Rheumatoid Arthritis: Berthelot JM

Berthelot JM, Klarlund M, McGonagle D, Bernelot-Moens HJ, Calin A, Harrison B, Schumacher HR, Kaarela K, Drosos AA, Hülsemann JL, Koh WH, Konttinen YT, Punzi L, Tanimoto K, Williams HJ, Wolfe F, Zerbini CA, Saraux A, Anonymous00239. · Department of Rheumatology, Nantes University Medical School, CHU Nantes, France. · J Rheumatol. · Pubmed #11361225 No free full text.

Abstract: OBJECTIVE: To determine how experts would classify 10 early-arthritis cases (7 atypical) and to study discrepancies in diagnoses relative to ACR criteria for rheumatoid arthritis (RA) or ESSG criteria for spondyloarthropathy (SpA). METHODS: Ten real cases (5 met ACR criteria for RA, 6 ESSG criteria for SpA, 3 both and 2 neither) followed for 28.5 +/- 4.8 months were sent as paper cases to 20 international and 12 French experts. Each expert selected a diagnosis among 8 possible choices and rated it on a 0-10 confidence scale. For each case, 3 analog scales (0-100 mm) were used to indicate the probability of RA, SpA or undifferentiated arthritis (UA). RESULTS: Experts often disagreed about diagnoses (up to 5 different diagnoses for a given case, with a mean of 3.9 per case). Similarly, expert opinions on probabilities for RA and SpA differed widely, with great overlap between confidence for RA, SpA and UA. Fulfilment of ACR or ESSG criteria was poorly related to the experts' diagnosis and evaluation of probabilities for RA and SpA. However, UA was a relatively infrequent choice (19%). CONCLUSIONS: There was no general consensus about the nosology of early RA and SpA. Classification of atypical early arthritis was not resolved by currently available criteria for RA and SpA. This may have implications for therapy in early disease.

Berthelot JM, Saraux A, Maugars Y, Prost A, Le Goff P. · Department of Rheumatology, Hôtel-Dieu, CHU Nantes, 44093, Nantes-Cedex 01, France. · Semin Arthritis Rheum. · Pubmed #11303308 No free full text.

Abstract: OBJECTIVE: To compare the conclusions of studies addressing the outcome of early-arthritis cohorts. METHODS: The methodologies of previous reports on early-arthritis cohorts were examined, and their results and conclusions were compared. RESULTS: Thirty-four reports on 23 cohorts of early arthritis were found. The methodology was poor in most studies, with numerous inclusion and exclusion biases, frequently short follow-up periods, and a lack of precision about the rationale for diagnosis. However, similar conclusions were reached on several points: a large number of cases of early arthritis remained undifferentiated and/or resolved spontaneously, about 80% of cases initially classified as undifferentiated or rheumatoid arthritis retained this diagnosis during follow-up, and the incidence of psoriatic arthritis in most studies was similar (2% to 4%). Conversely, there were striking discrepancies among studies concerning the frequency of crystal arthropathies (0% to 18%), spondyloarthropathy (1% to 33%) and rheumatoid arthritis (15% to 47%). CONCLUSIONS: There appears to be a lack of agreement among researchers about the nosology and/or taxonomy of many cases of mild arthritis, despite the existence of classification criteria. RELEVANCE: Recognition of cultural bias in the diagnosis of early arthritis could be a prerequisite for the optimization of new sets of criteria for the diagnosis of early rheumatoid arthritis and spondyloarthropathy.

Glémarec J, Guillot P, Laborie Y, Berthelot JM, Prost A, Maugars Y. · Rheumatology Department, Hôtel-Dieu Teaching Hospital, Nantes, France. · Joint Bone Spine. · Pubmed #10773969 No free full text.

Abstract: OBJECTIVES: To evaluate the overall efficacy in various disorders of glucocorticoid injection into the lateral atlantoaxial joints, performed via the posterior route under fluoroscopic control. METHODS: Retrospective study of 26 patients including 16 (19 injections) with mechanical disorders and ten (16 injections) with inflammatory disorders. RESULTS: The response rate was 69.3%, the mean pain scale score decrease was 52.3 +/- 40.1%, and the mean duration of pain relief was 8.1 +/- 11.8 months. All three parameters were significantly (P < 0.005) better in the subgroup with inflammatory disorders than in the subgroup with mechanical disorders (response rate, 100% vs 50%; pain scale score decrease, 80 +/- 27% vs 34.2 +/- 40%, and pain relief duration, 16.9 +/- 14.9 months vs 24.5 months). A single patient developed a side effect (moderately severe hypertension). CONCLUSION: Glucocorticoid injection into the lateral atlantoaxial joints is a valid treatment alternative in patients who fail to respond to conventional noninvasive therapy.

Scotet E, Peyrat MA, Saulquin X, Retiere C, Couedel C, Davodeau F, Dulphy N, Toubert A, Bignon JD, Lim A, Vie H, Hallet MM, Liblau R, Weber M, Berthelot JM, Houssaint E, Bonneville M. · INSERM U463, Institut de Biologie, Nantes, France. · Eur J Immunol. · Pubmed #10092102 No free full text.

Abstract: We recently evidenced a dramatic enrichment for T cells reactive against Epstein-Barr virus (EBV) within inflamed joints of two rheumatoid arthritis patients. To assess the generality of this phenomenon and its relevance to autoimmunity, we studied the responses of CD8 T cells from patients with either acute or chronic inflammatory diseases (rheumatoid arthritis: n = 18, ankylosing spondylitis: n = 5, psoriatic arthritis: n = 4, Reiter's syndrome: n = 3, arthrosis: n = 2, uveitis: n = 2, multiple sclerosis: n = 2, encephalitis: n = 1) against viral proteins derived from EBV and another common herpes virus, human cytomegalovirus (CMV). T cell responses against EBV and/or CMV epitopes were frequently observed within CD8 T cells derived from chronic inflammatory lesions, irrespective of their location (knee, eye, brain) and autoimmune features. In most cases, CD8 T cells derived from affected organs yielded stronger anti-viral T cell responses than CD8 T cells derived from patients' PBL, even in chronic inflammatory diseases devoid of autoimmune features or induced by defined bacterial agents. Taken together, these results suggest that the presence of virus-specific T cells within inflamed lesions of patients suffering from autoimmune diseases is a general phenomenon associated with chronic inflammation rather than the initiating cause of the autoimmune process. Since this phenomenon was sometimes associated with long-term T repertoire biases within inflamed lesions, the physiopathological significance of T cell clonal expansions found in a recurrent fashion within chronically inflamed autoimmune lesions should be interpreted with caution.

Le Goff B, Vabres B, Cochereau I, Bouvard B, Lamirel C, Maugars Y, Berthelot JM. · No affiliation provided · J Rheumatol. · Pubmed #19208537 No free full text.

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Goëb V, Berthelot JM, Joly P, Mejjad O, de Quatrebarbes J, Reynaud-Hautin C, Vittecoq O, Le Loët X. · No affiliation provided · Rheumatology (Oxford). · Pubmed #15757964 links to  free full text

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Berthelot JM, Glemarec J, Maugars Y, Prost A. · No affiliation provided · Rheumatology (Oxford). · Pubmed #12048303 links to  free full text

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Berthelot JM, Saraux A. · No affiliation provided · Arthritis Rheum. · Pubmed #10943885 links to  free full text

This publication has no abstract.