Modélisation mathématique pour évaluer l’impact économique de mesures de prévention dans la gonarthrose

Objective: the purpose of this work was to design a decision support model to estimate the impact of a health action (weight loss in this case) in a population at risk for knee osteoarthritis (KOA) on the incidence and costs of KOA over a 5-year period. Methods: a Markov model with 2 states was developed and tested in a virtual population built from the incident cohort CHECK. Fictitious persons were randomly assigned to an initial health status per normal laws. At each cycle, these characteristics were used to determine the probability of developing KOA. To evaluate the effect of weight loss, overweight/obese patients lose 2.5 points of BMI during the 5-year period, based on the literature. The direct costs due to KOA and overweight were extracted from the literature. For the indirect costs, we evaluated the loss of productivity with the method of human capital. Results: the fictitious cohort contained 9300 patients, with 81.4% women and a mean BMI of 28.2+/- 2.7 kg/m². 6666 were overweight/obese and 788 of these, developed KOA. If this cohort benefited from management of overweight/obesity, 1586 patients would reach a BMI < 25 kg/m², and 148 KOA would be spared, ie, 23%. Savings over 5 years would be 240€ and 176€ per target patient in direct and indirect costs, respectively. Conclusion: this model allows to estimate the economic impact of weight loss in overweight/obese patients without KOA. A loss of 2.5 points of BMI would avoid 148 KOA and 416€ per target patient in 5 years.Introduction : la gonarthrose est fréquente et coûteuse. L’obésité est un facteur de risque bien identifié. L’objectif de ce travail a été de créer un modèle mathématique pour estimer l’impact de la perte de poids sur la prévalence et les coûts liés à la gonarthrose dans une population à risque. Matériels et méthodes : le modèle a estimé le nombre d’arthroses évitées sur une période de 5 ans si les patients en surpoids ou obèses perdaient 2,5 points d’IMC, dans une population virtuelle de patients ayant une douleur de genou sans gonarthrose. La population virtuelle a été construite à partir des caractéristiques de la cohorte incidente CHECK (Cohort Hip and Cohort Knee). Les coûts directs liés à la gonarthrose et au surpoids ont été extraits de la littérature. Les coûts indirects ont été évalués selon la méthode du capital humain. Résultats : une cohorte fictive de 10000 patients a été construite (81,4% de femmes, IMC moyen de 28,2+/- 2,7 kg/m², 6666 personnes en surpoids ou obèses). Sur 5 ans, il a été estimé que 788 patients auraient une gonarthrose. Si cette cohorte bénéficiait d’une prise en charge du surpoids et de l’obésité permettant une perte de 2,5 points d’IMC, 1586 personnes atteindraient un IMC < 25kg/m² et 148 gonarthroses seraient évitées, soit 23%. Un coût direct total de 240€ par patient cible serait épargné en 5 ans, et un coût de 176€ par patient cible en coûts indirect. Conclusion : dans ce modèle et selon les paramètres retenus, une perte de 5 à 9% d’IMC sur une frange de patients obèses ou en surpoids permettrait de prévenir 23% des gonarthroses devant survenir et d’éviter un coût (direct et indirect) de 416€ par patient cible en 5 ans

Intra-articular injections in thumb osteoarthritis: A systematic review and meta-analysis of randomized controlled trials

International audienceObjectivesThe objective was to assess the efficacy of intra-articular injections of corticosteroids or hyaluronic acid in thumb osteoarthritis.MethodsA systematic review of the literature was performed until August 2014. All controlled trials reporting the efficacy on pain, functional capacity and pulp pinch force of hyaluronic acid or corticosteroids in thumb osteoarthritis were selected. Pooled standardized response means (SRMs) were assessed by meta-analysis.ResultsSix trials were included and contributed to 3 meta-analyses (hyaluronic acid versus placebo, corticosteroids vs. placebo and hyaluronic acid vs. corticosteroids). Among the 428 patients included, 169 were treated with hyaluronic acid, 147 with corticosteroids and 74 with placebo. Versus placebo at week 12, hyaluronic acid (2 trials, 148 patients) lead to better functional capacity (SRM −1.14 [−1.69; −0.60]) with no difference on pain; corticosteroids (2 trials, 164 patients) lead to no difference on pain or function. When comparing hyaluronic acid vs. corticosteroids (4 trials, 304 patients), no difference was evidenced until week 12. At week 24, pain was significantly lower in the corticosteroids group (SRM 1.44 [0.14; 2.74]) and pulp pinch force higher in the hyaluronic acid group (SRM −0.75 [−3.87; −1.97]).ConclusionThis meta-analysis shows great heterogeneity. Hyaluronic acid may be useful to increase functional capacity and corticosteroids to decrease pain in thumb osteoarthritis at week 24

Increased incidence of sexually transmitted infections in Geneva, Switzerland

BACKGROUND: Focal outbreaks of sexually transmitted infections (STIs) such as syphilis and gonorrhoea have been reported in the large cities of Western Europe over the past few years. The aim of our study was to determine whether a similar trend is observed in Geneva and the situation with regard to HIV infection. METHODS: We review the incidence of syphilis, gonorrhoea, Chlamydia trachomatis and HIV in Geneva from 1999 to 2004. RESULTS: Figures indicate a steady and sustained increase in the incidence of syphilis, gonorrhoea and Chlamydia trachomatis in Geneva since 1999 that is maintained into 2004. As for HIV, the number of positive testings in Switzerland has stabilised and primary infection figures do not indicate an increase in newly acquired infections in Geneva. CONCLUSION: The situation in Geneva is similar to that observed elsewhere in Western Europe and indicates the need of public health interventions

Impairment of glyoxalase-1, an advanced glycation end-product detoxifying enzyme, induced by inflammation in age-related osteoarthritis

Abstract Background Accumulation of advanced glycation end-products (AGEs) is involved in age-related osteoarthritis (OA). Glyoxalase (Glo)-1 is the main enzyme involved in the removal of AGE precursors, especially carboxymethyl-lysine (CML). We aimed to investigate the expression of several AGEs and Glo-1 in human OA cartilage and to study chondrocytic Glo-1 regulation by inflammation, mediated by interleukin (IL)-1β. Methods Ex vivo, we quantified AGEs (pentosidine, CML, methylglyoxal-hydroimidazolone-1) in knee cartilage from 30 OA patients. Explants were also incubated with and without IL-1β, and we assessed Glo-1 protein expression and enzymatic activity. In vitro, primary cultured murine chondrocytes were stimulated with increasing concentrations of IL-1β to assess Glo-1 enzymatic activity and expression. To investigate the role of oxidative stress in the IL-1β effect, cells were also treated with inhibitors of mitochondrial oxidative stress or nitric oxide synthase. Results Ex vivo, only the human cartilage CML content was correlated with patient age (r = 0.78, p = 0.0031). No statistically significant correlation was found between Glo-1 protein expression and enzymatic activity in human cartilage and patient age. We observed that cartilage explant stimulation with IL-1β decreased Glo-1 protein expression and enzymatic activity. In vitro, we observed a dose-dependent decrease in Glo-1 mRNA, protein quantity, and enzymatic activity in response to IL-1β in murine chondrocytes. Inhibitors of oxidative stress blunted this downregulation. Conclusion Glo-1 is impaired by inflammation mediated by IL-1β in chondrocytes through oxidative stress pathways and may explain age-dependent accumulation of the AGE CML in OA cartilage