Christina Duftner

Objective: Ultrasonography is crucial for diagnosing giant cell arteritis (GCA); however, training opportunities are rare. This study tested the reliability of ultrasonography findings and measurements of the intima-media thickness (IMT) among ultrasonography experts by using phantoms of the axillary (AA) and temporal arteries (TA) created with high-resolution 3D printing. Methods: Twenty-eight participants from 12 European countries received eight sets of phantoms of the AA and the superficial TA (including common, frontal and parietal branches), which were examined in a blinded fashion according to a predefined protocol and evaluated based on Outcome Measures in Rheumatology (OMERACT) GCA ultrasound definitions. Due to difficulties with the delineation of the intima-media complex, the parietal branch of the phantoms was modified, and a second round was conducted. The IMT was measured, and phantoms were classified as normal or vasculitic. Results: In both rounds, the phantoms were correctly classified as normal/abnormal in >81% of cases yielding a Fleiss’ kappa of 0.80 (95% CI 0.78 to 0.81) in round 1 and 0.74 (95% CI 0.72 to 0.75) in round 2. IMT measurements revealed an intraclass correlation coefficient (ICC 1.1) of 0.98 (95% CI 0.98 to 0.99) in both rounds. Intrarater reliability was good with a median Cohens Kappa of 0.83 and median ICC of 0.78. Conclusion: The study demonstrated high reliability among ultrasound experts in applying the OMERACT ultrasound definitions for GCA and in measuring the IMT using a 3D-printed phantom of the AA and TA. This phantom could assist clinicians in training to assess the large arteries of patients with suspected or established GCA.

Objective To test the reliability of the Outcome Measures in Rheumatology Giant cell arteritis (GCA) Ultrasonography Score (OGUS) and other composite scores in a patient-based exercise involving experts and non-experts in vascular ultrasonography. Methods Six GCA patients were scanned twice (two rounds separated ≥3 hours) by 12 experts and 12 non-experts. Non-experts received 90 min of theoretical and 240 min of practical training between rounds 1 and 2. Ultrasonography was conducted on temporal arteries (common superficial, frontal and parietal branches) and axillary arteries bilaterally to calculate the OGUS, the Southend score and the Halo count. Inter-reader and intra-reader reliability were assessed by intraclass correlation coefficient (ICC). Results Mean age of GCA patients was 78±5.1 years, 2 (33.3%) were women, and all were in clinical remission. Expert inter-reader ICC of the OGUS was 0.60 in both rounds, 0.40 in round 1 and 0.51 in round 2 for the Southend score and 0.45 and 0.52, respectively, for the Halo count. Median ICCs for intra-reader reliability were 0.86, 0.73 and 0.65 for the OGUS, Southend score and Halo count, respectively. For non-experts, inter-reader ICCs in round 1 were 0.20 for the OGUS, 0.20 for a normalised Southend score (=score divided by available segments) and 0.35 for a normalised Halo count. After training, inter-reader reliability ICCs improved to 0.52, 0.29 and 0.54, respectively. Conclusion Inter-reader reliability was fair to moderate, and intra-reader reliability was good for OGUS, Southend score and Halo count among experts. Inter-reader reliability of non-experts in vascular ultrasonography improved after the training.

To determine the association of cardiovascular atherosclerotic plaque monosodium urate deposits with the occurrence of major cardiovascular events in gout and hyperuricemia patients. This retrospective cohort study included patients with clinically suspicion of gout, who performed a dual energy computed tomography of the affected limb and thorax between 1 June 2012 and 5 December 2019. Clinical and laboratory parameters were retrieved from patients’ charts. Established cardiovascular risk factors were evaluated. Medical history review identified the presence of major adverse cardiac events with a median follow-up time of 33 months (range 0–108 months) after the performed computed tomography scan. Full data sets were available for 189 patients: 131 (69.3%) gout patients, 40 (21.2%) hyperuricemia patients and 18 (9.5%) controls. Patients with cardiovascular monosodium urate deposits (n = 85/189, 45%) revealed increased serum acute phase reactants, uric acid levels and calcium scores in computed tomography compared with patients without cardiovascular monosodium urate deposits. Major adverse cardiac events were observed in 35 patients (18.5%) with a higher prevalence in those patients revealing cardiovascular monosodium urate deposits (n = 22/85, 25.9%) compared with those without cardiovascular monosodium urate deposits (n = 13/104, 12.5%, OR 2.4, P = 0.018). This is the first study demonstrating the higher hazard of major adverse cardiac events in patients with dual energy computed tomography-verified cardiovascular monosodium urate deposits. The higher prevalence of cardiac events in patients with cardiovascular monosodium urate deposits may facilitate risk stratification of gout patients, as classical cardiovascular risk scores or laboratory markers fail in their proper identification.

Objectives: The primary aim of the CHANGE survey is to determine the current state of gender equity within rheumatology, and secondarily, to review the physician perspective on bullying, harassment and equipoise of opportunities within rheumatology. Methods: The CHANGE e-survey is a cross-sectional self-reported questionnaire adapted from EULAR’s gender equity in academic rheumatology task force. The survey was launched in January 2023; it is available in six languages and distributed widely via rheumatology organizations and social media. Eligible participants include rheumatologist physicians and rheumatology health-care professionals. Survey responses will undergo descriptive analysis and inter-group comparison aiming to explore gender-based discrimination using logistic regression, with subgroup analyses for country/continent variations. Conclusion: This e-survey represents a comprehensive global initiative led by an international consortium, aimed at exploring and investigating the gender-related disparities and obstacles encountered by rheumatologists and rheumatology health-care professionals across diverse communities and health-care environments. By pursuing this initiative, we aim to take the broader rheumatology community a step closer to understanding the underlying origins of inequities and their determinants. Such insights are pivotal in identifying viable interventions and strategies to foster gender equity within the field. Ultimately, our collective objective is to ensure equitable access to opportunities for every individual, irrespective of gender, thereby promoting inclusivity and fairness across the entire spectrum of professional practice and career development.

Anemia of inflammation (AI) is frequently present in subjects with inflammatory disorders, primarily caused by inflammation‐driven iron retention in macrophages. So far, only limited data on qualitative and quantitative estimates of tissue iron retention in AI patients exist. We performed a prospective cohort study analyzing splenic, hepatic, pancreatic, and cardiac iron content with MRI‐based R2*‐relaxometry in AI patients, including subjects with concomitant true iron deficiency (AI+IDA) hospitalized between 05/2020–01/2022. Control groups were individuals without inflammation. Spleen R2* values in AI patients with ferritin ≤200 μg/L (AI+IDA) were comparable with those found in controls. In AI patients with ferritin >200 μg/L, spleen (47.6 s⁻¹ vs. 19.3 s⁻¹, p < .001) and pancreatic R2* values (32.5 s⁻¹ vs. 24.9 s⁻¹, p = .011) were significantly higher compared with controls, while liver and heart R2*‐values did not differ. Higher spleen R2* values were associated with higher ferritin, hepcidin, CRP, and IL‐6 concentrations. Spleen R2* values normalized in AI patients after recovery (23.6 s⁻¹ vs. 47.6 s⁻¹, p = .008), while no changes were found in patients with baseline AI+IDA. This is the first study investigating tissue iron distribution in patients with inflammatory anemia and AI with concomitant true iron deficiency. The results support the findings in animal models demonstrating iron retention in macrophages, which are primarily accumulating in the spleen under inflammatory conditions. MRI‐related iron measurement may help to better characterize actual iron needs and to define better biomarker thresholds in the diagnosis of true ID in patients with AI. It may qualify as a useful diagnostic method to estimate the need for iron supplementation and to guide therapy.

While >50% of medical students and residents are women, their proportion drastically diminishes within higher ranks and leadership roles; this is known as the ‘leaky pipeline’. We aimed to evaluate the leaky pipeline among rheumatologists across Europe and to assess determinants inducing rheumatologists to leave hospitals. Experts in the field of economics developed a questionnaire with scientific focus on the leaky pipeline among rheumatologists, which was distributed electronically by national scientific societies of EULAR countries and by individual contacts. We performed common factor analysis, univariate t-tests and multivariate regression analyses to appraise our dataset. A total of 311 hospital-based rheumatologists from 23/45 EULAR countries (52.7% females, 47.3% males) answered the questionnaire. The presence of the leaky pipeline was evident for the entire sample. Of 64% female rheumatologists only 34.2% of departments’ directors were female, with noteworthy regional differences. Female doctors reported higher intentions to leave their hospital (β = 0.28, P < 0.05) and lower commitment towards their current organization (β = –0.34, P < 0.05) when compared with males. Women reported lower levels of job satisfaction (β = –0.26, P < 0.10), promotion justice (β = –0.55, P < 0.01) and career perspectives (β = –0.26, P < 0.10, one-tailed) than men, explaining their lower organizational commitment. Female rheumatologists perceive worse job opportunities and satisfaction than males. Many reasons for the leaky pipeline are beyond the control of organizations. Based on our results, organizations should be encouraged to reconsider and adjust their performance management practices to enable an equitable work environment.