Publications by authors named "Martin Krusche"

23 Publications

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[Model curriculum of the German Society for Rheumatology for advanced training in the discipline internal medicine and rheumatology].

Z Rheumatol 2021 Jul 23. Epub 2021 Jul 23.

Abteilung für Rheumatologie, Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Campus Benjamin Franklin, Charité Universitätsmedizin, Berlin, Deutschland.

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http://dx.doi.org/10.1007/s00393-021-01053-9DOI Listing
July 2021

[Differential diagnosis of a vasculitic syndrome of the lower limb].

Z Rheumatol 2021 Jul 9. Epub 2021 Jul 9.

Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander-Str. 26, 24576, Bad Bramstedt, Deutschland.

Vasculitides can present with various clinical signs and symptoms. Besides disease-specific organ manifestations, the skin, peripheral nerves and musculature are frequently involved. The combination of elevated serological inflammatory markers, vasculitic skin lesions, active polyneuropathy and immobilizing myalgia of the lower limb musculature is highly suspicious for muscular polyarteritis nodosa (mPAN). Based on the case of a 63-year-old female patient with a vasculitic syndrome confined to the lower limb due to mPAN, important differential diagnoses of the these disease manifestations are discussed. Magnetic resonance imaging of the affected muscles and subsequent muscle biopsy (including skin and fascia) provide the relevant diagnostic data.
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http://dx.doi.org/10.1007/s00393-021-01044-wDOI Listing
July 2021

Patient self-sampling: a cornerstone of future rheumatology care?

Rheumatol Int 2021 06 10;41(6):1187-1188. Epub 2021 Apr 10.

Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.

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http://dx.doi.org/10.1007/s00296-021-04853-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035871PMC
June 2021

Digital Health Transition in Rheumatology: A Qualitative Study.

Int J Environ Res Public Health 2021 03 5;18(5). Epub 2021 Mar 5.

AGEIS, Faculty of Medicine, Université Grenoble Alpes, 38706 Grenoble, France.

The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.
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http://dx.doi.org/10.3390/ijerph18052636DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967307PMC
March 2021

Bilateral rhabdomyolysis of the arms after an extensive horse ride.

Rheumatology (Oxford) 2021 Mar 16. Epub 2021 Mar 16.

Department of Radiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117.

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http://dx.doi.org/10.1093/rheumatology/keab244DOI Listing
March 2021

Digital rheumatology in the era of COVID-19: results of a national patient and physician survey.

RMD Open 2021 02;7(1)

Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany

Objective: To analyse the impact of the COVID-19 pandemic on rheumatic patients' and rheumatologists' usage, preferences and perception of digital health applications (DHAs).

Methods: A web-based national survey was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League against Rheumatism. The prospective survey was distributed via social media (Twitter, Instagram and Facebook), QR code and email. Descriptive statistics were calculated, and regression analyses were performed to show correlations.

Results: We analysed the responses of 299 patients and 129 rheumatologists. Most patients (74%) and rheumatologists (76%) believed that DHAs are useful in the management of rheumatic and musculoskeletal diseases (RMDs) and felt confident in their own usage thereof (90%; 86%). 38% of patients and 71% of rheumatologists reported that their attitude had changed positively towards DHAs and that their usage had increased due to COVID-19 (29%; 48%). The majority in both groups agreed on implementing virtual visits for follow-up appointments in stable disease conditions. The most reported advantages of DHAs were usage independent of time and place (76.6%; 77.5%). The main barriers were a lack of information on suitable, available DHAs (58.5%; 41.9%), poor usability (42.1% of patients) and a lack of evidence supporting the effectiveness of DHAs (23.2% of rheumatologists). Only a minority (<10% in both groups) believed that digitalisation has a negative impact on the patient-doctor relationship.

Conclusion: The COVID-19 pandemic instigated an increase in patients' and rheumatologists' acceptance and usage of DHAs, possibly introducing a permanent paradigm shift in the management of RMDs.
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http://dx.doi.org/10.1136/rmdopen-2020-001548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907631PMC
February 2021

Train to target - How we might learn in the future.

Joint Bone Spine 2021 07 23;88(4):105126. Epub 2020 Dec 23.

Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany.

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http://dx.doi.org/10.1016/j.jbspin.2020.105126DOI Listing
July 2021

The virtual fishbowl: bringing back dynamic debates to medical conferences.

Ann Rheum Dis 2020 Dec 15. Epub 2020 Dec 15.

Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany.

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http://dx.doi.org/10.1136/annrheumdis-2020-219552DOI Listing
December 2020

[Thiamazole-induced arthritis].

Z Rheumatol 2021 Mar 16;80(2):180-183. Epub 2020 Nov 16.

Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Deutschland.

We report the case of a 42-year-old male patient with acute onset of asymmetrical polyarthritis of the medium and large joints as well as fever and elevated serological inflammation markers. The symptoms began shortly after initiation of thiamazole treatment for newly diagnosed Graves' disease. Antithyroid arthritis syndrome (AAS) is a rare but serious adverse side effect of antithyroid treatment with thioamides such as thiamazole. Clinically, AAS may present with myalgia, arthralgia, fever, exanthema and polyarthritis. In the case of suspected AAS, when possible the thionamide medication should be rapidly discontinued or modified in consultation with the endocrinologist. In some cases anti-inflammatory therapy with NSAID or corticosteroids may be required for symptom control.
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http://dx.doi.org/10.1007/s00393-020-00921-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929958PMC
March 2021

Validation of the Mobile Application Rating Scale (MARS).

PLoS One 2020 2;15(11):e0241480. Epub 2020 Nov 2.

Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University Ulm, Ulm, Germany.

Background: Mobile health apps (MHA) have the potential to improve health care. The commercial MHA market is rapidly growing, but the content and quality of available MHA are unknown. Instruments for the assessment of the quality and content of MHA are highly needed. The Mobile Application Rating Scale (MARS) is one of the most widely used tools to evaluate the quality of MHA. Only few validation studies investigated its metric quality. No study has evaluated the construct validity and concurrent validity.

Objective: This study evaluates the construct validity, concurrent validity, reliability, and objectivity, of the MARS.

Methods: Data was pooled from 15 international app quality reviews to evaluate the metric properties of the MARS. The MARS measures app quality across four dimensions: engagement, functionality, aesthetics and information quality. Construct validity was evaluated by assessing related competing confirmatory models by confirmatory factor analysis (CFA). Non-centrality (RMSEA), incremental (CFI, TLI) and residual (SRMR) fit indices were used to evaluate the goodness of fit. As a measure of concurrent validity, the correlations to another quality assessment tool (ENLIGHT) were investigated. Reliability was determined using Omega. Objectivity was assessed by intra-class correlation.

Results: In total, MARS ratings from 1,299 MHA covering 15 different health domains were included. Confirmatory factor analysis confirmed a bifactor model with a general factor and a factor for each dimension (RMSEA = 0.074, TLI = 0.922, CFI = 0.940, SRMR = 0.059). Reliability was good to excellent (Omega 0.79 to 0.93). Objectivity was high (ICC = 0.82). MARS correlated with ENLIGHT (ps<.05).

Conclusion: The metric evaluation of the MARS demonstrated its suitability for the quality assessment. As such, the MARS could be used to make the quality of MHA transparent to health care stakeholders and patients. Future studies could extend the present findings by investigating the re-test reliability and predictive validity of the MARS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241480PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605637PMC
December 2020

#Covid4Rheum: an analytical twitter study in the time of the COVID-19 pandemic.

Rheumatol Int 2020 12 29;40(12):2031-2037. Epub 2020 Sep 29.

Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.

Social media services, such as Twitter, offer great potential for a better understanding of rheumatic and musculoskeletal disorders (RMDs) and improved care in the field of rheumatology. This study examined the content and stakeholders associated with the Twitter hashtag #Covid4Rheum during the COVID-19 pandemic. The content analysis shows that Twitter connects stakeholders of the rheumatology community on a global level, reaching millions of users. Specifically, the use of hashtags on Twitter assists digital crowdsourcing projects and scientific collaboration, as exemplified by the COVID-19 Global Rheumatology Alliance registry. Moreover, Twitter facilitates the distribution of scientific content, such as guidelines or publications. Finally, digital data mining enables the identification of hot topics within the field of rheumatology.
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http://dx.doi.org/10.1007/s00296-020-04710-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523492PMC
December 2020

Digital crowdsourcing: unleashing its power in rheumatology.

Ann Rheum Dis 2020 09 11;79(9):1139-1140. Epub 2020 Jun 11.

Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany.

The COVID-19 pandemic forces the whole rheumatic and musculoskeletal diseases community to reassemble established treatment and research standards. Digital crowdsourcing is a key tool in this pandemic to create and distil desperately needed clinical evidence and exchange of knowledge for patients and physicians alike. This viewpoint explains the concept of digital crowdsourcing and discusses examples and opportunities in rheumatology. First experiences of digital crowdsourcing in rheumatology show transparent, accessible, accelerated research results empowering patients and rheumatologists.
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http://dx.doi.org/10.1136/annrheumdis-2020-217697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456558PMC
September 2020

Acceptance, Usage, and Barriers of Electronic Patient-Reported Outcomes Among German Rheumatologists: Survey Study.

JMIR Mhealth Uhealth 2020 07 20;8(7):e18117. Epub 2020 Jul 20.

Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.

Background: The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists.

Objective: This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified.

Methods: Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey.

Results: A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs.

Conclusions: The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.
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http://dx.doi.org/10.2196/18117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400039PMC
July 2020

What will be the job of the rheumatologist in 2030?

Joint Bone Spine 2020 12 9;87(6):525-527. Epub 2020 Apr 9.

Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, 1, Charitéplatz, D-10117 Berlin, Germany.

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http://dx.doi.org/10.1016/j.jbspin.2020.03.016DOI Listing
December 2020

Tocilizumab treatment for polyarteritis nodosa.

Rheumatology (Oxford) 2020 Oct;59(10):e63-e65

Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Altona, Hamburg, Klinikum Bad Bramstedt, Germany.

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http://dx.doi.org/10.1093/rheumatology/keaa079DOI Listing
October 2020

Cocaine-induced ANCA-associated renal disease: a case-based review.

Rheumatol Int 2019 Nov 10;39(11):2005-2014. Epub 2019 Aug 10.

Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie Nephrologie, Paul-Ehrlich-Strasse 1, 22763, Hamburg, Germany.

Idiopathic antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are a group of diseases that are often difficult to diagnose due to the wide range of clinical manifestations. Notably, renal involvement is a serious organ complication, which usually requires intensive immunosuppressive therapy and is prone to recurrence. In recent years, there has been some progress regarding the understanding of the pathogenesis of the diseases. It has been shown that both cocaine and levamisole, which is a common adulterant of cocaine, can trigger the formation of ANCAs and lead to the corresponding symptoms. We report two cases of AAV with different renal manifestations associated with cocaine consumption. Furthermore, we performed a review of the literature to identify, characterize and describe histologically documented cases of renal involvement in AAV, related to cocaine abuse. Cocaine/levamisole-induced vasculitis may, therefore, mimic idiopathic AAV. Although the detection of ANCA and anti-PR3 (proteinase 3, PR3) as well as anti-MPO antibodies (myeloperoxidase, MPO) are the serological hallmark of idiopathic AAV, certain clinical- and antibody constellations should lead to consideration of illicit drugs as inductors of the disease. Especially in young patients, certain serologic constellations (e.g., PR3 and MPO double positivity, positive antinuclear antibodies, low complement level, and positive testing for antiphospholipid antibodies), skin involvement, musculoskeletal symptoms and hematologic (anemia, leukopenia) affections should prompt testing for cocaine and levamisole consumption via urine drug testing. Treatment includes both immunosuppressive approaches and drug cessation but is difficult since many patients continue cocaine consumption.
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http://dx.doi.org/10.1007/s00296-019-04410-9DOI Listing
November 2019

German Mobile Apps in Rheumatology: Review and Analysis Using the Mobile Application Rating Scale (MARS).

JMIR Mhealth Uhealth 2019 08 5;7(8):e14991. Epub 2019 Aug 5.

Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.

Background: Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety.

Objective: The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists.

Methods: The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers.

Results: In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms.

Conclusions: To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.
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http://dx.doi.org/10.2196/14991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699116PMC
August 2019

Outcomes of patients with systemic sclerosis treated with rituximab in contemporary practice: a prospective cohort study.

Ann Rheum Dis 2019 07 9;78(7):979-987. Epub 2019 Apr 9.

Internal Medicine and Rheumatology Department, Cantacuzino Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Objective: To assess the safety and efficacy of rituximab in systemic sclerosis (SSc) in clinical practice.

Methods: We performed a prospective study including patients with SSc from the European Scleroderma Trials and Research (EUSTAR) network treated with rituximab and matched with untreated patients with SSc. The main outcomes measures were adverse events, skin fibrosis improvement, lung fibrosis worsening and steroids use among propensity score-matched patients treated or not with rituximab.

Results: 254 patients were treated with rituximab, in 58% for lung and in 32% for skin involvement. After a median follow-up of 2 years, about 70% of the patients had no side effect. Comparison of treated patients with 9575 propensity-score matched patients showed that patients treated with rituximab were more likely to have skin fibrosis improvement (22.7 vs 14.03 events per 100 person-years; OR: 2.79 [1.47-5.32]; p=0.002). Treated patients did not have significantly different rates of decrease in forced vital capacity (FVC)>10% (OR: 1.03 [0.55-1.94]; p=0.93) nor in carbon monoxide diffusing capacity (DLCO) decrease. Patients having received rituximab were more prone to stop or decrease steroids (OR: 2.34 [1.56-3.53], p<0.0001). Patients treated concomitantly with mycophenolate mofetil had a trend for better outcomes as compared with patients receiving rituximab alone (delta FVC: 5.22 [0.83-9.62]; p=0.019 as compared with controls vs 3 [0.66-5.35]; p=0.012).

Conclusion: Rituximab use was associated with a good safety profile in this large SSc-cohort. Significant change was observed on skin fibrosis, but not on lung. However, the limitation is the observational design. The potential stabilisation of lung fibrosis by rituximab has to be addressed by a randomised trial.
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http://dx.doi.org/10.1136/annrheumdis-2018-214816DOI Listing
July 2019

Scleroderma Renal Crisis: Risk Factors for an Increasingly Rare Organ Complication.

J Rheumatol 2020 02 1;47(2):241-248. Epub 2019 Apr 1.

From the Department of Dermatology and Venereology, University Hospital Cologne; Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne; Department of Rheumatology, Charité Universitätsmedizin Berlin; Department of Dermatology and Allergology, Charité Universitätsmedizin Berlin; Department of Rheumatology, Immanuel Krankenhaus Berlin-Buch, Berlin; Department of Rheumatology, University Hospital Heidelberg, Heidelberg; Department of Dermatology and Venereology, University Hospital Muenster, Muenster; University Hospital Halle, Halle; Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases; Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmonology), University Hospital Tuebingen, Tuebingen; Department for Internal Medicine, Rheumatology, Immunology and Nephrology, Asklepios Clinic Altona, Hamburg; Department of Rheumatology, University Hospital Wuerzburg, Wuerzburg; Department of Rheumatology, Krankenhaus St. Josef; Department of Dermatology, HELIOS University Hospital Wuppertal, Wuppertal; Department of Dermatology, University Hospital Carl Gustav Carus, Dresden; Department of Dermatology and Venereology, Ruhr-University-Bochum, Bochum; Department of Rheumatology, University Medical Center-UKSH, Luebeck; Department of Dermatology, Venereology and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, University Witten-Herdecke, Witten; Department of Rheumatology, Johanniter-Krankenhaus im Flaeming Treuenbrietzen, Treuenbrietzen; University Medical Center Freiburg, Freiburg; Department of Rheumatology, Justus Liebig University Giessen, Kerckhoff Clinic, Bad Nauheim; Department of Rheumatology, University Hospital Erlangen, Erlangen; Department of Dermatology and Allergology, Ludwig Maximilian University, Munich, Germany; Department of Dermatology, Medical University of Graz, Graz, Austria.

Objective: Scleroderma renal crisis (SRC) is a severe life-threatening manifestation in patients with systemic sclerosis (SSc). However, the knowledge about risk factors for SRC is limited. We determined here the frequency of SRC and identified risk factors for the prediction of SRC.

Methods: Based on regular followup data from the German Network for Systemic Scleroderma, we used univariate and multivariate generalized estimating equations to analyze the association between clinical variables, SSc subsets, therapy [i.e., angiotensin-converting enzyme inhibitors (ACEi), corticosteroids], and the occurrence of SRC.

Results: Data of 2873 patients with 10,425 visits were available for analysis with a mean number of registry visits of 3.6 ± 2.8 and a mean time of followup of 3.6 ± 3.8 years. In total, 70 patients developed SRC (70/2873, 2.4%). Of these patients, 57.1% (40/70) were diagnosed with diffuse cutaneous SSc, 31.4% (22/70) with limited cutaneous SSc, and 11.4% (8/70) with SSc-overlap syndromes. Predictive independent factors with the highest probability for SRC were positive anti-RNA polymerase antibodies (RNAP), a history of proteinuria prior to SRC onset, diminished DLCO, and a history of hypertension. Interestingly, positive antitopoisomerase autoantibodies did not predict a higher risk for SRC. Further, patients with SRC were significantly more frequently treated with ACEi and corticosteroids without being independently associated with SRC.

Conclusion: In this cohort, SRC has become a rare complication. By far the highest risk for SRC was associated with the detection of anti-RNAP and proteinuria.
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http://dx.doi.org/10.3899/jrheum.180582DOI Listing
February 2020

Tocilizumab treatment in refractory polyarteritis nodosa: a case report and review of the literature.

Rheumatol Int 2019 02 21;39(2):337-344. Epub 2018 Nov 21.

Asklepios Klinik Altona, Rheumatologie, Klinische Immunologie, Nephrologie, Paul-Ehrlich-Straße 1, 22763, Hamburg, Germany.

Polyarteritis nodosa (PAN) is a rare systemic vasculitis affecting multiple organs. Current standard treatment includes the use of glucocorticoids and cyclophosphamide. Unfortunately, some patients do not respond to this treatment and other therapeutic options are needed. We present a case of a young male with refractory PAN and ongoing biopsy evidence of active vasculitis despite optimal standard therapies, who was successfully treated with interleukin-6 antagonist, tocilizumab. A 24-year-old male presented with severe immobilizing polyneuropathy and myalgias. Clinical features included fasciitis, tenosynovitis, early signs of polyneuropathy, and panniculitis, which were largely refractory to the standard therapies. The previous unsuccessful treatments included high-dose glucocorticoids, methotrexate, cyclophosphamide, rituximab, anakinra, and intravenous immunoglobulins. Magnetic resonance imaging showed signs of myositis, with muscle biopsy confirming the diagnosis of PAN. Rapid clinical improvement and sustained remission occurred after interleukin-6 inhibition with tocilizumab at increased dose of 800 mg every 4 weeks. The used search strategy identified 20 publications of which four articles were included for the further analysis. In total, we report the clinical outcome of five PAN cases from the literature and the present one. The present case and the systematic review of literature suggest that tocilizumab is a possible treatment option for, otherwise, refractory hepatitis B virus negative PAN. Randomized-controlled trials are required to evaluate the safety and efficacy of tocilizumab in PAN.
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http://dx.doi.org/10.1007/s00296-018-4210-2DOI Listing
February 2019
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