Association between the TNFRII 196R allele and diagnosis of rheumatoid arthritis

Tumour necrosis factor (TNF)-α plays a key role in the pathogenesis of rheumatoid arthritis (RA). It binds to two receptors, namely TNF receptor (TNFR)I and TNFRII. Several studies have suggested an association between TNFRII 196R/R genotype and RA. The objective of the present study was to evaluate the predictive value of the TNFRII 196R allele for RA diagnosis and prognosis in a cohort of patients with very early arthritis. We followed up a total of 278 patients recruited from the community, who had swelling of at least two joints that had persisted for longer than 4 weeks but had been evolving for less than 6 months, and who had not received disease-modifying antirheumatic drugs or steroid therapy. At 2 years, patients were classified according to the American College of Rheumatology criteria. All patients were genotyped with respect to TNFRII 196M/R polymorphism. Radiographs of hands and feet (read according to the modified Sharp method) and the Health Assessment Questionnaire were used to quantify structural and functional severity. The cohort of 278 patients was found to include 156 and 122 RA and non-RA patients, respectively. The TNFRII 196R allele was found to be associated with RA (P = 0.002). However, progression of radiographic severity and Health Assessment Questionnaire scores over 1 year did not differ between carriers of the 196R allele and noncarriers. Our findings suggest that the TNFRII 196R allele may be associated with RA diagnosis but that it does not predict early radiographic progression or functional severity in patients with very early, unclassified arthritis

Evaluation globale standardisée systématique des rhumatismes inflammatoires chroniques: intérêts et limites

Introduction: National and international recommendations call for an annual standardized systematic holistic review in the management of chronic inflammatory rheumatism (CIR). This includes an assessment of disease activity and severity, as well as patient education on the disease, knowledge of pharmacological and non-pharmacological treatments, adherence to treatment and screening for comorbidities. Our study aims to recall the definition of a holistic review (HR), to present the evidence of their effectiveness and to give an overview of HR practices in France. Methods: A literature review was conducted in the Pubmed database to identify randomized controlled trials (RCTs) or meta-analyses reporting the efficacy of a multidisciplinary intervention in ICR or other chronic diseases. Two online surveys were sent to all rheumatology departments in France and to a sample of independent rheumatologists, with 34 and 19 questions respectively. These questionnaires were used to determine the profile of the responding center/rheumatologist, the existence of an HR and the obstacles or facilitators to its implementation. Results: Literature search yielded 872 articles, 24 of which were finally included: 16 RCTs and 8 meta-analyses. Only 3 articles concerned ICRs, including one meta-analysis of 10 RCTs in rheumatoid arthritis (RA). Of these 3 studies, 2 RCTs in systemic lupus and systemic sclerosis showed a favorable impact of a multidisciplinary approach on SLEDAI and grip strength and mouth opening respectively, while the meta-analysis in RA showed no benefit on disability or disease activity.The questionnaire was answered by 72 centers and 186 rheumatologists. A third of the centers had already implemented a HR during an day hospitalization. 70 % of centers estimated that they managed more than 10 patients per month, devoting an average of 35 minutes of rheumatologist time and 90 minutes of cumulative time for all other healthcare professionals (HCPs) involved in the program. Most of the HCPs involved were nurses (92 %), dieticians (56 %) and physiotherapists (56 %). The main obstacles to setting up a HR were the lack of paramedical resources, lack of economic value and lack of support from treating rheumatologists, while patient motivation was seen as a facilitating factor. Conclusion: Although HR is recommended, there is little evidence of its effectiveness in ICR. Only 36 % of responding centers have implemented such a program. This survey helps to identify the obstacles and facilitators, and to find solutions for extending this practice

Pronostic de la polyarthrite rhumatoïde (étude de la valeur informative des critères cliniques, biologiques, immunologiques et génétiques dans une cohorte de 126 patients atteints de polyarthrite rhumatoïde récente, suivis en ville)

ROUEN-BU Médecine-Pharmacie (765402102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Intérêt de l éducation thérapeutique collective dans la gestion de biothérapie par voie sous cutanée chez des patients atteints de rhumatisme inflammatoire chronique

Objectif. Evaluation de l apport de séances collectives d éducation thérapeutique (ETPC) dans l acquisition des bonnes pratiques pour la gestion de biothérapie sous-cutanée (SC) dans le cadre de rhumatismes inflammatoires chroniques (RIC). Matériels et méthodes. Notre équipe d éducation thérapeutique a élaboré un auto-questionnaire évaluant - la technique d injection - les éléments de surveillance - les conduites à tenir selon des situations cliniques - la mise à jour vaccinale - le suivi médical (rhumatologique, dentaire et gynécologique) et le besoin d informations pour les patients porteurs d'un RIC traités par biothérapie SC. Les instaurations de biothérapie SC ont lieu en hôpital de jour (HDJ) où tous les patients reçoivent une séance d'ETP individuelle. Le groupe ETPC comprend les patients volontaires qui suivent une séance d ETPC dans les trois à six mois suivant le début de la biothérapie SC. Les séances collectives regroupent 6 à 12 patients. Elles se déroulent en 3 temps - remplissage de l auto-questionnaire - rappel des modalités techniques de l injection - rappel des conduites à tenir selon les situations cliniques. Puis les participants sont réévalués à douze mois lors du renouvellement hospitalier de la biothérapie par le même questionnaire. Le groupe contrôle est constitué des patients vus en consultation de renouvellement annuel qui ont seulement bénéficié de la séance d ETP individuelle en HDJ. A un an, on compare les questionnaires du groupe ETPC au groupe contrôle. Par ailleurs, pour le groupe ETPC, on compare le questionnaire précédant la séance d ETPC au questionnaire rempli à un an pour évaluer la progression de leurs compétences. Résultats. Entre juillet 2009 et juillet 2012 : 64 patients ayant bénéficié d'une séance d'ETPC ont pu être réévalués à 1 an et comparés à 305 patients sans ETPC . A un an, le groupe ETPC a significativement montré par le test exact de Fisher de meilleures compétences techniques et de gestion des risques infectieux pneumologiques, urinaires, cutanés, ORL (p<0,001), abdominaux (p=0,008), chirurgicaux (p=0,009) et dentaires (p=0,015) par rapport au groupe contrôle. La connaissance des mises à jour vaccinales a également été statistiquement meilleure. Le groupe ETPC a significativement progressé entre la séance collective et l évaluation annuelle essentiellement dans la gestion des risques infectieux pulmonaires, cutanés, ORL et urinaires. Le besoin d informations a également été satisfait. Discussion. La gestion de situations concrètes sous biothérapie a été évaluée grâce à un questionnaire abordant la technique et les situations cliniques. L intérêt des séances d ETPC est démontré par rapport au groupe contrôle mais aussi au sein du groupe ETPC via les progrès identifiés dans les six mois suivant la séance collective. On peut penser que l inclusion sur la base du volontariat a induit une sélection de patients plus désireux d informations avec de meilleures compétences initiales. Conclusion. Dans notre étude, l'ETPC permet l acquisition de meilleures compétences dans la gestion des biothérapies sous-cutanées avec maintien de ces acquis à un an.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Detection of educational needs of patients with inflammatory arthritis: feasibility and results in routine care

Background: Therapeutic Patient education (TPE) is part of the disease management of inflammatory rheumatic diseases. The detection of unmet educational needs by the rheumatologist may increase the patients’ motivation for education. Objectives: (1) Assess the feasibility of a systematic procedure to detect patients educational needs in current practice. (2) Determine the type of patients’ needs. Methods: In a pragmatic prospective pilot study, the rheumatologist invited outpatients with rheumatoid arthritis (RA) or spondyloarthritis (SpA) to complete a questionnaire of educational diagnosis. The questionnaire was elaborated according to the French National Health Authority guidelines. Six domains were assessed: knowledge and beliefs about disease and treatments, impact on family and social life, impact on professional life, emotional well-being and management by the health care system. For each domain, patients were asked whether they encountered difficulties or needed more information or help. Results: The questionnaire was proposed by the rheumatologist to 68 patients of the 120 outpatients during a 4 month period in hospital or private practice. 53/68 (78%) questionnaires were completed. The reasons of non-distribution were: lack of time (27), severe medical condition (20), oversight (11), literacy or cognitive barriers (6), recent contact with a TPE program (6), other reasons (10). Some patients experiencing language or cultural barriers were subsequently helped by a hospital pharmacist to fulfill the questionnaire. Seventy-four questionnaires were finally analyzed (55 RA and 19 SpA patients, mean age 57 years (24-87)) l’sixty-four percent patients expressed at least one educational need. Patients experienced difficulties or needed information or help in relation to the disease (14% experienced difficulties/55% needed information or help), treatment (respectively 10%/39%), social and family life (33%/35%), professional life (53%/44%), health care system (11%/34%), emotional status (38%/49%).There was no statistical difference between the expression of at least one educational need and age, type of arthritis, duration of disease, hospital or private care, biologic treatment. 61% patients wished to meet another health professional or other patients. The questionnaire was considered helpful by 77% patients. Only 3 patients found the questionnaire too long and none thought it was intrusive. Conclusions: Detection of patients’ educational needs in current practice is feasible using a self-administrated questionnaire with good acceptability. This procedure is a first step in an educational process. For some patients having language or cultural barriers, the help of another professional is essential. Educational needs are high in patients with arthritis. They are widely underestimated in routine care and include major socio-professional and psychological issues

Mise en place d’une consultation spécialisée « Douleur et Travail » au CHU de Rouen

International audienc

Assessment of adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis

International audienc

Relapse in rheumatoid arthritis patients undergoing dose reduction and withdrawal of biologics: are predictable factors more relevant than predictive parameters? An observational prospective real-life study

International audienc

Impact of ACR 2010 fibromyalgia criteria fulfillment on disease activity evaluation in patients with axial spondyloarthritis treated with infliximab

International audienc