Intraarticular cortisone injection for osteoarthritis of the hip. Is it effective? Is it safe?

Osteoarthritis of the hip is a significant source of morbidity in the elderly. Treatment guidelines are available for the management of hip osteoarthritis, but these do not address the application of intraarticular corticosteroid injection. The intraarticular injection of corticosteroid is used in the management of other large joint osteoarthritic diseases and is well studied in the knee, however, this data cannot be used to make sound clinical decisions regarding its use for hip osteoarthritis. There are also concerns regarding the safety of this modality. Review of the published literature reveals that there are eight trials examining the efficacy of intraarticular corticosteroid injection for hip osteoarthritis and of these only four are randomized controlled trials. In general, the available literature demonstrates a short-term reduction of pain with corticosteroid injection and is indicated for patients refractory to non-pharmacologic or analgesic and NSAID therapy. The use of radiologic-guidance is recommended and, with proper sterile technique, the risk of adverse outcomes is very low. Future randomized controlled trials are needed to further examine the efficacy and safety of intraarticular corticosteroid injection for hip osteoarthritis

Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study

BACKGROUND: Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. METHODS: In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. FINDINGS: Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31–1·57]), were male compared with female (1·38 [1·05–1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23–1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50–3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49–3·02]). Risk factors varied among different disease subtypes. INTERPRETATION: Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. FUNDING: American College of Rheumatology and the European Alliance of Associations for Rheumatology

Characterization of resistance-welded thermoplastic composite double-lap joints

An investigation of resistance welding of thermoplastic composite double-lap shear joints is presented. Double-lap shear specimens consisting of carbon fibre/poly-etherether-ketone (PEEK/CF), carbon fibre/poly-etherketone-ketone (PEKK/CF), carbon fibre/poly-ether-imide (PEI/CF) and glassfibre/poly-ether-imide (PEI/GF) were resistance-welded using a stainless steel mesh heating element. The objective of this work was to study the mechanical performances of the double lap shear resistance-welded joints and to compare them with the single lap shear resistance-welded joints. The welded specimens were analyzed using static and dynamic lap shear tests and optical and scanning electron microscopy. Lap shear strengths of 53 MPa, 49 MPa, 45 MPa and an extrapolated value of 34 MPa were obtained for PEEK/CF, PEKK/CF, PEI/CF and PEI/GF double-lap joints, respectively. Infinite fatigue lives were obtained at 30% for PEEK/CF and PEKK/CF, 25% for PEI/CF and 20% for PEI/GF. Resistance-welded double-lap joints were found to have equivalent static and fatigue mechanical properties compared with single-lap joints, for all materials tested.Ce travail présente une étude des joints à recouvrement double de matériaux composites à matrice thermoplastique assemblés par soudage par résistance. Des échantillons de joints à recouvrement double constitués de fibre de carbone/polyéther éther cétone (PEEK/CF), fibre de carbone/polyéther cétone cétone (PEKK/CF), fibre de carbone/polyéther imide (PEI/CF) et fibre de verre/polyéther imide (PEI/CF), ont été assemblés pas soudage par résistance à l'aide d'un élément chauffant en acier inoxydable. L'objectif de ce travail est d'étudier les performances mécaniques des joints à recouvrement double soudés pas résistance et de les comparer avec celles des joints à recouvrement simple. Les échantillons soudés ont été analysés à l'aide de tests de chargement statiques et dynamiques, ainsi que pas microscopie optique et par microscopie électronique à balayage. Une résistance au cisaillement de 53 MPa, 49 MPa, 45M Pa, et une valeur extrapolée de 34 MPa ont été obtenues pour les joints à recouvrement double de PEEK/CF, PEKK/CF, PEI/CF et PEI/GF, respectivement. Une durée de vie indéterminée en fatigue de 30% du chargement statique pour les joints de PEEK/CF et PEKK/CF, de 25% pour les joints de PEI/CF, et de 20% pour les joints de PEI/GF ont été obtenues. Pour chacun des matériaux testés, les joints à recouvrement double soudés par résistance ont donné lieu à des propriétés mécaniques en statique et en fatigue équivalentes à celles des joints à recouvrement simple

TROIS CAS DE TENDINOPATHIE SURVENANT AU COURS D'UN TRAITEMENT PAR STATINE

PARIS7-Xavier Bichat (751182101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Hydraulically informed graph theoretic measure of link criticality for the resilience analysis of water supply networks

Water Distribution Networks (WDN) are complex and highly interconnected systems. To maintain operation under failure conditions, WDNs should have built-in resilience based on topological and energy redundancy. There are various methods for analysing the resilience of WDNs based on either hydraulic models or surrogate network measures; however, not a single universally accepted method exists. Hydraulic modeling of disruptive operational scenarios suffer from combinatorial restrictions and uncertainties. Methods that rely on surrogate network measures do not take into account the complex interactions between topological and energy redundancy. To bridge this gap, the presented work introduces a hydraulically informed surrogate measure of pipe criticality for the resilience analysis of WDNs, called Water Flow Edge Betweenness Centrality (WFEBC). The WFEBC combines the random walk betweenness centrality with hydraulic (energy) loss principles in pipes. The proposed network resilience estimation method is applied to a case study network and an operational network. Furthermore, a network decomposition approach is proposed to complement the network estimation method and facilitate its scalability to large operational networks. The described resilience analysis method is benchmarked against a hydraulic model-based analysis of WDN reserve capacity. WFEBC is also applied to assess the improvement in resilience allowed by the implementation of a dynamically adaptive topology in an operational network. The benefits and limitations of the proposed method are discussed

Building a Methodology for Assessing Service Quality under Intermittent Domestic Water Supply

This document proposes a methodology for assessing the quality of water distribution service in the context of intermittent supply, based on a comparison of joint results from literature reviews and feedback from drinking water operators who had managed these networks, with standards for defining the quality of drinking water service. The paper begins by reviewing and proposing an analysis of the definition and characterization of intermittent water supply (IWS), highlighting some important findings. The diversity of approaches used to address the issue and the difficulty of defining a precise and detailed history of water supply in the affected systems broadens the spectrum of intermittency characterization and the problems it raises. The underlined results are then used to structure an evaluation framework for the water service and to develop improvement paths defined in the intermittent networks. The resulting framework highlights the means available to water stakeholders to assess their operational and management performance in achieving the improvement objectives defined by the environmental and socio-economic contexts in which the network operates. Practical examples of intermittent system management are collected from water system operators and presented for illustration purposes (Jeddah, Algiers, Port-au-Prince, Amman, Cartagena, Barranquilla, Mexico, Cancun, Saltillo, Mumbai, Delhi, Coimbatore …)

Factors influencing the use of tocilizumab as monotherapy in patients with rheumatoid arthritis in a real-life setting: results at 1 year of the ACT-SOLO study

International audienceIntroduction: Using a biologic disease-modifying antirheumatic drug (bDMARD) as monotherapy in clinical practice for patients with rheumatoid arthritis (RA) is common and recognised by health authorities although current guidelines recommend to combine them with conventional synthetic (cs)DMARDs. This study mainly aimed to search for real-life factors influencing the use of tocilizumab as MONO or in combination (COMBO).Methods: In this non-interventional, prospective, national, multicentre study, data were collected every 3 months over a 12-month period in RA patients starting tocilizumab. The proportion of monotherapy patients was described, together with significant explicative factors.Results: Among the 577 analysed patients recruited from January 2012 to August 2013 (228 monotherapy patients; 40%), 79% were women, mean RA duration was 11 +/- 9 years, previous RA treatments included bDMARDs and csDMARDs in 75% of cases and mean Disease Activity Score 28 joints-Erythrocyte Sedimentation Rate (DAS28-ESR) was 5.2 +/- 1.3 at inclusion. Explicative factors for monotherapy were at least 65 years (OR=1.47, p=0.0485), no methotrexate within the two last years (OR=5.96, p<0.0001), past severe infection (OR=1.99, p=0.0272) and higher baseline DAS28-ESR (OR=1.22, p=0.0086). Regarding clinical results (DAS28-ESR, Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) low disease activity and remission; ACR20/50/70 and European League Against Rheumatism (EULAR) response; Health Assessment Questionnaire Disability Index (HAQ-DI) score), no relevant differences between monotherapy and combination patients were observed at 1 year. A total of 23 tocilizumab-treated patients (4%) experienced serious infections; no new safety signals were noted with no differences between groups.Conclusions: ACT-SOLO confirms the high proportion of RA patients receiving tocilizumab as MONO in clinical practice. The study also showed that clinical results at 1 year were similar between MONO and COMBO patients in a real-life setting

Lymphomes des annexes de l'oeil au cours du syndrome de Gougerot-Sjögren [Lymphomas of the ocular adnexa in Gougerot-Sjögren syndrome. Apropos of 4 cases].

The risk of malignant B cell lymphoma is increased in Sjögren's syndrome (SS). Orbital localization seems infrequent. We report 4 cases of malignant lymphoma (ML) occurring in 4 women aged 47 to 77 years, with primary SS in 3 cases, located to the conjunctiva in 2 cases, the lacrymal gland in 1 case and the eyelid in 1 case. The interval between the diagnosis of SS and orbital ML varied from 6 months to 15 years. All 4 lymphomas were of the B cell type, low histopathologic grade, with monoclonal gammopathy in 1 case. Extraocular lymphoma was initially present in 1 case. ML remained localized in 2 cases with a follow-up of 4 and 6 years. Two patients treated by excisional biopsy alone are in complete remission 3 and 6 years later. The 2 other patients treated with orbital radiotherapy and chemotherapy died rapidly (transformation into a high grade malignancy in 1 case). We conclude that clinical, immunopathologic features, as well as prognosis and treatment of ocular adnexa ML in SS are similar to those of primary ML without SS