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1. Clinical Characteristics of Pruritus in Systemic Sclerosis Vary According to the Autoimmune Subtype

Author

Laurent Misery, Greta Gourier, Alain Saraux, Elisabeth Pasquier, Margaux Mazeas, H. Sonbol, Yves Renaudineau, Claire Abasq-Thomas, Valérie Devauchelle-Pensec, Emmanuelle Le Moigne, F. Huet, Julie Lemerle, Elize Campillo, C. Théréné, Emilie Brenaut, Service de dermatologie (Dermato - BREST), 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), Département de Médecine Interne et Pneumologie [Brest] (DMIP - Brest), Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Laboratoire d'Immunologie et Immunothérapie, Service de dermatologie ( Dermato - BREST ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Lymphocyte B et Auto-immunité ( LBAI ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département de Médecine Interne et Pneumologie [Brest] ( DMIP - Brest ), Centre National de Référence CERAINO, Service de Rhumatologie ( Hôpital de la Cavale Blanche ), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)

Subjects
Male, 0301 basic medicine, Time Factors, autoantibodies, [SDV]Life Sciences [q-bio], Disease, medicine.disease_cause, Severity of Illness Index, Scleroderma, Autoimmunity, Surveys and Questionnaires, systemicsclerosis, Registries, itch, skin and connective tissue diseases, integumentary system, autoimmunity, General Medicine, Middle Aged, Pathophysiology, 3. Good health, Antibodies, Antinuclear, RL1-803, Female, medicine.medical_specialty, Dermatology, 03 medical and health sciences, Severity of illness, medicine, Humans, Serologic Tests, Aged, Retrospective Studies, Scleroderma, Systemic, [ SDV ] Life Sciences [q-bio], business.industry, Autoantibody, qualityoflife, Retrospective cohort study, pruritus, medicine.disease, eye diseases, body regions, stomatognathic diseases, 030104 developmental biology, inflammation, Concomitant, business, Biomarkers
Abstract

International audience; Pruritus is a frequent symptom in systemic sclerosis (SSc), with a prevalence of 40-65%, but its pathophysiology is poorly understood. This study investigated the immunological component of pruritus. Fifty-six patients with SSc responded to a standardized questionnaire regarding both SSc disease and pruritus characteristics. Among patients with SSc, those with pruritus did not display a particular immunological profile (inflammatory, humoral, and/or cellular factors), but pruritus was, in most cases, concomitant with the development of SSc. Thus, pruritus characteristics were evaluated further, according to the detection of anti-centromere autoantibodies (ACA), into ACA+ (n = 17) and ACA- (n = 19). The ACA+ subgroup was characterized by a longer evolution of SSc and pruritus, pruritus present outside the sclerotic area, and a shorter daily duration of pruritus. In conclusion, the concomitant appearance of the 2 processes and the differences observed between ACA+ and ACA- subgroups support the presence of an immunological component in pruritus.

Published
2018

2. Publisher Correction: Rheumatological features of Whipple disease

Author

Aleth Perdriger, Béatrice Bouvard, Nathan Foulquier, Philippe Goupille, Jean-Marie Berthelot, Clémentine Leleu, Adrien Le Pluart, François Robin, Jean-David Albert, Guillaume Le Mélédo, Elisabeth Gervais, Alice Tison, Alain Saraux, Pauline Preuss, Grégoire Cormier, Justine Vix, Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Service de rhumatologie [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de rhumatologie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Groupe innovation et ciblage cellulaire (GICC), EA 7501 [2018-...] (GICC EA 7501), Université de Tours (UT), and CHU La Roche sur Yon

Subjects
Adult, Diagnostic Imaging, Male, medicine.medical_specialty, Science, [SDV]Life Sciences [q-bio], Diagnosis, Differential, 03 medical and health sciences, 0302 clinical medicine, Rheumatic Diseases, Humans, Medicine, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, 030304 developmental biology, Aged, 80 and over, 0303 health sciences, Multidisciplinary, business.industry, Whipple Disease, Middle Aged, Publisher Correction, Dermatology, Anti-Bacterial Agents, Treatment Outcome, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, Symptom Assessment, business, Biomarkers, 030217 neurology & neurosurgery
Abstract

Whipple disease (WD) is a rare infectious systemic disease. Rheumatologists are at the frontline of WD diagnosis due to the early rheumatological manifestations. An early diagnosis is crucial, as usual anti-rheumatic drugs, especially TNF inhibitors, may worsen the disease course. We conducted a retrospective multicentre national study from January 2010 to April 2020 to better characterize the rheumatological features of WD. Classic WD (CWD) was defined by positive periodic acid-Schiff (PAS) staining of a small-bowel biopsy sample, and non-CWD (NCWD) was defined by negative PAS staining of a small-bowel biopsy sample but at least one positive Tropheryma whipplei (TW) polymerase chain reaction (PCR) for a digestive or extradigestive specimen. Sixty-eight patients were enrolled, including 11 CWD patients. Twenty patients (30%) received TNF inhibitors during the WD course, with inefficacy or symptom worsening. More digestive symptoms and systemic biological features were observed in CWD patients than in NCWD patients, but both patient groups had similar outcomes, especially concerning the response to antibiotics and relapse rate. Stool and saliva TW PCR sensitivity were both 100% for CWD and 75% for NCWD and 89% and 60% for small-bowel biopsy sample PCR, respectively. WD encountered in rheumatology units has many presentations, which might result from different pathophysiologies that are dependent on host immunity. Given the heterogeneous presentations and the presence of chronic carriage, multiple TW PCR tests on samples from specific rheumatological sites when possible should be performed, but samples from nonspecific digestive and extradigestive sites also have great value.

Published
2021

3. Rheumatological features of Whipple disease

Author

Alice Tison, Pauline Preuss, Clémentine Leleu, François Robin, Adrien Le Pluart, Justine Vix, Guillaume Le Mélédo, Philippe Goupille, Elisabeth Gervais, Grégoire Cormier, Jean-David Albert, Aleth Perdriger, Béatrice Bouvard, Jean-Marie Berthelot, Nathan Foulquier, Alain Saraux, the network of rheumatologists from the Grand Ouest 'VICTOR HUGO', Michel, Geneviève, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Service de rhumatologie [Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), PRES Université Nantes Angers Le Mans (UNAM), Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Pontchaillou [Rennes], Service de rhumatologie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre hospitalier La Roche-Sur-Yon, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), This study is part of the French network of University Hospitals VICTOR HUGO (InnoVation en reCherche OsTeo-aRticulaire des Hôpitaux Universitaires du Grand Ouest’)'., Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)

Subjects
Systemic disease, medicine.medical_specialty, Saliva, [SDV.IMM] Life Sciences [q-bio]/Immunology, medicine.drug_class, Science, Antibiotics, Periodic acid–Schiff stain, Pathogenesis, Gastroenterology, Article, law.invention, Tropheryma whipplei, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, law, Internal medicine, medicine, Signs and symptoms, Polymerase chain reaction, 030203 arthritis & rheumatology, Multidisciplinary, biology, business.industry, Whipple Disease, medicine.disease, biology.organism_classification, 3. Good health, Medicine, [SDV.IMM]Life Sciences [q-bio]/Immunology, 030211 gastroenterology & hepatology, business
Abstract

Whipple disease (WD) is a rare infectious systemic disease. Rheumatologists are at the frontline of WD diagnosis due to the early rheumatological manifestations. An early diagnosis is crucial, as usual anti-rheumatic drugs, especially TNF inhibitors, may worsen the disease course. We conducted a retrospective multicentre national study from January 2010 to April 2020 to better characterize the rheumatological features of WD. Classic WD (CWD) was defined by positive periodic acid-Schiff (PAS) staining of a small-bowel biopsy sample, and non-CWD (NCWD) was defined by negative PAS staining of a small-bowel biopsy sample but at least one positive Tropheryma whipplei (TW) polymerase chain reaction (PCR) for a digestive or extradigestive specimen. Sixty-eight patients were enrolled, including 11 CWD patients. Twenty patients (30%) received TNF inhibitors during the WD course, with inefficacy or symptom worsening. More digestive symptoms and systemic biological features were observed in CWD patients than in NCWD patients, but both patient groups had similar outcomes, especially concerning the response to antibiotics and relapse rate. Stool and saliva TW PCR sensitivity were both 100% for CWD and 75% for NCWD and 89% and 60% for small-bowel biopsy sample PCR, respectively. WD encountered in rheumatology units has many presentations, which might result from different pathophysiologies that are dependent on host immunity. Given the heterogeneous presentations and the presence of chronic carriage, multiple TW PCR tests on samples from specific rheumatological sites when possible should be performed, but samples from nonspecific digestive and extradigestive sites also have great value.

Published
2021

4. Epidemiology of cutaneous involvement in Sjögren syndrome: Data from three French pSS populations (TEARS, ASSESS, diapSS)

Author

Raphaèle Seror, Laurent Misery, Philippe Dieudé, Eric Hachulla, Xavier Mariette, Gilles Hayem, Jacques-Eric Gottenberg, Camille Villon, Aleth Perdriger, Laure Orgeolet, Jean-Jacques Dubost, Divi Cornec, Jacques Morel, Pierre-Yves Hatron, Jean-Marie Berthelot, Vincent Goëb, Anne-Laure Fauchais, Valérie Devauchelle-Pensec, Véronique Le Guern, Sandrine Jousse-Joulin, Olivier Vittecoq, Claire Larroche, Alain Saraux, Anne-Marie Roguedas, CHRU de Brest - Département de dermatologie, Hôpital Morvan - CHRU de Brest (CHU - BREST ), Service de dermatologie (Dermato - BREST), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de rhumatologie [Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Centre de Rhumatologie (Rhumato - BICHAT), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Rhumatologie [CHU Gabriel-Montpied], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de Médecine interne A et polyclinique médicale [CHU Limoges], CHU Limoges, Service de Rhumatologie - AMIENS (AMIENS - Rhumato), CHU Amiens-Picardie, Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, Service de médecine interne [Avicenne], Hôpital Avicenne [AP-HP], Département de Rhumatologie (Rhumato - Ambroise Paré - PARIS), Centre Hospitalier Universitaire Ambroise Paré (CHU Ambroise Paré), Service de médecine interne et centre de référence des maladies rares [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Unité thérapeutique d'immunologie clinique et des maladies ostéoarticulaires [Hôpital Lapeyronie, Montpellier], Hôpital Lapeyronie [Montpellier] (CHU), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), and Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche)

Subjects
medicine.medical_specialty, Visual analogue scale, Placebo, Severity of Illness Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, Dry skin, medicine, Prevalence, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Pain Measurement, 030203 arthritis & rheumatology, integumentary system, business.industry, Hypergammaglobulinemia, medicine.disease, Dermatology, eye diseases, 3. Good health, stomatognathic diseases, Sjogren's Syndrome, Cohort, Tears, [SDV.IMM]Life Sciences [q-bio]/Immunology, Rituximab, medicine.symptom, business, medicine.drug
Abstract

To determine the prevalence and significance of dermatological disorders in primary Sjögren syndrome (pSS).We used 2 pSS French cohorts (ASSESS, in which prevalence of skin disorders in 395 patients was evaluated; and diapSS, in which 76 on 139 pSS patients had an examination by a dermatologist) and baseline data of the TEARS randomized trial (110 patients with recent or active pSS treated with rituximab or placebo and evaluated for skin dryness using a visual analogue scale (VAS) out of 100).Skin manifestations included in the EULAR Sjögren syndrome disease activity index (ESSDAI) were rare in the ASSESS cohort (n=16/395, 4.1%, mainly purpuras; only 3 had high activity), but they were associated with activity in the other ESSDAI domains (peripheral neurological (P0.001), muscular (P0.01), haematological (P0.05), biological (P0.05), history of arthritis (P0.01), splenomegaly (P0.05) and higher gamma globulin levels (P0.01)). In the diapSS cohort, compared to pSS patients not receiving a dermatological consultation, the pSS patients who had a dermatological consultation had significantly more dermatological involvement outside the ESSDAI score [38.2% (29/76) versus 15.9% (10/63); P0.01]. The TEARS study showed a high prevalence of cutaneous dryness (VAS50; 48.2%) and found that patients with dry skin had higher VAS pain (P0.01) and drought (P0.01) scores.ESSDAI skin activity is rare and associated with hypergammaglobulinemia and ESSDAI activity. Systematic dermatological examination is informative for non-specific lesions. The most common skin disorder is skin dryness, which is associated with a higher pain and overall subjective dryness.

Published
2020

5. Rituximab for rheumatoid arthritis-associated large granular lymphocytic leukemia, a retrospective case series

Author

Frank Verhoeven, Renaud Felten, Daniel Wendling, Martin Soubrier, Alain Saraux, Eric Toussirot, Jean Sibilia, Charles Dervout, V. Grobost, Bruno Gombert, Divi Cornec, Hervé Lobbes, Marc Ruivard, CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), FHU 'Integrated center for research in inflammatory diseases - InCREASe', Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté]), Service de rhumatologie [Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Equipe Plate-forme GENOMAX (Inserm U1109), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Fédération Hospitalo-Universitaire OMICARE-Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA), Service de Rhumatologie, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université de Besançon, Hopital saint louis (LA ROCHELLE - Hôpital Saint Louis), CH La Rochelle, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de Rhumatologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, CCSD, Accord Elsevier, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Etablissement français du sang [Bourgogne-Franche-Comté] (EFS [Bourgogne-Franche-Comté])-Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon] (UNICANCER/CRLCC-CGFL), UNICANCER-UNICANCER-Université Bourgogne Franche-Comté [COMUE] (UBFC), Fédération Hospitalo-Universitaire OMICARE-Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg (UNISTRA)-Université de Strasbourg (UNISTRA)-Immuno-Rhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Strasbourg (UNISTRA), Lymphocyte B et Auto-immunité (LBAI), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM)

Subjects
medicine.medical_specialty, Cyclophosphamide, [SDV.IMM] Life Sciences [q-bio]/Immunology, Large granular lymphocytic leukemia, Population, Gastroenterology, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, Cyclosporin a, medicine, Humans, Rheumatoid factor, 030212 general & internal medicine, education, ComputingMilieux_MISCELLANEOUS, Retrospective Studies, 030203 arthritis & rheumatology, education.field_of_study, business.industry, Middle Aged, medicine.disease, 3. Good health, Leukemia, Large Granular Lymphocytic, Methotrexate, Anesthesiology and Pain Medicine, Rheumatoid arthritis, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, Rituximab, business, medicine.drug
Abstract

Objectives To assess the efficacy and tolerance profile of rituximab in rheumatoid arthritis (RA)-associated large granular lymphocyte leukemia (LGLL). Methods Multicenter retrospective case series. Inclusion criteria were RA defined by the ACR/EULAR 2010 criteria and LGLL defined by absolute LGL count ≥ 0.3 × 109/L with evidence of an expanded clonal LGL population (flow cytometry, TCR-γ polymerase chain reaction, or Stat3 mutation). Results Fourteen patients (10 women, mean age 55.2 ± 14.2 years) included; 13 were seropositive for anti-cyclic citrullinated peptides (n = 11) or rheumatoid factor (n = 10). LGLL diagnosis was made 9.5 [IQR: 3.25;15.5] years after RA diagnosis. Thirteen patients had T-LGLL. Rituximab was the first-line therapy for LGLL for 4 patients. Previous treatment lines included methotrexate (n = 7), cyclophosphamide (n = 2), cyclosporin A (n = 1), or granulocyte colony-stimulating factor (n = 4). Rituximab was used in monotherapy (n = 8) or associated to methotrexate (n = 3), granulocyte colony-stimulating factor (n = 2), or alkylating agents (n = 1). The number of rituximab cycles ranged from 1 to 11 (median 6), with high heterogeneity in dosing regimens. Median duration response after rituximab initiation was 35 [IQR: 23.5;41] months. The overall response rate was 100%: 8 patients experienced complete response (normalization of blood count and LGL ≤ 0.3 × 109/L) and 6 experienced partial responses (improvement in blood counts without complete normalization). The tolerance profile was good, with no infectious complications. Conclusion rituximab appears as a valuable therapeutic option for RA-associated LGLL.

Published
2020

6. Adherence to Treat-to-target Management in Rheumatoid Arthritis and Associated Factors: Data from the International RA BIODAM Cohort

Author

Marina Backhaus, Ori Elkayam, J. Carter Thorne, Gianfranco Ferraccioli, Paul P. Tak, Mikkel Østergaard, M. Govoni, Joanne Homik, Clifton O. Bingham, Walter P. Maksymowych, Hilde Berner Hammer, Dirkjan van Schaardenburg, Alexandre Sepriano, Maxime Dougados, Joel Paschke, Désirée van der Heijde, Sofia Ramiro, Robert Landewé, Alain Cantagrel, Alain Saraux, Cheryl Barnabe, Oliver FitzGerald, Maggie Larché, Luigi Sinigaglia, E. Hutchings, Maurizio Rossini, Thierry Schaeverbeke, Gerd R Burmester, Bernard Combe, Gilles Boire, R. Dadashova, Leiden University Medical Center (LUMC), Zuyderland Hospital [Heerlen, The Netherlands], St Vincent's University Hospital, Rigshospitalet [Copenhagen], Copenhagen University Hospital, University of Alberta, Tel Aviv Sourasky Medical Center [Te Aviv], The Arthritis Program Research Group, McMaster University [Hamilton, Ontario], Università cattolica del Sacro Cuore [Piacenza e Cremona] (Unicatt), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Université de Sherbrooke (UdeS), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, CHU de Bordeaux Pellegrin [Bordeaux], Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Equipe 4 : ECaMO - Épidémiologie clinique appliquée aux maladies rhumatismales et musculo-squelettiques (CRESS - U1153), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM), HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-HESAM Université - Communauté d'universités et d'établissements Hautes écoles Sorbonne Arts et métiers université (HESAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Università degli studi di Verona = University of Verona (UNIVR), Università degli Studi di Ferrara = University of Ferrara (UniFE), Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, parent, Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), University of Calgary, Johns Hopkins University School of Medicine [Baltimore], VU University Medical Center [Amsterdam], Diakonhjemmet Hospital, CaRE Arthritis Ltd, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Salvy-Córdoba, Nathalie, 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), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)-Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), University of Verona (UNIVR), Università degli Studi di Ferrara (UniFE), Hôpital Pierre-Paul Riquet [Toulouse], CHU Toulouse [Toulouse], Clinical Immunology and Rheumatology, and AII - Inflammatory diseases

Subjects
0301 basic medicine, medicine.medical_specialty, MESH: Antirheumatic Agents, MESH: Remission Induction, MESH: Rheumatoid Factor, Immunology, Best Treatment Practices, Rheumatoid Arthritis, Severity of Illness Index, Longitudinal model, Gee, NO, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Rheumatoid Factor, Internal medicine, MESH: Severity of Illness Index, medicine, Humans, Immunology and Allergy, Generalized estimating equation, MESH: Treatment Outcome, 030203 arthritis & rheumatology, MESH: Arthritis, Rheumatoid, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Humans, business.industry, Remission Induction, Protocol Requirement, Baseline model, Treat to target, rheumatoid arthritis, T2T. rheumatology, medicine.disease, T2T. rheumatology, Treatment Outcome, 030104 developmental biology, Rheumatoid Arthritis, Best Treatment Practices, Treat-to-target, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Antirheumatic Agents, Rheumatoid arthritis, Cohort, Tumor Necrosis Factor Inhibitors, Treat-to-Target, MESH: Tumor Necrosis Factor Inhibitors, business
Abstract

Objective.Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T.Methods.Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model).Results.A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02–1.19), smoking (OR 1.32, 95% CI 1.08–1.63) and high number of tender joints (OR 1.03, 95% CI 1.02–1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50–0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model.Conclusion.Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].

Published
2020

7. Trajectory analysis combining pain and physical function in individuals with knee and hip osteoarthritis: results from the French KHOALA cohort

Author

Francis Guillemin, Jacques Pouchot, C. Rotonda, Joël Coste, Alain Saraux, Maud Wieczorek, Anne-Christine Rat, Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Unité d’Epidémiologie et de Biostatistiques [APHP Cochin-Broca-Hôtel Dieu], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département de médecine interne - hôpital européen Georges-Pompidou, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), LabEx IGO, Partenaires INRAE, Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de Rhumatologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), and KHOALA

Subjects
Male, medicine.medical_specialty, Multivariate analysis, Arthroplasty, Replacement, Hip, Population, Osteoarthritis, Knee Joint, Osteoarthritis, Hip, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, physical function, Rheumatology, medicine, Humans, trajectories, Pharmacology (medical), pain, 030212 general & internal medicine, education, Arthroplasty, Replacement, Knee, Exercise, Multinomial logistic regression, Aged, 030203 arthritis & rheumatology, education.field_of_study, business.industry, Middle Aged, Osteoarthritis, Knee, Physical Functional Performance, medicine.disease, Arthralgia, Distress, osteoarthritis, Latent Class Analysis, Cohort, Physical therapy, Disease Progression, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business, Psychosocial
Abstract

Objectives The aims of this study were to identify homogeneous subgroups of knee and/or hip OA patients with distinct trajectories of the combination of pain and physical function (PF) over time and to determine the baseline factors associated with these trajectories. Methods We used data from the Knee and Hip Osteoarthritis Long-term Assessment (KHOALA) cohort, a French population-based cohort of 878 patients with symptomatic knee and/or hip OA. Pain and PF were measured annually over 5 years with the Medical Outcomes Study Short Form 36 questionnaire. First, trajectory models were estimated with varying numbers of groups for each of the outcomes separately then fitted into a multi-trajectory model. We used multinomial logistic regression to determine the baseline characteristics associated with each trajectory. Results Univariate four-class models were identified as most appropriate for pain and PF. Comparison of separate trajectories showed that 41% of patients included in the severe functional limitations trajectory did not belong to the more severe pain trajectory (Cramér’s V statistic = 0.45). Group-based multi-trajectory modelling revealed four distinct trajectories of pain and PF. On multivariate analyses, female sex, older age, high Kellgren grade, low physical activity intensity, low psychosocial distress score (high distress) and low vitality score were associated with the more severe symptoms trajectory. Conclusion Over 5 years, we identified four distinct trajectories combining pain and PF. Management of weight, fatigue and psychosocial distress and the practice of physical activity seem important to maintain function and limit pain in patients with lower-limb OA.

Published
2020

8. Pathogenesis-based treatments in primary Sjogren's syndrome using artificial intelligence and advanced machine learning techniques: a systematic literature review

Author

Nathan Foulquier, Pascal Redou, Jacques-Olivier Pers, Christophe Le Gal, Bénédicte Rouvière, Alain Saraux, Laboratoire de Traitement de l'Information Medicale (LaTIM), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), 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 National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Institut National de la Santé et de la Recherche Médicale (INSERM)-IMT Atlantique Bretagne-Pays de la Loire (IMT Atlantique), Institut Mines-Télécom [Paris] (IMT)-Institut Mines-Télécom [Paris] (IMT)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM)

Subjects
Big Data, Data Analysis, 0301 basic medicine, Artificial intelligence, Computer science, [SDV]Life Sciences [q-bio], Immunology, Big data, Machine learning, computer.software_genre, Machine Learning, 03 medical and health sciences, 0302 clinical medicine, advanced machine learning techniques, Screening method, Humans, Immunology and Allergy, Statistical analysis, Natural Language Processing, 030203 arthritis & rheumatology, Pharmacology, business.industry, systematic literature review, Databases, Bibliographic, 3. Good health, Sjogren's Syndrome, 030104 developmental biology, Systematic review, Sjogren s, business, computer, Research Paper
Abstract

International audience; Big data analysis has become a common way to extract information from complex and large datasets among most scientific domains. This approach is now used to study large cohorts of patients in medicine. This work is a review of publications that have used artificial intelligence and advanced machine learning techniques to study physio pathogenesis-based treatments in pSS. A systematic literature review retrieved all articles reporting on the use of advanced statistical analysis applied to the study of systemic autoimmune diseases (SADs) over the last decade. An automatic bibliography screening method has been developed to perform this task. The program called BIBOT was designed to fetch and analyze articles from the pubmed database using a list of keywords and Natural Language Processing approaches. The evolution of trends in statistical approaches, sizes of cohorts and number of publications over this period were also computed in the process. In all, 44077 abstracts were screened and 1017 publications were analyzed. The mean number of selected articles was 101.0 (S.D. 19.16) by year, but increased significantly over the time (from 74 articles in 2008 to 138 in 2017). Among them only 12 focused on pSS but none of them emphasized on the aspect of pathogenesis-based treatments. To conclude, medicine progressively enters the era of big data analysis and artificial intelligence, but these approaches are not yet used to describe pSS-specific pathogenesis-based treatment. Nevertheless, large multicentre studies are investigating this aspect with advanced algorithmic tools on large cohorts of SADs patients.

Published
2018

9. Diabetes at the time of rheumatoid arthritis diagnosis is an independent predictor of pejorative outcomes: Data from the early arthritis ESPOIR cohort

Author

Jacques Morel, Alain Saraux, Francis Berenbaum, Jean-Pierre Daurès, Jérémie Sellam, Bruno Fautrel, Claire Daien, Bernard Combe, Nathalie Rincheval, Institut de Génétique Moléculaire de Montpellier (IGMM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Service d'immuno-rhumatologie[Montpellier], Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie [CHU Saint-Antoine], CHU Saint-Antoine [AP-HP], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), 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), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Immunologie et Pathologie (EA 2216), CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Institut de Génétique Moléculaire de Montpellier ( IGMM ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ), Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital Lapeyronie [Montpellier] ( CHU ), Service de Rhumatologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Lymphocyte B et Auto-immunité ( LBAI ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre National de Référence CERAINO, Service de Rhumatologie ( Hôpital de la Cavale Blanche ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), CIC - Montpellier, Université Montpellier 1 ( UM1 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)

Subjects
Male, medicine.medical_specialty, Outcomes, Independent predictor, Early rheumatoid arthritis, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Diabetes mellitus, Internal medicine, Diabetes Mellitus, medicine, Humans, 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, 030203 arthritis & rheumatology, [ SDV ] Life Sciences [q-bio], business.industry, Diabetes, Pejorative, Middle Aged, [SDV.MHEP.EM]Life Sciences [q-bio]/Human health and pathology/Endocrinology and metabolism, Prognosis, medicine.disease, Radiography, Early Diagnosis, Glucose, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatoid arthritis, Cohort, Disease Progression, Female, business, Early arthritis
Abstract

International audience

Published
2018

10. Spinal-pelvic orientation: potential effect on the diagnosis of spondyloarthritis

Author

Laure Gossec, Antoine Feydy, Florent Garrigues, M. Herbette, Pascal Claudepierre, Alain Saraux, A. Simon, Damien Loeuille, Thierry Marhadour, Lucile Deloire, Désirée van der Heijde, Monique Reijnierse, Guillermo Carvajal Alegria, Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Département de radiologie [Brest] (DR - Brest), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de neurochirurgie [Brest], Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Service de Radiologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Department of Radiology (MVS), Leiden University Medical Center (LUMC), Service de Rhumatologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Epidemiology in Dermatology and Evaluation in Therapeutics (EpiDermE), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), and Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Adult, Male, sacral slope, Lordosis, Radiography, Lumbar vertebrae, sacroiliitis, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Spondylarthritis, ankylosing spondylitis, Back pain, medicine, Humans, Pharmacology (medical), Prospective Studies, Pelvic Bones, Postural Balance, Orientation, Spatial, Pelvis, health care economics and organizations, 030203 arthritis & rheumatology, Ankylosing spondylitis, Lumbar Vertebrae, business.industry, Sacroiliitis, Reproducibility of Results, lumbar lordosis, axial spondyloarthritis, Pelvimetry, medicine.disease, Magnetic Resonance Imaging, medicine.anatomical_structure, Back Pain, Lumbosacral angle, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, medicine.symptom, business, Nuclear medicine, 030217 neurology & neurosurgery
Abstract

Objective To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. Methods Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle ( Results Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. Conclusion Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.

Published
2019

11. Plea for standardization of disease activity scores

Author

Valérie Devauchelle-Pensec, Alain Saraux, Lea Saraux, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), and Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
030203 arthritis & rheumatology, medicine.medical_specialty, Standardization, business.industry, [SDV]Life Sciences [q-bio], Reference Standards, Disease activity, 03 medical and health sciences, 0302 clinical medicine, Plea, Rheumatology, Outcome Assessment, Health Care, medicine, [SDV.IMM]Life Sciences [q-bio]/Immunology, Health Status Indicators, Humans, Pharmacology (medical), 030212 general & internal medicine, Intensive care medicine, business, ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2019

12. Peripheral-blood b-cell subset disturbances in inflammatory joint diseases induced by Tropheryma whipplei

Author

Jacques-Olivier Pers, M. Herbette, Divi Cornec, Clara Le Guillou, Christophe Jamin, Alain Saraux, Dewi Guellec, Sandrine Jousse-Joulin, Jean-Michel Cauvin, Maëlle Le Goff, Thierry Marhadour, Valérie Devauchelle-Pensec, Yves Renaudineau, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHRU de Brest, Département information médicale (CHU - BREST ), Laboratoire d'Immunologie et Immunothérapie [Brest], Michel, Geneviève, Lymphocytes B, Autoimmunité et Immunothérapies (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-LabEX IGO Immunothérapie Grand Ouest, and Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Institut Brestois Santé Agro Matière (IBSAM)

Subjects
Male, 0301 basic medicine, B Cells, Biopsy, [SDV]Life Sciences [q-bio], Artificial Gene Amplification and Extension, Lymphocyte Activation, Polymerase Chain Reaction, Immunoglobulin D, Gastroenterology, Serology, White Blood Cells, Animal Cells, Medicine and Health Sciences, Lymphocytes, health care economics and organizations, Aged, 80 and over, Multidisciplinary, medicine.diagnostic_test, biology, T Cells, Ceftriaxone, Middle Aged, Flow Cytometry, Anti-Bacterial Agents, 3. Good health, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, Doxycycline, Medicine, Female, Cellular Types, Whipple Disease, Research Article, Hydroxychloroquine, Adult, Subset Analysis, medicine.medical_specialty, Adolescent, Science, Immune Cells, Inflammatory Diseases, Immunology, 030106 microbiology, Naive B cell, education, B-Lymphocyte Subsets, Tropheryma, Surgical and Invasive Medical Procedures, Research and Analysis Methods, Flow cytometry, Tropheryma whipplei, 03 medical and health sciences, Diagnostic Medicine, Internal medicine, medicine, Humans, Antibody-Producing Cells, Molecular Biology Techniques, Molecular Biology, B cell, Aged, Retrospective Studies, Blood Cells, business.industry, Biology and Life Sciences, Cell Biology, Memory B cells, biology.organism_classification, 030104 developmental biology, ROC Curve, biology.protein, business
Abstract

Objective To look for abnormalities in circulating B-cell subsets in patients with rheumatic symptoms of Whipple’s disease (WD). Method Consecutive patients seen between 2010 and 2016 for suspected inflammatory joint disease were identified retrospectively. Results of standardized immunological and serological tests and of peripheral-blood B-cell and T-cell subset analysis by flow cytometry were collected. Patients with criteria suggesting WD underwent PCR testing for Tropheryma whipplei, and those with diagnosis of WD (cases) were compared to those without diagnosis (controls). We used ROC curve analysis to evaluate the diagnostic value of flow cytometry findings for WD. Results Among 2917 patients seen for suspected inflammatory joint disease, 121 had suspected WD, including 9 (9/121, 7.4%) confirmed WD. Proportions of T cells and NK cells were similar between suspected and confirmed WD, whereas cases had a lower proportion of circulating memory B cells (IgD-CD38low, 18.0%±9.7% vs. 26.0%±14.2%, P = 0.041) and higher ratio of activated B cells over memory B cells (4.4±2.0 vs. 2.9±2.2, P = 0.023). Among peripheral-blood B-cells, the proportion of IgD+CD27- naive B cells was higher (66.2%±18.2% vs. 54.6%±18.4%, P = 0.047) and that of IgD-CD27+ switched memory B cells lower (13.3%±5.7% vs. 21.4%±11.9%, P = 0.023), in cases vs. controls. The criterion with the best diagnostic performance was a proportion of IgD+CD27- naive B cells above 70.5%, which had 73% sensitivity and 80% specificity. Conclusion Our study provides data on peripheral-blood B-cell disturbances that may have implications for the diagnosis and pathogenetic understanding of WD.

Published
2019

13. Assessment of major salivary gland size in primary Sjögren’s syndrome: comparison between clinical examination and ultrasonography

Author

Laëtitia Le Pottier, Divi Cornec, Pauline Marteau, Thierry Marhadour, Sophie Varache, Yves Gauvin, Maelenn Gouillou, Valérie Devauchelle-Pensec, Dewi Guellec, Guillermo Carvajal Alegria, Sebastian Costa, Jacques-Olivier Pers, Alain Saraux, Yves Renaudineau, Sylvie Boisramé, Sandrine Jousse-Joulin, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Anatomie et Pathologie, Brest, Service ORL, Department of Odontology, and Laboratoire d'Immunologie et Immunothérapie [Brest]

Subjects
Male, Intraclass correlation, Concordance, salivary glands, [SDV]Life Sciences [q-bio], Submandibular Gland, Physical examination, Severity of Illness Index, Palpation, parotidomegaly, 03 medical and health sciences, 0302 clinical medicine, Cohen's kappa, Rheumatology, stomatognathic system, Major Salivary Gland, medicine, Humans, Parotid Gland, 030212 general & internal medicine, Physical Examination, Ultrasonography, 030203 arthritis & rheumatology, medicine.diagnostic_test, business.industry, ultrasound, Ultrasound, Organ Size, Middle Aged, Parotid gland, stomatognathic diseases, Sjogren's Syndrome, medicine.anatomical_structure, ROC Curve, Sjögren’s syndrome, Female, business, Nuclear medicine, ESSDAI
Abstract

Objective Parotidomegaly is a criterion of the EULAR Primary Sjogren Syndrome Disease Activity Index (ESSDAI). The cut-off value was set at 3 cm in length for the parotid gland, 2 cm for the submandibular glands. However, clinical appreciation of salivary glands size remains hazardous. The objective is to evaluate inter-observer reproducibility of parotid gland measurement by palpation, and to secondary evaluate its reliability compared to US assessment. Methods Outpatients with primary Sjogren Syndrome (pSS) or with a diagnostic suspicion, in a single reference centre, were included. They underwent clinical examination by two independent investigators (VDP and DC), evaluating: parotid gland swelling, parotid gland size (direct measurement with a decameter under the mandibular angle), and pain. Cohen's kappa coefficient was calculated to determine inter-observer concordance for parotid gland swelling, and intraclass correlation coefficient to determine inter-observer agreement of gland size measurement. Results Thirty-four patients (33 women, 1 man) were included. Clinical data were complete for 33 patients. Inter-observer concordance Kappa coefficient was 0.90 [0.76–1.00] for detection of parotidomegaly over 66 parotid glands. It was of 0.60 [0.42–0.73] for gland length measurement. For one observer, the median cut-off for defining parotidomegaly was 4.15 cm; for the second observer, it was of 4.92 cm. For submandibular glands palpation, no correlation was found between investigators. A significant association between clinical parotidomegaly and a larger echographic surface was found. Conclusion Clinical measurement of parotidomegaly was concordant between two observers on a binary mode (presence/absence). However, concordance on direct measurement was weak. US could be a complementary examination.

Published
2019

14. Effect of cumulative exposure to corticosteroid and DMARD on radiographic progression in rheumatoid arthritis: results from the ESPOIR cohort

Author

Bruno Fautrel, Baptiste Louveau, Alain Saraux, Francis Guillemin, Yann De Rycke, Alexandre Lafourcade, Florence Tubach, David Hajage, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie (UPMC), Université Pierre et Marie Curie - Paris 6 (UPMC), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables (ECEVE (U1123 / UMR_S_1123)), Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Department of Biostatistics, Institut Curie [Paris], CIC Brest, Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital de la Cavale Blanche, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CIC epidémiologie clinique/ essais cliniques, Hôpital Bichat - Claude Bernard, Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Pharmacoépidémiologie (Cephepi), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut Curie, Service de Rhumatologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], and Institut National de la Santé et de la Recherche Médicale (INSERM)-AP-HP Hôpital universitaire Robert-Debré [Paris]-Université Paris Diderot - Paris 7 (UPD7)

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, [SDV]Life Sciences [q-bio], Cumulative Exposure, Arthritis, Administration, Oral, Logistic regression, Arthritis, Rheumatoid, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Rheumatology, Internal medicine, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Young adult, Glucocorticoids, ComputingMilieux_MISCELLANEOUS, Aged, Retrospective Studies, 030203 arthritis & rheumatology, Dose-Response Relationship, Drug, business.industry, Retrospective cohort study, Middle Aged, medicine.disease, 3. Good health, Radiography, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatoid arthritis, Antirheumatic Agents, Cohort, Disease Progression, Population study, Female, Joints, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies, Forecasting
Abstract

Objectives Several authors have tried to predict the risk of radiographic progression in RA according to baseline characteristics, considering exposure to treatment only as a binary variable (Treated: Yes/No). This study aims to model the risk of 5-year radiographic progression taking into account both baseline characteristics and the cumulative time-varying exposure to corticosteroids or DMARDs. Methods The study population consisted of 403 patients of the Etude et Suivi des Polyarthrites Indifferenciees Recentes cohort meeting the 1987 ACR or 2010 ACR/EULAR criteria for RA at inclusion and having complete radiographic data at baseline and 5 years. Radiographic progression was defined at 5 years as a significant increase of the Sharp/van der Heidje score (smallest detectable difference ⩾5). The best logistic regression model was selected from the following: model including only clinico-biological baseline characteristics; model considering baseline characteristics and treatments as binary variables; and model considering baseline characteristics and treatments as weighted cumulative exposure variables. Results Radiographic progression occurred in 143 (35.5%) patients. The best model combined anti-citrullinated peptide antibody positivity, ESR, swollen joint count >14 and erosion score at baseline, as well as corticosteroids, MTX/LEF (MTX or LEF) and biologic DMARDs (bDMARDs) as weighted cumulative exposure variables. Recent cumulative exposure to high doses of corticosteroids (⩽ 3months) was significantly associated with the risk of 5-year radiographic progression and a significant protective association was highlighted for a 36-month exposure to bDMARDs. Conclusion Corticosteroids and bDMARDs play an important role in radiographic progression. Accounting for treatment class and intensity of exposure is a major concern in predictive models of radiographic progression in RA patients.

Published
2018

15. Development and psychometric validation of a patient-reported outcome measure to assess fears in rheumatoid arthritis and axial spondyloarthritis: the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire

Author

Pierre Chauvin, V. Saulot, Thibault de Chalus, Jean-Michel Joubert, Alain Saraux, Christophe Hudry, Francis Berenbaum, Laure Gossec, Caroline Dreuillet, F. Russo-Marie, Sabine Tong, G. Cukierman, Department of Rheumatology, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], UCB Pharma, Colombes, UCB Laboratoire, UCB Laboratoires, Arthritis Fondation Courtin, Régénération et croissance de l'axone = Axonal Growth and Regeneration (NPS-12), Neurosciences Paris Seine (NPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de Biologie Paris Seine (IBPS), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Neuroscience Paris Seine (NPS), Centre National de la Recherche Scientifique (CNRS)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut de Biologie Paris Seine (IBPS), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), and Sorbonne Universités

Subjects
Adult, Male, musculoskeletal diseases, rheumatoid arthritis, medicine.medical_specialty, Psychometrics, [SDV]Life Sciences [q-bio], Immunology, education, Hospital Anxiety and Depression Scale, Logistic regression, General Biochemistry, Genetics and Molecular Biology, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Cronbach's alpha, Surveys and Questionnaires, Spondylarthritis, ankylosing spondylitis, medicine, Humans, Immunology and Allergy, Patient Reported Outcome Measures, Prospective Studies, 030212 general & internal medicine, Qualitative Research, Depression (differential diagnoses), health care economics and organizations, Aged, 030203 arthritis & rheumatology, Ankylosing spondylitis, business.industry, Fear, Clinical and Epidemiological Research, Middle Aged, medicine.disease, patient perspective, Cross-Sectional Studies, Rheumatoid arthritis, Physical therapy, Anxiety, Female, Patient-reported outcome, medicine.symptom, business
Abstract

ObjectivesTo develop and validate an outcome measure for assessing fears in patients with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA).MethodsFears were identified in a qualitative study, and reformulated as assertions with which participants could rate their agreement (on a 0–10 numeric rating scale). A cross-sectional validation study was performed including patients diagnosed with RA or axSpA. Redundant items (correlation >0.65) were excluded. Internal consistency (Cronbach’s α) and factorial structure (principal component analysis) were assessed. Patients were classified into fear levels (cluster analysis). Associations between patient variables and fear levels were evaluated using multiple logistic regression.Results672 patients were included in the validation study (432 RA, 240 axSpA); most had moderate disease activity and were prescribed biologics. The final questionnaire included 10 questions with high internal consistency (α: 0.89) and a single dimension. Mean scores (±SD) were 51.2 (±25.4) in RA and 60.5 (±22.9) in axSpA. Groups of patients with high (17.2%), moderate (41.1%) and low (41.7%) fear scores were identified. High fear scores were associated with high Arthritis Helplessness Index scores (OR 6.85, 95% CI (3.95 to 11.87)); high Hospital Anxiety and Depression Scale anxiety (OR 5.80, 95% CI (1.19 to 4.22)) and depression (OR 2.37, 95% CI (1.29 to 4.37)) scores; low education level (OR 3.48, 95% CI (1.37 to 8.83)); and high perceived disease activity (OR 2.36, 95% CI (1.10 to 5.04)).ConclusionsOverall, 17.2% of patients had high fear scores, although disease was often well controlled. High fear scores were associated with psychological distress. This questionnaire could be useful both in routine practice and clinical trials.

Published
2018

16. Comparison of 2002 AECG and 2016 ACR/EULAR classification criteria and added value of salivary gland ultrasonography in a patient cohort with suspected primary Sjögren’s syndrome

Author

Steeve Genestet, Sebastian Costa, Rozenn Le Berre, Alain Saraux, Béatrice Cochener, Sylvie Boisramé-Gastrin, Dewi Guellec, Yves Renaudineau, Jacques-Olivier Pers, Divi Cornec, Sandrine Jousse-Joulin, Thierry Marhadour, Valérie Devauchelle-Pensec, Maëlle Le Goff, Centre National de Référence CERAINO, Service de Rhumatologie (Hôpital de la Cavale Blanche), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Service de Médecine Interne Gériatrique (BREST - SMIG), Explorations fonctionnelles neurologiques, Service d'ophtalmologie [Brest], Université de Brest (UBO)-Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), CHRU Brest - Service d'Odontologie (CHU - BREST - Odontologie), and Laboratoire d'Immunologie et Immunothérapie

Subjects
Adult, Male, musculoskeletal diseases, medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, Classification criteria, Cross-sectional study, Concordance, [SDV]Life Sciences [q-bio], education, Salivary Glands, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, Diagnosis, medicine, Humans, 030212 general & internal medicine, skin and connective tissue diseases, 10. No inequality, ComputingMilieux_MISCELLANEOUS, Aged, Ultrasonography, 030203 arthritis & rheumatology, Salivary gland, business.industry, Middle Aged, medicine.disease, stomatognathic diseases, Cross-Sectional Studies, Sjogren's Syndrome, medicine.anatomical_structure, Sjögren’s syndrome, Cohort, Female, lcsh:RC925-935, business, Primary, Rheumatism, Research Article, Cohort study
Abstract

Background The objective was to evaluate concordance between 2002 American-European Consensus Group (AECG) and 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) classification criteria for primary Sjögren’s syndrome (pSS) and to assess how salivary gland ultrasonography (SGUS) might improve the classification of patients. Methods Patients with suspected pSS underwent a standardised evaluation, including SGUS, at inclusion into the single-centre Brittany DIApSS cohort. Agreement between the two criteria sets was assessed using Cohen’s κ coefficient. Characteristics of discordantly categorised patients were detailed. Results We prospectively included 290 patients between 2006 and 2016, among whom 125 (43%) met ACR/EULAR criteria and 114 (39%) also met AECG criteria; thus, 11 (4%) patients fulfilled only ACR/EULAR, no patients AECG only, and 165 (57%) patients neither criteria set. Concordance was excellent (κ = 0.92). Compared to patients fulfilling both criteria sets, the 11 patients fulfilling only ACR/EULAR criteria had similar age and symptom duration but lower frequencies of xerophthalmia and xerostomia (p

Published
2017

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