Inflammatory rheumatic diseases such as rheumatoid arthritis (RA) lead to local periarticular demineralization through localized arthritis in one or more joints; however, the autoimmune-mediated systemic inflammatory process is also a driver of systemic bone loss, osteoporosis, which leads to an increased risk of fractures. The Umbrella Organization Osteology (DVO) guidelines 2023 recommend a risk-adapted approach involving systematic fracture risk assessment, early baseline diagnostics and consistent specific osteoporosis treatment, including antiresorptive and osteoanabolic strategies. For rheumatology practice this means firmly integrating osteological assessment, including fracture risk management as well as pharmacological and nonpharmacological osteological treatment into the structured care of patients with inflammatory rheumatic diseases.
Introduction In January 2021 the coronavirus disease 2019 (COVID-19) was coupled to high case numbers and mortality worldwide and in Germany. The start of the vaccination campaign was initially characterized by limited availability and uncertainty but rapidly gained momentum. Patients with inflammatory rheumatic diseases (IRD) were prioritized at an early stage due to the high risk for a severe disease trajectory. In this group vaccination proved to be effective and greatly reduced the risk of a severe course. The aim of the study was to ascertain the willingness for vaccination and the influencing factors in patients with IRD in order to optimize vaccination strategies and to reach vulnerable groups more easily. Methods Between January and April 2021 a nationwide survey was carried out in Germany among N= 3661 patients with IRD and N=381 control patients with other chronic internal diseases. The questionnaire covered willingness to undergo vaccination against COVID-19 and demographic and disease-related variables. For the analysis, "willing to be vaccinated" and "already vaccinated" were pooled ("vaccination willingness") and compared the unwilling. The statistical evaluation was carried out using chi(2)-tests, odds ratio (OR) analyses and logistic regression to identify independent influencing factors. Results The proportions of those willing to be vaccinated were comparable in both groups with 90% very high (IRD 89.2% and control group 93.9%). They continually increased in both groups during the observational period and with increasing age. Another strong predictor was a previously carried out simultaneous vaccination for influenza, which was associated with a significantly higher willingness to be vaccinated in both groups. Conclusion The willingness to be vaccinated against COVID-19 at the time of the vaccination rollout in Germany was high. For patients with IRD, it was predicted by age, previous vaccination against influenza and the timing of vaccination but not the subtype of IRD or the type of immunomodulatory medication. Young patients with IRD in particular should be systematically identified as a risk group with a low willingness to be vaccinated. For this patient group an intensified target group-specific vaccination counselling should be integrated into the clinical care, which specifically addresses suitable information channels for those affected.
Background The transition from pediatric to adult rheumatology care represents a particular challenge for young people with juvenile idiopathic arthritis (JIA). Objectives To investigate the continuity of care, disease burden, transition competence and unmet needs among young adults with JIA. Material and methods Within the Innovation Fund project InfoTrans, a cross-sectional survey was conducted among- individuals insured with the Barmer health insurance aged 16-25 years with JIA and pseudonymously linked with health insurance claims data. For the present analysis, young adults aged 20 years and older with prior pediatric rheumatology care were included. Data collected comprised current healthcare utilization, patient-reported outcomes, transition competence (Transitions-KompAZ), and psychological well-being (WHO-5). Results Among 269 surveyed young adults with JIA, 45% were receiving specialist rheumatology care. Participants receiving rheumatology care showed higher transition competence (22.7 vs. 19.0; p < 0.001), had more frequently attended a transition consultation (17% vs. 9%), and were more often aware of the website "mein-rheuma-wird-erwachsen.de" (33% vs. 20%; p = 0.013). Despite comparable disease burden, participants without specialist care received DMARD therapy less frequently (18% vs. 63%). Gaps in care were also observed among participants receiving rheumatology care: the average interval between the last pediatric rheumatology and first adult rheumatology visit was 9.9 months. Overall, 35% had not received a medical transfer summary report, more than 40% were dissatisfied with preparation for transfer, and approximately 1 in 5 participants reported relevant depressive symptoms. Conclusion Relevant discrepancies remain between recommendations for structured transitional care and actual care delivery. Disease-related knowledge appears to be a central factor for continuous follow-up in rheumatology. The findings underline the importance of early patient education and better integration of support services.
Subsequent to the publication of the Federal Joint Committee (G-BA) regulations in the Federal Gazette in March 2020, G-BA rheumatology centers have been established in Germany as key facilities for providing high-quality acute inpatient care to people with inflammatory rheumatic diseases. In accordance with the prevailing regulations, by May 2026, 31 facilities in 14 of the 16 federal states had been designated, including 24 G-BA rheumatology centers for adults and 7 G-BA rheumatology centers for pediatric and adolescent rheumatology. The review article describes the evolution and contemporary state of the G-BA rheumatology centers in Germany, in conjunction with an exposition of the structural prerequisites, task profiles and functions in the care of inpatients with inflammatory rheumatic diseases at other hospitals or specialized rehabilitation facilities. The emphasis is on networking and quality assurance activities, scientific and guideline-based work, the evaluation of innovative treatment and the role of the centers in continuing medical education as special tasks.
Background: Sjogren's disease belongs to the group of collagenoses, it is characterized by xerophthalmia and xerostomia and typically shows autoimmune phenomena in laboratory test parameters (mostly specific antibodies against cytoplasmic ribonucleoprotein complexes). So far there is no approved immunomodulatory treatment for Sjogren's disease but that may soon change. Aims and methods: Patients with Sjogren's disease were prospectively and consecutively included in a descriptive single-center study to be assessed with the EULAR Sjogren's disease activity index (ESSDAI) and the EULAR Sjogren's disease patient reported index (ESSPRI). Results: Within a time period of 20 weeks during the first months of 2026 a total of 70 patients with Sjogren's disease were documented (62 with primary Sjogren's disease) of whom 68 fulfilled the classification criteria for Sjogren's disease (97%). The mean age was 60.5 years (range 24-84 years), 98% were female and the mean duration of sicca symptoms was 9.7 +/- 8.2 years (range 1-25 years). Almost two thirds of the patients regularly used eyedrops and 25% were treated with hydroxychloroquine and 12% with methotrexate. The mean ESSPRI score was 5.4 and the mean ESSDAI was 9.7 points. In the former the focus was on the sicca symptoms (6.3), followed by tiredness (5.7) and pain (5). For the ESSDAI joint pain (63%) was most frequently reported, followed by gland-related (43%), constitutional symptoms (13%) and lymphadenopathy (8%), whereas for laboratory parameters biological (44%) and hematological (15%) abnormalities were reported. Overall, 42 patients had an ESSPRI score >= 5 (60.0%) and 34 had an ESSDAI score >= 5 (48.6%). Only 13 female patients had a score <= 5 in both ESSDAI and ESSPRI (18.6%). Of the patients 20 (28.6%) had an ESSPRI score >= 5 and an ESSDAI score >= 5. Discussion: This observational study shows that a not insubstantial number of patients with Sjogren's disease would fulfil the criteria for immunomodulatory treatment.
