A pilot study of IL-1 inhibition by anakinra in acute gout

Monosodium urate crystals stimulate monocytes and macrophages to release IL-1β through the NALP3 component of the inflammasome. The effectiveness of IL-1 inhibition in hereditary autoinflammatory syndromes with mutations in the NALP3 protein suggested that IL-1 inhibition might also be effective in relieving the inflammatory manifestations of acute gout. The effectiveness of IL-1 inhibition was first evaluated in a mouse model of monosodium urate crystal-induced inflammation. IL-1 inhibition prevented peritoneal neutrophil accumulation but TNF blockade had no effect. Based on these findings, we performed a pilot, open-labeled study (trial registration number ISRCTN10862635) in 10 patients with gout who could not tolerate or had failed standard antiinflammatory therapies. All patients received 100 mg anakinra daily for 3 days. All 10 patients with acute gout responded rapidly to anakinra. No adverse effects were observed. IL-1 blockade appears to be an effective therapy for acute gouty arthritis. The clinical findings need to be confirmed in a controlled study

Cranial neuropathies in granulomatosis with polyangiitis (Wegener's): a case-based review

The purpose of this case-based review is to highlight cranial nerve involvement in granulomatosis with polyangiitis (Wegener's). In this disease, cranial nerve involvement may be less frequent than other neurological manifestations, but often goes unrecognized by physicians as a sign of the disease, and its prevalence and importance is likely underestimated. Awareness of this aspect of the disease is necessary to make the proper diagnosis rapidly, as it can be a major feature of a patient's presentation. We also briefly discuss the known pathogenic mechanisms, which could be important when selecting the best therapeutic option

Gestion du risque d'avalanche et action collective dans les Alpes suisses

Abstract : The residents of mountain communities exposed to avalanches know the risks associated with such events through their own field of experience. Under pressure from the public authorities, the risks are managed through the implementation of protective, zoning and monitoring measures, which are generally well accepted by the local population. However, two case studies show that effective action may be delayed for a long time because of financial reasons or disagreement between the social players involved. The local population is more concerned about economic and social developments than a possible aggravation of the situation regarding avalanche risks.Partie III - Action collective et gestion territoriale Part III - Collective Action and planning Gestion du risque d'avalanche et action collective dans les Alpes suisses Management of avalanche risks and collective action in the Swiss Alps Laurent Bridel, Sylvie Dulex Putallaz, Anne Herold-Revaz Résumé : Les résidants des communes montagnardes exposées aux avalanches connaissent ce risque dans la mesure de leur proche expérience. Sous la pression des autorités, le risque est géré par des mesures de protection, de zonage ou de surveillance de manière générale bien acceptées par la population. Toutefois, les deux études de cas montrent que les actions efficaces peuvent être longuement différées pour des raisons financières ou de désaccord entre les divers acteurs sociaux concernés. La population de montagne est plus soucieuse de l'évolution économique et sociale que d'une possible aggravation du risque d'avalanche.Bridel Laurent, Dulex Putallaz Sylvie, Herold-Revaz Anne. Gestion du risque d'avalanche et action collective dans les Alpes suisses. In: Revue de géographie alpine, tome 86, n°2, 1998. pp. 77-90

Prescription of hypnotics and tranquilisers at the Geneva prison's outpatient service in comparison to an urban outpatient medical service

OBJECTIVES: Examine whether an overconsumption of tranquillizers exists in prison and discuss possible reasons. METHODS: Comparative study during three weeks at Geneva: prison outpatient service and Medical Policlinic (MP) of the University Hospital. RESULTS: When comparing the 113 (prison) and 151 (MP) male patients younger than 39 years, we found important differences concerning the quality and quantity of prescriptions of psychoactive drugs: ten times more prison patients than patients from the MP were treated with benzodiazepines (BZD). The differences persisted even when considering only prisoners who were not known to be street drug, alcohol or long time BZD consumers. CONCLUSIONS: The differences cannot be explained by the high percentage of drug addicts in prison. Our results suggest the importance of factors related to the prison environment

Evaluation of drug prescription at the Geneva prison's outpatient service in comparison to an urban outpatient medical service

PURPOSE: To analyse non-psychotropic drug prescription in a prison outpatient clinic in comparison with an urban medical outpatient service. METHODS: Comparative study during 3 weeks at Geneva: prison outpatient service and medical policlinic (MP) of the University Hospital. RESULTS: The most often prescribed non-psychotropic drugs at the Geneva prison were systemic analgesics (mostly non-steroidal anti-inflammatory drugs (NSAID) and paracetamol), dermatologicals, systemic anti-infectives and drugs for the gastrointestinal system. For most types of non-psychotropic drugs, frequency of prescription as well as the prescribing patterns were similar in the prison ambulatory service and the urban MP. Dermatologicals were prescribed more frequently at the prison than at the MP. Analgetics have been prescribed mainly for osteoarticulary reasons, especially low back pain at the MP, and for traumatism and headache at the prison. CONCLUSIONS: The higher frequency of dermatological prescriptions could be due to prison environmental factors. We do not have arguments for any overprescription of analgesics or other non-psychotropic drugs. The data did not show any prescription or co-prescription of several substances that violated clinical guidelines

La représentation des risques par les habitants: Perception différenciée et adaptations psychologiques

International audienc

Inhibition of monosodium urate-induced peritoneal neutrophil influx by anti-IL-1 treatment

<p><b>Copyright information:</b></p><p>Taken from "A pilot study of IL-1 inhibition by anakinra in acute gout"</p><p>http://arthritis-research.com/content/9/2/R28</p><p>Arthritis Research & Therapy 2007;9(2):R28-R28.</p><p>Published online 12 Mar 2007</p><p>PMCID:PMC1906806.</p><p></p> BALB/C mice were injected intraperitoneally with 0.5 mg monosodium urate (MSU) crystals together with PBS or anti-IL-1RI mAb (200 μg) or anakinra (200 μg). BALB/C mice were injected intraperitoneally with 0.5 mg MSU crystals together with PBS or anti-TNF mAb (200 μg) or anakinra (200 μg). Neutrophil influx in the peritoneum was quantified 6 hours later. Values are the mean ± standard error of the mean of five mice per group. An unpaired Student's test was used to calculate the value

Genres de la presse écrite et analyse de discours

Non seulement les genres conditionnent l’écriture des articles, mais les quotidiens se distinguent par les genres qu’ils favorisent. Les articles ici réunis reprennent une partie des communications données lors d'un colloque tenu à l'Université de Lausanne, en février 2000. Ils abordent la question des genres de la presse écrite sous un double éclairage : historique, attentif à l'évolution et aux différences culturelles des genres, et plus proprement linguistique, centré sur la description de genres spécifiques : du fait divers à la nécrologie, en passant par l’éditorial, le billet et les relations de paroles et la question des hyperstructures.Cette réunion de chercheurs allemands, belges, espagnols, français et suisses illustre le travail collectif mené dans des domaines disciplinaires aussi différents que l’apprentissage du français langue étrangère, les sciences de la communication et la linguistique du discours. L’analyse des discours journalistiques n’apparaît ainsi pas comme un territoire réservé, mais comme un espace de confrontation de méthodes et d’éclairages complémentaires

B cell depletion may be more effective than switching to an alternative anti-tumor necrosis factor agent in rheumatoid arthritis patients with inadequate response to anti-tumor necrosis factor agents

Objective: Patients with rheumatoid arthritis (RA) in whom the response to anti-tumor necrosis factor (anti-TNF) therapy is inadequate have several therapeutic options, such as switching to an alternative anti-TNF agent or initiating B cell-depleting therapy with rituximab (RTX). Although both therapeutic options have been proven effective in trials, no head-to-head comparisons are available. The aim of this study was to compare the effectiveness of RTX with that of an alternative anti-TNF agent in the management of patients with RA who had an inadequate response to anti-TNF therapy.Methods: This prospective cohort study was nested within the Swiss Clinical Quality Management RA cohort and included all patients who had an inadequate response to at least 1 anti-TNF agent and subsequently received either 1 cycle of RTX or an alternative anti-TNF agent. The primary outcome was the evolution of RA disease activity (as measured on the Disease Activity Score in 28 joints [DAS28]), which was analyzed using multivariate regression models for longitudinal data.Results: One hundred sixteen patients with RA were included; 50 patients received 1 cycle of RTX, and 66 patients were treated with a second or a third alternative anti-TNF agent. At baseline, there were no significant differences between the 2 groups in age, sex, disease duration, and disease activity. Evolution of the DAS28 was more favorable in the group that received RTX compared with the group that received an alternative anti-TNF agent (P = 0.01). At 6 months, the mean decrease in the DAS28 was -1.61 (95% confidence interval [95% CI] -1.97, -1.25) among patients receiving RTX and -0.98 (95% CI -1.33, -0.62) among those receiving subsequent anti-TNF therapy.Conclusion: The results of this observational study suggest that treatment with RTX may be more effective than switching to an alternative anti-TNF agent in patients with RA in whom active disease persists despite anti-TNF therapy.</p