Impact de l'éducation thérapeutique sur les compétences de sécurité de patients traités par biothérapie intraveineuse pour un rhumatisme inflammatoire en hôpital de jour

Introduction : Les patients traités par biothérapie doivent en connaître les complications. L'acquisition de compétences de sécurité est l'un des objectifs des programmes d'éducation thérapeutique (ETP) dans les rhumatismes inflammatoires chroniques (RIC). Objectifs : Évaluation de l'impact du programme ETP RHIN-RIC sur les compétences de sécurité et d'autosoins de patients sous biothérapie pour un RIC. Méthodes : Appréciation par le questionnaire Biosecure des compétences de 80 patients sous biothérapie intraveineuse pour un RIC en hôpital de jour de Rhumatologie du Groupe Hospitalier de la région Mulhouse-Sud-Alsace. Résultats : Parmi les patients, 10 % jugeaient l'information qui leur avait été prodiguée insuffisante. Le score moyen était de 65,9/100 (écart-Type 19,15). Il variait significativement avec le niveau d'éducation (p = 0,009). Le score moyen était significativement plus élevé chez les patients dont le traitement avait été introduit récemment (p = 0,043). Parmi les patients, 37,5 % avaient intégré le programme d'ETP. Le score Biosecure moyen était significativement plus élevé dans le groupe ETP (71,87/100 contre 62,32/100 ; p = 0,038) et ce également dans le sous-groupe de niveau d'éducation moindre. Il n'y avait pas de différence significative sur le contrôle de la pathologie ou la survenue d'infections. Conclusion : Les programmes d'ETP permettent une meilleure maîtrise des compétences de sécurité, et une meilleure implication du patient dans la gestion de sa pathologie et de son traitement

Prospective assessment of bone texture parameters at the hand in rheumatoid arthritis

International audienceObjective: Fractal bone analysis (Hmean) is a texture parameter ă reflecting bone microarchitecture. The BMA device (D3ATM Medical ă Systems, Orleans, France) is a high-resolution X-ray device that allows ă assessment of bone texture analysis. We aimed to measure Hmean in ă rheumatoid arthritis patients at the second and third metacarpal bones, ă at baseline and after 1 year of follow-up, and to assess the ă relationship of Hmean and rheumatoid arthritis disease parameters. ă Methods: Patients with rheumatoid arthritis according to ACR criteria ă were included. They were assessed over 1 year, in the context of a ă prospective study conducted in Maastricht. For this substudy, activity ă of the disease was assessed by erythrocyte sedimentation rate, ă C-reactive protein and Disease Activity Score 28 performed at each ă visit. Radiographic bone damage was assessed using hand and feet ă radiographs at baseline and on a 1-year basis. The bone texture ă parameters were evaluated on the second and third metacarpal heads of ă the left hand using BMA device. ă Results: One hundred and sixty-five rheumatoid arthritis patients were ă included in this study. At baseline, Hmean was negatively correlated ă with age [r= 0.22 (13= 0.013)] and erythrocyte sedimentation rate ă [r= 0.16 (13= 0.039)]. No significant correlation was found between ă Hmean and Disease Activity Score, disease activity Visual Analog Scale, ă daily corticosteroid dose and C-reactive protein. There was a ă significant increase in Hmean of second and third metacarpal bones over ă 1 year (1.6% and 1.3%, P< 0.01) except in patients with local second ă and third metacarpal bones erosion. ă Conclusion: The bone texture parameter Hmean is influenced by age, ă inflammation and local erosions in rheumatoid arthritis. (C) 2013 ă Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All ă rights reserved

L’alliance thérapeutique est associée à l’adhésion au traitement chez les enfants atteints d’arthrite juvénile idiopathique

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Therapeutic alliance is associated to treatment adherence in children with juvenile idiopathic arthritis

International audienceTherapeutic alliance (TA) is the agreement between caregiver and patient during the care process. Therapeutic adherence is a major issue for the management of Juvenile Idiopathic Arthritis (JIA) requiring child's strong ability to follow treatments. The aim of this study was to evaluate the relationship between TA and adherence in patients with JIA.Methods: Observational, cross-sectional, multicenter study. Children, with JIA, aged 8-16, were included. Children, parents and physicians completed the Helping Alliance Questionnaire (HAQ-CP) for assessing TA. Adherence was measured using the Child/Parent Adherence Report Questionnaire (CARQ & PARQ). Demographic data, disease characteristics, current treatments and social environment were collected. The univariate relationship between TA and adherence, was studied by Pearson correlation coefficient. The multivariate analysis used a multiple linear regression model.Results: A total of 119 patients were included: 68.9% girls, mean age (SD) 12.4 (2.9) years, disease duration 73.1 (48.2) months. JIA was in remission (52%), in low activity (32%) and active (16%). TA scores were high (≥80/100) for children, parents and physicians. HAQCP was highly correlated with CARQ (r=0.31; P<0.001) PARQ (r=0.37; P<0.001). In univariate analysis, disease activity (P<0.05), place of residence (P<0.01) and family status (P<0.01) were associated with child's TA. In multivariate analysis, only the place of residence (P<0.001) and the family status (P<0.05) remained associated with TA.Conclusion: TA strongly influences therapeutic adherence and therefore may be important for treatment effectiveness

Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise

International audienceAbstract Objectives To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA. Methods Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients. Results Intra-reader reliability was good for binary scoring (Cohen’s kappa 0.62, range 0.47–0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66–0.86; 0.76, 0.61–0.84; and 0.87, 0.77–0.94, respectively); and moderate for effusion (0.55, 0.24–0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light’s kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54–0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40–0.60, respectively). We obtained the best scores for the knee (0.71, 0.54–0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children. Conclusions This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies

Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise

Objectives. To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA. Methods. Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients. Results. Intra-reader reliability was good for binary scoring (Cohen’s kappa 0.62, range 0.47-0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66-0.86; 0.76, 0.61-0.84; and 0.87, 0.77-0.94, respectively); and moderate for effusion (0.55, 0.24-0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light’s kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54-0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40-0.60, respectively). We obtained the best scores for the knee (0.71, 0.54-0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children. Conclusions. This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies

Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial

International audienceObjectives: To compare the benefits of a tight-control/treat-to-target strategy (TC/T2T) in axial spondyloarthritis (axSpA) with those of usual care (UC).Methods: Pragmatic, prospective, cluster-randomised, controlled, open, 1-year trial (NCT03043846). 18 centres were randomised (1:1). Patients met Axial Spondylo Arthritis International Society (ASAS) criteria for axSpA, had an Ankylosing Spondylitis Disease Activity Score (ASDAS) ≥2.1, received non-optimal treatment by non-steroidal anti-inflammatory drugs and were biologic-naive.Interventions: (1) TC/T2T: visits every 4 weeks and prespecified strategy based on treatment intensification until achieving target (ie, ASDAS <2.1); (2) UC: visits every 12 weeks and treatment at the rheumatologist's discretion.Main outcome: Percentage of patients with a ≥30% improvement on the ASAS-Health Index (ASAS-HI). Other efficacy outcomes and adverse events were recorded. A health economic evaluation was performed.Statistical analysis: Two-level mixed models were used to estimate efficacy outcomes. Cost-effectiveness was assessed by the incremental cost per quality-adjusted life-year (QALY) gained for TC/T2T versus UC.Results: 160 patients were included (80/group). Mean (SD) age was 37.9 (11.0) years and disease duration was 3.7 (6.2) years; 51.2% were men. ASDAS at inclusion was 3.0 (0.7), and ASAS-HI was 8.6 (3.7). ASAS-HI improved by ≥30% in 47.3% of the TC/T2T arm and in 36.1% of those receiving UC (non-significant). All secondary efficacy outcomes were more frequent in the TC/T2T arm, although not all statistically significant. Safety was similar in both arms. From a societal perspective, TC/T2T resulted in an additional 0.04 QALY, and saved €472 compared with UC.Conclusion: TC/T2T was not significantly superior to UC for the primary outcome, while many secondary efficacy outcomes favoured it, had a similar safety profile and was favourable from a societal health economic perspective