are not aware of the recent EULAR recommendations for PA, many understand and agree that PA is beneficial for their health status. Health care providers should concentrate on the patients who are not active and do not know about the benefits of PA., (Copyright © 2023 Société française de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.)
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- 2023
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40. High Prevalence of Foot Insufficiency Fractures in Patients With Inflammatory Rheumatic Musculoskeletal Diseases.
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Buehring B, Al-Azem N, Kiltz U, Fruth M, Andreica I, Kiefer D, Tsiami S, Baraliakos X, and Braun J
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- Humans, Female, Middle Aged, Male, Retrospective Studies, Prevalence, Bone Density, Absorptiometry, Photon methods, Pain, Fractures, Stress diagnostic imaging, Fractures, Stress epidemiology, Musculoskeletal Diseases, Foot Diseases
- Abstract
Objective: To assess the prevalence of foot insufficiency fractures (IF) in patients with rheumatic musculoskeletal disease (RMD) with foot pain., Methods: In a retrospective design, 1752 magnetic resonance imaging (MRI) scans of consecutive patients presenting with foot pain in 2 time periods between 2016 and 2018 were evaluated. The group with IF was matched with controls with foot pain without IF. Bone mineral density (BMD) was assessed by dual-energy x-ray absorptiometry. Multivariate analyses were performed., Results: A total of 1145 MRI scans of patients (median age 59 yrs, 82.9% female) with an inflammatory (65.4%) and of 607 with no inflammatory (34.6%) RMD (median age 58 yrs, 80.8% female) were available. Most patients had rheumatoid arthritis (RA; 42.2%), and others had psoriatic arthritis (22.4%), axial spondyloarthritis (11.1%), or connective tissue disease (CTD; 7.6%). Foot IF were found in 129 MRI scans of patients (7.5%). There was no difference between time periods. The prevalence of IF was highest in CTD (23%) and RA (11.4%). More patients with an inflammatory than a noninflammatory RMD had IF (9.1% vs 4.1%, respectively; P < 0.001). Using conventional radiography, IF were only detected in 25%. Low BMD and a history of fractures were more frequent in patients with IF than without (42.6% vs 16.2% and 34.9% vs 8.6%, respectively; P < 0.001)., Conclusion: A high prevalence of foot fractures was found in MRI scans of patients with RMD, many without osteoporosis. MRI was more sensitive than radiographs to detect IF., (Copyright © 2023 by the Journal of Rheumatology.)
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- 2023
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41. Changes of immunosuppressive medication because of COVID-19 by patients with chronic inflammatory rheumatic diseases: anxiety was not a major driver.
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Andreica I, Jast R, Rezniczek GA, Kiefer D, Buehring B, Kiltz U, Baraliakos X, and Braun J
- Subjects
- Female, Humans, Middle Aged, Male, Anxiety epidemiology, Depression epidemiology, Depression etiology, SARS-CoV-2, Chronic Disease, COVID-19, Influenza, Human prevention & control, Arthritis, Psoriatic, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid drug therapy, Arthritis, Rheumatoid epidemiology, Rheumatic Diseases drug therapy, Rheumatic Diseases epidemiology
- Abstract
Objectives: To study treatment decisions of patients with chronic inflammatory rheumatic diseases (CIRD) at the beginning of the SARS- CoV-2 pandemic in relation to disease characteristics with focus on anxiety., Methods: A total of 970 CIRD patients diagnosed with rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), psoriasis arthritis (PsA) and connective tissue diseases (CTD), selected from our records who had presented to our hospital at least twice during last year, were contacted by telephone to be asked about medication changes, health status and therapy satisfaction. Standardised tools were used to assess disease activity, anxiety and depression, the latter by Hospital Anxiety and Depression Score (HADS) with a score ≥8 denoting definite anxiety and/or depression. The cut-off for RADAI was set at ≥3.2 and for BASDAI ≥4. Compliance with prevention rules and vaccination status were assessed., Results: Complete interviews of 557 patients (57.4%) made between April and July 2020 were available for analysis. The median age was 55 (47-63), disease duration 9.0 (4.5-17.0) years, 61.9% females. A recent change in medication was reported by 197 patients (35.4%), 51.2% of which admitted that this decision was mainly made due to the pandemic with more changes occurring with bDMARDs (21.8%) than cDMARDs (6.6%) and corticosteroids (5.4%). There was no major difference between patients who changed because of the pandemic or self-reported inactive disease versus patients who did not change therapy regarding disease activity, depression and anxiety (41%, 17.2%, 31.3% vs. 47.5%, 22.5%, 35.0% vs. 48.9%, 27.7%, 34.1%). More than 90% of patients reported that they rigorously followed Corona prevention rules. The majority of patients were vaccinated against influenza (55.3%) and pneumococci (61.3%), respectively., Conclusions: Anxiety, depression and disease activity did not play an important role in decisions favouring change of therapy, even though many patients changed medication due to the pandemic. Patients probably protected themselves by strictly adhering to hygiene recommendations. Vaccination rates against influenza and pneumococci were better than previously reported, but still too low.
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- 2022
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42. Prevalence of sarcopenia in patients with rheumatoid arthritis using the revised EWGSOP2 and the FNIH definition.
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Dietzel R, Wiegmann S, Borucki D, Detzer C, Zeiner KN, Schaumburg D, Buehring B, Buttgereit F, and Armbrecht G
- Subjects
- Aged, Humans, C-Reactive Protein, Cross-Sectional Studies, Glucocorticoids, National Institutes of Health (U.S.), Prednisone, Prevalence, United States epidemiology, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid drug therapy, Arthritis, Rheumatoid epidemiology, Sarcopenia diagnosis, Sarcopenia epidemiology, Sarcopenia etiology
- Abstract
Objective: In rheumatoid arthritis (RA), chronic inflammation can enhance the development of sarcopenia with a depletion of muscle mass, strength and performance. Currently, a consensus definition for sarcopenia and solid results for the prevalence of sarcopenia in patients with RA are lacking., Methods: In this cross-sectional study, 289 patients ≥18 years with RA were recruited. Dual X-ray absorptiometry was performed to measure appendicular lean mass. Assessment of muscle function included grip strength, gait speed and chair rise time. Prevalence of sarcopenia was defined using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) and the Foundation for the National Institutes of Health (FNIH) definition. In addition, the RA study population was compared with existing data of healthy controls (n=280)., Results: 4.5% of patients (59.4±11.3 years) and 0.4% of controls (62.9±11.9 years) were affected by sarcopenia according to the EWGSOP2 definition. Body weight (OR 0.92, 95% CI 0.86 to 0.97), body mass index (BMI) (OR 0.70, 95% CI 0.57 to 0.87), C reactive protein (CRP) (OR 1.05, 95% CI 1.01 to 1.10), disease duration (OR 1.08, 95% CI 1.02 to 1.36), current medication with glucocorticoids (OR 5.25, 95% CI 2.14 to 24.18), cumulative dose of prednisone equivalent (OR 1.04, 95% CI 1.02 to 1.05) and Health Assessment Questionnaire (HAQ) (OR 2.50, 95% CI 1.27 to 4.86) were associated with sarcopenia in patients with RA. In contrast, the prevalence was 2.8% in patients compared with 0.7% in controls when applying the FNIH definition, and body height (OR 0.75, 95% CI 0.64 to 0.88), BMI (OR 1.20, 95% CI 1.02 to 1.41), CRP (OR 1.06, 95% CI 1.01 to 1.11) and HAQ (OR 2.77, 95% CI 1.17 to 6.59) were associated with sarcopenia., Conclusion: Sarcopenia is significantly more common in patients with RA compared with controls using the EWGSOP2 criteria. The FNIH definition revealed sarcopenia in individuals with high BMI and fat mass, regardless of the presence of RA., Trial Registration Number: It was registered at the German Clinical Trials Registry (DRKS) as well as WHO Clinical Trials Registry (ICTRP) (DRKS00011873, registered on 16 March 2017)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2022
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43. Monitoring of Disease Activity With a Smartphone App in Routine Clinical Care in Patients With Axial Spondyloarthritis.
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Kempin R, Richter JG, Schlegel A, Baraliakos X, Tsiami S, Buehring B, Kiefer D, Braun J, and Kiltz U
- Subjects
- Adult, Female, Humans, Male, Antirheumatic Agents therapeutic use, Axial Spondyloarthritis, Mobile Applications, Spondylarthritis drug therapy, Spondylitis, Ankylosing drug therapy
- Abstract
Objective: To investigate the performance of a health app with respect to usability, adherence, and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA)., Methods: Consecutive patients with axSpA were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by 2 further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit; they also completed the Mobile App Rating Scale and the System Usability Scale after 3 and 6 months., Results: Of 103 patients with axSpA, 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) 4.3 (2.0), and 76.8% treated with biologic disease-modifying antirheumatic drugs. Patients' adherence to regular app exports was 29.0% and 28.4% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity ( P = 0.02) and older age ( P = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (intraclass correlation coefficients 0.99 [95% CI 0.98-0.99]). Performance of the app was rated as good., Conclusion: Collection of digital PROs by AxSpA Live App may be successfully used in patients with axSpA with high disease activity. Our study showed equivalence of digital data, but adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients., (Copyright © 2022 by the Journal of Rheumatology.)
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- 2022
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44. Balance and prospective falls in patients with rheumatoid arthritis.
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Wiegmann S, Armbrecht G, Borucki D, Buehring B, Buttgereit F, Detzer C, Schaumburg D, Zeiner KN, and Dietzel R
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- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Postural Balance, Prospective Studies, Young Adult, Accidental Falls, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid epidemiology
- Abstract
Background: Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA., Methods: For the baseline, the balance performance of 289 men and women with RA, ages 24-85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported., Results: A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), FICSIT-4 scoring 0-4 (OR = 2.38, 1.13-5.0), and one-leg standing (OR = 2.14, 1.06-4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03-6.69), total sway of semitandem (OR = 3.07, CI 1.10-8.57) and tandem (OR = 2.86, CI 1.06-7.69), and area of sway of semitandem (OR = 2.80, CI 1.11-7.08) stands were associated with falls., Conclusions: The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls., Trial Registration: The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 ( DRKS00011873 )., (© 2022. The Author(s).)
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- 2022
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45. Effect of semi-recumbent vibration exercise on muscle outcomes in older adults: a pilot randomized controlled clinical trial.
- Author
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Taani MH, Binkley N, Gangnon R, Krueger D, and Buehring B
- Subjects
- Aged, Aged, 80 and over, Exercise, Humans, Muscle Strength physiology, Muscle, Skeletal, Pilot Projects, Hand Strength physiology, Vibration therapeutic use
- Abstract
Background: Many older adults with physical limitations living in residential care apartments are unable to exercise in a standing position and are at risk for declining in muscle function leading to falls and injury. Novel approaches to achieve exercise benefits are needed. The purpose of this study was to test the effect of semi-recumbent vibration exercise on muscle outcomes in older adults living in residential care apartment complexes (RCACs)., Methods: A randomized, crossover design was used to examine the effect of semi-recumbent vibration exercise on muscle function and mass among 32 RCAC residents (mean age 87.5 years) with physical limitations. Participants received a randomized sequence of two study conditions: sham or vibration for 8 weeks each separated by a 4-week washout. Before and after the 8 weeks of vibration treatment and sham treatment, muscle mechanography was used to assess muscle function including jump power, weight-corrected jump power, and jump height. Short physical performance battery (SPPB) and handgrip strength were also used to measure muscle function. Bioelectrical impedance spectroscopy was used to estimate skeletal muscle mass. The effect of the vibration treatment on muscle outcomes was analyzed through mixed effects linear regression models., Results: Vibration exercise leads to better jump height (p < .05) compared to sham exercise but also poorer chair rise performance (p = 0.012). Other muscle functions tests and muscle mass parameters showed non-significant changes., Conclusion: This small pilot study showed no conclusive results on the effect of semi-recumbent vibration exercise on muscle function and mass in older adults living in RCAC. However, the promising signals of improved jump performance could be used to power larger studies of longer duration with various vibration doses to determine the benefit of vibration exercise in this physically impaired, high-risk population with few exercise capabilities., Trial Registration: The study is registered at clinicaltrials.gov ( NCT02533063 ; date of first registration 26/08/2015)., (© 2022. The Author(s).)
- Published
- 2022
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46. Effects of secukinumab on bone mineral density and bone turnover biomarkers in patients with ankylosing spondylitis: 2-year data from a phase 3 study, MEASURE 1.
- Author
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Braun J, Buehring B, Baraliakos X, Gensler LS, Porter B, Quebe-Fehling E, and Haemmerle S
- Subjects
- Adult, Antibodies, Monoclonal, Humanized, Biomarkers, Bone Density, Bone Remodeling, Female, Humans, Male, Axial Spondyloarthritis, Spondylitis, Ankylosing diagnostic imaging, Spondylitis, Ankylosing drug therapy
- Abstract
Background: Axial spondyloarthritis including ankylosing spondylitis (AS) is characterized by chronic inflammation and new bone formation in the axial skeleton. On the other hand, bone loss, osteoporosis and an increased risk of vertebral fractures is known to frequently occur in AS. In the MEASURE 1 study, the clinically efficacious interleukin-17A inhibitor secukinumab was shown to have limited radiographic progression through 4 years in patients with active AS. Here we present a post hoc analysis to evaluate the effect of secukinumab on bone mineral density (BMD) and bone turnover biomarkers over 2 years in this study., Methods: BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine, total hip, and femoral neck. Spinal radiographs performed at baseline and Week 104 were assessed by modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) and analyzed in relation to BMD change, considering baseline syndesmophytes. Bone turnover biomarkers were assessed at baseline and at Weeks 52 or 104., Results: Among 104 patients included in this analysis, 66% were male, with a mean (SD) age of 40.4 (12.3) years. In postmenopausal women and men ≥50 years of age (T-score), the proportion of patients having normal BMD at baseline and Week 104 were 54.5%/54.5% (lumbar spine), 31.6%/55.6% (total hip), and 42.1%/44.4% (femoral neck). Similarly, at baseline, the proportion of patients with osteopenia/osteoporosis was 31.8%/13.6% (lumbar spine), 57.9%/10.5% (total hip), 42.1%/15.8% (femoral neck), and 36.4%/9.1% (lumbar spine), 44.4%/0% (total hip) and 55.6%/0% (femoral neck) at Week 104, respectively. In premenopausal women and men < 50 years of age (Z-score), the proportion of patients having BMD below the expected range for age at baseline and Week 104 were 25.0%/21.2% (lumbar spine), 11.3%/17.8% (total hip), and 9.9%/8.9% (femoral neck). In relation to mSASSS change scores ≥2 over 2 years, the increase in lumbar spine BMD was not related to radiographic progression and syndesmophyte formation. No significant changes were observed in the bone turnover markers over time., Conclusion: The high proportion of AS patients with diminished BMD was confirmed in this study. An increase of BMD in the lumbar spine after 2 years of secukinumab treatment in patients with AS was found that was probably unrelated to radiographic progression. No relevant effects of secukinumab on bone turnover biomarkers were documented., Trial Registration: MEASURE 1 (post hoc analysis) Clinicaltrials.gov, NCT01358175 ; Registered, 23 May 2011., (© 2021. The Author(s).)
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- 2021
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47. Osteosarcopenia, an Asymmetrical Overlap of Two Connected Syndromes: Data from the OsteoSys Study.
- Author
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Pourhassan M, Buehring B, Stervbo U, Rahmann S, Mölder F, Rütten S, Trampisch U, Babel N, Westhoff TH, and Wirth R
- Subjects
- Aged, Aged, 80 and over, Bone Diseases, Metabolic complications, Female, Humans, Inpatients statistics & numerical data, Male, Osteoporosis complications, Prevalence, Prospective Studies, Sarcopenia complications, Syndrome, Bone Diseases, Metabolic epidemiology, Osteoporosis epidemiology, Sarcopenia epidemiology
- Abstract
Osteoporosis and sarcopenia are two chronic conditions, which widely affect older people and share common risk factors. We investigated the prevalence of low bone mineral density (BMD) and sarcopenia, including the overlap of both conditions (osteosarcopenia) in 572 older hospitalized patients (mean age 75.1 ± 10.8 years, 78% women) with known or suspected osteoporosis in this prospective observational multicenter study. Sarcopenia was assessed according to the revised definition of the European Working Group on Sarcopenia in Older People (EWGSOP2). Low BMD was defined according to the World Health Organization (WHO) recommendations as a T-score < -1.0. Osteosarcopenia was diagnosed when both low BMD and sarcopenia were present. Low BMD was prevalent in 76% and the prevalence of sarcopenia was 9%, with 90% of the sarcopenic patients showing the overlap of osteosarcopenia (8% of the entire population). Conversely, only few patients with low BMD demonstrated sarcopenia (11%). Osteosarcopenic patients were older and frailer and had lower BMI, fat, and muscle mass, handgrip strength, and T-score compared to nonosteosarcopenic patients. We conclude that osteosarcopenia is extremely common in sarcopenic subjects. Considering the increased risk of falls in patients with sarcopenia, they should always be evaluated for osteoporosis.
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- 2021
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48. Association between sarcopenia, physical performance and falls in patients with rheumatoid arthritis: a 1-year prospective study.
- Author
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Wiegmann S, Armbrecht G, Borucki D, Buehring B, Buttgereit F, Detzer C, Schaumburg D, Zeiner KN, and Dietzel R
- Subjects
- Accidental Falls prevention & control, Adult, Aged, Aged, 80 and over, Hand Strength, Humans, Middle Aged, Physical Functional Performance, Prospective Studies, United States, Young Adult, Arthritis, Rheumatoid diagnosis, Arthritis, Rheumatoid epidemiology, Sarcopenia diagnosis, Sarcopenia epidemiology
- Abstract
Background: Patients with rheumatoid arthritis (RA) are at increased risk of falls and fractures. Sarcopenia occurs more frequently in RA patients due to the inflammatory processes. Early diagnosis and prevention programmes are essential to avoid serious complications. The present study aims to identify risk factors for falls related to sarcopenia and physical performance., Methods: In a 1-year prospective study, a total of 289 patients with RA, ages 24-85 years, were followed using quarterly fall diaries to report falls. At the baseline, medical data such as RA disease duration and Disease Activity Score (DAS28
CRP ) were collected. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ). Appendicular skeletal mass was determined by Dual X-ray-Absorptiometry (DXA). Physical performance was evaluated by handgrip strength, gait speed, chair rise test, Short Physical Performance Battery, and FICSIT-4. Muscle mechanography was measured with the Leonardo Mechanograph®. Sarcopenia was assessed according to established definitions by the European Working Group on Sarcopenia in Older People (EWGSOP2) and The Foundation for the National Institutes of Health (FNIH). Univariate and multiple logistic regression analysis were used to explore associations with falling. Receiver-operating characteristics (ROC) were performed, and the area under the curve is reported., Results: A total of 238 subjects with RA completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. No association was found between sarcopenia and prospective falls. Age (OR = 1.04, CI 1.01-1.07), HAQ (OR = 1.62, 1.1-2.38), and low FICSIT-4 score (OR = 2.38, 1.13-5.0) showed significant associations with falls., Conclusions: In clinical practice, a fall assessment including age, self-reported activities of daily life and a physical performance measure can identify RA patients at risk of falling., Trial Registration: The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 ( DRKS00011873 )., (© 2021. The Author(s).)- Published
- 2021
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49. Are patients with rheumatic diseases on immunosuppressive therapies protected against preventable infections? A cross-sectional cohort study.
- Author
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Kiltz U, Celik A, Tsiami S, Buehring B, Baraliakos X, Andreica I, Kiefer D, and Braun J
- Subjects
- Cross-Sectional Studies, Hepatitis B Vaccines, Humans, Vaccination, Hepatitis B epidemiology, Hepatitis B prevention & control, Rheumatic Diseases drug therapy, Rheumatic Diseases epidemiology
- Abstract
Objective: To evaluate the prevalence of infections, prevalence of hospitalisation due to infections, the vaccination status and perceived screening of infections prior to the start of biologic disease modifying antirheumatic drugs (bDMARDs) of a patient cohort with chronic inflammatory rheumatic diseases (CIRD)., Methods: Consecutive CIRD patients reporting to our specialised centre were prospectively included (n=975) in this cross-sectional study. Data on comorbidities including infections, treatment, vaccination status, screening for latent tuberculosis infection (LTBI) and hepatitis B (HepB) were collected. Antibodies against measles and HepB were measured by ELISA. The vaccination status was assessed by a predefined vaccination score (0-26) categorising patients into four immunisation states: low (0-6), moderate (7-13), good (14-20), high (21-26)., Results: All patients on bDMARDs (n=499) were screened for LTBI, and 469 for HepB (94%). All LTBI patients (n=16) received isoniazid (3.2%) and 16 chronic HepB patients received lamivudine (3.4%). Protective measles specific IgG-antibodies were found in 901 patients (92.4%). Although 629 patients were educated about vaccination strategies (64.5%), only 540 showed a vaccination card (55.4%). Only 49% of patients had undergone pneumococcal vaccination and less than 30% were protected against HepB and influenza, while 7.6% have not protective antibody titres against measles. No patient met the German national vaccination recommendations requiring a complete documentation of vaccines. The mean vaccination score was 13.3±4.2 with 5.7% of patients having a low, 43.9% a moderate, 47.0% a good and 3.3% a high score., Conclusions: The majority of CIRD patients are n0t sufficiently vaccinated against pneumococci, HepB, influenza and measles. Although CIRD patients and general practitioners regularly receive professional information about the need of vaccination, vaccination rates were low to moderate. Interdisciplinary quality projects should be planned to change that inacceptable result., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2021
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50. Defining an international cut-off of two-legged countermovement jump power for sarcopenia and dysmobility syndrome.
- Author
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Hong N, Siglinsky E, Krueger D, White R, Kim CO, Kim HC, Yeom Y, Binkley N, Rhee Y, and Buehring B
- Subjects
- Aged, Cohort Studies, Female, Humans, Independent Living, Male, Prevalence, Syndrome, Sarcopenia diagnosis, Sarcopenia epidemiology
- Abstract
We aimed to establish jump power cut-offs for the composite outcome of either sarcopenia (EWGSOP2) or dysmobility syndrome using Asian and Caucasian cohorts. Estimated cut-offs were sex specific (women: < 19.0 W/kg; men: < 23.8 W/kg) but not ethnicity specific. Jump power has potential to be used in definitions of poor musculoskeletal health., Purpose: Weight-corrected jump power measured during a countermovement jump may be a useful tool to identify individuals with poor musculoskeletal health, but no cut-off values exist. We aimed to establish jump power cut-offs for detecting individuals with either sarcopenia or dysmobility syndrome., Methods: Age- and sex-matched community-dwelling older adults from two cohorts (University of Wisconsin-Madison [UW], Korean Urban Rural Elderly cohort [KURE], 1:2) were analyzed. Jump power cut-offs for the composite outcome of either sarcopenia defined by EWGSOP2 or dysmobility syndrome were determined., Results: The UW (n = 95) and KURE (n = 190) cohorts were similar in age (mean 75 years) and sex distribution (68% women). Jump power was similar between KURE and UW women (19.7 vs. 18.6 W/kg, p = 0.096) and slightly higher in KURE than UW in men (26.9 vs. 24.8 W/kg, p = 0.050). In UW and KURE, the prevalence of sarcopenia (7.4% in both), dysmobility syndrome (31.6% and 27.9%), or composite of either sarcopenia or dysmobility syndrome (32.6% and 28.4%) were comparable. Low jump power cut-offs for the composite outcome differed by sex but not by ethnicity (< 19.0 W/kg in women; < 23.8 W/kg in men). Low jump power was associated with elevated odds of sarcopenia (adjusted odds ratio [aOR] 4.07), dysmobility syndrome (aOR 4.32), or the composite of sarcopenia or dysmobility syndrome (aOR 4.67, p < 0.01 for all) independent of age, sex, height, and ethnicity., Conclusion: Sex-specific jump power cut-offs were found to detect the presence of either sarcopenia or dysmobility syndrome in older adults independent of Asian or Caucasian ethnicity.
- Published
- 2021
- Full Text
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