In the present study, we investigated bone geometry, microstructure, and volumetric bone mineral density (vBMD) in a cohort of patients with nonradiographic axial spondyloarthritis (nr-axSpA) in order to define the early bone changes occurring in axial spondyloarthritis (axSpA) and to define potential factors for deterioration of bone microstructure. Patients with axSpA (n = 107) and healthy control subjects (n = 50) of similar age and sex were assessed for geometric, volumetric, and microstructural parameters of bone using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the radius. Additionally, demographic and disease-specific characteristics of patients with axSpA were recorded. Patients with nr-axSpA and control subjects were comparable in age, sex, and body mass index. Geometric and microstructural analysis by HR-pQCT revealed a significantly reduced cortical area (p = 0.022) and cortical thickness (p = 0.006) in patients with nr-axSpA compared with control subjects. Total and cortical vBMD were significantly reduced in patients with nr-axSpA (p = 0.042 and p = 0.007, respectively), whereas there was no difference in trabecular vBMD. Patients with a short disease duration (< 2 years; n = 46) also showed significant reduction of cortical thickness and cortical area compared with control subjects. Patients with disease duration > 2 years (n = 55) additionally developed a decrease of cortical and total vBMD. Multiple regression models identified male sex to be associated with lower cortical vBMD and female sex to be associated with lower trabecular vBMD. Bone microstructure in patients with nr-axSpA is characterized primarily by deterioration of cortical bone. Cortical bone loss starts early and is evident within the first 2 years of the disease.

The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.

Background: Inflammatory arthritides (IA) such as rheumatoid arthritis or psoriatic arthritis are disorders that can be difficult to comprehend for health professionals and students in terms of the heterogeneity of clinical symptoms and pathologies. New didactic approaches using innovative technologies such as virtual reality (VR) apps could be helpful to demonstrate disease manifestations as well as joint pathologies in a more comprehensive manner. However, the potential of using a VR education concept in IA has not yet been evaluated. Objective: We evaluated the feasibility of a VR app to educate health care professionals and medical students about IA. Methods: We developed a VR app using data from IA patients as well as 2D and 3D-visualized pathological joints from X-ray and computed tomography–generated images. This VR app (Rheumality) allows the user to interact with representative arthritic joint and bone pathologies of patients with IA. In a consensus meeting, an online questionnaire was designed to collect basic demographic data (age, sex); profession of the participants; and their feedback on the general impression, knowledge gain, and potential areas of application of the VR app. The VR app was subsequently tested and evaluated by health care professionals (physicians, researchers, and other professionals) and medical students at predefined events (two annual rheumatology conferences and academic teaching seminars at two sites in Germany). To explore associations between categorical variables, the χ2 or Fisher test was used as appropriate. Two-sided P values ≤.05 were regarded as significant. Results: A total of 125 individuals participated in this study. Among them, 56% of the participants identified as female, 43% identified as male, and 1% identified as nonbinary; 59% of the participants were 18-30 years of age, 18% were 31-40 years old, 10% were 41-50 years old, 8% were 51-60 years old, and 5% were 61-70 years old. The participants (N=125) rated the VR app as excellent, with a mean rating of 9.0 (SD 1.2) out of 10, and many participants would recommend use of the app, with a mean recommendation score of 3.2 (SD 1.1) out of 4. A large majority (120/125, 96.0%) stated that the presentation of pathological bone formation improves understanding of the disease. We did not find any association between participant characteristics and evaluation of the VR experience or recommendation scores. Conclusions: The data show that IA-targeting innovative teaching approaches based on VR technology are feasible.

Zusammenfassung: Hintergrund: Das Bündnis Rheumatologie fordert mithilfe der Kampagne Rheuma2025 eine Verbesserung der studentischen Ausbildung, um in Zukunft die Versorgung rheumatologischer Patientinnen und Patienten zu sichern. Fragestellung: Wir stellten uns die Frage, ob eine Kombination aus traditionellen und innovativen Lehrmethoden sowohl eine Qualitätsverbesserung der Lehre als auch eine Attraktivitätssteigerung der Fachdisziplin Rheumatologie ermöglicht. Material und Methoden: Das Lehrkonzept „Rheuma (be-)greifen“, bestehend aus 5 Modulen zu Anamnese mit Schauspielpatientinnen und -patienten, Gelenkultraschall, Gelenkpunktion, 3‑D-Druck von pathologischen Gelenken und Virtual-Reality-Applikation auf Basis realer Fälle in der curricularen Lehre von Studierenden der Humanmedizin, wurde konzipiert und etabliert. Ergebnisse: Die Evaluation des Lehrkonzeptes bei 93 Studierenden der Humanmedizin erbrachte eine durchgehend hohe Akzeptanz aller Module, welche durchwegs mit „sehr effektiv“ oder „eher effektiv“ bewertet wurden. Module, die unmittelbar auf Patientinnen und Patienten bezogen sind, wie Anamnese mit Schauspielpatientinnen und -patienten, Gelenkultraschall und -punktion, zeigte eine noch etwas höhere Akzeptanz als die Visualisierungsmethoden mittels 3‑D-Druck und VR-Applikation. Diskussion: Innovative Lehrmethoden können dabei helfen, die Akzeptanz der rheumatologischen Lehre zu stärken, insbesondere wenn klassische Lehrinhalte durch die Verwendung neuartiger Methoden unterstützt werden.

Zusammenfassung: Hintergrund/Ziel: Patientenedukation ist integraler Bestandteil der Behandlung von Patient*innen mit axialer Spondyloarthritis (axSpA). Allerdings sind die verfügbaren validen Messinstrumente zur Erhebung des krankheitsbezogenen Wissens veraltet und im Falle der axSpA nur in englischer Sprache verfügbar. Die Ziele dieser Studie waren daher (1) die Entwicklung eines geeigneten deutschsprachigen Instruments zur Messung krankheitsspezifischen Wissens bei axSpA-Patient*innen und (2) die Pilotierung dieses Instruments. Methoden: Verfügbare Messinstrumente speziell für die axSpA wurden von einem Expertengremium geprüft, und ein Entwurf des aktuellen G‑ASKQ7 wurde abgestimmt. Nach Evaluation der Augenscheinvalidität und entsprechenden Anpassungen wurden erwachsene konsekutive axSpA-Patient*innen der rheumatologischen Hochschulambulanz des Universitätsklinikums Erlangen gebeten, den Fragebogen auszufüllen. Es wurden Korrelationen zwischen dem erreichten Summenscore und weiteren erhobenen Parametern (Alter, Geschlecht und Krankheitsdauer) untersucht. Ergebnisse: Der entwickelte G‑ASKQ7-Fragebogen umfasst 7 Fragen, wurde als leicht verständlich bewertet und innerhalb von durchschnittlich 6,3 ±2,0 min ausgefüllt; 65 axSpA-Patient*innen (36 Frauen; mittleres Alter: 45,3 ± 12,4 Jahre; mittlere Erkrankungsdauer: 8,6 ±7,3 Jahre) beantworteten den finalen Fragebogen. Der G‑AKSQ7-Mittelwert lag bei 17,8/25 und war bei Frauen (19,0/25) signifikant höher als bei Männern (16,3/25) (p = < 0,05). Am häufigsten wurde Frage 7 (79,3 %) mit Hinblick auf das Selbstmanagement der Erkrankung korrekt beantwortet. Frage 4 mit Blick auf die Messung der Krankheitsaktivität wurde am schlechtesten beantwortet (55,8 %). Es konnte keine signifikante Korrelation zwischen der Krankheitsdauer (p = 0,57; r = 0,07; Pearson-Korrelationstest) oder dem Alter (p = 0,67; r = −0,05; Pearson-Korrelationstest) und dem krankheitsbezogenen Wissen festgestellt werden. Diskussion: Der G‑ASKQ7 bietet erstmals ein deutschsprachiges Instrument zur Ermittlung des krankheitsspezifischen Wissens von axSpA-Patient*innen. Durch eine routinemäßige Erhebung mittels G‑ASKQ7 kann der individuelle Wissensbedarf von Patient*innen niedrigschwellig ermittelt werden, und Edukationsinhalte können gezielt auf Patient*innen abgestimmt werden. Eine kontinuierliche Aktualisierung und weitere Evaluationsstudien sind erforderlich.

Patients at risk for rheumatoid arthritis (RA) describe fluctuating and nonspecific symptoms, making it difficult to quantify symptom burden and recognize RA progression. This study aimed to assess feasibility and diagnostic value of a multimodal digital self-monitoring program in preclinical RA. This prospective cohort study included individuals at-risk for RA, who first watched self-produced educational videos about (preclinical) RA and joint self-examination techniques and then started the REMOTRA symptom monitoring. Key outcomes measured included patient acceptance (Net Promoter Score: NPS), monitoring program usability (System usability scale: SUS), monitoring adherence, diagnostic accuracy, and reported symptom burden. A total of 43 participants (65.9% female, mean age 50.1 years) were enrolled. The educational and self-examination videos received NPS ratings of 54.4 and 31.6, respectively. The monitoring software received usability scores of 88.1/100 (SD: 5.5) at three months and 85.4/100 (SD: 16.0) at 6 months. 24/41 (58.5%) completed all questionnaires, and the average app usage was 4.8 months (SD: 1.8). None of the patients with a REMOTRA score below 10 developed RA, yielding a negative predictive value and sensitivity of 100%. However, the positive predictive value was 12%, and the specificity was 42.1%. Analgesic and cortisone usage was reported by 58.5% and 29.3% of participants, respectively. The strong patient acceptance, ease of use, and high adherence rates, combined with encouraging diagnostic outcomes, underscore the potential of this personalized digital monitoring and education approach. These findings suggest that further validation through multicenter studies is warranted.