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4.
Eur J Rheumatol ; : 1-4, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31329539

RESUMO

OBJECTIVE: Septic sacroiliitis is a difficult diagnosis rarely considered in an emergency in case of pelvic pain associated with fever. In these cases, a computed tomography (CT) is classically performed to exclude digestive or gynecological disorder, but the sacroiliac joint is not systematically analyzed. The aim of the present study was to detect the early signs of septic sacroiliitis on CT. METHODS: In a monocentric retrospective study, the characteristics, biology, and imaging of patients with septic sacroiliitis were analyzed. RESULTS: Seven cases of septic sacroiliitis were included in the study. For all patients, a CT scan with contrast-enhanced acquisitions of the pelvis was performed. The 4 early signs of septic sacroiliitis frequently not evocated by a radiologist in an emergency were highlighted as follows: fat infiltration in front of the sacroiliac joint (83%), anterior bulging of the sacroiliac capsule (46%), and piriformis and iliac muscles swelling (71% for both). All patients had at least one of these signs; 86% had at least 2 signs. Magnetic resonance imaging was performed for 5 out of 7 patients and confirmed the aspect of infectious sacroiliitis. CONCLUSION: Systematic analysis of the sacroiliac joint and adjacent muscles on pelvic CT scan is necessary to avoid the unrecognition of septic sacroiliitis in case of pelvic pain with fever.

7.
Joint Bone Spine ; 86(6): 747-752, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31228620

RESUMO

OBJECTIVE: Information and education are recommended for patients with inflammatory arthritis including rheumatoid arthritis (RA) and spondyloarthritis (SpA). However, there is no consensus on which knowledge is essential to enhance patients' self-management. The aim of this study was to determine such knowledge. METHODS: Based on published knowledge questionnaires (KQs) collected by a systematic literature review, a list of items was elaborated, classified in domains and sub domains. A Delphi process was performed with rheumatologists, healthcare professionals and patients in 2014-2015, selecting the items considered useful. RESULTS: Three published KQs were analysed: 2 for RA; 1 for SpA and 5 unpublished KQs were collected. In the KQs, 90 knowledge items were mentioned for RA and 67 for SpA. The 1st Delphi round enlarged the list to 322 items for RA and 265 items for SpA. The second round selected 69 and 59 knowledge items for RA and SpA respectively, of which 36 (52%) and 34 (57%) were not present or modified from the published KQs. Key domains included treatment strategies, managing cDMARDs and bDMARDs, managing symptomatic medications. Knowledge on non-pharmacological treatment concerned pain and fatigue, physical activity, adaptative skills to personal and professional environment, patient-HP communication and shared decision-making. CONCLUSION: The present study provides a corpus of knowledge considered essential for patients in the self-management of their arthritis. The selection of many items reflects recent emphasis on professional recommendations and the patients' perspective. Future work should lead to the development of new updated KQs for patients with inflammatory arthritis.

8.
J Rheumatol ; 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31154418

RESUMO

OBJECTIVE: Inflammatory bowel disease (IBD) is a well-known extraarticular feature of spondyloarthritis (SpA). The aims of this study were to evaluate factors associated with IBD and incidence over 5 years of followup in the DESIR cohort. METHODS: DESIR is a prospective observational cohort of patients with recent-onset inflammatory back pain suggestive of axial SpA. All available variables in the database were compared between patients with and without IBD at baseline and 5 years, and occurrence over 5 years of followup, with uni- and then multivariable analysis. RESULTS: At baseline, of 708 patients, 35 had IBD (prevalence 4.94%, CI 95% 3.3-6.5). IBD was associated (multivariable) with history of uveitis, levels of Dickkopf-1, and tumor necrosis factor, but not with phenotypic presentation (peripheral arthritis, enthesitis, dactylitis, uveitis) or baseline serum levels of other cytokines. At 5 years, 480 patients were analyzed, 58 with IBD. IBD was associated (multivariable) with fulfillment of modified New York criteria, sick leave, Bath Ankylosing Spondylitis Disease Activity Index, and smoking. There was no association with magnetic resonance imaging scores, enthesitis, psoriasis, and bone mineral density. Twenty-three incident cases of IBD were recorded: estimated occurrence rate of 0.95/100 (95% CI 0.57-1.35) patient-years (PY). Incidence of IBD is associated (multivariable) with HLA-B27 (OR 0.36, 95% CI 0.22-0.59), fulfillment of modified New York criteria (OR 3.35, 95% CI 1.85-6.08), and familial history of IBD (OR 3.31, 95% CI 1.62-6.77). CONCLUSION: In early SpA, IBD occurs with an incidence of 1/100 PY, and is associated with poor outcome, familial history of IBD, absence of HLA-B27, and fulfillment of modified New York criteria.

9.
Joint Bone Spine ; 2019 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-31216488

RESUMO

Local sacroiliac injections represent an available treatment option in spondyloarthritis (SpA). There is no synthetic data about efficacy of this procedure in SpA. The aim of this review is to analyze the available data of the literature of local sacroiliac injections in SpA. METHODS: A Pubmed search of papers published after 1990 was performed. RESULTS: Pubmed search retained 15 publications in spondyloarthritis, 12 with corticosteroids (total of 468 injections in 268 patients), including 2 small-sized controlled studies, and 3 with TNF blockers (24 patients in open studies). With steroids, the two controlled studies (with a total number of 30 patients only) demonstrated significant results over placebo. In open studies, good response was reported in more than 80% of the cases, with a mean duration of improvement over 8 months. Reduction of sacroiliac inflammation on MRI was also found in several studies after injection. There is no consensus about the technique of injection or the type of steroid injected. No particular safety concern was reported. Many limitations have to be considered in the interpretation of these results. CONCLUSION: This kind of procedure should be kept in the therapeutic armament in the current setting of costly targeted systemic treatments of spondyloarthritis. However, definition of a clear position in the treatment strategy needs further well-conducted studies.

11.
Immunotherapy ; 11(7): 557-560, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30943857
12.
Clin Rheumatol ; 38(8): 2265-2273, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30989408

RESUMO

INTRODUCTION/OBJECTIVES: Septic arthritis is a diagnostic and therapeutic emergency because of a high morbidity and mortality. Nevertheless, the etiologic diagnosis is often difficult. The aim of our study was to determine if serum procalcitonin was a discriminatory biomarker in case of arthritis of undetermined etiology. METHOD: Patients were separated in five groups: gouty arthritis, calcium pyrophosphate deposition arthritis, osteoarthritis or post-traumatic arthritis ("mechanical" arthritis), chronic inflammatory rheumatic arthritis, and septic arthritis. Levels of serum white blood cells, C-reactive protein and procalcitonin were measured. RESULTS: Ninety-eight patients were included: 18 in the "gout" group, 26 in the "calcium pyrophosphate deposition arthritis" group, 16 in the mechanical group, 18 in the "chronic inflammatory rheumatic" group, and 20 in the "sepsis" group. The area under the receiver operating characteristic curve of white blood cells, C-reactive protein, and procalcitonin levels to diagnose a septic arthritis were 0.69 (IC95% 0.55-0.83), 0.82 (IC95% 0.73-0.91), and 0.87 (IC95% 0.76-0.98) respectively. For a cutoff of 0.5 ng/ml, procalcitonin sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio were 65%, 91%, 65%, 91%, 7.2, and 0.4, respectively. Serum C-reactive protein and procalcitonin levels were correlated, were not different in sepsis or gout groups, and were higher in non-septic arthritis with poly-arthritis than with mono-arthritis (p < 0.05). CONCLUSIONS: Serum procalcitonin is a useful biomarker in arthritis management with diagnosis performances higher than those of other biomarkers (white blood cells, C-reactive protein).Key Points• Diagnostic performances of serum procalcitonin level in septic arthritis are higher than those of serum C-reactive protein or white blood cells levels.• Serum procalcitonin levels are not different in septic arthritis or gouty arthritis.• Serum procalcitonin levels are higher in non-septic arthritis with poly-arthritis than with mono-arthritis.

13.
Transl Stroke Res ; 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30887278

RESUMO

Emerging data revealed that rheumatoid arthritis (RA) is associated with higher risk of cerebrovascular diseases. Whereas cerebral endothelial dysfunction is acknowledged as a critical aspect of cerebrovascular diseases, its presence in RA and the mechanisms involved are currently unknown. By using the model of rat adjuvant-induced arthritis (AIA), the present study investigated cerebrovascular reactivity in pressurized middle cerebral arteries (MCA) on day 33 post-immunization. The results revealed that arthritis induced a dramatic decrease in the vasodilatory response to acetylcholine (ACh), ADP, and bradykinin (n = 7-9 arteries, p < 0.0001). By using nor-NOHA, L-NAME, BH4, and Tempol, the results showed that the reduced response to ACh relied on arginase overactivation (n = 8), low NOS activity (n = 8), BH4 deficiency (n = 9), and excessive superoxide production (n = 9). Immunohistological analysis revealed an endothelial upregulation of arginase 2 (p < 0.05, n = 5-6) and NADPH oxidase (p < 0.05, n = 5-7) while eNOS expression was unchanged in AIA (n = 6). To assess whether arginase inhibition may be a relevant therapeutic, AIA rats were treated with an arginase inhibitor (nor-NOHA, 40 mg/kg/day, i.p., n = 20 rats) daily from day 10 to day 33 post-immunization. The treatment alleviated the impaired response of MCA to endothelium-dependent agonists, through an increase in NOS signaling and a suppression of BH4 deficiency and superoxide overproduction. By contrast, it did not change the course of arthritis. In conclusion, arthritis induced a cerebrovascular endothelial dysfunction involving an imbalance in the arginase/NOS pathway. Arginase inhibition appears as a promising therapy beyond anti-rheumatic drugs for reducing the risk of cerebrovascular diseases in RA.

14.
Rheumatology (Oxford) ; 58(6): 1099-1103, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30715482

RESUMO

OBJECTIVE: To evaluate radiographic outcomes after an early treatment for 21 days with etanercept, naproxen, celecoxib, prednisone or methotrexate in adjuvant-induced arthritis in rats. METHODS: At the onset of arthritis, rats were daily treated with naproxen (10 mg/kg/day i.p.), celecoxib (3 mg/kg/day), prednisolone (10 mg/kg/day), etanercept (10 mg/kg/3 days), methotrexate (2 mg/kg/3 days) or saline solution (vehicle) for 21 days. The arthritis score was daily monitored. At the end of treatment, a hind paw radiographic examination was performed with a BMA high-resolution digital X-ray system (40 mV, 10 mA). A score of 0-20 was determined for each paw. Plasma levels of TNFα were measured. RESULTS: Compared with vehicle, all treatments reduced (P < 0.001) the arthritis score. All treatments, except methotrexate, slowed radiographic destruction (P < 0.001). All treatments, except etanercept, reduced the plasma level of TNFα. Naproxen, glucocorticoid and celecoxib were more effective than etanercept on the radiographic score (P < 0.01). Naproxen was the only treatment to be more effective on all different radiographic subscores than etanercept. CONCLUSION: Our study demonstrated for the first time that an early treatment with NSAIDs, excluding cyclooxygenase-2 selective inhibitor, is more beneficial than a TNFα blocker in preventing structural damage in adjuvant-induced arthritis.

15.
Pharmacogenomics J ; 19(4): 368-374, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30647443

RESUMO

Biological disease-modifying anti-rheumatic drugs (bDMARDs) have changed care of patients with rheumatoid arthritis (RA). However, bDMARDs are costly, can lead to serious infections, and induce a sustained remission in only 30% of RA patients. In this study, we sought to determine if the clinical response to treatment with Tocilizumab (TCZ), an IL-6 inhibitor, varied with genetic background. The efficacy of TCZ was assessed using the European League Against Rheumatism (EULAR) response criteria, measured after 3 months of treatment in two samples of French RA patients (TOCI and ROC studies). Single nucleotide polymorphisms (SNPs) in 21 candidate genes were genotyped using KasPar method (LGC-genomics, UK) and then analyzed to determine their contribution to variation in the response to treatment. One hundred twenty-three patients in the TOCI group (79.8%) and 48 patients in the ROC group (80%) experienced good or moderate EULAR response. The clinical response to treatment was associated with SNP genotype in the gene IL6R, with patients with the homozygous AA-genotype for rs12083537 (IL6R) showing a significantly better response than homozygous or heterozygous patients with the G allele [TOCI: 87.5% of responders for AA genotype vs. 72.2% for AG or GG genotype (p = 0.018); ROC patients: 89.2% of responders for AA genotype vs. 65.2% for AG or GG genotype, p = 0.044]. A meta-analysis combining data from the two cohorts confirmed the lower response rate in patients carrying a copy of the G allele (OR (95% CI) = 0.35 (0.16-0.61), p = 0.001). No association was found with any of the other SNPs tested.

16.
Joint Bone Spine ; 2019 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-30677505

RESUMO

The recent demonstration that DNA from several mucosal bacteria, including Prevotella spp, could be found in numerous tissues (mesenteric lymph nodes, spleen, serum, liver, lung, eye and ankle joints), either in HLA-B27 rats with or without arthritis, or control rats without HLA-B27, could be a revolution in our understanding of spondyloarthritis and close disorders, including rheumatoid arthritis. Indeed, similar translocations of dead or alive bacteria or fungi from mucosa to joints, could contribute to the onset and flares of inflammatory rheumatisms. This state of the art article addresses six questions revived by this finding: 1-How does this bacterial DNA or living bacteria traffic from mucosa to joints? 2-Can some mucosal bacteria remain alive in those tissues, including joints? 3-Could bacteria from the gut microbiota ('self-bacteria') protect the host cells from invasion by more pathogenic bacteria (like dog-shepherds protect from wolves)? 4-Does the composition of the joint or bone marrow microbiota depends on local metabolism, which might differ from gut metabolism? 5-Could bacterial antigens from mucosal microbiota be sufficient to trigger trained immunity of presenting cells in joints, or does such phenomenon (with lasting epigenetic changes of presenting cells) require intra-cellular infection of presenting cells or their ancestors? 6-In which subsets of cells could living bacteria preferentially persist for a long period in the joint area? Transient or dormant infections within bone-marrow mesenchymal stem cells leading to trained immunity of some of their daughter cells in joints or enthesis, lasting after clearance or the invader, is an attractive hypothesis to test.

17.
Clin Exp Rheumatol ; 37(4): 561-565, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30620273

RESUMO

OBJECTIVES: We aimed to describe the prevalence and characteristics of peripheral enthesitis in recent onset axial spondyloarthritis, estimate the incidence of peripheral enthesitis over time, and determine the factors associated with the presence of peripheral enthesitis. METHODS: 708 patients with recent onset axial spondyloarthritis were enrolled in the DESIR cohort ( prospective multi-centre, longitudinal). Data regarding the patients and spondyloarthritis characteristics at baseline with a specific focus on enthesitis and occurrence of peripheral enthesitis were collected during the five years of follow-up. RESULTS: At inclusion, 395 patients (55.8%) reported peripheral enthesitis. The locations were mainly the plantar fascia (53.7%) and the Achilles tendon (38.5%). During the 5-year follow-up period, 109 additional patients developed peripheral enthesitis resulting in an estimated (Kaplan-Meier method) percentage of 71% (95% CI: 68-75). Variables associated with peripheral enthesitis in the univariate analysis were: older age, male gender, absence of HLA B27, MRI sacroiliitis and fulfilled Modified NY criteria, presence of anterior chest wall pain, peripheral arthritis, dactylitis, psoriasis, high BASDAI, BASFI, mean score ASAS-and the use of NSAIDs. Only the history of anterior chest wall pain and of peripheral arthritis were retained in the multivariate analysis (odds ratio (OR)=1.6 [95% confidence interval [1.1-2.3], and OR=2.1 [1.4-3.0], respectively). CONCLUSIONS: This study highlights the high prevalence of peripheral enthesitis in recent onset axial spondyloarthritis, and suggests that in combination with peripheral arthritis, enthesitis might have an impact on the burden of the disease.


Assuntos
Entesopatia/epidemiologia , Sacroileíte , Espondilartrite , Idoso , Estudos de Coortes , Comorbidade , Efeitos Psicossociais da Doença , Feminino , Antígeno HLA-B27 , Humanos , Masculino , Estudos Prospectivos , Sacroileíte/epidemiologia , Espondilartrite/epidemiologia
18.
Joint Bone Spine ; 86(4): 483-490, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30578852

RESUMO

OBJECTIVES: To understand the pathophysiology of cardiovascular (CV) dysfunction in rheumatoid arthritis (RA) is crucial, but limited by the paucity of animal models able to mimic CV impairments. We wanted to determine if the rat model of Pristane-Induced Arthritis (PIA) reproduced cardiometabolic impairments of RA. METHODS: Dark Agouti rats received an injection of pristane or saline (controls) at day 0. Reactivity to vasoconstrictors and vasodilators was studied in aortic rings and mesenteric arteries at day 28 (acute) and day 120 post-induction (chronic phase). Circulating markers of inflammation, lipid and glucose levels, arthritis and radiographic scores were assessed. RESULTS: In aortic rings, PIA induced a reduced vasoconstriction to phenylephrine and serotonin in both phases of the model. The relaxant effect of acetylcholine was decreased in PIA in acute (P < 0.05) but not in chronic phase. In mesenteric arteries, only the acetylcholine-induced vasorelaxation was impaired in PIA rats in the chronic phase (P < 0.001). Serum interleukin-6 levels were higher, total cholesterol and triglycerides levels were lower in PIA in both phases (P < 0.001) whereas myeloperoxidase activity and blood glucose were unchanged. Adiponectine levels were lower in PIA in acute (P < 0.001) but not in chronic phase. Endothelial function correlated with interleukin-6, total cholesterol levels and arthritis score in aorta but not in mesenteric arteries. CONCLUSIONS: As new information, PIA induces endothelial dysfunction in micro-/macro-vascular beds and low lipid levels, like in RA. This model of chronic arthritis might be useful to study CV pathophysiology and to screen new therapeutic options for reducing CV risk in RA.

19.
Artigo em Inglês | MEDLINE | ID: mdl-30500270

RESUMO

INTRODUCTION: Ankylosing spondylitis is the prototype of spondyloarthritis, a chronic inflammatory disease involving mainly the axial skeleton. The treatment strategy was, until now, restricted to NSAIDs and anti TNF agents. Targeting Interleukin 17 is an emerging option with a currently available biologic agent, secukinumab. Areas covered: This paper reviews the available data published on secukinumab (and other anti-IL-17 agents) in ankylosing spondylitis, evaluating the effect on clinical outcomes as well as radiological progression and extra articular manifestations and safety. Expert opinion: Secukinumab represents the first anti IL-17A agent available for the treatment of ankylosing spondylitis, with evidence of efficacy upon signs and symptoms of the disease, even after anti TNF failure, and acceptable safety profile.

20.
Clin Rheumatol ; 2018 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-30328022

RESUMO

Dactylitis is a frequent disabling feature of psoriatic arthritis (PsA). Therapeutic strategy on dactylitis is not really codified. We performed a complementary literature review (since a previous one in 2014) of efficacy of new treatments recently used in PsA on this specific clinical manifestation. Eleven publications were retained (4697 patients). In the randomized double-blind placebo-controlled trials analyzed, authors declared ustekinumab, ixekizumab, adalimumab, and apremilast efficient. Secukinumab, clazakizumab, abatacept, and tofacitinib were promising. Brodalumab was ineffective. Calculations of odds ratios for residual dactylitis were significant for clazakizumab 100 mg and secukinumab in anti-TNF-naïve population. Homogenization of dactylitis assessment and use of this criterion as primary outcome are necessary to have better data on treatment efficacy in the future.

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