Rheumatoid Arthritis: Le Goff P

Botton E, Saraux A, Laselve H, Jousse S, Le Goff P. · Service de rhumatologie, Hôpital de la cavale blanche, CHU Brest, 29609 Brest cedex, France. · Joint Bone Spine. · Pubmed #14563459 No free full text.

Abstract: Although bone and joint manifestations are common in children with cystic fibrosis (CF), they have received little attention in adults. As compared to healthy individuals, bone mineral density is low, even with calcium intakes greater than 1500 mg/d. Nevertheless, calcium and phosphate levels in blood and urine are often normal, and vitamin D levels vary. Short stature with a low body mass index and central hypogonadism are the rule in these patients. Fractures and kyphosis are often reported. CF arthropathy occurs in 2-8.5% of patients. Arthritis develops, and there may be skin eruptions. Non-steroidal antiinflammatory drug therapy is effective. Hypertrophic osteoarthropathy associated with respiratory failure is present in 2-7% of patients. Rheumatoid arthritis, spondyloarthropathies, sarcoidosis, and amyloidosis have been reported in association with CF. Knee pain due to patellofemoral syndrome, quinolone-induced arthropathy, and mechanical back pain have been described. Rheumatoid factor titers are higher than in healthy controls, particularly in patients with episodic arthritis. No data are available on antiperinuclear factor or antikeratin antibody titers. Tests for antinuclear antibody are usually negative. Circulating immune complex levels and antibodies to heat shock proteins may be elevated. Antineutrophil cytoplasmic antibody of the bactericidal/permeability-increasing protein (BPI) or azurocidin (AZ) type has been reported, often in high titers (up to 40%).

Devauchelle-Pensec V, Saraux A, Alapetite S, Colin D, Le Goff P. · Rheumatology Department (DC), Hĵpital de la Cavale Blanche, CHU Brest, BP 814, F 29609 Brest Cedex, France. · Joint Bone Spine. · Pubmed #12477226 No free full text.

Abstract: The extent to which radiographs of the hands and feet can contribute to the diagnosis of early rheumatoid arthritis (RA) has received little research attention. Yet, the workup for recent-onset inflammatory joint disease usually includes radiographs of the hands and feet. We reviewed the literature for data on the value of these radiographs for diagnosing early RA. We sought to determine whether radiographic changes in the hands and feet constitute a valid diagnostic criterion, i.e., show good discrimination, good reproducibility, and an ability to detect early disease. Furthermore, we evaluated whether the sensitivity, specificity, and positive and negative predictive values of these changes could be calculated from published data. Few cohort studies of early inflammatory joint disease have been published, and the data come mainly from studies in early RA. Among radiographic alterations described to date, erosions seem associated with the best reliability and discriminating power. Radiographic alterations are of limited sensitivity for early rheumatoid arthritis because they occur only after some time. Radiographs of the hands and feet are far easier to obtain than magnetic resonance imaging and ultrasonography, which seem promising but are still undergoing validation.

Mamoune A, Durand V, Le Goff P, Pennec YL, Youinou P, Le Corre R. · Laboratory of Immunology, Brest University Medical School, France. · Histol Histopathol. · Pubmed #10809380 No free full text.

Abstract: CD45RO+ T cells are referred to as memory or helper-inducer while CD45RA+ T cells are regarded as naive or suppressor-inducer T cells. The former population predominates in the peripheral blood and even more in the synovial fluid of patients with rheumatoid arthritis, to the expense of the latter population. Within the CD45RB+ compartment, there appears to be more of the fully-differentiated than of the early-differentiated CD4+ T cells. In spite of the fact that these lymphocytes are close to undergoing apoptosis, this programmed cell death is inhibited in the rheumatoid synovium.

Berthelot JM, Saraux A, Maugars Y, Prost A, Le Goff P. · Rheumatology Department, Brest Teaching Hospital, France. · Rev Rhum Engl Ed. · Pubmed #10339779 No free full text.

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Saraux A, Le Goff P. · Rheumatology Department, La Cavale Blanche Teaching Hospital, Brest, France. · Rev Rhum Engl Ed. · Pubmed #10084164 No free full text.

This publication has no abstract.

Devauchelle Pensec V, Saraux A, Berthelot JM, Alapetite S, Jousse S, Chales G, Thorel JB, Hoang S, Nouy-Trolle I, Martin A, Chiocchia G, Youinou P, Le Goff P. · Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, CHU Brest, Brest, France. · J Rheumatol. · Pubmed #14705220 No free full text.

Abstract: OBJECTIVE: In a cohort of patients with early arthritis, to evaluate how well foot radiographs at study inclusion predicted a diagnosis of rheumatoid arthritis (RA) 2 years later. METHODS: A cohort of patients with arthritis of less than one year duration was evaluated in a multicenter study and followed for 30 +/- 11 months. An observer blinded to patient data read all 149 hand and foot radiographs done at study inclusion, using item 7 of the 1987 American College of Rheumatology (ACR) criteria for RA and Sharp's method to score erosions and joint space narrowing. RESULTS: The kappa coefficient for the 1987 ACR item 7 was 0.52 for bony decalcification and 0.87 for erosions. Intra and interobserver correlation coefficients for Sharp's scores ranged from 0.90 to 0.98. Erosions at the feet were significantly associated with RA. The item 7 erosion component at the feet was more specific than the full item 7 (97.5% vs 94%; p = 0.01). Sharp's erosion score at the feet was not better than the erosion component of item 7 (sensitivity 18%; specificity 97.5%). Combined use of radiographs of the hands and feet improved the diagnostic performance of the item 7 erosion component; (sensitivity and specificity of item 7 erosions at the hands combined with the feet were 32.5% and 94.5%, respectively). CONCLUSION: The "erosion" criterion at the feet had the best diagnostic performance and was significantly associated with a diagnosis of RA. Combining hand and foot radiographs improved diagnostic performance.

Devauchelle-Pensec V, Berthelot JM, Jousse S, Samjee I, Josseaume T, Colin D, Chalés G, Thorel JB, Hoang S, Martin A, Youinou P, Le Goff P, Saraux A. · Unit of Rheumatology, Cavale Blanche Hospital, CHU Brest, Brest, France. · J Rheumatol. · Pubmed #16783864 No free full text.

Abstract: OBJECTIVE: To evaluate the ability of baseline hand radiographs to predict the diagnosis 2 years later in a cohort of patients with early arthritis. METHODS: A total of 258 patients with arthritis onset within the previous year were evaluated. At baseline, all patients underwent a standardized evaluation including laboratory tests and radiographs. Hand radiographs were read by a blinded observer who used a standardized procedure for detecting features of crystal deposition diseases and rheumatoid arthritis (RA). After 30 +/- 11.3 months, the final diagnosis was established by a panel of rheumatologists. All radiographs were evaluated. RESULTS: Significant associations were found between radiographic features and a clinical diagnosis of RA, calcium pyrophosphate dihydrate (CPPD) arthritis, and hydroxyapatite arthritis. No radiographic abnormalities suggesting psoriatic arthritis or gout were seen. The sensitivities of hand radiographs for diagnosing CPPD or hydroxyapatite arthritis ranged from 80% to 100%. Baseline hand radiographs suggested the final diagnosis in 31/258 patients, including 21 (22.5%) of the 93 patients with RA, 10 of the 11 (91%) patients with CPPD or hydroxyapatite deposition disease, and none of the patients with other disorders. Sensitivity was 29%, specificity 86.5%, positive predictive value 61%, and negative predictive value 63%. CONCLUSION: In our cohort of patients with recent arthritis, the overall performance of hand radiographs in predicting a diagnosis 2 years later was modest. However, they had an excellent diagnostic value for calcium deposition diseases.

Ollivier Y, Saraux A, Le Goff P. · Unit of Rheumatology, Hôpital de la Cavale Blanche, CHU Brest, BP 814, F 29609 Brest-Cedex, France. · Clin Exp Rheumatol. · Pubmed #15638052 No free full text.

Abstract: OBJECTIVE: To evaluate the influence of lifestyle factors on the prevalence of rheumatoid arthritis (RA) by comparing Roman Catholic nuns and the general female population. METHOD: RA prevalence in the general population was evaluated using a standardized telephone survey in 1857 homes taken at random. Individuals who reported an inflammatory joint disease were contacted by a rheumatologist of our unit, missing data were collected from the general practitioner or rheumatologist with the patient's permission, and if necessary a physical examination was done by a rheumatologist. The 9 largest Roman Catholic nun communities in Brittany were screened using the same standardized questionnaire administered face-to-face; nuns who reported an inflammatory joint disease were interviewed and examined by rheumatologists. In both populations, RA was diagnosed when (1) the rheumatologist of our unit who interviewed the patient considered the RA classification criteria positive and (2) the rheumatologist who examined the patient gave a diagnosis of RA independently from RA classification criteria. RESULTS: Data were available for 1706 adult females in the general population and 721 nuns. Of the 20 nuns who reported RA or polyarthritis, 11 received a diagnosis of RA (prevalence 1.52%). The prevalences adjustedfor the French population after 40 years were 1.66% (95% confidence interval, 0.84-2.44) and 1.33 (0.27-2.40) among the nuns and the general female population, respectively. CONCLUSION: Although our nun population was too small for definite conclusions, we found no evidence of a difference in RA prevalence among nuns and the general female population in Brittany.

Saraux A, Berthelot JM, Devauchelle V, Bendaoud B, Chalès G, Le Henaff C, Thorel JB, Hoang S, Jousse S, Baron D, Le Goff P, Youinou P. · Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, CHU Brest, BP 824, F-29609 Brest-Cedex, France. · J Rheumatol. · Pubmed #14719190 No free full text.

Abstract: OBJECTIVE: To compare the diagnostic values of antiperinuclear factor (APF), antikeratin antibody (AKA), and anti-cyclic citrullinated peptides (anti-CCP) to discriminate between patients with and without rheumatoid arthritis (RA) and to determine the diagnostic value of anti-CCP used alone or with other tests. METHODS: Two hundred and seventy patients with early arthritis underwent standardized investigations in 1995-1997. The clinical utility of APF, AKA, and anti-CCP in first-visit sera was evaluated using receiver-operating characteristic curves. Combinations of anti-CCP with other laboratory tests were assessed by multiple logistic regression. RESULTS: Anti-CCP, APF, and AKA were not perfectly correlated with one another. Anti-CCP with 53 UI as the cutoff was 47% sensitive and 93% specific, versus 52% and 79%, and 47% and 94%, for APF and AKA, respectively. Multiple logistic regression selected anti-CCP, AKA, IgM-rheumatoid factor (RF) ELISA, and the latex test. CONCLUSION: Rheumatologists can routinely use 2 or 3 tests for diagnosing RA (latex and/or IgM RF ELISA, and either AKA or anti-CCP ELISA) and can add a third or fourth test when the diagnosis remains in doubt.

Berthelot JM, Bernelot-Moens HJ, Klarlund M, McGonagle D, Calin A, Schumacher HR, Combe B, De Bandt M, Drosos AA, Flipo RM, Harris BJ, Kaarela K, Le Goff P, Meyer O, Punzi L, Zerbini CA, Saraux A, Anonymous00207. · Department of Rheumatology, Nantes University Medical School, CHU Nantes, France. · Clin Exp Rheumatol. · Pubmed #12051392 No free full text.

Abstract: OBJECTIVES: To determine areas of agreement and disagreement among experts in the interpretation of the published criteria for RA (ACR) and spondylarthropathies ( ESSG). METHODS: Thirty-two experts (16 from France and 16 from 10 other countries) replied anonymously to a mailed questionnaire. RESULTS: Tenosynovitis and 'sausage-like' painless swelling of the toes were considered as criteria for RA by 18 and 14 experts, respectively. The definition of symmetry differed widely among experts (symmetry of only one group of joints was sufficient for 13). Twenty-five experts considered erosions of other joints than the wrists and fingers as a criterion for RA, 17 thought that fulfilment of criteria could be achieved cumulatively, and 19 would appreciate clarifications of the current criteria. Among possible clarifications for RA, it was frequently recommended that morning stiffness and nodules be eliminated and that new marker antibodies, X-rays of the feet, and exclusion criteria be added. Twenty-three of the 29 experts who gave an opinion (79%) agreed with the notion of SP in the absence of axial signs and sacroiliitis, 26/31 (84%) indicated that a patient can have both RA and SP, and 19/30 (63%) thought that RA and SP could be regarded as syndromes more than diseases. Only 5/32 experts relied more on the criteria than on their clinical judgement in diagnosing RA. CONCLUSIONS: There would seem to be a needfor the optimisation of RA and ESSG criteria, particularly within the context of early arthritis.

Saraux A, Berthelot JM, Chalès G, Le Henaff C, Mary JY, Thorel JB, Hoang S, Dueymes M, Allain J, Devauchelle V, Baron D, Le Goff P, Youinou P. · Rheumatology Unit, Hôpital de la Cavale Blanche, Brest, France. · Arthritis Rheum. · Pubmed #11954009 No free full text.

Abstract: OBJECTIVE: To determine which laboratory test or tests at presentation best predicted a diagnosis of rheumatoid arthritis (RA) 2 years later. METHODS: Two hundred seventy patients with early arthritis seen in 7 hospitals underwent comprehensive evaluations at 6-month intervals for 2 years, when the diagnosis of RA was assessed by 5 rheumatologists. The sensitivity and specificity of each test at the first visit for discriminating between RA (38%, n = 98) and non-RA patients were determined. Optimal cutoffs for continuous tests were derived from receiver operating characteristic curves. Sensitivity and specificity of test combinations selected by multiple logistic regression were determined. RESULTS: IgM rheumatoid factor (RF) by enzyme-linked immunosorbent assay, IgG-antikeratin antibody (AKA), and latex test had the strongest associations with RA. These 3 tests formed the most powerful combination for distinguishing RA from non-RA. CONCLUSION: IgM-RF, IgG-AKA, and the latex test are the best laboratory tests for discriminating between patients with and without RA. Combining these tests slightly improves diagnostic value.

Saraux A, Bourdon V, Devauchelle V, Le Goff P. · Rheumatology department, CHU de Brest, France. · Joint Bone Spine. · Pubmed #11808985 No free full text.

Abstract: OBJECTIVE: Serum CH50 and C4 levels are usually normal or elevated in rheumatoid arthritis (RA) but are classically decreased in patients with serious extra-articular manifestations (SEAMs) of the disease. The objective of this study was to evaluate whether complement assays are useful in diagnosing or predicting SEAMs of RA. METHODS: First, a cross-sectional study of 405 patients admitted for RA compared patients with and without hypocomplementemia. Then, a retrospective longitudinal design was used to investigate within-patient complement level variations overtime. RESULTS: In the univariate analysis, patients with low CH50 and C4 levels were more likely to have vasculitis and/or cryoglobulinemia than those with normal CH50 and C4 levels, and nodules were more common in the patients with low than with normal C4 levels. In a multivariate model based on symptoms, low C4 was associated with vasculitis and pleurisy and low CH50 with vasculitis. However, these associations were too weak to make CH50 and C4 determination useful for detecting SEAMs, and the within-subject variations in patients with SEAMs limited the predictive value of these assays. CONCLUSION: Hypocomplementemia is of limited usefulness for detecting or predicting SEAMs.

Devauchelle Pensec V, Saraux A, Berthelot JM, Alapetite S, Chalès G, Le Henaff C, Thorel JB, Hoang S, Nouy-Trolle I, Martin A, Baron D, Youinou P, Le Goff P. · Unit of Rheumatology and the Laboratory of Immunology, Hôpital de la Cavale Blanche, Brest, France. · J Rheumatol. · Pubmed #11764204 No free full text.

Abstract: OBJECTIVE: To evaluate the ability of hand radiographs collected at study inclusion to predict a diagnosis of rheumatoid arthritis (RA) 2 years later, in a cohort of patients with early arthritis. METHODS: We evaluated 270 patients with arthritis of less than one year duration. At the first visit, all patients underwent a standardized evaluation including laboratory tests and radiographs. Followup was 30+/-11.3 mo. The hand radiographs were read by observers blinded to patient data who looked for item 7 of the 1987 ACR criteria for RA and used Sharp's method to score erosions and joint space narrowing. RESULTS: The kappa coefficient for ACR item 7 was < 0.65 for bony decalcification and > 0.8 for erosions. Intra and interobserver correlation coefficients for Sharp score ranged from 0.90 to 0.95. The "erosion" component of ACR item 7 was more specific than the full item 7 (96% versus 87.5%; p = 0.02). Sharp erosion score was not better than the erosion component of item 7 (sensitivity 17%; specificity 96%). CONCLUSION: Regardless of the criterion used, hand radiographs were of limited value to predict which patients would be considered as having RA 2 years later. Diagnostic performance was similar for the "erosions" component of the 1987 ACR item 7 and for Sharp erosion score. The full 1987 ACR item 7 (erosions or bony decalcification) performed less well.

Saraux A, Berthelot JM, Chalès G, Le Henaff C, Thorel JB, Hoang S, Valls I, Devauchelle V, Martin A, Baron D, Pennec Y, Botton E, Mary JY, Le Goff P, Youinou P. · Rheumatology Unit, la Cavale Blanche Hospital, Brest Teaching Hospital, France. · Arthritis Rheum. · Pubmed #11710704 No free full text.

Abstract: OBJECTIVE: To determine how well the American College of Rheumatology (ACR; formerly, the American Rheumatism Association) 1987 classification criteria for rheumatoid arthritis (RA), when used at study inclusion in a cohort of 270 patients with early (<1 year) arthritis, predicted a diagnosis of RA 2 years later and how well they classified these patients at the end of the 2 years. METHODS: Patients were evaluated during 1995-1997 at 7 hospitals in the Brittany region of France. Patients were evaluated at 6-month intervals until November 1999. The diagnosis made by a panel of 5 rheumatologists (P5R) after the last visit was used as the "gold standard." The ACR 1987 criteria for RA were applied prospectively, without taking into account the initial diagnosis. RESULTS: At the last visit (mean +/- SD followup 29.1 +/- 11.8 months; median 30 months), the P5R diagnosed RA in 98 patients. At the last visit, classification by the ACR criteria was satisfactory, and the combination of an office-based rheumatologist's (OBR's) diagnosis of RA and fulfillment of the ACR criteria was sensitive (87%; 85 of 98 RA patients had both) and highly specific (99%; 170 of 172 non-RA patients did not have both). Application of the criteria at the first visit was of limited value for predicting a diagnosis of RA 2 years later. CONCLUSION: After a 2-year followup, the ACR 1987 classification criteria used in combination with an OBR's diagnosis were effective in distinguishing patients with and without RA. The criteria were not useful for predicting RA in patients with arthritis onset within the previous year. Some patients who met the criteria at baseline and after 2 years did not have RA, suggesting that incorporating exclusion criteria may improve the performance of the ACR criteria when used without taking into account the diagnosis by a rheumatologist, particularly in early arthritis.

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.

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

This publication has no abstract.