Rheumatoid Arthritis: Bouvenot J

Baeteman C, Guyot L, Bouvenot J, Chossegros C, Cheynet F, Loudot C, Serratrice J, Attarian S. · Service de stomatologie et chirurgie maxillo-faciale, CHU La-Timone, boulevard Jean-Moulin, 13385 Marseille cedex 5, France. · Rev Stomatol Chir Maxillofac. · Pubmed #18533206 No free full text.

Abstract: INTRODUCTION: Labial salivary gland biopsy (LSGB) is a very useful technique that is often performed in our specialty. A lot of these LSGB yield normal results and the interest of this technique may be discussed. This study was made to answer two questions: one on the diagnostic interest of LSGB for the suspected pathology, secondly to verify if there was a correlation between the results of LSGB assessment and the patient's final diagnosis. MATERIAL AND METHODS: Ninety-six LSGB were performed in 2004 for Sjögren syndrome, sarcoidosis, amyloidosis and other auto-immune diseases. The histological study assessed the Chisholm-Mason score and screened for amyloidosis and sarcoidosic granuloma. The prescribing unit gave the final diagnosis. RESULTS: The LSGB was very specific (100% of specificity) and there were no false positive results; conversely, its sensitivity was lower, that is 75% for Sjögren syndrome, 67% for amyloidosis, 60% for sarcoidosis and 14% for other auto-immune disease (not defined). DISCUSSION: LSGB can be recommended for Sjögren syndrome; it is also useful for amyloidosis. In sarcoidosis it gives poor results and presents no interest for other auto-immune diseases.The LSGB prescribed for patients with a suspected initial single diagnosis (Sjögren syndrome only, or amyloidosis only, or sarcoidosis only, or an other auto-immune disease only) significantly increases the specificity and the sensitivity of the technique and suggests that specificity and sensitivity are linked to patient selection and not to LSGB itself.

Guis S, Balandraud N, Bouvenot J, Auger I, Toussirot E, Wendling D, Mattei JP, Nogueira L, Mugnier B, Legeron P, Landt O, Serre G, Roudier J, Roudier C. · INSERM UMR 639 and Assistance Publique Hôpitaux de Paris, Hôpital de la Conception, Marseille, France. · Arthritis Rheum. · Pubmed #18050183 links to  free full text

Abstract: OBJECTIVE: To determine whether the -308 A/G tumor necrosis factor alpha (TNFalpha) gene polymorphism can predict the outcome of etanercept therapy in 86 patients with rheumatoid arthritis (RA), as already observed in patients treated with infliximab. METHODS: Eighty-six RA patients treated with etanercept were genotyped for -308 A/G TNFalpha gene polymorphism by polymerase chain reaction and melting curve analysis, using specific gene primers and probes. Patients were subdivided into group A (G/A genotype) and group G (G/G genotype). We compared clinical responses to etanercept between groups A and G after 6 months, using the Disease Activity Score in 28 joints (DAS28). After 12-month treatment, 48 of 86 patients were evaluated again. RESULTS: Of 86 patients, 18 (21%) belonged in group A and 68 (79%) belonged in group G. After 6-month treatment, 55.6% of patients in group A and 82.4% of patients in group G had DAS28 improvement >1.2 (P = 0.027 by chi-square). The mean +/- SD DAS28 improvement was 1.69 +/- 1.31 in group A and 2.23 +/- 1.19 in group G (P = 0.098 by t-test). After 1-year treatment 48 patients were tested again: 10 (21%) belonged in group A and 38 (79%) belonged in group G. Forty percent of patients in group A and 87% in group G had DAS28 improvement >1.2 (P = 0.005 by chi-square). The mean +/- SD DAS28 improvement was 1.334 +/- 1.37 in group A and 2.29 +/- 1.47 in group G (Mann-Whitney U test = 115, P = 0.0057). CONCLUSION: RA patients with a -308 G/G TNFalpha genotype respond to etanercept better than patients with a -308 A/G genotype.