Search

Au siècle précédent, la chirurgie était une étape fréquente dans le traitement de la polyarthrite rhumatoïde (PR). Depuis l'utilisation précoce du méthotrexate et l'avènement des thérapies ciblées, la gestion globale a radicalement changé. Notre objectif était de déterminer la proportion de patients atteints de PR inclus dans la cohorte ESPOIR qui ont eu besoin d'une intervention chirurgicale (chirurgie orthopédique quelle qu'elle soit (CO) ou chirurgie orthopédique « majeure » (COM) (arthrodèse, arthroplastie et synovectomie)) et d'identifier les déterminants de ce recours à la chirurgie. Tous les patients de la cohorte française ESPOIR (au moins deux articulations gonflées pendant > 6 semaines et < 6 mois, aucun autre diagnostic que celui de PR, et aucune exposition antérieure aux glucocorticoïdes ou aux traitements de fond) ont été inclus entre 2002 et 2005. Nous avons sélectionné uniquement les patients qui remplissaient les critères ACR/EULAR. Leurs données démographiques, cliniques, biologiques, génétiques et radiologiques ont été recueillies. Nous avons évalué la proportion de patients ayant eu recours à une chirurgie orthopédique liée à la PR entre l'inclusion et la 12eme année de suivi (Tableau 1). Les déterminants prédictifs de ces chirurgies à l'inclusion ont été étudiés par analyse univariée puis multivariée (régression logistique). Sur 647 patients, 90 (13,9 %) ont eu au moins une CO et 36 (5,6 %) au moins une COM. En univarié, l'âge (p = 0,04), l'invalidité (p = 0,03), le score HAQ (p = 0,04), l'allèle HLA DRB1 (p = 0,009) et les anticorps anti-CCP (p = 0,02) étaient associés aux futures CO. Le handicap (p = 0,02), l'allèle HLA DRB1 (p = 0,04), les anticorps anti-CCP (p = 0,04), les anticorps anti-nucléaires (p = 0,04) et la présence d'un pincement radiographique (p = 0,02) étaient significativement associés à la COM. Seule la présence d'au moins un allèle HLA DRB1 est demeurée dans le modèle d'analyse multivariée (OR 2,1 (95 %IC 1,08–4,27 ; p = 0,03 pour CO et OR 2,58 (95 %IC 1,04–6,40), p = 0,04 pour COM, respectivement). Au total, 13,9 % et 5,6 % des patients atteints d'arthrite précoce répondant aux critères ACR/EULAR dans la cohorte ESPOIR ont respectivement eu recours à une CO et une COM entre l'inclusion et le suivi de 12 ans. Seule la présence d'au moins un allèle HLA DRB1 prédisait ces interventions chirurgicales lors de l'inclusion. [ABSTRACT FROM AUTHOR]

Les glucocorticoïdes à faibles doses (GC) améliorent presque tous les cas de pseudopolyarthrite rhizomélique (PPR), mais des événements indésirables sont fréquents. Le but de cet essai randomisé contrôlé versus placebo chez les patients atteints d'une PPR récente était d'évaluer si le baricitinib (inhibiteur de JAK 1/2) permet d'atteindre un contrôle de la maladie sans GC par voie orale dans les PPR récentes. Nous avons mené un essai randomisé à double insu (1:1) contrôlé versus placebo en groupe parallèle entre le 1er décembre 2020 et le 30 août 2023. Le protocole a été enregistré sur clinicaltrials.gov (NCT04027101). Trente-quatre patients ayant une PPR récente naïve de GC avec un score d'activité DAS-PPR CRP > 17 ont reçu 4 mg de baricitinib par voie orale ou un placebo correspondant (avec un sauvetage des GC par voie orale possible en cas d'activité élevée de la maladie) pendant 12 semaines, puis 2 mg de baricitinib ou un placebo correspondant, jusqu'à la semaine 24. Une infiltration subdeltoïdienne de GC était autorisée à la semaine 0 et à la semaine 4. Le critère d'évaluation principal était le DAS-PPR CRP < 10 sans sauvetage par GC par voie orale de la semaine 0 à la semaine 12. La période de suivi était de 36 semaines. Nous avons randomisé 34 patients (18 patients avec baricitinib et 16 patients avec le placebo ; 22 femmes et 12 hommes). L'âge moyen était de 69,1 (±7,2) ans. La durée moyenne d'évolution depuis le premier symptôme était de 60,7 (±46,9) jours. Le DAS-PPR CRP moyen était de 31,7 (±10,5). Comparativement au placebo, la dose de 4 mg de baricitinib a permis d'obtenir un DAS-PPR CRP comparable à la semaine 12, avec moins de participants nécessitant un sauvetage par GC oral. Le critère d'évaluation principal a été atteint à la semaine 12 par 14/18 (77,8 %) et 2/16 (13,3 %) des patients dans les groupes baricitinib et placebo, respectivement (RR [IC à 95 %] : 5,8 [3,2 ; 10,6] ; valeur de p brute = 0,0004 ; valeur de p ajustée sur le centre < 0,0001). Aucun décès, aucun événement cardiovasculaire indésirable majeur ou nouveau signal de tolérance n'a été observé. Les patients atteints de PPR récente naïve de traitement prenant 4 mg de baricitinib ont nettement moins souvent besoin de GC par voie orale que ceux sous placebo pour atteindre une faible activité de la maladie à la semaine 12, sans nouveau signal de sécurité (Fig. 1). Ce qui pourrait révolutionner la prise en charge de la maladie, notamment en cas de contre indication relative des GC (ostéoporose, diabète, troubles psychiques, hypertension...). [ABSTRACT FROM AUTHOR]

Objectives: Salivary gland ultrasound (SGUS) has an interest in primary Sjögren's disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset., Methods: In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities were classified according to the semiquantitative score as defined by OMERACT. Patients were separated into 4 groups (Group A: < 5 years, Group B: 5-9 years, Group C: 10-20 years, and Group D: > 20 years from the onset of buccal dryness). The association between disease duration groups and SGUS lesions was quantified in terms of odds ratios and 95% confidence intervals., Results: A total of 247 patients were consecutively included between May 2019 and February 2022. Eighty-nine percent of patients had a focus score ≥1/4 mm2, and 85% had positive anti-Ro/SSA. pSD duration was associated with a pathological OMERACT score (score 2 or 3): OR for 5-year duration: 1.23 [95% CI 1.04; 1.47], p= 0.0383). Considering each US item, the only statistical association with pSD duration was found regarding the presence of hyperechoic bands (25% or more): OR for five-year duration 1.18 [95% CI 1.03; 1.36], p= 0.038), independent of an older age., Conclusion: pSD duration was associated with the presence of hyperechoic bands, but not with hypoechoic areas, suggesting a progressive fibro-adipose evolution., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Reading hand and foot X-rays in rheumatoid arthritis patients is difficult and time-consuming. In research, physicians use the modified Sharp van der Heijde Sharp (mvdH) score by reading of hand and foot radiographs. The aim of this study was to create a new method of determining the mvdH via eye tracking and to study its concordance with the mvdH score. We created a new method of quantifying the mvdH score based on reading time of a reader monitored via eye tracking (Tobii Pro Lab software) after training with the aid of a metronome. Radiographs were read twice by the trained eye-tracking reader and once by an experienced reference radiologist. A total of 440 joints were selected; 416 could be interpreted for erosion, and 396 could be interpreted for joint space narrowing (JSN) when read by eye tracking (eye tracking could not measure the time spent when two pathological joints were too close together). The agreement between eye tracking mvdH Sharp score and classical mvdH Sharp score yes (at least one erosion or JSN) versus no (no erosion or no JSN) was excellent for both erosions (kappa 0.97; 95% CI: 0.96-0.99) and JSN (kappa: 0.95; 95% CI: 0.93-0.097). This agreement by class (0 to 10) remained excellent for both erosions (kappa 0.82; 95% CI: 0.79-0.0.85) and JSN (kappa: 0.68; 95% CI: 0.65-0.0.71). To conclude, eye-tracking reading correlates strongly with classical mvdH-Sharp and is useful for assessing severity, segmenting joints and establishing a rapid score for lesions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Quéré et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Major salivary gland ultrasonography (SGUS) demonstrated its good metric properties as an outcome measure for diagnosing primary Sjögren's disease (SD). The objective was to assess SGUS reliability among sonographers with different levels of experience, using web training., Methods: Sonographers from expert centers participated in the reliability exercise. Before exercises, training was done by videoconferencing. Reliability of the two most experienced sonographers (MES) was assessed and then compared to other sonographers. Intra-reader and inter-reader reliability of SGUS items were assessed by computing Cohen's κ coefficients., Results: All sets were read twice by all 14 sonographers within a 4-month interval. Intra-reader reliability of MES was almost perfect for homogeneity, substantial for Outcome Measures in Rheumatology (OMERACT) scoring system (OMERACTss). Among LES (less experienced sonographers), reliability was moderate to almost perfect for homogeneity, fair to moderate for OMERACTss, and fair to almost perfect for binary OMERACTss. Inter-reader reliability between MES was almost perfect for homogeneity, substantial for diagnosis, moderate for OMERACTss, and substantial for binary OMERACTss. Compared to MES, reliabilities of LES were moderate to almost perfect for both homogeneity and diagnosis, only fair to moderate for OMERACTss, but increased in binary OMERACTss., Conclusions: Videoconferencing training sessions in an international reliability exercise could be an excellent tool to train experienced and less-experienced sonographers. SGUS homogeneity items is useful to distinguish normal from abnormal salivary glands parenchyma independently of diagnosis. Structural damage evaluations by OMERACT scoring system is a new comprehensive score to diagnose patients with SD and could be easily used by sonographers in a binary method., (© 2024. The Author(s).)

Objective: The SARS-CoV-2 pandemic has induced an exceptional sanitary crisis, potentially having an impact on treatment continuation, for juvenile idiopathic arthritis (JIA) patients receiving immunosuppressive therapies. After national lockdowns, many patients were also concerned about their safety at school. We evaluated the impact of the pandemic on the optimal continuation of treatment and on the return to school in JIA patients. Methods: JIA patients under 18 years of age, usually treated with disease-modifying anti-rheumatic drugs (DMARDs) were prospectively included during their outpatient visit and completed a standardized questionnaire. The primary outcome was DMARD treatment modification in relation to the context of the pandemic but we also evaluated the pandemic's impact on the schooling. Results: One hundred and seventy three patients from 8 different expert centers were included between May and August 2020. Their mean age was 11.6 years (± 4.1 years), and most of them 31.2% (54/173) had a rheumatoid factor-negative polyarticular JIA. Fifty percent (86/172) were treated with methotrexate, and 72.5% (124/171) were treated with bDMARDs. DMARD treatment modification in relation to the pandemic was observed in 4.0% (7/173) of participants. 49.1% (81/165) of the patients did not return to school due to a personal/parental decision in 69.9% (55/81) of cases. Two patients were diagnosed positive for SARS-CoV-2 infection. Conclusion: This study suggests that JIA patients treated with DMARDs continued their treatment during the pandemic and were rarely affected by symptomatic COVID-19. In contrast, parents' reluctance was a major obstacle for returning to school. Therefore, more solidified school reopening strategies should be developed., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Quéré, Lemelle, Lohse, Pillet, Molimard, Richer, Sordet, Despert, Rossi-Semerano, Borocco, Kone-Paut, Gervais, Guellec and Devauchelle-Pensec.)

Biofilms are microbial communities characterized by three-dimensional growth resulting from the ability of individual cells to adhere to each other as well as to produce an extracellular matrix that ensures biofilm physical cohesion. Numerous bacteria produce cellulose as a biofilm matrix polymer, a property relying on the expression of bacterial cellulose synthesis (Bcs) proteins and their post-translational activation upon binding of cyclic di-guanosine mono-phosphate second messenger (c-di-GMP) produced by diguanylate cyclases. In Escherichia coli and other Enterobacteriaceae, two genes of unknown function, yhjR and yhjQ, are located upstream of the bcs genes. Here, we show that yhjQ, but not yhjR, is essential for cellulose biosynthesis; it has therefore been renamed bcsQ. Using a green fluorescent protein (GFP) fusion approach, we demonstrate that BcsQ, a MinD homologue, displays a polar localization and that cell-to-cell adhesion is initiated through production of cellulose at the BcsQ-labelled pole. Although we did not detect a similar localization for other Bcs proteins, immunogold labelling of cellulose itself at the pole of individual bacteria indicates the localized activity of the cellulose biosynthesis apparatus. These results therefore suggest that BcsQ could participate in spatial restriction of cellulose biosynthesis activity in Enterobacteriaceae.

Despite the economic and sanitary problems caused by harmful biofilms, biofilms are nonetheless used empirically in industrial environmental and bioremediation processes and may be of potential use in medical settings for interfering with pathogen development. Escherichia coli is one of the bacteria with which biofilm formation has been studied in great detail, and it is especially appreciated for biotechnology applications because of its genetic amenability. Here we describe the development of two new genetic tools enabling the constitutive and inducible expression of any gene or operon of interest at its native locus. In addition to providing valuable tools for complementation and overexpression experiments, these two compact genetic cassettes were used to modulate the biofilm formation capacities of E. coli by taking control of two biofilm-promoting factors, autotransported antigen 43 adhesin and the bscABZC cellulose operon. The modulation of the biofilm formation capacities of E. coli or those of other bacteria capable of being genetically manipulated may be of use both for reducing and for improving the impact of biofilms in a number of industrial and medical applications.