3D X-ray Microtomography Volume Correlation to Study Fatigue Crack Growth

International audienceGlobal digital volume correlation is used to analyze a series of computed tomography images of a nodular graphite cast iron specimen subjected in situ to a fatigue test. From the obtained displacement field, a specific procedure is implemented to extract stress intensity factors all along the crack front. The proposed methodology allows one to measure key parameters in fatigue crack propagation directly from 3D images

Patients' and Practitioners' Views of Knee Osteoarthritis and Its Management: A Qualitative Interview Study

PURPOSE: To identify the views of patients and care providers regarding the management of knee osteoarthritis (OA) and to reveal potential obstacles to improving health care strategies. METHODS: We performed a qualitative study based on semi-structured interviews of a stratified sample of 81 patients (59 women) and 29 practitioners (8 women, 11 general practitioners [GPs], 6 rheumatologists, 4 orthopedic surgeons, and 8 [4 GPs] delivering alternative medicine). RESULTS: Two main domains of patient views were identified: one about the patient-physician relationship and the other about treatments. Patients feel that their complaints are not taken seriously. They also feel that practitioners act as technicians, paying more attention to the knee than to the individual, and they consider that not enough time is spent on information and counseling. They have negative perceptions of drugs and a feeling of medical uncertainty about OA, which leads to less compliance with treatment and a switch to alternative medicine. Patients believe that knee OA is an inevitable illness associated with age, that not much can be done to modify its evolution, that treatments are of little help, and that practitioners have not much to propose. They express unrealistic fears about the impact of knee OA on daily and social life. Practitioners' views differ from those of patients. Physicians emphasize the difficulty in elaborating treatment strategies and the need for a tool to help in treatment choice. CONCLUSIONS: This qualitative study suggests several ways to improve the patient-practitioner relationship and the efficacy of treatment strategies, by increasing their acceptability and compliance. Providing adapted and formalized information to patients, adopting more global assessment and therapeutic approaches, and dealing more accurately with patients' paradoxal representation of drug therapy are main factors of improvement that should be addressed

A Need to Meet Patient Expectations

Funding Information: Open access funding provided by Università degli Studi di Palermo within the Nicola Veronese reports personal fees from IBSA, Mylan, and Fidia outside of the submitted work. Cyrus Cooper reports personal fees from Alliance for Better Bone Health, Amgen, Eli Lilly, GSK, Medtronic, Merck, Novartis, Pfizer, Roche, Servier, Takeda, and UCB outside of the submitted work. Jean-Yves Reginster reports CRUI-CARE Agreement. Funding Information:grants from IBSA-Genevrier, Mylan, CNIEL, and Radius Health (through his institution); consulting fees from IBSA-Genevrier, Mylan, CNIEL, Radius Health, and Pierre Fabre; fees for participation in review activities from IBSA-Genevrier, Mylan, CNIEL, Radius Health, and Teva; and payment for lectures from Ag-Novos, CERIN, CNIEL, Dairy Research Council (DRC), Echolight, IBSA-Genevrier, Mylan, Pfizer Consumer Health, Teva, and Theramex outside of the submitted work. Olivier Bruyère reports grants or lecture fees from Amgen, Aptissen, Biophytis, IBSA, MEDA, Mylan, Novartis, Sanofi, Servier, SMB, TRB Chemedica, UCB, and Viatris outside of the submitted work. Ali Mobasheri declares personal fees from Abbott, Abbvie, Achē Laboratórios Farmacêuticos, Galapagos, GSK Consumer Healthcare, Kolon TissueGene, Laboratoires Expansciences, Merck, Pacira Biosciences, Pfizer, Sanofi, and Servier. François Rannou reports grants or lecture fees from Pierre Fabre, Mylan, MSD, Thuasne, IBSA, Pfizer, Genévrier, Expanscience, Scarcell, Skindermic, and Peptinov. Ida K. Haugen reports grants from Pfizer and is a consultant for Novartis outside of the submitted work. Elaine M. Dennison declares grants/fees from Pfizer, Lilly, UCB, and Viatris. Philip G. Conaghan is supported in part by the National Institute for Health and Care Research (NIHR) Leeds Biomedical Research Centre (the views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health), and reports consultancies or lecture fees from AbbVie, Amgen, AstraZeneca, Eli Lilly, Galapagos, GSK, Grunenthal, Pfizer, Novartis, and UCB. Nasser M. Al-Daaghri, Antonella Fioravanti, Sara Cheleschi, Jean-Pierre Pelletier, Maarten de Wit, Etienne Cavalier, Radmila Matijevic, Germain Honvo, Régis Pierre Radermecker, René Rizzoli, Jaime Branco, Andrea Laslop, María Concepción Prieto Yerro, Alberto Migliore, Gabriel Herrero-Beaumont, and Nicholas R. Fuggle declare that they have no conflicts of interest. Publisher Copyright: © 2022, The Author(s).Knee osteoarthritis (OA) is one of the most common and disabling medical conditions. In the case of moderate to severe pain, a single intervention may not be sufficient to allay symptoms and improve quality of life. Examples include first-line, background therapy with symptomatic slow-acting drugs for OA (SYSADOAs) or non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) performed a review of a multimodal/multicomponent approach for knee OA therapy. This strategy is a particularly appropriate solution for the management of patients affected by knee OA, including those with pain and dysfunction reaching various thresholds at the different joints. The multimodal/multicomponent approach should be based, firstly, on different combinations of non-pharmacological and pharmacological interventions. Potential pharmacological combinations include SYSADOAs and NSAIDs, NSAIDs and weak opioids, and intra-articular treatments with SYSADOAs/NSAIDs. Based on the available evidence, most combined treatments provide benefit beyond single agents for the improvement of pain and other symptoms typical of knee OA, although further high-quality studies are required. In this work, we have therefore provided new, patient-centered perspectives for the management of knee OA, based on the concept that a multimodal, multicomponent, multidisciplinary approach, applied not only to non-pharmacological treatments but also to a combination of the currently available pharmacological options, will better meet the needs and expectations of patients with knee OA, who may present with various phenotypes and trajectories.publishersversionpublishe

Association of Gender with Clinical Expression, Quality of Life, Disability, and Depression and Anxiety in Patients with Systemic Sclerosis

OBJECTIVES: To assess the association of gender with clinical expression, health-related quality of life (HRQoL), disability, and self-reported symptoms of depression and anxiety in patients with systemic sclerosis (SSc). METHODS: SSc patients fulfilling the American College of Rheumatology and/or the Leroy and Medsger criteria were assessed for clinical symptoms, disability, HRQoL, self-reported symptoms of depression and anxiety by specific measurement scales. RESULTS: Overall, 381 SSc patients (62 males) were included. Mean age and disease duration at the time of evaluation were 55.9 (13.3) and 9.5 (7.8) years, respectively. One-hundred-and-forty-nine (40.4%) patients had diffuse cutaneous SSc (dcSSc). On bivariate analysis, differences were observed between males and females for clinical symptoms and self-reported symptoms of depression and anxiety, however without reaching statistical significance. Indeed, a trend was found for higher body mass index (BMI) (25.0 [4.1] vs 23.0 [4.5], p = 0.013), more frequent dcSSc, echocardiography systolic pulmonary artery pressure >35 mmHg and interstitial lung disease in males than females (54.8% vs 37.2%, p = 0.010; 24.2% vs 10.5%, p = 0.003; and 54.8% vs 41.2%, p = 0.048, respectively), whereas calcinosis and self-reported anxiety symptoms tended to be more frequent in females than males (36.0% vs 21.4%, p = 0.036, and 62.3% vs 43.5%, p = 0.006, respectively). On multivariate analysis, BMI, echocardiography PAP>35 mmHg, and anxiety were the variables most closely associated with gender. CONCLUSIONS: In SSc patients, male gender tends to be associated with diffuse disease and female gender with calcinosis and self-reported symptoms of anxiety. Disease-associated disability and HRQoL were similar in both groups

Frequency and Interrelations of Risk Factors for Chronic Low Back Pain in a Primary Care Setting

INTRODUCTION: Many risk factors have been identified for chronic low back pain (cLBP), but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs) for cLBP. METHODS: A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA) was performed to study their interrelations. RESULTS: A total of 2068 GPs (68.9%) included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1%) and initial limitation of activities of daily living (66.4%). For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0%) and frequent heavy lifting at work (65.5%). On MCA, we identified 3 risk-factor dimensions (axes) for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension. DISCUSSION: Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a "work-related" dimension are the most important cLBP risk factors in the working population

Design of Group IIA Secreted/Synovial Phospholipase A2 Inhibitors: An Oxadiazolone Derivative Suppresses Chondrocyte Prostaglandin E2 Secretion

Group IIA secreted/synovial phospholipase A2 (GIIAPLA2) is an enzyme involved in the synthesis of eicosanoids such as prostaglandin E2 (PGE2), the main eicosanoid contributing to pain and inflammation in rheumatic diseases. We designed, by molecular modeling, 7 novel analogs of 3-{4-[5(indol-1-yl)pentoxy]benzyl}-4H-1,2,4-oxadiazol-5-one, denoted C1, an inhibitor of the GIIAPLA2 enzyme. We report the results of molecular dynamics studies of the complexes between these derivatives and GIIAPLA2, along with their chemical synthesis and results from PLA2 inhibition tests. Modeling predicted some derivatives to display greater GIIAPLA2 affinities than did C1, and such predictions were confirmed by in vitro PLA2 enzymatic tests. Compound C8, endowed with the most favorable energy balance, was shown experimentally to be the strongest GIIAPLA2 inhibitor. Moreover, it displayed an anti-inflammatory activity on rabbit articular chondrocytes, as shown by its capacity to inhibit IL-1β-stimulated PGE2 secretion in these cells. Interestingly, it did not modify the COX-1 to COX-2 ratio. C8 is therefore a potential candidate for anti-inflammatory therapy in joints

Effect of a Simple Information Booklet on Pain Persistence after an Acute Episode of Low Back Pain: A Non-Randomized Trial in a Primary Care Setting

Mass-media campaigns have been known to modify the outcome of low back pain (LBP). We assessed the impact on outcome of standardized written information on LBP given to patients with acute LBP.A 3-month pragmatic, multicenter controlled trial with geographic stratification.Primary care practice in France.2752 patients with acute LBP.An advice book on LBP (the "back book").The main outcome measure was persistence of LBP three months after baseline evaluation.2337 (85%) patients were assessed at follow-up and 12.4% of participants reported persistent LBP. The absolute risk reduction of reporting persistent back pain in the intervention group was 3.6% lower than in the control group (10.5% vs. 14.1%; 95% confidence interval [-6.3% ; -1.0%]; p value adjusted for cluster effect = 0.01). Patients in the intervention group were more satisfied than those in the control group with the information they received about physical activities, when to consult their physician, and how to prevent a new episode of LBP. However, the number of patients who had taken sick leave was similar, as was the mean sick-leave duration, in both arms, and, among patients with persistent pain at follow-up, the intervention and control groups did not differ in disability or fear-avoidance beliefs.The level of improvement of an information booklet is modest, but the cost and complexity of the intervention is minimal. Therefore, the implications and generalizability of this intervention are substantial.ClinicalTrials.gov NCT00343057

Analyse à large échelle du profil d'expression des gènes dans des chondrocytes articulaires soumis à un stress mécanique de type étirement (la relaxine une nouvelle cible d'intérêt dans les pathologies ostéoarticulaires ?)

Le cartilage articulaire est un tissu conjonctif spécialisé recouvrant les surfaces osseuses et assurant, avec d autres tissus comme la membrane synoviale, le bon fonctionnement des articulations. Le cartilage est composé d'un type cellulaire, le chondrocyte, qui assure la synthèse et la dégradation d une matrice extracellulaire essentielle à ses propriétés mécaniques. Les articulations, en conditions physiologique et pathologique, sont soumises à deux stress principaux agissant sur l homéostasie du cartilage : le stress mécanique et le stress inflammatoire. Le premier objectif de ma thèse était d étudier l effet d un stress mécanique de type étirement sur le profil d expression des gènes dans des chondrocytes articulaires de lapin en culture primaire en utilisant une approche à grande échelle (micro arrays). Nous avons identifié 36 et 57 transcrits répertoriés dans le génome de lapin et dont les taux d expression sont respectivement augmentés et diminués par un étirement équibiaxial cyclique (5%, 1Hz, 20h). Certains gènes sont connus pour leur implication dans l inflammation, la mort cellulaire et la dégradation matricielle. Parmi eux, celui de la relaxine (RLN) était le gène le plus induit par l étirement. La relaxine, hormone peptidique de la superfamille de l insuline/relaxine, est connue pour son implication dans la reproduction et la grossesse. En revanche son rôle dans le cartilage articulaire restait à étudier. Le deuxième objectif de ma thèse était, par conséquent, de caractériser la fonction de la RLN dans le cartilage. Mes résultats de RT PCR quantitative montrent pour la première fois que la quantité des transcrits de la RLN est augmentée par le stress mécanique et le stress inflammatoire (traitement par l interleukine 1 ) dans des chondrocytes articulaires de lapin. De plus, la quantité des transcrits de la RLN est diminuée au cours de la dédifférenciation des chondrocytes. Dans un modèle de gonarthrose induite chez la souris par déstabilisation du ménisque médial, j ai montré par immunofluorescence que la RLN est principalement présente au niveau des couches superficielles du cartilage de genou et que son expression diminue dans le cartilage arthrosique par rapport au cartilage normal. De plus, le traitement par de la RLN de chondrocytes de lapin augmente l activité de la métalloprotéinase MMP 9 impliquées dans la dégradation du cartilage. En conclusion, cette étude montre que la RLN est sensible aux stress mécanique et inflammatoire et la dédifférenciation des chondrocytes. Elle suggère que cette hormone pourrait moduler l homéostasie du cartilage. La RLN est donc une cible potentielle d intérêt dans les pathologies ostéoarticulaires.The articular cartilage is a specialized conjunctive tissue covering bone surfaces. It ensures, together with other tissues like the synovial membrane, the right functioning of the articulations. The cartilage is formed of one cellular type, the chondrocyte, which is responsible for the synthesis and degradation of the extracellular matrix required for its mechanical properties. The joints, under physiological and pathological conditions, are subjected to two main types of stress that affect cartilage homeostasis: mechanical stress and inflammatory stress. The first objective of my PhD thesisis is to study the effect of stretching, one type of mechanical stress, on the gene expression profile in rabbit articular chondrocytes in culture using a large scale approach (micro arrays). 36 and 57 transcripts of the rabbit genome which are up regulated and down regulated by equibiaxial cyclic tensile stretching (5%, 1Hz, 20h) respectively were identified. Some of these genes are known for their implication in inflammation, cell death and matrix degradation. Among them, the relaxin (RLN) gene is the most induced by stretching. RLN is a peptide hormone that belongs to the insulin/relaxin superfamily. It is known for its implication in reproduction and pregnancy. However, the role of RLN in cartilage is still to be studied. The second objective of my PhD thesis is, consequently, to characterize the function of RLN in cartilage. My qRT PCR results show, for the first time, that the RLN transcript levels increase upon mechanical and inflammatory (interleukin 1 treatment) stress in rabbit articular chondrocytes. Moreover, RLN transcript levels decrease during cell dedifferentiation. In a model of gonarthrosis induced in mice by destabilization of the medial meniscus, I showed by immunofluorescence that RLN is mainly present in the superficial layers of the knee cartilage and that its expression decreases in osteoarthritic cartilage as compared to normal cartilage. Furthermore, treatment of rabbit chondrocytes with RLN increases the activity of the metalloproteinase MMP 9 involved in cartilage degradation. In conclusion, this study shows that RLN is sensitive to mechanical and inflammatory stress and to chondrocyte dedifferentiation. It also suggests that this hormone could modulate cartilage homeostasis. Therefore, RLN is a potential target in osteoarticular pathologies.PARIS5-Bibliotheque electronique (751069902) / SudocSudocFranceF