Rheumatology and Clinical Immunology

Associated with the Department of Rheumatology and Clinical Immunology is a special rheumatological-immunological laboratory, in which serological and cellular diagnostics for autoimmune and immunodeficiency diseases are carried out and further developed. Approximately 60 - 70% of the blood samples come from our Department, with the rest from other departments and clinics of the Medical Center - University of Freiburg as well as from outside. It is a reference laboratory for complicated immunological issues.

Sonography employs ultrasound waves to obtain information about inflammations of joint surfaces, tendon attachments (entheses) or vessels, among other things. It thus represents a quickly-utilized, pain-free procedure which also has the advantage that the sound waves used are not harmful to the body's tissues. Ultrasound diagnosis is carried out in our Department under the supervision of DEGUM-certified (German Society of Ultrasound in Medicine) physicians.

Arthrocentesis (joint aspiration) is a diagnostic procedure used to determine the cause of a joint swelling or effusion. In particular, arthrocentesis provides information on whether inflammatory changes are present in the joint. Based on analysis of the puncture specimen, bacterial infections as well as crystal deposits can be ruled out. With the help of a Synovia analysis, the material obtained from the puncture can be investigated further. This makes it possible to determine the type and degree of inflammation.

Capillaroscopy allows early diagnosis of inflammatory connective tissue diseases. Under a microscope, the physician examines the fine veins in the nail grooves and can thus detect changes in the vessels.

Rheumatoid arthritis mostly affects the joints, but can also attack synovial tendon sheaths, blood vessels or internal organs. Around 1% of the population are affected, women 3 - 4 times more frequently than men. Typical age at onset: 4 - 6 years. Among women over 60 years of age, 70 of every 100,000 are affected per year. The average life expectancy will be shortened by 15 - 20% depending on when the diagnosis is made, e.g. by about 5 years with an age at onset of 50. Untreated rheumatoid arthritis can lead to a significant reduction in life expectancy. Many highly effective therapeutic options are meanwhile available for treatment of this inflammatory disease.

Collagenoses are inflammatory connective tissue diseases which, aside from the joints, eyesight and muscles, can also affect the blood vessels, kidneys, skin, blood formation and nervous system. The most important disease in this spectrum is systemic lupus erythematosus (SLE). This especially affects women between 20 and 40 years of age. The disease frequency (morbidity) is 4 - 6 cases per 100,000 people each year. In addition to mild illnesses with rheumatic joint and muscle pain, sun sensitivity and skin rashes, severe forms also occur that involve the internal organs (kidney, heart, liver, lung, brain etc.). Other diseases in this area are scleroderma, inflammatory muscular diseases (myositides), as well as inflammatory salivary gland diseases (e.g. Sjögren's syndrome). In these patients, antibodies in the blood are directed against parts of their own bodies, for example the cell nuclei (anti-nuclear antibodies or ANAs). These antibodies can be associated with inflammatory processes which damage the body.

We treat:

• Systemic lupus erythematosus
• Mixed collagenosis
• Anti-Phospholipid Syndrome
• Sjogren disease
• Dermato/poliomyositis

The term "autoinflammation" was first coined in connection with a group of hereditary syndromes that are characterized by periodically recurring fevers (agues). Characteristic of autoinflammatory diseases are systemic inflammatory body processes with no indication of underlying infections, allergies, immunodeficiencies or autoimmune diseases. Patients affected often suffer from continuous or recurring skin rashes. In addition, fevers, joint pains and headaches, as well as a number of other symptoms, can occur. Since autoinflammatory syndromes are usually very rare diseases, they often involve a diagnosis that is delayed by several years or even decades. A late diagnosis often leads to severe complications, which explains the high morbidity and mortality rates for these diseases. Because of the generalized inflammation, diagnosis and treatment of autoinflammatory diseases is in many cases a big challenge, which can only be dealt with through the participation of various specialist disciplines. Patients affected are supervised by pediatricians and rheumatologists, depending on their age and where the disease appears. Fortunately, new therapeutic developments often allow very effective treatment of autoinflammatory diseases.

We treat:

• Tendon pain
• Inflammation of the tendon sheath
• Soft tissue rheumatic disorders /fibromyalgia syndrome
• Myopathy
• Polymyalgia rheumatica

These diseases affect the spine, sacroiliac and peripheral joints, among others, but can also attack connective tissue, the skin and mucous membranes, intestines and urinary tract. There is often an association with HLA-B27, a surface feature of white blood cells. Frequency: about 1% of people. In the main disease of this group, ankylosing spondylitis, 6 new cases are expected per 100,000 people each year. Age at onset: 20 - 40 years, but sometimes also in childhood. Men are affected more often than women. Life expectancy is not greatly reduced, but the quality of life is very much so, and complications can lead to death.

We treat:

• Ankylosing spondylitis
• Bekhterev's disease
• Arthropathic psoriasis
• Reactive arthritis

Vasculitides affect blood vessels, connective tissue and internal organs, and if untreated can quickly lead to severe, sometimes life-threatening complications. About 50 people in 100,000 are affected, with an annual incidence rate of about 5 - 10 per 100,000 people. Life expectancy is sometimes significantly reduced, but this has improved considerably in recent decades due to better treatment options. Today, the 10-year survival rates following diagnosis are over 90%. In some patients (Wegener's granulomatosis/granulomatosis with polyangiitis) there are autoantibodies (ANCAs) against components of the white blood cells (neutrophil granulocytes).

We treat:

• Temporal arteritis
• Granulomatosis with polyangiitis
• Eosinophilic granulomatosis with polyangiitis
• Microscopic polyangiitis (MPA)
• Cryoglobulinemia vasculide
• Wegener's Disease
• Horton's disease / polymyalgia rheumatica
• Takayasu arteritis
• Panarteritis nodosa
• Henoch-Schonlein purpura
• Behcet's Disease
• Ormond's Disease
• Winiwarter-Buerger Disease
• Urticaria Vasculitis
• Sarcoidosis and other granulomatosa

Autoimmune Thrombozytopenien, autoimmunhämolytische Anämien, Leukopenien Immunzytopenien sind Krankheiten, bei denen das Immunsystem einzelne Zelltypen des eigenen Blutes zerstört. Durch die Bildung von Autoantikörpern gegen Blutplättchen, rote Blutzellen oder weiße Blutzellen entstehen gefährliche Krankheitsbilder wie die autoimmune Thrombozytopenie (Morbus Werlhoff), autoimmunhämolytische Anämien und Leukopenien. Diese Erkrankungen kommen isoliert vor oder als Komplikationen anderer Autoimmunerkrankungen wie z.B. den Kollagenosen. Die Therapiemöglichkeiten sind gut und ähneln denen bei Kollagenose.

• Autoimmune thrombocytopenias
• Autoimmune hemolytic anemias
• Leukopenias

Crystal arthropathies are acute or chronic joint diseases involving crystal deposits that are caused by metabolic disturbances. The crystals can cause a very strong local inflammatory reaction and thus lead to painful joint swellings and functional limitations. The main diseases are gout and chondrocalcinosis. Diagnostically, in addition to imaging methods (X-ray, sonography, possibly dual-energy CT), synovial analysis with crystal detection is also helpful. In addition to the anti-inflammatory treatment in the acute phase, dietary or medicinal measures for urinary acidification are usually required.

The large number of highly effective drugs that have been developed in recent years for the treatment of inflammatory rheumatologic disorders can potentially lead to impaired immune responses by interfering with congenital or acquired immune mechanisms. This may in some patients lead to a reduced vaccination response or an increased susceptibility to infections. With modern immunological laboratory methods it is already possible to monitor immune system function during the administration of immunosuppressive drugs. This considerably increases the safety of the treatment. In addition, in some cases biomarkers allow the potential risk of infection under immunosuppressive treatment to be estimated.