In October 2024, the Standing Committee on Vaccination (STIKO) adjusted its recommendation on seasonal influenza vaccination for people aged 60 and over. Based on new study data, the MF59-adjuvanted influenza vaccine is now recommended as equivalent to the high-dose vaccine: The MF59-adjuvanted vaccine was shown to be superior in terms of effectiveness compared to non-adjuvanted standard vaccines in older adults. The immune response to the adjuvanted vaccine was broader and stronger than to the standard vaccine. The MF59-adjuvanted vaccine had a similar safety profile to the high-dose vaccine, both showing slightly increased local and systemic reactogenicity compared to the standard vaccine. STIKO believes that recommending both vaccines could increase acceptance and willingness to be vaccinated in the target population.

Amiodarone, a potent antiarrhythmic drug, may cause thyroid dysfunction due to its high iodine content. Both hypo- and hyperthyroidism can occur. Early diagnosis, differentiation of subtypes, and individualized therapy are essential to prevent severe complications and improve patient outcomes.

Musculoskeletal complaints of the shoulder/pelvic girdle are symptoms frequently described in patient care and are attributed to degenerative changes associated with increasing patient age. Polymyalgia rheumatica(PMR) is the second most common differential diagnosis of an inflammatory genesis after rheumatoid arthritis and should be ruled out. Patients diagnosed with PMR exhibit symptoms such as acute weakness, pain, morning stiffness in the neck, shoulders and pelvis. The manifestation of B-symptoms is possible. The clinical examination should encompass differential diagnoses and complications, such as giant cell arteritis. Laboratory testing shows elevated levels of inflammatory markers in almost all cases. Arthrosonography reveals tenosynovitis of the biceps tendon, bursitis or joint effusion of the hip. The initial treatment for PMR is the administration of steroids. In cases of disease activity, methotrexate, sarilumab or rituximab may be considered as potential treatment options.

Patients with cardiovascular, renal, and metabolic diseases are at increased risk of hyperkalemia, particularly when treated with RAASi. However, data on the management of hyperkalemia in German primary care practices are limited. The retrospective, cross-sectional study WATCH-K included 411202 patients from primary care practices with documented chronic kidney disease (CKD), heart failure (HF), hypertension, and/or diabetes mellitus, all at elevated risk for hyperkalemia. Patients were observed for ≥1 year. The study analyzed the frequency of serum potassium measurements, the prevalence and diagnosis of hyperkalemia, and its treatment with potassium binders. In the overall population 70.8% of patients received RAASi therapy, and 35.2% had their serum potassium levels measured at least once during the year, most frequently among patients with CKD (44.8%) and HF (42.8%). Among all patients tested, 24.5% (n=35368) showed hyperkalemic values, but only 2.0% (n=696) had a recorded diagnosis. Only 10.9% (n=76) of them were treated with potassium binders, and only 15.8% (n=12) of them received modern agents such as sodium zirconium cyclosilicate or patiromer. The management of hyperkalemia in high-risk patients in German primary care should be significantly improved through more frequent potassium monitoring and guideline-directed use of potassium binders to enhance patient outcomes. Furthermore, exploring the reasons behind the cautious use of medication to treat hyperkalemia may provide valuable insights.

Invasive treatment of carotid stenosis is directed towards the prevention of ischemic stroke. Contemporary guidelines, based on the best available evidence, recommend carotid endarterectomy for symptomatic carotid stenosis of 50-99%. Revascularization should ideally be performed within 48 hours to 14 days following the index ischemic event. In asymptomatic patients, intervention is indicated in the presence of clinical or morphological markers associated with an increased risk of carotid stenosis-related stroke. Carotid artery stenting represents a complementary alternative to endarterectomy, particularly in patients at high surgical risk. Given that several recommendations are based on expert opinion rather than high-level evidence, interdisciplinary decision-making plays a crucial role. Patients with limited life expectancy should not undergo invasive treatment; all patients with carotid artery disease should receive optimal medical therapy.

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the predominant types of large-vessel vasculitis, sharing IL-6-mediated immunopathology but differing in age profile and clinical phenotype. Glucocorticoids (GC) remain standard for induction therapy, although relapse rates and treatment-associated toxicity on GC monotherapy are high. Therefore, current guidelines support early tapering and the use of GC-sparing agents in relapsing or high-risk patients. Tocilizumab is now established as standard therapy in GCA, while methotrexate remains an alternative option. Recently, the janus kinase (JAK) inhibitor upadacitinib has gained regulatory approval for GCA, supported by results of a phase 3 trial. In TAK, conventional immunosuppressants are used in new-onset disease, while TNF-alpha or IL-6-blockade can be considered in relapsing or refractory disease. Optimal duration of treatment is not yet well defined.

The therapeutic goal describes the desired outcome of (intensive) treatment. A therapeutic goal may only be pursued if it is (still) achievable according to professional assessment. There is often disagreement within the multi-professional treatment team about whether a goal is achievable or not. This article analyzes the individual steps involved in reflecting on, discussing, and setting therapeutic goals and, if necessary, changing them.