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Inflammation medicine – the Kiel model

The Comprehensive Center for Inflammation Medicine (CCIM) is still unique in Germany even ten years after it was inaugurated. The special outpatient clinic for chronic inflammatory diseases shows how interdisciplinary cooperation works for both the clinic and research.

Doctors at a round table
© Sascha Klahn

Concentrated specialist knowledge: every Tuesday, physicians from various disciplines meet to consult on best practices for diagnostics and therapy in complicated cases.

At first glance, the building at Rosalind-Franklin-Straße 12 looks like many other clinics, perhaps a bit more modern. It was fully renovated before it opened in 2009. In fact, however, many things about this centre for people with chronic inflammatory diseases run differently from other clinics. "We understand that these diseases are holistic phenomena that extend well beyond the visible inflammation of the skin, bowels, or joints," explains Professor Stefan Schreiber. "The key word here is systems medicine." The director of the Department of Internal Medicine I at the UKSH on the Kiel campus, and spokesperson for the Cluster of Excellence Precision Medicine in Chronic Inflammation (PMI) initiated and promoted the establishment of the centre. "Our goal is to overcome barriers and to consider and treat inflammations not as fixed to one organ, but on a holistic basis." Diseases such as psoriasis or the chronic bowel inflammation Crohn's disease are not as different as it seems at first glance. The underlying mechanisms are similar for all of them. It is not uncommon for patients to have inflammation at several places in the body. The holistic approach is reflected in interdisciplinary treatment of patients in the CCIM.

"We have all of the specialists who treat people with inflammation diseases on one floor, right next door to each other. And this is, to my knowledge, unique in Germany," emphasizes Professor Bimba Hoyer, the head of the centre. All office consultations use a common registration, so that appointments can be coordinated and extra trips avoided. The proximity is also helpful for the physicians. "We talk to each other more often and share information simply because of the fact that we cross each others' paths or see each other in the kitchen," explains rheumatologist Hoyer.

Besides these random encounters, there are fixed events every week – the case conference for inflammation medicine – where all of the specialties come together to discuss complex cross-disciplinary cases. For example, one patient with a chronic inflammatory bowel disease also had inflammation of the spinal column. She wanted to get pregnant and needed specific, targeted therapy. "These conferences have representatives from gastroenterology, dermatology and rheumatology. Ophthalmology and neuroimmunology are also often represented. And if I want to talk about a patient with an ENT problem or a kidney problem, then I invite the appropriate specialists," says Hoyer. Up to 15 experienced professors and medical specialists discuss the course of a disease, X-rays and exam results and develop an individual proposal for therapy. This approach has long been established for cancer treatments with what is called a tumour board. For inflammation medicine, the Kiel clinic is unique in its consistent implementation. "We are currently working on certifying a showcase centre, similar to oncology," says Professor Stefan Schreiber.

Holistic and interdisciplinary treatment at the Comprehensive Center for Inflammation Medicine is, however, just one aspect. The close interconnection between clinical and research work is also unique among the hospital environment. There are, after all, still many unanswered questions, and most of all there is no cure for those affected. "Medicine only has a very limited set of solutions to offer at the moment for these chronic diseases. Only perhaps 20 to 30 percent of all patients have their disease activity fully controlled by modern therapies. Therefore, we need to research intensively in order to improve," emphasizes Schreiber.

This research also takes place across diseases and is completely synchronized. For example, blood samples are taken using the same pattern for different diseases, and the same questionnaires are used to characterize quality of life. Everyone uses the same file templates in order to record biographical data, lifestyle factors, disease histories, symptoms and medications in a structured manner. "We have one common biobank where samples are collected and can be linked to disease data. This allows us to look for common features within the various diseases," adds Hoyer.

One important research goal, for example, is to detect within just a few days whether a particular therapy is working for a patient or not. To this end, a large, European-wide study will start soon, in which Professor Schreiber is involved as a leader, and which is being financed by the European Commission with nearly €80 million. "We are investigating what happens very early in a therapy, and which molecular processes are switched on. This gives rise to the question of how to tell as soon as possible what is good for the patient over the long term.”

Author: Kerstin Nees

Centre for innovative and interdisciplinary medicine

The Comprehensive Center for Inflammation Medicine (CCIM) is an innovative therapy and research facility located at both UKSH campuses. The idea, concept, and implementation trace back to the Cluster of Excellence Inflammation at Interfaces, which has been continued since 2019 as the Cluster of Excellence Precision Medicine in Chronic Inflammation (PMI). The Kiel centre houses both the outpatient clinics for internal medicine and dermatology, which deal with inflammatory systemic diseases, and the working spaces for collaborating Cluster researchers.

Every day, more than ten consultation sessions are held in parallel in the various specialties, as well as interdisciplinary joint consultation sessions, such as dermatology and rheumatology, or gastroenterology and surgery. A collective nursing team organizes appointments for consultations and manages examinations and therapies. In the weekly inflammation medicine case conferences, complex disease cases are presented and discussed across specialties. Every year, over 30,000 patients visit the Kiel CCIM. Many of them are also participating in clinical studies. Currently, over 20 interdisciplinary clinical studies are underway, looking to optimize early detection and treatment.

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