Rheumatoid Arthritis: Morvan J

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.

Adomaviciute D, Pileckyte M, Baranauskaite A, Morvan J, Dadoniene J, Guillemin F. · Institute of Experimental and Clinical Medicine at Vilnius University, Vilnius, Lithuania. · Scand J Rheumatol. · Pubmed #18415768 No free full text.

Abstract: OBJECTIVE: To assess the prevalence of rheumatoid arthritis (RA) and spondyloarthropathy (SpA) in two Lithuanian cities, Vilnius and Kaunas. METHODS: The first step in this study involved the translation and validation of a telephone questionnaire developed by rheumatologists and epidemiologists in France. The second step comprised the prevalence survey. To detect RA and SpA cases in the populations of Vilnius and Kaunas, 6542 subjects selected randomly (every 50th) from the latest telephone book were interviewed by telephone using a validated case detection questionnaire (the screening phase). All subjects with rheumatic symptoms but an uncertain diagnosis were contacted by a rheumatologist (confirmation phase) by telephone. If the diagnosis remained uncertain, the subjects were invited for a rheumatological examination. RESULTS: We attempted to contact 3370 telephone numbers in Vilnius and 3172 in Kaunas, and had a response rate of 62.5% and 67.7%, respectively. Over the course of all the study phases (telephone interview, rheumatologist's interview, and clinical examination), 39 RA cases and 27 SpA cases were detected, resulting in a crude prevalence of 0.92% for RA (95% CI 0.65-1.25) and 0.64% (95% CI 0.42-0.92) for SpA. The standardized prevalence rate according to age and sex in the Lithuanian population showed an RA prevalence of 0.55 (95% CI 0.39-0.74) and a SpA prevalence of 0.84 (95% CI 0.53-1.21). CONCLUSIONS: The prevalence of RA and SpA in Lithuania was found to be one of the higher rates in Europe. A telephone interview using a validated short questionnaire enabled a cost- and time-saving epidemiological survey to be conducted to detect RA and SpA cases in the community.

Morvan J, Coste J, Roux CH, Euller-Ziegler L, Saraux A, Guillemin F. · School of Public Health, Nancy University, Nancy, France. · Ann Epidemiol. · Pubmed #18374278 No free full text.

Abstract: BACKGROUND: Two-phase surveys often are used to estimate prevalence, in particular when the disease is rare or the case ascertainment procedure difficult and/or costly. However, few authors of such surveys take into account the sensitivity error associated with the use of a screening procedure in the first phase and its imprecision in correcting the prevalence estimate and confidence interval. METHODS: Two examples of two-phase surveys of rheumatic diseases (hip and knee osteoarthritis, rheumatoid arthritis and spondyloarthropathies) are used to present methodological approaches to obtain corrected prevalence estimates. Two methods for assessing the accuracy of the screening procedure are described--two-phase pilot and case-control designs--that are best suited for frequent and rare diseases, respectively, and naive and corrected estimates of prevalence compared. RESULTS: When the sensitivity error is not taken into account, prevalence is underestimated, as is, especially, the width of its confidence interval. In our examples, the corrected confidence interval width increased up to 50% as compared with naïve one. CONCLUSIONS: The screening procedure accuracy should be thoroughly assessed in two-phase prevalence surveys and prevalence estimates and their confidence intervals corrected accordingly.