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ObjectiveThe Assessment of Spondyloarthritis international Society Health Index (ASAS HI) measures global functioning and health in patients with axial spondyloarthritis (axSpA) covering domains of physical, emotional, and social functioning. The main aim of this study was to investigate the sensitivity to change of ASAS HI in comparison with established variables of disease activity, function, and mental health.MethodsPatients with axSpA from the disease register RABBIT-SpA with follow-up time of at least 12 months and available ASAS HI questionnaires were included. Patients received questionnaires addressing disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], Ankylosing Spondylitis Disease Activity Score [ASDAS]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), mental health (5-item World Health Organization Well-Being Index [WHO-5]), and global functioning (ASAS HI). Standardized response means (SRMs) were calculated to compare the sensitivity to change of different variables.ResultsSix hundred and sixty-seven patients were included, 552 treated with biologic disease-modifying antirheumatic drugs (bDMARDs) and 115 with conventional synthetic DMARDs and/or nonsteroidal antiinflammatory drugs (control group). Between baseline and month 12, the mean ASAS HI declined from 6.9 to 5.1 in the bDMARD group and from 5.9 to 5.6 in the conventionally treated group. In the bDMARD group, the SRM of ASAS HI was 0.52, compared to 0.59 for BASFI, 0.65 for WHO-5, 0.73 for BASDAI, and 0.90 for ASDAS. The following ASAS HI domains were most frequently affected: pain (78% agreed), maintaining body position (75%), and energy/drive (73%). In the patients receiving bDMARDs, there was an improvement in all items. In the control group, the largest improvement was seen in pain.ConclusionAs expected, ASDAS and BASDAI as disease activity scores showed high sensitivity to change, whereas changes in physical function (BASFI), mental health (WHO-5), and the broader concept of functioning and health (ASAS HI) were moderate.

Funding The study received support from the American College of Rheumatology (ACR) and European Alliance of Associations for Rheumatology (EULAR). OBJECTIVES: To investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS: Demographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression. RESULTS: Of 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25-2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39-2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42-0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19. CONCLUSION: Older age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics. publishersversion published

BackgroundPsoriatic arthritis (PsA) and axial spondyloarthritis (axSpA) show certain overlaps: A subset of patients with PsA can develop axial involvement (axial PsA, axPsA), while a subset of patients with axSpA presents with psoriasis (axSpA+pso). Treatment strategy for axPsA is mostly based on axSpA evidence.ObjectivesTo compare demographic and disease-specific parameters of axPsA and axSpA+pso.MethodsRABBIT-SpA is a prospective longitudinal cohort study. AxPsA was defined based on (1) clinical judgement by rheumatologists; (2) imaging (sacroiliitis according to modified New York criteria in radiographs or signs of active inflammation in MRI or syndesmophytes/ankylosis in radiographs or signs of active inflammation in spine MRI). axSpA was stratified into axSpA+pso and axSpA without pso.ResultsPsoriasis was documented in 181/1428 axSpA patients (13%). Of 1395 PsA patients, 359 (26%) showed axial involvement. 297 patients (21%) fulfilled the clinical definition and 196 (14%) the imaging definition of axial manifestation of PsA. AxSpA+pso differed from axPsA regardless whether clinical or imaging definition was used. axPsA patients were older, more often female and less often HLA-B27+. Peripheral manifestations were more often present in axPsA than in axSpA+pso, whereas uveitis and inflammatory bowel disease were more common in axSpA+pso. Burden of disease (patient global, pain, physician global) was similar among axPsA and axSpA+pso patients.ConclusionsAxPsA differs from axSpA+pso in its clinical manifestations, irrespective of whether axPsA is defined clinically or by imaging. These findings support the hypothesis that axSpA and PsA with axial involvement are distinct entities, so extrapolation of treatment data from randomised controlled trials in axSpA should be performed with caution.

ObjectivesTo investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).MethodsDemographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression.ResultsOf 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25–2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39–2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42–0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19.ConclusionOlder age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.

Objective This study aimed to update the prevalence estimates of inflammatory rheumatic diseases (IRD) in Germany. Methods A systematic literature search in PubMed and Web of Science (last search 08 November 2022) identified original articles (regional and nationwide surveys and claims data analyses for arthritides, connective tissue diseases, and vasculitides) on prevalences for the period 2014–2022. Data sources, collection period, case definition, and risk of bias are reported. Prevalences were estimated from available national data, with consideration of international data. Results Screening by two authors yielded 263 hits, of which 18 claims data analyses and 2 surveys met the inclusion criteria. Prevalences ranged from 0.42 to 1.85% (rheumatoid arthritis), 0.32–0.5% (ankylosing spondylitis), 0.11–0.32% (psoriatic arthritis), 0.037–0.14% (systemic lupus erythematosus), 0.07–0.77% (Sjögren’s disease/sicca syndrome), 0.14–0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04–0.05% (giant cell arteritis, ≥ 50 years), and 0.015–0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2–3.0%, which corresponds to approximately 1.5–2.1 million affected individuals. The prevalence of juvenile idiopathic arthritis was reported to be around 0.10% (0.07–0.10%) of 0–18-year-olds, corresponding to about 14,000 children and adolescents in Germany. Conclusion This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on claims data analyses. In the absence of multistage population studies, the available data are, overall, uncertain sources for prevalence estimates, with a moderate to high risk of bias.

Published by Elsevier Ltd., Background: Differences in the distribution of individual-level clinical risk factors across regions do not fully explain the observed global disparities in COVID-19 outcomes. We aimed to investigate the associations between environmental and societal factors and country-level variations in mortality attributed to COVID-19 among people with rheumatic disease globally. Methods: In this observational study, we derived individual-level data on adults (aged 18-99 years) with rheumatic disease and a confirmed status of their highest COVID-19 severity level from the COVID-19 Global Rheumatology Alliance (GRA) registry, collected between March 12, 2020, and Aug 27, 2021. Environmental and societal factors were obtained from publicly available sources. The primary endpoint was mortality attributed to COVID-19. We used a multivariable logistic regression to evaluate independent associations between environmental and societal factors and death, after controlling for individual-level risk factors. We used a series of nested mixed-effects models to establish whether environmental and societal factors sufficiently explained country-level variations in death. Findings: 14 044 patients from 23 countries were included in the analyses. 10 178 (72·5%) individuals were female and 3866 (27·5%) were male, with a mean age of 54·4 years (SD 15·6). Air pollution (odds ratio 1·10 per 10 μg/m3 [95% CI 1·01-1·17]; p=0·0105), proportion of the population aged 65 years or older (1·19 per 1% increase [1·10-1·30]; p, MAG is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K01 AR070585 and K24 AR074534 [JY]). KDW is supported by the Department of Veterans Affairs and the Rheumatology Research Foundation Scientist Development award. JAS is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant numbers K23 AR069688, R03 AR075886, L30 AR066953, P30 AR070253, and P30 AR072577), the Rheumatology Research Foundation (K Supplement Award and R Bridge Award), the Brigham Research Institute, and the R. Bruce and Joan M. Mickey Research Scholar Fund. NJP is supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (T32-AR-007258). AD-G is supported by grants from the Centers for Disease Control and Prevention and the Rheumatology Research Foundation. RH was supported by the Justus-Liebig University Giessen Clinician Scientist Program in Biomedical Research to work on this registry. JY is supported by grants from the National Institutes of Health (K24 AR074534 and P30 AR070155).

Zusammenfassung Zielsetzung Es erfolgt eine aktualisierte Schätzung der Prävalenz entzündlich rheumatischer Erkrankungen (ERE) in Deutschland. Methodik Mit einer systematischen Literaturrecherche in PubMed und Web of Science (letzte Suche am 08.11.2022) wurden Originalartikel (regionale und bundesweite Surveys und Routinedatenanalysen für Arthritiden, Kollagenosen und Vaskulitiden) zur Prävalenz von ERE für den Zeitraum 2014 bis 2022 identifiziert. Datenquellen, Erhebungszeitraum, Diagnosedefinition und das Risiko einer Verzerrung werden berichtet. Die Prävalenzen wurden anhand der verfügbaren Daten unter Berücksichtigung internationaler Angaben geschätzt. Ergebnisse Die Suche durch 2 Autorinnen ergab 263 Treffer, von denen 18 Routinedatenanalysen und 2 Surveys die Einschlusskriterien erfüllten. Die Prävalenzangaben lagen bei 0,42–1,85 % (rheumatoide Arthritis), 0,32–0,5 % (ankylosierende Spondylitis), 0,11–0,32 % (Psoriasisarthritis), 0,037–0,14 % (systemischer Lupus erythematodes), 0,07–0,77 % (Sjögren/Sicca-Syndrom), 0,14–0,15 % (Polymyalgia rheumatica, ab 40 Jahre), 0,04–0,05 % (Riesenzellarteriitis, ab 50 Jahre) und 0,015–0,026 % (ANCA-assoziierte Vaskulitis). Das Bias-Risiko war in 13 Studien moderat, in 7 Studien hoch. Anhand dieser Ergebnisse schätzen wir die Prävalenz von ERE in Deutschland auf 2,2–3,0 %. Dies entspricht in etwa 1,5 bis 2,1 Mio. Betroffenen. Die Prävalenz der juvenilen idiopathischen Arthritis wurde mit ca. 0,10 % (0,07–0,13 %) der 0‑ bis 18-Jährigen angegeben, was etwa 14.000 Kindern und Jugendlichen in Deutschland entspricht. Schlussfolgerung Dieses systematische Review zeigt einen Anstieg der Prävalenzen von ERE in Deutschland, basiert jedoch fast ausschließlich auf Routinedatenanalysen. In Ermangelung mehrstufiger Bevölkerungsstudien sind die vorliegenden Daten bei moderat bis hohem Verzerrungsrisiko insgesamt unsichere Quellen für Prävalenzschätzungen.

To update the estimated prevalence of inflammatory rheumatic diseases (IRD) in Germany.A systematic literature search in PubMed and Web of Science (last search 8 November 2022) identified original articles (regional and nationwide surveys and routine data analyses for arthritides, connective tissue diseases, and vasculitides) on the prevalence for the period 2014-2022. Data sources, collection period, case definition, and risk of bias are reported. The prevalences were estimated from available national data, with consideration of international data.Screening by 2 authors yielded 263 hits, of which 18 routine data analyses and 2 surveys met the inclusion criteria. Prevalence data ranged from 0.42% to 1.85% (rheumatoid arthritis), 0.32-0.5% (ankylosing spondylitis), 0.11-0.32% (psoriatic arthritis), 0.037-0.14% (systemic lupus erythematosus), 0.07-0.77% (Sjoegren's disease/sicca syndrome), 0.14-0.15% (polymyalgia rheumatica, ≥ 40 years), 0.04-0.05% (giant cell arteritis, ≥ 50 years), and 0.015-0.026% (ANCA-associated vasculitis). The risk of bias was moderate in 13 and high in 7 studies. Based on the results, we estimate the prevalence of IRD in Germany to be 2.2-3.0%, which corresponds to approximately 1.5-2.1 million affected individuals. Prevalence data of juvenile idiopathic arthritis was reported to be around 0.10% (0.07-0.10%) of patients 0-18 years old, corresponding to about 14,000 children and adolescents in Germany.This systematic review shows an increase in the prevalence of IRD in Germany, which is almost exclusively based on routine data analyses. In the absence of multistage population studies, the available data are overall uncertain sources for prevalence estimates at moderate to high risk of bias.ZIELSETZUNG: Es erfolgt eine aktualisierte Schätzung der Prävalenz entzündlich rheumatischer Erkrankungen (ERE) in Deutschland.Mit einer systematischen Literaturrecherche in PubMed und Web of Science (letzte Suche am 08.11.2022) wurden Originalartikel (regionale und bundesweite Surveys und Routinedatenanalysen für Arthritiden, Kollagenosen und Vaskulitiden) zur Prävalenz von ERE für den Zeitraum 2014 bis 2022 identifiziert. Datenquellen, Erhebungszeitraum, Diagnosedefinition und das Risiko einer Verzerrung werden berichtet. Die Prävalenzen wurden anhand der verfügbaren Daten unter Berücksichtigung internationaler Angaben geschätzt.Die Suche durch 2 Autorinnen ergab 263 Treffer, von denen 18 Routinedatenanalysen und 2 Surveys die Einschlusskriterien erfüllten. Die Prävalenzangaben lagen bei 0,42–1,85 % (rheumatoide Arthritis), 0,32–0,5 % (ankylosierende Spondylitis), 0,11–0,32 % (Psoriasisarthritis), 0,037–0,14 % (systemischer Lupus erythematodes), 0,07–0,77 % (Sjögren/Sicca-Syndrom), 0,14–0,15 % (Polymyalgia rheumatica, ab 40 Jahre), 0,04–0,05 % (Riesenzellarteriitis, ab 50 Jahre) und 0,015–0,026 % (ANCA-assoziierte Vaskulitis). Das Bias-Risiko war in 13 Studien moderat, in 7 Studien hoch. Anhand dieser Ergebnisse schätzen wir die Prävalenz von ERE in Deutschland auf 2,2–3,0 %. Dies entspricht in etwa 1,5 bis 2,1 Mio. Betroffenen. Die Prävalenz der juvenilen idiopathischen Arthritis wurde mit ca. 0,10 % (0,07–0,13 %) der 0‑ bis 18-Jährigen angegeben, was etwa 14.000 Kindern und Jugendlichen in Deutschland entspricht.Dieses systematische Review zeigt einen Anstieg der Prävalenzen von ERE in Deutschland, basiert jedoch fast ausschließlich auf Routinedatenanalysen. In Ermangelung mehrstufiger Bevölkerungsstudien sind die vorliegenden Daten bei moderat bis hohem Verzerrungsrisiko insgesamt unsichere Quellen für Prävalenzschätzungen.

To make research responsible and research outcomes meaningful, it is necessary to communicate our research and to involve as many relevant stakeholders as possible, especially in application-oriented—including information and communications technology (ICT)—research. Nowadays, stakeholder engagement is of fundamental importance to project success and achieving the expected impact and is often mandatory in a third-party funding context. Ultimately, research and development can only be successful if people react positively to the results and benefits generated by a project. For the wider acceptance of research outcomes, it is therefore essential that the public is made aware of and has an opportunity to discuss the results of research undertaken through two-way communication (interpersonal communication) with researchers. Responsible Research and Innovation (RRI), an approach that anticipates and assesses potential implications and societal expectations regarding research and innovation, aims to foster inclusive and sustainable research and innovation. Research and innovation processes need to become more responsive and adaptive to these grand challenges. This implies, among other things, the introduction of broader foresight and impact assessments for new technologies beyond their anticipated market benefits and risks. Therefore, this article provides a structured workflow that explains “how to develop a stakeholder engagement plan” step by step.

Hintergrund und Stand (inter)nationaler Forschung: Die Psoriasis-Arthritis (PsA) ist eine chronisch entzündliche Erkrankung, die den Bewegungsapparat, die Haut und die Nägel betrifft. Die Diagnose und Versorgung der PsA-Patient*innen erfolgt in Deutschland in der Regel durch Dermatolog*innen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: COVID-19-Impfungen reduzieren nachweislich das Risiko für schwere Verläufe einer SARS-CoV-2-Infektion. Auch bei Patienten mit entzündlich-rheumatischen Erkrankungen (ERE) und bei Patienten unter Immunmodulation konnte mehrheitlich eine ausreichende humorale Immunantwort auf [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: Psoriasis-Arthritis (PsA) ist eine chronisch-entzündliche Erkrankung, bei der das muskuloskeletale System (periphere Arthritis, Achsenskelettbeteiligung, Enthesitis) sowie Haut und Hautanhang betroffen sind. Diagnostische Kriterien für die axiale Beteiligung sind bisher nicht ausreichend [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: Zu Beginn der Impfkampagne herrschte Ungewissheit bezüglich der Verträglichkeit und Sicherheit der neuartigen Impfstoffe gegen SARS-CoV-2 bei Patienten mit rheumatischen Erkrankungen (RE) mit und ohne Immunmodulation. Es lagen insbesondere keine Daten bezüglich der Verträglichkeit [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: Die Psoriasis-Arthritis (PsA) ist eine chronisch entzündliche Erkrankung, die den Bewegungsapparat, die Haut und die Nägel betrifft. Die therapeutische Betreuung erfolgt in der Regel durch Dermatolog*innen oder Rheumatolog*innen. Ziel der Untersuchung ist es, Patient*innen [zum vollständigen Text gelangen Sie über die oben angegebene URL]

Einleitung: Seit Beginn der Pandemie haben Virusmutationen, Zulassung von Impfstoffen, Medikamente zur Therapie von COVID-19 sowie der fortschreitende Informationsgewinn zum Umgang mit dem Coronavirus Einfluss auf den Verlauf der Pandemie genommen. Zur Frage, inwieweit sich die klinischen Verläufe [zum vollständigen Text gelangen Sie über die oben angegebene URL]

ZusammenfassungDurch das COVID-19-Register (www.covid19-rheuma.de) der Deutschen Gesellschaft für Rheumatologie erfolgte erstmalig die Erfassung und systematische Evaluation einer viralen Infektion bei Patienten mit entzündlich rheumatischen Erkrankungen (ERE). Hierdurch war und ist eine schnelle Generierung von wissenschaftlichen Daten möglich, welche helfen, die Betreuung von Patienten mit ERE im Rahmen der Pandemie zu verbessern. Neben der Bestätigung allgemeiner Risikofaktoren – auch für Patienten mit ERE – wie Patientenalter und Komorbiditäten (z. B. kardiovaskuläre, chronische Lungen- und Nierenerkrankungen) konnten die Einnahme von Glukokortikoiden und die Krankheitsaktivität der rheumatischen Erkrankung als krankheitsspezifische Risikofaktoren für die Notwendigkeit einer stationären Behandlung wegen COVID-19 identifiziert werden. Auswertungen der kontinuierlich wachsenden Kohorte von Patienten mit entzündlich rheumatischen Erkrankungen und einer COVID-19-Infektion erlauben, Handlungsempfehlungen für die Betreuung der Patienten auf eine bessere Evidenz zu stützen. Die Kooperation mit internationalen rheumatologischen Registern (z. B. europäisches COVID-19-Register für ERE) ermöglicht Analysen aggregierter Kohortendaten von Patienten mit entzündlich rheumatischen Erkrankungen und einer SARS-CoV-2-Infektion für internationale Vergleiche und statistisch noch besser abgesicherte Aussagen.

ZusammenfassungUm für die Behandlung der rheumatoiden Arthritis unter der Vielzahl an zugelassenen krankheitsmodifizierenden Antirheumatika die geeignete Therapie auszuwählen, werden Patienten anhand ihres Risikos für einen ungünstigen Krankheitsverlauf stratifiziert. Die Auswahl geeigneter Parameter zur Risikostratifizierung werden in dieser Übersichtsarbeit dargestellt. Beim heutigen Therapieziel einer Remission sind hohe Krankheitsaktivität, Funktionseinschränkungen, Begleiterkrankungen und Übergewicht relevante Faktoren für einen ungünstigen Verlauf. Weitere Einflussfaktoren auf die Therapieentscheidung wie Begleiterkrankungen, Infektionsrisiko und spezielle Risikokonstellationen wie vorausgegangene schwerwiegende Infektionen oder Malignome werden in diesem Artikel diskutiert.