Place des orhtèses articulées dans la prise en charge de la gonarthrose fémoro-tibiale (revue de la littérature et étude ouverte préliminaire d'une nouvelle orthèse)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Comment on: Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice: reply

Type de document : lettre à l'éditeurInternational audienc

Biomechanical effectiveness of a distraction-rotation knee brace in medial knee osteoarthritis: Preliminary results

International audienceBackground: Non-pharmacological therapies are recommended for the care of knee osteoarthritis patients. Unloader knee braces provide an interesting functional approach, which aims to modulate mechanical stress on the symptomatic joint compartment. We aimed to confirm the biomechanical effects and evaluate functional benefits of a new knee brace that combines a valgus effect with knee and tibial external rotation during gait in medial osteoarthritis patients. Methods: Twenty patients with unilateral symptomatic medial knee osteoarthritis were included and they performed two test sessions of 3D gait analysis with and without the brace at the initial evaluation (W0) and after 5 weeks (W5) of wearing the brace. VAS-pain, satisfaction scores, WOMAC scores, spatio-temporal gait parameters (gait speed, stride length, stance and double stance phases, step width), and biomechanical data of the ipsilateral lower limb (hip, knee, ankle and foot progression angles) were recorded at each session. Results: VAS-pain and WOMAC significantly decreased at W5. Walking speed was not significantly modified by knee bracing at W0, but increased significantly at W5. Knee adduction moments and foot progression angles significantly decreased in the terminal stance and push off, respectively, with bracing at W0 and W5. Lower-limb joint angles, moments and powers were significantly modified by wearing the brace at W0 and W5. Conclusion: This new knee brace with distraction-rotation effects significantly alters knee adduction moments and foot progression angles during gait, which might lead to significant functional gait improvements and have carry-over effects on pain at the short term in osteoarthritis patients (<2 months). (C) 2014 Elsevier B.V. All rights reserved

Clinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis

International audienceEvaluation of the clinical effectiveness and safety of a new custom-made valgus knee brace (OdrA) in medial knee osteoarthritis (OA) in terms of pain and secondary symptoms.METHODS:Open-label prospective study of patients with symptomatic medial knee OA with clinical evaluation at 6 and 52 weeks (W6, W52). We systematically assessed pain on a visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), spatio-temporal gait variables, use of nonsteroidal anti-inflammatory drugs (NSAIDs) and analgesic-sparing effects of the brace and tolerance. Mean scores were compared at baseline, W6 and W52 and the effect size (ES) and 95% confidence intervals (95% CIs) were calculated.RESULTS:We included 20 patients with knee OA (mean age 64.2±10.2 years, mean body mass index 27.2±5.4 kg/m2). VAS pain and KOOS were improved at W6 and W52: pain (ES=0.9 at 1 year), amelioration of other symptoms (ES=0.4), and function in activities of daily living (ES=1.1), sports and leisure (ES=1.5), quality of life (ES=0.9) and gait speed (ES=0.41). In total, 76% of patients showed clinical improvement at 1 year. Analgesic and NSAIDs consumption was significantly decreased at W6 and W52. One serious adverse effect noted was lower-limb varices, and observance was deemed satisfactory at 1 year.CONCLUSION:This new unloader brace appeared to have good effect on medial knee OA, with an acceptable safety profile and good patient compliance

Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice

International audienceObjective. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.Methods. This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the dose of CS.Results. Inclusion of 130 patients [women 80.8%, mean age 56.7 years (S.D. 14.0), RA duration 16.3 years (S.D. 10.4), mean baseline 28-joint DAS (DAS28) 5.1 (S.D. 1.4), mean baseline dose of CS 10.0 mg/day (S.D. 8.2) prednisone equivalent. Decreases in the mean daily dose of CS and in the DAS28 were observed during follow-up [respectively 6.5mg (S.D. 4.8) at week 24 (P < 0.0001) and 3.0mg (S.D. 1.4) at week 24 (P < 0.0001)]. The only variable that correlated with the decrease in the dose of CS was the initial dose of the drug (r = 0.82, P < 0.001).Conclusion. The introduction of TCZ led to rapid and long-lasting CS sparing that did not correlate with the reduction in disease activity. It is possible that in patients treated with high-dose CS, the main objective of the clinician is to reduce dosage of CS rather than RA activity

Efficacy and safety of tocilizumab in elderly patients with rheumatoid arthritis

International audienc

Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice

Supplementary data are available at Rheumatology Online.International audienceObjective: The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice.Methods: The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy.Results: In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents.Conclusion: In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD