Rheumatoid Arthritis: Jousse-Joulin S

Devauchelle-Pensec V, Pennec Y, Morvan J, Pers JO, Daridon C, Jousse-Joulin S, Roudaut A, Jamin C, Renaudineau Y, Roué IQ, Cochener B, Youinou P, Saraux A. · Hôpital de la Cavale Blanche, CHU Brest, France. · Arthritis Rheum. · Pubmed #17330280 links to  free full text

Abstract: OBJECTIVE: There is evidence to support a dominant role for B cells in the pathophysiology of primary Sjögren's syndrome (SS). Therefore, we evaluated the safety and efficacy of anti-CD20 monoclonal antibody. METHODS: Sixteen patients who met the new American-European Consensus Group criteria for primary SS and scored >50 on at least 2 of 4 visual analog scales (VAS; 100 mm) evaluating global disease, pain, fatigue, and global dryness received infusions of low-dose rituximab (375 mg/m(2)) at weeks 0 and 1 without steroid premedication. RESULTS: Slow rituximab infusions (100 mg/hour) were well tolerated, with only 1 patient experiencing serum sickness-like disease. There was a dramatic reduction in B cells of the blood and salivary gland (SG). At week 12, VAS scores with respect to fatigue and dryness (P < 0.05), tender point count (P < 0.035), and quality of life as evaluated by the Short Form 36 questionnaire (SF-36; P < 0.001) were significantly improved. At week 36, significant improvements were noted in the 4 VAS scores (P < 0.05), tender joint count (P = 0.017), tender point count (P = 0.027), and SF-36 (P < 0.03). Pulmonary manifestations were ameliorated in 1 patient. Patients with improvements on at least 3 of the 4 VAS scores at any visit (n = 11) had a shorter disease duration than the other patients (n = 5; mean +/- SD duration 3.8 +/- 5.4 versus 30.1 +/- 29.5 years; P = 0.02). CONCLUSION: Low-dose rituximab infusions were well tolerated without the benefit of steroids. Infusions induced a rapid depletion of B cells in the blood and SG and could improve primary SS. Controlled studies are needed.

Guennoc X, Narbonne V, Jousse-Joulin S, Devauchelle-Pensec V, Dougados M, Daurès JP, Saraux A. · Rheumatology Unit and Immunology Department, Brest Teaching Hospital, F 29609 Brest Cedex, France. · J Rheumatol. · Pubmed #19531755 No free full text.

Abstract: OBJECTIVE: To evaluate the seroprevalence of hepatitis B (HBV) and C (HCV) in patients living in France with recent-onset polyarthritis suggesting rheumatoid arthritis. METHODS: The 813 patients in the ESPOIR cohort were screened for anti-HCV antibodies and HBs antigen. RESULTS: Seroprevalence was 0.86% for HCV (n = 7) and 0.12% for HBV (n = 1). HCV-related arthritis was diagnosed in 4 (0.5%) patients; no patient had HBV-related arthritis. HCV-seropositive patients had significantly higher transaminase levels (ALAT, 41.5 IU vs 23.2 IU, p = 0.02; and ASAT, 39.2 IU vs 21.8 IU, p = 0.001) but only 2 patients had ASAT or ALAT levels > 40 IU. No significant differences were found for anti-CCP antibodies, C-reactive protein, erythrocyte sedimentation rate, or other test. HCV seroprevalence was significantly higher in the subgroup with history of blood transfusion than in other patients (3.7% vs 0.42%, p = 0.02). Two of the 7 HCV positive patients and the single patient with confirmed hepatitis B infection were born in areas with higher prevalence of viral hepatitis (Togo, Senegal, Vietnam). Positive hepatitis status was known before study inclusion in 4 of the 7 HCV-positive patients and in the HBV-positive patient. CONCLUSION: The prevalence of HBV and HCV in a population of patients with recent-onset polyarthritis suggestive of RA was not greater than expected based on data from the general population in the same geographic area. Routine HBV and HCV serological testing did not contribute substantially to the diagnosis of recent-onset polyarthritis. Although advisable before initiating immunosuppressive or hepatotoxic drugs, serological testing for HCV and HBV is unnecessary in routine diagnostic evaluation of recent-onset polyarthritis.

Binard A, Alassane S, Devauchelle-Pensec V, Berthelot JM, Jousse-Joulin S, Chalés G, Le Henaff C, Thorel JB, Hoang S, Youinou P, Saraux A. · Unit of Rheumatology and the Laboratory of Immunology, la Cavale Blanche Hospital, Brest Teaching Hospitals, Brest, France. · J Rheumatol. · Pubmed #17985408 No free full text.

Abstract: OBJECTIVE: To evaluate clinical, laboratory, and radiological features and outcomes in patients with monoarthritis (MA), identified in a cohort of patients with early arthritis. METHODS: A cohort of 270 patients with undiagnosed arthritis of less than 1 year's duration was divided into 3 groups: single episode of MA (MA, n = 27), MA with a history of patient-reported arthritis (MA + past, n = 23), and oligo- or polyarthritis (OA/PA, n = 220). At 6-month intervals, all patients underwent a standardized examination, radiographs, and standard laboratory tests including rheumatoid factors (RF), antiperinuclear factor (APF), antikeratin antibody (AKA), anticyclic citrullinated peptide antibody (anti-CCP), antinuclear antibodies, and HLA-AB-DR typing. After a median followup of 30 months, the diagnosis was evaluated by a hospital-based rheumatologist. RESULTS: Age and sex did not differ across the 3 groups. Knee involvement was more common in the MA group than in the MA + past group (p < 0.03), whereas hand and metatarsophalangeal involvement was less common (p < 0.03 and p < 0.0001, respectively). RF and anti-CCP were less often positive in the MA group than in the MA + past group (p < 0.02 and p < 0.001, respectively) and the OA/PA group (p < 0.02 and p < 0.03). No patient in the MA group received a diagnosis of rheumatoid arthritis (RA). RA was less common and disease modifying antirheumatic drugs were prescribed less often in the MA group than in the other 2 groups (p < 0.0001 for both comparisons). CONCLUSION: The MA group was clearly different from the other groups, with a favorable outcome and no risk of progression to RA.

Guennoc X, Samjee I, Jousse-Joulin S, Devauchelle V, Roudaut A, Saraux A. · Rheumatology Department, Brest Teaching Hospital, CHU de Brest, 29609 Brest, France. · Joint Bone Spine. · Pubmed #17574895 No free full text.

Abstract: OBJECTIVE: To evaluate the quality of patient information about fluoroscopy-guided rheumatologic procedures, and to look for an impact on the patient's experience of the procedure. METHODS: One hundred and nineteen patients completed questionnaires before and after undergoing fluoroscopy-guided interventions. We looked for associations between the information supplied by the rheumatologist who recommended the procedure and pain, anxiety, awareness of potential complications, and the match between patient expectations and actual experience. RESULTS: 62.8% of patients reported receiving information about the procedure. Only 20.5% reported receiving specific information about potential adverse events, although 80.9% felt this information would have been useful. Most patients (74.8%) would have liked to receive additional information. Only 10.1% patients were given written information. Mean (+/-SD) anticipated pain severity as assessed in the waiting room before the procedure on a 0-10 scale was 4.5+/-2.4 in women and 4.2+/-2.3) in men. Actual pain severity during the procedure as assessed on the same scale was 2.7+/-2.6 in women and 2.2+/-1.6 in men. The level of information about the procedure did not influence anticipated or actual pain severity. Anxiety was reported by 59.8% patients and was more common in women (P<0.001), in patients given written information (P=0.05), and in patients undergoing their first intervention (P=0.05). Information was perceived as alleviating anxiety by 69.9% patients, and 77.3% of patients felt they would experience less anxiety if they had the procedure a second time. Only 21.2% patients were able to name a potential adverse event, and this proportion was not influenced by receiving written information. A mismatch between expectations about the procedure or its duration and actual experience was reported by 17 (17/69, 24.6%) and 34 (34/98, 34.7%) patients, respectively, with no significant differences across study subgroups. CONCLUSION: Information about interventional rheumatology procedures is required for ethical principles and legislation. Patients increasingly expect detailed information, which may increase the likelihood that the procedure unfolds smoothly. Our results indicate a need for optimizing patient information. Standardized written material deserves to be evaluated as a means of better meeting the informational needs of patients.

Wakefield RJ, D'Agostino MA, Iagnocco A, Filippucci E, Backhaus M, Scheel AK, Joshua F, Naredo E, Schmidt WA, Grassi W, Moller I, Pineda C, Klauser A, Szkudlarek M, Terslev L, Balint P, Bruyn GA, Swen WA, Jousse-Joulin S, Kane D, Koski JM, O'Connor P, Milutinovic S, Conaghan PG, Anonymous00480. · Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK. · J Rheumatol. · Pubmed #17407236 No free full text.

Abstract: Ultrasound (US) is a relatively new imaging modality in rheumatology that offers great potential as a diagnostic and management tool. In 2004, an OMERACT Ultrasound Special Interest Group was formed to address the metric qualities of US as a potential outcome measure. A preliminary systematic review highlighted the deficiencies in the literature, particularly with regard to the reliability of interpreting and acquiring images; as a consequence, a number of exercises were proposed to address these issues. This report describes a series of iterative studies that have resulted in improved intra- and inter-reader reliability for detecting and scoring synovitis from both static and real-time images of the hand joints of patients with rheumatoid arthritis. The reliability of acquiring images was also enhanced using standardized positions. Future studies will assess the value of US in clinical trials.

Saraux A, Binard A, Devauchelle-Pensec V, Jobic Y, Jousse-Joulin S. · No affiliation provided · Ann Intern Med. · Pubmed #18838737 links to  free full text

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