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

Author

Carole Duquenne, Alain Saraux, Valérie Devauchelle-Pensec, Divi Cornec, Stephan Pavy, Alain Cantagrel, Sandrine Jousse-Joulin, T. Marhadour, Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Service de Rhumatologie [CHU de la Cavale-Blanche], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), CHU Le Kremlin-Bicêtre (Rheumatology Department), and Department of Rheumatology

Subjects
030203 arthritis & rheumatology, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, [SDV.IMM]Life Sciences [q-bio]/Immunology, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, 3. Good health
Abstract

Resume Objectifs Chez les patients souffrant de polyarthrite debutante, naifs de traitement de fond, nous avons evalue la prevalence de la lymphopenie initiale et persistante, le diagnostic sous-jacent, les risques d’infection et de neoplasie ou d’hemopathie maligne. Methodes Huit cent treize patients souffrant de polyarthrite debutante inclus dans la cohorte Espoir ont eu un examen clinique, des examens de laboratoire (serologies virales, examens immunologiques et profil cytokinique), et des radiographies. Nous avons determine la prevalence de la lymphopenie a l’inclusion et a 3 ans, les facteurs associes, les diagnostics, et les risques d’infection, de neoplasie ou d’hemopathie maligne. Resultats A l’inclusion, 50/813 patients (6,2 %) avaient une lymphopenie. La lymphopenie etait associee a la presence de facteur rhumatoide positif ( p = 0,02), une cytopenie ( p ≤0,05) une hepatite C ( p = 0,05), une C-reactive proteine ( p ≤0,05) et un DAS 28 augmentes ( p ≤ 0,05). Le profil cytokinique et la progression radiologique n’etaient pas significativement differents entre les patients avec ou sans lymphopenie. Les diagnostics suspectes a l’inclusion etaient : une polyarthrite rhumatoide (PR, n = 27), une arthrite indifferenciee ( n = 15), un lupus erythemateux systemique (LES, n = 3), une spondyloarthrite ( n = 2), un syndrome de Gougerot-Sjogren ( n = 1), une hemopathie ( n = 1), et une fibromyalgie ( n = 1). Sur un total de 42 patients, 15 (35,7 %) ayant une lymphopenie initiale, avaient une lymphopenie persistante apres 3 ans, dont 5 avec des causes documentees (LES, hepatite C, denutrition, traitement par azathioprine et tamoxifene) ; aucun n’avait d’infection a PVB19, VIH ou VHB et aucun n’avait d’infection, de tumeur ou hemopathie maligne pendant le suivi. Le diagnostic final chez ces 15 patients etait : PR ( n = 6), arthrite indifferenciee ( n = 6), LES ( n = 1), spondyloarthrite ( n = 1), et fibromyalgie ( n = 1). Conclusion La lymphopenie est rare dans la polyarthrite debutante. La cause la plus courante est la PR, avec une inflammation marquee et d’autres cytopenies frequentes. La lymphopenie dans la polyarthrite debutante est souvent de courte duree, meme lorsque le methotrexate est prescrit.

Published
2016
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2. Increased Dickkopf-1 in Recent-onset Rheumatoid Arthritis is a New Biomarker of Structural Severity. Data from the ESPOIR Cohort

Author

Xavier Mariette, Jacques-Eric Gottenberg, Gaetane Nocturne, Stephan Pavy, Alain Saraux, Saida Boudaoud, Valérie Devauchelle-Pensec, Raphaèle Seror, Thierry Schaeverbeke, Gabriel J. Tobón, Philippe Chanson, Corinne Miceli-Richard, CHU Le Kremlin-Bicêtre (Rheumatology Department), Department of Rheumatology, Régulation de la réponse immune, infection VIH-1 et autoimmunité, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie, CHU Bordeaux [Bordeaux], CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Signalisation Hormonale, Physiopathologie Endocrinienne et Métabolique, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA)

Subjects
Adult, Genetic Markers, Male, 0301 basic medicine, medicine.medical_specialty, Inflammatory arthritis, Anti-Inflammatory Agents, Severity of Illness Index, Article, Arthritis, Rheumatoid, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Risk Factors, Internal medicine, Severity of illness, medicine, Humans, ComputingMilieux_MISCELLANEOUS, Adaptor Proteins, Signal Transducing, 030203 arthritis & rheumatology, Multidisciplinary, biology, business.industry, C-reactive protein, Case-control study, Middle Aged, Prognosis, medicine.disease, 3. Good health, C-Reactive Protein, 030104 developmental biology, chemistry, Case-Control Studies, Rheumatoid arthritis, Bone Morphogenetic Proteins, Cohort, Immunology, Disease Progression, biology.protein, Intercellular Signaling Peptides and Proteins, Biomarker (medicine), Sclerostin, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, Joints, business, Biomarkers
Abstract

Rheumatoid arthritis (RA) is the most common chronic inflammatory rheumatic condition over the world. RA is potentially disabling because chronic inflammation of the joints leads to joint destruction. To date, the best predictor of radiographic progression for patients with early RA is the presence of radiographic erosions at baseline, but a limited number of predictive biomarkers of structural progression are currently used in daily practice. Here, we investigated Dickkopf-1 (DKK-1) and sclerostin (SOST) serum levels in patients with recent inflammatory arthritis from the ESPOIR cohort. This cohort is a prospective, multicenter French cohort of 813 patients with early arthritis. We observed that mean baseline DKK-1 level was higher among RA patients with than without radiological progression within the first 2 years of evolution. DKK-1 level was still associated with radiographic progression in a model including other main predictors of severity (erosions at baseline and anti-CCP antibody positivity). This study demonstrates that increased DKK-1 level at baseline predicted structural progression after 2-year follow-up and suggests that DKK-1 might be a new structural biomarker for early RA.

Published
2016
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3. Increase in Dickkopf-1 Serum Level in Recent Spondyloarthritis. Data from the DESIR Cohort

Author

Joanne Nithitham, Gaetane Nocturne, Karine Briot, Christian Roux, Kimberly E. Taylor, Lindsey A. Criswell, Francis Berenbaum, Xavier Mariette, Antoine Feydy, Maxime Dougados, Pascal Claudepierre, Corinne Miceli-Richard, Floris A. van Gaalen, Philippe Goupille, Philippe Chanson, Saida Boudaoud, Raphaèle Seror, Stephan Pavy, Philippe Dieudé, Désirée van der Heijde, Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA), Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Université Francois Rabelais [Tours], Service d'endocrinologie, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Universiteit Leiden [Leiden], CHU Saint-Antoine [APHP], Service de rhumatologie B, Université Paris Descartes - Paris 5 (UPD5), Service de radiologie, CHU Cochin [AP-HP], Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Henri Mondor, Service de rhumatologie [Bichat], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 (UPD7), University of California [San Francisco] (UCSF), University of California, Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Universiteit Leiden, University of California [San Francisco] (UC San Francisco), University of California (UC), Immunologie des Maladies Virales et Autoimmunes ( IMVA - U1184 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris-Sud - Paris 11 ( UP11 ) -Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ), Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -APHP-CHU Saint-Antoine [APHP], Université Paris Descartes - Paris 5 ( UPD5 ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris]-Université Paris Diderot - Paris 7 ( UPD7 ), and University of California [San Francisco] ( UCSF )

Subjects
Adult, Genetic Markers, Male, medicine.medical_specialty, Multivariate analysis, Genotype, Cross-sectional study, lcsh:Medicine, Single-nucleotide polymorphism, Gastroenterology, Polymorphism, Single Nucleotide, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Internal medicine, Spondylarthritis, medicine, Humans, lcsh:Science, Wnt Signaling Pathway, 030304 developmental biology, Adaptor Proteins, Signal Transducing, 030203 arthritis & rheumatology, 0303 health sciences, Ankylosing spondylitis, Multidisciplinary, business.industry, lcsh:R, Desir cohort, Sacroiliitis, medicine.disease, 3. Good health, Cross-Sectional Studies, Back Pain, Cohort, Immunology, Bone Morphogenetic Proteins, Intercellular Signaling Peptides and Proteins, lcsh:Q, Female, France, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Cohort study, Research Article
Abstract

International audience; Objectives : To investigate DKK-1 and SOST serum levels among patients with recent inflammatory back pain (IBP) fulfilling ASAS criteria for SpA and associated factors.Methods : The DESIR cohort is a prospective, multicenter French cohort of 708 patients with early IBP (duration >3 months and

Published
2015
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4. Lymphopenia in early arthritis: Impact on diagnosis and 3-year outcomes (ESPOIR cohort)

Author

Sandrine Jousse-Joulin, Divi Cornec, Alain Saraux, Carole Duquenne, Stephan Pavy, Valérie Devauchelle-Pensec, Thierry Marhadour, Alain Cantagrel, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Physiopathologie Toulouse Purpan (CPTP), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), and Centre d'Investigation Clinique (CIC - Brest)

Subjects
Male, medicine.medical_specialty, Early inflammatory joint disease, [SDV]Life Sciences [q-bio], Arthritis, Azathioprine, MESH: Arthritis, MESH: Lymphopenia, Rheumatology, immune system diseases, Internal medicine, Lymphopenia, Diagnosis, medicine, Prevalence, Rheumatoid factor, Humans, Longitudinal Studies, Prospective Studies, Rheumatoid arthritis, MESH: Longitudinal Studies, MESH: Prevalence, 2. Zero hunger, Cytopenia, Systemic lupus erythematosus, MESH: Humans, MESH: Middle Aged, business.industry, Middle Aged, medicine.disease, Prognosis, MESH: Male, MESH: Prospective Studies, 3. Good health, MESH: France, Hematologic disease, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Cohort, Immunology, Female, France, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, medicine.drug
Abstract

Objectives In 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. Methods 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. Results 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), Sjogren'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). Conclusions 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.

Published
2015
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5. The learning curve of nurses for the assessment of swollen and tender joints in rheumatoid arthritis

Author

Pascal Richette, Sandrine Guis, Maxime Dougados, Laure Gossec, Mélanie Gilson, Minh Nguyen, Martin Soubrier, Gaël Mouterde, Vincent André, Emmanuelle Dernis, Ghislaine Gill, Gérard Chalès, Peter P. Cheung, François Pouyol, Stephan Pavy, Adeline Ruyssen-Witrand, Thierry Marhadour, Isabelle Chary-Valckenaere, Nathalie Balandraud, National University Health System, Singapore, Université Paris Descartes - Faculté de Médecine ( UPD5 Médecine ), Université Paris Descartes - Paris 5 ( UPD5 ), Service de rhumatologie B, Centre Hospitalier du Mans, Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), CHU Pontchaillou [Rennes], Ingénierie Moléculaire et Physiopathologie Articulaire ( IMoPA ), Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), CHU Grenoble, Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Centre de résonance magnétique biologique et médicale ( CRMBM ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) -Centre National de la Recherche Scientifique ( CNRS ), Hôpital Lapeyronie, Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Roger Salengro, Hôpital de la Cavale Blanche, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ), Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], CHU Clermont-Ferrand, CHU Gabriel Montpied ( CHU ), Vietnam National University - Ho Chi Minh City ( VNU-HCM ), CHU Pitié-Salpêtrière [APHP], Groupe de recherche sur les maladies systémiques (EA 4058), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), National University Health System [Singapore] (NUHS), Centre Hospitalier Le Mans (CH Le Mans), Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Institut de Génétique Moléculaire de Montpellier (IGMM), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie [Montpellier] (CHU), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Hôpital Roger Salengro [Lille], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Université Paris Diderot, Sorbonne Paris Cité, Paris, France, Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Epidémiologie et analyses en santé publique : risques, maladies chroniques et handicaps (LEASP), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT)-Université de Toulouse (UT)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Gabriel Montpied [Clermont-Ferrand], Vietnam National University - Ho Chi Minh City (VNU-HCM), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Gènes HLA-DR, Autoanticorps et Microchimérisme dans la Polyarthrite Rhumatoïde et la Sclérodermie (HLA-DR), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)

Subjects
Male, musculoskeletal diseases, medicine.medical_specialty, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, education, Physical examination, Arthritis, Rheumatoid, 03 medical and health sciences, Skills retention, 0302 clinical medicine, Primary outcome, [ SDV.BBM.BC ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], Rheumatology, Internal medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Humans, 030212 general & internal medicine, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], Physical Examination, ComputingMilieux_MISCELLANEOUS, 030203 arthritis & rheumatology, medicine.diagnostic_test, business.industry, Gold standard, Swollen joints, Middle Aged, medicine.disease, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Learning curve, Rheumatoid arthritis, Physical therapy, Female, Joints, Clinical Competence, business, Learning Curve, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; Objective: In rheumatoid arthritis (RA), nurses are now increasingly involved in joint count assessment but training is not standardized. The aim was to evaluate and describe the learning curve of nurses for the assessment of swollen and tender joints in RA. Method: Twenty nurses from university rheumatology centres inexperienced with joint counts were allocated to a rheumatologist from their centre (teacher). Acquisition of skills consisted of Phase 1: (training), a centralized 4 hour training session, with (a) lecture and demonstration, and (b) practical sessions on patients with their teachers, followed by Phase 2: (practice) involving further practice on 20 patients in their own hospitals. Primary outcome was achievement of adequate swollen joint agreement between nurse and their teacher (''gold standard'') at the ``joint'' level defined by prevalence adjusted biased adjusted kappa (PABAK) > 0.60. Agreement at the ``patient'' level of swollen joint count (SJC), tender joint count (TJC) as well as DAS28 between nurse and their teacher were assessed with intra-class correlation coefficients (ICC). Results: During the training phase, 75% of nurses achieved a swollen joint PABAK > 0.60 when compared with their teachers, which further improved to 89% after the 20 practice patients (Phase 2). Median swollen joint PABAK improved from 0.64 (Q1 :Q3 0.55,0.86) to 0.83 (Q1 :Q3 0.77,1) by the end of Phase 2. At the ``patient'' level, SJC agreement remained globally stable (ICC, 0.52 to 0.66), while TJC and DAS28 agreement remained excellent throughout. Conclusion: Nurses inexperienced in joint counts were able to achieve excellent agreement with their teachers in assessment of tender and swollen joints through a short training session; practice further enhanced this agreement. Larger longitudinal studies are required to assess skills retention. (C) 2013 Societe francaise de rhumatologie. Published by Elsevier Masson SAS. All rights reserved.

Published
2014
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6. Improving agreement in assessment of synovitis in rheumatoid arthritis

Author

Peter P. Cheung, Emmanuel Chatelus, François Pouyol, Adeline Ruyssen-Witrand, Laure Gossec, Mélanie Gilson, Sandrine Guis, Martin Soubrier, Nathalie Balandraud, Thierry Marhadour, Pascal Richette, Ghislaine Gill, Isabelle Chary-Valckenaere, Stephan Pavy, Emmanuelle Dernis, Vincent André, Gérard Chalès, Gaël Mouterde, Maxime Dougados, National University Health System, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Centre Hospitalier du Mans, Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), CHU Pontchaillou [Rennes], Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Rhumatologie, Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de Référence pour les Maladies Systémiques Autoimmunes Rares, CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie, Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Roger Salengro, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), AP-HP, pôle appareil locomoteur, Service de rhumatologie, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, National University Health System [Singapore] (NUHS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Roger Salengro [Lille], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Gabriel Montpied [Clermont-Ferrand], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Paris Descartes - Faculté de Médecine ( UPD5 Médecine ), Université Paris Descartes - Paris 5 ( UPD5 ), Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), Ingénierie Moléculaire et Physiopathologie Articulaire ( IMoPA ), Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Centre de résonance magnétique biologique et médicale ( CRMBM ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) -Centre National de la Recherche Scientifique ( CNRS ), CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ), and CHU Gabriel Montpied ( CHU )

Subjects
Male, MESH: Synovitis, MESH : Aged, Arthritis, MESH: Observer Variation, Severity of Illness Index, MESH : Consensus, Arthritis, Rheumatoid, MESH : Cross-Sectional Studies, [ SDV.BBM.BC ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], 0302 clinical medicine, Medicine, MESH : Female, 030212 general & internal medicine, skin and connective tissue diseases, MESH : Joints, MESH : Synovitis, Observer Variation, MESH: Aged, MESH: Arthritis, Rheumatoid, Synovitis, MESH: Middle Aged, medicine.diagnostic_test, Swollen joints, MESH : Adult, Middle Aged, 3. Good health, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], MESH: Reproducibility of Results, MESH: Joints, Rheumatoid arthritis, MESH : Severity of Illness Index, Female, Clinical Competence, MESH: Clinical Competence, Clinical competence, Adult, musculoskeletal diseases, medicine.medical_specialty, Validation study, Consensus, MESH : Male, Physical examination, [ SDV.BBM.BM ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, 03 medical and health sciences, MESH: Cross-Sectional Studies, Rheumatology, MESH: Rheumatology, MESH: Severity of Illness Index, Humans, MESH : Middle Aged, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], MESH: Consensus, MESH : Rheumatology, Aged, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH : Reproducibility of Results, MESH : Humans, Reproducibility of Results, MESH: Adult, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, MESH : Observer Variation, medicine.disease, MESH : Clinical Competence, MESH: Male, Cross-Sectional Studies, MESH : Arthritis, Rheumatoid, Physical therapy, Joints, Treatment decision making, business, MESH: Female
Abstract

International audience; Synovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience.; Eighteen rheumatologists from French university rheumatology units participated in three 30 minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa.; Global agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%.; Consensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists.

Published
2013
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7. Pharmacotherapy (excluding biotherapies) for ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion

Author

Thierry Schaeverbeke, Frédéric Lavie, Emmanuelle Dernis, Alain Cantagrel, René Marc Flipo, Xavier Le Loët, Pascal Claudepierre, Philippe Goupille, Alain Saraux, Daniel Wendling, Stephan Pavy, Bernard Combe, Jacques Tebib, Jean-Francis Maillefert, Xavier Mariette, Service de rhumatologie, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service d'immunologie et rhumatologie, Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service de Rhumatologie, Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Bordeaux [Bordeaux], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département de Rhumatologie[Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie

Subjects
Male, medicine.medical_specialty, Consensus, Alternative medicine, MEDLINE, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Rheumatology, MESH: Practice Guidelines as Topic, medicine, Humans, Spondylitis, Ankylosing, 030212 general & internal medicine, MESH: Consensus, Spondylitis, Randomized Controlled Trials as Topic, MESH: Treatment Outcome, 030203 arthritis & rheumatology, Ankylosing spondylitis, Evidence-Based Medicine, MESH: Humans, business.industry, Anti-Inflammatory Agents, Non-Steroidal, Evidence-based medicine, MESH: Follow-Up Studies, medicine.disease, MESH: Spondylitis, Ankylosing, MESH: Anti-Inflammatory Agents, Non-Steroidal, MESH: Sensitivity and Specificity, MESH: Male, 3. Good health, MESH: France, Treatment Outcome, MESH: Randomized Controlled Trials as Topic, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Meta-analysis, Family medicine, Practice Guidelines as Topic, Physical therapy, Female, France, business, MESH: Female, Rheumatism, MESH: Evidence-Based Medicine, Follow-Up Studies
Abstract

International audience; OBJECTIVES: To develop recommendations about pharmacotherapy (excluding biotherapeutic agents) in patients with axial forms of ankylosing spondylitis (AS) seen in everyday clinical practice. METHODS: The recommendations were based on evidence from the literature. First, a scientific committee used a Delphi procedure to select five focal points about which recommendations were needed. Then, a literature task force looked for relevant publications in the following: Cochrane, PubMed, and Ovid databases; and abstracts from the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. Based on the data in these publications, recommendations were drafted then validated by a group of experts. The strength of each recommendation was determined, as well as the extent of agreement among the experts. RESULTS: The four focal points were the best strategy for using nonsteroidal anti-inflammatory drugs, role for systemic glucocorticoid therapy, role for glucocorticoid injections into the sacroiliac joints and entheses, and role for slow-acting drugs (e.g., methotrexate, sulfasalazine, leflunomide, thalidomide, and pamidronate). Of the 661 promising publications identified by the literature search, 173 were found to be relevant. The evidence in these 173 papers was reported to experts during interactive workshops. At the end of the workshops, the experts drafted recommendations, which were then validated by having all panel participants vote during a final meeting. There were seven recommendations, whose strength ranged from A to D. CONCLUSION: Seven recommendations about pharmacotherapy in patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS in France.

Published
2007
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8. Imaging for the diagnosis and follow-up of ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion

Author

Frédéric Lavie, Bernard Combe, Jean-Francis Maillefert, Thierry Schaeverbeke, Xavier Le Loët, Emmanuelle Dernis, Alain Saraux, René-Marc Flipo, Pascal Claudepierre, Stephan Pavy, Philippe Goupille, Alain Cantagrel, Daniel Wendling, Jacques Tebib, Xavier Mariette, Service de rhumatologie, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), CHU Bordeaux [Bordeaux], Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service de Rhumatologie, Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Service d'immunologie et rhumatologie, Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département de Rhumatologie[Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie

Subjects
Male, Delphi Technique, Alternative medicine, MESH: Monitoring, Physiologic, MESH: Delphi Technique, 030218 nuclear medicine & medical imaging, Scientific evidence, MESH: Magnetic Resonance Imaging, 0302 clinical medicine, MESH: Practice Guidelines as Topic, Randomized Controlled Trials as Topic, computer.programming_language, Evidence-Based Medicine, MESH: Follow-Up Studies, Continuity of Patient Care, MESH: Spondylitis, Ankylosing, Magnetic Resonance Imaging, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Radiological weapon, Practice Guidelines as Topic, Female, France, MESH: Tomography, X-Ray Computed, Diagnostic Imaging, medicine.medical_specialty, MEDLINE, Sensitivity and Specificity, 03 medical and health sciences, Rheumatology, medicine, Humans, Spondylitis, Ankylosing, Medical physics, Monitoring, Physiologic, 030203 arthritis & rheumatology, Ankylosing spondylitis, MESH: Humans, business.industry, MESH: Diagnostic Imaging, Evidence-based medicine, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, MESH: France, MESH: Continuity of Patient Care, MESH: Randomized Controlled Trials as Topic, Physical therapy, Tomography, X-Ray Computed, business, computer, MESH: Female, Delphi, Rheumatism, MESH: Evidence-Based Medicine, Follow-Up Studies
Abstract

International audience; OBJECTIVE: To develop recommendations regarding imaging studies for the diagnosis and follow-up of patients with axial forms of ankylosing spondylitis (AS) seen in everyday practice. METHODS: Evidence from the literature and expert opinion were used to develop the recommendations. Using the Delphi consensus procedure, a scientific committee selected five areas of interest, about which scientific evidence was sought by searching Medline and the databases maintained by the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. Based on this evidence, a panel of experienced rheumatologists drafted recommendations, using expert opinion if needed to supplement gaps in evidence. For each recommendation, the level of evidence and the extent of agreement among the experts were specified. RESULTS: The five areas of interest dealt with the usefulness of imaging studies for the diagnosis, follow-up, prognostic evaluation, and assessment of treatment responses in patients with AS. The literature search retrieved 144 articles based on titles and abstracts. After elimination of articles that did not include an analysis of the radiological evaluation of AS, 73 articles were left for review. Eight recommendations were drafted then validated by having all panel participants vote during a final meeting. CONCLUSION: Eight recommendations about the use of imaging studies in patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS.

Published
2007
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9. Clinical and laboratory follow-up for treating and monitoring patients with ankylosing spondylitis: development of recommendations for clinical practice based on published evidence and expert opinion

Author

Bernard Combe, Alain Cantagrel, Thierry Schaeverbeke, Emmanuelle Dernis, Alain Saraux, Frédéric Lavie, Xavier Mariette, Philippe Goupille, Pascal Claudepierrre, Jean Francis Maillefert, René-Marc Flipo, Daniel Wendling, Jacques Tebib, Xavier Le Loët, Stephan Pavy, Service de rhumatologie, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de Rhumatologie, Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Bordeaux [Bordeaux], Service d'immunologie et rhumatologie, Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département de Rhumatologie[Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie

Subjects
Male, MESH: Combined Modality Therapy, Delphi Technique, Delphi method, MESH: Monitoring, Physiologic, MESH: Risk Assessment, Severity of Illness Index, MESH: Delphi Technique, 0302 clinical medicine, MESH: Practice Guidelines as Topic, 030212 general & internal medicine, BASDAI, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Continuity of Patient Care, MESH: Spondylitis, Ankylosing, Combined Modality Therapy, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Meta-analysis, Practice Guidelines as Topic, Female, France, medicine.medical_specialty, Consensus, MEDLINE, Clinical Chemistry Tests, Risk Assessment, Sensitivity and Specificity, 03 medical and health sciences, Rheumatology, MESH: Severity of Illness Index, medicine, Humans, Spondylitis, Ankylosing, Medical physics, MESH: Consensus, Spondylitis, Monitoring, Physiologic, 030203 arthritis & rheumatology, Ankylosing spondylitis, MESH: Humans, MESH: Clinical Chemistry Tests, business.industry, Evidence-based medicine, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, MESH: France, MESH: Continuity of Patient Care, MESH: Randomized Controlled Trials as Topic, Physical therapy, business, BASFI, MESH: Female, MESH: Evidence-Based Medicine
Abstract

International audience; OBJECTIVE: To develop French recommendations about the clinical and laboratory follow-up of patients with axial ankylosing spondylitis (AS) seen in everyday practice. METHODS: The recommendations were developed based on evidence from the literature and on expert opinion. A Delphi consensus procedure was used by a scientific committee to select five focal points, about which evidence was obtained by searching Medline and the databases maintained by the French Society for Rheumatology, European League against Rheumatism, and American College of Rheumatology. The results of the literature review were used by a panel of experienced rheumatologists to draft and to validate the recommendations, using expert opinion if needed to supplement gaps in published knowledge. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS: The three focal points selected using the Delphi procedure dealt with choosing the best clinical and laboratory parameters for monitoring patients with AS; whether follow-up benefits from the use of composite indices (e.g., the Bath Ankylosing Spondylitis Disease Activity Index [BASDAI], the BAS Functional Index [BASFI] and the BAS Metrology Index [BASMI]); and the clinical and laboratory parameters that predict functional or structural outcomes in patients with AS. The literature search retrieved 1510 relevant articles based on titles and abstracts, of which 322 were selected for in-depth review. Five recommendations about the clinical and laboratory follow-up of patients with AS were developed then validated by having all panel participants vote during a final meeting. CONCLUSION: Recommendations about the clinical and laboratory follow-up of patients with AS were developed. They can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of patients with AS.

Published
2007
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