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Latourte A, Gottenberg JE, Luxembourger C, Pane I, Claudepierre P, Richette P, Lafforgue P, Combe B, Cantagrel A, Sibilia J, Flipo RM, Gaudin P, Vittecoq O, Schaeverbeke T, Dougados M, Sellam J, Ravaud P, Mariette X, Seror R. Safety of surgery in patients with rheumatoid arthritis treated by abatacept: data from the French Orencia in Rheumatoid Arthritis Registry. Rheumatology (Oxford) 2017; 56:629-637. [PMID: 28053274 DOI: 10.1093/rheumatology/kew476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Indexed: 01/04/2023] Open
Abstract
Objective To investigate the frequency and risk factors of postoperative complications in RA patients treated with abatacept (ABA). Methods The Orencia RA registry recruited 1012 patients receiving ABA for RA in routine care. Data from patients treated with ABA who underwent surgery were reviewed to describe the frequency of postoperative complications. Characteristics of patients and surgeries with and without complications were compared to identify factors associated with complications. Results We identified 205 (20.3%) patients who underwent 263 surgeries, including 176 (66.9%) orthopaedic surgeries. Nineteen (7.2%) surgeries, in 19 patients (9.3%), entailed complications, including 7 delayed wound healing (2.7% of surgeries) and 6 surgical site infections (2.3% of surgeries). The median time between the last infusion of ABA and surgery was 5.9 weeks (range: 0.3-12.0 weeks), with no significant difference between patients with and without complications. The median corticosteroids daily dosage was higher in the group with complications [10.0 (6.25-15.0) vs 6.0 (5.0-10.0) mg/day, P = 0.042]. In multivariate analysis, only the duration of ABA treatment was significantly associated with postoperative complications [adjusted odds ratio (aOR) = 0.94 (95% CI: 0.89, 0.99) for each month of treatment], as were orthopaedic surgeries compared with other kinds of surgery [aOR = 4.45 (95% CI: 1.01, 20.2)]. Conclusion In RA patients treated with ABA, the rate of surgical complications was low: 7.2% and higher in case of orthopaedic procedure and a more recent initiation of ABA. The median time between surgery and the last infusion of ABA was short and did not influence the rate of postoperative complications.
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Grimaldi-Bensouda L, Rossignol M, Koné-Paut I, Krivitzky A, Lebrun-Frenay C, Clet J, Brassat D, Papeix C, Nicolino M, Benhamou PY, Fain O, Costedoat-Chalumeau N, Courcoux MF, Viallard JF, Godeau B, Papo T, Vermersch P, Bourgault-Villada I, Breart G, Abenhaim L, Abbas F, Abdelmoumni A, Hilliquin P, Requeda E, Adoue D, Brassat D, Agard C, Masseau A, Aladjidi N, Clet J, Fernandes H, Lemasson G, Perel Y, Raymond I, Richer O, Vital A, Allain-Launay E, Bru M, Nicolino M, Thomas C, Altman JJ, Amsallem D, Aras N, Boukari L, Dubrel M, Fain O, Letellier E, Lucidarme N, Mekinian A, Morin AS, Stirnemann J, Atlan C, Audry D, Augustin J, Bakir R, Bartolucci P, Chevalier X, Godeau B, Guillaud C, Khellaf M, Limal N, Lousteau V, Mahevas M, Méliksetyan G, Michel M, Roumier M, Bayart S, Bonnet F, Decaux O, Bekherraz A, Brihaye B, Dachez R, Daugas E, Hayem G, Meyer O, Papo T, Pasqualoni E, Sacre K, Travert F, Bellon H, Beltrand J, Lefrere F, Simon A, Benhamou PY, Benveniste O, Bolgert F, Costedoat-Chalumeau N, De Paz R, Demeret S, Fautrel B, Jacqueminet S, Louapre C, Maillart E, Morel N, Papeix C, Rigabert J, Bensaid P, Berger C, Berquin P, Le Moing AG, Berroir S, Besson G, Boutte C, Casez O, Bonnotte B, Audia S, Bossu-Estour C, Bourgarit A, Dupuy A, Keshmandt H, Bourre B, Brac A, Perrin A, Pondarré C, Villar-Fimbel S, Bruckert I, Cosson A, Magy-Bertrand N, Tisserand G, Camu W, Carlander B, Morales RJ, Cances C, Pasquet M, Castilla Lievre MA, Chabroux S, Charif M, Chatelus E, Sibilia J, Chevrant-Breton J, Clavel S, Bille-Turc F, Cohen J, Courcoux MF, Leverger G, Machet L, Cuisset JM, Cony-Makhoul P, Darsy P, Favre S, Giraud P, Leitenschenck L, Monteiro I, Morati C, DeSeze J, Dinulescu M, Dhaoui T, Dommange-Romero F, Drevard E, Dupuis C, Dumuis ML, Durand JM, Farad S, Lecomte P, Pierre P, Fouyssac F, Gaudin P, Gautier A, Gellen-Dautremer J, Jarrin I, Richette P, Georget E, Gras P, Moreau T, Giraud E, Hacini M, Mayer A, Guillaumat C, Guillaume S, Guitton C, Kone-Paut I, Marsaud C, Rossi L, Guyot MH, Hassler P, Heimfert C, Heinzlef O, Hillion B, Hocquelet C, Husson H, Ichai P, Jeziorski E, Deslandre CJ, Le Guern V, Kamenov K, Kerlan V, Lemoine P, Misery L, Pan-Petesch B, Krivitzky A, Labauge P, Rodier M, Lacade C, Razafimahefa B, Lachgar K, Larmarau MP, Leblanc T, Lebrun-Frenay C, Lefèbvre P, Lejoyeux P, Leske C, Ly K, Magy L, Mansuy S, Marechaud R, Martin Negrier ML, Sole G, Maupetit J, Mazingue F, Mochon S, Moktar B, Morcamp D, Morlet-Barla N, Nicolas G, Pautot V, Pellier I, Verret JL, Outteryck O, Vermersch P, Pallot-Prades B, Paquet JM, Puechal X, Sortais A, Pelletier J, Rico A, Pez D, Stankoff B, Quittet P, Rémy C, Roba E, Rosario H, Roudaut N, Sonnet E, Ruel M, Sebban S, Schaepelynck P, Simonin MJ, Vial C, Viallard JF, Ladedan I, Zenone T. Risk of autoimmune diseases and human papilloma virus (HPV) vaccines: Six years of case-referent surveillance. J Autoimmun 2017; 79:84-90. [DOI: 10.1016/j.jaut.2017.01.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/08/2016] [Accepted: 01/26/2017] [Indexed: 10/20/2022]
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Chevreau M, Romand X, Gaudin P, Juvin R, Baillet A. Bisphosphonates for treatment of Complex Regional Pain Syndrome type 1: A systematic literature review and meta-analysis of randomized controlled trials versus placebo. Joint Bone Spine 2017; 84:393-399. [PMID: 28408275 DOI: 10.1016/j.jbspin.2017.03.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/15/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Complex Regional Pain Syndrome Type 1 is a severely disabling pain syndrome with no definite established treatment. We have performed a systematic literature review and meta-analysis of all randomized controlled trials to assess the benefit of bisphosphonates on pain and function in patients with Complex Regional Pain Syndrome Type 1. METHODS A systematic literature search was performed in the Medline, Embase and Cochrane databases. Two authors selected independently blinded randomized trials comparing bisphosphonates to placebo on short-term (J30 to J40) and medium term pain (M2-M3), safety and function in patients with CRPS 1. The methodological quality of the studies was analyzed. Data were aggregated using the method of the inverse of the variance. RESULTS 258 articles were identified. Four trials of moderate to good quality comprising 181 patients (90 in the bisphosphonate group and 91 in the placebo group) were included in this meta-analysis. Short-term pain Visual Analog Scale was significantly lower in the bisphosphonate group versus the placebo group (SMD=-2.6, 95%CI [-1.8, -3.4], P<0.001), as well as the medium term Visual Analog Scale pain (SMD=-2.5, 95%CI [-1.4, -3.6], P<0.001). There were more adverse events in the bisphosphonate group (35.5%) than in the placebo group (16.4%) with a relative risk of 2.1 (95%CI [1.3, 3.5], P=0.004) and a number needed to harm of 4.6, (95%CI [2.4, 168.0]) but no serious side effects. CONCLUSIONS Our results suggest that bisphosphonates reduce pain in patients with Complex Regional Pain Syndrome type 1. Other studies are needed to determine their effectiveness.
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Baillet A, Gastaldi R, Ravey JN, Gaudin P. Bone Marrow Edema in the Sacroiliac Joint—Degenerative Sacroiliac Joint Disease Might Be More Likely Than Spondyloarthritis: Comment on the Article by Turina et al. Arthritis Rheumatol 2017; 69:1123-1124. [DOI: 10.1002/art.40075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/14/2017] [Indexed: 11/09/2022]
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Fautrel B, Morel J, Berthelot JM, Constantin A, De Bandt M, Gaudin P, Maillefert JF, Meyer O, Pham T, Saraux A, Solau-Gervais E, Vittecoq O, Wendling D, Erpelding ML, Guillemin F. Validation of FLARE-RA, a Self-Administered Tool to Detect Recent or Current Rheumatoid Arthritis Flare. Arthritis Rheumatol 2017; 69:309-319. [DOI: 10.1002/art.39850] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 08/11/2016] [Indexed: 12/19/2022]
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Clay M, Mazouyes A, Gilson M, Gaudin P, Baillet A. Risk of postoperative infections and the discontinuation of TNF inhibitors in patients with rheumatoid arthritis: A meta-analysis. Joint Bone Spine 2016; 83:701-705. [DOI: 10.1016/j.jbspin.2015.10.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 10/28/2015] [Indexed: 11/15/2022]
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Mistretta F, Mari K, Le Boedec M, Jousse-Joulib S, Ferlet JF, Marhadour T, Chales G, Grange L, Hacquard-Bouder C, Loeuille D, Sellam J, Albert JD, Bentin J, Chary-Valckenaere I, D’Agostino MA, Etchepare F, Gaudin P, Hudry C, Dougados M, Saraux A. Existe-t-il des facteurs qui influencent la concordance entre évaluation clinique et échographie dans la polyarthrite rhumatoïde ? Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tatar Z, Migne C, Petera M, Gaudin P, Lequerre T, Marotte H, Tebib J, Pujos Guillot E, Soubrier M. Variations in the metabolome in response to disease activity of rheumatoid arthritis. BMC Musculoskelet Disord 2016; 17:353. [PMID: 27549132 PMCID: PMC4994199 DOI: 10.1186/s12891-016-1214-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 08/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anti-Tumor Necrosis Factor (TNF) therapies are able to control rheumatoid arthritis (RA) disease activity and limit structural damage. Yet no predictive factor of response to anti-TNF has been identified. Metabolomic profile is known to vary in response to different inflammatory rheumatisms so determining it could substantially improve diagnosis and, consequently, prognosis. The aim of this study was to use mass spectrometry to determine whether there is variation in the metabolome in patients treated with anti-TNF and whether any particular metabolomic profile can serve as a predictor of therapeutic response. METHODS Blood samples were analyzed in 140 patients with active RA before initiation of anti-TNF treatment and after 6 months of Anti-TNF treatment (100 good responders and 40 non-responders). Plasma was deproteinized, extracted and analyzed by reverse-phase chromatography-QToF mass spectrometry. Extracted and normalized ions were tested by univariate and ANOVA analysis followed by partial least-squares regression-discriminant analysis (PLS-DA). Orthogonal Signal Correction (OSC) was also used to filter data from unwanted non-related effects. Disease activity scores (DAS 28) obtained at 6 months were correlated with metabolome variation findings to identify a metabolite that is predictive of therapeutic response to anti-TNF. RESULTS After 6 months of anti-TNF therapy, 100 patients rated as good responders and 40 patients as non-responders according to EULAR criteria. Metabolomic investigations suggested two different metabolic fingerprints splitting the good-responders group and the non-responders group, without differences in anti-TNF therapies. Univariate analysis revealed 24 significant ions in positive mode (p < 0.05) and 31 significant ions in negative mode (p < 0.05). Once intersected with PLS results, only 35 ions remained. Carbohydrate derivates emerged as strong candidate determinants of therapeutic response. CONCLUSIONS This is the first study describing metabolic profiling in response to anti-TNF treatments using plasma samples. The study highlighted two different metabolic profiles splitting good responders from non-responders.
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Baillieul S, Guinot M, Dubois C, Prunier A, Mahler F, Gaudin P. Set the pace of bone healing - Treatment of a bilateral sacral stress fracture using teriparatide in a long-distance runner. Joint Bone Spine 2016; 84:499-500. [PMID: 27477316 DOI: 10.1016/j.jbspin.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/10/2016] [Indexed: 12/27/2022]
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Gossec L, Molto A, Foissac F, Soubrier M, Fayet F, Gaudin P, Dougados M. AB1019 Is The Self-Assessment of Disease Activity (auto-DAS28) by Patients A Feasible and Acceptable Measure over The Long Term in Rheumatoid Arthritis (RA)? Three-Year Follow-up of A Nurse-Led Program in 771 Patients with Established RA. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gossec L, Molto A, Foissac F, Fayet F, Mouterde G, Gaudin P, Soubrier M, Dougados M. THU0621 One Third of Patients with Established Rheumatoid Arthritis (RA) Are Correctly Vaccinated against Influenza and Pneumococcus and This Is Increasing: 3 Year Longitudinal Assessment of 776 Patients: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Sigaux J, Bailly F, Gossec L, Alfaiate T, Gandjbakhch F, Foltz V, Morel J, Dernis E, Gaudin P, Brocq O, Berthelot JM, Balblanc JC, Mariette X, Tubach F, Fautrel B. FRI0155 Fifty Percent of Patients Who Tapered TNF-Blockers while in Stable Remission Are Able To Maintain A Tapered Regimen at 3 Year: Long Term Follow-Up Extension of The Strass Trial. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cheung PP, Mari K, Devauchelle-Pensec V, Jousse-Joulin S, D'Agostino MA, Chalès G, Gaudin P, Mariette X, Saraux A, Dougados M. Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis. RMD Open 2016; 2:e000205. [PMID: 27042336 PMCID: PMC4800805 DOI: 10.1136/rmdopen-2015-000205] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Objective To evaluate the predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (RA). Methods A post hoc analysis was performed on a prospective 2-year study of 59 patients with active RA starting on antitumour necrosis factor (TNF). Tenderness and synovitis was assessed clinically at baseline, followed by blinded ultrasound assessment (B-mode and power Doppler ultrasound (PDUS)) on the hands and feet (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal and 10 metatarsophalangeal (MTP) joints). Radiographs of these joints were performed at baseline and at 2 years. The risk of radiographic progression with respect to the presence of baseline tenderness or synovitis, as well as its persistence (after 4 months of anti-TNF), was estimated by OR (95% CI). Results Baseline tender joints were the least predictive for radiographic progression (OR=1.53 (95% CI 1.02 to 2.29) p<0.04), when compared to synovitis (clinical OR=2.08 (95% CI 1.39 to 3.11) p<0.001 or PDUS OR=1.80 (95% CI 1.20 to 2.71) p=0.005, respectively). Tender joints with the presence of synovitis were predictive of radiographic progression (OR=1.89 (95% CI 1.25 to 2.85) p=0.002), especially seen in the MTP joints. Non-tender joints with no synovitis were negatively predictive (OR=0.57 (95% CI 0.39 to 0.82) p=0.003). Persistence of tender joints was negatively predictive (OR=0.38 (95% CI 0.18 to 0.78) p=0.009) while persistence of synovitis was predictive (OR=2.41 (95% CI 1.24 to 4.67) p=0.01) of radiographic progression. Conclusions Synovitis is better than tenderness to predict for subsequent structural progression. However, coexistence of tenderness and synovitis at the level of an individual joint is predictive of structural damage, particularly in the MTP joints. Trial registration number NCT00444691.
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Clavarino G, Adriouach S, Quesada JL, Clay M, Chevreau M, Trocmé C, Grange L, Gaudin P, Gatti E, Pierre P, Cesbron JY, Dumestre-Pérard C. Unfolded protein response gene GADD34 is overexpressed in rheumatoid arthritis and related to the presence of circulating anti-citrullinated protein antibodies. Autoimmunity 2016; 49:172-8. [DOI: 10.3109/08916934.2016.1138220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Maugars Y, Albert JD, Bard H, Baron D, Bloch JG, Bourgeois P, Cormier G, D'Agostino MA, Diebolt V, Dixneuf V, Etchepare F, Gandjbakhch F, Gaudin P, Lecoq B, Lellouche H, Monod P, Rolland D, Sanchez JP, Le Goff B. Prevention of iatrogenic infections in interventional rheumatology: Optimal measures but adapted to each risk. Joint Bone Spine 2015; 83:250-3. [PMID: 26494595 DOI: 10.1016/j.jbspin.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/14/2015] [Indexed: 10/22/2022]
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Braud AM, Hubert M, Gaudin P, Lebeau T. A quick rhizobacterial selection tests for the remediation of copper contaminated soils. J Appl Microbiol 2015; 119:435-45. [PMID: 26042640 DOI: 10.1111/jam.12865] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/27/2015] [Accepted: 05/21/2015] [Indexed: 12/01/2022]
Abstract
AIMS The main objective of the study is to develop and improve quick bacterial tests to select the best candidates for the bioaugmentation of metal-contaminated soil, coupled with phytoextraction. METHODS AND RESULTS Bacteria isolates (181) were selected from a collection originated from a Cu-contaminated sediment, on the basis of several miniaturized biochemical tests adapted to the copper contamination. Amongst them, we used a growth soil based-medium to select metal-tolerant bacteria, and their ability to grow and mobilize metals by mean of metabolites (siderophores, organic acids) was also assessed. CONCLUSION The result of the bacterial selection tests showed differences in presence or absence of copper, especially for phosphate-solubilizing strains which ability decreased by 53% in the presence of copper hydroxide phosphate as compared to the standard tricalcium phosphate test. A promising Pseudomonas putida was selected from the collection. SIGNIFICANCE AND IMPACT OF THE STUDY The study underlined the importance of choosing significant selection tests regarding the nature of the metal occurring in the soil to be cleaned-up to assess the real potential of each bacterial strain for subsequent soil bioaugmentation purposes.
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Fautrel B, Pham T, Alfaiate T, Gandjbakhch F, Foltz V, Morel J, Dernis E, Gaudin P, Brocq O, Solau-Gervais E, Berthelot JM, Balblanc JC, Mariette X, Tubach F. Step-down strategy of spacing TNF-blocker injections for established rheumatoid arthritis in remission: results of the multicentre non-inferiority randomised open-label controlled trial (STRASS: Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study). Ann Rheum Dis 2015; 75:59-67. [PMID: 26103979 DOI: 10.1136/annrheumdis-2014-206696] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 06/06/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED Tumour necrosis factor (TNF)-blocker tapering has been proposed for patients with rheumatoid arthritis (RA) in remission. OBJECTIVE The trial aims to compare the effect of progressive spacing of TNF-blocker injections (S-arm) to their maintenance (M-arm) for established patients with RA in remission. METHODS The study was an 18-month equivalence trial which included patients receiving etanercept or adalimumab at stable dose for ≥1 year, patients in remission on 28-joint Disease Activity Score (DAS28) for ≥6 months and patients with stable joint damage. Patients were randomised into two arms: maintenance or injections spacing by 50% every 3 months up to complete stop. Spacing was reversed to the previous interval in case of relapse, and eventually reattempted after remission was reachieved. The primary outcome was the standardised difference of DAS28 slopes, based on a linear mixed-effects model (equivalence interval set at ±30%). RESULTS 64 and 73 patients were included in the S-arm and M-arm, respectively, which was less than planned. In the S-arm, TNF blockers were stopped for 39.1%, only tapered for 35.9% and maintained full dose for 20.3%. The equivalence was not demonstrated with a standardised difference of 19% (95% CI -5% to 46%). Relapse was more common in the S-arm (76.6% vs 46.5%, p=0.0004). However, there was no difference in structural damage progression. CONCLUSIONS Tapering was not equivalent to maintenance strategy, resulting in more relapses without impacting structural damage progression. Further studies are needed to identify patients who could benefit from such a strategy associated with substantial cost savings. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT00780793; EudraCT identifier: 2007-004483-41.
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Salmon JH, Gottenberg JE, Ravaud P, Cantagrel A, Combe B, Flipo RM, Schaeverbeke T, Houvenagel E, Gaudin P, Loeuille D, Rist S, Dougados M, Sibilia J, Le Loët X, Meyer O, Solau-Gervais E, Marcelli C, Bardin T, Pane I, Baron G, Perrodeau E, Mariette X. Predictive risk factors of serious infections in patients with rheumatoid arthritis treated with abatacept in common practice: results from the Orencia and Rheumatoid Arthritis (ORA) registry. Ann Rheum Dis 2015; 75:1108-13. [PMID: 26048170 DOI: 10.1136/annrheumdis-2015-207362] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 05/14/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Little data are available regarding the rate and predicting factors of serious infections in patients with rheumatoid arthritis (RA) treated with abatacept (ABA) in daily practice. We therefore addressed this issue using real-life data from the Orencia and Rheumatoid Arthritis (ORA) registry. METHODS ORA is an independent 5-year prospective registry promoted by the French Society of Rheumatology that includes patients with RA treated with ABA. At baseline, 3 months, 6 months and every 6 months or at disease relapse, during 5 years, standardised information is prospectively collected by trained clinical nurses. A serious infection was defined as an infection occurring during treatment with ABA or during the 3 months following withdrawal of ABA without any initiation of a new biologic and requiring hospitalisation and/or intravenous antibiotics and/or resulting in death. RESULTS Baseline characteristics and comorbidities: among the 976 patients included with a follow-up of at least 3 months (total follow-up of 1903 patient-years), 78 serious infections occurred in 69 patients (4.1/100 patient-years). Predicting factors of serious infections: on univariate analysis, an older age, history of previous serious or recurrent infections, diabetes and a lower number of previous anti-tumour necrosis factor were associated with a higher risk of serious infections. On multivariate analysis, only age (HR per 10-year increase 1.44, 95% CI 1.17 to 1.76, p=0.001) and history of previous serious or recurrent infections (HR 1.94, 95% CI 1.18 to 3.20, p=0.009) were significantly associated with a higher risk of serious infections. CONCLUSIONS In common practice, patients treated with ABA had more comorbidities than in clinical trials and serious infections were slightly more frequently observed. In the ORA registry, predictive risk factors of serious infections include age and history of serious infections.
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Nourisson C, Gottenberg JE, Mariette X, Mulliez A, Bardin T, Cantagrel A, Combe B, Dougados M, Flipo RM, Gaudin P, Vittecoq O, Schaeverbeke T, Sibilia J, Soubrier M, Ravaud P, Tournadre A. AB0444 Impact of Gender on the Response and the Tolerance to Treatment with Abatacept in RA Patients: Results from the “Orencia and Rheumatoid Arthritis” Registry. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Viguier M, Rist S, Aubin F, Leccia MT, Richard MA, Esposito-Farèse M, Gaudin P, Pham T, Richette P, Wendling D, Sibilia J, Tubach F. Online training on skin cancer diagnosis in rheumatologists: results from a nationwide randomized web-based survey. PLoS One 2015; 10:e0127564. [PMID: 25996152 PMCID: PMC4440619 DOI: 10.1371/journal.pone.0127564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022] Open
Abstract
Patients with inflammatory rheumatisms, such as rheumatoid arthritis, are more prone to develop skin cancers than the general population, with an additional increased incidence when receiving TNF blockers. There is therefore a need that physicians treating patients affected with inflammatory rheumatisms with TNF blockers recognize malignant skin lesions, requiring an urgent referral to the dermatologist and a potential withdrawal or modification of the immunomodulatory treatment. We aimed to demonstrate that an online training dedicated to skin tumors increase the abilities of rheumatologists to discriminate skin cancers from benign skin tumors. A nationwide randomized web-based survey involving 141 French rheumatologists was conducted. The baseline evaluation included short cases with skin lesion pictures and multiple choice questions assessing basic knowledge on skin cancers. For each case, rheumatologists had to indicate the nature of skin lesion (benign; premalignant/malignant), their level of confidence in this diagnosis (10-points Likert scale), and the precise dermatological diagnosis among 5 propositions. Different scores were established. After randomization, only one group had access to the online formation consisting in 4 e-learning modules on skin tumors, of 15 minutes each (online training group). After reevaluation, the trained and the non-trained group (control group) were compared. The primary end-point was the number of adequate diagnoses of the nature of the skin lesions. The mean number of adequate diagnosis for the benign versus premalignant/malignant nature of the lesions was higher in the online training group (13.4 vs. 11.2 points; p value <0.0001). While the other knowledge scores were also significantly higher, no statistical difference was observed on the level of self-confidence between the 2 groups. In conclusion, the online formation was effective to improve the rheumatologists’ ability to diagnose skin cancer.
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Guerini H, Pluot E, Pessis E, Thevenin F, Campagna R, Feydy A, Gaudin P, Drapé J. Tears at the myotendinous junction of the infraspinatus: Ultrasound findings. Diagn Interv Imaging 2015; 96:349-56. [DOI: 10.1016/j.diii.2014.11.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chuong Nguyen MV, Lardy B, Paclet MH, Rousset F, Berthier S, Baillet A, Grange L, Gaudin P, Morel F. [NADPH oxidases, Nox: new isoenzymes family]. Med Sci (Paris) 2015; 31:43-52. [PMID: 25658730 DOI: 10.1051/medsci/20153101012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
NADPH oxidases, Nox, are a family of isoenzymes, composed of seven members, whose sole function is to produce reactive oxygen species (ROS). Although Nox catalyze the same enzymatic reaction, they acquired from a common ancestor during evolution, specificities related to their tissue expression, subcellular localization, activation mechanisms and regulation. Their functions could vary depending on the pathophysiological state of the tissues. Indeed, ROS are not only bactericidal weapons in phagocytes but also essential cellular signaling molecules and their overproduction is involved in chronic diseases and diseases of aging. The understanding of the mechanisms involved in the function of Nox and the emergence of Nox inhibitors, require a thorough knowledge of their nature and structure. The objectives of this review are to highlight, in a structure/function approach, the main similar and differentiated properties shared by the human Nox isoenzymes.
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Pers YM, Godfrin-Valnet M, Lambert J, Fortunet C, Constant E, Mura T, Pallot-Prades B, Jorgensen C, Maillefert JF, Marotte H, Wendling D, Gaudin P. Response to tocilizumab in rheumatoid arthritis is not influenced by the body mass index of the patient. J Rheumatol 2015; 42:580-4. [PMID: 25641885 DOI: 10.3899/jrheum.140673] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relationship between the body mass index (BMI) and the efficacy of tocilizumab (TCZ) in patients with rheumatoid arthritis (RA). METHODS We conducted a retrospective study in 222 patients with RA followed by 5 centers. The European League Against Rheumatism response was evaluated at 6 months. Univariate and multivariate logistic regressions were performed. RESULTS No significant association between the BMI and the response to TCZ at 6 months was found after adjustment for potential confounding factors (adjusted OR 0.45, 95% CI 0.16-1.24, p = 0.13 and OR 1.19, 95% CI 0.31-4.48, p = 0.78 for BMI 25-30 kg/m(2) and BMI > 30 kg/m(2), respectively, compared to BMI < 25 kg/m(2)). CONCLUSION Response to TCZ in patients with RA is not influenced by the baseline BMI, in contrast to anti-tumor necrosis factor drugs.
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Tournadre A, Tatar Z, Pereira B, Chevreau M, Gossec L, Gaudin P, Soubrier M, Dougados M. Application of the European Society of Cardiology, Adult Treatment Panel III and American College of Cardiology/American Heart Association guidelines for cardiovascular risk management in a French cohort of rheumatoid arthritis. Int J Cardiol 2015; 183:149-54. [PMID: 25666124 DOI: 10.1016/j.ijcard.2015.01.069] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/12/2014] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have greater rates of cardiovascular mortality and RA is an independent cardiovascular risk factor. For the management of cholesterol, the American College of Cardiology/American Heart Association (ACC/AHA) developed new guidelines for the general population. None of the European or American guidelines are specific to RA. The European League Against Rheumatism (EULAR) recommends applying a coefficient to cardiovascular risk equations based on the characteristics of RA. Our objective was to compare the three different sets of guidelines for the eligibility of statin therapy in RA-specific population with very high risk of cardiovascular disease. METHODS AND RESULTS We calculated the proportion of patients eligible for statins according to the guidelines of the European Society of Cardiology (ESC), the Adult Treatment Panel III (ATP-III) and the ACC/AHA in a French cohort of statin-naïve RA patients at least 40 years age. Of the 547 women and 130 men analyzed, statins would be recommended for 9.1% of the women and 26.4% of the men, 15.6% of the women and 53.1% of the men, 38.8% of the women and 78.5% of the men, according to the ESC, ATP-III and ACC/AHA guidelines respectively. CONCLUSIONS In RA patients, as has been observed in the general population, discordance in risk assessment and cholesterol treatment was observed between the three sets of guidelines. The use of the new ACC/AHA guidelines would expand the eligibility for statins and may be applied to RA population a condition at very high risk of cardiovascular disease.
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Pers YM, Schaub R, Constant E, Lambert J, Godfrin-Valnet M, Fortunet C, Bourichi W, Prades BP, Wendling D, Gaudin P, Jorgensen C, Maillefert JF, Marotte H. Efficacy and safety of tocilizumab in elderly patients with rheumatoid arthritis. Joint Bone Spine 2015; 82:25-30. [DOI: 10.1016/j.jbspin.2014.07.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 07/31/2014] [Indexed: 12/11/2022]
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