Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2021
[Diagnostic approach and differential diagnosis of mon- and oligoarthritis].
Reasons of mon- and oligoarthritis are heterogeneous. The diagnostic approach includes a detailed medical anamnesis, physical examination and imaging (conventional X-ray, sonography, MRI and, CT). ⋯ In addition to crystal arthropathies and septic arthritis, differential diagnosis of mon-/oligoarthritis includes reactive arthritis, arthrosis and monarthritic courses of SpA/PsA. A rheumatologist should be consulted particularly in the case of persistent monarthritides, in order to initiate a specific therapy to prevent secondary damage.
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Polyarthritis is defined by the palpable synovitic swelling of more than 4 joints. Polyarthritis is always due to a systemic disease and not a local process. ⋯ It is also important to differentiate arthritis from osteoarthrosis. The objective of this paper is to give an overview on patient history, clinical presentation, diagnostic investigations and the differential diagnosis of the most common diseases that present as polyarthritis.
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CARDIOVASCULAR RISK PROFILE OF PATIENTS WITH INFLAMMATORY ARTHRITIS: Patients with inflammatory arthritis have an increased risk of cardiovascular disease compared to the general population. The discovery of this fact dates back to over a decade ago, but cardiovascular morbidity and mortality in these patients have not yet significantly improved. In 2021, the management of cardiovascular risk in patients with inflammatory arthritis remains an important aspect for general practitioners, rheumatologists and researchers. ⋯ Tumor necrosis factor α inhibitors, for instance, reduce cardiovascular event rate by 15 %. Data on methotrexate is less robust but also suggests a protective effect in patients with inflammatory arthritis. Studies on the relatively new janus kinase inhibitors are expected to provide new data in the coming years.
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Dtsch. Med. Wochenschr. · Apr 2021
[When to test in biomarker-stratified therapy of non-small cell lung cancer - Biomarker-stratified therapy of Non-small cell lung cancer: when and what to test?]
Therapy of non-small cell lung cancer (NSCLC) should be based on biomarker test results in the palliative setting. To this end, testing of all patients in stage IV and in the future also in the earlier stages will be important. In a conference with the patronage of the German Cancer Society, the question of "reflex testing", i.e. independently of tumor stage, was discussed but not deemed to be acceptable. The current report summarizes the results of the consensus conference and discusses possible paths to efficent biomarker testing in NSCLC.
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A common intuition says the death of a younger person is more tragic, since older people could already live through more "innings" of their life. The most important reason against using age as a criterion in triage is however the infinite value of the other: In a relationship of responsibility and care, which is the functional base of medicine also in situations of emergency, the life of each other has infinite value, and therefore cannot be weighed against each other.