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As one of the leading causes of disability in adults worldwide, its toll on patients and its economic burden for payers are substantial. The issue of change in OA management with the evolution of reimbursement schemes needs to be addressed. To assess the impact of terminating the reimbursement of symptomatic slow-acting drugs in OA (SYSADOAs) in France in terms of volume and cost, from a healthcare payer perspective. We obtained costs and volumes from French public national databases. We considered three exposure periods around cutoff dates according to decisions of decreased then terminated SYSADOA reimbursement. The periods included 19 345 (control), 20 066 (secondary), and 16 200 (primary) patients, respectively. Mean ages were 66.2 (±11.8), 65.3 (±11.6) and 64.6 (±11.5) years and about 70% were women. The volume of nonsteroidal anti-inflammatory drug (NSAID) deliveries estimated by defined daily doses (DDDs) decreased during the periods from 40.5 (±76.3) DDDs per patient in 2008 to 29.6 (±66.4) in 2015. The volume of analgesic deliveries increased slowly over the three periods, from 70.2 (±108.9) DDDs in 2008 to 76.9 (±123.1) in 2015 for all patients. Our results did not show a measurable impact of terminating SYSADOA reimbursement on the delivery of NSAIDs and analgesics or on hospitalizations. However, neither do they allow for concluding that terminating SYSADOA reimbursement did not generate an increase in deliveries of non-reimbursed drugs, with their associated potential risks for public health. [ABSTRACT FROM AUTHOR]

Objective: TGFβ is a key player in cartilage homeostasis and OA pathology. However, few data are available on the role of TGFβ signalling in the different OA phenotypes. Here, we analysed the TGFβ pathway by transcriptomic analysis in six mouse models of OA.Method: We have brought together seven expert laboratories in OA pathophysiology and, used inter-laboratories standard operating procedures and quality controls to increase experimental reproducibility and decrease bias. As none of the available OA models covers the complexity and heterogeneity of the human disease, we used six different murine models of knee OA: from post-traumatic/mechanical models (meniscectomy (MNX), MNX and hypergravity (HG-MNX), MNX and high fat diet (HF-MNX), MNX and seipin knock-out (SP-MNX)) to aging-related OA and inflammatory OA (collagenase-induced OA (CIOA)). Four controls (MNX-sham, young, SP-sham, CIOA-sham) were added. OsteoArthritis Research Society International (OARSI)-based scoring of femoral condyles and ribonucleic acid (RNA) extraction from tibial plateau samples were done by single operators as well as the transcriptomic analysis of the TGFβ family pathway by Custom TaqMan® Array Microfluidic Cards.Results: The transcriptomic analysis revealed specific gene signatures in each of the six models; however, no gene was deregulated in all six OA models. Of interest, we found that the combinatorial Gdf5-Cd36-Ltbp4 signature might discriminate distinct subgroups of OA: Cd36 upregulation is a hallmark of MNX-related OA while Gdf5 and Ltbp4 upregulation is related to MNX-induced OA and CIOA.Conclusion: These findings stress the OA animal model heterogeneity and the need of caution when extrapolating results from one model to another. [ABSTRACT FROM AUTHOR]

Objective: We evaluated the ability of Coll2-1, a type II collagen peptide, to activate pro-inflammatory pathways in synovial cells and to induce arthritis in Lewis rats.Method: Human synoviocytes and chondrocytes from knee OA patients were cultured for 24 h with/without Coll2-1 and/or purified immunoglobulin G (AS0619) binding specifically this peptide, and/or CLI-095, a TLR-4 signaling inhibitor and/or apocynin and diphenyleneiodonium, Reactive oxygen species (ROS) production inhibitors. The Interleukin (IL)-8 and Vascular Endothelium Growth Factor (VEGF) expression, the IL-8 production, the IκB-α and p65 phosphorylation and ROS were evaluated. Coll2-1 peptide, bovine type II collagen (CIA), streptococcal cell wall (SCW) or saline solution were injected into Lewis rats. The Coll2-1 peptide was injected subcutaneously (SC; 20-200μg/100μl/animal) or intra-articularly (IA; 0.5-5μg/50μl/animal) and compared to CIA injected in SC (200μg/100μl/animal) and SCW in IA (5μg/50μl/animal). The animals were injected on day 0 and monitored for 28 days. Histological lesions assessment was performed using an arthritis score.Results: Coll2-1 peptide significantly increased IL-8 gene expression and production by synoviocytes. AS0619 and CLI-095 significantly decreased IL-8 expression. Coll2-1 induced p65 and IκBα phosphorylation and oxidative stress inhibitors decreased it. In human chondrocytes culture, Coll2-1 significantly increased MMP-3 and VEGF gene expression. In Lewis rats, CIA, SCW or Coll2-1 injection triggered arthritis. Like CIA or SCW, Coll2-1 induced synovitis, loss of cartilage proteoglycans, cartilage structure lesion and subchondral bone remodeling.Conclusions: Coll2-1 activates synoviocytes to produce IL-8 and induces arthritis in rat. These findings suggest that neutralizing Coll2-1 could be a therapeutic approach of arthritis. [ABSTRACT FROM AUTHOR]

Objective: Transforming growth factor-β (TGFβ) is a major regulator of cartilage homeostasis and its deregulation has been associated with osteoarthritis (OA). Deregulation of the TGFβ pathway in mesenchymal stem cells (MSCs) has been proposed to be at the onset of OA. Using a secretome analysis, we identified a member of the TGFβ family, TGFβ-induced protein (TGFβi or βIGH3), expressed in MSCs and we investigated its function and regulation during OA.Design: Cartilage, bone, synovium, infrapatellar fat pad and bone marrow-MSCs were isolated from patients with OA or healthy subjects. Chondrogenesis of BM-MSCs was induced by TGFβ3 in micropellet culture. Expression of TGFβi was quantified by RT-qPCR, ELISA or immunohistochemistry. Role of TGFβi was investigated in gain and loss of function experiments in BM-MSCs and chondrocytes.Results: TGFβi was up-regulated in early stages of chondrogenesis and its knock-down in BM-MSCs resulted in the down-regulation of mature and hypertrophic chondrocyte markers. It likely occurred through the modulation of adhesion molecules including integrin (ITG)β1, ITGβ5 and N-cadherin. We also showed that TGFβi was upregulated in vitro in a model of OA chondrocytes, and its silencing enhanced the hypertrophic marker type X collagen. In addition, TGFβi was up-regulated in bone and cartilage from OA patients while its expression was reduced in BM-MSCs. Similar findings were observed in a murine model of OA.Conclusions: Our results revealed a dual role of TGFβi during chondrogenesis and pointed its deregulation in OA joint tissues. Modulating TGFβi in BM-MSCs might be of interest in cartilage regenerative medicine. [ABSTRACT FROM AUTHOR]

Summary: Objective: To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide. Method: Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1–10 risk and benefit scores. Results: Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation). Conclusion: These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences. [Copyright &y& Elsevier]

Summary: Objective: Hypoxia/reoxygenation (H/R) is an important feature in the osteoarthritis (OA) physiopathology. Nitric oxide is a significant proinflammatory mediator in the inflamed synovium. The purpose of this study was to investigate the effects of H/R on inducible NO synthase (iNOS) activity and expression in OA synoviocytes. In addition we studied the relationship between nitrosative stress and NADPH oxidase (NOX) in such conditions. Methods: Human cultured synoviocytes from OA patients were treated for 24 h with interleukin 1-β (IL-1β), tumour necrosis factor α (TNF-α) or neither; for the last 6 h, they were submitted to either normoxia or three periods of 1-h of hypoxia followed by 1-h of reoxygenation. metabolism (iNOS expression, nitrite and peroxynitrite measurements) was investigated. Furthermore, superoxide anion production, NOX subunit expression and nitrosylation were also assessed. Results: iNOS expression and nitrite (but not peroxynitrite) production were significantly increased under H/R conditions when compared with to normoxia (P < 0.05). H/R conditions decreased production from ∼0.20 to ∼0.12 nmol min−1 mg proteins−1 (P < 0.05), while NOXs' subunit expression and p47-phox phosphorylation were increased. NOXs and p47-phox were dramatically nitrosylated under H/R conditions (P < 0.05 vs normoxia). Using NOS inhibitors under H/R conditions, p47-phox nitrosylation was prevented and production was restored at normoxic levels (0.21 nmol min−1 mg of proteins−1). Conclusions: Our results provide evidence for an up-regulation of iNOS activity in OA synoviocytes under H/R conditions, associated to a down-regulation of NOX activity through nitrosylation. These findings highlight the importance of radical production to OA pathogenesis, and appraise the metabolic modifications of synovial cells under hypoxia. [Copyright &y& Elsevier]

Summary: Objective: To assess disability and health-related quality of life (HRQoL) of patients with knee or hip OA in primary care and to determine factors associated with GPs'' opinion that their patients will need prosthetic replacement within 1 year after the consultation. Methods: Design: A cross-sectional national survey. Setting: Primary care in France. Participants: 1471 GPs and 4183 patients with hip or knee OA. Measures: Pain on an 11-point numeric scale (0–10), disability on the Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) (1–100) and Lequesne index (0–24), and quality of life on the Medical Outcomes Study 36-item Short Form (MOS SF-36; 0–100). Results: We analyzed records of 4121 patients (2540 knee, 1581 hip OA). Patients with knee or hip OA exhibited high and similar levels of pain (5.2±2.1 and 5.3±2.3) and disability (Lequesne score: 12.0±4.2 and 11.8±4.3; WOMAC score: 45.7±19.3 and 45.2±17.3) The decrease in HRQoL was similar for patients with either location of the disease. GPs more often considered that their patients with hip OA would need prosthetic replacement within 1 year (28.1%) than those with knee OA (15.8%). Most factors associated with GPs'' opinion were identified for both locations of disease and were related to disability and pain levels. Conclusions: In the primary care setting, patients with knee or hip OA have similar, high disability levels and substantially low HRQoL. Patients'' disability seems to play a central role in GPs'' opinion of the need for their patients with either type of OA to undergo prosthetic replacement within 1 year. [Copyright &y& Elsevier]

Summary: Objective: To assess the relevance of using the aggregate physical component score (PCS) and mental component score (MCS) of the Medical Outcomes Study 36-item Short Form Health Survey (SF-36) for patients with knee and hip osteoarthritis (OA). Methods: We conducted a cross-sectional national survey in a primary care setting in France. A total of 1474 general practitioners enrolled 4183 patients with hip or knee OA. Construct validity of PCS and MCS was assessed by convergent and divergent validity and factor analysis. Results: Records of 4133 patients (98.8%) were analyzed (2540 knee, 1593 hip OA). PCS mean scores were 32.0±8.4 and 31.8±8.4 and MCS scores 47.1±11.0 and 46.8±11.1, for knee and hip OA, respectively. Acceptable convergent and divergent validity was observed, and correlation between PCS and MCS mean scores was low (r =0.14). However, factor analysis performed on the eight subscale scores failed to support the use of PCS and MCS aggregate scores. It extracted two factors which were similar for both OA types and differed from the a priori stratification. Scores for two subscales usually attributed to MCS – emotional role and social functioning – were shared between factors, and scores for another subscale – general health perception – usually belonging to the PCS was in the mental component factor. Conclusions: Our results suggest that aggregate scores from the PCS and MCS of the SF-36 as they are currently defined may not be optimal for used in hip and knee OA patients to assess health-related quality of life. [Copyright &y& Elsevier]

Abstract: Background: In developed countries, chronic low back pain (LBP) is one the most common reasons for disability and work-time loss. Conventional treatments have not slowed the increasing prevalence of chronic LBP. Therefore, in a search for new solutions to the problem, functional restoration programs were developed. Objective: To synthesize the literature on the efficacy of functional restoration programs for LBP. Methods: We performed a systematic literature search of the MedLINE database using the keywords LBP, functional restoration, work-hardening program, exercise therapy, rehabilitation, aerobic, and cognitive behavioral therapy. Synthesis: The term “functional restoration” has been associated with a full-day multidisciplinary program lasting from 3 to 6 weeks. Results of most published controlled studies on the efficacy of functional restoration programs are positive regarding the return-to-work rate. Maintaining job status with the pre-injury employer is often best accomplished by the provision of suitable modified duties. Finally, results of functional restoration programs in terms of return-to-work rate probably depend strongly on the social security system of the country where the program was developed. [Copyright &y& Elsevier]

Résumé: État de la question: Dans les pays industrialisés, les lombalgies sont une des causes les plus fréquentes d''incapacité et d''arrêt de travail. La lombalgie chronique ne représente vraisemblablement pas plus de 10% de l''ensemble des lombalgies, mais elle est responsable de 85% des coûts induits par ce symptôme. La mise en évidence d''un syndrome de déconditionnement à l''effort chez le lombalgique chronique a conduit à l''élaboration de programmes de restauration fonctionnelle. Objectif: Proposer une synthèse de l''intérêt des programmes de restauration fonctionnelle dans la lombalgie après analyse systématique de la littérature. Méthode: Recherche bibliographique à partir de la base de données Medline avec les mots clés low back pain, functional restoration, work hardening program, exercise therapy, rehabilitation, aerobic, cognitive behavioral therapy. Synthèse: Les programmes de restauration fonctionnelle constituent des prises en charge multidisciplinaires lourdes et coûteuses pour des périodes variant de trois à six semaines. Les concepts clefs de ces programmes sont l''acceptation de la douleur, la prise en charge du problème par le patient lui-même, la progression par contrat. Les études contrôlées concernant l''efficacité de ces programmes sur la proportion de patients reprenant leurs activités professionnelles sont le plus souvent positives. L''adjonction de procédures de reprise facilitée des activités professionnelles à la prise en charge multidisciplinaire des lombalgies chroniques en accident de travail et en arrêt de travail prolongé semble entraîner une augmentation du taux de reprise et une accélération de celle-ci. Enfin, il semble que les résultats des programmes de restauration professionnelle quant à la réinsertion socioprofessionnelle, soient très largement dépendants du système de protection sociale du pays dans lequel ils ont été développés. [Copyright &y& Elsevier]

Résumé: Objectif: Développer une méthode rigoureuse s''appuyant sur les résultats d''études publiées, l''évaluation des pratiques professionnelles française et l''opinion d''experts pluridisciplinaire pour élaborer des recommandations dans le domaine de la prescription de rééducation. Méthodes et résultats: La méthode de la SOFMER (Société française de médecine physique et de réadaptation) a été élaborée pour le développement de recommandations en rééducation. Elle a été utilisée initialement pour établir des recommandations pour la pratique clinique dans la rééducation de l''arthrose de la hanche et du genou opérée et non opérée. Des praticiens spécialisés en médecine physique et réadaptation (MPR), chirurgie orthopédique et rhumatologie ont identifié, analysé et résumé la littérature à l''aide de la grille de cotation de l''Anaes (Agence nationale pour l''accréditation et l''évaluation en santé). Les données utilisées étaient issues d''études comparatives contrôlées randomisées ou non, d''études de suivi de cohorte, d''études cas témoins, de revues d''études contrôlées et d''études de cas. Les conclusions ont été présentées lors des trois congrès nationaux des sociétés savantes françaises de MPR, rhumatologie et chirurgie orthopédique afin qu''elles soient discutées et adaptées aux pratiques professionnelles françaises. Enfin, un panel d''experts pluridisciplinaire (médecins spécialistes de MPR, rhumatologie et chirurgie orthopédique; médecins généralistes; kinésithérapeutes; assistantes sociales; pédicure–podologues; ergothérapeutes; infirmières et patients) ont validé les recommandations élaborées à partir du travail d''expertise et des réponses obtenues lors des congrès sur les pratiques. Conclusion: La méthode SOFMER peut être un outil util pour le développement de recommandations par tous les médecins concernés par le vaste champ de la rééducation. [Copyright 2007 Elsevier]

Abstract: Objective: The development of a rigorous methodology based on published results of clinical trials, evaluation of daily practice in France and multidisciplinary expert opinion to elaborate recommendations for rehabilitation interventions. Methods and results: The following describes the methodology of SOFMER (Société Française de Médecine Physique et de Réadaptation [French Society of Physical Medicine and Rehabilitation]) for developing recommendations for rehabilitation interventions. The test case was developing recommendations for rehabilitation in hip or knee osteoarthritis (OA) and hip or knee arthroplasty. Physicians in rehabilitation, orthopedic surgery and rheumatology identified, synthesized, and analyzed data from the literature by use of the usual French system of grading trials (the French Agency for Accreditation and Evaluation in Healthcare [ANAES] scale). The data were published results of comparative controlled studies such as randomized controlled trials, controlled clinical trials, cohort studies, case control studies, reviews of clinical trials, and case series, as well as uncontrolled cohort studies. The resulting recommendations were presented to the three annual French national congresses of rehabilitation, rheumatology, and orthopedic surgery for comment and for adapting to French professional practice. Finally, a panel of multidisciplinary experts (physicians in physical medicine and rehabilitation, rheumatologists, orthopedic surgeons, general practitioners, physical therapists, social workers, podologists, occupational therapists, nurses, and patients) validated the recommendations. Conclusion: The SOFMER methodology could be an interesting tool for use in developing recommendations elaborated by all the concerned medical and surgical specialists in the wide domain of rehabilitation. [Copyright &y& Elsevier]

Copyright of EMC-Rhumatologie--Orthopedie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Rhumatologie--Orthopedie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Rhumatologie--Orthopedie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. – To assess the impact of functional restoration programs on fears, avoidance and beliefs in chronic low back pain.Methods. – Open prospective study in eight spine centers. Seventy patients enrolled in several restoration programs were evaluated before and at the end of the program. Variables recorded were pain (VAS), disability (Quebec back pain disability scale), handicap (VAS), anxiety and depression (HAD scale), and fears, avoidance and beliefs (FABQ).Results. – All variables recorded significantly improved at the end of the programs except for fears about professional activities (FABQ1) and lumbar mobility. Fears about physical activities (FABQ2) significantly decreased after these programs. Variations in FABQ1 and FABQ2 scores were not correlated with variations in scores of outcome measures assessing impairment, disability, and handicap.Conclusion. – Functional restoration programs in their current form in France do not decrease fears and beliefs about professional activities in chronic low back pain patients. Adding psychosocial intervention at the work place to the functional restoration programs may lead to a better impact on fears about work thus reducing work loss. [Copyright &y& Elsevier]

Introduction/Background We aimed to determine patient acceptable symptom state (PASS) and minimally clinically important improvement (MCII) estimates for patient-reported outcomes (PROs) in systemic sclerosis (SSc). Material and method Two hundred and twenty patients participated in the SCLEREDUC trial, a 12-month, randomised controlled study comparing the efficacy on disability assessed by the HAQ-DI at 12-months of physical therapy compared to usual care in patients with SSc. Self-rated state and change in patient health at 12 months post-randomization were assessed by using 2 external anchoring questions from the Medical Outcomes Study 36-Item Short Form. Patients who self-rated their health as “excellent”, “very good” or “good” were considered as having an acceptable symptom state and those who self-rated their health change at 12 months as “somewhat better” were considered as minimally improved. PASS estimates were obtained using the 75th percentile method and the MCII estimates by using the mean change in scores method. Results Answers to both anchoring questions at 12 months were available for 151/220 (68.6%) participants. PASS (95% CI) and mean (SD) MCII estimates at 12 months were respectively: 53.75 (34.00 to 68.00) and −6.74 (32.02) for the joint-pain visual analog scale (range 0–100), 1.41 (1.13 to 1.63) and −0.21 (0.48) for the Health Assessment Questionnaire Disability Index (HAQ-DI, range 0–3), 1.27 (1.07 to 1.62) and −0.13 (0.45) for the scleroderma HAQ (sHAQ, range 0–3), 26.00 (17.00 to 37.00) and −3.38 (9.87) for the Cochin Hand Function Scale (range 0–90), and 19.40 (17.20 to 21.90) and −5.69 (6.79) for the McMaster-Toronto Arthritis Patient Preference Disability Questionnaire (range 0–30). For all PROs, higher scores indicate higher symptoms levels. Conclusion The present study provides PASS and MCII estimates for commonly used PROs in SSc. These estimates are useful in interpreting the clinical relevance of outcomes used in patients’ care and in clinical trials. ClinicalTrials.gov identifier: NCT00318188 . [ABSTRACT FROM AUTHOR]

Introduction/Background Nonspecific low back pain is first cause of years lived with disability. An active disc disease is present in up to 58% of patients with low back pain. We aimed to describe patients with chronic low back pain and an active disc disease who respond and those who do not respond to intradiscal glucocorticoid or to intradiscal contrast. Material and method We conducted a secondary analysis of the PREDID study, a randomized trial of 135 patients with chronic low back pain and an active disc disease. Overall, 61 participants received an intradiscal injection of glucocorticoid (25 mg prednisolone acetate) during discography and 60 received discography alone. Fourteen participants did not receive the allocated treatment and were not included in this secondary analysis. The primary outcome was the description of clinical, demographical, psychological and social characteristics of responders and non-responders to intradiscal glucocorticoid and to intradiscal contrast at 1 month, as defined in the primary trial. Independent variables associated to clinical response were assessed by logistic regression. Results Participants who responded to intradiscal corticosteroid injection were more often highly educated (18/34 [52.9%] vs. 6/26 [23.1%], respectively), whereas participants who did not respond were more often on sick leave (14/27 [51.9%] vs. 5/34 [14.7%]). The independent variable most strongly associated with the absence of therapeutic response to intradiscal glucocorticoid was sick leave (OR = 33.8, 95% CI = 2.4 to 472.2). Similar results were observed with response to intradiscal contrast injection but the magnitude of differences was lower. Conclusion Patients with chronic low back pain and an active disc disease who respond to an intradiscal injection of corticosteroids or contrast have a social profile different from those who do not respond. Registration ClinicalTrials.gov number NCT00804531 (First received: December 8, 2008. Last updated: June 23, 2016). Funding French Ministry of Health (Programme Hospitalier de Recherche Clinique, project No. P070157). [ABSTRACT FROM AUTHOR]

Cette étude a pour but de faire une synthèse de la littérature concernant le risque hémorragique associé aux gestes rachidiens percutanés et d'évaluer le sur-risque associé à la prise d'un traitement anticoagulant ou antiagrégant plaquettaire. Une revue systématique de la littérature a été effectuée, par une double sélection, des articles disponibles sur MEDLINE, EMBASE et COCHRANE, évaluant la prévalence des complications hémorragiques dans les gestes percutanés musculosquelettiques. Les articles concernant les gestes percutanés rachidiens ont été sélectionnés. Les complications rapportées étaient les hématomes épiduraux, les saignements du système nerveux central, les saignements locaux et les retours sanguins lors de la réalisation du geste. Une méta-analyse a été réalisée pour déterminer la prévalence de ces complications pour chaque geste rachidien et le sur-risque hémorragique lié aux anticoagulants et antiagrégants plaquettaires. L'analyse de la littérature a retrouvé 2407 articles dont 73 ont été inclus dans la méta-analyse de prévalence (Tableau 1). Il n'y a pas de différence entre les patients sous antiagrégants plaquettaires ou anticoagulants et les autres concernant le risque d'hématomes épiduraux avec un OR de 0,95 IC95 [0,16–5,52], ni pour les retours sanguins avec un OR à 0,78 IC95 [0,47–1,29]. Le risque hémorragique reste très rare mais potentiellement très grave lors de la réalisation d'un geste percutané rachidien. La gestion des anticoagulants et antiagrégants plaquettaires doit donc être précautionneuse, nécessite un consensus et une actualisation des recommandations pour harmoniser les pratiques. [ABSTRACT FROM AUTHOR]

Importance Physical therapy could be of interest to reduce disability of systemic sclerosis (SSc) patients. Objective To develop a physical therapy program for SSc and compare its efficacy with that of usual care. Design 12-month, parallel-group randomized controlled trial involving a modified Zelen design conducted between September 2005 and October 2011. Randomization was computer-generated with allocation concealment by fax to a central coordinating office. Investigators were not blinded, but participants in the control group were blinded to study hypothesis. Setting Four tertiary-care hospitals. Participants Patients were enrolled if they had a SSc diagnosis, a disability rating ≥ 0.5 on the Health Assessment Questionnaire Disability Index (HAQ-DI) or complaints of decreased mouth opening or limited range of motion of at least one joint. Interventions The experimental intervention was a 1-month personalized supervised physical therapy program provided by specifically trained care providers followed by home sessions. The comparator was usual care. Main outcomes and measures The primary outcome was the HAQ-DI score at 12 months. Results In the intention-to-treat analysis, as compared with the usual care group ( n = 108), patients in the physical therapy group ( n = 110) showed reduced disability at 1 month (HAQ-DI between-group difference (0.14; 95% confidence interval [CI] –0.24 to –0.03; P = 0.01), at 6 months the HAQDI scores between-group difference was –0.12; 95% CI, –0.23 to 0.01; P = 0.054. There was no statistically significant difference at 12 months (between-group difference at 12 months, –0.01; 95% CI –0.15 to 0.13; P = 0.86). There was a statistically significant difference for hand mobility and function, and pain, at 1 month but no difference at 12 months. Microstomia was lower in the physical therapy group at 1, 6 and 12 months (between-group difference at 12 months, 1.62; 95% CI 0.32 to 2.93; P = 0.01). No differences in adverse effects were observed between the two treatment groups. Conclusions and relevance A 1-month personalized supervised physical therapy program followed by home exercise sessions had short-term benefits for patients with SSc but did not reduce disability at 12 months. The program had long-term benefits for microstomia. Trial registration clinicaltrials.gov identifier NCT00318188 . [ABSTRACT FROM AUTHOR]