Demographic change is expected to further aggravate the existing shortage of rheumatological care in Germany, particularly in rural regions. Increased involvement of general practitioners (GPs) and more digitalization are therefore considered promising strategies to improve care of rheumatological patients.

The antimetabolite methotrexate (MTX) was originally used in chemotherapeutic treatment for cancer. Since the early 1980s, MTX has become indispensable in the treatment of rheumatoid arthritis and is established worldwide as the standard of care for the treatment of many inflammatory rheumatic diseases. The mechanism of action of MTX is not completely understood; the adenosine signaling pathway likely plays a role. There are several undesired side-effects associated with MTX (e.g., nausea, elevated transaminase levels, and cytopenia). Based on numerous case reports, it is also postulated that there is MTX-induced osteopathy, which manifests as bone pain and insufficiency fractures. The present article presents the current data and evaluates it critically.

Dual-energy X‑ray absorptiometry (DXA) assessing the lumbar spine and bilateral proximal femurs is the current guideline-recommended standard method for quantitative measurement of bone density. The output of DXA-the T score-reflects the number of standard deviations by which the measured bone density differs from the average of a healthy young reference population. The operational World Health Organization (WHO) definition of osteoporosis is based on a T score ≤-2.5 at the femoral neck, although other measurement locations are interpreted analogously in clinical routine. Numerous studies have shown that a decrease in bone density is associated with an exponential increase in the fracture risk. However, consideration of the bone density in isolation is inadequate to predict the real fracture risk. Therefore, DXA results must always be interpreted within the context of other clinical risk factors. Additional DXA methods and further analyses can significantly improve the diagnostic accuracy.

Belimumab and anifrolumab are two biologic therapies currently employed in the management of systemic lupus erythematosus (SLE). Belimumab is approved for both SLE and lupus nephritis (LN), whereas anifrolumab is not currently approved for LN and has only been evaluated for LN in one published phase II trial. Direct head-to-head comparative data are lacking. This meta-analysis aims to indirectly compare the efficacy and safety of belimumab and anifrolumab using evidence from randomized controlled trials (RCTs).

Fibromyalgia is a chronic pain syndrome associated with a substantial physical and psychological burden. The effectiveness of pharmacological treatment is limited, whereas nonpharmacological self-management strategies, such as exercise, cognitive behavioral therapy (CBT) and mindfulness-based approaches, are recommended. These can increasingly be delivered as online programs and significantly improve access to these forms of treatment.

Chronic inflammatory diseases such as psoriasis (PsO) and psoriatic arthritis (PsA) are associated with a high disease burden and significant healthcare needs. Given limited specialist resources, the use of medical health apps is increasingly coming into focus as a means of supporting patients in self-management and closing gaps in care. This review highlights digital health applications available in Germany for PsO and PsA. Their functions, objectives, and potential benefits in the context of care are analysed. Six relevant apps were identified based on a systematic literature review and a structured search of the popular app stores. None of the applications are currently approved as digital health applications (German: DiGA). The apps differ in terms of their target groups, range of functions, and scientific evidence. While some primarily deal with dermatological aspects (e.g., Sorea, Psoriasis Monitor), others focus more on rheumatological issues (e.g., Mida Rheuma App, Rheuma-Auszeit). The range is supplemented by educational apps (e.g., PSO Kiosk) and therapy-accompanying apps (e.g., MyTherapy). Such digital apps can promote understanding of the disease, contribute to improving therapy adherence and have a positive effect on mental well-being, especially in patients with PsO and PsA, who often experience stress and mental comorbidities. Even though no app has yet achieved DiGA status, individual applications can be a useful addition to care.

The satisfaction of patients with rheumatoid arthritis (RA) influences disease control, treatment adherence and both physical and psychological well-being, which are key factors for long-term treatment success. However, due to limited physician resources, guideline-based patient-centered care cannot be universally implemented. As a response, the integration of trained rheumatological specialist assistants (RFA) into the care is evaluated as a complementary approach.

Since the 1980s, various terms have been used to describe diseases with the primary finding of sterile bone inflammation (osteitis), which is attributed to the rheumatological spectrum. Various terms, such as SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, SCCH (sternocostoclavicular hyperostosis), and ACW (anterior chest wall syndrome), are in use to describe overlapping clinical phenomena with the leading finding of sterile, nonbacterial osteitis that have not yet been classified as a uniform entity. Against this background, an international panel of experts developed statements and recommendations in 2023 and 2024 as part of a consensus process using a standardized procedure. These establish adult chronic nonbacterial osteitis (CNO) as the uniform name for the disease. In addition, 16 recommendations for diagnosis and therapy were formulated and discussed. On this basis, the clinical implementation of the consensus recommendations has the potential to significantly improve the quality of treatment for adult CNO. This is described in detail below. It is important to emphasize the independence of adult CNO as an entity, which is not a subgroup of axial spondyloarthritis (axSpA) or psoriasis arthritis (PsA), but nevertheless occurs as an overlapping disease in 20-30% of cases. Diagnosis focuses on clinical activity parameters for quantifying symptoms and targeted radiological imaging of osteitis in the affected region (preferably with magnetic resonance imaging). The consensus recommendations provide relatively specific treatment recommendations, starting with NSAIDs (for 4-12 weeks, depending on therapy response), alternatively or subsequently coxibs, then intravenous bisphosphonates (for 3-12 months, depending on therapy response), alternatively or subsequently TNFi (also for 3-12 months), whereas no specific recommendations are formulated for long-term therapies. There are specific features for the use of these therapeutic modalities in Germany that must be taken into account, particularly with regard to off-label use. Conventional DMARDs are not used for adult CNO, unless there is an indication for this in patients with overlapping PsA or axSpA.

This study aimed to reassess the diagnostic contribution of minor salivary gland biopsy (MSGB) in patients with clinically suspected Sjögren's disease (csSjD) and to assess its association with serological status, clinical features, and fulfillment of classification criteria.

Over the last 40 years, the clinical picture of chronic osteomyelitis without a microbiological cause has increasingly been described as chronic nonbacterial osteomyelitis/osteitis (CNO) in the sense of an entity. With the sharpening of the clinical picture, the disease designations became increasingly homogeneous. Consequently, an internationally agreed classification of CNO for childhood has recently been published, which is based on two studies on clinical diagnostic criteria. With regard to pathophysiology, findings have also shown that CNO can be categorised as an auto-inflammatory disease. However, it remains a diagnosis of exclusion. Quite a few differential diagnostic entities must be considered, which are almost indistinguishable from genuine CNO both clinically and morphologically. For the latter, a genetic or metabolic cause is still largely unknown, although various activations of inflammatory pathways have been described. In the meantime, the basis has been laid for conducting controlled studies in which, in addition to the classification, parameters for disease activity and suggestions for inactive disease and remission have been published.This review describes the historical development towards a now more clearly defined disease. It discusses diagnostic and therapeutic algorithms using the example of an adolescent patient with spinal and extremity manifestations.

The objective of this meta-analysis was to assess the relationships of the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) with systemic lupus erythematosus (SLE) and to determine the correlation of these indices with disease activity as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI).