Diagnostic accuracy of blood B-cell subset profiling and autoimmunity markers in Sjögren's syndrome.

International audienceThe aims of this study were to evaluate the diagnostic accuracy of blood B-cell subset profiling and immune-system activation marker assays in primary Sjögren's syndrome (pSS) and to assess whether adding these tools to the current laboratory item would improve the American-European Consensus Group (AECG) criteria. METHODS: In a single-center cohort of patients with suspected pSS, we tested the diagnostic performance of anti-SSA, antinuclear antibody (ANA), rheumatoid factor (RF), gammaglobulins, IgG titers, and B-cell ratio defined as (Bm2 + Bm2')/(eBm5 + Bm5), determined using flow cytometry. The reference standard was a clinical diagnosis of pSS established by a panel of experts. RESULTS: Of 181 patients included in the study, 77 had pSS. By logistic regression analysis, only ANA ≥1:640 (sensitivity, 70.4%; specificity 83.2%) and B-cell ratio ≥5 (sensitivity, 52.1%; specificity, 83.2%) showed independent associations with pSS of similar strength. In anti-SSA-negative patients, presence of either of these two criteria had 71.0% sensitivity but only 67.3% specificity for pSS; whereas combining both criteria had 96.2% specificity but only 12.9% sensitivity. Adding either of these two criteria to the AECG criteria set increased sensitivity from 83.1% to 90.9% but decreased specificity from 97.1% to 85.6%, whereas adding both criteria in combination did not substantially modify the diagnostic performance of the criteria set. The adjunction of RF + ANA ≥1:320, as proposed in the new American College of Rheumatology (ACR) criteria, did not improve the diagnostic value of anti-SSA. CONCLUSIONS: Blood B-cell subset profiling is a simple test that has good diagnostic properties for pSS. However, adding this test, with or without ANA positivity, does not improve current classification criteria

Rôle du pharmacien d'officine dans la prise en charge des lombalgies et lomboradiculalgies d'origine commune

Les lombalgies et lomboradiculalgies d'origine commune présentent une forte prévalence dans la population française, puisqu'on estime que 60 à 90% des personnes souffriront de lombalgie au cours de leur vie. La prise en charge est difficile: le soulagement de la douleur et la récupération de la mobilité représentent l'essentiel du traitement, mais le risque de rechute et de passage à la chronicité est important. Le pharmacien d'officine peut participer à cette prise en charge à de nombreux niveaux: de la délivrance de médicaments et de matériel médical ou orthopédique, à l'activité de conseiller association thérapeutiques dites naturelles et informations concernant la prévention des rechutes. Le but de cette thèse est de faire le point sur les données actuelles concernant les lombalgies et lomboradiculalgies non compliquées et leurs traitements, médicamenteux ou non.Low back pain and radiculalgia of the common sort have a high prevalence in the French population, as it is estimated that 60 to 90% of the population will suffer from low back pain at some point during their lives. Medical care is particularity difficult: easing the pain and helping with the recovery of physical mobility represent the main part of the treatment, though there is a high risk of relapse and persistency of the pathology. Pharmacists can participate in the delivery of care at many levels, from delivering drugs and orthopaedic equipment to acting as counselors. The aim of the thesis is to review current information and data concerning low back pain and radiculalgia, as well as their treatments, whether medicinal or not.RENNES1-BU Santé (352382103) / SudocLYON1-BU Santé (693882101) / SudocSudocFranceF

[Osteoarthritis epidemiology and risk factors].

International audienceOsteoarthritis is the world's most widespread rheumatic disease. It mainly affects people aged over 65. The elderly, women, obese people and those with previous injuries are most at risk from osteoarthritis

[Osteoarthritis epidemiology and risk factors].

International audienceOsteoarthritis is the world's most widespread rheumatic disease. It mainly affects people aged over 65. The elderly, women, obese people and those with previous injuries are most at risk from osteoarthritis

Is routine ankle-brachial pressure index evaluation useful in rheumatoid arthritis?

International audienc

Diagnostic value of blood B-cell subset profiling for primary Sjögren's syndrome.

International audienc

Place de l’échographie ostéo-articulaire dans la prise en charge de la pseudopolyarthrite rhizomélique

International audienc

La lymphopénie dans la polyarthrite débutante : impact sur le diagnostic et les résultats à 3ans (la cohorte Espoir)

International audienc

Lymphopenia in early arthritis: Impact on diagnosis and 3-year outcomes (ESPOIR cohort).

International audienceIn patients with early arthritis naive to disease-modifying antirheumatic drugs, we evaluated the prevalence of initial and persistent lymphopenia, underlying diagnoses, and risk of infection or malignancy.Eight hundred and thirteen patients with early arthritis included in the ESPOIR cohort had a clinical examination, laboratory tests (viral serology, immunological tests, and cytokine profile), and radiographs. We determined the prevalence of lymphopenia at baseline and after 3 years, associated factors, diagnoses, and risk of infection or malignancy.At baseline, 50/813 (6.2%) patients had lymphopenia. Lymphopenia was associated with positive rheumatoid factor (P=0.02), cytopenia (P≤0.05), hepatitis C (P=0.05), higher C-reactive protein and DAS28 (P≤0.05 for both). Cytokine profile and radiological progression were not significantly different between patients with and without lymphopenia. Suspected diagnoses at inclusion were rheumatoid arthritis (RA, n=27), unclassified arthritis (n=15), systemic lupus erythematosus (SLE, n=3), spondyloarthritis (n=2), Sjögren's syndrome (n=1), hematologic disease (n=1), and fibromyalgia (n=1). Fifteen patients out of 42 (35.7%) with initial lymphopenia had persistent lymphopenia after 3 years, including 5 with documented causes (lupus, hepatitis C, undernutrition, azathioprine, and tamoxifen); none had PVB19, HIV, or HBV infection and none experienced infections, solid or hematologic malignancies during follow-up. Final diagnoses in these 15 patients were RA (n=6), unclassified arthritis (n=6), SLE (n=1), spondyloarthritis (n=1), and fibromyalgia (n=1).Lymphopenia is rare in early arthritis. The most common rheumatic cause is RA, in which marked inflammation and other cytopenias are common. Lymphopenia in early arthritis is often short-lived, even when methotrexate is prescribed