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Article ; Online: A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae.

Panagiotides, Noel G / Zimprich, Fritz / Machold, Klaus / Schlager, Oliver / Müller, Markus / Ertl, Sebastian / Löffler-Stastka, Henriette / Koppensteiner, Renate / Wadowski, Patricia P

International journal of environmental research and public health

2023 Volume 20, Issue 6

Abstract: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms ...

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient's condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren's syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient's autoimmune reactions.
MeSH term(s)	Humans ; Female ; COVID-19/complications ; SARS-CoV-2 ; Paresthesia ; Small Fiber Neuropathy/etiology ; Small Fiber Neuropathy/complications ; Headache/complications ; Arthralgia
Language	English
Publishing date	2023-03-10
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2175195-X
ISSN	1660-4601 ; 1661-7827
ISSN (online)	1660-4601
ISSN	1661-7827
DOI	10.3390/ijerph20064918
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Article ; Online: Effects of a brief workplace-centered consultation for employees with musculoskeletal pain on health outcomes: a prospective cohort study.

Leiss, Harald / Hucke, Miriam / Bécède, Manuel / Machold-Fabrizii, Veronika / Smolen, Josef S / Machold, Klaus P

Scientific reports

2019 Volume 9, Issue 1, Page(s) 5867

Abstract: Musculoskeletal (MSK) diseases affect a substantial proportion of the population. Specialist consultations were offered at the workplace for people with musculoskeletal (MSK)-complaints. We analyzed data on pain and well-being as well as health economic ... ...

Abstract	Musculoskeletal (MSK) diseases affect a substantial proportion of the population. Specialist consultations were offered at the workplace for people with musculoskeletal (MSK)-complaints. We analyzed data on pain and well-being as well as health economic data at baseline. Lasting effects of the consultation were analyzed at a follow-up-interview after 12 months. Baseline data of 344 individuals were available. Occupations were divided into physically highly demanding (HD) or less demanding. Women reported significantly higher pain levels and less QoL than men. Sick leave days were significantly more in HD-workers. Independent of workload, significantly higher percentages of women had cervical- and upper limb-pain than men, with significantly higher pain in upper limbs in HD-workers. 235 participants were available for telephone-follow-up. QoL and MSK-pain improved significantly. Yearly out-of-pocket spendings for treatments significantly increased. NSAID use significantly decreased, whereas use of non-drug musculoskeletal-medical-services was significantly higher after one year. Regarding MSK-symptoms in gainfully employed individuals, the study showed significantly different workload-dependent differences in QoL. Significant effects of a consultation by a MSK-specialist were shown in terms of improved MSK-pain and overall well-being. This workplace-centered consultation had significant effects on beneficial health-behavior such as decreased use of NSAID and increased engagement in gymnastics and physiotherapy.
MeSH term(s)	Adult ; Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Drug Prescriptions/statistics & numerical data ; Female ; Follow-Up Studies ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Musculoskeletal Pain/drug therapy ; Musculoskeletal Pain/pathology ; Prospective Studies ; Quality of Life ; Referral and Consultation ; Telephone ; Workload ; Workplace ; Young Adult
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal
Language	English
Publishing date	2019-04-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-019-42387-4
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Article: The Supply of Rheumatology Specialist Care in Real Life. Results of a Nationwide Survey and Analysis of Supply and Needs.

Puchner, Rudolf / Vavrovsky, Anna / Pieringer, Herwig / Hochreiter, Ronald / Machold, Klaus P

Frontiers in medicine

2020 Volume 7, Page(s) 16

Abstract: Objectives: ...

Abstract	Objectives:
Language	English
Publishing date	2020-01-30
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2775999-4
ISSN	2296-858X
ISSN	2296-858X
DOI	10.3389/fmed.2020.00016
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Article ; Online: Prevention and cure of rheumatoid arthritis: is it possible?

Machold, Klaus P

Best practice & research. Clinical rheumatology

2010 Volume 24, Issue 3, Page(s) 353–361

Abstract: Advances in treatment of rheumatoid arthritis have made it possible to profoundly influence signs and symptoms as well as the course of joint destruction in inflammatory arthritis. Earlier and more efficient treatment appears to significantly improve the ...

Abstract	Advances in treatment of rheumatoid arthritis have made it possible to profoundly influence signs and symptoms as well as the course of joint destruction in inflammatory arthritis. Earlier and more efficient treatment appears to significantly improve the prognosis of this disease. Despite these advances, cure (the absence of signs and symptoms without further treatment) is still relatively rare, observable in, at most, 20% of the patients. Remission (or a state of very low disease activity), however, has been observed with intense and individually tailored treatment in up to 75% of patients. The use of structured assessments followed by individual modification of the intensity of treatment aiming for remission leads to better clinical responses and radiological outcomes. It remains to be seen whether earlier and more aggressive treatment of patients with not yet 'fully established' rheumatoid arthritis may succeed in preventing at least some of them from progressing to destructive arthritis.
MeSH term(s)	Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/prevention & control ; Arthritis, Rheumatoid/rehabilitation ; Disease-Free Survival ; Drug Administration Schedule ; Humans ; Quality of Life ; Remission Induction ; Secondary Prevention ; Tertiary Prevention
Language	English
Publishing date	2010-06
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2052323-3
ISSN	1532-1770 ; 1521-6942
ISSN (online)	1532-1770
ISSN	1521-6942
DOI	10.1016/j.berh.2009.12.014
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Article ; Online: Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit.

Schneeweiss-Gleixner, Mathias / Hillebrand, Caroline / Jaksits, Stephanie / Fries, Jonathan / Zauner, Michael / Heinz, Gottfried / Sengölge, Gürkan / Staudinger, Thomas / Zauner, Christian / Aletaha, Daniel / Machold, Klaus P / Schellongowski, Peter / Bécède, Manuel

RMD open

2023 Volume 9, Issue 4

Abstract: Objectives: Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.: Methods: This is a single-centre ... ...

Abstract	Objectives: Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies. Methods: This is a single-centre retrospective study of patients with SRDs admitted to an ICU at the Vienna General Hospital between 2012 and 2020. Single-predictor and multiple logistic regression analysis was performed to identify potential outcome determinants. Results: A total of 144 patients accounting for 192 ICU admissions were included. Connective tissue diseases (CTDs), vasculitides and rheumatoid arthritis were the most common SRDs requiring ICU admission. Leading causes for ICU admission were respiratory failure and shock, as reflected by a high number of patients requiring mechanical ventilation (60.4%) and vasopressor therapy (72.9%). Overall, 29.2% of admissions were due to SRD-related critical illness. In 70.8% patients, co-existent SRD not responsible for the acute critical illness was documented. When comparing these subgroups, CTDs and vasculitides had a higher frequency in the patients with SRD-related critical illness. In a significantly higher proportion of patients in the SRD-related subgroup, diagnosis of SRD was made at the ICU. ICU and 6-month mortality in the overall population was 20.3% and 38.5%, respectively. Age, glucocorticoid therapy prior to hospital admission and disease severity were associated with poor outcome. Conclusions: In this study, respiratory failure was the leading cause of ICU admission as reflected by high rates of required mechanical ventilation. Despite considerable severity of critical illness, survival rates were comparable to a general ICU population.
MeSH term(s)	Humans ; Critical Illness/therapy ; Retrospective Studies ; Intensive Care Units ; Rheumatic Diseases/epidemiology ; Rheumatic Diseases/therapy ; Rheumatic Diseases/complications ; Respiratory Insufficiency/epidemiology ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy ; Vasculitis/complications
Language	English
Publishing date	2023-11-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2812592-7
ISSN	2056-5933 ; 2056-5933
ISSN (online)	2056-5933
ISSN	2056-5933
DOI	10.1136/rmdopen-2023-003287
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Article: Infliximab treatment strategy: dose titration based on response in patients with RA.

Machold, Klaus P

Nature clinical practice. Rheumatology

2007 Volume 3, Issue 9, Page(s) 494–495

Language	English
Publishing date	2007-09
Publishing country	United States
Document type	Comment ; Journal Article
ZDB-ID	2228569-6
ISSN	1745-8390 ; 1745-8382
ISSN (online)	1745-8390
ISSN	1745-8382
DOI	10.1038/ncprheum0575
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Article ; Online: A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae

Noel G. Panagiotides / Fritz Zimprich / Klaus Machold / Oliver Schlager / Markus Müller / Sebastian Ertl / Henriette Löffler-Stastka / Renate Koppensteiner / Patricia P. Wadowski

International Journal of Environmental Research and Public Health, Vol 20, Iss 4918, p

2023 Volume 4918

Abstract	Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient’s condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren’s syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient’s autoimmune reactions.
Keywords	autoimmune small fiber neuropathy ; SARS-CoV-2 ; long COVID ; primary Sjögren’s syndrome ; Medicine ; R
Subject code	610
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Characteristics and outcome of critically ill patients with systemic rheumatic diseases referred to the intensive care unit

Daniel Aletaha / Peter Schellongowski / Michael Zauner / Klaus P Machold / Gottfried Heinz / Thomas Staudinger / Christian Zauner / Gürkan Sengölge / Mathias Schneeweiss-Gleixner / Caroline Hillebrand / Stephanie Jaksits / Jonathan Fries / Manuel Bécède

RMD Open, Vol 9, Iss

2023 Volume 4

Abstract: Objectives Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.Methods This is a single-centre retrospective ... ...

Abstract	Objectives Patients with systemic rheumatic diseases (SRDs) are at risk of admission to the intensive care unit (ICU). Data concerning these critically ill patients are limited to few retrospective studies.Methods This is a single-centre retrospective study of patients with SRDs admitted to an ICU at the Vienna General Hospital between 2012 and 2020. Single-predictor and multiple logistic regression analysis was performed to identify potential outcome determinants.Results A total of 144 patients accounting for 192 ICU admissions were included. Connective tissue diseases (CTDs), vasculitides and rheumatoid arthritis were the most common SRDs requiring ICU admission. Leading causes for ICU admission were respiratory failure and shock, as reflected by a high number of patients requiring mechanical ventilation (60.4%) and vasopressor therapy (72.9%). Overall, 29.2% of admissions were due to SRD-related critical illness. In 70.8% patients, co-existent SRD not responsible for the acute critical illness was documented. When comparing these subgroups, CTDs and vasculitides had a higher frequency in the patients with SRD-related critical illness. In a significantly higher proportion of patients in the SRD-related subgroup, diagnosis of SRD was made at the ICU. ICU and 6-month mortality in the overall population was 20.3% and 38.5%, respectively. Age, glucocorticoid therapy prior to hospital admission and disease severity were associated with poor outcome.Conclusions In this study, respiratory failure was the leading cause of ICU admission as reflected by high rates of required mechanical ventilation. Despite considerable severity of critical illness, survival rates were comparable to a general ICU population.
Keywords	Medicine ; R
Subject code	610
Language	English
Publishing date	2023-10-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: COVID-19 as a putative trigger of anti-MDA5-associated dermatomyositis with acute respiratory distress syndrome (ARDS) requiring lung transplantation, a case report.

Anderle, Karolina / Machold, Klaus / Kiener, Hans P / Bormann, Daniel / Hoetzenecker, Konrad / Geleff, Silvana / Prosch, Helmut / Laccone, Franco / Heil, Peter M / Petzelbauer, Peter / Aletaha, Daniel / Blüml, Stephan / Kastrati, Kastriot

BMC rheumatology

2022 Volume 6, Issue 1, Page(s) 42

Abstract: Background: Autoimmune disease following COVID-19 has been studied intensely since the beginning of the pandemic. Growing evidence indicates that SARS-CoV-2 infection, by virtue of molecular mimicry can lead to an antigen-mediated cross-reaction ... ...

Abstract	Background: Autoimmune disease following COVID-19 has been studied intensely since the beginning of the pandemic. Growing evidence indicates that SARS-CoV-2 infection, by virtue of molecular mimicry can lead to an antigen-mediated cross-reaction promoting the development of a plethora of autoimmune spectrum diseases involving lungs and extrapulmonary tissues alike. In both COVID-19 and autoimmune disease, the immune self-tolerance breaks, leading to an overreaction of the immune system with production of a variety of autoantibodies, sharing similarities in clinical manifestation, laboratory, imaging, and pathology findings. Anti-Melanoma Differentiation-Associated gene 5 dermatomyositis (anti-MDA5 DM) comprises a rare subtype of systemic inflammatory myopathies associated with characteristic cutaneous features and life-threatening rapidly progressive interstitial lung disease (RP-ILD). The production of anti-MDA5 autoantibodies was proposed to be triggered by viral infections. Case presentation: A 20-year-old male patient with polyarthritis, fatigue and exertional dyspnea was referred to our department. An elevated anti-MDA5 autoantibody titer, myositis on MRI, ground glass opacifications on lung CT and histological features of Wong-type dermatomyositis were confirmed, suggesting the diagnosis of an anti-MDA5 DM. Amid further diagnostic procedures, a serologic proof of a recent SARS-CoV-2 infection emerged. Subsequently, the patient deteriorated into a fulminant respiratory failure and an urgent lung transplantation was performed, leading to remission ever since (i.e. 12 months as of now). Conclusions: We report a unique case of a patient with a new-onset anti-MDA5 DM with fulminant ARDS emerging in a post-infectious stage of COVID-19, who underwent a successful lung transplantation and achieved remission. Given the high mortality of anti-MDA5 DM associated RP-ILD, we would like to highlight that the timely recognition of this condition and urgent therapy initiation are of utmost importance.
Language	English
Publishing date	2022-07-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2918121-5
ISSN	2520-1026 ; 2520-1026
ISSN (online)	2520-1026
ISSN	2520-1026
DOI	10.1186/s41927-022-00271-1
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Article ; Online: The Supply of Rheumatology Specialist Care in Real Life. Results of a Nationwide Survey and Analysis of Supply and Needs

Rudolf Puchner / Anna Vavrovsky / Herwig Pieringer / Ronald Hochreiter / Klaus P. Machold

Frontiers in Medicine, Vol

2020 Volume 7

Abstract: Objectives: To study the balance between the supply and need for rheumatology care in Austria. In addition, to investigate rheumatologists' work-hours, the amount of time rheumatologists dedicate to care for patients with rheumatic and musculoskeletal ... ...

Abstract	Objectives: To study the balance between the supply and need for rheumatology care in Austria. In addition, to investigate rheumatologists' work-hours, the amount of time rheumatologists dedicate to care for patients with rheumatic and musculoskeletal diseases (RMD), with non-RMD problems, and other professional activities such as research, teaching, and administration.Methods: A questionnaire covering aspects of professional activities was sent to all 215 rheumatologists registered with the Austrian Medical Association. The data collected was set in relation to the need calculated on the basis of recommendations put forward by the German society of rheumatology.Results: 149 of the 215 rheumatologists (69.0%) responded. Median weekly working time was 50 h (IQR 45–60). 47.4% of the working time was spent for care of patients with RMD. The remaining time was dedicated to patients with non-rheumatic diseases (19.6%), research and teaching (8.4%), and administration (24.5%). The number of full-time equivalents (FTE, based on a 40-h work-week) available for rheumatology care, thus, was calculated to be 178.5. Based on disease prevalence/incidence estimates and on the time allocation results of this survey, our study resulted in a need of 4.29 rheumatologists per 100.000 adult inhabitants (301.79 for an adult population of 7.03 × 106).Conclusion: The study demonstrated a substantial mismatch between the available supply and the need for rheumatology care. The results of our study are a conservative estimate, which should be taken into consideration for future healthcare workforce planning. In particular, the rising need for rheumatologists should be met by increasing the numbers of those specialists.
Keywords	musculoskeletal disorders ; rheumatoid arthritis ; rheumatology workforce ; epidemiology ; health services research ; rheumatology care ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2020-01-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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