Background Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety. Objective The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists. Methods The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers. Results In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms. Conclusions To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.

Uveal melanoma is the most common primary malignancy of the eye in adults. Despite significant improvements in treatment of the primary tumor, to date none of these therapies prevent metastatic disease or improve overall survival. We are exploring immunotherapeutic options for metastatic uveal melanoma using MHC II uveal melanoma cell-based vaccines that target the activation of tumor-reactive CD4+ T cells. Previously, we showed that these uveal melanoma cell-based vaccines activate CD4+ T cells within total peripheral blood lymphocytes (PBMC). Since PBMC include professional antigen presenting cells, we now demonstrate that Mel202/DR1/CD80 vaccine cells directly activate a diverse repertoire of purified, naïve CD4+ T cells. The activated CD4+ T cells proliferated, secreted high amounts of interferon gamma (IFNγ) and produced a heterogeneous profile of Th1, Th2 and Th17 cytokines. Analysis of the TCR-Vβ-repertoire showed that a polyclonal T cell response was induced, suggesting the capacity of vaccine-activated CD4+ T cells to target multiple tumor (neo)antigens. In addition, a subset of the responding CD4+ T cells expressed forkhead box protein P3 (FoxP3), indicating that although a regulatory component of the vaccine-activated CD4+ T cell response was induced, the anti-tumor vaccine response was not limited by these regulatory CD4+ T cells. Finally, Mel202/DR1/CD80 uveal melanoma vaccine cells expressed the intercellular adhesion molecule 1 (ICAM-1) that was pivotal for CD4+ T cell activation via lymphocyte function-associated antigen 1(LFA-1). In conclusion, MHC II uveal melanoma vaccines activate purified CD4+ T cells and may serve as a novel immunotherapy for uveal melanoma patients.

Career situation of first and presenting authorPost-doctoral fellow.IntroductionRheumatoid arthritis (RA) is characterized by chronic synovitis and joint destruction. Autoantibodies and autoreactive B cells are a hallmark of RA. Furthermore, Th17 cells have been demonstrated to be crucial for disease development. However, checkpoints and mechanisms regulating the onset of rheumatoid arthritis (RA) remain largely unclear.ObjectivesRecently, we have demonstrated, that Th17 cells suppress the enzyme ST6 a-galactoside b-2,6-sialyltransferase in developing plasma cells. Thereby, Th17 cells are able to increase the inflammatory activity of autoantibodies in an IL-23 dependent manner by regulating the degree of Fc-glycosylation. However, the molecular mechanisms that mediate this IL-23/Th17-mediated proinflammatory reprogramming of B cells and the relevance for arthritis remains to be determined in detail.MethodsK/BxN mice were treated twice a week with neutralizing antibodies against IL-17A and IL-22 from week 1 until week 9. Both, clinical, histological and immunological parameters of arthritis were assessed. Serum was collected weekly and autoantibody titers were determined using ELISA. Collected Sera were used for K/BxN serum transfer to evaluated IgG activity. Additionally, the expression levels of the corresponding interleukin receptors (IL17RA and IL22Ra1) were analyzed during collagen-induced arthritis.ResultsHere we show, that in contrast the upregulation of IL-22Ra1 on plasmablasts in the spleen, lymph node and bone-marrow during collagen-induced arthritis, its blockade during K/BxN arthritis did not prevent the onset of arthritis. Also, the IgG from K/BxN mice remained its inflammatory activity. We also show, that while IL17RA is basically absent on B cells during arthritis, the neutralization of IL-17A during K/BxN arthritis led to a strongly delayed development of autoimmune arthritis. Furthermore, depletion of IL17A led to a decreased titer of autoantibodies during early phases of K/BxN arthritis. However, in the K/BxN serum transfer mice which received serum that was produced in the absence of IL-17 were not protected against inflammatory arthritis.ConclusionsOur data indicate that IL-22 is not directly involved in the regulation of IgG activity during K/BxN arthritis. Furthermore, our data indicate that IL-17A is indeed a crucial cytokine during inflammatory processes inside the joint and may be involved in the germinal center reaction or plasma cell survival. However, neither IL-17 nor IL-22 is involved in the IL-23/Th17-mediated proinflammatory reprogramming of B cells to produce highly pathogenic autoantibodies. Therefore, other cytokines produced by Th17 cells and/or mechanisms depending on cell-cell contact proteins might orchestrate the Th17/B-cell crosstalk leading to the downregulation of St6gal1 in developing plasma cells.Disclosure of InterestNone declared.

BACKGROUND Chronic rheumatic diseases need long-term treatment and professional supervision. Mobile apps promise to improve the lives of patients and physicians. In routine practice, however, rheumatology apps are largely unknown and little is known about their quality and safety. OBJECTIVE The aim of this study was to provide an overview of mobile rheumatology apps currently available in German app stores, evaluate app quality using the Mobile Application Rating Scale (MARS), and compile brief, ready-to-use descriptions for patients and rheumatologists. METHODS The German App Store and Google Play store were systematically searched to identify German rheumatology mobile apps for patient and physician use. MARS was used to independently assess app quality by 8 physicians, 4 using Android and 4 using iOS smartphones. Apps were randomly assigned so that 4 apps were rated by all raters and the remaining apps were rated by two Android and two iOS users. Furthermore, brief app descriptions including app developers, app categories, and features were compiled to inform potential users and developers. RESULTS In total, 128 and 63 apps were identified in the German Google Play and App Store, respectively. After removing duplicates and only including apps that were available in both stores, 28 apps remained. Sixteen apps met the inclusion criteria, which were (1) German language, (2) availability in both app stores, (3) targeting patients or physicians as users, and (4) clearly including rheumatology or rheumatic diseases as subject matter. Exclusion criteria were (1) congress apps and (2) company apps with advertisements. Nine apps addressed patients and 7 apps addressed physicians. No clinical studies to support the effectiveness and safety of apps could be found. Pharmaceutical companies were the main developers of two apps. Rheuma Auszeit was the only app mainly developed by a patient organization. This app had the highest overall MARS score (4.19/5). Three out of 9 patient apps featured validated questionnaires. The median overall MARS score was 3.85/5, ranging from 2.81/5 to 4.19/5. One patient-targeted and one physician-targeted app had MARS scores >4/5. No significant rater gender or platform (iOS/Android) differences could be observed. The overall correlation between app store ratings and MARS scores was low and inconsistent between platforms. CONCLUSIONS To our knowledge, this is the first study that systematically identified and evaluated mobile apps in rheumatology for patients and physicians available in German app stores. We found a lack of supporting clinical studies, use of validated questionnaires, and involvement of academic developers. Overall app quality was heterogeneous. To create high-quality apps, closer cooperation led by patients and physicians is vital.