Friday, February 19, 2016

Twitter and more

I've just encountered problems to access the internet, especially my own blog and Twitter. I haven't found a solution, yet, but I'm working on it, which means I call the guys from IT. I had my coffee 1.0, but obviously this didn't help.

PS. Just tried to send this message to Twitter. Impossible.

PPS. I've just received an email by our IT manager: "...
aufgrund der aktuellen Sicherheitsprobleme bedingt durch die Cyberangriffe auf Krankenhäuser, wurden zahlreiche Schutzmassnahmen ergriffen.Unter anderem ist jeglicher Download aus dem Internet (somit auch der Dateizugriff), WebMail und div. Seiten gesperrt. ...". He refers to cyber attacs on hospitals in Germany, one of them is located only 10 km from here; German link:,15184906,33815836.html. So nearly everything is blocked now.

I've just got access to my blog again! Hooray!
New entries will follow soon.


Thursday, February 18, 2016

Carpe Diem Haiku Theme Week No. 1 episode 4: The Tibetan Book of Living and Dying: Insight 3 "thinking about death gives life meaning"


Frozen rivulet
During spring there comes the sun
Stream dances again

The sky has opened
Above the burning ghat
Smoke rises with souls

(too bad, the picture to the second haiku is with the Tibet pictures)

Carpe Diem Haiku No. 920 Hunger (Empathy)

Man at waste basket
Shopping cart with PET bottles
Give him your refunds

A boy and a girl
Sharing a banana peel
Hunger always hopes

Carpe Diem Haiku Tokubetsudesu No. 70 Tibetan’s Mgur, a religious form of poetry

Winter time of frost
Hot butter tea is ready
Meditation gone

Cut off all desires
But still there's the smell of soup
Throughout the temple

Flying prayer flags
The wind is our messenger
Gompa* and vastness

* Gompa means small temple

A couple of years ago I had the opportunity to visit Milarepa's cave. Pelgye Ling Monastery is built around this cave. The air at an altitude of at 3,750 metres (12,300 ft) is clear, smelling of wild flowers and herbs from the valley of Lapchi Gang. Pilgrims come with offerings. Often small bank notes are left behind. Monastery is affiliated with the Gelugpa Sera Monastery in Lhasa. For more details look at Wikipedia under Milarepa's cave (that's where my information comes from).

 The valley of Lapchi Gang

Pelgye Ling Monastery

Inside the cave

Inside the cave


Wednesday, February 17, 2016

WIN Olokizumab

I’ve just noticed that people have been interested in my article from 2013 “Olokizumab – any new developments?” I therefore adopted the WIN (=what is new?) from the ACR meeting sessions.

To tell the story in short, let me begin a little bit earlier than at “what is new?”. As nothing on olokizumab appeared at the EULAR meeting in Madrid in June 2013, I wondered: “Nothing! / Very strange as olokizumab targets interleukin-6 (IL-6). … Postponed or abandoned?” In July 2013 there had been an announcement by UCB: “UCB out-licenses RA drug olokizumab to Russia's R-Pharm”.
In 2014 I thought that olokizumab had been abandoned as nothing had been published at the EULAR 2014 Meeting in Paris.

MC Genovese and colleagues published: “Efficacy and safety of olokizumab in patients with rheumatoid arthritis with an inadequate response to TNF inhibitor therapy: outcomes of a randomised Phase IIb study” in Annals of the Rheumatic Diseases (2014).
MC Genovese and colleagues (other group of researchers) published at the ACR 2015 Meeting in San Francisco: “Long-Term Safety and Efficacy of Olokizumab in Patients with Moderate-to-Severe Rheumatoid Arthritis Who Have Previously Failed Anti-TNF Treatment“. The researchers looked at data from Western and Asian patients. Conclusion: “OKZ [OLOKIZUMAB] was well-tolerated, with an expected safety profile for this class of agent. Reductions in disease activity were sustained to Wk48. These results support the development of OKZ for the treatment of moderate-to-severe RA in Western and Asian pts.”

These recent studies aren’t so interesting in the results, but still there is a story being told. UCB still hasn’t given up and keeps a low fire burning. I doubt that olokizumab will be approved as a drug against rheumatoid arthritis.

Olokizumab – any new developments?

UCB out-licenses RA drug olokizumab to Russia's R-Pharm

Newer Biologics at the EULAR 2014 Meeting in Paris

Genovese MC, Fleischmann R, Furst D , Janssen N , Carter J, Dasgupta B , Bryson J , Duncan B, Zhu W, Pitzalis C, Durez P, Kretsos K. Efficacy and safety of olokizumab in patients with rheumatoid arthritis with an inadequate response to TNF inhibitor therapy: outcomes of a randomised Phase IIb study. Ann Rheum Dis. 2014 Sep;73(9):1607-15. doi: 10.1136/annrheumdis-2013-204760. Epub 2014 Mar 18.

Genovese MC, Fleischmann R, Tanaka Y, Furst DE, Yamanaka H, Joshi R, Zhu W, Shao J, Mashimo H, Takeuchi T. Long-Term Safety and Efficacy of Olokizumab in Patients with Moderate-to-Severe Rheumatoid Arthritis Who Have Previously Failed Anti-TNF Treatment [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). Accessed February 17, 2016.


Tuesday, February 16, 2016

One of my patients suffering from akylosing spondylitis came on a routine visit today. She is injecting a TNF-inhibitor on her own and doing fine. Though we call her disease in remission, she still has aches and pains. During nights she complained about having difficulties in turning from one side to the other in bed. And look, what a friend has developed for her:

She describes her bedroom with having gable walls, under which she has placed her bed. This easy had made grip is fixed in the slanted wall. I think the problem is just getting it properly fixed, so that one can apply some force to it. Now, she can turn in her bed more easily and reduce the burden of her disease. 
I like if patients, friends, and relatives find solutions for daily problems. 


Carpe Diem Haiku Theme Week No. 1 epsiode 2 The Tibetan Book of Living and Dying, Insight 1 We are travelers

Round and round they go
The pilgrims at Mount Kailash
Wind catching prayers

Wind catching prayers
Even from diseased pilgrims
Still in the bardo

Still in the bardo
Waiting amidst drum and song
By the bön shaman

Monday, February 15, 2016

Carpe Diem Haiku Special No. 197 Hamish's third "Forest Walks, a winter kikobun"

Lately I’ve been hiking in Switzerland. We went up into the mountains, donning the snowshoes, and walked through the winter landscape. We started, when the mists turned the landscape into a magical theatre. Far away there wasn’t anything seen anymore.

The mists do not hide
They reveal all the treasures
You might just walk by

No one walked, where we had set out our path across the meadows, through dense or less dense forests, crossing the green border to France, and crossing back. The snow had turned to be very heavy and snow and melted water fell on us from the mighty fir trees or the smaller beech trees. Snow was clinging to the snowshoes and walking grew heavy.

Glaring snow and sky
The deep green and black of firs
The deer disappears

Then the sun broke through, thinning the clouds, which now were running above within one’s reach.
Later we reached the summer pasture with the chalet, now closed of course, but it was a serene place for a picnic.

The snow did not only record our imprints, but we saw, where deer and hare had run.

The hills do not mind
But the snow can't keep secrets
Frolicking rabbits

Carpe Diem Haiku No. 919 Intuition

On the way back home
Not entering the alley
Passing the cut throats

Too much reckoning
Not listening the belly
Just sit, do not think

Bats don’t use sonar
They just happen to be there
Where the fly appears


Bio-Cortison ist eine Mogelpackung – so nun ist das schon einmal raus. Cortison wird korrekterweise im Deutschen Kortison geschrieben, aber das machen auch viele Ärzte falsch. Ja, man benutzt gerne ein C, wenn es wissenschaftlicher aussehen soll; das machen eben auch Ärzte so, ich finde das schlecht!
Wo Kortison drauf steht, da sollte auch Kortison drin sein. Ist es aber nicht! In Bio-Cortison sind Weihrauch, Curcumin und Leinöl enthalten. Das Präparat nennt sich TNF direkt. Das soll wohl an den Tumor-Nekrose-Faktor erinnern, den wir in der Rheumatologie blockieren; dafür sind spezielle Antikörper notwendig, das schafft man nicht mit Nahrungsergänzungsmitteln. In den Produktinformationen von TNF direkt findet man die Bezeichnung Bio-Cortison übrigens nicht; die finden Sie in dem Artikel " Tumornekrosefaktor-Alpha - Entzündungsfaktor TNF-alpha senken -": "Ein neuer pflanzlicher TNF -Hemmer!" bzw. dem darinnen annoncierten Artikel "Gibt es eine "Bio-Cortison" Therapie?"(Link:
Ich kann verstehen, dass man Kortison reduzieren will. Und es regt mich jedes Mal auf, wenn ich Patienten sehe, die überflüssigerweise mit Kortison behandelt worden sind, denn Kortison hat Nebenwirkungen in allen Dosierungen. Es gibt keine harmlose Dosierung, allerdings sind die niedrigen Dosierungen weniger gefährlich.
Einige Erkrankungen müssen zwingend mit Kortison behandelt werden (z.B. der schwere allergische Asthma-Anfall, Gefäßentzündungen (Vaskulitis) oder die Polymyalgia rheumatica) – ein plötzliches Absetzen oder Ersetzen durch Bio-Cortison könnte da lebensbedrohlich werden.

Weihrauch und Curcumin sind auch in Dr. Hittich CuraQuick Kapseln (siehe zur Wirkung dort: TNF oder Bio-Cortison enthält dazu noch Leinöl. Überlegen Sie einmal, wie viel Leinöl in so eine Kapsel passt.

Was kostet Bio-Cortison? Ich fand Preise um 45-50 € pro Monat. Also bei einer Dauertherapie mit diesem Nahrungsersatzmittel ca. 600 € im Jahr. Das wäre mir zu viel. Nehmen Sie Bio-Leinöl, wenn Sie omega-3-Fettsäuren zuführen wollen, aber lassen Sie die Kapseln im Regal. Curcuma (Gelbwurz/Turmeric) ist ein hervorragendes Gewürz. Sie können sich mit einem Currygericht täglich genügend davon zuführen – erwarten Sie allerdings nicht zu viel in Hinsicht auf Ihre Erkrankung.

Ich habe nochmals die Produktinformationen "TNF direkt mit Weihrauch, Curcumin und Leinöl" aufgerufen ( Inhaltsstoffe: „Hochwertiges Leinöl“ (unklar bleibt, wie es zu der Einteilung in hoch- und minderwertiges Leinöl kommt, Afrikanischer Weihrauch, „bioverfügbares Curcumin“ (hier bleibt unklar, wie bioverfügbar das Curcumin ist und ob es gegenüber dem Gewürz überhaupt besser bioverfügbar ist).

Schließlich lese ich: „Laut Gutachten (Health Claims) der Europäischen Behörde für Lebensmittelsicherheit (EFSA) können folgende Stoffe einen wissenschaftlich belegten Beitrag zu Ihrer Gesundheit leisten: (hier klicken)“. Ich erwartete, dass dort der eine oder andere Stoff von TNF direkt aufgelistet wäre, aber dort fand sich keiner der Inhaltsstoffe. In den Produktinformationen werden auch keine Health Claims angeführt; da ist der Hersteller rechts konform vorgegangen. Aber schließlich gaukelt der Link dem Leser vor, es könnte so etwas geben. Deshalb ist es immer wichtig, die Links auch zu lesen.


Sunday, February 14, 2016

Carpe Diem Haiku No. 918 Touch/Tactioception (Pain)

On the soft carpet
Of green moss beneath the trees
So deep blue the sky

The cat with soft paws
Running on the coarse concrete
Soft tea in hard bowl

Winter plays with cold rain
The snow drops don’t feel the cold
Rain drops make them chime

When I’ve read Chèvrefeuille’s introduction, I felt reminded of Strangelove by Depeche Mode:
Will you give it to me
Will you take the pain
I will give to you
Again and again
And will you return it
And of course of the song Luka by Susan Vega:
They only hit until you cry
After that you don't ask why

Snow drops are called Schneeglöckchen in German, literally snow chimes.

Saturday, February 13, 2016

Carpe Diem Haiku No. 917 direction

Sun behind a tree ()
To the North () waves on the shore
Soon the geese return ()

Next to steering wheel
The compass set behind glass
The sea may churn now

Guugu Yimithirr language: „The language is notable for its use of pure geographic directions (north, south, east, west) rather than egocentric directions (left, right, forward, backward), …”. And it’s the source language for the word kangaroo.

Pepe Lienhards rechte Hand

Von einer Litfaßsäule blickt mich Pepe Lienhard an. Und ich weiß nicht, was er da mit seiner rechten Hand ausdrücken will. Soll mich das einladen? Ich höre mir keine Big Band Musik an. Ich höre mich sehr unterschiedliche Musik an, ACDC / Rock genauso wie Kirchenmusik, Barock, Jazz, Pop oder Weltmusik. Das Saxophon auf dem Bild erinnert mich zu sehr an Exzesse populärer Big Band Musik im Fernsehen der 60iger Jahre - bringen wir es auf den Punkt: Max Greger.

So blickte mir Pepe Lienhard entgegen

Zurück zu Pepes rechter Hand. Als Rheumatologe dachte ich zuerst: leidet der Mann an einer Dupuytren'schen Kontraktur (Knötchen und Verbackung von Gewebe der Beugesehnen mit der Haut in der Innenfläche der Hand, oft 4. und 5. Strahl)? Nein, tut er nicht. Es ist auch kein Herbeiwinken. Die Geste des Pistole-auf-jemanden-Richtens ist es auch nicht. Mir kommt der Verdacht, dass diese Geste zufällig ist und überhaupt nichts bedeutet. Ich lasse mich aber gerne eines Besseren belehren.


Banküberfall in Köln-Buchheim

Ich stamme aus Köln-Buchforst, aber in Buchheim gehe ich häufig zur Bank. Das Foto im Artikel „Fahndung“ des EXPRESS zeigt diese Bank. Buchforst und Buchheim grenzen aneinander. Das kann man gut zu Fuß bewältigen. Aber die Bankräuberin fuhr mit dem eigenen Auto zum Tatort.
Ich wurde erst heute darauf aufmerksam, da mir die Überschrift des EXPRESS: „Bitterarm. Da hat sie eine Bank überfallen“ entgegen schrie.
Aus den Berichten geht hervor, dass sie Kassenwartin in einem Kleingärtnerverein ist und ein eigenes Auto besitzt. Das würde ich nicht als „bitterarm“ bezeichnen. Ich kann die Bezeichnung „verzweifelt“, die der EXPRESS im Artikel „Akute Geldnot“ verwendet, besser verstehen.
Die Frau hat allerdings kriminelle Energie entwickelt. Zunächst hatte sie im Kleingärtnerverein Geld unterschlagen und danach hatte sie die Bank überfallen. Aber ich würde mich nicht wundern, wenn dieser ungeschickte Überfall vor Gericht nicht nur als Verzweiflungstat, sondern auch als demonstrativer Akt gewertet werden sollte. Irgendwie erinnert es mich an Gathmann (STERN), der z.B. eine Bank mit einem Croissant in der Hand überfallen hat.

Mich wird es nicht hindern, weiter die Bank in Buchheim aufzusuchen.

Fahndung Frau überfällt Sparkasse in Köln-Buchheim - und flüchtet mit der Beute

Fotofahndung erfolgreich! Buchheimer Bankräuberin in Köln-Buchforst gefasst

Akute Geldnot Gestatten, Kölns wohl verzweifeltste Bankräuberin!



Friday, February 12, 2016

FreitagsGedichte / Kurze Gedichte 12.02.2016

    der lichte
Und weiter
In tiefen
Das Schicksal

Bleibt vom
Am Ende
Der GrabStein

Den Schnee
Die Tür
Vor den
Kamin setzen
    Ganz ruhig
Treiben lassen

    im Winter
Der Mond
Ist allein
    Der wahre

    die AutoBahn

    aber das
Nicht nur
Nur Sitzen

    auch wenn
Wir es

    wir nehmen
Auch die
Oder wir
    Wie sie

    die silbernen
Der geKräuselten
Des Sees
    Ein Gedicht

    in den
Zu retten

    bevor sie
Die Kleider
In ihre
Sie dann

    höre auf
Das Singen
Der Sphären
Mußt du
    Ohne Kristall

Thursday, February 11, 2016

BI 655066 (a humanized IgG1 monoclonal antibody) at the ACR 2015 meeting in San Francisco

P.J. Mease mentioned IL-23 as a target in psoriatic arthritis in an article in Current Opinion in Rheumatology (Curr. Opin. Rheumatol) and he stressed the importance of “having effective medicines with an alternative mechanism of action [, which] will improve our ability to diminish disease activity impact on patient lives.”
And recently I’ve read an article, titled: “Boehringer says anti-IL-23 drug beats Stelara [Ustekinumab] in psoriasis trial”, in which we’re told: “New data from a phase II trial of Boehringer Ingelheim's psoriasis candidate BI 655066 back up earlier results showing it is more effective than a rival drug from Johnson & Johnson.” Well, this article talks about psoriasis and not of psoriatic arthritis.
But I guess, you’re also interested in hearing more about this potential drug.

Kim Papp and colleagues presented a phase 2 study at the ACR 2015 Annual Meeting in San Francisco [abract No. 2144]: “Efficacy and Safety of Different Dose Regimens of a Selective IL-23p19 Inhibitor (BI 655066) Compared with Ustekinumab in Patients with Moderate-to-Severe Plaque Psoriasis with and without Psoriatic Arthritis [PsA]”. (With and without!) BI 655066 is a humanizedIgG1 MAB, which selectively inhibits IL-23p19. “166 patients were randomly assigned (1:1:1:1 ratio) to receive subcutaneous injections of one of three dosage regimens of BI 655066 (18 mg single dose at Week 0; 90 or 180 mg at Weeks 0, 4, and 16), or ustekinumab (45 or 90 mg, based on weight, at Weeks 0, 4, and 16).” The primary endpoint of PASI 90 response at Week 12 was achieved by up to 81.0 of BI 655066 patients and 40.0% of ustekinumab patients. There were only 46 (27.7%) patients with PsA “(either previously diagnosed by rheumatologist [n=13] or suspected by investigator [n=33])”, who nevertheless showed a good pain reduction (VAS). Conclusion: “Selective blockade of IL-23p19 with BI 655066, in the 90 mg and 180 mg arms, were associated with PASI responses superior to ustekinumab in patients with moderate-to-severe plaque psoriasis. Treatment with BI 655066 or ustekinumab was associated with numeric improvement in pain-VAS in patients with diagnosed or suspected PsA. Further studies are needed to assess long-term efficacy and safety of BI 655066 in both psoriasis and PsA.”

I think in treating skin psoriasis dermatologist are beyond PASI90, so I’d call 81% achieving PASI90 good, but not outstanding. There were only 28% of patients with psoriatic arthritis in the study and furthermore only a very small number of the patient (N=13) of the whole cohort (N=166), which amount to a meagre 8% of patients, were properly diagnosed by a rheumatologist. There has been a pain reduction, but that isn’t enough to judge the efficacy of BI 655066 against signs and symptoms of psoriatic arthritis. As the authors stated: “Further studies are needed”. So, we have to wait for Boehringer to sponsor a proper study on psoriatic arthritis.

Mease PJ Inhibition of interleukin-17, interleukin-23 and the TH17 cell pathway in the treatment of psoriatic arthritis and psoriasis [abstract]. Curr Opin Rheumatol. 2015 Mar;27(2):127-33. doi: 10.1097/BOR.0000000000000147.

Papp K, Menter A, Sofen H, Tyring S, Lacour JP, Berner B, Bennett N, Aslanyan S, Flack M, Scholl P. Efficacy and Safety of Different Dose Regimens of a Selective IL-23p19 Inhibitor (BI 655066) Compared with Ustekinumab in Patients with Moderate-to-Severe Plaque Psoriasis with and without Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). Accessed February 11, 2016.


Wednesday, February 10, 2016

New way of an old scam on LinkedIn

Today I've been contacted on LinkedIn and received a scam note:

Hello kirsch, Greetings to you. My name is Mr. [name] Haddad. I am a Bank Officer in Al Khan (Sharjah), United Arab Emirates. I am writing you in regards to an opportunity in my bank which will be of an immense benefit to both of us. It is about your last name which is the reason I contacted you. I know you would like me to explain in detail my purpose for contacting you here on LinkedIn but this is not something I can share with you on a platform like LinkedIn. I want you to write me through my email address:Hadda[name] I will reply you with details as soon as I receive your mail so you can tell me your mind after going through my letter. I look forward with eager anticipation of hearing from you. God bless. Regards, Haddad.

I must have been very unobservant to allow this individual on LinkedIn. To those, who aren't familiar with this kind of scam: if I'll give my email address to him, I'll receive an email tellling me, because I have the same name as a client I can get hold of the account of dead client and we devide the 14.5 zillion US$.

Please, if you receive such a mail, LinkedIn note, or fax (I did so these days - the Spanish scam), just don't answer it.