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Abstract: Recent data suggest that group B streptococcal arthritis is being increasingly diagnosed. We retrospectively reviewed the records of patients admitted to our Teaching Hospital Rheumatology Department for septic arthritis between May 2000 and May 2004 and we reviewed the relevant literature to determine the characteristics of group B streptococcal arthritis. We compared age, hospital stay duration, and number of joints involved in the patients with group B streptococcal arthritis and in those with septic arthritis due to other organisms. Of 48 consecutive patients with septic arthritis, five (10.4%) had arthritis due to group B streptococci. Mean age of these five patients was 51.6±18.3 years and mean hospital stay duration was 13.2±9.23 days. Arthritis distribution was oligoarticular in three patients, polyarticular in one patient, and monoarticular in one patient. The mean number of involved joints was significantly (P =0.005) higher in the patients with group B streptococcal arthritis than in the other patients (2.6±1.5 vs 1.1±0.4 joints). Age and hospital stay duration were not significantly different. The frequently oligoarticular or polyarticular distribution of group B streptococcal arthritis, together with the sometimes limited symptoms, may lead to diagnostic wanderings or delays. [Copyright &y& Elsevier]

The article focuses on a study which aims to track the repopulation of B cell subsets in peripheral blood as well as their subsequent homing into salivary glands in patients with primary Sjögren's syndrome treated with rituximab. The results of the study show that treatment with rituximab may be less effective at purging B cells from sites of disease in affected tissues.

This article discusses findings of a study, which identified the cells that produce BAFF in the salivary glands of patients with Sjögren's syndrome. It also analyzed BAFF receptor expression by local T and B lymphocytes. Several methods used to identify the source of BAFF include in situ hybridization of the transcripts for BAFF combined with staining of membrane markers, regular and real-time reverse transcription-polymerase chain reaction and RT-PCR of sorted single-cell T and B lymphocytes.

Abstract: Major breakthroughs have occurred with classification of B-cells into populations and subpopulations. With respect to their expression of CD5, they comprise the B1 and B2 populations, with the former further divided into B1a and B1b subpopulations. The oncologic process starts from transitional type 1 (T1) and T2 immature B-cells, through marginal zone or germinal center B-cells, ending up with memory B-cells and plasma cells (PCs). They may also be categorized based on their functional commitment with polarized B effector (Be)1 and Be2, with B-activating factor of the tumor-necrosis factor-producing B-cells, and with short-lived and long-lived PCs. Such a seemingly homogeneous family of cells has thus turned out to be a genuine mosaic of B-lymphocyte subsets. [Copyright &y& Elsevier]

Résumé: Plusieurs publications récentes suggèrent que la fréquence des arthrites septiques dues aux streptocoques bêtahémolytiques du groupe B augmente. Nous avons étudié rétrospectivement les arthrites infectieuses hospitalisées dans notre service hospitalo-universitaire de rhumatologie entre mai 2000 et mai 2004. Nous avons d''une part, à partir de nos cas d''arthrites à streptocoques du groupe B et de la revue de la littérature, décrit les caractéristiques de ces infections et d''autre part, comparé nos cas d''arthrites à streptocoques du groupe B aux cas d''arthrites septiques à germes différents concernant l''âge, la durée d''hospitalisation et le nombre d''articulations atteintes. Sur 48 arthrites septiques hospitalisées consécutivement, le streptocoque du groupe B était retrouvé chez cinq patients représentant 10,4 % du total de nos arthrites infectieuses. Dans le groupe d''arthrites septiques à streptocoque du groupe B l''âge moyen est de 51,6±18,3 ans et la durée moyenne d''hospitalisation de 13,2±9,23 jours. L''atteinte est polyarticulaire dans un cas, oligoarticulaire dans trois et monoarticulaire dans un cas. Le nombre d''articulations atteintes est significativement plus élevé (p =0,005) dans les arthrites à streptocoques du groupe B que dans le reste de la population étudiée (2,6±1,5 vs 1,1±0,4 articulations). Nous n''avons pas mis en évidence de différence significative concernant l''âge et la durée d''hospitalisation. Le caractère souvent oligo- ou polyarticulaire de ces infections, associé à une présentation clinique parfois frustre, peut rendre le diagnostic difficile et tardif. [Copyright 2006 Elsevier]

Background: Despite guidelines, poor access to appropriate care for juvenile idiopathic arthritis (JIA) patients remains a global issue. Prompt referral to a pediatric rheumatology (PR) center and effective care is known to be critical for changing the natural history of the disease and improving long-term prognosis. This project assesses socio-economic factors of delayed referral to a pediatric rheumatologist (PRst) for JIA patients in France and Switzerland within the Juvenile Inflammatory Rheumatism (JIR) Cohort. Methods: All patients diagnosed with JIA, presenting at one center of the JIRcohort in France or Switzerland with additional data on referral pathway were included. Patient characteristics at first visit to the PR center, dates of visits to healthcare providers during referral, and parent characteristics were extracted from the JIRcohort database. Results: Two hundred fifty children were included. The overall median time to first PR assessment was 2.4 months [1.3; 6.9] and ranged widely across the JIA subtypes, from 1.4 months [0.6; 3.8] for children with systemic juvenile idiopathic arthritis (sJIA) to 5.3 months [2.0; 19.1] for children with enthesitis-related arthritis (ERA). A diagnosis of ERA and an appointment with an orthopedist during the referral pathway were significantly associated with a longer time before the first PR visit (hazard ratio HR 0.50 [95% CI: 0.29; 0.84]) and HR 0.68 [95% CI: 0.49; 0.93], respectively) in multivariable analysis. Having a mother with a post-graduate educational attainment level was tendentially associated with a shorter time before the first PR visit, (HR 1.32 [95% CI: 0.99; 1.78]). Conclusions: Time to first PRst visit was most often short compared to other studies and close to the British recommendations. However, this time remained too long for many patients. We observed no social inequities in access to a PRst, but we show the need to improve effective pathway and access to a PR center for JIA patients. [ABSTRACT FROM AUTHOR]

The conventional classification of mature B cells overlooks the diversity within IgD+ CD27− naïve B cells. Here, to identify distinct mature naïve B cells, we categorized CD45RBMEM55- B cells (NA RB-) and CD45RBMEM55+ B cells (NA RB+) and explore their function and localization in circulation and tissues under physiological and pathological conditions. NA RB+ B cells, found in secondary lymphoid organs, differentiate into plasmablasts and secrete IgM. In Sjögren's disease, their numbers decrease, and they show over-activation and abnormal migration, suggesting an adaptive disease response. NA RB+ B cells also appear in inflamed salivary glands, indicating involvement in local immune responses. These findings highlight the distinct roles of NA RB+ B cells in health and Sjögren's disease. [Display omitted] •.IgD+ CD45RBMEM55+ (NA RB+) and IgD+ CD45RBMEM55- B cells are phenotypically, transcriptionally, and functionally distinct. • NA RB+ B cells normally circulate between lymphoid organs but are recruited to inflamed salivary glands in Sjögren's Disease. • In Sjögren's Disease, NA RB+ B cells show an activated phenotype, altered migration, and are near ectopic lymphoid structures. [ABSTRACT FROM AUTHOR]

Abstract: Be they follicular cells within the germinal centers (GCs) or marginal zone (MZ), all naïve mature B lymphocytes need tonic signaling to stay alive. We reasoned that the same holds true for those B lymphocytes that proliferate in the salivary glands (SGs) of patients with primary Sjögren’s syndrome. Based on B cell infiltration, 11 SGs and three tonsil samples were selected for further examination. Tissue sections were stained using CD20 combined with CD10, CD21, CD27, CD38 or IgD. They were also laser-microdissected for quantitative RT-PCR of transcription factors, GC-specific activation-induced cytidine deaminase (AID) and TLR9. Some B cell aggregates proved to be real GCs according to their membrane markers, whereas others were clusters of transitional type II B cells. These contained mRNAs for Notch-2 and Blimp-1, but not for Pax-5, Bcl-6 and AID. Unanticipated was the finding of mRNAs for TLR9 in these clusters of MZ B-cells, but not in the real GCs. Not only do TLR9 deliver sufficiency of tonic signaling to keep B cells alive, but they also confer autoreactive B cells with an MZ-like phenotype. Thus, TLRs might be targets for forthcoming biotherapies. [Copyright &y& Elsevier]

Defective regulation of secondary immunoglobulin V(D)J gene rearrangement promotes the production of autoantibodies in systemic lupus erythematosus (SLE). It remains unclear, however, whether the regulation of the recombination-activating genes RAG1 and RAG2 is effective in SLE. RAG1 and RAG2 messenger RNA expression was analysed before and after in vitro activation of sorted CD19+ CD5– B cells with anti-immunoglobulin M antibodies, in 20 SLE patients and 17 healthy controls. The expression of CDK2 and p27Kip1 regulators of the RAG2 protein, were examined. The levels of interleukin-6 (IL-6) and its influence on RAG regulation were also evaluated in vitro. SLE patients had increased frequency of RAG-positive B cells. B-cell receptor (BCR) engagement induced a shift in the frequency of κ- and λ-positive cells, associated with a persistence of RAG messenger RNA and the maintenance of RAG2 protein within the nucleus. While expression of the RAG2-negative regulator CDK2 was normal, the positive regulator p27Kip1 was up-regulated and enhanced by BCR engagement. This effect was the result of the aberrant production of IL-6 by SLE B cells. Furthermore, IL-6 receptor blockade led to a reduction in p27Kip1 expression, and allowed the translocation of RAG2 from the nucleus to the cytoplasm. Our study indicates that aberrant production of IL-6 contributes to the inability of SLE B cells to terminate RAG protein production. Therefore, we hypothesize that because of constitutive IL-6 signalling in association with BCR engagement, SLE B cells would become prone to secondary immunoglobulin gene rearrangements and autoantibody production. [ABSTRACT FROM AUTHOR]

Abstract: Analysis of salivary glands of patients with primary Sjögren''s syndrome has yielded conflicting results with respect to T helper (Th)1/Th2 polarization. This balance might parallel the progress of the local lesions. B-cells are now taking center stage in this disease. They can also be primed to differentiate into two cytokine-production pathways, dubbed B effector (Be) 1 and Be2 cells. This is discussed in the light of our recent finding that Be1 accompany Th1, while Be2 accompany in the tissue lesions. [Copyright &y& Elsevier]

Objective: To evaluate the quality of patient information about fluoroscopy-guided rheumatologic procedures, and to look for an impact on the patient's experience of the procedure.Methods: One hundred and nineteen patients completed questionnaires before and after undergoing fluoroscopy-guided interventions. We looked for associations between the information supplied by the rheumatologist who recommended the procedure and pain, anxiety, awareness of potential complications, and the match between patient expectations and actual experience.Results: 62.8% of patients reported receiving information about the procedure. Only 20.5% reported receiving specific information about potential adverse events, although 80.9% felt this information would have been useful. Most patients (74.8%) would have liked to receive additional information. Only 10.1% patients were given written information. Mean (+/-SD) anticipated pain severity as assessed in the waiting room before the procedure on a 0-10 scale was 4.5+/-2.4 in women and 4.2+/-2.3) in men. Actual pain severity during the procedure as assessed on the same scale was 2.7+/-2.6 in women and 2.2+/-1.6 in men. The level of information about the procedure did not influence anticipated or actual pain severity. Anxiety was reported by 59.8% patients and was more common in women (P<0.001), in patients given written information (P=0.05), and in patients undergoing their first intervention (P=0.05). Information was perceived as alleviating anxiety by 69.9% patients, and 77.3% of patients felt they would experience less anxiety if they had the procedure a second time. Only 21.2% patients were able to name a potential adverse event, and this proportion was not influenced by receiving written information. A mismatch between expectations about the procedure or its duration and actual experience was reported by 17 (17/69, 24.6%) and 34 (34/98, 34.7%) patients, respectively, with no significant differences across study subgroups.Conclusion: Information about interventional rheumatology procedures is required for ethical principles and legislation. Patients increasingly expect detailed information, which may increase the likelihood that the procedure unfolds smoothly. Our results indicate a need for optimizing patient information. Standardized written material deserves to be evaluated as a means of better meeting the informational needs of patients. [ABSTRACT FROM AUTHOR]

Abstract: Objectives. – To determine the incidence and nature of karate injuries sustained in karate clubs and to identify risk factors for injuries. Methods. – One hundred eighty-six individuals from three karate clubs in Brest, France, were entered in a retrospective study extending from September 2002 to June 2003. Each athlete was asked to complete a questionnaire on karate injuries sustained during the previous year (type, location, mechanism, exercise during which the injury occurred, number of days off training and work, and medical care). Injury types were described by number of injuries and risk factors per number of injured athletes. Results. – Forty-eight (28.8%) of the 186 athletes sustained 83 injuries (63 while training and 20 while competing). The annual injury rate was 44.6 per 100 athletes. Incidence rates were similar in males and females and across the three clubs but increased with age, time spent training (3.6±1.7 vs. 2.9±1.5 h/week; P =0.001), rank (lower ranks vs. brown and black belts, P =0.015), and years of practice (7.3±5.5 years in athletes with injuries vs. 5.1±4.8 in those without injuries; P =0.03). Injuries consisted of 43 (53%) hematomas, 16 (19%) sprains, seven (7%) muscle lesions, six (7%) fractures, four (5%) malaise episodes, and seven (7%) miscellaneous lesions. Time off training occurred for 26 (31.3%) injuries and ranged from 8 to>30 days. The body region involved was the head in 22 (26.5%) injuries, the torso in eight injuries (9.6%), the upper limb in 24 (28.9%) injuries, and the lower limb in 29 (35%) injuries. Conclusion. – Karate injuries are fairly common but usually minor. They are more likely to occur during competitions than while training. The head and limbs are the main regions involved. Longer training times per week and higher rank are associated with an increased risk of injury. Prevention seems crucial. [Copyright &y& Elsevier]

Objective. The management of recent-onset rheumatoid arthritis (RA) is not well standardized. We conducted a survey of drugs prescribed to RA patients in Brittany at presentation and during the first 1 to 3 years of follow-up. Methods. A cohort of 270 patients with recent-onset inflammatory joint disease was recruited between 1995 and 1997. The evaluation at presentation included a medical history, a thorough physical examination, and a standard battery of investigations. Follow-up at 6-month intervals was offered. At the last visit, between June and December 1999, a panel of five rheumatologists established that 98 patients had RA. Results. At presentation, hydroxychloroquine and injectable gold were the most widely used second-line drugs, and only two patients were offered a combination of second-line drugs. At the last visit, the most commonly used drugs were methotrexate, injectable gold, and hydroxychloroquine (23, 23, and 21 patients, respectively); only three patients were on more than one second-line drug and 38 (38/98, 39%) patients were on glucocorticoid therapy. Conclusion. Rheumatologists in Brittany prefer monotherapy with hydroxychloroquine or injectable gold as the initial treatment. Later, they rely mainly on methotrexate, injectable gold, and hydroxychloroquine, often in combination with glucocorticoid therapy. [Copyright &y& Elsevier]

Abstract: Sjögren''s syndrome (SS) is an autoimmune exocrinopathy characterized by an epithelium injury with dense lymphocytic infiltrates, mainly composed of activated T and B cells. Present at the interface of genetic and environmental risk factors, DNA methylation is suspected to play a key role in SS. To clarify this point, global DNA methylation was tested within salivary gland epithelial cells (SGEC), peripheral T cells and B cells from SS patients. Global DNA methylation was reduced in SGEC from SS patients, while no difference was observed in T and B cells. SGEC demethylation in SS patients was associated with a 7-fold decrease in DNA methyl transferase (DNMT) 1 and a 2-fold increase in Gadd45-alpha expression. The other DNA methylation/demethylation partners, tested by real time PCR (DNMT3a/b, PCNA, UHRF1, MBD2, and MBD4), were not different. Interestingly, SGEC demethylation may be attributed in part to the infiltrating B cells as suspected in patients treated with anti-CD20 antibodies to deplete B cells. Such hypothesis was confirmed using co-culture experiments with human salivary gland cells and B cells. Furthermore, B cell-mediated DNA demethylation could be ascribed to an alteration of the PKC delta/ERK/DNMT1 pathway. As a consequence, part of the SGEC dysfunction in SS may be linked to epigenetic modifications, thus opening new therapeutic perspectives in SS. [Copyright &y& Elsevier]

Abstract: CD6 is one of a pair of related genes encoding CD5-associated receptors on all T cells and a subset of B cells. The current availability of “T1h”, a humanized anti-CD6 monoclonal antibody for B cell-mediated autoimmune disorders revives analysis of the B-cell subset expression of CD6, particularly in primary Sjögren’s syndrome (SS). Refined phenotype of B-lymphocytes peripheral blood (PB), bone marrow and tonsils revealed that the overlap between the expression of CD6 is less close to that of CD5 than currently acknowledged. In contrast to CD5, CD6 is absent on transitional B cells, while present on mature and memory B cells. Interestingly, the PB proportion of CD6+ B cells is decreased in patients with primary SS, as opposed to those with rheumatoid arthritis. The reduction in primary SS does not result from the shedding of CD6 from the membrane of B cells, but from the lowering of memory B lymphocytes. It may result from the ability of CD6 to make transmigration of CD27+ memory B cells into the salivary glands (SGs) easier. Consistent with this view is our finding that CD166 (one of the ligands for CD6) is highly expressed on epithelial cells of patients’ SGs. This study is relevant in that the humanized T1h anti-CD6 becomes an alternative to anti-CD20 for treatment of primary SS. [Copyright &y& Elsevier]

Abstract: There is a crucial need for reliable diagnostic criteria for SS. Our objective was to evaluate the frequency of xerosis in patients with primary Sjögren’s syndrome (SS), and compare histopathology of cutaneous sweat glands and labial salivary glands (LSGs), with respect to their contribution to the diagnosis. Twenty-two patients with primary SS and 22 matched normal volunteers were invited to rate their skin dryness on a visual analog scale. The skin was dryer (58.3 ± 10.1 versus 38.9 ± 7.6, P < 0.01), and xerosis more frequent (9 of 22 versus 2 of 22, P < 0.02) in the patients than in the controls. The axilla skin was chosen for a 6-mm punch biopsy. Lymphocytic infiltration was seen in the skin of 8 of the 12 patients tested. Two of them had normal LSGs. Most interestingly, B cell infiltrates were identified in patients’ skin infiltrates, so that their presence might be a clue to the diagnosis of primary SS. These cell aggregates associated memory CD10−/CD20+/CD27+/IgD− B lymphocytes and immature CD20+/CD24 + lymphocytes. These latter findings strongly suggest that skin biopsies warrant inclusion into the routine clinical care of patients suspected of suffering from primary SS. [ABSTRACT FROM AUTHOR]

The article focuses on the study that aims to know the mechanisms that control in the re-expression that involves the B cells accumulating in the synovial tissue of rheumatoid arthritis (RA) patients. Since specific DNA breaks are detectable after coculture with RA fibroblast-like synoviocytes (FLS), enzymes are functional. It is noted that two independent signals are required of recombination-activating gene (RAG) gene expression in B cells that infiltrate the synovium of RA patients.

Résumé: Introduction: Nous avons tenté d''évaluer la qualité de l''information reçue par les patients, ainsi que son impact sur le déroulement des soins, dans le cadre de la rhumatologie interventionnelle. Méthodes: Nous avons collecté 119 questionnaires remplis par les patients avant et après qu''ils bénéficient d''un geste sous scopie. Quatre paramètres principaux ont été étudiés en fonction de l''information donnée par le rhumatologue ayant posé l''indication de ce geste: la douleur, l''angoisse, la connaissance des complications possibles et la surprise face au déroulement de l''intervention. Résultats: 62,8% des patients se disent informés du déroulement de l''intervention, mais seulement 20,5% d''entre eux ont reçu une information portant spécifiquement sur les complications alors qu''ils sont 80,9% à estimer utile de les connaître. 74,8% des patients auraient souhaité un complément d''information. Seuls 10,1% des consultants ont bénéficié d''une information écrite. En salle d''attente, la douleur pressentie moyenne évaluée de 0 à 10 est de 4,56 (écart-type=2,46) chez les femmes et 4,23 (écart-type=2,30) chez les hommes. La douleur effectivement ressentie est cotée à 2,73 (écart-type=2,67) chez les femmes et 2,20 (écart-type=1,67) chez les hommes. On ne met pas en évidence de différence de douleur pressentie ou réelle en fonction du niveau d''information. 59,8% des patients se disent stressés (n = 67/112). Les patients les plus angoissés sont les femmes (p <0,001), ceux informés par écrit (p = 0,05) et ceux venant pour la première fois (p = 0,05). L''information reçue a contribué à diminuer l''anxiété de 69,9% des répondants et 77,3% de ces derniers déclarent qu''ils seraient moins stressés s''ils devaient revenir. Seuls 21,2% des patients sont capables de citer une complication possible de l''intervention dont ils vont bénéficier. Il n''existe pas de différence significative à ce niveau entre ceux ayant reçu une information écrite et les autres. Enfin, 24,6% (n = 17/69) et 34,7% (n = 34/98) des patients se disent surpris par le déroulement et la durée du geste sous scopie. Il n''existe pas de différence significative à ce niveau entre les sous-populations étudiées. Conclusion: L''information en rhumatologie interventionnelle reste une obligation éthique et médicolégale répondant à une demande croissante des patients. Bien menée, elle peut avoir des retombées positives sur le bon déroulement des soins. Cette étude met en évidence la nécessité de l''optimiser. Pour cela, l''utilisation de supports écrits standardisés pourrait constituer une aide précieuse mais demandant encore à être évaluée. [Copyright &y& Elsevier]

Résumé: Objectifs: Le but de ce travail est d''étudier, dans une cohorte de patients adressés pour le diagnostic étiologique d''une ou plusieurs métastases osseuses, l''intérêt des différents moyens diagnostiques utilisés pour la recherche du cancer primitif. Méthodes: Une étude rétrospective monocentrique a été conduite d''octobre 1990 à janvier 2000 sur une cohorte de patients présentant un cancer d''origine indéterminée avec au moins une métastase osseuse. Les patients ont tous bénéficié au minimum d''une scintigraphie osseuse, d''une radiographie de poumon, d''une échographie abdominale. Les tomodensitométries thoracoabdominales et cérébrales ainsi que la recherche de marqueurs tumoraux étaient réalisés selon le contexte. Nous avons étudié la valeur des examens complémentaires réalisés pour la recherche d''un cancer primitif, en prenant pour gold standard le diagnostic retenu au terme de nos explorations. Résultats: Cent cinquante-deux dossiers (104 hommes et 48 femmes) ont été analysés. L''âge moyen était de 63,5 ± 12,5 ans. La localisation du cancer primitif est pour 37 patients pulmonaires, pour 26 prostatiques, pour 24 gynécologiques, pour 11 urologiques, pour 11 digestives, pour 6 ORL et pour 4 divers. Dans 33 cas il n''est pas retrouvé. Les localisations principales des autres métastases sont hépatiques (20,4%), pulmonaires (17,1%), pleurales (13,2%), puis cérébrales (7,2%). Une ou plusieurs biopsies osseuses ont été réalisées chez 107 patients. Dans 83 cas une seule biopsie a été réalisée, mais deux biopsies ont été nécessaires dans 16 cas, et trois biopsies dans sept cas. Ces prélèvements ont été réalisés 62 fois dans le service de rhumatologie (avec ou sans scopie), six fois sous scanner, et 32 fois dans un service de chirurgie (48 au niveau du bassin, 32 sur une localisation vertébrale, dix au niveau du sacrum, sept autres). L''anatomopathologie des biopsies osseuses est en faveur d''un adénocarcinome dans 58 cas, d''un carcinome épidermoïde dans 28 cas, d''un carcinome indifférencié dans deux cas et autres dans neuf cas. Dans 80 cas un deuxième site métastatique paraissait plus accessible, permettant une biopsie non osseuse. La valeur localisatrice des marqueurs tumoraux apparaît relativement faible hormis le PSA. Conclusion: Les biopsies osseuses réalisées par les rhumatologues, en général sous scopie, permettent dans la grande majorité des cas d''apporter un diagnostic étiologique ou au moins anatomopathologique. Si les marqueurs tumoraux sont souvent positifs, leur valeur localisatrice reste faible. [Copyright &y& Elsevier]

Résumé: Objectifs. – Étudier l''incidence et décrire les caractéristiques des blessures engendrées par la pratique du karaté en club, ainsi que les facteurs qui peuvent l''influencer. Méthodes. – Cent quatre-vingt-six pratiquants de karaté dans trois clubs différents ont été inclus de septembre 2002 à juin 2003, à Brest dans une étude rétrospective. Un questionnaire a été soumis à chaque karatéka lui demandant de répertorier ses blessures survenues au cours de l''année passée (type, localisation, mécanisme, exercice pendant lequel est survenue la blessure, le nombre de jours d''arrêt des activités sportives et du travail, soins nécessaires). L''analyse a porté sur les « blessures » pour la description des atteintes et sur les « blessés » pour celle des facteurs de risques. Résultats. – Quarante-huit des 186 élèves se sont blessés (28,8 %), représentant 83 blessures (63 à l''entraînement et 20 en compétition), soit un taux annuel de 44,62 blessures pour 100 élèves. Les blessures ne sont pas plus fréquentes chez les hommes que chez les femmes, ni dans un club par rapport aux autres, alors que l''incidence augmente avec l''age, le nombre d''heures d''entraînement par semaine (3,6±1,7 vs 2,9±1,5 heures ; p : 0,001), le grade (ceintures marron et noires ; p : 0,015), et les années de pratique (blessés 7,3±5,5 ans vs non blessés 5,1±4,8 ; p : 0,03). Les blessures se répartissent en 43 (53 %) hématomes, 16 (19 %) entorses, sept (7 %) lésions musculaires, six (7 %) fractures, quatre (5 %) malaises, et sept (7 %) lésions diverses. Vingt-six (31,3 %) blessures ont entraîné un arrêt de 8 à 30 jours et plus des activités sportives. Enfin, la localisation de ces blessures est pour 22 (26,5 %) à la tête, huit (9,6 %) pour le tronc, 24 (28,9 %) le membre supérieur et 29 (35 %) pour le membre inférieur. Conclusion. – Les blessures sont relativement fréquentes, mais souvent bénignes, et surviennent plus rarement à l''entraînement qu''en compétition. Les blessures touchent principalement la face et les membres, et sont essentiellement observées chez ceux qui pratiquent le plus souvent et au plus haut niveau. La prévention paraît primordiale. [Copyright 2006 Elsevier]

Objective. The management of recent-onset rheumatoid arthritis (RA) is not well standardized. We conducted a survey of drugs prescribed to RA patients in Brittany at presentation and during the first one to three years of follow-up. Methods. A cohort of 270 patients with recent-onset inflammatory joint disease was recruited between 1995 and 1997. The evaluation at presentation included a medical history, a thorough physical examination, and a standard battery of investigations. Follow-up at six-month intervals was offered. At the last visit, between June and December 1999, a panel of five rheumatologists established that 98 patients had RA. Results. At presentation, hydroxychloroquine and injectable gold were the most widely used second-line drugs, and only two patients were offered a combination of second-line drugs. At the last visit, the most commonly used drugs were methotrexate, injectable gold, and hydroxychloroquine (23, 23, and 21 patients, respectively); only three patients were on more than one second-line drug and 38 (38/98, 39%) patients were on glucocorticoid therapy. Conclusion. Rheumatologists in Brittany prefer monotherapy with hydroxychloroquine or injectable gold as the initial treatment. Later, they rely mainly on methotrexate, injectable gold, and hydroxychloroquine, often in combination with glucocorticoid therapy. [ABSTRACT FROM AUTHOR]