National survey on the non-pharmacological modalities prescribed by French general practitioners in the treatment of lower limb (knee and hip) osteoarthritis. Adherence to the EULAR recommendations and factors influencing adherence.

BACKGROUND: Guidelines for the treatment of lower limb osteoarthritis (LLOA) include non-pharmacological (NPM) and pharmacological modalities (PM). In France, general practitioners (GPs) are the main prescribers of pharmacological treatment for LLOA but little is known about the non-pharmacological modalities they usually prescribe. OBJECTIVE: To determine how French GPs prescribe non-pharmacological modalities of LLOA treatment in daily practice. METHODS: A four-point questionnaire (systematically, frequently, rarely, never) was built to assess the French GPs' opinion regarding the NPM of LLOA treatment (10 questions). The questionnaire was given between April and June 2005 to 3000 GPs, all over the French regions. The percentage reported in this abstract are those of the systematic and frequent responses. RESULTS: 59.2% of the questionnaires (n=1775) could be retrieved. Weight reduction recommendations (76%), joint sparing (71.7%), physical activity development (61.7%), rehabilitation (57.8%), self-exercise (46%) were the more frequently prescribed NPM. Sticks (36%), insoles (35.6%), bed relief (25.4%) and knee bracing (10.5%) were far less regularly proposed. However weight reduction and physical activity development appeared to be the patients less-well observed NPM. The main means used to improve the efficacy of the diet were the support of a nutritionist (74.5%) and the support of the GPs (70.7%) far beyond the support group and familial intervention (both 36,6%). The large majority of GPs considered that a good physical activity was essential (51.7%) or useful (43.3%) to the success of the weight reduction programme. The main recommended physical activities were walking (84.3%), swimming (74.3%), cycling (47%) and water-gymnastics (40.4%). To improve the success of the physical activity development, analgesics were recommended by 93% of GPs, settling up through rehabilitation by 57.4%, support through GPs appointments by 50%. Lastly, 68.4% of GPs recommended a systematic analgesic consumption, since a non-steroidal anti-infammatory drug (NSAID) prescription was proposed by only 30.5%, and NSAID treatment before or after physical activities by 19% and 9.3% respectively. CONCLUSION: This large survey shows that non-pharmacological modalities are frequently prescribed by French GPs in the treatment of LLOA, in addition to analgesic therapy. However, most GPs consider that some of them are difficult to follow in the long term.

Questionnaire survey of management and prescription of general practitioners in knee osteoarthritis: a comparison with 2000 EULAR recommendations.

OBJECTIVE: A large-scale questionnaire survey on the way to handle and treat knee osteoarthritis (OA) was conducted with French general practitioners (GPs). Results of this questionnaire were compared with the 2000 EULAR recommendations on the treatment of knee OA. RESULTS: There was a high response rate among GPs (70%). Major findings included a high request rate for radiological examinations even if not required (about one-third of GPs in the case of a non-inflammatory condition); the under-utilization of non-pharmacological treatments as a first line approach; the prescription of paracetamol as the first-line drug; the co-prescription of non-steroidal anti-inflammatory drugs in 40% as a first-line approach; and a low rate of corticoidsteroid prescription. CONCLUSIONS: There is reasonable agreement between the results of this survey and EULAR 2000 recommendations. However, non-pharmacological approaches are under-utilized and should be reinforced.

Piroxicam therapy: a double blind, randomized, multicenter study comparing 2 versus 4 week treatment in patients with painful knee osteoarthritis with effusion.

OBJECTIVE: To compare the efficacy and safety of piroxicam 20 mg once a day for 14 or 28 days in patients with knee osteoarthritis (OA) and synovial effusion. METHODS: We conducted a multicenter, randomized, double blind study in 1905 outpatients. Efficacy was assessed by changes in synovial effusion, pain on a 100 mm visual analog scale (VAS), and impairment using Lequesne's functional index. Patients were classified at Day 28 as improved (defined as VAS and Lequesne index decrease of at least 30% from Day 14), worsened (defined as VAS and Lequesne index increase of at least 30% from Day 14), or unchanged. Safety was assessed on the basis of adverse events reported by the patients. RESULTS: After 14 days, changes in pain, synovial effusion, and functional impairment significantly decreased from baseline within each group (p < 0.001, respectively), but did not differ between the groups. Between 14 and 28 days, outcome measure changes were significantly better in the 28 day group, p = 0.01, 0.0001, and 0.0001, respectively. In the 28 day and 14 day groups, improvement with regard to pain was observed for 339 (52.4%) and 280 (29.4%) patients, respectively, (p < 0.0001), and with regard to functional impairment for 298 (31.5%) and 233 (24.3%) patients (p < 0.0001). Adverse events accounted for 7.5 and 6.7% of withdrawals in the 28 day and 14 day groups, respectively. CONCLUSION: When administration of piroxicam 20 mg is prolonged to 28 days, continuing benefit is observed for some patients with knee OA with painful synovial effusion without a significant difference in safety.

[Autoimmune diseases after unusual exposure to silica or silicones. 3 cases]. / Maladies auto-immunes après expositions inhabituelles à la silice ou aux silicones. Trois observations.

A woman, who had intensively used an abrasive cleansing powder rich in silica for 12 years, developed a connective tissue disease consisting of destructive inflammatory oligoarthritis, Gougerot-Sjögren's syndrome, Raynaud's syndrome, anti-nuclear antibodies and hypocomplementemia. Another woman, who had sprayed silicone-glaze on cables for 15 years, suffered from edematous scleroderma. A man, who had sprayed the same silicone-glaze on cables over a 20 year period, had a subluxing arthropathy. These autoimmune syndromes were compared with diseases classically induced by exposure to silica and silicone. To the best of our knowledge, these means of exposure have not been reported previously and merit being known in the aim of prevention.