Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE)

Objective: To develop a whole-body MRI-scoring system for peripheral arthritis and enthesitis. Methods: After consensus on definitions/locations of MRI pathologies, four multi-reader exercises were performed. Eighty-three joints were scored 0-3 separately for synovitis and osteitis, thirty-three entheses 0-3 separately for soft tissue inflammation and osteitis. Results: In the last exercise, reliability was moderate-good for musculoskeletal radiologists and rheumatologists with previously demonstrated good scoring proficiency. Median pairwise single-measure/average-measure ICCs were 0.67/0.80 for status scores and 0.69/0.82 for change scores; kappas ranged 0.35-0.77. Conclusion: WBMRI scoring of peripheral arthritis and enthesitis is reliable which encourages further testing and refinement in clinical trials

Intérêt de l' échographie osthéoaticulaire dans les polyarthrites débutantes (résultats de l' étude échographique d'espoir)

Le diagnostic et l évaluation précoce d une polyarthrite rhumatoïde (PR) débutante est un élément clé pour une bonne réponse thérapeutique. L échographie est une nouvelle technique d imagerie qui permet une détection plus sensible des synovites et érosions. ESPOIR est une cohorte multicentrique française de polyarthrites débutantes, qui inclue 813 adultes ayant au moins 2 arthrites depuis au moins 6 semaines et moins de 6 mois.L étude échographique d ESPOIR a porté sur 127 patients ayant eu une évaluation échographique à l inclusion, issus de 4 des 13 centres. L analyse transversale à l inclusion des données cliniques, radiographiques et échographiques a montré que l échographie était plus sensible que l examen clinique pour la détection des synovites, et retrouvait 6,8 fois plus d érosions chez 3,3 fois plus de patients que la radiographie standard. Le suivi à 2 ans de ces patients a permis de montrer que l échographie en elle-même ne suffisait pas à faire le diagnostic de PR selon les critères ACR 1987 à 2 ans ou selon les nouveaux critères ACR/EULAR 2010. En revanche, certains paramètres échographiques précoces étaient associés à un pronostique structural plus sévère. Les érosions échographiques initiales sont prédictives de la présence d une polyarthrite érosive typique de PR à 2 ans. De plus l activité Doppler initiale était associée à une progression rapide des érosions définie par une variation du score de Sharp érosion >= 5 à 1 an. Ces deux paramètres échographiques étaient également associés à la progression radiographique durant la première année en régression linéaire. A l échelle de l articulation, là encore, l activité Doppler ainsi que la présence d érosion échographique étaient des paramètres précoces associés à la présence d une érosion radiographique observée à 1 an sur la même articulation. En conclusion, cette étude issue des données de la cohorte ESPOIR a permis de montrer l intérêt de l échographie pour une détection plus sensible et précoce des synovites et érosions, sans toutefois de spécificité diagnostique pour la PR. C est surtout au plan pronostique que cet outil s avère le plus performant, l activité Doppler initiale et la présence d érosions échographiques étant des marqueurs indépendants associés à une atteinte structurale plus sévère.PARIS6-Bibl.Pitié-Salpêtrie (751132101) / SudocSudocFranceF

PADI 4 (un nouveau gène de susceptibilité de la polyarthrite rhumatoïde)

LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Recommendations for the pragmatic use of ultrasound in rheumatoid arthritis by the GEISPER French group

International audienceObjective: To develop recommendations for the appropriate use of ultrasound in the management of rheumatoid arthritis (RA) in routine practice based on data from the literature and of experts opinion. Methods: Based on a systematic literature review, a scientific committee decided on themes and relevant questions to draw up an initial draft of recommendations. These recommendations were submitted to a group of experts in ultrasound in rheumatic and musculoskeletal diseases using a Delphi method, which produced preliminary recommendations. These were submitted to an expanded group of ultrasound experts for relevance, comprehensibility and comprehensiveness. The level of agreement of the experts were recorded during a face-to-face meeting. Results: Following two rounds of the Delphi, a consensus was reached on three overarching principles, including definitions of joints, tendons and articular sites to be examined, and 10 recommendations. These recommendations underline the benefit of ultrasound for the diagnosis of RA in cases of inflammatory arthralgia or undifferentiated arthritis as well as in assessing the extent of initial structural and inflammatory damage. They also define the role of ultrasound during follow-up or when considering treatment reduction once clinical remission has been achieved. Lastly, they illustrate the utility of ultrasound in facilitating technical procedures. Conclusion: These 10 consensus-based recommendations should harmonize and optimize clinical practice and thus improve the management of RA patients

La vitesse de progression radiologique annuelle initiale est un nouveau facteur de risque de prédiction de la dégradation articulaire ultérieure : les résultats de la cohorte ESPOIR.

National audienc

Surgery for infective endocarditis on mitral annulus calcification

Background and aim of the study: The study aim was to assess the characteristics of bacterial endocarditis complicating mitral annulus calcification, and to evaluate the surgical results. Methods: Twenty-four patients (mean age 64 years) underwent surgery for mitral insufficiency secondary to mitral endocarditis with annulus calcification (acute, n = 18; healed, n = 6). Surgery was performed as an emergency in seven cases for septic (n = 3) or cardiogenic (n = 4) shock. An aortic prosthesis had previously been placed in three cases. Comorbidities noted included chronic renal insufficiency/dialysis (n = 8), cancer (n = 6), coronary disease (n = 6), and obstructive cardiomyopathy (n = 1). Nine patients suffered an embolic complication, such as stroke (n = 7, of which three had coma), splenic (n = 3), or lower limb (n = 1). The microorganism present was identified as Staphylococcus aureus (n = 9), Streptococcus/Enterococcus sp. (n = 12), or others (n = 3). The left atrial diameter was 48 mm, the ejection fraction 63%, and the septal thickness 13 mm. Results: The mean severity score of annulus calcifications (range: 1 to 5) was 1.9. The anatomical lesions included: vegetations (n = 16, of which eight were >10 mm), leaflet perforation (n = 9), chordae rupture (n = 9), aortic abscess (n = 2) and mitral annular abscess (n = 9), and one fistulation into the pericardium. The valve was repaired in 15 cases, and replaced in nine (seven bioprostheses, two mechanical). Associated procedures included aortic valve replacement (n = 7) and coronary artery bypass (n = 3). The in-hospital mortality was 29% (n = 7); all patients who died were operated on during the acute phase. All patients who presented with septic shock or coma died. After a mean follow up of 46 months, six patients had died (overall survival was 46% at 33 months), and 11 were in NYHA class I/II. One recurrence of endocarditis was treated medically. Conclusion: Bacterial endocarditis complicating mitral annulus calcification has a poor prognosis due to the frequent comorbidity and severity of the infectious complications. Patients in septic shock or coma do not appear to be suitable candidates for surgery. Valve repair was possible in two-thirds of the present patients; otherwise, a bioprosthetic replacement was the option of choice

Mitral annulus calcification: determinants of repair feasibility, early and late surgical outcome

Objective: The aim of this study was to determine the factors influencing the feasibility of valve repair and the surgical outcome in patients with mitral annulus calcification. Methods: In 124 patients with mitral annulus calcification undergoing surgery, two entities were distinguished: Barlow disease (myxomatous leaflets, n = 60) and fibroelastic deficiency (FED) (normal leaflets, n = 64). The calcification score was lower (1.9 vs 2.8); the annulus was more dilated (ring 35 vs 32 mm) and ruptured chordae were more frequent (77% vs 37%) in Barlow than in FED (p < 0.001). The clinical profile was different: age (60 +/- 14 vs 73 +/- 8 years, p < 0.001), systemic hypertension (22% vs 70%, p < 0.001), chronic renal insufficiency (5% vs 22%, p < 0.01), cancer (7% vs 25%, p < 0.01). Multifocal atherosclerosis was less frequent in Barlow than in FED: carotid disease (17% vs 54%, p < 0.001), aortic atheroma (21 % vs 51 %, p < 0.001) and coronary disease (22% vs 56%, p < 0.01). Echocardiography showed two different patterns in Barlow and FED: aortic valve stenosis (1.7% vs 31%), left atrial diameter (54 vs 49 mm), left ventricular end-diastolic diameter (62 vs 54 mm), interventricular septal thickness (11 vs 13 mm), and systolic pulmonary pressure (40 vs 56 mmHg), respectively (p < 0.001). Bacterial endocarditis was observed in 24 cases (19%). Results: The surgical technique was a valve repair in 68% and a replacement in 32%. The repair rate depended upon the extent of annulus calcifications (p < 0.001) and the type of degenerative disease (95% vs 44% in Barlow and FED p < 0.001). In-hospital mortality was 14% (Barlow: 5% vs FED: 23%, p < 0.01). The mean follow-up was 50 t 41 months. Overall 5-year year survival was 76% (Barlow: 90% vs FED: 64%, p < 0.001) and survival free from cardiac event was 69% at 5 years (Barlow: 87% vs FED: 52%, p < 0.001). Five-year survival was higher following repair than replacement (84% vs 64% p < 0.001). Chronic renal insufficiency and bacterial endocarditis were two predictors of early and late death (p < 0.01). Conclusions: The aetiopathogeny of the degenerative mitral disease responsible for annulus calcifications corresponded to distinct anatomical, clinical and echographic patterns. It was a main determinant of repair feasibility, early and late surgical outcom

La vitesse de progression radiologique annuelle initiale est un nouveau facteur de risque de prédiction de la dégradation articulaire ultérieure : les résultats de la cohorte ESPOIR.

National audienc