Rheumatoid Arthritis: Guedes C

Guedes C, Dumont-Fischer D, Leichter-Nakache S, Boissier MC. · Rheumatology Department and Joint Immunopathology and Immunointervention Unit, Bobigny-Avicenne Teaching Hospital. · Rev Rhum Engl Ed. · Pubmed #10567978 No free full text.

Abstract: Rheumatoid arthritis reduces not only quality but also length of life. In the 14 main studies conducted since 1980, in a total of 13,424 patients, the mean standardized mortality ratio was 1.82 (range, 0.87-3) as compared to the population at large. Life expectancy was shortened by 5 to 10 years in most studies. The diversity of the methods used explains the discrepancies among results. Excess mortality may occur in only some subsets of patients. Both rheumatoid complications and an increase in nonspecific causes of death (e.g., infections) contribute to the excess mortality. Factors predictive of premature death are the same as those predictive of functional impairment. Many unknowns remain about the condition of rheumatoid arthritis patients at the end of their life.

Guedes C, Bianchi-Fior P, Cormier B, Barthelemy B, Rat AC, Boissier MC. · Rheumatology Department, Bobigny-Avicenne Teaching Hospital, France. · Arthritis Rheum. · Pubmed #11324775 links to  free full text

Abstract: OBJECTIVES: Current knowledge of the cardiac manifestations of rheumatoid arthritis (RA) stems only from clinical and transthoracic echocardiography (TTE) studies. To determine the incidence and type of heart lesions in RA, we coupled TTE with transesophageal echocardiography (TEE), which is more sensitive and more accurate. METHODS: Thirty unselected RA patients (26 women and 4 men aged 27 to 84 years, with a mean age of 57.8+/-15.1 years) free of known progressive heart disease underwent a chest radiograph, an electrocardiogram, laboratory tests, and TTE coupled with TEE. Results were compared with those in age- and sex-matched patients who were free of rheumatic disease and who underwent TEE to investigate a neurologic or cardiologic disorder. RESULTS: Mitral regurgitation (MR) was evidenced in 24 cases (80%). Among the controls, only 11 (37%) had MR (P < 0.001). Aortic regurgitation was found in 10 cases (33%), versus 7 controls (not significant-NS). Seven cases (23%) versus only 2 controls (7%) had tricuspid valve abnormalities (NS). Pericarditis was found in 4 cases (13%) and in none of the controls. Eleven cases had evidence of cardiomyopathy (37%) and 12 (40%) had atheroma of the aorta, this last being missed by TTE in 10 patients. Echo-generating nodules were seen on a mitral valve in 2 cases and on an aortic valve in 1. We found no correlations linking cardiac lesions to clinical or laboratory features of RA. CONCLUSION: Our study demonstrated that cardiac involvement, particularly of the mitral valve, is extremely common in RA patients.

Saraux A, Guedes C, Allain J, Devauchelle V, Valls I, Lamour A, Guillemin F, Youinou P, Le Goff P. · Rheumatology Unit, Brest University Medical Hospital, CHU Brest, France. · J Rheumatol. · Pubmed #10606373 No free full text.

Abstract: OBJECTIVE: To document the prevalence of rheumatoid arthritis (RA) and spondyloarthropathy (SpA) in Brittany, France. METHODS: (1) Members of rheumatism self-help groups screened cases using questionnaires. (2) Rheumatologists in our unit contacted persons who had possible inflammatory rheumatic diseases and persons who refused the first interview. (3) When diagnosis remained unknown or discordant with the questionnaire, the general practitioner or the rheumatologist of these patients was interviewed. (4) Patients without diagnosis and who had not had a rheumatological examination were examined without charge by a rheumatologist. RESULTS: An overall prevalence rate of 0.62% (0.33-0.91) and 0.47% (0.22-0.72) was found for RA and for SpA, respectively. The prevalence of RA and SpA was 0.86 (0.39-1.33) and 0.53 (0.16-0.9) in women and 0.32 (0.01-0.63) and 0.41 (0.05-0.77) in men. The minimum prevalence of RA and SpA calculated on the estimated initial group (3189 persons) was 0.53 (0.28-0.78) and 0.41 (0.18-0.63), respectively. CONCLUSION: Our telephone survey revealed that the prevalences of RA and SpA are nearly similar among our population and that SpA is as common in women as in men.

Belghomari H, Saraux A, Allain J, Guedes C, Youinou P, Le Goff P. · Unit of Rheumatology, Brest University Medical School Hospital, CHU de la Cavale Blanche, France. · J Rheumatol. · Pubmed #10606359 No free full text.

Abstract: OBJECTIVE: To carry out a cross sectional case-control study of the risk factors for articular destruction in a large sample of patients with a long history of rheumatoid arthritis (RA), presupposing that the variables we measured were unrelated to the duration of disease. METHODS: Each inpatient with RA admitted to our department from January 1, 1985, to December 31, 1995, underwent standard examination, laboratory tests, and hand roentgenograms. We carried out a radiographic cross sectional study on 287 of them. Radiographic evaluation was performed by the same observer (correlation coefficient 0.97) using the modified Sharp method. To investigate an association between articular destruction and prognostic variables, a matched analysis of the case-control data and calculation of the odds ratio (OR) with 95% confidence intervals (CI) were carried out. For each patient with severe articular destruction, patients hospitalized during the study period with the same disease duration but without severe articular destruction were included as controls. The sample size was chosen to show an OR > 2 (1-alpha = 95%; 1-beta = 80%). RESULTS: The risk of articular joint destruction was higher in women than in men (OR 2.72, CI 1.17-7.9, p<0.023), whereas age at onset or the presence of HLA-DR4, antiperinuclear factor, or antikeratin antibodies was not sufficiently strongly associated with the process of articular destruction to be considered relevant prognostic markers. CONCLUSION: We conclude that female sex is significantly associated with a higher risk of articular destruction.

Saraux A, Guedes C, Belghomari H, Youinou P, Le Goff P. · No affiliation provided · Arthritis Rheum. · Pubmed #10088791 links to  free full text

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