Christina Gebhardt

To give further insights into the safety of SARS-CoV-2 vaccinations in patients with inflammatory rheumatic diseases (IRDs) compared to healthy individuals and to highlight changes over the course of repeated vaccinations. In this single-centre study, SARS-CoV-2 vaccinated IRD patients were recruited from the hospital of the University of Munich. Healthcare workers served as the control group. Adverse events following each vaccination were assessed using questionnaires. Descriptive statistics and non-parametric tests were used to illustrate the differences between IRD patients and the control group. Between January 1, 2021, and Septemper 30, 2022, 235 IRD patients (60.4% female) and 102 healthy individuals (66.7% female) were enrolled in this study. The frequency of patients who experienced adverse events after the first vaccination (140 [59.6%]) was significantly lower compared to the control group (86 [84.3%]) (OR = 0.274 [95% CI: 0.151–0.497]; P < 0.0001). The same was true after the second vaccination (patients: 138 [58.7%]; controls: 80 [78.4%]) (OR = 0.391 [0.228–0.670]; P < 0.001), and after the third vaccination (123 [56.4%]; 70 [69.3%]) (OR = 0.573 [0.348–0.946]; P = 0.029). Local side effects occurred with similar frequency in both groups. However, systemic effects occurred significantly less frequently in patients after all vaccinations than in controls (1. vaccination 97 [41.3%] to 61 [59.8%]: OR = 0.472 [0.294–0.759], P = 0.002; 2. vaccination 91 [38.7%] to 60 [58.8%]: OR = 0.442 [0.275–0.710], P < 0.001; 3. vaccination: 85 [39.0%] to 52 [51.5%]: OR = 0.602 [0.374–0.969], P = 0.036). SARS-CoV-2 vaccines were well tolerated by patients with IRDs. They experienced systemic side effects less frequently in patients than in healthy controls, suggesting a possible association between IRDs/immunosuppressive therapies and attenuation of vaccination reactions. Further research is needed to determine the cause of these differences.

Zusammenfassung Die Labordiagnostik spielt in der Rheumatologie eine entscheidende Rolle. Neben diversen Autoantikörpern helfen auch molekulargenetische Untersuchungen bei der Einordnung unterschiedlichster Symptomkomplexe und letztlich der Diagnosestellung. Klinisch von Bedeutung sind hier einerseits die HLA-Allele wie HLA-B51 im Kontext des Morbus Behçet, aber auch der Nachweis von Mutationen monogen vererbter hereditärer Fiebersyndrome, z. B. im MEVF-Gen beim familiären Mittelmeerfieber. Wichtig bei der Veranlassung genetischer Untersuchungen ist es, die rechtlichen Grundlagen wie die Aufklärungspflicht sowie die Rechte der Patienten zu kennen. Darüber hinaus sollte man sich die klinischen und epidemiologischen Merkmale der unterschiedlichen Erkrankungen bewusst machen, um so eine möglichst zielgerichtete Diagnostik in die Wege leiten zu können. Denn genau wie bei der Antikörperdiagnostik gilt auch bei genetischen Untersuchungen in der Rheumatologie der Grundsatz, dass entsprechende Ergebnisse immer im klinischen Kontext zu interpretieren sind und nie für sich allein genommen eine diagnostische oder gar therapeutische Relevanz nach sich ziehen.

Background: Early diagnosis of giant cell arteritis (GCA) is crucial to avoid loss of vision, but detailed headache characteristics of GCA have been poorly studied. Clinical prediction rules have shown promise in guiding management decisions in suspected GCA. Methods: This is a prospective, monocentric cohort study on patients ≥50 years of age with suspected GCA. The diagnostic efficacy and safety of a previously published prediction rule embedded in a stepwise diagnostic algorithm is compared to the final clinical diagnosis incorporating the results of temporal artery biopsy (TAB). The protocol of the ongoing study is presented in detail. Based on an interim analysis of the first 50 included patients, characteristics of cranial symptoms of patients with positive and negative TAB are compared, and a modification of the original prediction rule is presented. Results: TAB was positive in 23 and negative in 26 cases. In one patient, the TAB specimen contained no arterial segment, so this patient was excluded from the interim analysis. Headache was more commonly located temporally and bilaterally. Cranial ischemic symptoms and superficial temporal artery-related symptoms were more common in patients with positive TAB. The quality and intensity of headaches did not differ significantly between groups. As the original prediction rule misclassified a single patient who eventually had a positive TAB, the clinical prediction rule was modified. Conclusions: Given the limited sensitivity and specificity of cranial symptoms, a stepwise diagnostic algorithm based on the modified prediction rule may facilitate clinical decision-making in suspected GCA.