The clinical picture of "frozen shoulder" is still poorly understood. In order to present the current state of knowledge on aetiology, diagnosis, and treatment, and to provide recommendations for the professional groups involved, a working group was formed by the DGOU and the DVSE to create a German language, evidence-based guideline, which was published in 2022 by the AWMF. The following summarises the development and the most important results.

At least 1comorbidity occurs in 80% of patients with rheumatoid arthritis (RA). In addition to cardiovascular comorbidities psychological comorbid conditions are common. The prevalence of depression and anxiety is higher in patients than in the general population. Screening for comorbidities is crucial. Ashortage of outpatient specialist care barely allows resources for this. The implementation of team-based care holds the potential to improve the standard of care while simultaneously working against the shortage of care. The aim of the study was to examine the effects of care on the course of depression and anxiety in patients with seropositive RA and active disease. Amulticenter pragmatic randomized controlled trial was conducted over the course of 1year with 224 patients. After baseline, five more visits followed. In the intervention group (IG), three were initially carried out by qualified rheumatological assistants. Depression, anxiety and patient satisfaction with outpatient care were looked at in detail. In the IG the anxiety symptoms significantly improved over 12months (p = 0.036). The proportions of patients with anxiety also significantly changed in the IG (p < 0.001), while there was no change in the control group between baseline and month12. The values of the depression scale did not differ significantly (p = 0.866). In terms of the information dimension of the satisfaction questionnaire, patients in the IG felt significantly better informed after 6months (p = 0.013) and 12months (p = 0.003). Apositive effect of team-based care on the course of depression and anxiety in patients with seropositive RA and active disease could be shown.

The majority of knowledge about fibromyalgia syndrome (FMS) derives from studies of female patients. Little is known about the clinical characteristics and treatment outcomes of male patients with FMS. In this retrospective cohort study with a prospective posttreatment follow-up, we investigated whether male patients with FMS differ from female patients in terms of 1) symptom burden, 2) psychological characteristics, and 3) clinical treatment response. We identified 263 male (4%) out of 5,541 patients with FMS completing a 3-week multimodal pain-treatment program. Male patients (51.3 ± 9.1 years) were age- and time-matched (1:4) with female patients (N = 1,052, 51.3 ± 9.0 years). Data on clinical characteristics, psychological comorbidities, and treatment responses were obtained from medical records and validated questionnaires. Levels of perceived pain, psychological comorbidity, and functional capacity were similar between genders, although male patients with FMS showed a higher prevalence of alcohol abuse. Compared to female patients, male patients experienced themselves less often as overly accommodating (Cohen’s d = −.42) but more often as self-sacrificing (d = .26) or intrusive (d = .23). Regarding pain coping, male patients were less likely to utilize mental distraction, rest- and relaxation techniques, or counteractive activities (d = .18–.27). Male patients showed a slightly worse overall response rate than women (69% vs 77%), although differences between individual outcome measures were small (d < .2). Although male and female patients in our cohort were similar in clinical presentation and treatment response, the gender-specific differences in interpersonal problems and pain coping suggest consideration of these aspects in the treatment of male patients with FMS. PerspectiveKnowledge about fibromyalgia mostly derives from studies of female patients. Identifying and understanding gender-specific differences in fibromyalgia is an important roadmap in the treatment of this syndrome by focusing on specific gender aspects such as differences in interpersonal problems and pain coping mechanisms.

Fibroblast growth factor-23 (FGF-23) is a phosphaturic hormone used to monitor chronic kidney disease (CKD) in humans. The aim of this pilot study was to compare three diagnostic assays and to assess how the results correlate with parameters of renal dysfunction in cats. Four groups of 10 cats each were formed retrospectively according to creatinine, based on IRIS staging. FGF-23 was measured using two different ELISAs (MyBioSource and Kainos ELISA FGF-23 Kit) and an automated assay on the DiaSorin Liaison platform. Measurements were performed in 40 cats. Spearman's rank correlation coefficient showed a strong correlation between the Kainos and DiaSorin assays (ρ = 0.742/p < 0.001) and a low correlation (ρ = 0.443/p = 0.005) between the Kainos and MyBioSource assays. The measurements with the Kainos assay strongly correlated with urea (ρ = 0.835/p < 0.001) and creatinine (ρ = 0.764/p < 0.001), and moderately correlated with SDMA (ρ = 0.580/p < 0.001) and phosphorus (ρ = 0.532/p < 0.001). The results of the MyBioSource and DiaSorin assays only showed a moderate correlation with urea (ρ = 0.624/0.572) and creatinine (ρ = 0.622/0.510) concentrations (p = 0.001 each). The Kainos assay showed the strongest correlation (ρ = 0.806) with the various creatinine concentrations according to the IRIS, followed by the MyBioSource (ρ = 0.663/p < 0.001) and DiaSorin assays (ρ = 0.580/p < 0.001). Overall, the Kainos assay demonstrated the best correlations with both biomarkers and various creatinine concentrations according to the IRIS. Individual assay-based reference values should be established to make a reliable interpretation of FGF-23 levels possible to diagnose or monitor feline CKD.

BackgroundRandomized controlled trials have demonstrated the efficacy and safety of FIL for moderate to severe RA;[1–3] however, real-world evidence is lacking.ObjectivesTo evaluate the rationale for starting FIL in patients (pts) with moderate to severe RA in Germany. Secondary objectives were to describe pt characteristics, concomitant use of glucocorticoids (GCs) and/or methotrexate (MTX), and prior treatment with disease-modifying antirheumatic drugs (DMARDs). Disease activity was an exploratory objective.MethodsThis multicenter retrospective chart review included pts aged ≥18 years with confirmed moderate to severe RA, who initiated FIL before 1 December 2021, with medical records available for ≥6 months prior to initiating FIL (index date) or since initial diagnosis. Data were collected using electronic case report forms; collection was completed on 2 May 2022. Reasons for starting FIL were recorded at index, based on pre-set response categories. Disease activity was assessed in pts with available data using the Clinical Disease Activity Index and Disease Activity Score for 28 joints with C-reactive protein, 3 and 6 months after the index date. Discontinuation of FIL (including reasons) was assessed during the available follow-up of 12 months.ResultsThis study included 301 pts with RA from 20 practices across Germany. Selected baseline pt characteristics and comorbidities are summarized (Table 1). Overall, pts had previously been treated with conventional synthetic (cs) DMARDs (n=282, 93.7%), GCs (n=241, 80.1%), biologic (b) DMARDs (n=199, 66.1%), and targeted synthetic (ts) DMARDs (n=113, 37.6%). One, two, and ≥3 prior advanced DMARDs were received by 87 (28.9%), 51 (16.9%), and 90 (29.9%) pts, respectively; 73 pts (24.3%) were advanced DMARD-naïve. Last treatments before initiating FIL included csDMARDs (n=120, 43.0%), bDMARDs (n=97, 34.8%), GCs (n=88, 31.5%), and tsDMARDS (n=63, 22.6%). Most pts received FIL as monotherapy (n=220, 73.1%); pts received FIL + GCs (n=32, 10.6%), FIL + MTX (n=26, 8.6%), and FIL + MTX + GCs (n=23, 7.6%). Reasons for initiating FIL included oral administration (n=236, 78.4%), fast onset of action (n=201, 66.8%), administration as monotherapy (n=197, 65.4%), good controllability (n=176, 58.5%), good benefit/risk ratio (n=155, 51.5%), low potential for drug-drug interactions (n=97, 32.2%), dosage adjustment in elderly pts (n=35, 11.6%), lower risk of herpes zoster (n=45, 15.0%), and inefficacy of previous therapies (n=10, 3.3%). Disease activity during the follow-up is shown (Figure 1). In total, 43 pts (14.3%) discontinued FIL during the follow-up because of: lack of efficacy (n=26, 8.6%), intolerance or adverse drug reaction (n=12, 4.0%), lack of drug adherence (n=4, 1.3%), and remission (n=1, 0.3%).ConclusionIn this real-world setting in Germany, reasons for initiating FIL were related to general Janus kinase inhibitor, as well as FIL-specific, attributes. Most pts received FIL as monotherapy. FIL was effective and generally well tolerated; however, longer-term data are needed.

BackgroundSystemic Lupus Erythematosus (SLE) is an autoimmune disease affecting different organs and causing significant morbidity and mortality. Pulmonary arterial hypertension (PAH) is a rare manifestation of SLE. The prevalence of PAH in patients with SLE varies between 0.5 to 5% [1]. No screening algorithms have been developed in patients with SLE.In patients with SSc, PAH is characterized by changes in the pulmonary vasculature and endothelial dysfunction. These microvascular changes are also present in periphery, observed with nailfold video-capillaroscopy (NVC) [2]. NVC findings may help to identify patients at a significant high risk of future development of PAH [3].ObjectivesThe aim of our work is to analyze the clinical and demographic features and nailfold capillary changes of patients with SLE-related PAH compared to a group of SLE patients without PAH.MethodsWe identified and selected 20 patients with SLE and type I PAH and collected demographic, clinical and laboratory features from 8 rheumatology centers across Europe. We could perform NVC on 9 patients. We selected as controls 68 patients with SLE who underwent cardiopulmonary screening to exclude PAH: we collected demographic, clinical and laboratory features and performed NVC. The presence of SD pattern was assessed as previously described [4]. Patients satisfied the 2019 EULAR/ACR SLE classification criteria. We excluded patients with a diagnosis of mixed tissue disease and overlap syndrome.ResultsDemographic and clinical features of patients with SLE-PAH and SLE controls are shown in Table 1. All patients with SLE-PAH were female, age and disease duration were not different between the 2 groups. LAC+ and anti-RNP+ was more prevalent in patients with SLE-PAH. No differences were observed for anti-Sm, anti-Ro, anti-La and anti-phospholipid antibodies. Of clinical features, skin and CNS involvement were more prevalent in patients with SLE-PAH than in SLE controls. Raynaud’s phenomenon was more prevalent in patients with SLE-PAH than in SLE controls. In patients with SLE-PAH we observed a significantly higher prevalence of scleroderma pattern at NVC than in controls: patients with SLE-PAH showed a lower number of capillary density and a higher frequency of megacapillaries. In multivariate analysis, Raynaud phenomenon and anti-RNP are predictors of PAH in patients with SLE. The McFadden’s R-squared for the model is 0.30.ConclusionOur data show that LAC+, RNP+, Raynaud’s, Skin and CNS involvement and a SD pattern at NVC is more prevalent in patients with SLE PAH than in patients with SLE without PAH. Our results point to a generalized microvascular involvement and a hypercoagulation state in patients with SLE PAH. The variables we identified could be used to implement a screening algorithm to identify patients with SLE with a high risk of developing PAH.

Methods of complementary and alternative medicine (CAM) are appealing for many patients with rheumatic diseases. The scientific data are currently characterized by alarge number of publications that stand in contrast to aremarkable shortage of valid clinical studies. The applications of CAM procedures are situated in an area of conflict between efforts for an evidence-based medicine and high-quality therapeutic concepts on the one hand and ill-founded or even dubious offers on the other hand. In 2021 the German Society of Rheumatology (DGRh) launched acommittee for CAM and nutrition, which aims to collect and to evaluate the current evidence for CAM applications and nutritional medical interventions in rheumatology, in order to elaborate recommendations for the clinical practice. The current article presents recommendations for nutritional interventions in the rheumatological routine for four areas: nutrition, Mediterranean diet, ayurvedic medicine and homeopathy.