Rheumatoid Arthritis: Guillemin F

Saraux A, Guillemin F, Fardellone P, Guggenbuhl P, Behier JM, Cantagrel A, Euller-Ziegler L, Flipo RM, Juvin R, Le Loet X, Masson C, Sany J, Schaeverbeke T, Coste J, Anonymous00053. · Rheumatology Department, Hôpital de la Cavale Blanche, CHU Brest, 29609 Brest cedex, France. · Joint Bone Spine. · Pubmed #14769520 No free full text.

Abstract: OBJECTIVE: To evaluate agreement between a rheumatologist visit and a telephone interview by a patient organization member, regarding the diagnosis of rheumatoid arthritis (RA) or spondyloarthropathy (SpA) and the classification criteria for these two conditions. METHOD: Patients underwent a standardized interview and physical examination by hospital-based rheumatologists, who diagnosed RA in 230 cases, SpA in 175, and other conditions (controls) in 195. Members of patient organizations then used a standardized questionnaire to interview the patients by telephone about their diagnosis and about 1987 ACR classification criteria for RA and the ESSG criteria for SpA. RESULTS: Agreement between the two sources of data was poor for the classification criteria but satisfactory for the diagnosis (kappa, 0.84 (0.81-0.87) for RA and 0.78 (0.75-0.81) for SpA). CONCLUSION: Standardized telephone interviews conducted by patient organization members accurately identify the diagnosis made by rheumatologists based on a physical examination and medical record review, whereas agreement is poor regarding classification criteria for RA and SpA.

Guillemin F, Gérard N, van Leeuwen M, Smedstad LM, Kvien TK, van den Heuvel W, Anonymous00341. · School of Public Health EA 3444, Faculty of Medicine, 9 avenue de la Forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy Cedex, France. · J Rheumatol. · Pubmed #14719198 No free full text.

Abstract: OBJECTIVE: To quantify articular damage and to investigate prognostic factors for joint damage progression in rheumatoid arthritis (RA). METHODS: RA patients satisfying the 1987 American College of Rheumatology criteria and with disease duration under 5 years were sampled from the EURIDISS longitudinal cohort study in Norway, The Netherlands, and France. Hand radiographs were assessed at baseline and at 2 to 3 year followup using Sharp score modified by van der Heijde. Assessment of erosion and joint space narrowing, performed in sequential order by a single reader blinded to patients' characteristics, had high intraobserver reproducibility (intraclass correlation coefficient 0.98-0.99). Baseline prognostic factors were analyzed in a multivariate linear regression model. RESULTS: A total of 318 patients with RA aged 52.4 years (70.4% were female) and with a mean 2 years' disease duration at baseline were followed over 30 months. Median (quartiles) baseline and followup modified Sharp scores were 3 (0-11) and 9 (1-27), respectively, with 35.8% and then 22.3% of patients with no radiological damage. Controlling for age, sex, and country, the final joint damage was predicted by baseline modified Sharp score, rheumatoid factor positivity, time from disease diagnosis, patient global health assessment, and erythrocyte sedimentation rate, and by followup duration, explaining 76.8% of the outcome variance. CONCLUSION: This multinational study confirmed the prognostic role in RA of a set of features previously identified in smaller cohorts. It indicates which disease characteristics should be focused on in the early years of RA to identify patients at higher risk of developing severe disease and who are candidates for aggressive therapy.

Guillemin F, Saraux A, Fardellone P, Guggenbuhl P, Behier JM, Coste J, Anonymous00210. · EA 3444, Department of Clinical Epidemiology and Evaluation, University Hospital, Nancy, France. · Ann Rheum Dis. · Pubmed #12972474 links to  free full text

Abstract: OBJECTIVE: To assess the performance in the detection of cases of rheumatoid arthritis (RA) and the spondyloarthropathies (SpA) of a questionnaire suitable for use in telephone surveys conducted by patient interviewers. METHODS: A questionnaire was designed with reference to the signs, symptoms, and epidemiological criteria for RA (ACR 1987) and SpA (ESSG 1991). Three groups of respondents were recruited from the rheumatology outpatient clinics of 10 university hospitals: 235 with RA, 175 with SpA, and 195 controls with other rheumatological disorders. All diagnoses were confirmed by a rheumatologist. Patient from self help groups and social organisations were trained by a polling company professional to conduct a standard telephone interview using the new questionnaire. RESULTS: In an RA-control comparison, logistic regression showed that a set of five items, predominantly ACR criteria, were the most informative. Self reported diagnosis performed best (sensitivity 0.99, specificity 0.87). In an SpA-control comparison, a set of three items from the ESSG criteria were the most informative, with self reported diagnosis again performing best (sensitivity 0.85, specificity 0.96). Overall agreements with clinical diagnoses were 97.7% for RA and 94.4% SpA, dropping to 90.4% and 79.1%, respectively, when self reported diagnosis was excluded. Without self reported diagnosis, questions about peripheral joint and spinal pain made significant contributions to diagnostic performance. CONCLUSION: A questionnaire in plain language was developed for use in detecting cases of RA and SpA. It performed satisfactorily when administered by patient interviewers and is now available for epidemiological surveys of the general population.

Guillemin F. · Epidemiology, Health Economics and Prevention, School of Public Health, BP 184, Faculty of Medicine 54505 Vandoeuvre-les-Nancy, France. · Best Pract Res Clin Rheumatol. · Pubmed #12787510 No free full text.

Abstract: The concept of disease activity is useful for characterizing chronic rheumatic diseases and their current degree of severity. Disease activity should be clearly differentiated from damage, which is irreversible. A number of requirements must be met in order to make a measure of disease activity acceptable and valid. Methods for measurement have been developed in the areas of biological, radiographic, ultrasound and computerized imaging techniques. Recently, a particular effort has been made to develop questionnaires in the form of complex indices, derived from the observations of physicians, and self-report questionnaires for patients. Such assessments of disease activity are available for most of the chronic inflammatory rheumatic diseases. They are particularly relevant at a time when new biological drug therapy is being developed. Research effort is needed to develop more instruments suitable for use in clinical practice for individual patients.

Maetzel A, Tugwell P, Boers M, Guillemin F, Coyle D, Drummond M, Wong JB, Gabriel SE, Anonymous00151. · Division of Clinical Decision Making and Health Care Research, Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. · J Rheumatol. · Pubmed #12672224 No free full text.

Abstract: Improvement in the quality of economic evaluation could be documented as a consequence of international and national standardization efforts. One such effort is the recommendation that all economic evaluations in a given field produce findings in a standard format using a reference case. A reference case-based economic evaluation would adhere to specific settings with regard to outcomes, comparators, modeling techniques, and use of costs to facilitate comparisons among economic evaluations performed with the same objective. In the past, the Outcome Measures in Rheumatology Clinical Trials (OMERACT) consensus conference has successfully developed widely used, consensus-based outcome criteria for clinical improvement in rheumatoid arthritis (RA). Present efforts are being directed at the development of recommendations for the type and format of a reference case economic evaluation for newly developed disease modifying antirheumatic drugs (DMARD). This document discusses 13 important elements that experts considered to be relevant for the development of a reference case recommendation for economic evaluations in RA. We provide the rationale for each element and discuss how each element has been addressed in published economic evaluations of DMARD.

Pouchot J, Larbre JP, Lemelle I, Sommelet D, Grouteau E, David L, Duquesne A, Deslandre CJ, Koné Paut I, Pillet P, Goumy L, Barbier C, Guyot MH, Mazingue F, Laloum SG, Fischbac M, Quartier P, Guyot C, Jean S, Legall E, Plouvier E, Bost M, de Lumley L, Brégeon C, Guillemin F, Coste J, Prieur AM, Anonymous00241. · Internal Medicine Department, Médecine Interne, Hĵpital Louis Mourier, 178, rue des Renoullers, Colombes, France. · Joint Bone Spine. · Pubmed #12477231 No free full text.

Abstract: OBJECTIVES: To translate, cross-culturally adapt, and validate the functional disability tool Childhood Health Assessment Questionnaire (CHAQ), a variant of the Health Assessment Questionnaire (HAQ), in children with juvenile idiopathic arthritis (JIA). CHILDREN AND METHODS: The disability index is the mean of the scores on the eight domains of the CHAQ and can range from 0 (no disability) to 3 (maximum disability). The CHAQ was first translated into French and adapted, then validated in a multicenter cross-sectional study in 306 children with JIA (systemic onset, 23%; polyarticular onset, 22%; extended oligoarticular subtype, 25%; and persistent oligoarticular subtype, 30%). RESULTS: Overall CHAQ scores discriminated between the four JIA subtypes (systemic: 1.1 +/- 0.9; polyarticular: 0.8 +/- 0.7, extended oligoarticular 0.8 +/- 0.7, and persistent oligoarticular: 0.4 +/- 0.5 [P < 0.0001]). Reproducibility evaluated by test-retest at a 7-day interval was excellent (intraclass coefficient, 0.91), as was agreement between the Parent's and Children's versions of the questionnaire (intraclass coefficient, 0.89). Significant correlations were found between the overall CHAO score and variables reflecting disease severity (joint counts, physician's and parent's global assessments, and erythrocyte sedimentation rate), indicating excellent convergent validity of the tool. CONCLUSION: The French version of the CHAQ displays good psychometric characteristics, although its sensitivity to change remains to be established. The French version of the CHAO should prove useful in international studies and can be expected to be helpful for monitoring individual patients with JIA.

Saraux A, Maillefert JF, Fautrel B, Flipo RM, Kaye O, Lafforgue P, Guillemin F, Botton E. · Rheumatology Unit, Brest Teaching Hospital, France. · Ann Rheum Dis. · Pubmed #12079905 links to  free full text

Abstract: BACKGROUND: The cause of recent onset polyarthritis can be difficult to identify. OBJECTIVE: To determine which laboratory and imaging studies French rheumatologists recommend, not taking cost into account, for the diagnosis of recent onset polyarthritis without extra-articular manifestations. METHODS: From the list of the French Society for Rheumatology, a random sample of 210 rheumatologists was selected, who were asked to complete a questionnaire on the laboratory and imaging studies they would recommend in two fictional cases of recent onset polyarthritis (possible rheumatoid arthritis (RA)-case 1 and probable RA-case 2). RESULTS: In case 1, the following were recommended by over 75% of respondents: hand radiographs, rheumatoid factors (RFs), and antinuclear antibodies (ANA) (92%, 98%, and 98%, respectively). 50-74% of respondents recommended radiographs of the feet, knees, and chest (50%, 57%, and 66%, respectively); blood cell counts, erythrocyte sedimentation rate (ESR), serum assays of C reactive protein (CRP), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (65%, 74%, 67%, and 62%, respectively). 25-49% recommended determination of creatinine and proteinuria, HLA-B27, antikeratin antibody, radiographs of the pelvis, and synovial fluid analysis. Several investigations were recommended less often in case 2 than in case 1. Nevertheless, some laboratory and imaging studies (radiographs of hand, feet, knees, chest x rays, blood cell counts, ANA, RF, antikeratin antibody, CRP, ESR, creatinine, AST and ALT, proteinuria, and joint aspiration) were recommended by more than 25% of respondents in both cases. CONCLUSION: Wide variations were found among rheumatologists, indicating a need for standardisation. Some laboratory and imaging studies are recommended by at least 25% of respondents in recent onset polyarthritis with or without clues suggesting RA. In contrast, many tests were considered useful by fewer than 25% of the respondents in both cases.

Girard F, Guillemin F, Novella JL, Valckenaere I, Krzanowska K, Vitry F, Vittecoq O, Eschard JP, Blanchard F, Le Loët X. · EA 3444 and Centre Hospitalier Universitaire de Nancy, France. · Rheumatology (Oxford). · Pubmed #11886965 links to  free full text

Abstract: OBJECTIVE: To compare the use of health-care by rheumatoid arthritis (RA) patients and non-arthritic subjects (NA) and to look for factors determining their patterns of health-care use. METHODS: A multicentre cohort of 223 RA and 446 NA subjects matched for age, gender, period of data collection and residence were questioned about their use of health-care services. Patterns of health-care use were identified by principal components analysis. Factors determining the use of health-care services were assessed by multiple linear and logistic regression analysis. RESULTS: The proportions of RA subjects who declared having had at least one contact with the health-care system in the previous 12 months and in the previous 4 weeks were higher than those for NA subjects for all health and social professionals except dentists and homeopaths. Types of health-care use explored were hospital, prescribed, general ambulatory and specialized ambulatory care. Factors determining health-care use were disease status, administrative area, employment status and age. CONCLUSIONS: RA subjects use health-care services more widely than NA subjects. Variation in recourse behaviour is related to differences within administrative areas.

Pouchot J, Ruperto N, Lemelle I, Sommelet D, Grouteau E, David L, Duquesne A, Job Deslandre C, Kone Paut I, Pillet P, Goumy L, Barbier C, Guyot MH, Mazingue F, Gandon Laloum S, Fischbach M, Quartier P, Guyot C, Jean S, Le Gall E, Plouvier E, Bost M, de Lumley L, LePlège A, Larbre JP, Guillemin F, Coste J, Landgraf JM, Prieur AM, Anonymous00066. · Service de Médecine Interne, Hôpital Louis Mourier, Colombes, France. · Clin Exp Rheumatol. · Pubmed #11510333 No free full text.

Abstract: We report the results of the cross-cultural adaptation and validation into the French language of two health status instruments. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific instrument that measures functional ability in daily living activities in children with juvenile idiopathic arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health related quality of life instrument designed to capture the physical and psychosocial well-being of children independently from the underlying disease. Five hundred children were enrolled including 306 patients with JIA classified into systemic (23%), polyarticular (22%), extended oligoarticular (25%), and persistent oligoarticular (30%) subtypes, and 194 healthy children. Both instruments were reliable with intra-class correlation (ICC) coefficients for the test-retest procedure of 0.91 for the CHAQ, and 0.87 and 0.89 for the physical and psychosocial summary scores of CHQ, respectively. Agreement between parents and children evaluated for the CHAQ was high with an ICC of 0.89 for the disability index; weighted kappa coefficients for the 8 domains ranged from 0.61 to 0.72. Convergent validity was demonstrated by significant correlations with the JIA core set of variables (physician and parent global assessment, scores for active joints and joints with limited range of motion, erythrocyte sedimentation rate) for both instruments. Both CHAQ and CHQ discriminated between healthy and JIA children, but only the disease specific CHAQ questionnaire discriminated clearly between the 4 JIA subtypes. In conclusion, the French versions of the CHAQ and the CHQ are reliable, and valid health assessment questionnaires to be used in children suffering from JIA.

Kolopp-Sarda MN, Guillemin F, Chary-Valckenaere I, Béné MC, Pourel J, Faure GC. · Laboratoire d'Immunologie, Faculté de Médecine & CHU Nancy, France. · Clin Exp Rheumatol. · Pubmed #11326478 No free full text.

Abstract: OBJECTIVE: To appreciate the evolution of serum angiogenic and/or adhesion molecules levels during a long term follow-up of rheumatoid arthritis (RA) patients. METHODS: Serum levels of 5 soluble adhesion/angiogenesis glycoproteins (VEGF, CD31, CD54, CD62E, CD106) were measured in Elisa in samples collected over 6 years in a cohort of 43 RA patients with monitored clinical parameters of disease activity and severity. RESULTS: RA patients had significantly higher levels (p < 0.0001) of sCD106 (VCAM-1) than control subjects. Conversely, the levels of soluble VEGF, CD31, CD54 and CD62E were normal or lower than normal. No statistically significant time effect was noted. No effect either was noted as related to the therapeutic agents taken by the patients. CONCLUSION: The sustained elevated serum levels of sCD106 observed here imply that this molecule might be related to the chronicity and progression of RA.

Suurmeijer TP, Waltz M, Moum T, Guillemin F, van Sonderen FL, Briançon S, Sanderman R, van den Heuvel WJ. · Interuniversity Centre for Social Science, Theory and Methodology, Department of Medical Sociology, University of Groningen, The Netherlands. · Arthritis Rheum. · Pubmed #11324773 links to  free full text

Abstract: OBJECTIVE: The aim of this study was to examine the quality of life (QoL) profiles of patients with early rheumatoid arthritis (RA) and to relate these to disease and impairment variables as indicated, respectively, by erythrocyte sedimentation rate (ESR) and by tender joint count (Ritchie Articular Index), fatigue, and pain. METHODS: The present study uses part of the European Research on Incapacitating Disease and Social Support data of 573 patients with recently diagnosed RA (268 from the Netherlands, 216 from Norway, and 89 from France). A series of clinical and psychosocial data were collected on 4 (the Netherlands, France) and 3 (Norway) occasions, with 1-year intervals separating the waves of data collection. RESULTS: Of the disease activity (ESR) and impairment variables (tender joint count, fatigue, pain), fatigue was identified as the consequence of disease that differentiated best on a series of QoL aspects such as disability, psychological well-being, social support, and "overall evaluation of health." Next came pain and tender joint count, and ESR showed by far the least differentiating ability. A principal-component analysis on the QoL measures used in this study yielded one general factor measuring "overall QoL." After rotation, two separate factors were encountered, one referring to the physical domain and the other to the psychological and social domains of QoL. Again, the QoL of RA patients experiencing much fatigue appeared to decline the most. CONCLUSIONS: Because of the highly variable nature of RA, impairments, activities of daily living (ADL) and instrumental ADL restrictions, and psychosocial distress can vary erratically. In particular, "fatigue" as measured over a period of 2 to 3 years distinguished best among RA patients as shown by their QoL profiles. Although the physical domain was most affected, the significant effect of RA on the psychosocial domain should not be underestimated.

Ludig A, Guillemin F, Chary-Valckenaere I, Suurmeijer TP, Moum T, van den Heuvel WJ. · Rheumatology Unit, CHU Brabois, Nancy, France. · Scand J Rheumatol. · Pubmed #11132203 No free full text.

Abstract: OBJECTIVE: To analyse drug consumption in the first years of rheumatoid arthritis (RA) in France, the Netherlands, and Norway, in a longitudinal study between 1991 and 1993. PATIENTS AND METHODS: The EURIDISS cohort followed up over three years included 695 RA subjects with less than 5 years disease duration. Clinical and biological parameters, drug consumption according to ATC classification, and use of local treatment were recorded. RESULTS: In the Netherlands consumption of second-line treatment occurred early on, and remained constant over time. In France, it was consumed by half of the subjects and decreased during follow-up (p<0.001). In Norway, 50% of the subjects were on second-line treatment at the outset. NSAIDs rather than corticoids were the most widely consumed. Patients underwent frequently local treatments with decrease frequency of infiltrations over time (p<0.001). CONCLUSION: Second-line treatments were used in the first years of disease development, following varying sequences in the different countries.

Haavardsholm EA, Kvien TK, Uhlig T, Smedstad LM, Guillemin F. · Oslo City Department of Rheumatology, Diakonhjemmet Hospital, Norway. · J Rheumatol. · Pubmed #11128668 No free full text.

Abstract: OBJECTIVE: To examine the agreement between and compare the sensitivity to change of the Arthritis Impact Measurement Scale (AIMS2) and AIMS2 Short Form (AIMS2-SF) in a large sample of rheumatoid arthritis (RA) patients examined within the framework of a longitudinal observational study. METHODS: Data were collected from patients in a community based RA register by a postal survey in April 1994 (1,030 respondents) and again in 1996 (1,153 respondents), comprising AIMS2, Modified Health Assessment Questionnaire (MHAQ), Medical Outcome Survey SF-36, and other commonly used health status measures. The degree of agreement was examined by plotting differences between AIMS2 and AIMS2-SF against the mean of the 2 scores for the 5 main components. The upper and lower limits of agreement (mean diff. +/- 1.96 SD) were calculated and plotted. The intraclass correlation coefficients were computed by repeated measurement ANOVA. Validity was assessed on the basis of external indicators of health status, and responsiveness on the basis of standardized response means. RESULTS: The AIMS2 and AIMS2-SF showed substantial to near-perfect agreement. Best agreement was seen for the physical and affect components. Better agreement for the symptom component was obtained when replacing item 42 with item 38. Internal consistency was high in all components. The 2 forms correlated similarly with scores from other instruments within the same domains, showing similar construct validity. There was no difference in responsiveness between the 2 forms when using changes in patient assessed global disease activity as external indicator of change in health status, and responsiveness for the physical and symptom dimension was similar to other instruments (SF-36, MHAQ). CONCLUSION: The AIMS2-SF is amenable for use in large surveys with a modification of one item in the symptom scale.

Viller F, Guillemin F, Briançon S, Moum T, Suurmeijer T, van den Heuvel W. · Henri Poincaré University, School of Public Health, School of Medicine, Vandoeuvre-les-Nancy, France. · Joint Bone Spine. · Pubmed #10875314 No free full text.

Abstract: OBJECTIVE: To delineate compliance with drug therapy in rheumatoid arthritis patients, determine specific characteristics of compliant and noncompliant patients, and look for changes in compliance over time. PATIENTS AND METHODS: A prospective European cohort study (EURIDISS) recruited 556 patients in four countries over three years. Compliance with drug dosages and dosing times was evaluated yearly using a questionnaire. RESULTS: Of the 556 patients, 429 (77.2%) were on drug therapy at all three evaluation time points. Use of steroids, nonsteroidal anti-inflammatory drugs, and second-line drugs varied significantly across countries. The compliance behavior was stable over time in 59.5% of them (35.7% of patients were consistently compliant and 23.8% consistently noncompliant); it was independent of disease duration and from the clinical features of the disease. Older patients and women were more likely to be compliant (odds ratios, 2.5 and 2, respectively). CONCLUSION: Compliance with drug therapy can be measured using two simple questions. Compliance is more closely dependent on individual behavior than on responses to specific features of rheumatoid arthritis.

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.

Viller F, Guillemin F, Briançon S, Moum T, Suurmeijer T, van den Heuvel W. · School of Public Health, Faculty of Medicine, University of Nancy, Vandoeuvre-les-Nancy, France. · J Rheumatol. · Pubmed #10529126 No free full text.

Abstract: OBJECTIVE: Patient compliance is considered necessary for the success of drug treatment in chronic diseases. We document compliance with drug treatment and the factors affecting it in a cohort of patients with rheumatoid arthritis (RA). METHODS: A prospective cohort study of 556 patients with RA followed for 3 years in 4 counties: Oslo, Norway; Groningen, The Netherlands; and Nancy and Reims, France. Compliance to treatment was assessed annually by interview in terms of adherence to the dose and timing of the prescribed drug regimen. RESULTS: Of the 556 subjects, 429 (77.2%) were taking medication for RA throughout the observation period. Consistent behavior was recorded in 59.5% of cases: 35.7% were consistently compliant, and 23.8% consistently noncompliant. Factors significantly associated with good compliance were older age (p = 0.00), female sex (p = 0.03), decreased disability (p = 0.04), very satisfactory contacts with health care professionals (p = 0.03), and more personal knowledge about the disease and its treatment (p = 0.03). CONCLUSION: This longitudinal study identified compliance behavior as consistent over time in 60% of patients, determined by quality of contact with professionals and the amount of patient information available.