Personalized therapy in rheumatoid arthritis (PETRA): a protocol for a randomized controlled trial to test the effect of a psychological intervention in rheumatoid arthritis.

Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects cartilage and bone. Psychological stress can both trigger disease exacerbation and result from disease activity. As standard pharmacological interventions alone have limited success in treating RA, a more comprehensive biopsychosocial approach to treatment has been recommended. In this prospective randomized controlled trial (RCT), a psychotherapeutically guided, group-based intervention program will be conducted with RA patients over a period of 9 months. This program combines a dynamic-interactional model with disorder-specific coping-oriented perspectives to improve patients' social, emotional, and problem-solving competencies as well as stress system functional status. The enrolment of 440 patients, randomly allocated to either an intervention (n = 220) or control group (n = 220), is planned. To evaluate the intervention effect, various indicators of RA disease activity, stress system activity, and psychological condition will be assessed through sets of standardized questionnaires and biochemical analyses of blood and saliva samples. Moreover, healthcare-related costs for each patient will be obtained using routine health insurance data. Outcome variables will be measured in all patients at regular intervals prior to intervention (baseline), during the 9-month intervention (five time points), and during a 9-month follow-up phase (three time points), allowing the comprehensive analysis of within- and between-subject effects, i.e. trajectories of the target variables in the intervention and control groups. In addition, to investigate the intervention effects on real-life stress system functioning in RA, 10 integrative single-case studies (n = 5 from the intervention group, n = 5 from the control group) will be conducted. In each study, once before and after the 9-month intervention, urine samples will be collected, and patients will fill out questionnaires for approximately 1 month at 12-h intervals. Moreover, weekly in-depth interviews will be conducted with patients to determine their previous week's emotionally positive and negative incidents. Using time series analysis, it is then possible to investigate whether and how stress system function in these RA patients has improved from the applied intervention. By using both an investigational macro- and microperspective, this project aims to evaluate a psychological intervention in the routine care of individuals with RA.Trial registration German Clinical Trials Register DRKS00028144. Registered on 1 March 2022.

Ein Leben für die Gesundheit der Armen: Laudatio für Prof. Dr. med. Gerhard Trabert anlässlich der Verleihung der Salomon-Neumann-Medaille.

The German Society for Social Medicine and Prevention (DGSMP) confers the Salomon Neumann Medal for outstanding merit in the field of Preventive and Social Medicine. The Salomon Neumann Medal 2017 was awarded to Gerhard Trabert, founder and chairman of the association "Poverty and Health in Germany" and professor for social medicine und social psychiatry at the RheinMain University of applied sciences in Wiesbaden. It honours a physician in the field of social medicine, whose personality and activity as "doctor for the poor of today", carries the sociopolitical engagement of Salomon Neumann, fittingly to the 200th birthday of the award's name giver, into our time.

[Health care reform as a development of the health care system]. / Gesundheitsreform als Gesundheitssystementwicklung.

The German health care system is undergoing a serious crisis. Current health care policies have been failing badly. The parties involved in the provision of health care are willing and able to conduct health reform. All healthcare workers expect to be included in the decision-making processes. They anticipate that their expertise and skills will be appreciated and employed to make improvements. Wise and thoughtful health policy decisions would focus on measures to support innovative practices within the existing system and strengthen current change processes. It is proposed that the reform be based on sustainable procedures. Change Management within the health care system should be guided by the principles of the Learning Organisation and the varied experience with sophisticated industrial management practices. Successful health systems development opens up new opportunities for social and economic growth.