Christine Uhlemann

Therapie der Hyperhidrosis mittels Leitungswasseriontophorese Positive Effekte auf Abheilungszeit und Rezidivfreiheit bei Hand-Fuß-Ekzemen

ZusammenfassungHyperhidrose ist eine belästigende Folge der ekkrinen Überfunktion (autonomes Nervensystem) und ein konstitutioneller Faktor in der Ekzemunterhaltung. In einer klinischen Studie wurde bei 54 Patienten mit Hyperhidrosis manuum et pedum eine Therapie mit der Leitungswasseriontophorese mit unterbrochenem Gleichstrom durchgeführt. Nach 10 unter ärztlicher Kontrolle durchgeführten Behandlungen gaben 89% der Patienten eine Besserung der Hyperhidrose an. Zwanzig Patienten, die zugleich an einem palmoplantaren Ekzem litten und mindestens 6 Monate eine Heimbehandlung fortgeführt hatten, wurden mit einem in Alters- und Geschlechtsverteilung entsprechendem historischen Patientenkollektiv bezüglich Abheilungszeit und Rezidivfreiheit verglichen. Im Trend ergab sich eine (nicht signifikant) kürzere Abheilungszeit von durchschnittlich 20 vs. 22,3 Tagen (p>0,05). Statistisch hochsignifikant war jedoch der Vorteil bezüglich des rezidivfreien Zeitraums (24,8 vs. 8,35 Wochen; p<0,0001). Die Effekte der Leitungswasseriontophorese sind nicht allein auf die Schweißdrüsensekretion beschränkt. Aufgrund jüngerer Literaturdaten sind Capsaicin-artige Wirkungen des Gleichstromes ebenfalls zu vermuten. Es wird die Hypothese formuliert, daß der Gleichstrom der Leitungswasseriontophorese die neurogene Entzündung unterbricht, was sich auf eine verlängerte Rezidivfreiheit beim hyperhidrotischen Hand-Fuß-Ekzem positiv auswirkt.SummaryHyperhidrosis is due to an overfunction of eccrine glands (triggered by the autonomous nervous system) and may be a cofactor for palmoplantar eczema (dermatitis). Tapwater iontophoresis was used in 54 patients with hyperhidrosis manuum et pedum. After 10 applications directed by the dermatologist, 89% of patients noted an improvement in their hyperhidrosis. 20 patients suffering from palmoplantar eczema (dermatitis) who continued the treatment at home for at least 6 months were compared with a historical sex- and age-matched group of 20 eczema-patients without iontophoresis: The factors evaluated were the time needed for clearing and the relapse-free interval. Though iontophoresis-treated patients had a slightly faster clearing, this was statistically not significant (20 vs. 22.3 days; p >0.05). However, the difference for relapse-free interval between the two groups was statistically highly significant (24.8 weeks vs. 8.35 weeks; p<0.0001).Tapwater iontophoresis seems to be effective not only to control sweating. According to recently published data, galvanization seems to have a capsaicin-like effect as well. Our hypothesis is therefore, that galvanization with tapwater iontophoresis interrupts the neurogenic inflammation and prolongs the relapse-free interval in hyperhidrotic palmoplantar eczema (dermatitis).

Lupus erythematosus-associated red lunula.

BACKGROUND Red lunulae have only rarely been described in patients with lupus erythematosus. OBJECTIVE We assessed the frequency and classified the type of red lunulae in patients with definite lupus erythematosus seen in an interdisciplinary dermatorheumatologic outpatient clinic. METHODS We studied 56 patients with either systemic or cutaneous lupus erythematosus for the presence of red lunulae. RESULTS Eleven of 56 patients (19.6%) with lupus erythematosus had red lunulae. All of them showed a complete type of red lunulae, which was seen on all finger nails in 10 patients and on a single finger nail in 1 patient. Seven patients suffered from systemic lupus, the other from subacute cutaneous (n = 2) or chronic discoid cutaneous lupus (n = 2). There was no statistically significant difference in autoantibody expression or treatment regimen between patients with or without red lunulae. However, symptomatic patients had a shorter disease interval, and all but 1 showed either periungual erythema or chilblain lupus. Periungual erythema was not observed in any patient without red lunulae. CONCLUSION Red lunulae, although rarely described in the literature, are not an uncommon symptom of patients with lupus erythematosus. They seem to be associated with periungual erythema or chilblain lupus. Red lunulae should be considered in the clinical spectrum of lupus disease.

Dercum’s disease (Lipomatosis dolorosa): successful therapy with pregabalin and manual lymphatic drainage and a current overview

Dercum’s disease which is also termed lipomatosis dolorosa is a rare and relatively unknown disease. In this entity the upper arms, elbows, stomach wall, buttocks, thighs and knees are predominantly affected showing painful subcutaneous adipose tissue deposits. In addition severe hyperalgesia can be triggered by light pressure and touch. Analgesic and/or nonsteroidal antirheumatic drugs have usually only a minor or no effect. Here, we report a patient with Dercum’s disease who was successfully treated with pregabalin and manual lymphatic drainage, and present a current overview of the literature.

Therapeutic Ultrasound in Lower Extremity Wound Management

In medical practice, ultrasound (US) is used for diagnosis and therapy. High-frequency (1-4 MHz) and low-frequency (20-120 KHz) therapeutic US are relevant to wound healing. The heating effects of high-frequency US are important, whereas the mechanical effects of low-frequency US must be considered. The physiological effects of low-frequency US include metabolic enhancement, perfusion, wound cleansing, and the acceleration of wound granulation. The therapeutic efficacy of US depends on dose (W/cm 2 time)and dosage (frequency of application, series). At adequate doses, high-frequency and low-frequency therapeutic US induce in vitro cell proliferation; protein synthesis; and the production of cytokines by fibroblasts, osteoblasts, and monocytes. The mechanical effects of low-frequency US cause transient cavitation in wound surfaces for soft and smooth wound cleaning, ulcer debridement, and the stimulation of granulation. These effects can be determined in clinical studies, though the quality of the studies done so far and of the evidence of the usefulness of US is poor. Nevertheless, high-frequency and low-frequency US may be reasonable options in the management of chronic wounds.

Transdermal CO2 Application in Chronic Wounds

Chronic wounds are a challenge to treatment. In this retrospective study, the effect of transdermal CO2 application on wound healing in chronic ulcers was investigated and compared to the effect of CO2 on acute surgical wounds. Eightysix patients (52 females and 34 males) with chronic wounds of different origin except arterial occlusive disease were included. In addition, 17 patients (5 females, 12 males) with wide excision wounds after surgical therapy of acne inversa were considered. The indication for CO2 application was a wound at risk for infection. Treatment was performed with a Carboflow® device once daily for 30 to 60minutes. Therewas clinical evidence of improvement of granulation and reductionof discharge and malodor within 1 week of treatment in both chronic and acute wounds. Only 9 patients, all diabetics, needed an additional systemic antibiosis. The treatment was well tolerated. No adverse effects have been noted. Transdermal CO2 application is a useful method to reduce the risk of infection and improve wound healing in both chronic and certain acute wounds. Systematic prospective trials are needed.

Serielle Ganzkörperkältetherapie im Criostream bei entzündlich-rheumatischen Erkrankungen

ZusammenfassungHintergrund und Ziel:Der lokalen Kryotherapie wie auch der Ganzkörperkälteapplikation kommt eine zentrale Rolle bei der physikalischen Therapie entzündlich-rheumatischer Erkrankungen zu. Im Vergleich zur Kältekammertherapie bietet der Criostream (Ein-Personen-Kältekammer, die mit Stickstoff gekühlt wird) als neues technisches Verfahren mit deutlicher therapeutischer Kostensenkung eine innovative Alternative. Ziel der vorliegenden prospektiven Studie war die Untersuchung folgender Parameter: Schmerzlinderung unter serieller Ganzkörperkälteapplikation (neun Anwendungen an 5 aufeinanderfolgenden Tagen), Einfluss der Therapie auf funktionelle Parameter, proinflammatorische Zytokine (Tumor-Nekrose-Faktor-[TNF-]α, Interleukin-[IL-]1) und Aktivitätsscores, Kriterien der Praktikabilität und Akzeptanz der neuen Therapieform sowie zu beobachtende Nebenwirkungen.Patienten und Methodik:Die Analysestichprobe umfasste zehn Patienten mit entzündlich-rheumatischen Erkrankungen (vier Patienten mit rheumatoider Arthritis, drei Patienten mit Arthritis/Spondylitis psoriatica und drei Patienten mit ankylosierender Spondylitis; Durchschnittsalter 48 Jahre, durchschnittliche Krankheitsdauer 5,2 Jahre), die im Anschluss an eine Erstapplikation zweimal täglich im Criostream bei –145 °C behandelt wurden (initial 90 s mit Steigerung unter serieller Therapie auf zuletzt 2,5 min). Die statistische Analyse erfolgte anhand des Wilcoxon-Tests auf Gleichheit der Werte vor und nach Therapie.Ergebnisse:Es fanden sich eine signifikante Schmerzlinderung (zwischen Schmerzausgangs- und -endwert) bereits nach den Einzelanwendungen sowie eine im zeitlichen Verlauf zunehmende Schmerzverminderung. Die funktionellen Parameter wie auch die Aktivitätsscores zeigten ebenfalls signifikante Verbesserung, zudem war ein signifikanter Abfall von TNF-α (p < 0,01) und IL-1 (p < 0,05) zu objektivieren. Das angewandte Verfahren erwies sich als gut praktikabel und wurde durchgehend mit positiver Akzeptanz von Patientenseite beurteilt. Nebenwirkungen wurden lediglich nach der ersten Anwendung von zwei Patienten angegeben (einmal Kopfschmerzen, einmal unangenehmes Kältegefühl).Schlussfolgerung:Neben einer signifikanten Reduktion der Schmerzen und der proinflammatorischen Zytokine (TNF-α und IL-1) schafft eine serielle Kältetherapie im Criostream eine sehr gute Voraussetzung für eine anschließende spezifische und intensive krankengymnastische Beübung, die sich in verbesserten Funktionsscores widerspiegelt. Das neue Criostream-Verfahren stellt für den akut-rheumatologischen Alltag ein praktikables und vom Patienten gut toleriertes Physikotherapeutikum dar und bietet somit eine sinnvolle Ergänzung im multimodalen Therapiekonzept entzündlich-rheumatischer Erkrankungen.AbstractBackground and Purpose:Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]α and interleukin-[IL-]1), and improvement in functional scores.Patients and Methods:Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time).Results:Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-α (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold).Conclusion:The criostream offers an elegant and, from the patients point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.BACKGROUND AND PURPOSE Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]alpha and interleukin-[IL-]1), and improvement in functional scores. PATIENTS AND METHODS Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time). RESULTS Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-alpha (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold). CONCLUSION The criostream offers an elegant and, from the patients point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.

Serielle Kaltwasserreize (Kneipp’scher Oberguss) bei Patienten mit chronisch obstruktiver Bronchitis (COPD)

Patients with chronic obstructive pulmonary disease (COPD) often suffer from exacerbations caused by infections of the bronchial tract. Objective: What effects do hydrotherapeutic applications according to Kneipp have on lung function, blood gases, immune system and quality of life of patients with COPD? Patients and Methods: 20 patients with COPD (17 males, 3 females); mean age: 64; forced exspiratory volume (FEV1): 62 of 100% (on anverage); no acute exacerbations, no oral corticosteroids. Measurements were performed (I) at 10 weeks pre-treatment, (II) immediately before therapy (I–II: baseline-period), (III) after 10 weeks treatment with 3 cold affusions and 2 cold washings of the upper part of the body (self-treatment) per week each, (IV) 3 months after completion of the treatment (follow- up). The following parameters were measured: lung function, blood gases, routine lab, experimental lab (interleukines, lymphocytes), maximal exspiratory flow (PEF), quality of life and respiratory infections. Results: The pH increased over the course of the study. PEF and the number of lymphocytes significantly increased over the treatment (II–III). Intracellular expression of IL-4 by T lymphocytes decreased. However, the expression of IFN-γ increased. Frequency of infections was lower during follow-up (IV) than before and during therapy. Quality of life after treatment was estimated to be good in all patients. Conclusions: Repeated cold stimulations (affusions) can influence the frequency of respiratory infections and improve subjective well-being. It may cause an immunological modulation in terms of the Th1-type pattern.Patients with chronic obstructive pulmonary disease (COPD) often suffer from exacerbations caused by infections of the bronchial tract. Objective: What effects do hydrotherapeutic applications according to Kneipp have on lung function, blood gases, immune system and quality of life of patients with COPD? Patients and Methods: 20 patients with COPD (17 males, 3 females); mean age: 64; forced exspiratory volume (FEV1): 62 of 100% (on anverage); no acute exacerbations, no oral corticosteroids. Measurements were performed (I) at 10 weeks pre-treatment, (II) immediately before therapy (I–II: baseline-period), (III) after 10 weeks treatment with 3 cold affusions and 2 cold washings of the upper part of the body (self-treatment) per week each, (IV) 3 months after completion of the treatment (follow- up). The following parameters were measured: lung function, blood gases, routine lab, experimental lab (interleukines, lymphocytes), maximal exspiratory flow (PEF), quality of life and respiratory infections. Results: The pH increased over the course of the study. PEF and the number of lymphocytes significantly increased over the treatment (II–III). Intracellular expression of IL-4 by T lymphocytes decreased. However, the expression of IFN-γ increased. Frequency of infections was lower during follow-up (IV) than before and during therapy. Quality of life after treatment was estimated to be good in all patients. Conclusions: Repeated cold stimulations (affusions) can influence the frequency of respiratory infections and improve subjective well-being. It may cause an immunological modulation in terms of the Th1-type pattern.

Nagelveränderungen bei rheumatischen Erkrankungen

ZusammenfassungDas Nagelorgan ist der klinischen Untersuchung leicht zugänglich. Im Rahmen dermatologisch-rheumatologischer Krankheitsbilder ist die Kenntnis der wichtigsten assozierten Nagelveränderungen sehr hilfreich. Für einige wichtige Erkrankungen wie der psoriatrische Osteoarthropathie einschließlich der Sonderformen, dem Morbus Reiter und den Kollagenosen finden sich typische, teils auch charakteristische Symptome. Für andere Erkrankungen wie die Rheumatoidarthritis, die Arthritis urica und die Systemvaskulitiden sind assoziierte Nagelerkrankungen nicht selten, aber von geringerer diagnostischer Spezifität. Die vorliegende Übersicht bespricht sowohl Literatur – als auch eigene, in einer dermatologisch-rheumatologischen Gemeinschaftssprechstunde erhobene Daten.SummaryClinically the nail organ ist easy to investigate. When estimating dermato-rheumatological diseases, knowledge of important associated nail symptoms is extremely helpful. In some diseases like osteoarthropathia psoriatica and special variants, Reiter’s syndrome and connective tissue disease, typical or even characteristic symptoms can be found. In other disorders like rheumatoid arthritits, goal and systemic vasculitis, associated nail disorders are not uncommon, but of less diagnostic specificity. We review data from the literature and from our dermato-rheumatological outpatient clinic.

Beeinflusst Knoblauch die Blutfliesseigenschaften und die Durchblutung bei progressiver systemischer Sklerose

According to traditional European naturopathy garlic is an agent that increases perfusion. In studies with healthy subjects and in-vitro research garlic has shown influences on erythrocyte and thrombocyte aggregation as well as on vasoregulation. However, data on its effects in clinical populations are still lacking. Garlic may be useful for systemic sclerosis which is characterised by impaired perfusion that often cannot sufficiently be influenced by standard treatment. We investigated if dried garlic powder can influence rheologic properties and vasomotor function in systemic sclerosis. Subjects and Methods: During a randomised, double blind pilot study, 20 female inpatients with systemic sclerosis received a 7 day add-on therapy with either 900 mg dried garlic powder or placebo. Rheologic properties (erythrocyte aggregation, ADP-induced thromboycyte aggregation, plasma viscosity, fibrinogenous plasma level, blood sedimentation rate) were assessed initially as well as after 1 and 7 days of treatment. Vasomotor function was evaluated using near-infrared red photoplethysmography, a new diagnostic tool to assess microcirculation. Furthermore, acral skin temperature was measured. Results: After 7 days, only the verum treatment had induced a significant reduction of ADP-induced thrombocyte aggregation and a decrease in erythrocyte aggregation. Results showed no significant effects on vasomotor function, but an immediate effect of garlic on acral skin temperature. Discussion: According to the ‘Qualitätenlehre’ of traditional European naturopathy, garlic is classified as a ‘heating agent’. Our results suggest that the improvement of rheologic properties could be a possible biological correlate for this. Although further research is required, we conclude garlic could be a rational add-on therapy in the ‘Kältekrankheit’ (‘cold disease’) of systemic sclerosis.

Serielle Ganzkörperkältetherapie im Criostream bei entzündlich-rheumatischen Erkrankungen@@@Serial Whole-Body Cryotherapy in the Criostream for Inflammatory Rheumatic Diseases. A Pilot Study: Eine Pilotstudie

ZusammenfassungHintergrund und Ziel:Der lokalen Kryotherapie wie auch der Ganzkörperkälteapplikation kommt eine zentrale Rolle bei der physikalischen Therapie entzündlich-rheumatischer Erkrankungen zu. Im Vergleich zur Kältekammertherapie bietet der Criostream (Ein-Personen-Kältekammer, die mit Stickstoff gekühlt wird) als neues technisches Verfahren mit deutlicher therapeutischer Kostensenkung eine innovative Alternative. Ziel der vorliegenden prospektiven Studie war die Untersuchung folgender Parameter: Schmerzlinderung unter serieller Ganzkörperkälteapplikation (neun Anwendungen an 5 aufeinanderfolgenden Tagen), Einfluss der Therapie auf funktionelle Parameter, proinflammatorische Zytokine (Tumor-Nekrose-Faktor-[TNF-]α, Interleukin-[IL-]1) und Aktivitätsscores, Kriterien der Praktikabilität und Akzeptanz der neuen Therapieform sowie zu beobachtende Nebenwirkungen.Patienten und Methodik:Die Analysestichprobe umfasste zehn Patienten mit entzündlich-rheumatischen Erkrankungen (vier Patienten mit rheumatoider Arthritis, drei Patienten mit Arthritis/Spondylitis psoriatica und drei Patienten mit ankylosierender Spondylitis; Durchschnittsalter 48 Jahre, durchschnittliche Krankheitsdauer 5,2 Jahre), die im Anschluss an eine Erstapplikation zweimal täglich im Criostream bei –145 °C behandelt wurden (initial 90 s mit Steigerung unter serieller Therapie auf zuletzt 2,5 min). Die statistische Analyse erfolgte anhand des Wilcoxon-Tests auf Gleichheit der Werte vor und nach Therapie.Ergebnisse:Es fanden sich eine signifikante Schmerzlinderung (zwischen Schmerzausgangs- und -endwert) bereits nach den Einzelanwendungen sowie eine im zeitlichen Verlauf zunehmende Schmerzverminderung. Die funktionellen Parameter wie auch die Aktivitätsscores zeigten ebenfalls signifikante Verbesserung, zudem war ein signifikanter Abfall von TNF-α (p < 0,01) und IL-1 (p < 0,05) zu objektivieren. Das angewandte Verfahren erwies sich als gut praktikabel und wurde durchgehend mit positiver Akzeptanz von Patientenseite beurteilt. Nebenwirkungen wurden lediglich nach der ersten Anwendung von zwei Patienten angegeben (einmal Kopfschmerzen, einmal unangenehmes Kältegefühl).Schlussfolgerung:Neben einer signifikanten Reduktion der Schmerzen und der proinflammatorischen Zytokine (TNF-α und IL-1) schafft eine serielle Kältetherapie im Criostream eine sehr gute Voraussetzung für eine anschließende spezifische und intensive krankengymnastische Beübung, die sich in verbesserten Funktionsscores widerspiegelt. Das neue Criostream-Verfahren stellt für den akut-rheumatologischen Alltag ein praktikables und vom Patienten gut toleriertes Physikotherapeutikum dar und bietet somit eine sinnvolle Ergänzung im multimodalen Therapiekonzept entzündlich-rheumatischer Erkrankungen.AbstractBackground and Purpose:Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]α and interleukin-[IL-]1), and improvement in functional scores.Patients and Methods:Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time).Results:Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-α (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold).Conclusion:The criostream offers an elegant and, from the patients point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.BACKGROUND AND PURPOSE Local as well as whole-body cryotherapy is used to relieve pain and inflammation in rheumatic diseases. In comparison with a chamber-based whole-body cryotherapy, the novel criostream whole-body therapy (single-person cabin with cold air cooled by liquid nitrogen) as an innovative technique offers not only a rapid therapeutic effect but also a considerable reduction in costs. The aim of this study was to compare the effect of whole-body cryotherapy in the criostream on pain reduction, disease activity and pro-inflammatory cytokines (tumor necrosis factor-[TNF-]alpha and interleukin-[IL-]1), and improvement in functional scores. PATIENTS AND METHODS Ten patients with different active inflammatory rheumatic diseases (four patients with rheumatoid arthritis, three patients with ankylosing spondylitis, and three patients with psoriatic arthritis/spondylitis) underwent nine sessions of whole-body cryotherapy in 5 days for a short time period (at first 90 s, with step-up in each application to 2.5 min total time). RESULTS Pain and disease activity scores decreased significantly, and, subsequently, also the functional scores showed a significant amelioration. Furthermore, there was a significant reduction in TNF-alpha (p < 0.01) and IL-1 (p < 0.05). Side effects were reported only after the first application in two cases (headache and sensation of cold). CONCLUSION The criostream offers an elegant and, from the patients point of view, attractive therapeutic agent in the multimodal treatment concept for inflammatory rheumatic diseases.