Interaction between paracetamol and oral anticoagulants

Cross-cultural adaptation and validation of the French version of the Knee injury and Osteoarthritis Outcome Score (KOOS) in knee osteoarthritis patients

Udgivelsesdato: 2008-Apr OBJECTIVE: To adapt the Knee injury and Osteoarthritis Outcome Score (KOOS) into French and to evaluate the psychometric properties of this new version. METHODS: The French version of the KOOS was developed according to cross-cultural guidelines by using the "translation-back translation" method to ensure content validity. KOOS data were then obtained in patients with symptomatic knee osteoarthritis (OA). The translated questionnaire was evaluated in two knee OA population groups, one with no indication for joint replacement (medicine), and the other waiting for joint replacement (surgery). The psychometric properties evaluated were feasibility: percentage of respon…

Test-retest reliability of 3D kinematic gait variables in hip osteoarthritis patients

Import JabRef | WosArea Orthopedics; Rheumatology; International audience; Objectives: (1) to investigate the test-retest reliability of 3D gait analysis (3DGA) in hip Osteoarthritis (OA) patients; (2) to find the minimum number of gait trials needed to overcome intrinsic variability; (3) to check the accuracy of angles measured by the 3D system. Design: 23 Patients suffering from hip OA with no other major disease were recruited. We evaluated the reliability of spatio-temporal variables and body angles (lower-limb joints, trunk and pelvis angles) during two sessions of 3DGA using intra-class correlation coefficients (ICC). The minimum number of trials needed to overcome intrinsic variabili…

Le tocilizumab corrige le déséquilibre de la balance Th17/Treg chez les patients atteints de polyarthrite rhumatoïde

Expression of the multidrug resistance glycoprotein 170 in the peripheral blood lymphocytes of rheumatoid arthritis patients. The percentage of lymphocytes expressing glycoprotein 170 is increased in patients treated with prednisolone

International audience; Abstract: The objective was to evaluate the expression of the multidrug resistance P-glycoprotein (P-gp) in peripheral blood lymphocytes (PBL) of patients with rheumatoid arthritis (RA). PBL from 68 RA patients and 44 controls were evaluated. RA patients had a mean disease duration of 10.7 yr, with a mean number of past resistances to DMARDs of 0.82, and were treated with NSAIDs (n = 34), DMARDs (n = 25) and prednisolone (n = 40). Fluorescence flow cytometry was used to assess P-gp membrane expression on PBL. In the RA group, the percentage of PBL expressing P-gp was higher in patients treated with prednisolone than in other patients [mean +/- S.D.: 10.7 +/- 15.8% vs…

Brief Report: Inhibition of interleukin-6 function corrects Th17/Treg cell imbalance in patients with rheumatoid arthritis

OBJECTIVE: From an immunologic standpoint, the mechanisms by which treatment with tocilizumab (TCZ), a humanized anti-interleukin-6 (anti-IL-6) receptor antibody, results in improvement in rheumatoid arthritis (RA) patients are still not fully understood. In vitro studies and studies in mouse models have demonstrated the critical role of IL-6 in Th17 cell differentiation. Th17 lymphocytes have been shown to be strongly involved in RA pathogenesis, and the purpose of this study was to investigate the effect of IL-6 blockade on the balance between Th17 cells and Treg cells in patients with active RA. METHODS: Patients with active RA for whom TCZ had been prescribed by a rheumatologist were en…

Effects of loss of metatarsophalangeal joint mobility on gait in rheumatoid arthritis patients

Objective. To evaluate the effects of loss of range of motion (ROM) of the metatarsophalangeal (MTP) joint on the kinematic parameters of walking in rheumatoid arthritis (RA) patients. Methods. Inclusion of RA patients with inactive disease, no synovitis of the inferior limb and reduced ROM of the MTP joints. Evaluation of the ROM of the MTP dorsal and plantar flexion, and gait analysis using a three-dimensional computerized movement analysis. Calculation of gait parameters and maximal flexion and extension of the hips and knees during walking. Analysis 1 compared the ROM of dorsal and plantar flexion in patients with or without walking pain; 2 compared the gait parameters between patients …

The development of a short measure of physical function for knee OA KOOS-Physical Function Shortform (KOOS-PS) – an OARSI/OMERACT initiative

Udgivelsesdato: maj OBJECTIVE: To develop a short measure of physical function for knee osteoarthritis (OA) using multi-national data from individuals with varying degrees of severity of knee OA. METHODS: Rasch analysis, based on the partial credit model, was conducted on Knee injury and Osteoarthritis Outcome Score and Western Ontario McMaster Universities' Osteoarthritis Index data from individuals with knee OA, ranging from community to pre-total knee replacement samples from five countries. Fit of the data to the Rasch model was evaluated by overall model fit and item-level fit statistics (chi(2), size of residual, F-test). Invariance across age, gender and country was evaluated. Unidim…

OARSI–OMERACT definition of relevant radiological progression in hip/knee osteoarthritis

Summary Background Joint space width (JSW) evaluated in millimeters on plain X-rays is the currently optimal recognized technique to evaluate osteoarthritis (OA) structural progression. Data obtained can be presented at the group level (e.g., mean±standard deviation of the changes). Such presentation makes difficult the interpretation of the clinical relevance of the reported results. Therefore, a presentation at the individual level (e.g., % progressors) seems more attractive but requires to determining a cut-off. Several methodologies have been proposed to define cut-offs in JSW: arbitrary chosen cut-off, cut-off based on the validity to predict a relevant end-point such as the requiremen…

Vitamin D supplementation, bone turnover, and inflammation in HIV-infected patients

IF 1.307 (2017); International audience; ObjectiveTo assess whether vitamin D supplementation could be associated with a modification of inflammatory markers and bone turnover in HIV-1-infected patients.Patients and methodsPatients who participated in an initial survey in 2010 and who were followed in the same department were included in a new study in 2012. Between 2010 and 2012, vitamin D supplementation was offered to patients presenting with hypovitaminosis D as per appropriate guidelines. Clinical examinations were performed, and fasting blood samples were taken for inflammation and bone marker evaluations.ResultsOf the 263 patients who participated in the 2010 study, 198 were included…

Is the pelvis-thorax coordination a valuable outcome instrument to assess patients with Hip osteoarthritis?

Objective: The evaluation of the disease severity in hip osteoarthritis (OA) patients being currently based on subjective instruments. It would be of interest to develop more objective instruments, for example based on gait analysis. The aims of this study were to explore if pelvis-thorax coordination parameters could be valuable instrument outcomes to achieve this evaluation by assessing their reliability, discriminant capacity and responsiveness. Methods: Three groups of subjects; healthy, hip OA patients with severe disease (defined as indication to surgery), hip OA patients with less severe disease (no indication to surgery) were included. Hip OA patients with severe disease were evalua…

Long term structural effects of combination therapy in patients with early rheumatoid arthritis: five year follow up of a prospective double blind controlled study

Objective: To evaluate whether early combined therapy with methotrexate (MTX) and sulfasalazine (SSZ) during the first year in early rheumatoid arthritis (RA) induces long term beneficial effects, compared with monotherapy, when the further treatment strategy is a free choice. Methods: Study design: five year multicentre prospective longitudinal trial. Participants: 146/205 patients with RA previously included in a one year prospective randomised trial comparing the effects of treatment with MTX, SSZ, or a combination of both. Criteria for inclusion: patients with early RA (⩽1 year duration). Follow up: between the end of years 1 and 5, patients were followed up and treated by their own rhe…

A classification study of kinematic gait trajectories in hip osteoarthritis

The clinical evaluation of patients in hip osteoarthritis is often done using patient questionnaires. While this provides important information it is also necessary to continue developing objective measures. In this work we further investigate the studies concerning the use of 3D gait analysis to attain this goal. The gait analysis was associated with machine learning methods in order to provide a direct measure of patient control gait discrimination. The applied machine learning method was the support vector machine (SVM). Applying the SVM on all the measured kinematic trajectories, we were able to classify individual patient and control gait cycles with a mean success rate of 88%. With th…

Test–retest reliability and responsiveness of centre of pressure measurements in patients with hip osteoarthritis

International audience; Objective: The aim of this study was to determine a set of measures for the evaluation of balance in patients suffering from hip osteoarthritis (OA) that were both reliable and responsive to change.Design: Three groups of subjects; Healthy, hip OA patients without surgery, and hip OA with surgery (pre and post-surgery) were included in this study. Subjects had to perform balance tests in two positions: standard and narrowed stance. CoP-based measures test-retest reliability was assessed in hip OA without surgery group, responsiveness were assessed between all groups and between pre and postsurgery.Results: Intraclass Correlation Coefficient (ICC) values from hip OA w…

Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis

Abstract Objective Evaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms. Methods Open-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CI…

Choice of second-line disease-modifying antirheumatic drugs after failure of methotrexate therapy for rheumatoid arthritis: A decision tree for clinical practice based on rheumatologists' preferences

Objective To survey rheumatologists' preferences for the choice of a second-line disease-modifying antirheumatic drug (DMARD) after inadequate response with methotrexate (MTX) therapy in rheumatoid arthritis (RA). Methods Thirty-six rheumatologists stated their preferences for RA treatment after inadequate response with MTX therapy (optimal dose at least 6 months). From the initial scenario, we derived 54 vignettes varying by rheumatoid factor or anti–cyclic citrullinated peptide antibody presence, swollen joint count, Disease Activity Score in 28 joints, and structural damage. Respondents stated their preference among 5 therapeutic options: MTX continuation, switch to another conventional …

L’augmentation de la réponse Th17 au cours de la maladie de Horton et de la PPR est liée à des modifications fonctionnelles et non quantitatives de leurs précurseurs : les lymphocytes T CD4+ CD161+

Influence de l’expérience du lecteur sur la variabilité de mesure de l’interligne articulaire : étude transversale portant sur des lectures répétées de radiographies dans la coxarthrose

Resume Objectifs Les objectifs etaient d’evaluer l’amelioration de la mesure du pincement de l’interligne articulaire (PIA) dans la coxarthrose, en fonction de l’experience du lecteur. Methodes Cinquante radiographies de patients atteints de coxarthrose ont ete extraites de la base de donnees de l’etude randomisee et controlee ECHODIAH. Chacune d’entre elles a ete lue par deux lecteurs n’ayant pas le meme degre d’experience dans l’interpretation radiologique. Les reproductibilites intra-observateur et interobservateur ont ete evaluees par le calcul de la plus petite difference detectable (SDD) et le coefficient de correlation intraclasse (ICC). Resultats Reproductibilite interobservateur : …

Clinical practice format for choosing a second-line disease modifying anti-rheumatic drug in early rheumatoid arthritis after failure of 6 months' first-line DMARD therapy.

International audience; BACKGROUND: The objective was to develop a clinical practice format for choosing a second-line disease-modifying anti-rheumatic drug (DMARD) after a 6-month course of a first-line DMARD in patients with early RA. METHODS: A panel of 34 experts selected treatment option from various scenarios using the Thurstone pairwise method. The experts had to choose between two proposed DMARDs without proposing other options. The scenarios were obtained using the three items: DAS28, rheumatoid factor status and radiographic structural damage. A sample of 240 among 480 scenarios for each expert was taken at random. Responses given by at least 20% of the experts were considered per…

Prédiction de la réponse aux traitements de fond antirhumatismaux (DMARD) dans la polyarthrite rhumatoïde

Resume Objectif Examiner les facteurs potentiels predictifs de la reponse aux traitements de fond (DMARD) classiques dans la polyarthrite rhumatoide (PR). Methodes (1) design de l’etude : etude prospective sur six mois de suivi. Participants  : patients avec une PR active ; (2) intervention et suivi : introduction d’un DMARD. Reponse au traitement evaluee a six mois (criteres ACR20) ; (3) analyse : facteurs potentiels predictifs de la reponse : criteres demographiques, activite de la maladie, pourcentages de sous-populations de cellules mononucleees du sang peripherique (CMSP) exprimant la glycoproteine P, taux d’interleukine 1 beta (IL-1β) serique, IL-6, IL-8, IL-10, IL-12 et de facteur de…

Comparative evaluation of three semi-quantitative radiographic grading techniques for knee osteoarthritis in terms of validity and reproducibility in 1759 X-rays: report of the OARSI���OMERACT task force

OBJECTIVE: The objective of this work was to compare the measurement properties of three categorical X-ray scoring methods of knee osteoarthritis (OA), both on semiflexed and extended views. METHODS: In data obtained from trials and cohorts, X-rays were graded using Kellgren and Lawrence (KL), the OA Research Society International (OARSI) joint space narrowing score, and measurement of joint space width (JSW). JSW was analyzed as a categorical variable. Construct validity was assessed through logistic regression between X-ray stages and Western Ontario and McMaster Universities OA Index. Inter-observer reliability was assessed in 50 subjects for extended views by weighted kappa. Intra-obser…

L’échographie des ongles dans le rhumatisme psoriasique : étude pilote sur la faisabilité, la reproductibilité et la validité de mesure

Resume Objectif Etude de la faisabilite, de la reproductibilite et de la validite externe versus criteres de reference des parametres echographiques de l’ongle dans le rhumatisme psoriasique. Methodes Etude pilote prospective monocentrique sur huit parametres echographiques en mode B et doppler puissance portant sur l’interphalangienne distale (IPD), la matrice, le lit et la tablette ungueale. La reproductibilite intra-observateur et inter-observateur a ete evaluee pour les sept parametres quantitatifs (ICC et kappa). La recherche de correlations entre les variables echographiques et cliniques a permis d’estimer la validite externe. La faisabilite a ete appreciee par le temps d’examen et le…

Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for Osteoarthritis

Udgivelsesdato: 2009-Jul OBJECTIVE: To evaluate the internal consistency of the Hip disability and Osteoarthritis Outcome Score-Physical Function Short-form (HOOS-PS) and the Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) in total hip replacement (THR) and total knee (TKR) replacement. Construct validity and responsiveness were compared to the Western Ontario McMaster Universities' Osteoarthritis Index (WOMAC) Likert 3.0 physical function (PF) subscale and the PF excluding the items in the short measures (PF-exclusions). METHODS: Participants completed the full HOOS or KOOS, measures of fatigue, anxiety, depression and the Chronic Pain Grade (CPG) pre-su…

Usefulness of routine hepatitis C and hepatitis B serology in the diagnosis of recent-onset arthritis. Systematic prospective screening in all patients seen by the rheumatologists of a defined area--brief report.

Ansemant, Thiphaine | Ornetti, Paul | Garrot, Jean-Francois | Pascaud, Francoise | Tavernier, Christian | Maillefert, Jean-Francis; International audience; ''Objective: Previous studies evaluating the usefulness of systematic screening for hepatitis B and C in patients with recent-onset arthritis suffered from a major bias since they were conducted in hospitals. The objective of the present study was to evaluate the relevance of such screening, performed by hospital and office-based rheumatologists of a defined area, in the diagnosis of arthritis or inflammatory polyarthralgia of less than 1 year duration. Methods: The CRRRI is a network which includes most hospital and office-based rheumat…

Is time to joint replacement a valid outcome measure in clinical trials of drugs for osteoarthritis?

The rate of radiographic joint space narrowing is commonly used today as a structural outcome measure in clinical trials evaluating potential disease-modifying drugs in patients with hip osteoarthritis, but this results in a continuous variable. Among the methods proposed to circumvent this problem, it has been suggested that the incidence of total hip arthoplasty (THA) provides a hard outcome measure. It is a dichotomized variable, easy to measure and sensitive to change, with acceptable intrinsic validity. However, because this measure is limited by the variability of factors underlying the decision to perform surgery and the length of waiting lists, it has been suggested that time to ful…

Does Tocilizumab Indeed Reduce the Frequency of Th17 Cells? Comment on the Article by Thiolat et al

Cross-Talk Correction Method for Knee Kinematics in Gait Analysis Using Principal Component Analysis (PCA): A New Proposal

International audience; Background: In 3D gait analysis, the knee joint is usually described by the Eulerian way. It consists in breaking down the motion between the articulating bones of the knee into three rotations around three axes: flexion/extension, abduction/adduction and internal/external rotation. However, the definition of these axes is prone to error, such as the "cross-talk'' effect, due to difficult positioning of anatomical landmarks. This paper proposes a correction method, principal component analysis (PCA), based on an objective kinematic criterion for standardization, in order to improve knee joint kinematic analysis. Methods: The method was applied to the 3D gait data of …

Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: preliminary results.

Abstract Background Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Methods Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5weeks (W5…

Intérêt du dépistage systématique des hépatites B et C à visée diagnostique dans le bilan initial des rhumatismes inflammatoires débutants

Resume Objectif Les etudes realisees a ce jour pour evaluer l’interet d’un depistage systematique de l’hepatite B et C en cas d’arthrite d’installation recente souffrent toutes d’un biais methodologique important lie au recrutement hospitalier des malades. L’objectif de la presente etude consistait a evaluer la pertinence d’un tel depistage realise par les rhumatologues hospitaliers et liberaux d’une region geographique predefinie pour le diagnostic etiologique des arthrites et polyarthralgies inflammatoires datant de moins d’un an. Methodes Le CRRRI est un reseau qui rassemble la plupart des rhumatologues hospitaliers et liberaux d’une region de 506 755 habitants. Nous avons inclus tous le…

Perception des poussées de polyarthrite rhumatoïde telles que rapportées par les patients : sous-analyse de l’essai STRASS sur les stratégies de diminution progressive du traitement

Resume Objectifs Dans la polyarthrite rhumatoide (PR), patients et medecins peuvent avoir des perceptions differentes. L’objectif de ce travail etait de definir la notion de « poussees » du point de vue du patient. Methodes Analyse post-hoc d’un essai comparatif randomise consacre a une strategie de diminution progressive des anti-TNF chez des patients atteints de PR, ayant un score DAS 28 de remission depuis au moins six mois et randomises dans deux groupes : « espacement » (E) ou « maintien » (M) du traitement. La survenue de poussees rapportees par le patient (PRP) a ete evaluee tous les trois mois sur une periode de 18 mois par la question suivante : « Au cours des trois derniers mois, …

Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis

International audience; Objective: To determine the feasibility, reliability and validity of nails ultrasonography in psoriatic arthritis as an outcome measure.Methods: Pilot prospective single-centre study of eight ultrasonography parameters in B mode and power Doppler concerning the distal interphalangeal (DIP) joint, the matrix, the bed and nail plate. Intraobserver and inter-observer reliability was evaluated for the seven quantitative parameters (ICC and kappa). Correlations between ultrasonography and clinical variables were searched to assess external validity. Feasibility was assessed by the time to carry out the examination and the percentage of missing data.Results: Twenty-seven p…

Prediction of response to disease modifying antirheumatic drugs in rheumatoid arthritis.

Abstract Aim To investigate potential predictors of response to conventional DMARDs in RA. Methods Study design – 6-month follow-up prospective study. Participants RA patients with active disease. Intervention and follow-up Introduction of one DMARD. Response to treatment evaluated at 6 months (ACR20 criteria). Analysis Potential predictors of response, patients’ demographics, disease activity, percentages of PBMC subsets expressing P-gp, serum IL-1β, IL-6, IL-8, IL-10, IL-12, TNF-α levels, were evaluated using univariate and multivariate logistic regression analysis. ROC curve analyses were performed in order to obtain thresholds allowing the prediction of response. Results Forty-two patie…

Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group

Import JabRef | WosArea Orthopedics; Rheumatology; International audience; Objective: The Osteoarthritis Research Society International initiated a number of working groups to address a call from the US Food and Drug Administration (FDA) on updating draft guidance on conduct of osteoarthritis (OA) clinical trials. The development of disease-modifying osteoarthritis drugs (DMOADs) remains challenging. The Assessment of Structural Change (ASC) Working Group aimed to provide a state-of-the-art critical update on imaging tools for OA clinical trials. Methods: The Group focussed on the performance metrics of conventional radiographs (CR) and magnetic resonance imaging (MRI), performing systemati…

Severe hypovitaminosis D correlates with increased inflammatory markers in HIV infected patients

Abstract Background Even though it has been suggested that antiretroviral therapy has an impact on severe hypovitaminosis D (SHD) in HIV infected patients, it could be speculated that the different levels of residual inflammation on HAART (Highly Active Anti Retroviral Therapy) could contribute to SHD and aggravate bone catabolism in these patients. Methods A cross-sectional study was carried out in an unselected cohort of 263 HIV infected outpatients consulting during Spring 2010. Clinical examinations were performed and medical history, food habits, sun exposure and addictions were collected. Fasting blood samples were taken for immunological, virological, inflammation, endocrine and bone…