Systemic sclerosis is one of the most challenging autoimmune connective tissue diseases. 2024 new treatment recommendations were published by EULAR which now are amended by German recommendations for diagnostic and therapy. This overview article focuses on these new advices to help referring physicians to identify patients with typical clinical features earlier and thus to improve early diagnosis and future treatment options. Here, especially (but not solely) B-cell targeting therapies are in the scope.

Chronic kidney disease (CKD) has been increasingly recognized as a major global health burden, prompting the WHO and UN in 2025 to call for strengthened prevention, early detection, and improved care. CKD accounted for approximately 1.5 million deaths in 2023, with age standardized mortality continuing to rise. Metabolic risk factors, especially hypertension, diabetes, and obesity, are the primary drivers of CKD burden in adults, while environmental and occupational exposures play an additional role in low resource settings. Congenital anomalies, hereditary nephropathies, and early life kidney injury are the main risk determinants in children. CKD of unknown cause (CKDu) represents a distinct public health challenge in agricultural regions of low-income countries, affecting mainly younger adults without traditional risk factors, with heat stress, dehydration, and environmental toxins considered potential contributors.

The current guidelines of the European Society of Cardiology recommend the use of cardiac glycosides/digitalis in patients with heart failure and sinus rhythm only if the LVEF is ≤40% and if heart failure symptoms persist despite therapy with Betablockers, ACE inhibitors (or angiotensin receptor-neprilysin inhibitors), and mineralocorticoid receptor antagonists, in order to reduce the risk of further hospitalizations. Therapy with cardiac glycosides is not recommended in heart failure with an LVEF >40% and sinus rhythm. In patients with atrial fibrillation, therapy with cardiac glycosides may be used primarily for rate control in heart failure with an LVEF >40%, and in those with an LVEF ≤40% if heart rate control under Betablocker therapy is insufficient or not possible. In the recently published DIGIT-HF study, digitoxin at low serum concentrations reduced all-cause mortality and heart-failure-related hospitalizations in patients with heart failure and reduced ejection fraction, in addition to very good guideline-recommended pharmacological and device therapy. Both patients with sinus rhythm and those with atrial fibrillation benefited. Important new study data from the DECISION study on the use of digoxin in heart failure are expected in 2026. Other studies provide indications of favorable effects of cardiac glycosides on pulmonary arterial pressure values in heart failure and on heart-failure surrogate marker in atrial fibrillation. Digitoxin can be used safely at low serum concentrations in symptomatic heart failure with reduced ejection fraction to improve prognosis and prevent heart-failure hospitalizations. In particular, patients with atrial fibrillation, advanced heart-failure symptoms, low blood pressure, and higher heart rates should be treated with digitoxin, as well as patients in whom the use of currently recommended prognosis-improving pharmacotherapy is limited. Cardiac glycosides are an important and safe therapeutic option for rate control in patients with atrial fibrillation and heart failure. The study data on digoxin expected in 2026 are important for the final assessment of the use of cardiac glycosides in heart failure.

Patient self-inflicted lung injury (P-SILI) describes a pathophysiological concept in which patients with acute hypoxemic respiratory failure (AHRF) may exacerbate lung injury through excessive respiratory drive and vigorous spontaneous breathing efforts, thereby perpetuating respiratory failure. Spontaneous breathing-related lung injury is thought to be mediated by 4 main mechanisms: 1. increased mechanical stress on lung tissue, 2. heterogeneous ventilation with intrapulmonary gas redistribution (pendelluft), 3. augmented pulmonary blood flow leading to microvascular injury, and 4. Patient-ventilator asynchrony (PVA) in the setting of non-invasive ventilation (NIV). All of these mechanisms are closely linked to an elevated respiratory drive, which primarily arises from the underlying lung pathology, particularly alveolar flooding due to plasma leakage. Clinical monitoring of respiratory effort and neural respiratory drive is possible using techniques such as esophageal pressure measurement. However, these methods are often invasive, not fully validated, time- and resource-intensive, costly, and may be associated with reduced patient comfort.In the management of acute respiratory failure, including acute respiratory distress syndrome (ARDS) and AHRF, prevention of P-SILI is essential. Recent evidence suggests that late failure of NIV followed by delayed intubation is associated with the highest mortality rates. Consequently, the choice of ventilatory support must be individualized and continuously reassessed, taking into account the risk of both P-SILI and ventilator-induced lung injury. Non-invasive ventilation, high-flow nasal cannula therapy, pharmacological interventions, and prone positioning during spontaneous breathing all have therapeutic limits that require continuous, round-the-clock evaluation. To date, robust evidence from large clinical trials regarding their impact on the prevention and treatment of P-SILI, as well as the optimal timing of intubation, remains lacking.

More than half of the intensive care unit (ICU) survivors develop persistent cognitive, physical, and psychological impairments, summarized as post-intensive care syndrome (PICS), accompanied by reduced quality of life and restricted social participation. In this context, digital interventions are gaining attention as an adjunct to existing care. They facilitate the transfer of relevant patient information and direct communication with clinicians, improve access to PICS-related information, and support the access to therapeutic services. However, prior studies have largely addressed single PICS domains and focused mainly on feasibility.

With the global rise in cancer incidence, the number of critically ill oncology patients with potential need for intensive care unit (ICU) admission is also increasing. This trend is not solely attributable to disease progression, but also to the aging of the cancer population, often accompanied by significant comorbidities, and to complications arising from modern oncologic therapies. In particular, adverse effects related to chemotherapy, hematopoietic stem cell transplantation, and immunotherapies increasingly require intensive medical intervention. Although the marked heterogeneity of this patient population makes generalizations difficult, studies have shown that critically ill patients with hematologic malignancies can demonstrate favorable survival and recovery rates despite the severity of their illness. Acute respiratory failure (ARF) is among the most frequent indications for ICU admission in cancer patients. Therapeutic management is often complex and not standardized, especially in the context of treatment limitations. Non-invasive respiratory support strategies, such as high-flow oxygen therapy or non-invasive ventilation (NIV), may offer clinical benefit in carefully selected patients, provided that close monitoring and readiness to escalate therapy are ensured. Innovative immuno-oncologic treatment strategies have substantially broadened the therapeutic spectrum in oncology and often provide severely ill patients with curative options. However, these therapies are associated with specific and sometimes life-threatening adverse effects. Among the most significant are the cytokine release syndrome (CRS), triggered for example by CAR-T cells or T-cell engagers, and the immune effector cell-associated neurotoxicity syndrome (ICANS). In addition, other immune-related adverse events (irAEs) may occur in association with checkpoint inhibitor (ICI) therapies. These potentially life-threatening complications require structured diagnostic approaches, close interdisciplinary management, and early initiation of immunomodulatory therapy.

The rising prevalence of dementia, driven by demographic aging, underscores the urgent need for effective therapeutic strategies. This update reviews recent advances in anti-dementia treatments, focusing on pharmacological and non-pharmacological interventions. Acetylcholinesterase inhibitors (donepezil, rivastigmine, galantamine) and the NMDA receptor agonist memantine, traditionally used for Alzheimer's disease, are now recommended off-label for vascular dementia, offering modest cognitive benefits with manageable side effects. The approval of amyloid-targeting monoclonal antibodies - lecanemab and donanemab - marks a paradigm shift, as these agents demonstrate disease-modifying potential in mild cognitive impairment (MCI) and early Alzheimer's disease by reducing amyloid plaques and slowing cognitive decline. However, their use is complicated by amyloid-related imaging abnormalities (ARIA), necessitating careful patient selection and monitoring, particularly in APOE4 homozygotes. Non-pharmacological approaches, including cognitive and physical training, have gained prominence. Regular moderate exercise (150 minutes/week) improves cognitive function in MCI and dementia, while multimodal interventions (e.g., FINGER, POINTER) target risk reduction through lifestyle modifications. Digital health applications, such as "Neuronation" and "Memodio", offer promising adjuncts, though evidence remains limited. The failure of GLP-1 analogs (e.g., semaglutide) in recent trials highlights the challenges in repurposing metabolic agents for neurodegeneration. The introduction of disease-modifying therapies emphasizes the importance of early diagnosis and comprehensive geriatric assessment to balance efficacy, safety, and patient-centered outcomes. Ongoing research and real-world data will further clarify the long-term benefits and risks of these innovations, shaping future dementia care.

This review summarizes recent developments in the genetics of Wilson's disease, highlights major diagnostic innovations, discusses novel aspects of therapeutic strategies, and outlines advances in treatment monitoring that are of particular relevance for clinical practice. Recent genetic population studies based on carrier frequencies of ATP7B mutations suggest that the prevalence of Wilson's disease is higher than estimates derived from clinical patient registries. Current evidence indicates that some ATP7B mutations are associated with milder disease phenotypes and reduced penetrance, supporting the concept of genotype-phenotype associations. A major advance in the diagnosis of Wilson's disease is the introduction of Relative Exchangeable Copper (REC). An additional diagnostic improvement is metallothionein immunohistochemistry in liver biopsy specimens. In cases of Wilson's disease-related acute liver failure, immediate listing for liver transplantation is generally recommended. Based on recent studies, bridging plasma exchange therapy should be considered in all patients and particularly in patients without advanced hepatic encephalopathy, and in selected cases with early treatment and mild encephalopathy transplantation may be avoided.

Vascular-specific sports and exercise therapy should be offered as first-line therapy to all patients with intermittent claudication, provided that the patient is able to perform this therapy. The results should be evaluated after 3-6 months in terms of quality of life, and the vascular team should then discuss the next steps on an individual basis. Supervised walking training in a vascular sports group with a trained vascular trainer is the basic therapy. Home exercise training with targets and goal-oriented monitoring is equivalent to a structured training program in terms of the walking distance achieved and should be considered if supervised walking training is not possible. The current data situation is reflected in the S3 guideline of the DGA, according to which consensus recommendations are made for the implementation of vascular-specific sports and exercise therapy. Vascular trainer training has been standardized in a 16-hour curriculum and coordinated with the vascular medicine professional associations DGA and DGG as well as the professional associations DGPR and DVGS. The corresponding courses are offered regularly with mutual recognition. Rehabilitation clinics can specialize in the treatment of patients with PAD and have this recognized by a certificate from the DGA, DGG, and DGPR as a "rehabilitation clinic with vascular expertise." The implementation of rehabilitation measures for patients with intermittent claudication at the beginning of the diagnosis could support and promote the sustainability of vascular medicine sports and exercise therapy. Training patients as part of rehabilitation measures can increase patient adherence to secondary prevention medication.

Nutrition forms the basis in the treatment of type 2 diabetes mellitus (T2DM). An individually adapted, balanced diet can help reduce obesity, stabilize blood sugar levels and minimize the risk of secondary diseases. The main focus is on the selection of low-energy-dense, high-fiber foods, the avoidance of highly processed carbohydrates and a moderate calorie intake.

The therapeutic goal describes the desired outcome of (intensive) treatment. A therapeutic goal may only be pursued if it is (still) achievable according to professional assessment. There is often disagreement within the multi-professional treatment team about whether a goal is achievable or not. This article analyzes the individual steps involved in reflecting on, discussing, and setting therapeutic goals and, if necessary, changing them.

Giant cell arteritis (GCA) and Takayasu arteritis (TAK) are the predominant types of large-vessel vasculitis, sharing IL-6-mediated immunopathology but differing in age profile and clinical phenotype. Glucocorticoids (GC) remain standard for induction therapy, although relapse rates and treatment-associated toxicity on GC monotherapy are high. Therefore, current guidelines support early tapering and the use of GC-sparing agents in relapsing or high-risk patients. Tocilizumab is now established as standard therapy in GCA, while methotrexate remains an alternative option. Recently, the janus kinase (JAK) inhibitor upadacitinib has gained regulatory approval for GCA, supported by results of a phase 3 trial. In TAK, conventional immunosuppressants are used in new-onset disease, while TNF-alpha or IL-6-blockade can be considered in relapsing or refractory disease. Optimal duration of treatment is not yet well defined.

Giant cell arteritis (GCA) is the most common primary systemic vasculitis and can present with a cranial, large-vessel, or mixed phenotype. Rapid and secure diagnosis is essential to prevent irreversible visual loss. Imaging has fundamentally transformed the diagnostic pathway. Vascular ultrasound is the first-line modality, enabling high-resolution assessment of both cranial and extracranial vessels, detecting pathological findings such as the halo sign, compression sign, and increased intima-media thickness. Magnetic resonance imaging (MRI) serves as an important complementary modality without radiation exposure. However, persistent mural signal abnormalities in large vessels limit activity assessment. Imaging with [[18]F]FDG positron emission tomography-computed tomography (PET/CT) enables whole-body assessment and identification of extracranial involvement but is constrained by limited specificity for inflammation and frequent persistent uptake in remission. Emerging tracers such as [[18]F]FAPI and [[68]Ga]Ga-DOTA-Siglec-9 may further improve imaging of inflammation in GCA. Similarly, novel ocular imaging modalities, including transorbital ultrasound and optical coherence tomography angiography, offer promising tools for detecting macro- and microvascular ophthalmologic involvement.

Musculoskeletal complaints of the shoulder/pelvic girdle are symptoms frequently described in patient care and are attributed to degenerative changes associated with increasing patient age. Polymyalgia rheumatica(PMR) is the second most common differential diagnosis of an inflammatory genesis after rheumatoid arthritis and should be ruled out. Patients diagnosed with PMR exhibit symptoms such as acute weakness, pain, morning stiffness in the neck, shoulders and pelvis. The manifestation of B-symptoms is possible. The clinical examination should encompass differential diagnoses and complications, such as giant cell arteritis. Laboratory testing shows elevated levels of inflammatory markers in almost all cases. Arthrosonography reveals tenosynovitis of the biceps tendon, bursitis or joint effusion of the hip. The initial treatment for PMR is the administration of steroids. In cases of disease activity, methotrexate, sarilumab or rituximab may be considered as potential treatment options.