The ability of synovitis to predict structural damage in rheumatoid arthritis: A comparative study between clinical examination and ultrasound

Objectives: To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Methods: Patients with RA. Study design: Prospective, 2-year follow-up. Data collected: Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. Analysis: Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. Results: Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p<0.001 versus 1.61 (1.06-2.45) p=0.026 versus 1.75 (1.18-2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16-4.02) p=0.015 and 3.50 (1.77-6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression. Conclusions: This study confi rms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration

Arthrose destructrice rapide ou rapidement progressive

National audienceRapidly destructive osteoarthritis (RDOA) is considered as a rare and poorly diagnosed disease. RDOA is a destructive arthropathy that occurs most commonly in elderly women. The most typical radiological features are narrowing of the articular cartilage (chondrolysis) subchondral bone fracture, cysts in the femoral head/acetabulum, absence of osteophytes, flat femoral heads, and signs of joint effusion. RDOA was originally described in the hip but may also involve the shoulder and the knee. Pathogenesis is not well understood, but subchondral fracture probably plays a role in the development of destruction of the joint. Nevertheless, early diagnosis of the patients with rapid destructive arthritis of the hip is important to try to reduce complexity of surgical intervention.L’arthrose destructrice rapidement progressive (ADRP) est considérée comme une entité rare et méconnue. L’ADRP est une arthropathie destructrice qui survient plus souvent chez la femme âgée. Les signes d’imagerie les plus typiques sont le pincement de l’interligne articulaire (chondrolyse), l’existence d’une fracture sous-chondrale, de géodes de la tête fémorale et de l’acétabulum, l’absence d’ostéophytes, l’aplatissement de la tête fémorale, et des signes d’épanchement. L’ADRP a d’abord été décrite à la hanche mais peut toucher aussi l’épaule et le genou. Sa pathogénie n’est pas bien connue, mais la fracture sous-chondrale joue probablement un rôle dans la destruction ostéoarticulaire. Néanmoins, le diagnostic précoce des patients avec une ADRP de la hanche est important pour essayer de réduire la complexité de l’acte chirurgical

Positive association of the HLA DMB1*0101-0101 genotype with rheumatoid arthritis.

International audienc

Ambulatory Surgery in

High-energy extracorporeal shock-wave therapy for calcifying tendinitis of the rotator cuff A RANDOMISED TRIAL J.-D. Albert

Identification of patients with gout: elaboration of a questionnaire for epidemiological studies

International audienceOBJECTIVES: In France, the prevalence of gout is currently unknown. We aimed to design a questionnaire to detect gout that would be suitable for use in a telephone survey by non-physicians and assessed its performance. METHODS: We designed a 62-item questionnaire covering comorbidities, clinical features and treatment of gout. In a case-control study, we enrolled patients with a history of arthritis who had undergone arthrocentesis for synovial fluid analysis and crystal detection. Cases were patients with crystal-proven gout and controls were patients who had arthritis and effusion with no monosodium urate crystals in synovial fluid. The questionnaire was administered by phone to cases and controls by non-physicians who were unaware of the patient diagnosis. Logistic regression analysis and classification and regression trees were used to select items discriminating cases and controls. RESULTS: We interviewed 246 patients (102 cases and 142 controls). Two logistic regression models (sensitivity 88.0% and 87.5%; specificity 93.0% and 89.8%, respectively) and one classification and regression tree model (sensitivity 81.4%, specificity 93.7%) revealed 11 informative items that allowed for classifying 90.0%, 88.8% and 88.5% of patients, respectively. CONCLUSIONS: We developed a questionnaire to detect gout containing 11 items that is fast and suitable for use in a telephone survey by non-physicians. The questionnaire demonstrated good properties for discriminating patients with and without gout. It will be administered in a large sample of the general population to estimate the prevalence of gout in Franc

Bone mineral density assessed by dual-energy X-ray absorptiometry in patients with viral or alcoholic compensated cirrhosis. A prospective study.

International audienceBackground/aim: Cirrhosis is considered as a risk factor for osteoporosis whose prevalence is poorly known. The aim was to assess prospectively bone mineral density (BMD) in patients with alcoholic or viral compensated cirrhosis. Methods: From 2006 to 2008, patients with viral or alcoholic compensated cirrhosis had BMD assessment by dual-energy X-ray absorptiometry. The prevalence of osteopenia (-2.5 SD < T-score < -1 SD) and osteoporosis (T-score <= -2.5 SD), and the influence of age, gender and aetiology of cirrhosis were assessed using univariate and multiple regression analysis. Results: One hundred and nine patients were studied (72 men, 55.3 +/- 11.4 years and 37 women, 65.2 +/- 11.0); with HBV (n = 35), HCV (n = 43), or alcoholic cirrhosis (n = 31). At the lumbar spine, 25 patients had osteopenia and 12 had osteoporosis. At the femoral site, 23 had osteopenia and 4 had osteoporosis. Female gender had an independent decreased effect on the total BMD. Conclusions: The prevalence of osteoporosis was up to 11% at the lumbar spine, greater in women independently of age, without significant difference according to the aetiology of cirrhosis. (C) 2011 Elsevier Masson SAS. All rights reserved