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Darrieutort-Laffite C, Coiffier G, Aïm F, Banal F, Bart G, Chazerain P, Couderc M, Coquerelle P, Ducourau Barbary E, Flipo RM, Faudemer M, Godot S, Hoffmann C, Lecointe T, Lormeau C, Mulleman D, Piot JM, Senneville E, Seror R, Voquer C, Vrignaud A, Guggenbuhl P, Salliot C. 2023 French recommendations for diagnosing and managing prepatellar and olecranon septic bursitis. Joint Bone Spine 2024; 91:105664. [PMID: 37995861 DOI: 10.1016/j.jbspin.2023.105664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
Septic bursitis (SB) is a common condition accounting for one third of all cases of inflammatory bursitis. It is often related to professional activities. Management is heterogeneous and either ambulatory or hospital-based, with no recommendations available. This article presents recommendations for managing patients with septic bursitis gathered by 18 rheumatologists from the French Society for Rheumatology work group on bone and joint infections, 1 infectious diseases specialist, 2 orthopedic surgeons, 1 general practitioner and 1 emergency physician. This group used a literature review and expert opinions to establish 3 general principles and 11 recommendations for managing olecranon and prepatellar SB. The French Health authority (Haute Autorité de santé [HAS]) methodology was used for these recommendations. Designed for rheumatologists, general practitioners, emergency physicians and orthopedic surgeons, they focus on the use of biological tests and imaging in both outpatient and inpatient management. Antibiotic treatment options (drugs and duration) are proposed for both treatment modalities. Finally, surgical indications, non-drug treatments and prevention are covered by specific recommendations.
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Affiliation(s)
- Christelle Darrieutort-Laffite
- Rheumatology Department, CHU de Nantes, Nantes, France; Nantes Université, Oniris, CHU de Nantes, Inserm, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 44000 Nantes, France
| | | | - Florence Aïm
- Orthopedic Unit and Osteoarticular Reference Center, GH Diaconesses Croix Saint-Simon, Paris, France
| | - Fréderic Banal
- Department of Rheumatology, Centre Hospitalier Universitaire Amiens Picardie, 80054 Amiens, France
| | - Géraldine Bart
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Pascal Chazerain
- Rheumatology Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Marion Couderc
- Rheumatology Department, CHU Gabriel-Montpied, Clermont-Ferrand, France; Inserm/Imost, UMR 1240, Clermont-Ferrand, France
| | | | | | - René-Marc Flipo
- Department of Rheumatology, CHU de Lille, Université de Lille, 59000 Lille, France
| | - Maël Faudemer
- Rheumatology Department, CHU Saint-Antoine, 75012 Paris, France
| | - Sophie Godot
- Internal Medicine and Rheumatology department, Percy Army Training Hospital, Clamart, France
| | - Céline Hoffmann
- Emergency Department, Groupe Hospitalier Diaconnesses Croix Saint-Simon, 75020 Paris, France
| | - Thibaut Lecointe
- Orthopedic surgery Department, CHU d'Orléans, Orléans University, 45067 Orléans, France
| | | | - Denis Mulleman
- EA6295 Nano Medicines & Nano Probes Research Group, University of Tours, Department of Rheumatology, CHRU de Tours, Tours, France
| | - Jean-Maxime Piot
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Eric Senneville
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Raphaèle Seror
- Rheumatology Department, AP-HP, Hôpitaux Universitaires Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre of Immunology of Viral Infections and Autoimmune Diseases (IMVA), Inserm U1184, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | | | | | - Pascal Guggenbuhl
- Rheumatology Department, Hôpital Sud, CHU de Rennes, 35000 Rennes, France; Rennes University, Inserm, CHU de Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1317, 35000 Rennes, France
| | - Carine Salliot
- Rheumatology Department, CHU d'Orléans, Orléans University, 45067 Orléans, France.
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Lacasse M, Derolez S, Bonnet E, Amelot A, Bouyer B, Carlier R, Coiffier G, Cottier JP, Dinh A, Maldonado I, Paycha F, Ziza JM, Bemer P, Bernard L. 2022 SPILF - Clinical Practice guidelines for the diagnosis and treatment of disco-vertebral infection in adults. Infect Dis Now 2023; 53:104647. [PMID: 36690329 DOI: 10.1016/j.idnow.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/12/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023]
Abstract
These guidelines are an update of those made in 2007 at the request of the French Society of Infectious Diseases (SPILF, Société de Pathologie Infectieuse de Langue Française). They are intended for use by all healthcare professionals caring for patients with disco-vertebral infection (DVI) on spine, whether native or instrumented. They include evidence and opinion-based recommendations for the diagnosis and management of patients with DVI. ESR, PCT and scintigraphy, antibiotic therapy without microorganism identification (except for emergency situations), therapy longer than 6 weeks if the DVI is not complicated, contraindication for spinal osteosynthesis in a septic context, and prolonged dorsal decubitus are no longer to be done in DVI management. MRI study must include exploration of the entire spine with at least 2 orthogonal planes for the affected level(s). Several disco-vertebral samples must be performed if blood cultures are negative. Short, adapted treatment and directly oral antibiotherapy or early switch from intravenous to oral antibiotherapy are recommended. Consultation of a spine specialist should be requested to evaluate spinal stability. Early lifting of patients is recommended.
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Affiliation(s)
- M Lacasse
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - S Derolez
- Rhumatologie, 125 rue de Stalingrad, CHU Avicenne, 93000 Bobigny, France
| | - E Bonnet
- Maladies Infectieuses, Pl. Dr Baylac, CHU Purpan, 31000 Toulouse, France.
| | - A Amelot
- Neurochirurgie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - B Bouyer
- Chirurgie orthopédique et traumatologique, CHU de Bordeaux, Place Amélie Raba-léon, 33076 Bordeaux, France
| | - R Carlier
- Imagerie, Hôpital Raymond Poincaré, 104 Bd R Poincaré, 92380 Garches, France
| | - G Coiffier
- Rhumatologie, GH Rance-Emeraude, Hôpital de Dinan, 22100 Dinan, France
| | - J P Cottier
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - A Dinh
- Maladies Infecteiuses, CHU Raymond Poicaré, 92380 Garches, France
| | - I Maldonado
- Radiologie, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
| | - F Paycha
- Médecine Nucléaire, Hôpital Lariboisière, 2 rue Ambroise Paré 75010 Paris, France
| | - J M Ziza
- Rhumatologie et Médecine Interne. GH Diaconesses Croix Saint Simon, 75020 Paris, France
| | - P Bemer
- Microbiologie, CHU de Nantes, 1 Place A. Ricordeau, Nantes 44000 Cedex 1, France
| | - L Bernard
- Medecine Interne et Maladies Infectieuses, 2 Bd Tonnelé, CHU Bretonneau, 37044 Tours Cedex 09, France
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Zimmermann F, Robin F, Caillault L, Cazalets C, Llamas-Gutierrez F, Garlantézec R, Jousse-Joulin S, Diot E, Mensi SE, Belhomme N, Jégo P, Coiffier G, Lescoat A. Sicca syndrome in systemic sclerosis: a narrative review on a neglected issue. Rheumatology (Oxford) 2023; 62:SI1-SI11. [PMID: 35866609 DOI: 10.1093/rheumatology/keac412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
SSc is an auto-immune disease characterized by life-threatening manifestations such as lung fibrosis or pulmonary arterial hypertension. Symptoms with a detrimental impact on quality of life are also reported and sicca syndrome (xerostomia, xeropthalmia) is present in up to 80% of patients with SSc. Sicca syndrome can occur in the absence of overlap with Sjögren's disease and recent studies highlight that fibrosis of minor and major salivary glands, directly linked to the pathogenesis of SSc, could be a major contributor of xerostomia in SSc. This narrative review provides an overview of the clinical presentation, diagnostic strategies, management and future perspectives on sicca syndrome in patients with SSc.
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Affiliation(s)
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1.,Department of Rheumatology, Rennes University Hospital, University Rennes; Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolisms and Cancer), University Rennes
| | | | | | | | - Ronan Garlantézec
- Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | | | | | | | | | - Patrick Jégo
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | - Guillaume Coiffier
- Department of Internal Medicine.,Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
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Lescoat A, Robin F, Belhomme N, Ballerie A, de Saint Riquier M, Sebillot M, Albert JD, Le Gallou T, Perdriger A, Jégo P, Coiffier G, Cazalets C. Ultrasound Classification of Finger Pulp Blood Flow in Patients With Systemic Sclerosis: A Pilot Study. Arthritis Care Res (Hoboken) 2023; 75:299-306. [PMID: 34477332 DOI: 10.1002/acr.24779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/23/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. METHODS Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. RESULTS In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P = 0.024), whereas cold challenge decreased FPBF (P = 0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient = -0.50, P = 0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31-19.21], P < 0.0001). CONCLUSION PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | | | - Martine Sebillot
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, University of Rennes, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France, and Department of Rheumatology, CH Dinan, Dinan, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
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Zimmermann F, Robin F, Cadiou S, Belhomme N, Jégo P, Coiffier G, Lescoat A. Should we really include systemic sclerosis specific antibodies in the classification criteria of Sjogren's disease? Semin Arthritis Rheum 2023; 58:152158. [PMID: 36580854 DOI: 10.1016/j.semarthrit.2022.152158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
We have read with great interest the results from Marketos et al. regarding the positivity of specific systemic sclerosis auto-antibodies in patients with sicca symptoms. Based on complementary data from the literature, we rather believe scleroderma-associated antibodies should be considered either as a yellow flag for an association between scleroderma and Sjogren, or a potential undiagnosed scleroderma, rather than an isolated Sjogren's disease.
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Affiliation(s)
- François Zimmermann
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France
| | - Simon Cadiou
- Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France; Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
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Robin F, Albert JD, Lescoat A, Martel A, Perdriger A, DeBandt M, Maillot F, Coiffier G. Diagnostic Performances of Ultrasound Evaluation of Major Salivary Glands According to the 2019 Outcome Measures in Rheumatology Ultrasound Scoring System. Arthritis Care Res (Hoboken) 2022; 74:1924-1932. [PMID: 33973395 DOI: 10.1002/acr.24631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/19/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of ultrasound examination of the salivary glands (US-SG) according to the 2019 Outcome Measures in Rheumatology (OMERACT) US scoring system for Sjögren's syndrome (SS). METHODS The present work was a retrospective study based on a multicentric cohort with SS/sicca syndrome. The American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria for SS (a score of ≥4 without ocular staining score), the American-European Consensus Group (AECG) 2002 classification criteria, and clinician experts were considered as reference standards for diagnosis of SS. An OMERACT score of ≥2 according to 2 independent readers defined the diagnosis of SS based on US-SG assessment. Diagnostic performances and interobserver reproducibility of US-SG were assessed. RESULTS Forty-two patients fulfilling the ACR/EULAR 2016 criteria for SS were compared to 30 control subjects with sicca syndrome. Twenty-five patients were diagnosed as having SS according to US-SG evaluation, and they were more frequently observed in the SS group (52.5%) than in the control group (10.0%) (P < 0.001). US-SG showed an area under the curve (AUC) of 0.751 (95% confidence interval [95% CI] 0.621, 0.882) for the diagnosis of SS (ACR/EULAR 2016 classification). The inclusion of US-SG in the ACR/EULAR 2016 classification improved sensitivity (91.5% versus 89.4%) with limited decrease of specificity (96.0% versus 100%) and with an AUC of 0.975 (95% CI 0.945, 1.00). Similar results were observed when US-SG was included in the AECG 2002 classification criteria. Interobserver reproducibility of a score of ≥2 according to the 2019 OMERACT US scoring system for SS diagnosis was good (κ = 0.73 [95% CI 0.64, 0.81]). Histologic lymphocyte infiltration of the minor salivary glands was associated with the OMERACT grading of US-SG. CONCLUSION The present study confirms the good specificity of the 2019 OMERACT US classification measures of US-SG for the diagnosis of SS and its feasibility in daily practice.
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Affiliation(s)
| | | | - Alain Lescoat
- University Hospital Center of Rennes and University of Rennes, CHU Rennes, INSERM, EHESP, IRSET, UMR_S 1085, F-35000 Rennes, France
| | | | | | - Michel DeBandt
- University Hospital Center of Fort-de-France, Martinique, France
| | | | - Guillaume Coiffier
- University Hospital Center of Rennes, Rennes, France, and Hospital Center of Dinan, Dinan, France
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Caillault L, Coiffier G, Robin F, Droitcourt C, Lescoat A. Sclerosing tenosynovitis in a patient with pan-sclerotic morphea. Joint Bone Spine 2022; 89:105421. [PMID: 35671975 DOI: 10.1016/j.jbspin.2022.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Leïla Caillault
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France.
| | - Guillaume Coiffier
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France; Department of rheumatology, CH Dinan, Dinan, France
| | - François Robin
- Inserm, Inra, department of rheumatology, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, 35000 Rennes, France
| | - Catherine Droitcourt
- Inserm CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, department of dermatology, university of Rennes 1, CHU Rennes, Rennes, France
| | - Alain Lescoat
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, university of Rennes, CHU Rennes, 35000 Rennes, France
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Berthe P, Scailteux LM, Lescoat A, Staumont D, Coiffier G, Guéret P, Dupuy A, Oger E, Droitcourt C. Oral Janus kinase inhibitors and venous thromboembolic events in atopic dermatitis: protocols for a case-time control study and a nested case-control study based on the French national health insurance (SNDS) cohort. BMJ Open 2022; 12:e059979. [PMID: 36130766 PMCID: PMC9494565 DOI: 10.1136/bmjopen-2021-059979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Atopic dermatitis (AD) is a highly prevalent, chronic, inflammatory skin disease. Several orally administered Janus kinase inhibitors (JAKis, including baricitinib, upadacitinib and abrocitinib) have received a marketing authorisation for AD.Clinical trials in rheumatoid arthritis (RA) have flagged up a potential risk of JAKi-induced venous thromboembolic events (VTEs). Accordingly, the summary of product characteristics for a JAKi must mention VTEs as potential adverse drug reactions. In contrast to RA, AD per se is not associated with an elevated risk of VTEs. Assessing this potential risk among patients with AD would shed further light on the putative underlying relationship between JAKis and VTEs.Our research question is to investigate whether JAKi administration increases the risk of VTEs in adults with AD. Our primary objective is to assess the risk of VTEs in adults with AD exposed to JAKis compared to AD adults not exposed to JAKis, and our secondary objective is to evaluate whether JAKi initiation acts as a trigger of VTEs in adults with AD within 3 months. METHODS AND ANALYSIS Hence, we have designed (1) a nested case-control study and (2) a case-time control study in a cohort of adults with AD with data from the French national health insurance system (2017-2025).Here, we describe the study protocol, our methodological choices and certain novel aspects, including the combined value of the two assumptions and the use of an exhaustive national health insurance database with potentially greater statistical power for studying rare events in the population of patients with AD at a low risk of VTEs (thus limiting the influence of confounding factors). ETHICS AND DISSEMINATION The protocol has been approved by an independent ethics committee and registered with the French National Data Protection Commission. The study's findings will be published in peer-reviewed scientific journals and presented at international conferences.
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Affiliation(s)
| | - Lucie-Marie Scailteux
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Alain Lescoat
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
- Internal Medicine and Clinical Immunology, CHU Rennes, Rennes, France
| | - Delphine Staumont
- Department of Dermatology, Lille University Hospital Center, Lille, France
| | - Guillaume Coiffier
- Department of Rheumatology, CH Dinan, Dinan, France
- INSERM, INRA, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | | | - Alain Dupuy
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Emmanuel Oger
- Pharmacovigilance and Pharmacoepidemiology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, CHU Rennes, Rennes, France
- Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
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Richebé P, Coiffier G, Guggenbuhl P, Mulleman D, Couderc M, Dernis E, Deprez V, Salliot C, Urien S, Brault R, Ruyssen-Witrand A, Hoppe E, Chatelus E, Roux CH, Ottaviani S, Baufrere M, Michaut A, Pauvele L, Darrieutort-Laffite C, Wendling D, Coquerelle P, Bart G, Gervais E, Goeb V, Ardizzone M, Pertuiset E, Derolez S, Ziza JM, Flipo RM, Godot S, Seror R. Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016-2017. Ann Rheum Dis 2022; 81:annrheumdis-2022-222143. [PMID: 35820674 DOI: 10.1136/ard-2022-222143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments. METHODS For this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded. RESULTS Overall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0-14)). Knee was the most frequent site (n=160 (38.9%)), and Staphylococcus sp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; p<0.001), Charlson's index (OR 1.30, 95% CI 1.06 to 1.58; p=0.012), presence of bacteraemia (OR 4.02, 95% CI 1.35 to 11.99; p=0.008), antibiotic use in the previous 3 months (OR 3.32, 95% CI 1.11 to 9.87; p=0.029) and Staphylococcus aureus NJSA compared with Streptococcus sp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%). CONCLUSION Prognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.
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Affiliation(s)
- Pauline Richebé
- Service de rhumatologie, Hôpitaux universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Guillaume Coiffier
- Service de Rhumatologie, GHT Rance-Emeraude, CH Dinan et Saint-Malo, France, Dinan, France
| | - Pascal Guggenbuhl
- Service de Rhumatologie, CHU Rennes Univ Rennes, INSERM UMR 1241, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France, Rennes, France
| | - Denis Mulleman
- Service de rhumatologie, Centre de Référence en Infections Ostéo-Articulaires Complexes du grand Ouest, CHRU de Tours, Tours, France
| | - Marion Couderc
- Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | - Valentine Deprez
- Rheumatology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Carine Salliot
- Rheumatology, Nouvel Hôpital d'Orléans CHRO La Source, Orleans, France
| | - Saik Urien
- INSERN et Unité de recherche clinique, Site Tarnier (hôpital Cochin), Paris, France
| | - Rachel Brault
- Service rhumatologie, CHU Poitiers, Poitiers, France
| | | | | | - Emmanuel Chatelus
- Rheumatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Marie Baufrere
- Rheumatology, Hôpital Ambroise-Pare, Boulogne-Billancourt, France
| | - Alexia Michaut
- Centre Hospitalier Départemental Vendée Hôpital de Montaigu, Montaigu, France
| | - Loic Pauvele
- Rheumatology, Centre Hospitalier Universitaire de Reims Hôpital d'enfants, Reims, France
| | | | | | | | | | | | | | - Marc Ardizzone
- Rheumatology, Centre Hospitalier de Mulhouse, Mulhouse, France
| | | | - Sophie Derolez
- Rheumatology, Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Jean Marc Ziza
- Rheumatology, Hôpital de la Croix Saint-Simon, Paris, France
| | - René-Marc Flipo
- Service de Rhumatologie, CHU Roger Salengro, Université de Lille, Lille, France
| | - Sophie Godot
- Rheumatology, Hôpital de la Croix Saint-Simon, Paris, France
| | - Raphaele Seror
- Rheumatology, Hôpitaux universitaires Paris-Sud, Le Kremlin Bicêtre, France
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10
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Louis T, Wargny M, De Saint Riquier M, Nicolas B, Cazalets C, Jego P, Droitcourt C, Coiffier G, Lescoat A. Valeur prédictive des paramètres échographiques de la main sur la survenue des atteintes viscérales sclérodermiques au cours d’une étude longitudinale monocentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Pluart AL, Coiffier G, Darrieutort-Lafitte C, Godot S, Ottaviani S, Henry J, Brochard J, Cormier G, Couderc M, Hoppe E, Mulleman D, Khatchatourian L, Thuaut AL, Goff BL, Bart G. Spine immobilization and neurological outcome in Vertebral Osteomyelitis. SPONDIMMO, a prospective multicentric cohort. Joint Bone Spine 2021; 89:105333. [PMID: 34954077 DOI: 10.1016/j.jbspin.2021.105333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of our study was to describe spine immobilization in a multicentric cohort of vertebral osteomyelitis (VO), and evaluate its association with neurological complications during follow-up. METHODS We prospectively included patients from 2016 to 2019 in 11 centers. Immobilization, imaging, and neurological findings were specifically analyzed during a 6-month follow-up period. RESULTS 250 patients were included, mostly men (67.2%, n=168). Mean age was 66.7 ± 15 years. Diagnosis delay was 25 days. The lumbo-sacral spine was most frequently involved (56.4%). At diagnosis, 25.6% patients (n=64) had minor neurological signs and 9.2% (n=23) had major ones. Rigid bracing was prescribed for 63.5% (n=162) of patients, for a median of 6 weeks, with variability between centers (p<0.001). The presence of epidural inflammation and abscess on imaging was associated with higher rates of rigid bracing prescription (OR 2.33, p=0.01). Frailness and endocarditis were negatively associated with rigid bracing prescription (OR 0.65, p<0.01, and OR 0.42, p<0.05, respectively). During follow up, new minor or major neurological complications occurred in respectively 9.2% (n=23) and 6.8% (n=17) of patients, with similar distribution between immobilized and non-immobilized patients. CONCLUSION Spine immobilization prescription during VO remains heterogeneous and seems associated inflammatory lesions on imaging but negatively associated with frailness and presence of endocarditis. Neurological complications can occur despite rigid bracing. Our data suggest that in absence of any factor associated with neurological complication spine bracing might not be systematically indicated. We suggest that spine immobilization should be discussed for each patient after carefully evaluating their clinical signs and imaging findings.
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Affiliation(s)
| | - Guillaume Coiffier
- Department of Rheumatology, CHU Rennes, Rennes, France; Department of Rheumatology, GHT Rance-Emeraude, CH Dinan/Saint-Malo, France
| | | | - Sophie Godot
- Department of Rheumatology, AP-HP DCSS, Paris, France
| | | | - Julien Henry
- Department of Rheumatology, AP-HP Kremlin-Bicêtre, Paris, France
| | - Julia Brochard
- Department of Infectious Diseases, CH Saint-Nazaire, Saint-Nazaire, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD Vendée, La Roche-sur-Yon, France
| | - Marion Couderc
- Department of Rheumatology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | | | - Lydie Khatchatourian
- Department of internal medicine and infectious disease, CH Cornouaille, Quimper, France
| | - Aurélie Le Thuaut
- Direction of research, Methodology and Biostatistics platform, CHU Nantes, Nantes, France
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12
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Cadiou S, Coiffier G, Jouneau S, Jego P, Perdriger A, Belhomme N, Guillin R, Guggenbuhl P. Sacroiliac joint in sarcoidosis on computed tomography: a monocentric retrospective study (SISTER). Rheumatol Int 2021; 42:431-440. [PMID: 34636939 DOI: 10.1007/s00296-021-05021-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/01/2021] [Indexed: 11/28/2022]
Abstract
Sacroiliitis and spondyloarthritis (SpA) have been associated to sarcoidosis. Sarcoidosis bone involvement of the sacral or iliac bones has been reported to mimic SpA. We aimed to evaluate the prevalence of structural sacroiliitis and structural changes of the sacroiliac joints (SIJ) in patients with sarcoidosis by abdominal-pelvic computed tomography (AP-CT). In this monocentric retrospective study, three blinded readers evaluated AP-CT that had already been performed on patients with sarcoidosis and classified them as normal, degenerative, or inflammatory. A consensus was reached for the divergent cases. Erosion, ankylosis, and sclerosis, classically associated with sacroiliitis, were noted. SpA was defined according to the ASAS 2009 classification criteria. We identified 217 patients with proven sarcoidosis who underwent AP-CT. Only three patients had sacroiliitis by CT and four had SpA, representing 1.38% and 1.85% of the patients, respectively. Degenerative SIJs represented 28.1% of patients and were significantly associated with age, at least one pregnancy, rural lifestyle, ankylosis, diffuse idiopathic skeletal hyperostosis, sclerosis, and the presence of osteophytes. Four patients had axial bone sarcoidosis. Sacroiliitis, SpA, and degenerative changes of the SIJ have been highlighted by AP-CT in patients with sarcoidosis. Osteoarthritis of the SIJ in sarcoidosis was associated with age, pregnancy, and rural lifestyle. Further studies are needed to assess the link between SpA and sarcoidosis.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France.
| | | | - Stéphane Jouneau
- Department of Respiratory Medicine, Rennes University Hospital, Rennes, France.,University of Rennes 1, Rennes, France.,INSERM-IRSET UMR1085, Rennes, France
| | - Patrick Jego
- Internal Medicine Department, Rennes University Hospital, University of Rennes 1, 35000, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France
| | - Nicolas Belhomme
- Internal Medicine Department, Rennes University Hospital, 35000, Rennes, France
| | - Raphaël Guillin
- Department of Medical Imaging, Rennes University Hospital, 35000, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, University of Rennes 1, 16 Boulevard de Bulgarie, 35000, Rennes, France.,INSERM, CHU Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR 1241, Univ Rennes, 35000, Rennes, France
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13
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Corre C, Coiffier G, Le Goff B, Ferreyra M, Guennic X, Patrat-Delon S, Degeilh B, Albert JD, Tattevin P. Lyme arthritis in Western Europe: a multicentre retrospective study. Eur J Clin Microbiol Infect Dis 2021; 41:21-27. [PMID: 34417687 DOI: 10.1007/s10096-021-04334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
To characterize Lyme arthritis, with a focus on management, and outcome. Observational retrospective multicentre study in Western France, of all consecutive cases of Lyme arthritis, documented by Borrelia burgdorferi IgG on ELISA serological testing, confirmed by Western blot, with or without positive Borrelia PCR in synovial fluid, with no alternative diagnosis. We enrolled 52 patients (29 males), with a mean age of 43 ± 19.4 years. Most patients had monoarthritis (n = 43, 82.7%), involving the knee (n = 51, 98.1%), with a median delay between symptoms onset and Lyme arthritis diagnosis of 5 months (interquartile range, 1.5-8). Synovial fluid analysis yielded median white cell count of 16,000/mm3 (9230-40,500), and positive PCR in 16 cases (39%), for B. burgdorferi sensu stricto (n = 5), B. garinii (n = 5), B. afzelii (n = 3), and undetermined (n = 3). All patients received antibiotics, for a median duration of 28 days (21-30), with doxycycline (n = 44, 84.6%), ceftriaxone (n = 6, 11.5%), or amoxicillin (n = 2). Twelve patients (23.1%) also received intra-articular injection of glucocorticoids as first-line treatment. Of 47 patients with follow-up, 35 (74.5%) had complete resolution of Lyme arthritis. Lyme arthritis in Western Europe may be due to B. burgdorferi ss, B. afzelii, or B. garinii. Clinical presentation is similar to Lyme arthritis in North America (i.e. chronic knee monoarthritis), with low sensitivity of synovial fluid PCR (39%).
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Affiliation(s)
- Clémence Corre
- Rheumatology Department, Bretagne-Atlantique Hospital Center, Hôpital CHUBERT, Vannes, France
| | - Guillaume Coiffier
- Reference Centre for Tick-Borne Diseases in Western France, Rennes, France
- Rheumatology Department, University Hospital, Rennes, France
- Rheumatology Department, GHT Rance-Emeraude, René Pléven Hospital, Dinan, France
| | - Benoit Le Goff
- Rheumatology Department, University Hospital, Nantes, France
| | - Marine Ferreyra
- Rheumatology Department, Bretagne-Atlantique Hospital Center, Hôpital CHUBERT, Vannes, France
| | - Xavier Guennic
- Rheumatology Department, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Solène Patrat-Delon
- Reference Centre for Tick-Borne Diseases in Western France, Rennes, France
- Infectious Diseases Department, University Hospital, Rennes, France
| | - Brigitte Degeilh
- Reference Centre for Tick-Borne Diseases in Western France, Rennes, France
- Rheumatology Department, Yves Le Foll Hospital, Saint-Brieuc, France
| | - Jean-David Albert
- Reference Centre for Tick-Borne Diseases in Western France, Rennes, France
- Rheumatology Department, University Hospital, Rennes, France
| | - Pierre Tattevin
- Reference Centre for Tick-Borne Diseases in Western France, Rennes, France.
- Rheumatology Department, Yves Le Foll Hospital, Saint-Brieuc, France.
- Parasitology and Applied Zoology Laboratory, Rennes University Hospital, Rennes, France.
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, 2, rue Henri Le Guilloux, 35033 Cedex 9, Rennes, France.
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14
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Doaré E, Robin F, Racapé H, Le Mélédo G, Orione C, Guggenbuhl P, Goupille P, Gervais E, Dernis E, Bouvard B, Marhadour T, Coiffier G, Saraux A. Features and Outcomes of Microcrystalline Arthritis Treated by Biologics: A Retrospective Study. Rheumatol Ther 2021; 8:1241-1253. [PMID: 34218418 PMCID: PMC8380607 DOI: 10.1007/s40744-021-00335-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/10/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The usual treatments for crystal-associated arthritis are sometimes contraindicated; thus, new therapies against interleukin-1beta (IL-1) have been developed. We evaluated the characteristics of patients who received biological treatment for crystal-associated arthritis. PATIENTS AND METHODS We conducted a multicentric retrospective observational study in six rheumatology units in western France. Patients receiving a biological treatment for crystal-associated arthritis between 1 January 2010 and 31 December 2018 were included. Improvement was defined as at least a 50% decrease in the count of synovitis and C-reactive protein level. RESULTS Forty-six patients were included: 31 (67.4%) were treated for gouty arthritis, and 15 (32.6%) for calcium pyrophosphate crystal deposition disease (CCPD). The first biotherapy used was anakinra for 14 patients (93.3%) with CCPD and 31 patients (100.0%) with gout. The first biotherapy course was more efficient in treating gout than in treating CCPD, with success in 28 patients (90.3%) and 5 patients (35.7%), respectively (p = 0.001). Six patients (42.9%) with CCPD stopped their first biotherapy course because of side effects. Among the patients with gout, urate-lowering therapy was more frequently used after (100%) than before the first biotherapy course (67.7%) (p = 0.002). CONCLUSION Anakinra was prescribed for cases of refractory crystal-associated arthritis or cases with contraindications for usual treatments. The efficacy of anakinra in treating CCPD was not obvious. Patients with CCPD had more side effects. The biotherapy was introduced with a long-term objective, while anti-IL-1 therapies are approved for acute crises only.
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Affiliation(s)
- Elise Doaré
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France
| | - François Robin
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France
| | - Hélène Racapé
- Rheumatology Department, CHU d'Angers, 49100, Angers, France
| | - Guillaume Le Mélédo
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France.,Rheumatology Department, University Hospital of Tours; EA 7501, GICC, University of Tours, Tours, France
| | | | - Pascal Guggenbuhl
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France
| | - Philippe Goupille
- Rheumatology Department, University Hospital of Tours; EA 7501, GICC, University of Tours, Tours, France
| | | | | | | | - Thierry Marhadour
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France
| | - Guillaume Coiffier
- Rennes, Service de Rhumatologie, Institut NUMECAN (Nutrition Metabolisms and Cancer), Univ Rennes, INSERM, INRA, 35000, Rennes, France.,Rheumatology Unit, GHT Rance-Emeraude, CH, Dinan, France
| | - Alain Saraux
- Rheumatology Department, CHU, Centre de Référence Maladies Rares CERAINO, INSERM 1227, UBO, LabEx IGO, Brest CHU, Brest, France. .,Rheumatology Unit, Hôpital de la Cavale Blanche, BP 824, 29609, Brest Cedex, France.
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15
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Coiffier G, Berthoud O, Albert JD, Robin F, Goussault C, Gougeon-Jolivet A, Bendavid C, Guggenbuhl P. Elaboration of a new synovial predictive score of septic origin for acute arthritis on the native joint (RESAS). Rheumatology (Oxford) 2021; 60:2238-2245. [PMID: 33197255 DOI: 10.1093/rheumatology/keaa567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To establish a new predictive score for the diagnosis of septic arthritis (SA) according to different synovial fluid (SF) variables. METHODS First, we analysed the different clinical, biological and SF variables associated with the diagnosis of SA (according to the Newman's criteria) in a monocentric cohort of acute arthritis (<30 days) (n = 233) (SYNOLACTATE cohort). A new score predictive of SA (RESAS) was created using the independent discriminant variables after multivariate analysis. A value was attributed to each variable of the score according to the weighting based on their likelihood ratio for the diagnosis of SA. RESAS performance was then tested on the first cohort (internal validation) and then checked on a second independent cohort (n = 70) (external validation). RESULTS After multivariate analysis, four independent variables of the SF were included for RESAS: (i) purulent SF or white blood cells count ≥70 000/mm3; (ii) absence/presence of crystals; (iii) lactate; and (iv) glucose synovial level. RESAS ranged between -4 and +13 points. The performance of RESAS to predicted SA was excellent with area under the curve (AUC)=0.928 (0.877-0.980) in internal validation and AUC=0.986 (0.962-1.00) in external validation. For a RESAS threshold ≥+4, SA was diagnosed with Se=56.0% (0.371-0.733), Sp=98.1% (0.952-0.993), LR+=29.1 (10.4-81.6) in the first cohort and with Se=91.7% (0.646-0.985), Sp=98.3% (0.909-0.997), LR+=53.2 (7.56-373) in the second cohort. CONCLUSION RESAS is a new composite score of four SF variables with excellent performance to predicted SA in acute arthritis population.
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Affiliation(s)
| | | | | | - François Robin
- Rheumatology Department, CHU Rennes.,U1241, CIMIAD Unit, INSERM
| | | | | | - Claude Bendavid
- U1241, CIMIAD Unit, INSERM.,Biochemistry Department, CHU Rennes, University of Rennes 1, Rennes, France
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Abstract
Lyme borreliosis is a tick-borne disease that is widespread throughout the northern hemisphere. Ixodes ricinus is present throughout metropolitan France, except for the Mediterranean region. The debate revolves around whether or not a chronic form of Lyme disease exists. This controversy is not limited to France but has been reported worldwide. In France, in 2019, 24 scientific societies representing the medical disciplines most involved in Lyme disease, including the Société Française de Rhumatologie (French Rheumatology Society [SFR]) and the Société de Pathologie Infectieuse de la Langue Française (French Infectious Disease Society-SPILF), published recommendations on the management of Lyme borreliosis following a submission to the Director General of Health. These recommendations conflict with those of the Haute Autorité de Santé (HAS), a multi-specialties independent group of physician, on a key point: whether to add a new nosological entity labeled as "persistent polymorphous signs and symptoms (or syndrome) possibly due to tick bite." The creation of this new syndrome risks should increase anchoring bias, leading to the attribution of all symptoms to a possible tick bite, without considering differential diagnoses. Lyme disease has been extensively studied. Erythema migrans is the primary clinical manifestation. In the presence of nonmetabolic, nonseptic monoarthritis involving the knee or radiculitis of a lower limb during the summer, Lyme disease should be suspected. Serologic testing for Lyme disease is reliable in the case of late forms such as chronic arthritis, while the detection of Borrelia DNA in synovial fluid by PCR is inconsistent. Sometimes, the serology can be misleading in early forms such as radiculitis. Treatment is based on doxycycline for 14 days in early forms (radiculitis), or 28 days in late forms (arthritis). Arthritis can persist or recur after antibiotic therapy. The prevalence of a diffuse polyalgia syndrome (fibromyalgia) following Lyme disease does not seem to differ much from that in the general population. It is not improved by prolonged antibiotic therapy, which is therefore not recommended.
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Affiliation(s)
- Guillaume Coiffier
- Service de Rhumatologie, GHT Rance-Émeraude, CH Dinan, 74 boulevard Chateaubriand, 22100 Dinan, France; Centre de Référence des Maladies Vectorielles à Tiques (MVT), Pontchaillou, CHU Rennes, 33 boulevard Louis Guilloux, 35000 Rennes, France; Groupe de travail sur les Infections Ostéo-articulaires, Société Française de Rhumatologie (SFR), Paris, France.
| | - Pierre Tattevin
- Service de Maladies Infectieuses & Réanimation Médicale, Pontchaillou, CHU Rennes, 33 boulevard Louis Guilloux, 35000 Rennes, France; Centre de Référence des Maladies Vectorielles à Tiques (MVT), Pontchaillou, CHU Rennes, 33 boulevard Louis Guilloux, 35000 Rennes, France
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17
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Albert JD, Le Corvec M, Berthoud O, David C, Guennoc X, Hoppe E, Jousse-Joulin S, Le Goff B, Tariel H, Sire O, Jolivet-Gougeon A, Coiffier G, Loréal O. Ruling out septic arthritis risk in a few minutes using mid-infrared spectroscopy in synovial fluids. Rheumatology (Oxford) 2021; 60:1158-1165. [PMID: 32885254 DOI: 10.1093/rheumatology/keaa373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to show the usefulness of a mid-infrared fibre evanescent wave spectroscopy point of care device in the identification of septic arthritis patients in a multicentre cohort, and to apply this technology to clinical practice among physicians. METHODS SF samples from 402 patients enrolled in a multicentre cohort were frozen for analysis by mid-infrared fibre evanescent wave spectroscopy. The calibration cohort was divided into two groups of patients (septic arthritis and non-septic arthritis) and relevant spectral variables were used for logistic regression model. Model performances were tested on an independent set of 86 freshly obtained SF samples from patients enrolled in a single-centre acute arthritis cohort and spectroscopic analyses performed at the patient's bedside. RESULTS The model set-up, using frozen-thawed SFs, provided good performances, with area under the curve 0.95, sensitivity 0.90, specificity 0.90, positive predictive value 0.41 and negative predictive value 0.99. Performances obtained in the validation cohort were area under the curve 0.90, sensitivity 0.92, specificity 0.81, positive predictive value 0.46 and negative predictive value 0.98. The septic arthritis probability has been translated into a risk score from 0 to 4 according to septic risk. For a risk score of 0, the probability of identifying a septic patient is very low (negative predictive value of 1), whereas a risk score of 4 indicates very high risk of septic arthritis (positive predictive value of 1). CONCLUSION Mid-infrared fibre evanescent wave spectroscopy could distinguish septic from non-septic synovial arthritis fluids with good performances, and showed particular usefulness in ruling out septic arthritis. Our data supports the possibility of technology transfer. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT02860871.
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Affiliation(s)
- Jean-David Albert
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | | | - Olivia Berthoud
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Claire David
- Rheumatology Department, Centre Hospitalier de Bretagne Atlantique, Vannes, France
| | - Xavier Guennoc
- Rheumatology Department, Centre Hospitalier St-Brieuc, St-brieuc, France
| | - Emmanuel Hoppe
- Rheumatology Department, Centre Hospitalier Universitaire Angers, Angers, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire and Inserm, LBAI, UMR1227, Brest, France
| | - Benoît Le Goff
- Rheumatology Department, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | | | | | - Anne Jolivet-Gougeon
- INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, Centre Hospitalier Universitaire de Rennes, Rennes, France.,INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
| | - Olivier Loréal
- INSERM, Université de Rennes, INRAe, UMR 1241, Institut NUMECAN CHU Rennes, Rennes, France
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Dumoulin N, Cormier G, Varin S, Coiffier G, Albert JD, Le Goff B, Darrieutort-Laffite C. Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial. Am J Sports Med 2021; 49:883-891. [PMID: 33719606 DOI: 10.1177/0363546521992359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. PURPOSE To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients' clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. RESULTS Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. CONCLUSION Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.
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Robin F, Cadiou S, Albert JD, Bart G, Coiffier G, Guggenbuhl P. Methotrexate osteopathy: five cases and systematic literature review. Osteoporos Int 2021; 32:225-232. [PMID: 33128074 DOI: 10.1007/s00198-020-05664-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/01/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Methotrexate (MTX)-related osteopathy is rare, defined by the triad of pain, osteoporosis, and "atypical fractures" when it was first described in the 1970s in children treated with high doses MTX for acute leukemia. Since then, several cases have been reported in patients treated with low-dose MTX for inflammatory diseases. METHODS A systematic research of cases of MTX-related osteopathy was performed in records of Rheumatology Department of Rennes University Hospital. Data collection focused on demographic data, corticosteroid doses, MTX doses and intake method, cumulative doses, year of diagnosis, fracture location, bone densitometry value, and osteoporosis treatment if necessary. A literature review was also conducted to identify other cases in literature and try to understand the pathophysiological mechanisms of this rare entity. RESULTS We report 5 cases identified between 2011 and 2019, which represents the largest cohort described excluding oncology cases. Fracture locations were atypical for osteoporotic fractures. All patients improved in the following months with MTX withdrawal. All patients except one were treated with antiresorptives (bisphosphonates, denosumab). Two patients, treated with bisphosphonates, had a recurrence of fracture, once again of atypical location. Twenty-five cases were collected in literature with similar clinical presentation. The cellular studies that investigated the bone toxicity of MTX mainly showed a decrease in the number of osteoblasts, osteocytes, and chondrocytes in the growth plate and an increase in the number and activity of osteoclasts. In vitro, consequences of mechanical stimulation on human trabecular bone cells in the presence of MTX showed an alteration in mechano-transduction, with membrane hyperpolarization, acting on the integrin pathway. In contrast with our report, the cases described in the literature were not consistently associated with a decrease in bone mineral density (BMD). CONCLUSION MTX osteopathy while rare must be known by the rheumatologist, especially when using this treatment for inflammatory conditions. The mechanisms are still poorly understood, raising the question of a possible remnant effect of MTX on osteo-forming bone cells, potentially dose-dependent. Methotrexate (MTX) osteopathy, described as a clinical triad, pain, osteoporosis, and atypical stress fractures, while rare, must be known by the rheumatologist. Our cohort of 5 cases represent the largest series of the literature. Pathophysiological studies raised the question of a dose-dependent remnant effect of MTX on osteo-forming bone cells.
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Affiliation(s)
- F Robin
- INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, Rennes, France.
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France.
| | - S Cadiou
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - J-D Albert
- INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, Rennes, France
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - G Bart
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - G Coiffier
- INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, Rennes, France
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France
| | - P Guggenbuhl
- INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, Rennes, France
- Rheumatology department, Rennes University Hospital, 16 Boulevard de Bulgarie, 35200, Rennes, France
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Robin F, Berthoud O, Albert JD, Cadiou S, Gougeon-Jolivet A, Bendavid C, Guggenbuhl P, Coiffier G. External validation of Gout-calculator performance on a cohort of acute arthritis (SYNOLACTATE) sparing distal joints such as hallux and midfoot. A cross-sectional study of 170 patients. Clin Rheumatol 2020; 40:1983-1988. [PMID: 33113024 DOI: 10.1007/s10067-020-05382-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the performance of the Gout-calculator in a cohort of consecutive acute arthritis affecting large and intermediate joints (without an attack on hallux or midfoot joints). METHODS A retrospective study. Gout-calculator data were collected in medical records of patients included in the prospective consecutive cohort of acute arthritis called SYNOLACTATE. The diagnosis of gout was defined by the presence of sodium urate crystals in synovial fluid. The diagnostic performance of the Gout-calculator was studied by performing an ROC curve with the calculation of its AUC (95% CI) as well as the calculation of Sensitivity (Se), Specificity (Sp), and positive likelihood ratio (LR+). RESULTS 170 patients with acute arthritis were included. Variables associated with the diagnosis of gout were as follows: serum uric acid > 350 μmol/L (OR 5.52 (2.52-12.1), p < 0.001), joint redness (OR 5.08 (1.85-14.0), p = 0.001), previous patient-reported arthritis attack (OR 4.04 (1.92-8.49), p < 0.001), male (OR 3.00 (1.17-7.69), p = 0.02), hypertension or cardiovascular disease (OR 2.33 (1.07-5.06), p = 0.03). The median (IQR) of Gout-calculator was significantly higher in gouty arthritis (7.0 [5.5-8.1]) than in associated-CPP acute arthritis (4.0 [2.0-5.8]), septic arthritis (3.0 [2.0-5.1]), or others arthritis (3.5 [2.0-5.5]). The AUC was 0.833 (0.768-0.897) with for the threshold ≥ 8, a Se at 27.5% (0.161-0.428), Sp 97.7% (0.934-0.992), and LR+ 11.9 (3.5-40). CONCLUSION Despite diagnostic performances close to those published, the use of the Gout-calculator is not sufficient for the diagnosis of gout or to exclude the differential diagnosis of septic arthritis in the SYNOLACTATE cohort. KEY POINTS • For a Gout-calculator threshold of ≤ 4, Sensitivity is 92.5%, Specificity 50.8% and LR- 0.15 to the gout diagnosis. • For a Gout-calculator threshold of > = 8, Sensitivity is 27.5%, Specificity 97.7% and LR+ 11.9 to the gout diagnosis. • In a population of acute arthritis affecting large joints, Gout-calculator is not sufficient to discriminate between gouty arthritis and septic arthritis.
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Affiliation(s)
- F Robin
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - O Berthoud
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - J D Albert
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - S Cadiou
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France
| | - A Gougeon-Jolivet
- UMR INSERM U 1241, University of Rennes, Rennes, France.,Bacteriology Laboratory, Rennes University Hospital - Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - C Bendavid
- UMR INSERM U 1241, University of Rennes, Rennes, France.,Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2 Rue Henri Le Guilloux, 35000, Rennes, France
| | - P Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Hôpital Sud, 16 boulevard de Bulgarie, BP 90347, 35203, Rennes, Cedex 2, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, Groupe Territorial Hospitalier Rance-Emeraude Dinan Hospital, 74 boulevard Chateaubriand, 22100, Dinan, France.
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Coiffier G. The "step-sign": An ultrasound sign of aseptic osteonecrosis of the femoral head. Joint Bone Spine 2020; 88:105067. [PMID: 32942021 DOI: 10.1016/j.jbspin.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Guillaume Coiffier
- Rheumatology department, GHT Rance-Emeraude, Hospital of Dinan, 74 rue de Chateaubriand, BP 91056, 22100 Dinan, France.
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Couderc M, Bart G, Coiffier G, Godot S, Seror R, Ziza JM, Coquerelle P, Darrieutort-Laffite C, Lormeau C, Salliot C, Veillard E, Bernard L, Baldeyrou M, Bauer T, Hyem B, Touitou R, Fouquet B, Mulleman D, Flipo RM, Guggenbuhl P. 2020 French recommendations on the management of septic arthritis in an adult native joint. Joint Bone Spine 2020; 87:538-547. [PMID: 32758534 DOI: 10.1016/j.jbspin.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Septic arthritis (SA) in an adult native joint is a rare condition but a diagnostic emergency due to the morbidity and mortality and the functional risk related to structural damage. Current management varies and the recommendations available are dated. The French Rheumatology Society (SFR) Bone and Joint Infection Working Group, together with the French Language Infectious Diseases Society (SPILF) and the French Orthopaedic and Trauma Surgery Society (SOFCOT) have worked according to the HAS methodology to devise clinical practice recommendations to diagnose and treat SA in an adult native joint. One new focus is on the importance of microbiological documentation (blood cultures and joint aspiration) before starting antibiotic treatment, looking for differential diagnoses (microcrystal detection), the relevance of a joint ultrasound to guide aspiration, and the indication to perform a reference X-ray. A cardiac ultrasound is indicated only in cases of SA involving Staphylococcus aureus, oral streptococci, Streptococcus gallolyticus or Enterococcus faecalis, or when infective endocarditis is clinically suspected. Regarding treatment, we stress the importance of medical and surgical collaboration. Antibiotic therapies (drugs and durations) are presented in the form of didactic tables according to the main bacteria in question (staphylococci, streptococci and gram-negative rods). Probabilistic antibiotic therapy should only be used for patients with serious symptoms. Lastly, non-drug treatments such as joint drainage and early physical therapy are the subject of specific recommendations.
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Affiliation(s)
- Marion Couderc
- Rheumatology Department, Gabriel-Montpied Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Géraldine Bart
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France.
| | - Sophie Godot
- Rheumatology Department, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Raphaele Seror
- Rheumatology Department, Le Kremlin-Bicêtre Hospital, AP-HP, South Paris, France
| | - Jean-Marc Ziza
- Rheumatology Department, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Pascal Coquerelle
- Nephrology-Rheumatology Department, Bethune Hospital, Bethune, France
| | | | | | - Carine Salliot
- Rheumatology Department, Orléans Regional Hospital, Orléans, France
| | - Eric Veillard
- Rheumatology Practice, 6, rue des 4 Pavillons, 35400 Saint-Malo, France
| | - Louis Bernard
- Infectious Diseases Department, Bretonneau Hospital, Tours University Hospital, Tours, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Marion Baldeyrou
- Infectious Diseases Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Thomas Bauer
- Orthopaedic and Trauma Surgery Department, Ambroise-Paré Hospital, AP-HP, West Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Beate Hyem
- Biomedical Analysis Laboratory, Microbiology, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Robert Touitou
- General Medical Practice, 3, avenue du Bel Air, 75012 Paris, France
| | - Bernard Fouquet
- Physical Medicine and Rehabilitation Department, Trousseau Hospital, Tours, France
| | - Denis Mulleman
- Rheumatology Department, Bretonneau Hospital, Tours University Hospital, Tours, France
| | - René-Marc Flipo
- Rheumatology Department, Salengro Hospital, Lille University Hospital, Lille, France
| | - Pascal Guggenbuhl
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
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Cadiou S, Robin F, Guillin R, Perdriger A, Jouneau S, Belhomme N, Coiffier G, Guggenbuhl P. Spondyloarthritis and sarcoidosis: Related or fake friends? A systematic literature review. Joint Bone Spine 2020; 87:579-587. [PMID: 32622038 DOI: 10.1016/j.jbspin.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 06/08/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sarcoidosis and spondyloarthritis (SpA) have been regularly associated. Bone iliac granulomas have also been described. We propose herein a systematic review of rheumatologic axial manifestations of sarcoidosis. METHODS PubMed and the Cochrane Library were used to conduct this systematic literature review. Case reports and cross-sectional studies were reviewed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS A total of 41 articles were eligible. Three cross-sectional studies on the association between SpA and sarcoidosis showed a prevalence of sacroiliitis and SpA ranging from 12.9 to 44.8% and 12.9 to 48.3% in inflammatory back pain (IBP) subgroups, respectively. However, the IBP definitions and sacroiliac joint (SIJ) imaging modalities (X-rays or magnetic resonance imaging) were heterogeneous, and X-ray was mainly used for sacroiliitis diagnosis (in 78% of cases). Thirty-one case-report articles of the sarcoidosis-sacroiliitis association were identified, representing 35 patients. ASAS criteria for SpA were met in half of cases (16/32) and 46% (12/26) had HLA B27 positivity. Sarcoidosis occurred after sacroiliac symptoms in 47% of cases. In the seven case-report articles with granulomatous sacroiliac bone involvement, unilateral involvement seemed higher than in the sarcoidosis-sacroiliitis group. CONCLUSION Literature analysis found a good evidence of the association between SpA and sarcoidosis, and special attention should be given to patients reporting IBP. Unilateral sacroiliitis may raise suspicion of granulomatous bone involvement, distinct from sacroiliitis. Imaging modalities used to study the SIJ in patients with sarcoidosis have been heterogeneous and further investigation is needed.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, 35000 Rennes, France.
| | - Francois Robin
- Department of Rheumatology, Rennes University Hospital, 35000 Rennes, France
| | - Raphaël Guillin
- Department of Medical Imaging, Rennes University Hospital, 35000 Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, Rennes University Hospital, 35000 Rennes, France
| | - Stéphane Jouneau
- Department of Respiratory Medicine, Rennes University Hospital, University of Rennes 1, INSERM-IRSET UMR1085, Rennes, France
| | - Nicolas Belhomme
- Internal Medicine Department, Rennes University Hospital, 35000 Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital, 35000 Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, 35000 Rennes, France; CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), UMR INSERM U 1241, University of Rennes 1, 35000 Rennes, France
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Richebé P, Godot S, Coiffier G, Guggenbuhl P, Mulleman D, Couderc M, Dernis E, Deprez V, Salliot C, Urien S, Brault R, Ruyssen-Witrand A, Hoppe E, Gottenberg JE, Roux C, Ottaviani S, Breban M, Beaufrere M, Michaut A, Pauvele L, Darrieutort C, Wendling D, Coquerelle P, Bart G, Gervais E, Goeb V, Ardizzone M, Pertuiset E, Derolez S, Ziza JM, Flipo RM, Seror R. FRI0449 MANAGEMENT AND OUTCOME OF SEPTIC ARTHRITIS OF NATIVE JOINT: A NATIONWIDE SURVEY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Objectives:To describe current management and outcome of septic arthritis on native joint in French rheumatology departments.Methods:Retrospective, nation-wide multicentric study. 127 French rheumatology departments were contacted to report 10 successive cases of septic arthritis on native joint that occurred between the 01/01/16 to 31/12/17 (excluding mycobacteria). Characteristics, diagnosis procedure, therapeutic management and outcome were recorded.Results:52 centers included 363 patients (mean age 64± 18.7 years, mean Charlson comorbidity index 4±3). 28.3% patients had a preexisting arthropathy on affected joint. Monoarthritis was observed in 89.6% patients, knee was the most frequent site (38.9%). The most frequent pathogens wereStaphylococcus sp(50.7%) andStreptococcus sp.(23.3%). Bacteremia was found in 156 (45.1%) patients and endocarditis in only 12 (3.0%). Management was heterogeneous. All patients received antibiotics for a mean duration of 46.7±22 days (including intravenous route: 17.3±15.4 d). An initial monotherapy was administered in 42.3% of patients. Surgical procedure (mostly lavage 70.6%) was performed in 171 (48.3%), joint immobilization in 128 (35.3%) (median duration of 21.7±14.1 days). 94 (29.2%) patients have had serious complications including 29 (9.5%) death. Factors associated with death are reported in the table.Conclusion:This study shows that management of septic arthritis is very heterogenous with a still high rate of morbidity and mortality. We identified age, comorbidities, bacteremia and recent antibiotherapy were associated with mortality. Of note, duration of antibiotics was not. Thus, new guidelines are needed in order to facilitate septic arthritis management.Table:FactorsSurvivor(N=276)Dead(N=29)Univariate analysispAdjusted Odds ratio (95%IC)Multivariate analysispAge65 (16-97)82 (32-98)<0,0011,07 (1,03-1,12)< 0.001Charlson’s index1 (0-12)2 (0-9)0,00011,3 (1,05-1,63)0,018Delay before antibiotic initiation8,5 (0-310)5 (0-75)0,04840,99 (0,96-1,02)0,562Corticosteroid in the previous 3 months13,9%33,3%0,01842,56 (0,75-8,74)0,133Bacteriemia42,4%71,4%0,00615,07 (1,4-18,370,013Antibiotics in the previous 3 months26,6%56,6%0,00566,7 (2,04-22,01)0,002Disclosure of Interests:Pauline Richebé: None declared, Sophie Godot: None declared, Guillaume Coiffier: None declared, Pascal GUGGENBUHL: None declared, Denis Mulleman: None declared, Marion Couderc: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Valentine Deprez: None declared, Carine Salliot: None declared, Saik Urien: None declared, Rachel Brault: None declared, Adeline Ruyssen-Witrand Grant/research support from: Abbvie, Pfizer, Consultant of: Abbvie, BMS, Lilly, Mylan, Novartis, Pfizer, Sandoz, Sanofi-Genzyme, Emmanuel Hoppe: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Christian Roux: None declared, Sebastien Ottaviani: None declared, Maxime Breban: None declared, Marie Beaufrere: None declared, Alexia Michaut: None declared, Loic Pauvele: None declared, Christelle Darrieutort: None declared, Daniel Wendling: None declared, Pascal COQUERELLE: None declared, Géraldine Bart: None declared, Elisabeth Gervais: None declared, Vincent Goeb: None declared, Marc Ardizzone: None declared, Edouard Pertuiset: None declared, Sophie Derolez: None declared, Jean Marc Ziza: None declared, René-Marc Flipo Consultant of: Johnson and Johnson, MSD France, Novartis, Sanofi, Speakers bureau: Johnson and Johnson, MSD France, Novartis, Sanofi, Raphaèle Seror Consultant of: BMS UCB Pfizer Roche
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Lucas C, Rodriguez S, Jean R, Albert JD, Coiffier G, Dumontet E, Tarte K, Amé-Thomas P, Perdriger A. AB0034 EARLY IMMUNIZATION AGAINST TREATMENT IS ASSOCIATED TO POOR CLINICAL RESPONSE AT 6 MONTHS AND LOW NUMBER OF TRANSITIONAL B CELLS AT BASELINE IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY ADALIMUMAB. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Circulating anti-drug antibodies (ADAs) are detectable approximatively in 33% of adalimumab treated rheumatoid arthritis (RA) patients, often within the first 6 months of therapy1-2. Classically, circulating ADAs associate with their specific drugs to form immune complexes, increasing drug clearance, and by this mechanism reducing therapeutic effect3. B cell involvement leading to ADAs production is not yet well established.Objectives:To study early ADAs formation according to clinical response to an adalimumab therapy in RA patients and the relationship between ADAs and circulating B cell subsets.Methods:28 RA patients and 13 healthy controls were included. Patients all presented inadequately controlled RA under conventional treatment, were naive of biotherapies, and started an adalimumab treatment at baseline (M0). Responder status was determined according to the DAS28CRP score (<or>3.2) at 3 (M3) and 6 months (M6). ADAs plasma concentration >10pg/mL at M3 defined the immunized patient group. Circulating B cell subsets were quantified by flow cytometry at M0 and M3.Results:11 (42.3%) patients were immunized at M3. Among them, 4 (36.4%) were responders at M6 and 7 (63.6%) were non-responders. Presence and concentration of ADAs at M3 was associated to non-responder status at M6 (p=0.043; p=0.042). Immunized patients had lower transitional B cells count at M0 compared to non-immunized patients (p=0.031).Conclusion:A high but classical proportion of RA patients developed ADAs after only 3 months of adalimumab treatment. This immunization was associated to non-responder status at M6 and to a low blood transitional B cells count at baseline. Our results suggest transitional B cells implication inRA activity and biotherapy resistance due to immunization. Low concentrations of transitional B cells could be an early biomarker of immunization process against adalimumab.References:[1]Bartelds GM et al. JAMA. 2011[2]Moots RJ et al. PLoS ONE. 2017[3]Van Schouwenburg PA et al. Ann Rheum Dis. 2013Table.Patients characteristics at baselineCharacteristicsAll RA patients (n=28)M6 responders(n=16)M6 non-responders(n=10)Age (years)60.5 [47-78]65.5 [47-76]54 [47-78]Sex ratio M/F (% of F)0.4 (71,4%)0.5 (68.8%)0.3 (80.0%)Disease duration, (years)5.6 [0.7-43.0]6.8 [1.0-43.0]2.9 [0.7-31.0]Oral steroid use, (%)18 (64,3%)9 (56.2%)8 (80.0%)Oral steroids, dose (mg/day)5.0 [2.0-15]5.0 [4.0-12.5]8.5 [2.5-15.0]Methotrexate use, (%)24 (50.9%)14 (87.5%)8 (80.0%)Methotrexate, dose (mg/week)20 [10-25]20 [10-25]15 [10-20]*Leflunomide use, (%)3 (10.7)1 (6.3%)2 (20.0%)Leflunomide, dose (mg/day)20 [20-20]20 [20-20]20 [20-20]CRP, (mg/dL)5.5 [1.0-57.0]6.6 [1.0-46.8]3.6 [1.0-57.0]DAS28CRP score4.3 [3.3-5.7]4.1 [3.3-5.2]4.5 [3.4-5.7]RF positive, (%)20 (71.4%)12 (75.0%)6 (60.0%)RF, (U/mL)116 [19-640]88 [21-640]181 [19-336]ACPA positive, (%)25 (89.3%)15 (93.8%)8 (80.0%)ACPA, (U/mL)340 [11-340]340 [14-340]340 [11-340]Values are medians with ranges and frequencies with percentages. *p=0.050.Figure 1.Graph 1Immunization against treatment at 3 months and clinical response at 6 months in RA patients (n=26). Presence of ADAs at 3 months is associated to non-responder status at 6 months. Fisher exact test. R, responders at 6 months; NR, non-responders at 6 months; ADA+, immunized patients at 3 months; ADA-, non-immunized patients at 3 months.Figure 2.Graph 2Absolute number of transitional B cells at baseline in RA patients (n=28) according to immunized status at 3 months. Immunized patients at 3 months had lower transitional B cells at baseline than non-immunized patients. ADA+, immunized patients at 3 months; ADA-, non-immunized patients at 3 months. Data represent the mean; *p<0.05 by Mann-Whitney U test.Disclosure of Interests:None declared
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De Saint Riquier M, Ballerie A, Robin F, Belhomme N, Cazalets C, Droitcourt C, Perdriger A, Yelnik CM, Hachulla E, Sobanski V, Jégo P, Coiffier G, Lescoat A. THU0352 DIAGNOSTIC PERFORMANCES OF HAND ULTRASOUND PARAMETERS AND THEIR IMPACT ON THE 2013 ACR/EULAR CLASSIFICATION CRITERIA FOR SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Recent studies have highlighted that ultrasound (US) examination could offer a better assessment of hand manifestations of systemic sclerosis (SSc). Indeed, US allows a simultaneous evaluation of vascular, fibrotic and inflammatory hand features of the disease. Power Doppler US can especially explore macrovascular involvement characterized by an obliteration of digital arteries or ulnar arteries. Ulnar artery occlusion (UAO) is especially frequent in SSc patients and could be a relevant marker of the severity of SSc-associated vasculopathy. Among other hand manifestations of SSc, US evaluation can notably explore tenosynovial involvement such as fibrotic tenosynovitis (TS), which is considered to be SSc-specific.Objectives:This study aims to assess the diagnostic performances of these hand US parameters for the diagnosis of SSc.Methods:244 patients with suspected SSc were consecutively included. They all had US evaluation assessing the presence of fibrotic TS and UAO. The final diagnosis of SSc was based on the evaluation of an expert, independently from US results and from any pre-established classification criteria.Results:166 patients were finally diagnosed as SSc. 62 SSc and 8 non-SSc patients had UAO (uni or bilateral) (p=0.001). 23 SSc patients and 1 non-SSc patient had US fibrotic TS (p=0.007). A US SSc-pattern (presence of UAO and/or fibrotic TS) was reported in 73 SSc patients and 9 non-SSc patients (p<0.001). UAO had an area under ROC curve (AUC) for the diagnosis of SSc of 0.618 (95%CI 0.539-0.697); with Se= 0.373 (0.304-0.449) and spe=0.862 (0.751-0.928). The presence of a US fibrotic TS had an AUC of 0.561 (0.480-0.643); with Se= 0.139 (0.094-0.199) and spe=0.983 (0.909-0.997). The US-SSc pattern had a AUC of 0.641 (0.563-0.695), with Se=0.440 (0.367-0.516) and spe=0.845 (0.731-0.916). When used as a diagnostic tool, the original 2013 classification criteria had an AUC of 0.982 (0.969-0.996) with Se= 0.946 (0.900-0.971) and spe=0.931 (0.836-0.973). Including UAO and fibrotic TS in this classification had few impact (AUC of 0.979 (0.962-0.996) with Se= 0.940 (0.893-0.967) and and spe=0.931 (0.836-0.973)) but allows the substitution of some items (such as capillaroscopy) by US parameters with similar performances for diagnosis.Conclusion:The use of hand US parameters may help to refine the diagnostic strategy of SSc and their inclusion in addition with the items of the ACR/EULAR classification could be discussed.Disclosure of Interests:Marine de Saint Riquier: None declared, Alice Ballerie: None declared, François ROBIN: None declared, Nicolas Belhomme: None declared, Claire Cazalets: None declared, Catherine Droitcourt: None declared, Aleth Perdriger: None declared, Cécile Marie Yelnik: None declared, Eric Hachulla Speakers bureau: speaking fees from Actelion Pharmaceuticals,GlaxoSmithKline, and Bayer outside of the current study, Vincent Sobanski: None declared, Patrick Jégo: None declared, Guillaume Coiffier: None declared, Alain LESCOAT: None declared
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de Saint Riquier M, Ballerie A, Robin F, Belhomme N, Cazalets C, Droitcourt C, Perdriger A, Yelnik CM, Hachulla E, Sobanski V, Jégo P, Coiffier G, Lescoat A. Hand ultrasound for the diagnosis of scleroderma: a scoring strategy including US items and items from the EULAR/ACR classification. Clin Exp Rheumatol 2020; 38 Suppl 125:140-147. [PMID: 32865172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of hand ultrasound (US) in systemic sclerosis (SSc) and to explore its relevance within a combined diagnostic approach. METHODS 224 patients with suspected SSc were consecutively included. They all had US evaluation assessing the presence of fibrotic tenosynovitis (fibrotic TS) and ulnar artery occlusion (UAO). The final diagnosis of SSc was based on the clinical evaluation of a board of experts independently of any pre-established classification criteria. RESULTS 166 patients were finally diagnosed as SSc according to the experts as reference standard. 62 SSc and 8 non-SSc patients had UAO (uni or bilateral) (p=0.001). 23 SSc patients and 1 non-SSc patient had US fibrotic TS (p=0.007). A US SSc-pattern (presence of UAO and/or fibrotic TS) was reported in 73 SSc patients and 9 non-SSc patients (p<0.001). UAO had an area under ROC curve (AUC) for the diagnosis of SSc of 0.618 (95%CI 0.539- 0.697); with Se=0.373 (0.304-0.449) and Sp=0.862 (0.751-0.928). Fibrotic TS had an AUC of 0.561 (0.480-0.643); with Se=0.139 (0.094-0.199) and Sp=0.983 (0.909-0.997). The US-SSc pattern had a AUC of 0.641 (0.563- 0.695), with Se=0.440 (0.367-0.516) and Sp=0.845 (0.731-0.916). A scoring system including these US parameters and items from ACR/EULAR classification criteria had an AUC of 0.979 (0.962-0.996)) and allows the substitution of capillaroscopy by US parameters with similar performances. CONCLUSIONS The use of hand US parameters may help to refine the diagnostic strategy of SSc and their inclusion in a combined diagnostic approach could be discussed.
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Affiliation(s)
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Catherine Droitcourt
- Université de Rennes; CHU Rennes, Department of Dermatology; INSERM, CIC 1414, Rennes; REPERES Pharmacoepidemiology and access to Health Care, University Rennes 1 and French School of Public Health, UPRES EA 7449, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, Université de Rennes, France
| | - Cécile Marie Yelnik
- Université de Lille, U995, Lille Inflammation Research International Centre; and CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Vincent Sobanski
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
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Lescoat A, Cavalin C, Ballerie A, Lecureur V, Sesé L, Cazalets C, Lederlin M, Coiffier G, Belhomme N, Paris C, Garlantézec R, Jouneau S, Jégo P. Silica Exposure and Scleroderma: More Bridges and Collaboration between Disciplines Are Needed. Am J Respir Crit Care Med 2020; 201:880-882. [PMID: 31881815 PMCID: PMC7124714 DOI: 10.1164/rccm.201911-2218le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alain Lescoat
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Catherine Cavalin
- Université Paris-DauphineParis, France
- Laboratoire interdisciplinaire d’évaluation des politiques publiques de Sciences PoParis, France
- Centre d’études de l’emploi et du travailNoisy-le-Grand, France
| | - Alice Ballerie
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Valérie Lecureur
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
| | - Lucile Sesé
- Epidemiology of Allergic and Respiratory Diseases, IPLESP, Inserm and Sorbonne UniversitéParis, France
- AP-HP, Hôpital AvicenneBobigny, France
| | | | | | - Guillaume Coiffier
- CHU Rennes, University of RennesRennes, France
- Inserm U 1241, University of RennesRennes, France
| | | | - Christophe Paris
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- Consultations de pathologies professionnelles et environnementales, CHU RennesRennes, Franceand
| | - Ronan Garlantézec
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Stéphane Jouneau
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- Rennes University HospitalRennes, France
| | - Patrick Jégo
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
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Berthoud O, Coiffier G, Albert JD, Gougeon-Jolivet A, Goussault C, Bendavid C, Guggenbuhl P. Performance of a new rapid diagnostic test the lactate/glucose ratio of synovial fluid for the diagnosis of septic arthritis. Joint Bone Spine 2020; 87:343-350. [PMID: 32234547 DOI: 10.1016/j.jbspin.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/18/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the diagnostic performance of the synovial lactate, glucose and lactate/glucose ratio assay for the diagnosis of septic arthritis. METHODS In this monocentric cross-sectional study, synovial fluids were prospectively obtained from patients with acute joint effusion (<30 days) on native joint. Septic arthritis was defined using Newman's criteria. To evaluate diagnostic performance, Receiver Operating Characteristic (ROC) curves with Area under the curve (AUC), Sensitivities (Se), Specificities (Sp), LR+ their 95% confidence intervals were calculated. Synovial fluid cultures with gram staining, crystal analyses, synovial fluid white blood cell counts (WBC), lactate and glucose assays were performed. RESULTS A total of 233 synovial fluids were included. 25 patients had septic arthritis and 208 had non-septic arthritis (104 crystal-induced arthritis, 15 RA, 8 SpA, 6 reactive arthritis, and 75 acute arthritis of undifferentiated origin). Synovial lactate/glucose ratio performed higher than the synovial lactate or glucose assay separately (AUC: 0.859 [0.772-0.945]). Best synovial lactate/glucose ratio threshold to differentiate septic arthritis from non-septic arthritis was 5 Se 52% [0.34-0.7], Sp 98.1% [0.95-0.99], LR+ 27.0[9.50-76.00]). CONCLUSION The diagnostic performance of synovial lactate/glucose allows septic arthritis to be effectively and very quickly distinguished from other types of arthritis.
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Affiliation(s)
- Olivia Berthoud
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; UMR Inserm U 1241, University of Rennes, Rennes, France
| | - Anne Gougeon-Jolivet
- UMR Inserm U 1241, University of Rennes, Rennes, France; Bacteriology Laboratory, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claire Goussault
- Department of Rheumatology, Rennes University Hospital - Pontchaillou, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Claude Bendavid
- Department of Biochemistry, Rennes University Hospital - Pontchaillou, 2, rue Henri-LeGuilloux, 35000 Rennes, France; Inserm unité mixte de recherche 991, 35043 Rennes, France
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Robin F, Coiffier G, Albert JD, Darrieutort-Laffite C, Rio S, Le Goff B, Guggenbuhl P. Is ultrasound-guided caudal steroid injection effective in the management of lower lumbar radicular pain? A two-center prospective observational study on 150 patients. Joint Bone Spine 2019; 87:364-365. [PMID: 31811932 DOI: 10.1016/j.jbspin.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
- François Robin
- Department of rheumatology, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France; Inserm NuMeCan UMR 1274, CIMIAD, university of Rennes, 35000 Rennes, France.
| | - Guillaume Coiffier
- Department of rheumatology, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France; Inserm NuMeCan UMR 1274, CIMIAD, university of Rennes, 35000 Rennes, France
| | - Jean-David Albert
- Department of rheumatology, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France; Inserm NuMeCan UMR 1274, CIMIAD, university of Rennes, 35000 Rennes, France
| | | | - Simon Rio
- Department of rheumatology, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France
| | - Benoit Le Goff
- Department of rheumatology, CHU Nantes, 44000 Nantes, France
| | - Pascal Guggenbuhl
- Department of rheumatology, CHU de Rennes, 16, boulevard de Bulgarie, 35200 Rennes, France; Inserm NuMeCan UMR 1274, CIMIAD, university of Rennes, 35000 Rennes, France
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Lescoat A, Cavalin C, Ehrlich R, Cazalets C, Ballerie A, Belhomme N, Coiffier G, de Saint Riquier M, Rosental PA, Hachulla E, Sobanski V, Jégo P. The nosology of systemic sclerosis: how lessons from the past offer new challenges in reframing an idiopathic rheumatological disorder. Lancet Rheumatol 2019; 1:e257-e264. [PMID: 38229382 DOI: 10.1016/s2665-9913(19)30038-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/24/2022]
Abstract
Systemic sclerosis is a rare connective tissue disease characterised by a wide range of clinical manifestations. Compared with previous sets of criteria, the 2013 American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) classification of systemic sclerosis encompasses a broader and more relevant spectrum of the condition. Nonetheless, clinical and prognostic heterogeneity persists among patients fulfilling these criteria. The next task in the classification of systemic sclerosis is the development of new subset criteria that can successfully identify subgroups of patients with distinct prognostic or pathophysiological features. In this Viewpoint we describe the history of systemic sclerosis over the past century with the objective of highlighting the effect of previous nosological debates on efforts to understand and manage this disorder. Rather than seeking to present a systematic review of possible subgrouping for systemic sclerosis in relation to prognosis, we aim to clarify how nosological considerations have influenced our understanding of the cause and prognosis of this so-called idiopathic rheumatological disorder and how aetiological, prognostic, and pathophysiological hypotheses have helped to describe clusters within the disease. By reflecting on past nosological debates and endeavours, we identify challenges for the current initiative to develop a new subgrouping of systemic sclerosis.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France.
| | - Catherine Cavalin
- Interdisciplinary Research Institute for the Social Sciences, Université Paris-Dauphine, Université Paris Sciences et Lettres, Paris, France; Centre for European Studies and Comparative Politics, Sciences Po, Paris, France; Laboratory for Interdisciplinary Evaluation of Public Policies, Sciences Po, Paris, France; The Employment and Labour Research Centre, Noisy-le-Grand, France
| | - Rodney Ehrlich
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital, University of Rennes 1, Rennes, France; French National Institute of Health and Medical Research Unit 1241, University of Rennes 1, Rennes, France
| | - Marine de Saint Riquier
- Department of Rheumatology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | | | - Eric Hachulla
- Lille Inflammation Research International Center, University of Lille, Lille, France; French National Institute of Health and Medical Research, University of Lille, Lille, France; Département de Médecine Interne et Immunologie Clinique, Lille University Hospital, Lille, France; Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Vincent Sobanski
- Lille Inflammation Research International Center, University of Lille, Lille, France; French National Institute of Health and Medical Research, University of Lille, Lille, France; Département de Médecine Interne et Immunologie Clinique, Lille University Hospital, Lille, France; Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France
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Lescoat A, Ballerie A, Robin F, De Saint Riquier M, Belhomme N, Perdriger A, Jego P, Coiffier G, Cazalets C. Classification des flux pulpaires et caractérisation des index de résistance de l’artère radiale en échographie-doppler au cours de la sclérodermie systémique. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lescoat A, Leroy M, Coiffier G, Cazalets C, Belhomme N, Ballerie A, Robin F, Guggenbuhl P, Jego P. Densité minérale osseuse et Trabecular Bone Score (TBS) au cours de la sclérodermie systémique : résultats d’une étude transversale. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coiffier G, Martel A, Albert JD, Lescoat A, Bleuzen A, Perdriger A, De Bandt M, Maillot F. Ultrasonographic damages of major salivary glands are associated with cryoglobulinemic vasculitis and lymphoma in primary Sjogren's syndrome: are the ultrasonographic features of the salivary glands new prognostic markers in Sjogren's syndrome? Ann Rheum Dis 2019; 80:e111. [PMID: 31420324 DOI: 10.1136/annrheumdis-2019-216122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 12/17/2022]
Affiliation(s)
| | | | | | - Alain Lescoat
- Internal Medicine, CHU South Hospital, Rennes, France
| | | | | | - Michel De Bandt
- Rheumatology Department, University Hospital Martinique, Fort de France, France
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Coiffier G, Jousse-Joulin S, Cornec D, Garlantézec R, Bleuzen A, Diot E, Jego P, Ballerie A, Lescoat A. Ultrasonographic salivary gland evaluation in systemic sclerosis: is sicca syndrome secondary to an authentic overlap syndrome or another specific fibrotic manifestation of the disease? Ann Rheum Dis 2019; 79:e160. [DOI: 10.1136/annrheumdis-2019-215972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/05/2019] [Indexed: 12/19/2022]
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Coiffier G, Couderc M, Seror R, Bart G, Darrieutort-Laffite C, Le Goff B. Is it currently reasonable to offer short, 14-day antibiotic therapies after a surgical synovectomy in native joint septic arthritis? Ann Rheum Dis 2019; 79:e146. [PMID: 31278135 DOI: 10.1136/annrheumdis-2019-215887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Guillaume Coiffier
- Rhumatologie, CHU de Rennes, Rennes, France .,Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France
| | - Marion Couderc
- Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France.,Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Raphaele Seror
- Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France.,Rheumatology, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - Geraldine Bart
- Rhumatologie, CHU de Rennes, Rennes, France.,Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France
| | - Christelle Darrieutort-Laffite
- Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France.,Rheumatology, CHU Nantes, Nantes, France.,INSERM UMR1238, Nantes, France
| | - Benoit Le Goff
- Osteoarticular Infections Working Group of the French Society of Rheumatology, Paris, France.,Rheumatology, CHU Nantes, Nantes, France
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Lescoat A, Ballerie A, Belhomme N, Cazalets C, de Carlan M, Droitcourt C, Perdriger A, Jégo P, Coiffier G. Synovial involvement assessed by power Doppler ultra-sonography in systemic sclerosis: results of a cross-sectional study. Rheumatology (Oxford) 2019; 57:2012-2021. [PMID: 30053245 DOI: 10.1093/rheumatology/key214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To characterize hand synovial manifestations assessed by power Doppler ultrasonography (PDUS) in a cohort of unselected patients fulfilling the 2013 ACR/EULAR classification criteria for SSc and to evaluate the associations of these synovial manifestations with the main general clinical and biological features of SSc. Methods One hundred and three SSc patients were consecutively included and underwent PDUS evaluation of both hands assessing synovial and tenosynovial manifestations according to the OMERACT definitions. Clinical, biological and immunological SSc characteristics were recorded at the same time. Results Thirty-three patients (32%) had ultrasonographic synovial/tenosynovial involvement. The two main PDUS features were Doppler-positive/inflammatory synovitis (n = 18, 17.5%) and sclerosing tenosynovitis (TS) (n = 19, 18.4%). Inflammatory synovitis was more frequent in the wrist and MCP joints. Sclerosing TS was more frequent in men [odds ratio (OR) = 6.32, 95% CI: 2.17, 18.41; P = 0.001] and was associated with anti-RNA polymerase III antibodies (OR = 10.93, 95% CI: 1.84, 65.12; P = 0.01), diffuse SSc (OR = 18.24, 95% CI: 4.80, 69.32; P < 0.0001), interstitial lung disease (OR = 6.09, 95% CI: 1.86, 19.98; P = 0.001) and inflammatory arthralgia (OR = 14.64, 95% CI: 2.58, 83.10; P = 0.002). Inflammatory TS or synovitis were associated with CRP levels >5 mg/l (OR = 5.50, 95% CI: 1.81, 16.70; P = 0.001), pericarditis (OR = 7.81, 95% CI: 1.58, 38.71; P = 0.017) and inflammatory arthralgia (OR = 15.96, 95% CI: 2.80, 91.02; P = 0.002). Inflammatory synovitis and sclerosing TS were not significantly associated within an individual patient (OR = 2.77, 95% CI: 0.88, 8.70; P > 0.05). Conclusions Ultrasonographic synovial involvement is frequent in patients fulfilling the 2013 ACR/EULAR classification criteria and PDUS may have a part to play in a more accurate and precise description of musculoskeletal manifestations of the disease, especially as the question of a treat-to-target approach is arising for SSc.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Marine de Carlan
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Centre Hospitalier Universitaire de Rennes, Inserm, CIC, Rennes, France.,REPERES Pharmacoepidemiology and Access to Health Care, University of Rennes 1, Rennes, France.,French School of Public Health, UPRES EA, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
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Lescoat A, Yelnik CM, Coiffier G, Wargny M, Lamotte C, Cazalets C, Belhomme N, Ballerie A, Hatron P, Launay D, Perdriger A, Sobanski V, Hachulla E, Jégo P. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross‐Sectional Study. Arthritis Rheumatol 2019; 71:983-990. [DOI: 10.1002/art.40799] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alain Lescoat
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
| | - Cécile Marie Yelnik
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | - Christophe Lamotte
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | | | - Pierre‐Yves Hatron
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - David Launay
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | - Vincent Sobanski
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Eric Hachulla
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Patrick Jégo
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
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Darrieutort-Laffite C, Varin S, Coiffier G, Albert JD, Planche L, Maugars Y, Cormier G, Le Goff B. Are corticosteroid injections needed after needling and lavage of calcific tendinitis? Randomised, double-blind, non-inferiority trial. Ann Rheum Dis 2019; 78:837-843. [PMID: 30975645 DOI: 10.1136/annrheumdis-2018-214971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Steroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL. METHODS This was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0-100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up. RESULTS The estimated mean difference in the first week's maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups. CONCLUSION Non-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption. TRIAL REGISTRATION NUMBER NTC02403856.
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Affiliation(s)
| | - Stephane Varin
- Department of Rheumatology, CHD Vendée, La Roche sur Yon, France
| | | | | | - Lucie Planche
- Biometrics and Statistic Platform, CHU Nantes, Nantes, France
| | - Yves Maugars
- Department of Rheumatology, CHU Nantes, Nantes, France
| | - Grégoire Cormier
- Department of Rheumatology, CHD Vendée, La Roche sur Yon, France
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Cadiou S, Al Tabaa O, Nguyen CD, Faccin M, Guillin R, Revest M, Guggenbuhl P, Houvenagel E, Pertuiset E, Coiffier G. Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases. Clin Rheumatol 2019; 38:1773-1783. [PMID: 30868320 DOI: 10.1007/s10067-019-04500-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
Mycobacterium bovis Bacillus Calmette-Guérin (BCG) instillations are used in bladder cancer treatment. Adverse effects can occur. Osteoarticular complications are mainly reactive arthritis, but true infections have been described, such as vertebral osteomyelitis. We made a review of M. bovis BCG vertebral osteomyelitis after instillations for bladder cancer using PubMed search. We added three new French cases. Twenty-seven cases of BCG vertebral osteomyelitis had been reported on PubMed. Of the 30 cases, all were male, averaging 73.4 ± 8.7 years old. Median time between diagnosis and first and last instillation was 22.5 and 14 months respectively. Half of vertebral osteomyelitis was thoracic and lumbar in the other half. Sensitivo-motor deficit was present at diagnosis in 42% of cases. Other infectious locations were common, mainly infectious abdominal aortic aneurysms (20%). Rifampicin, ethambutol and isoniazid were the usual therapy. Poor outcomes were reported with 50% of one or more spine surgery. M. bovis BCG vertebral osteomyelitis following bladder instillation for bladder cancer is a rare complication. However, the late onset of back pain after instillations differentiates them from reactive arthritis. Concomitant septic location such as infectious abdominal aortic aneurysms must be known.
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Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 16 Boulevard de Bulgarie, 35200, Rennes, France.
| | - Omar Al Tabaa
- Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France
| | - Chi-Duc Nguyen
- Department of Rheumatology, Hôpital St Philibert GHICL, 249 Rue du grand but, 59462, Lomme, France
| | - Marine Faccin
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France
| | - Raphaël Guillin
- Department of Medical Imaging, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, CHU Univ Rennes, Inserm U 1230, F-35000, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France.,CHU Rennes, Univ Rennes, INSERM, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000, Rennes, France.,UMR INSERM U 1241, University of Rennes 1, 35000, Rennes, France
| | - Eric Houvenagel
- Department of Rheumatology, Hôpital St Philibert GHICL, 249 Rue du grand but, 59462, Lomme, France
| | - Edouard Pertuiset
- Department of Rheumatology, Centre Hospitalier René Dubos, 95301, Pontoise, France
| | - Guillaume Coiffier
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, 35000, Rennes, France.,UMR INSERM U 1241, University of Rennes 1, 35000, Rennes, France
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Coiffier G, David C, Gauthier P, Le Bars H, Guggenbuhl P, Jolivet-Gougeon A, Albert JD. Broad-range 16 s rDNA PCR in synovial fluid does not improve the diagnostic performance of septic arthritis in native joints in adults: cross-sectional single-center study in 95 patients. Clin Rheumatol 2019; 38:1985-1992. [PMID: 30850963 DOI: 10.1007/s10067-019-04492-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/12/2019] [Accepted: 02/24/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of bacterial identification by broad-range polymerase chain reaction (PCR) of ribosomal DNA (rDNA) 16 s (16S rDNA PCR) for the diagnosis of septic arthritis on native joints. METHODS Patients with acute mono or oligoarthritis who underwent synovial fluid puncture and prospective follow-up allowing definitive diagnosis (septic arthritis, crystal related disease, chronic inflammatory arthritis, undifferentiated arthritis) were recruited in this single-center study. Systematic analysis of synovial fluid included leukocytes count, search for urate and pyrophosphate crystals with polarized light microscopy, direct bacteriological examination (gram staining), bacteriological culture, and 16S rDNA PCR. RESULTS Ninety-five patients were included, 34 of which (35.8%) had septic arthritis. Nineteen (20.0%) patients had received probabilistic antibiotic therapy prior to joint puncture. Gram + cocci infection accounted for 79.4% of septic arthritis, of which nearly half (47.1%) was caused by Staphylococcus aureus. Eight (23.5%) septic arthritis patients had a 16S rDNA PCR positive in the synovial fluid with an AUC of 0.618 (95% CI, 0.493-0.742), a sensitivity of 0.24 (95% CI, 0.12-0.40), and a specificity of 1.00 (95% CI 0.94-1.00). The diagnostic performance of 16S rDNA PCR was lower than that of direct examination (AUC at 0.691, CI 95%, 0.570-0.812), blood cultures (AUC at 0.727, CI 95%, 0.610-0.844), and culture (0.925, CI 95%, 0.856-0.994) for the diagnosis of septic arthritis. There was no difference in the positivity of 16S rDNA PCR according to previous exposure to antibiotics. CONCLUSIONS 16 s rDNA PCR in the synovial fluid does not improve the diagnostic performance of septic arthritis on native adult joints, particularly for Gram-positive cocci infections.
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Affiliation(s)
- G Coiffier
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France.,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France
| | - C David
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France
| | - P Gauthier
- EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - H Le Bars
- EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - P Guggenbuhl
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France.,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France
| | - A Jolivet-Gougeon
- Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France.,EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - J D Albert
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France. .,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France.
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Coiffier G, Ferreyra M, Albert JD, Stock N, Jolivet-Gougeon A, Perdriger A, Guggenbuhl P. Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department. Clin Rheumatol 2018; 37:2241-2249. [DOI: 10.1007/s10067-018-4160-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/20/2018] [Accepted: 05/24/2018] [Indexed: 12/25/2022]
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Coiffier G, Albert JD, Robin F, Guggenbuhl P. Reply to the comment of Rothschild B. “Maltese cross interpretation”. Joint Bone Spine 2018. [DOI: 10.1016/j.jbspin.2018.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lescoat A, Coiffier G, de Carlan M, Droitcourt C, Ballerie A, Cazalets C, Perdriger A, Jégo P. Combination of Capillaroscopic and Ultrasonographic Evaluations in Systemic Sclerosis: Results of a Cross-Sectional Study. Arthritis Care Res (Hoboken) 2018; 70:938-943. [PMID: 28898558 DOI: 10.1002/acr.23413] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/05/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare microvascular damages on nailfold capillaroscopy (NFC) with macrovascular manifestations evaluated by hand power Doppler ultrasonography (PDUS) in systemic sclerosis (SSc) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers, acroosteolysis, and calcinosis. METHODS NFC, hand radiographs, and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were performed blinded for the results of radiographs and NFC. RESULTS UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NFC (odds ratio [OR] 4.04 [95% confidence interval (95% CI) 1.23-13.29]; P < 0.05, and OR 3.38 [95% CI 1.03-11.05]; P < 0.05, respectively). Digital ulcer history was associated with UAO (OR 10.71 [95% CI 3.36-34.13]; P < 0.0001), pathologic FPBF (OR 7.67 [95% CI 2.52-23.28]; P < 0.0001), late NFC pattern (OR 6.33 [95% CI 2.03-19.68]; P = 0.001), and severe capillary loss (OR 8.52 [95% CI 2.15-33.78]; P = 0.001). Acroosteolysis was also associated with UAO (OR 15.83 [95% CI 3.95-63.54]; P < 0.0001), pathologic FPBF (OR 5.52 [95% CI 1.71-17.90]; P = 0.003), late NFC pattern (OR 6.86 [95% CI 2.18-21.53]; P = 0.001), and severe capillary loss (OR 7.20 [95% CI 2.16-24.02]; P = 0.001). Calcinosis on radiographs was associated with late NFC pattern (OR 5.41 [95% CI 1.82-16.12]; P = 0.002), severe capillary loss (OR 12.69 [95% CI 3.14-51.26]; P < 0.0001), and UAO (OR 3.19 [95% CI 1.14-8.92]; P = 0.025). Combination of UAO and severe capillary loss in the same patient was especially associated with digital ulcer history (OR 18.60 [95% CI 2.24-154.34]; P = 0.001) and acroosteolysis (OR 10.83 [95% CI 2.56-45.88]; P = 0.001). CONCLUSION Microvascular damages evaluated by NFC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease.
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Affiliation(s)
- Alain Lescoat
- CHU Rennes, University of Rennes, and UMR INSERM U1085, Research Institute in Health, Environment, and Occupation, Rennes, France
| | | | | | | | | | | | - Aleth Perdriger
- CHU Rennes, University of Rennes, and UMR INSERM U991, Rennes, France
| | - Patrick Jégo
- CHU Rennes, University of Rennes, and UMR INSERM U1085, Research Institute in Health, Environment, and Occupation, Rennes, France
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Coirier V, Lescoat A, Chabanne C, Fournet M, Coiffier G, Jouneau S, Polard E, Jégo P. Pulmonary arterial hypertension in four patients treated by leflunomide. Joint Bone Spine 2018; 85:761-763. [PMID: 29329993 DOI: 10.1016/j.jbspin.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare disorder that can be drug-induced, mostly following treatment by appetite-suppressant drugs. We report four cases of patients who developed PAH following a treatment by leflunomide for rheumatoid arthritis, psoriatic arthritis or undetermined connective tissue disease. All patients described a progressive dyspnea from grade II to IV of NYHA classification; clinical examination found signs of heart failure. PAH was finally diagnosed and confirmed by right heart catheterisation. Haemodynamic explorations found pre-capillary pulmonary hypertension with mean pulmonary arterial pressure above 25mmHg, and pulmonary capillary wedge pressure under 15mmHg. Explorations of this pre-capillary pulmonary hypertension were conducted according to international guidelines: pulmonary or chronic thromboembolic aetiologies were excluded after ventilation/perfusion lung scan and high-resolution computed tomography. All other etiologic explorations were negative. Imputability of leflunomide was finally retained. Leflunomide was stopped for all patients; three of them received specific PAH treatments. A favourable clinical and/or haemodynamic evolution was observed for all patients. The conclusions of the investigations conducted by our pharmacovigilance centre were communicated to the European Medicines Agency, leading to the addition of "pulmonary hypertension" in the paragraph "special warning and precautions of use" of the package leaflet of leflunomide.
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Affiliation(s)
- Valentin Coirier
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France.
| | - Alain Lescoat
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
| | - Céline Chabanne
- Department of Cardiology, Rennes University Hospital, 35203 Rennes, France
| | - Maxime Fournet
- Department of Cardiology, Rennes University Hospital, 35203 Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital, 35203 Rennes, France
| | - Stéphane Jouneau
- Department of Pneumology, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
| | - Elisabeth Polard
- Department of Pharmacovigilance, Rennes University Hospital, 35203 Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
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Lescoat A, Ballerie A, Belhomme N, Droitcourt C, Le Noir De Carlan M, Cazalets C, Perdriger A, Jego P, Coiffier G. Atteintes musculosquelettiques de la main en échographie-doppler dans la sclérodermie systémique : résultats sur 102 patients et associations avec les caractéristiques de la maladie. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Flais J, Coiffier G, Brillet E, Perdriger A, Guggenbuhl P. Atypical presentation of spine bone metastasis in prostate cancer mimicking Pott's disease. ACTA ACUST UNITED AC 2017; 14:239-240. [PMID: 29263741 DOI: 10.11138/ccmbm/2017.14.1.239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 55-year-old man was hospitalized for a low back pain lasting for 3 months. Spinal MRI revealed a suggestive aspect of multilevel discitis L5-S1-S2 with paravertebral abscess. A thoraco-abdominal CT scan confirmed the presence of multiple pathological lymph nodes in several locations, bilateral micronodular pulmonary infiltrate; it also showed mirror bone erosions of vertebral L5 and S1 endplates, suggestive of disseminated tuberculosis with lung involvement and lymphadenopathy. A discovertebral L5-S1 biopsy was performed confirming the diagnosis of metastatic prostatic adenocarcinoma including a tumor infiltration of the intervertebral disc, without arguments for a septic processus superimposed without tuberculosis granuloma. Although rare, cases of metastases located at the disco-vertebral junction including prostatic cancer have already been described, and should be known to the clinician. The differential diagnosis with an infectious spondylodiscitis can be difficult in some case around the vertebral disc and in case of epiduritis and soft tissues involvement on MRI sequences. Disco-vertebral biopsy remains the cornerstone of the diagnosis.
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Affiliation(s)
- Jérémy Flais
- CHU Rennes, Service de Rhumatologie, Rennes, France.,Universite Rennes 1, Faculte de Medecine, Rennes, France
| | - Guillaume Coiffier
- CHU Rennes, Service de Rhumatologie, Rennes, France.,Universite Rennes 1, Faculte de Medecine, Rennes, France
| | - Eric Brillet
- CHU Rennes, Service d'Imagerie Medicale, Unite Musculo-Squelettique, Rennes, France
| | - Aleth Perdriger
- CHU Rennes, Service de Rhumatologie, Rennes, France.,Universite Rennes 1, Faculte de Medecine, Rennes, France
| | - Pascal Guggenbuhl
- CHU Rennes, Service de Rhumatologie, Rennes, France.,INSERM UMR 991, Rennes, France.,Universite Rennes 1, Faculte de Medecine, Rennes, France
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Coirier V, Lescoat A, Fournet M, Cazalets C, Coiffier G, Jouneau S, Chabanne C, Jégo P. [Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre]. Rev Med Interne 2017; 38:502-507. [PMID: 28545856 DOI: 10.1016/j.revmed.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. METHODS This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. RESULTS In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCO<60% and disease duration of more than 3 years, RHC was suggested for 31 patients whereas only 13 were indicated by the multidisciplinary group; among those patients only 7 had PAH. CONCLUSION The DETECT algorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed.
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Affiliation(s)
- V Coirier
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - A Lescoat
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - M Fournet
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - C Cazalets
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - G Coiffier
- Service de rhumatologie, CHU de Rennes, 35203 Rennes, France
| | - S Jouneau
- Service de pneumologie, CHU de Rennes, 35203 Rennes, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - C Chabanne
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - P Jégo
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
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Goussault C, Albert JD, Coiffier G, Lamer F, Guillin R, Le Goff B, Bouvard B, Dernis E, Ferreyra M, Cormier G, Guggenbuhl P, Perdriger A. Ultrasound characterization of ankle involvement in Löfgren syndrome. Joint Bone Spine 2017; 85:65-69. [PMID: 28343011 DOI: 10.1016/j.jbspin.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bilateral ankle arthritis is a classic diagnostic criterion for Löfgren syndrome. The objective of this study was to use ultrasonography to characterize the articular and periarticular involvement of the ankles in patients with Löfgren syndrome. METHODS Multicenter descriptive cohort study of patients with Löfgren syndrome who underwent ultrasonography of the ankles. We collected clinical data, imaging study findings, blood test results, and joint fluid properties in patients who underwent joint aspiration. RESULTS Findings from ultrasonography of the ankles in 40 patients were analyzed. The most common B-mode abnormality was subcutaneous edema (26/40), followed by tenosynovitis (22/40), with no differences in frequency across compartments. Joint involvement manifested as synovitis in 7 patients and effusion in 10 patients. Synovitis with increased vascularity by power Doppler was found in 3 patients. No statistically significant associations were found linking synovitis or tenosynovitis to clinical features (age and gender), laboratory tests, or imaging study findings. CONCLUSION Contrary to the classical view, our results indicate that ankle involvement in Löfgren syndrome is more often abarticular than articular. The inclusion of bilateral ankle arthritis among the diagnostic criteria for Löfgren syndrome deserves reappraisal.
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Affiliation(s)
- Claire Goussault
- Service de rhumatologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France.
| | - Jean-David Albert
- Service de rhumatologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - Guillaume Coiffier
- Service de rhumatologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - François Lamer
- Cabinet de rhumatologie, 21, boulevard Franklin-Roosevelt, 35000 Rennes, France
| | - Raphaël Guillin
- Service de radiologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - Benoit Le Goff
- Service de rhumatologie, Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 01, France
| | - Béatrice Bouvard
- Service de rhumatologie, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - Emmanuelle Dernis
- Service de rhumatologie, centre hospitalier du Mans, 194, avenue Rubillard, 72000 Le Mans, France
| | - Marine Ferreyra
- Service de rhumatologie, CH de Vannes, 20, boulevard Général-Maurice-Guillaudot, 56000 Vannes, France
| | - Grégoire Cormier
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85925 La-Roche-sur-Yon cedex 9, France
| | - Pascal Guggenbuhl
- Service de rhumatologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
| | - Aleth Perdriger
- Service de rhumatologie, CHU de Rennes, hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 2, France
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Lescoat A, Coiffier G, Rouil A, Droitcourt C, Cazalets C, de Carlan M, Perdriger A, Jégo P. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken) 2017; 69:543-551. [PMID: 27390194 DOI: 10.1002/acr.22965] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the relevance of power Doppler ultrasonography (PDUS) as a predictive tool of 1-year digital ulcer (DU) occurrence in systemic sclerosis (SSc). METHODS A total of 55 SSc patients and 19 controls underwent PDUS of both hands to evaluate the prevalence of ulnar artery occlusion (UAO) at baseline. Finger pulp blood flow (FPBF) of the third and fourth fingers was also assessed and considered as pathologic if a defect of the Doppler signal on a finger pulp was observed. All patients were clinically re-evaluated 6 and 12 months later and new ischemic DU occurrences in the meantime were retrospectively recorded. Patients were also asked to call if new DUs occurred between consultations. RESULTS PDUS parameters were normal in all controls. The prevalence of UAO was 36.4% and was bilateral in 70% of the SSc cases. A total of 56.4% of SSc patients had a pathologic FPBF. UAO and pathologic FPBF were associated with a history of multiple DU episodes (odds ratio [OR] 8.98 [95% confidence interval (95% CI) 2.52-32.01], P < 0.001, and OR 4.69 [95% CI 1.30-16.93], P = 0.014, respectively) and the occurrence of new DUs during the followup in the univariable model (OR 8.73 [95% CI 2.00-38.16], P = 0.005, and OR 12.65 [95% CI 1.50-106.77], P = 0.005, respectively). The association of UAO and pathologic FPBF in the same patient was a predictive factor of new DUs in the multivariable analysis (P = 0.015). CONCLUSION This study suggests that UAO and pathologic FPBF are associated with a history of multiple DUs and are predictors of new ischemic DUs. These parameters could be used as prognostic factors and considered in further studies evaluating DU treatment strategies.
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Affiliation(s)
| | | | - Alban Rouil
- CHU Rennes, University of Rennes, Rennes, France
| | | | | | | | | | - Patrick Jégo
- CHU Rennes, University of Rennes, Rennes, France
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