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Originaltitel: Allostatic load elevates the risk and adverse prognosis of immune-mediated inflammatory diseases: modulatory effects of lifestyle interventions and genetic susceptibility Link zur Quelle

Originaltitel: Specialized Pro-Resolving Lipid Mediators and Dietary Omega-3/6 Fatty Acids in Selected Inflammatory Skin Diseases: A Systematic Review Link zur Quelle

Originaltitel: Clinical Importance of Central Sensitization and... : Indian Journal of Dermatology Link zur Quelle

Kurkuma und Echinacea gelten als vielversprechende pflanzliche Stoffe, um das Immunsystem zu regulieren und Entzündungen zu bekämpfen[1][2][4]. Beide Pflanzen beeinflussen wichtige Immunzellen wie Makrophagen und wirken auf Botenstoffe ein, die Entzündungen auslösen[1][2]. **Was die Pflanzen bewirken:** Echinacea stimuliert die Produktion von weißen Blutkörperchen und hemmt gleichzeitig Entzündungsstoffe[2]. Kurkuma reduziert hingegen bestimmte Botenstoffe, die bei chronischen Entzündungen aktiv sind[4]. Für Menschen mit Psoriasis oder Psoriasis-Arthritis könnte das interessant sein, da beide Erkrankungen mit fehlgeleiteten Immunreaktionen verbunden sind. **Das Problem:** Bisher gibt es aber nur wenige aussagekräftige Studien am Menschen[1]. Die Pflanzen werden vom Körper nicht optimal aufgenommen. Deshalb forschen Wissenschaftler an neuen Formulierungen wie winzigen Fettkügelchen oder speziellen Komplexen, um die Wirkstoffe besser verfügbar zu machen. **Fazit:** Die Forschung ist vielversprechend, aber noch nicht weit genug fortgeschritten, um Echinacea oder Kurkuma als sichere Zusatztherapie zu empfehlen. Bevor ihr solche Präparate nutzt, solltet ihr mit eurem Arzt sprechen[1][2]. Originaltitel: Pharmacological Insights and Technological Innovations in Curcuma longa L. and Echinacea purpurea (L.) Moench as Plant-Derived Immunomodulators Link zur Quelle

**Gute Nachrichten für Psoriasis-Patienten: Biologika sind sicherer als gedacht** Eine neue französische Studie hat gute Neuigkeiten für Menschen mit Psoriasis, die mit Biologika behandelt werden.[1] Forscher untersuchten über 39.000 Patienten und stellten fest: Das Infektionsrisiko ist insgesamt sehr niedrig. Die wichtigste Erkenntnis betrifft zwei bestimmte Medikamentengruppen. Ustekinumab und die sogenannten IL-23-Inhibitoren zeigen das geringste Infektionsrisiko.[1] Das bedeutet konkret: Wenn man diese Mittel nimmt, ist das Infektionsrisiko besonders klein. Bei den Patienten in der Studie kam es zu etwa 27 Infektionen pro 1.000 Personenjahre, die eine Krankenhausbehandlung brauchten.[1] Das klingt nach viel, ist aber relativ gering. Zum Vergleich: Die meisten Patienten unter Biologika brauchten kaum Antibiotika. Die Quote lag bei nur 5,5 Prozent.[1] **Das solltest du wissen:** Die Studie verglich verschiedene Biologika miteinander. Manche Medikamente schnitten besser ab als andere. Das ist wichtig für Ärzte bei der Wahl des richtigen Mittels für dich.[1] Fazit: Biologika helfen dir, deine Psoriasis zu kontrollieren. Und das Infektionsrisiko ist dabei deutlich geringer als viele Patienten befürchten. Originaltitel: Infection risk among psoriasis biologic-new users: a cohort study on the French National Health Data System - PubMed Link zur Quelle

Originaltitel: The Environmental Determinants of Skin Health: Linking Climate Change, Air Pollution, and the Dermatologic Disease Burden Link zur Quelle

Originaltitel: Dimethyl Fumarate vs. Monomethyl Fumarate: Unresolved Pharmacologic Issues Link zur Quelle

**Mittelmeerdiät lindert Psoriasis-Beschwerden** Eine Studie untersuchte 38 Patienten mit leichter bis mittelschwerer Psoriasis über 16 Wochen.[1] Die eine Gruppe aß nach der Mittelmeerdiät. Die andere Gruppe erhielt normale Ernährungstipps. Das Ergebnis begeistert: Die Mittelmeerdiät-Gruppe verbesserte ihre Haut deutlich.[1] Bei fast der Hälfte der Teilnehmer sank die Krankheitsschwere um 75 Prozent.[1] Das erreichte niemand in der Kontrollgruppe. Auch der Blutzuckerspiegel sank in der Mittelmeerdiät-Gruppe.[2] Das ist wichtig. Viele Psoriasis-Patienten haben Diabetes-Risiko. Die Mittelmeerdiät besteht aus vielen Pflanzen. Menschen essen Obst, Gemüse, Fisch und Olivenöl.[1] Sie vermeiden rotes Fleisch. Diese Lebensmittel wirken entzündungshemmend. Teilnehmer berichteten außerdem: Der Schlaf wurde besser und die Lebensqualität stieg.[1] Forscher meinen: Die Ernährung könnte ein wichtiger Teil der Therapie werden. Sie funktioniert aber nur, wenn man sie auch wirklich durchzieht.[1] Originaltitel: The interaction between the Mediterranean diet, obesity, and disease severity: A case-control study on psoriatic patients - PubMed Link zur Quelle

Originaltitel: The Impact of Sleep Dysfunction on Inflammatory Skin Diseases: A Systematic Review Link zur Quelle

# Psoriasis erhöht das Risiko für Augenkrankheit Wissenschaftler haben herausgefunden, dass Psoriasis mit der altersbedingten Makuladegeneration (AMD) verbunden ist.[1][2] Diese Augenkrankheit führt zu Sehverlust und betrifft viele ältere Menschen. Eine große Studie zeigte, dass Psoriasis-Patienten ein um 56 % höheres AMD-Risiko haben.[1] Die Verbindung entsteht wahrscheinlich durch gemeinsame Entzündungsprozesse im Körper.[3] Bei Psoriasis ist auch die Fettverteilung gestört, was die Blutgefäße in den Augen schädigen kann.[1] Besonders die trockene Form von AMD tritt häufiger auf. Gute Nachricht: Patienten, die biologische Medikamente nehmen, haben ein um 27 % geringeres AMD-Risiko als jene mit älteren Behandlungen.[1] Das deutet darauf hin, dass diese Therapien nicht nur die Haut, sondern auch die Augen schützen könnten. Experten raten: Regelmäßige Augenuntersuchungen sind wichtig.[1] Berichte deinem Arzt sofort, wenn sich dein Sehen verschlechtert. Mehr Forschung ist nötig, um diese Verbindung besser zu verstehen. Originaltitel: Causal Association Between Psoriasis and Age-Related Macular Degeneration: A Two-Sample Mendelian Randomization Study Link zur Quelle

Originaltitel: Thykamine™: A New Player in the Field of Anti-Inflammatory Drugs Link zur Quelle

Die Suche nach neuen Behandlungen für Schuppenflechte wird immer intensiver. Forscher untersuchen derzeit pflanzliche Stoffe wie einen Kiefernpollen-Extrakt, der den Wirkstoff Dihydroquercetin enthält. Das klingt nach einem vielversprechenden Ansatz. Das Problem: Die verfügbaren Informationen zu dieser speziellen Studie sind leider begrenzt. Allerdings zeigen andere aktuelle Studien, dass natürliche Wirkstoffe bei Schuppenflechte helfen können. Sie wirken entweder allein oder zusammen mit herkömmlichen Medikamenten. Das ist besonders interessant, weil viele Menschen unter Nebenwirkungen von Standard-Therapien leiden. Pflanzliche Mittel könnten eine sicherere Alternative bieten. Allerdings warnen Experten: Auch natürliche Stoffe müssen gründlich erforscht werden. Wissenschaftler müssen prüfen, wie sie wirken und ob sie langfristig sicher sind. Momentan gibt es keine Heilung für Schuppenflechte. Aber die Forschung macht Fortschritte. Neue biologische Medikamente und pflanzliche Wirkstoffe geben vielen Patienten Hoffnung auf bessere Lebensqualität. Originaltitel: Biological activity study of a pine pollen extract rich in dihydroquercetin for the treatment of psoriasis Link zur Quelle

# Zusammenfassung der Studie Diese Studie untersuchte die Sicherheit, Verträglichkeit und Wirkungsweise eines neuen Medikaments namens SUDO-286 bei Menschen mit Schuppenflechte (Psoriasis). Das Medikament wurde als Creme oder Lotion direkt auf die Haut aufgetragen. Die Forscher wollten herausfinden, ob das Mittel gut vertragen wird, welche Nebenwirkungen auftreten können und wie es im Körper wirkt. ## Die Substanz SUDO-286 SUDO-286 ist ein neuer Wirkstoff, der gezielt ein bestimmtes Protein in den Zellen blockiert, das TYK2 heißt. Dieses Protein spielt eine wichtige Rolle bei Schuppenflechte, weil es die Entzündung in der Haut antreibt. Indem SUDO-286 dieses Protein bremst, soll die Entzündung abnehmen und die Haut heilen. Das Besondere an SUDO-286 ist, dass es als Creme direkt auf die betroffenen Hautstellen aufgetragen wird – nicht als Tablette geschluckt oder gespritzt. Das hat den Vorteil, dass der Stoff vor allem dort wirkt, wo er gebraucht wird, und weniger in den ganzen Körper gelangt. Die Studie war eine frühe Phase-1-Studie mit nur 15 Teilnehmern, um zunächst zu prüfen, ob das Medikament sicher ist. --- Originaltitel: Evaluation of Safety, Tolerability, and Pharmacodynamic Effects of Topically Applied SUDO-286 in Psoriasis Erkrankung: Plaque Psoriasis (Plaque-Schuppenflechte) Phase: Phase I (Human Pharmacology) Firma: Sudo Biosciences Limited Art der Verabreichung: Äußerliche Anwendung (topisch) https://euclinicaltrials.eu/search-for-clinical-trials/?lang=en&EUCT=2023-509079-18-00

Background and objectivesPsoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring.Patients and methodsThis prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2).ResultsMPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001).ConclusionsMPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.Weiterlesen

No abstract supplied.Weiterlesen

Objective and designThis prospective multicenter cohort study was conducted to identify and compare clinical factors associated with the effectiveness of commonly used biologics in Chinese patients with moderate-to-severe psoriasis.SubjectsPatients from the SPEECH registry initiating treatment with ixekizumab, secukinumab, guselkumab, or ustekinumab were included.TreatmentGuideline-recommended dosing; 3-month follow-up.MethodsThe primary endpoint was PASI90 response at 3 months. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for clinical predictors of treatment response.ResultsA total of 717 patients were included in the analysis. In guselkumab-treated patients, obesity (aOR 0.22, 95% CI 0.06-0.78) and prior biologic exposure (aOR 0.22, 95% CI 0.06-0.75) were independently associated with reduced PASI90 response. Psoriatic arthritis predicted poorer response to ustekinumab (aOR 0.16, 95% CI 0.03-0.78). For secukinumab, male sex reduced the likelihood of PASI90 (aOR 0.47, 95% CI 0.23-0.96), whereas family history of psoriasis improved outcomes (aOR 2.20, 95% CI 1.10-4.42). In ixekizumab-treated patients, obesity (aOR 0.38, 95% CI 0.18-0.80) was a negative predictor, while family history (aOR 2.79, 95% CI 1.22-6.38) enhanced treatment response.ConclusionsPredictors of biologic effectiveness differ by agent, supporting personalized treatment based on patient characteristics.Weiterlesen

Psoriasis and psoriatic arthritis (PsA) occasionally coexist with antinuclear antibody (ANA) positivity, cutaneous lupus erythematosus (CLE), or systemic lupus erythematosus (SLE), creating one of the most challenging therapeutic overlap scenarios in immunodermatology. Divergent immune pathways-IL-23/Th17-driven psoriatic inflammation versus type I interferon-mediated autoimmunity-generate unique vulnerabilities when systemic treatments are used. To synthesize treatment outcomes, lupus-related safety signals, and mechanistic insights across systemic therapies in patients with psoriasis or PsA who also exhibit ANA positivity, CLE, or SLE. A systematic review following PRISMA 2020 guidelines was conducted across PubMed/MEDLINE, Embase, the Cochrane Library, Scopus, and ClinicalTrials.gov from database inception through 31 October 2025. Thirty-three eligible reports (29 unique clinical studies; 1429 patients) were included and organized into six prespecified overlap subgroups. Mechanistic and translational studies-including ustekinumab and deucravacitinib SLE trial data and reports of IL-17 inhibitor-associated CLE-were reviewed separately to provide contextual interpretation. IL-23 inhibitors were consistently associated with a favorable cross-disease safety profile, with no clear signal for CLE worsening, SLE flares, or drug-induced autoimmunity. IL-17 inhibitors maintained strong psoriatic efficacy but were associated with an increased frequency of de novo or exacerbated CLE. TNF-α inhibitors showed the strongest association with ANA seroconversion, anti-dsDNA induction, drug-induced lupus, and lupus flares. Ustekinumab demonstrated a stable safety profile across lupus-spectrum disease despite variable efficacy in formal SLE trials. TYK2 inhibition provided dual modulation of IL-23 and type I interferon pathways and showed emerging utility in psoriasis or PsA coexisting with CLE or SLE. Apremilast, methotrexate, and mycophenolate mofetil remained reliable non-biologic systemic options. Phototherapy was associated with potential risk in ANA-positive or lupus-susceptible populations and therefore requires careful consideration. Interpretation is limited by the predominantly observational nature and heterogeneity of the available evidence. IL-23 inhibition and TYK2 inhibition appear to offer a balanced profile of efficacy and lupus-related safety in psoriatic disease complicated by lupus-spectrum autoimmunity. IL-17 inhibitors and TNF-α inhibitors may be associated with higher risk in CLE- or SLE-prone patients and therefore warrant particular caution. Personalized treatment strategies should integrate the relative dominance of psoriatic versus lupus disease, ANA/ENA profile, CLE subtype, and underlying mechanistic considerations. Prospective, biomarker-driven studies are needed to guide therapy in this increasingly recognized overlap population (PROSPERO registration: CRD420251241279).Weiterlesen

Psoriatic arthritis develops in up to one-third of individuals with psoriasis, typically following a prolonged subclinical phase. Diagnostic delays are common, often exceeding 2 years, and can result in irreversible joint damage. The growing recognition of this latent period has fuelled interest in earlier identification and interception. However, efforts are hampered by inconsistent definitions of early or subclinical psoriatic arthritis, insufficient prognostic tools, and an absence of consensus on the outcome for interception studies. This Review synthesises a rapidly evolving field, offering a framework organised around four crucial questions: first, what defines progression from psoriasis to psoriatic arthritis? Second, who is most at risk of transition? Third, how can progression be reliably measured using imaging, molecular biomarkers, or digital health technologies? Fourth, when should preventive intervention be considered? We critically examine new conceptual models, the limitations of existing classification criteria, advances in imaging and biomarker research, and the promise of digital phenotyping. Addressing the current challenges in definitions, risk stratification, measurement, and trial design is essential for the development of biologically grounded, ethically robust interception strategies.Weiterlesen

This study examined relationships between Early Maladaptive Schemas (EMS), emotion regulation, coping styles, and psoriasis outcomes in Istanbul, Turkey. Participants included 100 psoriasis patients (ages 25-45) and 107 healthy controls. Data were analyzed using structural equation modeling. Psoriasis patients scored significantly higher on six schemas: Emotional Deprivation, Approval Seeking, Pessimism, Self-Sacrifice, Punitiveness, and Unrelenting Standards (Cohen's d = 0.42-0.89). They also demonstrated greater emotion regulation difficulties and reduced adaptive coping. Mediation analyses revealed that maladaptive emotion-focused coping fully mediated relationships between EMS and quality of life deterioration (β = .11, 95% CI (.04, .19]) and psoriasis severity (β = .08, 95% CI [.02, .15]). Pessimism and Punitiveness schemas, impulse control difficulties, and maladaptive emotion-focused coping predicted general psychological symptom severity (measured by validated scales) (R2 = .46). Findings suggest maladaptive emotion-focused coping as a key mechanism linking schemas to psoriasis outcomes, supporting integrated dermatological and psychological interventions.Weiterlesen

Efficacious and well-tolerated systemic, oral treatments for psoriasis are needed. We report preclinical and phase 1c (NCT06808815) results for DC-806, a small molecule interleukin (IL)-17 inhibitor, for the treatment of mild-to-moderate psoriasis. Preclinical results demonstrated DC-806 targets IL-17AA and IL-17AF with secukinumab-like therapeutic efficacy. In the phase 1c trial, 32 patients consented to receive twice daily (BID) doses of placebo or DC-806 (200 mg or 800 mg) for 28 days. No serious adverse events (SAEs) or discontinuations due to treatment-related adverse events (TRAEs) occurred. In an exploratory analysis, adjusted mean percentage reductions from baseline in psoriasis area and severity indices (PASI) at Day 29 were 43.7%, 15.1%, and 13.3% for 800 mg BID, 200 mg BID, and placebo arms, respectively (800 mg BID vs placebo, P value = 0.0008). DC-806 was found to be well tolerated with an acceptable safety profile and preliminary signals of clinical efficacy in mild-to-moderate psoriasis. EudraCT Identifier: 2021-002888-21.Weiterlesen

Background and objectivesPsoriasis is a chronic inflammatory skin disease, and noninvasive diagnostic tools are essential for accurate diagnosis and treatment monitoring. Multiphoton microscopy (MPM) enables real-time, noninvasive skin imaging with submicron resolution. This study evaluated the diagnostic accuracy of MPM in psoriasis and its potential application in therapeutic monitoring.Patients and methodsThis prospective observational study enrolled 34 patients with psoriasis. It comprised three parts: (1) analysis of imaging features of lesional and nonlesional skin using multiphoton microscopy (MPM; Transcend Vivoscope); (2) evaluation of the diagnostic performance of MPM parameters compared with reflectance confocal microscopy (RCM); and (3) prospective monitoring of 24 patients treated with Benvitimod (Tapinarof) cream for 8 weeks (T0/T1/T2).ResultsMPM detected psoriasis characteristics (including hyperkeratosis, parakeratosis, an absent stratum granulosum, enlarged nucleus diameter, and absent bright rimming) with comparable diagnostic efficiency to RCM (AUC = 0.838, p < 0.001 vs. 0.824, p < 0.001). Psoriatic lesions showed significant perinuclear fluorescence accumulation compared to healthy skin (p < 0.001). All imaging features improved significantly after 8 weeks of treatment (p < 0.001). PASI/TLS scores showed correlations with the epidermal thickness (r = 0.403/0.492, p < 0.001), nuclear diameter (r = 0.4/0.375, p < 0.001), and fluorescence intensity (r = -0.419/-0.492, p < 0.001).ConclusionsMPM is a novel and non-invasive imaging technique for psoriasis evaluation and treatment monitoring.Weiterlesen

ObjectiveThis study aims to evaluate the clinical impacts of topical and/or oral administration of compounds rich in omega-3 fatty acids from various sources, such as oils and foods, on psoriatic lesions.DesignA systematic review was carried out.Data sourcesSearches were conducted in six databases (PubMed, Cochrane, VHL, Scopus, Embase, and Web of Science) using descriptors related to fatty acids and psoriasis.Study selectionInclusion criteria were studies published in the last 10 years (2013-2023) that involved patients with psoriasis and provided quantitative clinical outcome data, such as psoriasis severity scale.Data extractionTwo independent reviewers carried out the initial screening of the titles and abstracts identified in the search. The quality of studies was evaluated using the Newcastle-Ottawa Scale, the Risk of Bias in Randomized Studies of Interventions, and the Joanna Briggs Institute critical appraisal checklist.ResultsOut of 8570 articles identified, 9 met the inclusion criteria. The quality of randomized clinical trials and observational studies varied from low to high risk of bias, according to the respective parameters of each checklist.ConclusionsMost studies demonstrated that the topical and/or oral administration of omega-3 fatty acids from different sources significantly improved clinical parameters, as measured by severity scales and the Psoriasis Area and Severity Index (PASI).Weiterlesen

Abstract Background Psoriasis patients in China face significant challenges due to insufficient disease knowledge and limited access to medical resources, creating a need for reliable educational tools. Objectives This multicenter consensus study aimed to systematically evaluate the consultation quality of mainstream Chinese large language models (LLMs) for psoriasis patient education. Methods "365 Questions on Psoriasis" was jointly compiled by 109 Chinese psoriasis experts. Using an expert assessment methodology, nine dermatologists curated 40 high-frequency clinical questions from the book across five domains (etiology, triggers, treatment, management, psychosocial impact). Four Chinese LLMs (DeepSeek-R1, DeepSeek-V3, GLM-4, Qwen-3) were evaluated through double-blind scoring on a 10-point Likert scale assessing accuracy, completeness, clarity, and safety. Results Performance varied significantly, with mean scores ranging from 5.95 to 9.88 (SD: 0-3.05). Qwen-3 achieved the highest average score (9.12), while GLM-4 showed the greatest inconsistency. All responses avoided dangerous content, and 87.5% proactively emphasized the necessity of consulting a physician. However, 12.5% of responses deviated from evidence-based guidelines, particularly on complex topics like biologics and management. Conclusions Chinese LLMs show substantial potential for psoriasis education by providing generally safe information and appropriately directing users to doctors. However, current limitations exist, including performance inconsistency and occasional deviations from guidelines on specialized topics, indicating they are not yet replacements for professional medical. Weiterlesen

BackgroundDespite increased understanding of psoriasis pathogenesis, molecular classification of clinical phenotypes and disease severity is poorly defined. Knowledge gaps include whether molecular endotypes of psoriasis underlie distinct clinical phenotypes and the positive and negative molecular regulators of disease severity across tissue compartments.MethodsWe performed comprehensive RNA sequencing of skin and blood (n = 718) from prospectively-recruited, deeply-phenotyped discovery and replication cohorts of 146 subjects with moderate-to-severe chronic plaque psoriasis initiating TNF-inhibitor (adalimumab) or IL-12/23-inhibitor (ustekinumab) therapy.ResultsHere we show, using two complementary dimensionality reduction methods, that co-expressed gene modules and factors within skin and blood are significantly associated with psoriasis phenotypes and disease severity. We identify a 14-gene signature negatively associated with BMI in nonlesional skin and with disease severity in lesional skin. Genotype integration reveals that HLA-DQA1*01 and HLA-DRB1*15 genotypes are positively associated with baseline psoriasis severity. Using explainable machine learning models, we define two disease severity-associated gene modules in lesional skin - one positive, one negatively-associated - and a 9-gene signature in lesional skin predictive of disease severity. Disease severity signatures in blood are only seen following adalimumab exposure, suggesting greater systemic impact of adalimumab compared to ustekinumab, in line with its side effect profile. In contrast, a gene signature in blood linked to HLA-C*06:02 status is independent of disease severity or drug.ConclusionsThese findings delineate gene-environmental and genetic effects on the psoriasis transcriptome linked to disease severity.Weiterlesen

Originaltitel: Exploring clusters based on ultrasound-detected inflammation in patients with psoriatic arthritis: a post-hoc analysis from the ULTIMATE trial - BMC Musculoskeletal Disorders Link zur Quelle