Markers of B-lymphocyte activation are elevated in patients with early rheumatoid arthritis and correlated with disease activity in the ESPOIR cohort

International audienceINTRODUCTION: Little is known about systemic B-cell activation in early rheumatoid arthritis (RA). We therefore evaluated the serum levels of markers of B-cell activation in patients included in the ESPOIR early arthritis cohort. METHODS: In the ESPOIR early arthritis cohort (at least 2 swollen joints for more than 6 weeks but less than 6 months), 710 patients were assessed at 1 year and either met the 1987 American College of Rheumatology criteria for RA (n = 578) or had undifferentiated arthritis (n = 132). Baseline serum samples of patients naïve to corticosteroid and disease-modifying antirheumatic drug treatment were assessed for beta2-microglobulin, IgG, IgA, IgM, immunoglobulin free light chains of immunoglobulins, and B-cell activating factor of the tumor necrosis factor family (BAFF). The BAFF gene 871T>C polymorphism was genotyped in all patients. RESULTS: All markers of B-cell activation except BAFF and IgM were significantly higher in patients with early RA than those with undifferentiated arthritis. Anti-cyclic citrullinated peptide (anti-CCP) and beta2-microglobulin were associated with a diagnosis of early RA in the multivariate analysis. Markers of B-cell activation, except BAFF, were associated with disease activity, rheumatoid factor and anti-CCP secretion. The BAFF gene polymorphism was not associated with early RA. CONCLUSIONS: Markers of B-cell activation are elevated in patients with early RA, compared with undifferentiated arthritis, independently of any systemic increase in BAFF secretion, and correlate with disease activity. This study sheds new light on the early pathogenic role of B-lymphocytes in RA and suggests that targeting them might be a useful therapeutic strategy in early RA

Maternal Personal Exposure to Airborne Benzene and Intrauterine Growth

International audienceBACKGROUND: Studies relying on outdoor pollutants measures have reported associations between air pollutants and birth weight. OBJECTIVE: Our aim was to assess the relation between maternal personal exposure to airborne benzene during pregnancy and fetal growth. METHODS: We recruited pregnant women in two French maternity hospitals in 2005-2006 as part of the EDEN mother-child cohort. A subsample of 271 nonsmoking women carried a diffusive air sampler for a week during the 27th gestational week, allowing assessment of benzene exposure. We estimated head circumference of the offspring by ultrasound measurements during the second and third trimesters of pregnancy and at birth. RESULTS: Median benzene exposure was 1.8 microg/m(3) (5th, 95th percentiles, 0.5, 7.5 microg/m(3)). Log-transformed benzene exposure was associated with a gestational age-adjusted decrease of 68 g in mean birth weight [95% confidence interval (CI), -135 to -1 g] and of 1.9 mm in mean head circumference at birth (95% CI, -3.8 to 0.0 mm). It was associated with an adjusted decrease of 1.9 mm in head circumference assessed during the third trimester (95% CI, -4.0 to 0.3 mm) and of 1.5 mm in head circumference assessed at the end of the second trimester of pregnancy (95% CI, -3.1 to 0 mm). CONCLUSIONS: Our prospective study among pregnant women is one of the first to rely on personal monitoring of exposure; a limitation is that exposure was assessed during 1 week only. Maternal benzene exposure was associated with decreases in birth weight and head circumference during pregnancy and at birth. This association could be attributable to benzene and a mixture of associated traffic-related air pollutants

Male gonadal dose of ionizing radiation delivered during X-ray examinations and monthly probability of pregnancy: a population-based retrospective study

BACKGROUND: Male gonadal exposure to ionizing radiation may disrupt spermatogenesis, but its influence on the fecundity of couples has been rarely studied. We aimed to characterize the influence of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy. METHODS: We recruited a random sample of women who retrospectively described 1110 periods of unprotected intercourse beginning between 1985 and 1999 and leading either to a live birth or to no pregnancy; their duration was censored after 13 months. The male partner answered a telephone questionnaire on radiodiagnostic examinations. We assigned a mean gonadal dose to each type of radiodiagnostic examination. We defined male dose for each period of unprotected intercourse as the sum of the gonadal doses of the X-ray examinations experienced between 18 years of age and the date of discontinuation of contraception. Time to pregnancy was analysed using a discrete Cox model with random effect allowing to estimate hazard ratios of pregnancy. RESULTS: After adjustment for female factors likely to influence fecundity, there was no evidence of an association between male dose and the probability of pregnancy (test of homogeneity, p = 0.55). When compared to couples with a male gonadal dose between 0.01 and 0.20 milligrays (n = 321 periods of unprotected intercourse), couples with a gonadal dose above 10 milligrays had a hazard ratio of pregnancy of 1.44 (95% confidence interval, 0.73–2.86, n = 31). CONCLUSION: Our study provides no evidence of a long-term detrimental effect of male gonadal dose of ionizing radiation delivered during radiodiagnostic on the monthly probability of pregnancy during the year following discontinuation of contraceptive use. Classification errors due to the retrospective assessment of male gonadal exposure may have limited the statistical power of our study

Les comportements de prévention du Sida : prévalence et facteurs favorisants

Ducot (Béatrice), Spira (Alfred) - Preventive behaviour of AIDS : prevalence and conducive factors Prevention of sexually transmitted diseases and AIDS may be achieved by several different strategies : selection or reduction in the number of sexual partners, relinquishing certain sexual practices, and using condoms. 36 per cent of heterosexual men and 30 per ent of heterosexual women, who had had at least two different sexual partners during the last five years, and who were questioned in the ACSF survey claim that they had altered their behaviour, since AIDS entered into the picture. The most frequently mentioned changes are greater selectiveness and reduction in the number of sexual partners. Persons most likely to have changed their behaviour are those who do not live as a couple, those who have had a large number of partners in the past, and those who admit having suffered from a sexuality transmitted disease. Apart from those who have only had a single faithful (or perceived to be faithful) sexual partner, 15 per cent of men and 8 per cent of women with a single partner and 17 per cent of men and 5 per cent of women in multipartnerships say that they used condoms systematically during the last 12 months. Factors conducive to that type of the protection include the type of the new, or occasional partner and the recency of the relation. Finally, it seems, that having one or several confidants with whom very private matters can be discussed, makes people more conscious of the risk of infection and stimulates preventive behaviour.Ducot (Béatrice), Spira (Alfred). - Les comportements de prévention du Sida : prévalence et facteurs favorisants En matière de prévention des MST et du Sida, plusieurs stratégies peuvent être adoptées : sélection et diminution du nombre des partenaires sexuels, abandon de certaines pratiques, utilisation du préservatif lors des rapports. Parmi les sujets hétérosexuels interrogés lors de l'enquête ACSF, 36% des hommes et 30% des femmes ayant eu au moins 2 partenaires sexuels différents dans les 5 dernières années déclarent avoir « changé leur comportement depuis qu'on parle du Sida». Les changements les plus fréquemment cités sont une sélection et une diminution du nombre de partenaires. Les personnes les plus susceptibles d'avoir ainsi changé leur comportement sont les sujets ne vivant pas en couple, ayant eu un nombre élevé de partenaires et celles déclarant avoir déjà eu une MST. En ce qui concerne les douze derniers mois, si on exclut les personnes n'ayant eu qu'un seul partenaire conjoint fidèle ou ressenti comme tel, 15% des hommes et 8% des femmes monopartenaires, 17% des hommes et 5 % des femmes multipartenaires déclarent avoir utilisé de façon systématique un préservatif durant cette période. Les facteurs favorisant une telle protection sont le type de partenaire nouveau ou occasionnel et le caractère récent de la relation. Enfin, il semble que le fait d'avoir un ou plusieurs confidents avec le(s)quel(s) on parle de choses intimes favorise la prise de conscience du risque de contamination et l'adoption de comportement de prévention.Ducot (Béatrice), Spira (Alfred). - Comportamientos de prevención del Sida : preva- lencia y factores favorecedores En materia de prevención de enfermedades sexualmente transmisibles y del Sida se pueden adoptar varias estrategias : selección y disminución del numero de parejas, abando- no de ciertas prácticas, utilización del preservativo. Entre los individuos heterosexuales en- cuestados para ACSF, el 36 % de los hombres y el 30 % de las mujeres que habian tenido al menos dos parejas distintas durante los últimos cinco afios declaran haber « cambiado su comportamiento desde que se habla del Sida». Los cambios que se citan con más frecuencia son una selección y una disminución del numero de parejas. Las personas más susceptibles de haber cambiado de comportamiento son aquellas que no viven en pareja, con un numero elevado de parejas y las que declaran haber tenido anteriormente una enfermedad sexualmente transmisible. En cuanto al comportamiento durante los doce meses anteriores a la en- cuesta, si se excluyen las personas que declaran haber tenido una sola pareja supuesta о realmente fiel, un 15 % de los hombres y un 8 % de las mujeres con una sola pareja durante el periodo, y un 17 % de los hombres y un 5 % de mujeres con más de una pareja declaran haber utilizado el preservativo de forma sistemática. Algunos de los factores que favorecen la protección son el tipo de pareja, nueva u ocasional, y el carácter reciente de la relación. Finalmente, el hecho de tener uno o más confidentes con los cuales se comparten problemas fntimos favorece la concienciación del riesgo de infección y la adopción de un comportamiento preventivo.Ducot Béatrice, Spira Alfred. Les comportements de prévention du Sida : prévalence et facteurs favorisants. In: Population, 48ᵉ année, n°5, 1993. Sexualité et sciences sociales : les apports d'une enquête, sous la direction de Michel Bozon et Henri Leridon. pp. 1479-1503

Reproductive life events in the population living in the vicinity of a nuclear waste reprocessing plant.

International audienceOBJECTIVE: There is concern about the health of populations living close to nuclear waste reprocessing plants. A comparative study was conducted on reproductive life events in the general population living near the nuclear waste reprocessing plant in Beaumont-Hague, France and a reference area in Brittany. DESIGN, SETTING AND PARTICIPANTS: Women were randomly selected and retrospectively questioned on reproductive life events occurring between 1985 and 2000. The monthly probability of pregnancy (assessed by time to pregnancy for pregnancy attempts leading or not to a live birth), occurrence of involuntary infertility, miscarriage and birth weight were compared between both areas using regression models with random effect. RESULTS: Compared with the reference area (326 couples) and after adjustment for sociodemographic and behavioural factors, couples from Beaumont-Hague (857 couples) had an estimated hazard ratio of pregnancy of 1.19 (95% CI 0.89 to 1.58). The prevalence ratio of 12-month involuntary infertility was 0.99 (95% CI 0.64 to 1.55) and the odds ratio of miscarriage was 0.86 (95% CI 0.85 to 1.33) for Beaumont-Hague, compared with the reference area. Mean birth weight was similar in both areas (95% CI of difference -85 g to 53 g). CONCLUSION: No increased risk of adverse reproductive life events was highlighted in the population living in the vicinity of the French nuclear waste reprocessing plant, compared with the reference area. Reproductive health is unlikely to be strongly altered in the general population of Beaumont-Hague

When do involuntarily infertile couples choose to seek medical help?

International audienceOBJECTIVE: To estimate the probability of medical consultation for infertility during the course of a pregnancy attempt and to study its determinants. DESIGN: Pregnancy-based retrospective telephone survey analyzed with a discrete time Cox model. SETTING: Two rural counties in Brittany and Normandy, France. PATIENT(S): A random sample of 901 women from the general population aged 18-60 years reporting 1,460 pregnancy attempts resulting in a live birth between 1985 and 2000 (participation rate, 73%). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Probability of medical consultation for involuntary infertility cumulated over time. RESULT(S): The cumulative probability of medical consultation for involuntary infertility among nulligravid women was 45% after 12 months of involuntary infertility and 75% after 24 months. The probability of medical consultation at any time was half that for parous women (odds ratio 0.4, 95% confidence interval 0.2-0.6). More highly educated women were more likely to have sought medical help for infertility. Only 45% of women who had sought medical advice received infertility treatment. CONCLUSION(S): Our survival approach provides a description of infertility service use during the course of a pregnancy attempt, and confirms that parity and educational level are strong predictors of medical help-seeking behaviors

Does male age affect the risk of spontaneous abortion? An approach using semiparametric regression.

Couples in industrialized countries tend to delay attempting to have children, which may lower their chances of livebirth. The authors assessed the association between male age and the risk of spontaneous abortion between weeks 5 and 20 of pregnancy, controlling for female age. They interviewed by telephone a random cross-sectional population of 1,151 French women who had been pregnant between 1985 and 2000 (participation rate, 73%). A total of 12.2% of the 2,414 pregnancies resulted in spontaneous abortion. Semiparametric regression was used to define a discrete time survival model with a random effect taking into account induced abortions, in which female age was coded by a third-degree polynomial. This final model predicted that the risk (rate ratio) of spontaneous abortion was 2.13-fold higher for women age 25 years whose partner was age 35 years or older than for women age 25 years whose partner was younger than age 35 years (95% confidence interval: 1.07, 4.26). No such increased risk of spontaneous abortion with male age was estimated when the woman was age 35 years (rate ratio = 0.61, 95% confidence interval: 0.35, 1.07). Thus, increasing male age could increase the risk of spontaneous abortion when the female partner is less than 30 years of age