Intérêt de l'échopgraphie de l'ongle et correlation avec les différents paramètres cliniques dans le rhumatisme psoriasique

L enthèse constitue la lésion élémentaire du rhumatisme psoriasique et son atteinte joue probablement un rôle important dans l onychopathie psoriasique. L objectif de cette étude était d examiner, chez les patients présentant un rhumatisme psoriasique (RP), les caractéristiques échographiques des ongles, et leurs relations avec les autres symptômes de la maladie, afin de définir les paramètres d intérêt. Etaient inclus les patients présentant un rhumatisme psoriasique. L échographie portait sur 8 paramètres évaluant l interphalangienne distale (IPD), la matrice, le lit et la tablette de l ongle, en mode B et doppler. Ces données étaient ensuite corrélées aux différents aspects cliniques du rhumatisme psoriasique : activité, douleur axiale, périphérique, présence d une onychopathie, de synovites des IPD. 27 patients ont été inclus. 18 patients (67%) avaient au moins un ongle avec une dystrophie échographique de la tablette, dont 8 patients n ayant pas d antécédent connu d onychopathie. Pas de corrélation entre les caractéristiques cliniques du RP avec l épaisseur de la tablette, du lit unguéal et de la peau au dessus de la matrice de l ongle. La synovite en mode B des IPD était modérément corrélée à l intensité du doppler de la matrice (r=0.37, p<0.05), et du lit unguéal (r=0.31, p=0.11) et à la présence d une onychopathie. L intensité du signal doppler de la matrice unguéale tendait à être corrélée à l échelle visuelle analogique (EVA) périphérique (r=0.39, p=0.07), et inversement à celle du rachis (r=-0.37, p=0.08) mais semblait aussi influencée par l âge (r=0.52, p<0.05). L intensité du signal doppler des IPD n était corrélée significativement qu avec le nombre total de synovites cliniques (r=0.42, p<0.05). Les paramètres doppler de l ongle sembleraient plus pertinents que les autres paramètres échographiques étudiés dans cette étude. D autres travaux sont nécessaires pour confirmer ces résultats, en les comparant à d autres pathologies rhumatismales touchant les doigts.DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Osteitis fibrosa cystica

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Impact of systematic ultrasound of the knee on the rheumatologist’s clinical decision in patients consulting for knee pain

International audienceThis clinical practice study aimed to determine whether the results of systematic US in patients with knee pain modified the rheumatologist's choices concerning diagnostic management and therapy. Patients consulting for non-traumatic knee pain, with recent radiography of the knee, were consecutively included over 9 months. After the radio-clinical assessment, the rheumatologist made a principal diagnosis concerning the knee pain and defined the therapeutic management and a complementary imaging strategy if necessary. US of the painful knee was then done in accordance with the reference protocol with the operators blinded to the clinical results. After reading the US report, the rheumatologist re-evaluated his/her diagnostic and therapeutic approach and the complementary exploration strategy. In the 100 patients included (mean age = 62.9 +/- A 18.5 years, duration of knee pain = 14.4 +/- A 8.1 months) with a majority of knee osteoarthritis (61 %), the diagnosis was clarified or modified after the US in 31 % of cases (calcium pyrophosphate deposition arthropathy and tendinitis principally), which led to an intensification of therapy in 15 % of cases and a de-escalation in 5 % of cases. These changes mainly concerned injectable treatments. The US of the painful knee resulted in few changes in imaging prescriptions (6 %), and this was not significant for the number of MRIs requested. In real-life practice in rheumatology, systematic US of the knee clarified the initial clinical diagnosis in almost one-third of cases, but did not significantly modify the therapeutic management, which remained symptomatic, and did not reduce the number of other imaging examinations after the initial radio-clinical assessment

Reliability, validity and feasibility of nail ultrasonography in psoriatic arthritis

International audienceObjective: To determine the feasibility, reliability and validity of nails ultrasonography in psoriatic arthritis as an outcome measure.Methods: Pilot prospective single-centre study of eight ultrasonography parameters in B mode and power Doppler concerning the distal interphalangeal (DIP) joint, the matrix, the bed and nail plate. Intraobserver and inter-observer reliability was evaluated for the seven quantitative parameters (ICC and kappa). Correlations between ultrasonography and clinical variables were searched to assess external validity. Feasibility was assessed by the time to carry out the examination and the percentage of missing data.Results: Twenty-seven patients with psoriatic arthritis (age 55.0 +/- 16.2 years, disease duration 13.4 +/- 9.4 years) were included. Of these, 67% presented nail involvement on ultrasonography vs 37% on physical examination (P0.75) for the seven quantitative parameters, except for synovitis of the DIP joint in B mode. The synovitis of the DIP joint revealed by ultrasonography correlated with the total number of clinical synovitis and Doppler US of the nail (matrix and bed). Doppler US of the matrix correlated with VAS pain but not with the ASDAS-CRP or with clinical enthesitis. No significant correlation was found with US nail thickness.Conclusion: The feasibility and reliability of ultrasonography of the nail in psoriatic arthritis appear to be satisfactory. Among the eight parameters evaluated, power Doppler of the matrix which correlated with local inflammation (DIP joint and bed) and with VAS pain could become an interesting outcome measure, provided that it is also sensitive to change. (C) 2015 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved

The therapeutic alliance is associated with a better therapeutic adherence in children with juvenile idiopathic arthritis: reulsts of a French Multicenter Study

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COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

International audienceBackground: Various observations have suggested that the course of COVID-19 might be less favourable in patients with inflammatory rheumatic and musculoskeletal diseases receiving rituximab compared with those not receiving rituximab. We aimed to investigate whether treatment with rituximab is associated with severe COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases.Methods: In this cohort study, we analysed data from the French RMD COVID-19 cohort, which included patients aged 18 years or older with inflammatory rheumatic and musculoskeletal diseases and highly suspected or confirmed COVID-19. The primary endpoint was the severity of COVID-19 in patients treated with rituximab (rituximab group) compared with patients who did not receive rituximab (no rituximab group). Severe disease was defined as that requiring admission to an intensive care unit or leading to death. Secondary objectives were to analyse deaths and duration of hospital stay. The inverse probability of treatment weighting propensity score method was used to adjust for potential confounding factors (age, sex, arterial hypertension, diabetes, smoking status, body-mass index, interstitial lung disease, cardiovascular diseases, cancer, corticosteroid use, chronic renal failure, and the underlying disease [rheumatoid arthritis vs others]). Odds ratios and hazard ratios and their 95% CIs were calculated as effect size, by dividing the two population mean differences by their SD. This study is registered with ClinicalTrials.gov, NCT04353609.Findings: Between April 15, 2020, and Nov 20, 2020, data were collected for 1090 patients (mean age 55·2 years [SD 16·4]); 734 (67%) were female and 356 (33%) were male. Of the 1090 patients, 137 (13%) developed severe COVID-19 and 89 (8%) died. After adjusting for potential confounding factors, severe disease was observed more frequently (effect size 3·26, 95% CI 1·66-6·40, p=0·0006) and the duration of hospital stay was markedly longer (0·62, 0·46-0·85, p=0·0024) in the 63 patients in the rituximab group than in the 1027 patients in the no rituximab group. 13 (21%) of 63 patients in the rituximab group died compared with 76 (7%) of 1027 patients in the no rituximab group, but the adjusted risk of death was not significantly increased in the rituximab group (effect size 1·32, 95% CI 0·55-3·19, p=0·53).Interpretation: Rituximab therapy is associated with more severe COVID-19. Rituximab will have to be prescribed with particular caution in patients with inflammatory rheumatic and musculoskeletal diseases