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Background: Safety recommendations for Janus kinase inhibitors (JAKi) issued by the European Medical Agency (EMA) in 2023 could potentially influence treatment patterns for rheumatoid arthritis (RA) drugs, but little is known about the impact of these recommendations in routine clinical care., Methods: We retrospectively analyzed the German RHADAR rheumatology database for adult patients with RA and documentation of a new therapy with a JAKi, tumor necrosis factor inhibitor (TNFi), or interleukin-6 receptor inhibitor (IL-6Ri). Data were grouped into half-yearly intervals from quarter (Q)2/2020 to Q3/2023. The period from Q4/2022 to Q1/2023 immediately followed the initial EMA endorsement of Pharmacovigilance Risk Assessment Committee (PRAC) recommendations and Q2/2023-Q3/2023 immediately followed the direct healthcare provider communication (DHPC) containing the new safety JAKi recommendations., Results: Between April 1, 2020 and September 23, 2023, 3008 newly initiated therapies for TNFi (1499 [49.8%]), JAKi (1126 [37.4%]), and IL-6Ri (383 [12.7%]) were documented by the treating physicians. JAKi were increasingly used in the first two half-year periods (from 29.7% of these therapies in Q2/2020-Q3/2020 to 46.7% in Q2/2021-Q3/2021; odds ratio [OR] 2.08; p<0.001). The proportion of initiated JAKi therapies decreased significantly after the PRAC recommendations (32.9%; OR vs peak 0.56; p=0.001) and the DHPC letter (26.1%; OR vs peak 0.40; p<0.001). JAKi were more likely to be used as >3 rd -line therapy in later time periods., Conclusions: This exploratory study suggests that EMA safety recommendations for JAKi influenced treatment patterns of RA patients who received JAKi in Germany. Additional studies will be needed to confirm these findings., Competing Interests: P-PS received research funding from Chugai and speaker’s fees or travel grants from AbbVie, Boehringer/Ingelheim, Eli Lilly, Galapagos, and Janssen-Cilag. LR received travel/meeting support from AbbVie and Biocon Biologics Germany. ME received funding for the present study for data analysis from RHADAR GbR and also received consulting fees from AbbVie and RHADAR, speaker’s fees from AbbVie, Janssen-Cilag, Sanofi, and Swedish Orphan Biovitrum, and is on the advisory board of Chugai Pharma Germany. TW received consulting and/or speaker’s fees from AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Chugai, Fresenius Kabi, Galapagos, GSK, Janssen, Lilly, Medac, Nordic, Novartis, Sanofi, and UCB and travel/meeting support from AbbVie, Janssen, Lilly, and UCB. MF received consulting fees or travel/meeting support from AbbVie, Amgen, AstraZeneca, Eli Lilly, Novartis, Janssen, Hexal, Pfizer, Takeda, and UCB. MS received research grants from Chugai and Novartis, consulting and/or speaker’s fees from AbbVie, Alfasigma/Galapagos/Gilead, Amgen, AstraZeneca, BMS, Boehringer/Ingelheim, Chugai/Roche, EUSA-Pharma, Hexal/Sandoz, Janssen-Cilag, Lilly, Novartis, onkowissen.de, and UCB, travel/meeting support from Alfasigma/Galapagos, Boehringer/Ingelheim, Celgene, Chugai/Roche, Medac, Mylan, and UCB, participates on advisory boards for AbbVie, Alfasigma/Galapagos/Gilead, Amgen, AstraZeneca, Boehringer/Ingelheim, Chugai/Roche, EUSA-Pharma, Hexal/Sandoz, Janssen-Cilag, Lilly, Novartis, onkowissen.de, and UCB, and has a leadership role in the Deutsches Netzwerk Systemische Sklerodermie DNSS. MG receive grants from AbbVie, Eli Lilly, and Pfizer, consulting fees from Amgen, AstraZeneca, Novartis, and Takeda, speaker’s fees from AbbVie, Eli Lilly, Janssen, and Novartis, and travel/meeting support from AbbVie, Eli Lilly, Pfizer, and UCB. SH received speaker’s fees from AbbVie and travel/meeting support from Janssen-Cilag and UCB. PB-B received speaker’s fees from AbbVie, Boehringer Ingelheim, Chugai/Roche, Janssen-Cilag, Novartis, Pfizer, and UCB and travel/meeting support from AbbVie. CV received travel/meeting support from AbbVie and Galapagos/Alpha sigma. KK received speaker’s fees from AbbVie, Galapagos, Novartis, Rheumakademie, and UCB and travel/meeting support from UCB. GG received speaker’s fees from AbbVie, Galapagos, and Novartis and travel/meeting support from AbbVie and Novartis. SS-M received speakers fees from AbbVie, Boehringer Ingelheim, Eli Lilly, GSK, Janssen-Cilag, Novartis, and UCB. WV received travel support from Bundesverband Managed Care. MW received consulting and/or speaker’s fees from AbbVie, Fresenius, Galapagos, Lilly, and UCB and travel/meeting support from AbbVie, Galapagos, GSK, Lilly, and UCB. SK received grants from AbbVie, Novartis, and Sparrow, and consulting and/or speaker’s fees from AbbVie, Celgene, Chugai, Galapagos, Novartis, and Siemens Healthineers. PB-B, CvdD, KK, GG, SS-M, CK, WV, MW, and SK are members of RheumaDatenRhePort RHADAR GbR., (Copyright © 2024 Strunz, Risser, Englbrecht, Witte, Froehlich, Schmalzing, Gernert, Hueper, Bartz-Bazzanella, von der Decken, Karberg, Gauler, Späthling-Mestekemper, Kuhn, Vorbrüggen, Welcker and Kleinert.)

Background: The diagnosis of inflammatory rheumatic diseases (IRDs) is often delayed due to unspecific symptoms and a shortage of rheumatologists. Digital diagnostic decision support systems (DDSSs) have the potential to expedite diagnosis and help patients navigate the health care system more efficiently., Objective: The aim of this study was to assess the diagnostic accuracy of a mobile artificial intelligence (AI)-based symptom checker (Ada) and a web-based self-referral tool (Rheport) regarding IRDs., Methods: A prospective, multicenter, open-label, crossover randomized controlled trial was conducted with patients newly presenting to 3 rheumatology centers. Participants were randomly assigned to complete a symptom assessment using either Ada or Rheport. The primary outcome was the correct identification of IRDs by the DDSSs, defined as the presence of any IRD in the list of suggested diagnoses by Ada or achieving a prespecified threshold score with Rheport. The gold standard was the diagnosis made by rheumatologists., Results: A total of 600 patients were included, among whom 214 (35.7%) were diagnosed with an IRD. Most frequent IRD was rheumatoid arthritis with 69 (11.5%) patients. Rheport's disease suggestion and Ada's top 1 (D1) and top 5 (D5) disease suggestions demonstrated overall diagnostic accuracies of 52%, 63%, and 58%, respectively, for IRDs. Rheport showed a sensitivity of 62% and a specificity of 47% for IRDs. Ada's D1 and D5 disease suggestions showed a sensitivity of 52% and 66%, respectively, and a specificity of 68% and 54%, respectively, concerning IRDs. Ada's diagnostic accuracy regarding individual diagnoses was heterogenous, and Ada performed considerably better in identifying rheumatoid arthritis in comparison to other diagnoses (D1: 42%; D5: 64%). The Cohen κ statistic of Rheport for agreement on any rheumatic disease diagnosis with Ada D1 was 0.15 (95% CI 0.08-0.18) and with Ada D5 was 0.08 (95% CI 0.00-0.16), indicating poor agreement for the presence of any rheumatic disease between the 2 DDSSs., Conclusions: To our knowledge, this is the largest comparative DDSS trial with actual use of DDSSs by patients. The diagnostic accuracies of both DDSSs for IRDs were not promising in this high-prevalence patient population. DDSSs may lead to a misuse of scarce health care resources. Our results underscore the need for stringent regulation and drastic improvements to ensure the safety and efficacy of DDSSs., Trial Registration: German Register of Clinical Trials DRKS00017642; https://drks.de/search/en/trial/DRKS00017642., (©Johannes Knitza, Koray Tascilar, Franziska Fuchs, Jacob Mohn, Sebastian Kuhn, Daniela Bohr, Felix Muehlensiepen, Christina Bergmann, Hannah Labinsky, Harriet Morf, Elizabeth Araujo, Matthias Englbrecht, Wolfgang Vorbrüggen, Cay-Benedict von der Decken, Stefan Kleinert, Andreas Ramming, Jörg H W Distler, Peter Bartz-Bazzanella, Nicolas Vuillerme, Georg Schett, Martin Welcker, Axel Hueber. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 23.07.2024.)

In recent years Janus kinase inhibitors (JAKi) have joined tumor necrosis factor inhibitors (TNFi) and interleukin (IL)-17 inhibitors (IL-17i) as approved disease modifying anti-rheumatic drugs (DMARD) for moderate to severe forms of axial spondyloarthritis (axSpA). Drug survival in axSpA patients has not been well studied in a real-world outpatient scenario since the approval of JAKi. We aimed to analyze the three drug classes based on modes of actions (MoA) for their persistence rates among German axSpA outpatients. A retrospective analysis of the RHADAR database for axSpA patients with a new initiation of TNFi, IL-17i, or JAKi treatment between January 2015 and October 2023 was conducted. Analyses included Kaplan-Meier curves and adjusted Cox regressions for drug discontinuation. 1222 new biological DMARD (TNFi [n = 954], IL-17i [n = 190]) or JAKi (n = 78) treatments were reported. The median drug survival was 31 months for TNFi, 25 for IL-17i, and 18 for JAKi. The corresponding 2-year drug survival rate was 79.6%, 72.6%, and 62.8% for TNFi, IL-17i, and JAKi, respectively. The probability for discontinuation for JAKi was significantly higher compared with TNFi (HR 1.91 [95% CI 1.22-2.99]) as well as for IL-17i compared with TNFi (HR 1.43 [95% CI 1.02-2.01]), possibly related to more frequent use of TNFis as first-line therapy. IL-17i and JAKi discontinuation probabilities were similar. Primary non-response was the reason for drug discontinuation in most cases across all MoA. TNFi treatment might persist longer than JAKi and IL-17i in German axSpA outpatients, possibly related to more severe or refractory disease in patients with JAKi-treated or IL-17i-treated axSpA., (© 2024. The Author(s).)

Objective: Treatment options with disease-modifying antirheumatic drugs (DMARDs) for psoriatic arthritis (PsA) have evolved over recent years. In addition to Janus kinase inhibitors (JAKi), four classes of biologic DMARDs (bDMARDs; interleukin [IL]-23 inhibitors [IL-23i], IL-12/23 inhibitors [IL-12/23i], tumor necrosis factor inhibitors [TNFi], and IL-17 inhibitors [IL-17i]) are currently approved for moderate to severe PsA treatment. There is minimal evidence of the persistence of these drugs among PsA outpatients in a real-world scenario during the period following the approval of JAKi. Therefore, we aimed to analyze the drug survival rates of biologic and JAKi therapies among German PsA outpatients during routine clinical care., Methods: We retrospectively analyzed PsA patients with a new prescription for a biologic or JAKi in the RHADAR database between January 2015 and October 2023. Kaplan-Meier Curves and Cox regression modelling were used to compare drug survival rates., Results: 1352 new prescriptions with bDMARDs (IL-12/23i [n=50], IL-23i [n=31], TNFi [n=774], IL-17i [n=360]) or JAKi (n=137) were identified. The 5-year drug survival rate was 67.8% for IL-17i, 62.3% for TNFi, 53.3% for JAKi, and 46.0% for IL-12/23i. Discontinuation probabilities for JAKi and IL-12/23i were significantly higher compared with TNFi (JAKi hazard ratio [HR] 1.66, [95% CI 1.23-2.24], p=0.001; IL-12/23i HR 1.54, [95% CI 1.02-2.33], p=0.042) and IL-17i (JAKi HR 1.77, [95% CI 1.27-2.47], p=0.001; IL-12/23i HR 1.64, [95% CI 1.06-2.55], p=0.027). JAKi-treated patients had more severe disease and more osteoarthritis (OA) compared to TNFi and more OA compared to IL-17i., Conclusion: German PsA outpatients might persist longer with TNFi and IL-17i compared with IL-12/23i or JAKi. For TNFi, differences in subgroup characteristics and comorbidities (OA) may have affected drug survival rates. For IL-17i, the longer drug survival might not only be related to less OA compared to JAKi and, therefore, might be affected by other factors., Competing Interests: P-PS received speaker’s fees and travel grants from Janssen-Cilag Galapagos, Eli Lilly, Boehringer/Ingelheim and AbbVie less than $10,000 each as well as research funding from Chugai 25000$. ME received payment for data analysis from RHADAR and consulting fees from Abbvie and RHADAR as well as speaker fees and honoraria for lectures from Sanofi, Swedish orphan Biovitrum and Abbvie. ME leadership or fiduciary role from Chugai. LR declares that he has received travel and meeting support from Abbvie and Boehringer and speaking fees from Novartis. TW received honoraria for lectures from Abbvie, Amgen, BMS, Celgene, Fresenius Kabi, Galapagos, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, UCB. MF received speaker’s fees, travel grants or compensation for board memberships from AbbVie, Amgen, AstraZeneca, Novartis, Janssen, Hexal, Pfizer, Takeda, UCB and Eli Lilly. MS received speaker’s fees, travel grants, research funding, or compensation for consultancies or board memberships from AbbVie, Actelion, AstraZeneca, BMS, Boehringer/Ingelheim, Celgene, Chugai/Roche, Eli Lilly, Genzyme, Gilead, Hexal/Sandoz, Janssen-Cilag, MSD, Novartis, Pfizer, Sanofi Pasteur, Takeda Shire, UCB less than $ 10,000 each. MG received travel grants, compensation for advisory boards or speaker’s fees from AbbVie, Chugai, Eli Lilly, Hexal, Janssen, Novartis, Pfizer, Takeda. SS-M received speaker fees from Abbvie, Astra Zeneca, Boerhringer-Ingelheim, BMS, Galapagos, GSK, Lilly, MSD, Novartis, Pfizer, Sanofi, UCB. SK received grants from Abbvie, Novartis, and sparrow for phase 2/3 clinical trials and consulting or speaker fees from Abbvie, Celgene, Chugai, Galapagos, Novartis, and Siemens Healthineers. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Strunz, Englbrecht, Risser, Witte, Froehlich, Schmalzing, Gernert, Schmieder, Bartz-Bazzanella, von der Decken, Karberg, Gauler, Wurth, Späthling-Mestekemper, Kuhn, Vorbrüggen, Heck, Welcker and Kleinert.)

The categorization of axial spondyloarthritis (axSpA) into radiographic (r-axSpA) and non-radiographic (nr-axSpA) subtypes is important in clinical trials but may be of less value in clinical practice. This exploratory cross-sectional, multi-center study evaluated patients with axSpA under routine care at German clinical rheumatology sites (RHADAR real-world database), with a focus on imaging data used for diagnostic classifications. Our analyses included 371 patients with axSpA. The mean (standard deviation [SD]) age was 50.9 (14.0) years, disease duration was 16.4 (13.5) years, and 39.6% were female. Based on the rheumatologist's final assessment, almost half of patients had definite r-axSpA (n = 179; 48.2%), 53 (14.3%) had suspected r-axSpA, 112 (30.2%) had non-radiographic-axSpA (nr-axSpA), and 27 (7.3%) had undefined axSpA. Patients assessed with definite or suspected r-axSpA were more likely to be treated with disease-modifying antirheumatic drugs (DMARDs) (62.0% and 64.2%, respectively) compared with nr-axSpA or undefined axSpA patients (37.5% and 48.1%, respectively). Almost all patients (348/371; 93.8%) had sacroiliac joint imaging data (radiographs or magnetic resonance imaging) documented in their charts, but only 216 (58.2%) had conventional radiographs required for formal diagnosis of r-axSpA by modified New York criteria. Follow-up radiographic imaging in nr-axSpA patients was uncommon (23/216 [25.0%]) but confirmed r-axSpA in 9/23 patients (39.1%). In conclusion, radiographs were available for slightly more than half of axSpA patients. Follow-up imaging was infrequent during rheumatology care in Germany but confirmed r-axSpA in ~ 40% of patients originally considered to have nr-axSpA. The distinction between r-axSpA and nr-axSpA may be ill-defined in routine clinical practice., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Early and effective discrimination (triage) of patients with inflammatory rheumatic diseases (IRD) and other diseases (non-IRD) is essential for successful treatment and preventing damage. The aim of this study was to investigate diagnostic delays and pre-diagnosis treatment in patients newly presenting to rheumatology outpatient clinics. A total of 600 patients newly presenting to one university hospital and two non-academic centers were included. Time from onset of symptoms to rheumatology consultation "total delay" as well as medical treatment before consultation were recorded. Median time from symptom onset to rheumatologist appointment (total delay) was 30 weeks. Median time to online search, first physician appointment request and first physician appointment was 2, 4 and 5 weeks, respectively. Total delay was significantly shorter for IRD patients compared to non-IRD patients, 26 vs 35 weeks (p = 0.007). Only 17.7% of all patients and 22.9% of IRD patients had a delay of less than 12 weeks. Total delay was significantly lower in patients seen in non-academic centers compared to the university center, 20 vs 50 weeks (p < 0.0001). 32.2% of IRD patients received medical treatment that eased their symptoms prior to the rheumatology appointment. These findings highlight the persistent diagnostic delays in rheumatology; however, they also suggest that current triage strategies effectively lead to earlier appointments for IRD patients. Improvement of triage methods and pre-diagnosis treatment could decrease overall burden of disease in IRD patients., (© 2022. The Author(s).)

Spondyloarthritis may contribute to deficits in cognition. The objective of this study was to compare cognitive abilities in patients with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) with matched reference groups. This investigator-initiated, cross-sectional, exploratory study of adults with axSpA or PsA was conducted at two German rheumatology centres (November 2018-September 2019). All data on patient and disease characteristics and cognitive abilities were collected at a single visit. Cognitive function was assessed by the previously validated Memory and Attention Test subscores of selective attention, episodic working memory, and episodic short-term memory and compared with subscores from healthy age-, sex-, and education-matched reference subjects. The mean patient age was 51.1 and 55.8 years in the axSpA (n = 101) and PsA (n = 117) groups, respectively, and mean symptom duration was 13.7 and 10.3 years. Compared with matched reference subjects, axSpA and PsA patients showed significant impairments in selective attention (mean difference of -6.5 and -4.5, respectively, on a 45-point scale; P < 0.001 for both) and no significant differences in episodic working memory. The PsA cohort, but not the axSpA cohort, had significantly better episodic short-term memory subscores compared with matched reference subjects (mean change of 2.0 on a 15-point scale; P < 0.001). Explorative subgroup analyses were unable to identify factors influencing cognitive changes, including disease activity, pain, and function, but may have been underpowered. We conclude that impairments in selective attention may impact the ability of axSpA and PsA patients to process information. These findings warrant additional studies, including longitudinal analyses, in patients with spondyloarthritis., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Rheport is an online rheumatology referral system allowing automatic appointment triaging of new rheumatology patient referrals according to the respective probability of an inflammatory rheumatic disease (IRD). Previous research reported that Rheport was well accepted among IRD patients. Its accuracy was, however, limited, currently being based on an expert-based weighted sum score. This study aimed to evaluate whether machine learning (ML) models could improve this limited accuracy., Materials and Methods: Data from a national rheumatology registry (RHADAR) was used to train and test nine different ML models to correctly classify IRD patients. Diagnostic performance was compared of ML models and the current algorithm was compared using the area under the receiver operating curve (AUROC). Feature importance was investigated using shapley additive explanation (SHAP)., Results: A complete data set of 2265 patients was used to train and test ML models. 30.5% of patients were diagnosed with an IRD, 69.3% were female. The diagnostic accuracy of the current Rheport algorithm (AUROC of 0.534) could be improved with all ML models, (AUROC ranging between 0.630 and 0.737). Targeting a sensitivity of 90%, the logistic regression model could double current specificity (17% vs. 33%). Finger joint pain, inflammatory marker levels, psoriasis, symptom duration and female sex were the five most important features of the best performing logistic regression model for IRD classification., Conclusion: In summary, ML could improve the accuracy of a currently used rheumatology online referral system. Including further laboratory parameters and enabling individual feature importance adaption could increase accuracy and lead to broader usage., Competing Interests: Qinum and RheumaDatenRhePort developed and hold rights for Rheport. WV, CD, and PB-B were involved in the development of Rheport. JK was a member of the scientific board of RheumaDatenRhePort. WV, CD, SK, PB-B, and MW were members of RheumaDatenRhePort GbR. RHADAR GbR received honoraria from UCB Pharma GmbH, Sandoz Deutschland/Hexal AG, Lilly GmbH, and Galapagos Biopharma Germany GmbH, and research support from Novartis Pharma GmbH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Knitza, Janousek, Kluge, von der Decken, Kleinert, Vorbrüggen, Kleyer, Simon, Hueber, Muehlensiepen, Vuillerme, Schett, Eskofier, Welcker and Bartz-Bazzanella.)

Introduction: An increasing number of digital tools, including dedicated diagnostic decision support systems (DDSS) exist to better assess new symptoms and understand when and where to seek medical care. The aim of this study was to evaluate patient's previous online assessment experiences and to compare the acceptability, usability, usefulness and potential impact of artificial intelligence (AI)-based symptom checker (Ada) and an online questionnaire-based self-referral tool (Rheport)., Materials and Methods: Patients newly presenting to three German secondary rheumatology outpatient clinics were randomly assigned in a 1:1 ratio to complete consecutively Ada or Rheport in a prospective non-blinded multicentre controlled crossover randomized trial. DDSS completion time was recorded by local study personnel and perceptions on DDSS and previous online assessment were collected through a self-completed study questionnaire, including usability measured with the validated System Usability Scale (SUS)., Results: 600 patients (median age 52 years, 418 women) were included. 277/600 (46.2%) of patients used an online search engine prior to the appointment. The median time patients spent assessing symptoms was 180, 7, and 8 min, respectively using online using search engines, Ada and Rheport. 111/275 (40.4%), 266/600 (44.3%) and 395/600 (65.8%) of patients rated the respective symptom assessment as very helpful or helpful, using online search engines, Ada and Rheport, respectively. Usability of both diagnostic decision support systems (DDSS) was "good" with a significantly higher mean SUS score (SD) of Rheport 77.1/100 (16.0) compared to Ada 74.4/100 (16.8), ( p < 0.0001). In male patients, usability of Rheport was rated higher than Ada ( p = 0.02) and the usability rating of older (52 years ≥) patients of both DDSS was lower than in younger participants ( p = 0.005). Both effects were independent of each other. 440/600 (73.3%) and 475/600 (79.2%) of the patients would recommend Ada and Rheport to friends and other patients, respectively., Conclusion: In summary, patients increasingly assess their symptoms independently online, however only a minority used dedicated symptom assessment websites or DDSS. DDSS, such as Ada an Rheport are easy to use, well accepted among patients with musculoskeletal complaints and could replace online search engines for patient symptom assessment, potentially saving time and increasing helpfulness., Competing Interests: JK and has received research support from Novartis Pharma GmbH. Qinum and RheumaDatenRhePort developed and hold rights for Rheport. WV, PB-B, and MW are members of RheumaDatenRhePort. WV and PB-B were involved in the development of Rheport. JK is a member of the scientific board of RheumaDatenRhePort. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Knitza, Muehlensiepen, Ignatyev, Fuchs, Mohn, Simon, Kleyer, Fagni, Boeltz, Morf, Bergmann, Labinsky, Vorbrüggen, Ramming, Distler, Bartz-Bazzanella, Vuillerme, Schett, Welcker and Hueber.)

This longitudinal analysis compares the prevalence of depressive symptoms in patients with psoriatic arthritis in the context of the COVID-19 pandemic. Data from a national patient register in Germany were analyzed regarding the Patient Health Questionnaire 2 (PHQ-2) to identify cases suspicious for depression at two time points, i.e., before and during the COVID-19 pandemic. Only patients with complete concurrent information on the Disease Activity in Psoriatic Arthritis Score (DAPSA) were included in the analysis. The frequency of depressive symptoms in psoriatic arthritis patients during the COVID-19 pandemic did not differ from the prevalence rates measured before. In addition, prevalence rates for depressive symptoms did not differ when stratifying the patient sample for DAPSA levels of disease activity measured before the pandemic. These results were confirmed further in a sensitivity analysis, limiting the second PHQ-2 assessment to lockdown periods only. However, longitudinal data on the prevalence of depressive symptoms in patients with rheumatic diseases, in general, and psoriatic arthritis, in particular, are scarce in the context of the COVID-19 pandemic. For a sensible comparison of prevalence rates for depressive symptoms in the future, underlying SARS-CoV-2 infection rates and resulting local healthcare disruptions need to be taken into account, besides the potential use of different depression screening tools to evaluate resulting numbers sensibly and draw corresponding conclusions for patient care., Competing Interests: WV, CD, SK, PB-B, CK, KK, SS-M, PA, and MW are members of RheumaDatenRhePort GbR. RHADAR GbR received honoraria from UCB Pharma GmbH, Sandoz Deutschland/Hexal AG, Lilly GmbH, and Galapagos Biopharma Germany GmbH, and research support from Novartis Pharma GmbH. ME received remunerations from RheumaDatenRhePort GbR for statistical data analyses and consultation for previous projects. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Englbrecht, Bartz-Bazzanella, von der Decken, Gauler, Wurth, Aries, Karberg, Kuhn, Schuch, Späthling-Mestekemper, Vorbrüggen, Wendler, Welcker and Kleinert.)

Real-world data are crucial to continuously improve the management of patients with rheumatic and musculoskeletal diseases (RMDs). The German RheumaDatenRhePort (RHADAR) registry encompasses a network of rheumatologists and researchers in Germany providing pseudonymized real-world patient data and allowing timely and continuous improvement in the care of RMD patients. The RHADAR modules allow automated anamnesis and adaptive coordination of appointments regarding individual urgency levels. Further modules focus on the collection and integration of electronic patient-reported outcomes in between consultations. The digital RHADAR modules ultimately allow a patient-centered adaptive approach to integrated medical care starting as early as possible in the disease course. Such a closed-loop system consisting of various modules along the whole patient pathway enables comprehensive and timely patient management in an unprecedented manner., (©Stefan Kleinert, Peter Bartz-Bazzanella, Cay von der Decken, Johannes Knitza, Torsten Witte, Sándor P Fekete, Matthias Konitzny, Alexander Zink, Georg Gauler, Patrick Wurth, Peer Aries, Kirsten Karberg, Christoph Kuhn, Florian Schuch, Susanna Späthling-Mestekemper, Wolfgang Vorbrüggen, Matthias Englbrecht, Martin Welcker, RHADAR Group. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 20.05.2021.)

Background: Timely diagnosis and treatment are essential in the effective management of inflammatory rheumatic diseases (IRDs). Symptom checkers (SCs) promise to accelerate diagnosis, reduce misdiagnoses, and guide patients more effectively through the health care system. Although SCs are increasingly used, there exists little supporting evidence., Objective: To assess the diagnostic accuracy, patient-perceived usability, and acceptance of two SCs: (1) Ada and (2) Rheport., Methods: Patients newly presenting to a German secondary rheumatology outpatient clinic were randomly assigned in a 1:1 ratio to complete Ada or Rheport and consecutively the respective other SCs in a prospective non-blinded controlled randomized crossover trial. The primary outcome was the accuracy of the SCs regarding the diagnosis of an IRD compared to the physicians' diagnosis as the gold standard. The secondary outcomes were patient-perceived usability, acceptance, and time to complete the SC., Results: In this interim analysis, the first 164 patients who completed the study were analyzed. 32.9% (54/164) of the study subjects were diagnosed with an IRD. Rheport showed a sensitivity of 53.7% and a specificity of 51.8% for IRDs. Ada's top 1 (D1) and top 5 disease suggestions (D5) showed a sensitivity of 42.6% and 53.7% and a specificity of 63.6% and 54.5% concerning IRDs, respectively. The correct diagnosis of the IRD patients was within the Ada D1 and D5 suggestions in 16.7% (9/54) and 25.9% (14/54), respectively. The median System Usability Scale (SUS) score of Ada and Rheport was 75.0/100 and 77.5/100, respectively. The median completion time for both Ada and Rheport was 7.0 and 8.5 min, respectively. Sixty-four percent and 67.1% would recommend using Ada and Rheport to friends and other patients, respectively., Conclusions: While SCs are well accepted among patients, their diagnostic accuracy is limited to date., Trial Registration: DRKS.de, DRKS00017642 . Registered on 23 July 2019.

Purpose: It has been the aim of the following study to evaluate pulmonary changes in rheumatoid arthritis with high-resolution CT and to assess their correlation with joint manifestation and laboratory parameters., Material and Methods: The authors prospectively performed computed tomography (CT) in 83 patients with rheumatoid arthritis and graded pulmonary changes for frequency and severity. Included were patients with 6-7/7 ARA, BSR > 25/1 min and mean disease duration of 12 years (range, 1-44). Data of medical and drug histories, smoking habits, blood levels of rheumatoid factor (RF), antinuclear antibodies (ANA) and C-reactive protein as well as the degree of joint involvement were taken into account., Results: 58 patients (70%) had pathological CT scans showing the following abnormalities: interlobular thickening (44.5%), intralobular thickening (34%), nonseptal linear attenuation (35%), nodular or linear pleural thickening (32.5%), ground-glass pattern (19%), centrilobular nodules (13%), honeycombing (13%) and bronchiolectasis (9%). Intralobular thickening, honeycombing and pleural thickening were associated with a higher degree of joint manifestation; pleural thickening, honeycombing and ground-glass pattern were associated with a higher level of rheumatoid factor. There was no relationship between pulmonary changes and either the duration of the disease, antinuclear antibodies (ANA) or C-reactive protein., Conclusion: CT may be a useful noninvasive tool for recognition of RA-associated lung disease. Interstitial lung changes are frequent and they are independent of the duration of the disease. Pulmonary interstitial changes are more frequent and more severe in RF-positive patients and in case of more severe joint involvement.