Rheumatoid Arthritis: Ornetti P

Ornetti P, Chevillotte H, Zerrak A, Maillefert JF. · Department of Rheumatology, Dijon University Hospital, Dijon, FranceUniversity of Burgundy, Dijon, France. · Drugs Aging. · Pubmed #17109564 No free full text.

Abstract: Anti-tumour necrosis factor (TNF)-alpha represents a major advance in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis and psoriatic arthritis. It is usually well tolerated, but a potential increase in the incidence of some infections in patients taking anti-TNFalpha agents has been reported.Compared with younger people, elderly patients have more co-morbidities and are likely to be taking more medications. Moreover, the aging process induces an increase in the rate of infections. Nevertheless, in recent studies analysing the databases of etanercept trials, the normalised incidence of adverse events, serious adverse events, medically important infections and deaths was not increased in patients aged >or=65 years. However, these trials included patients who might have been healthier than elderly RA patients in the general population and therefore not truly representative. Conflicting results have been reported in several 'real-life' observational studies.Taken together, the available data are reassuring for carefully selected populations, at least for etanercept, but it is not possible to claim that anti-TNFalpha agents do, or do not, pose a particular risk for the general population of older patients. Additional studies aiming at determining the safety and benefit-risk ratio of anti-TNFalpha agents in elderly patients are needed. In addition, since the benefit-risk ratio of anti-TNFalpha agents might be different in patients aged 65, 75 or >80 years, when possible, subgroup analysis might also be useful.

Laroche D, Ornetti P, Thomas E, Ballay Y, Maillefert JF, Pozzo T. · INSERM-ERM 207 Motricité & Plasticité, Université de Bourgogne, BP 27877, 21078, Dijon Cedex, France. · Exp Brain Res. · Pubmed #16915399 No free full text.

Abstract: Rheumatoid arthritis (RA) is a leading cause of disability, which affects primarily the forefoot. Moreover, the forefoot is the final ground body interface for transmitting forces produced by the plantar flexors in order to move the body forward. Therefore, a dysfunction in patients with arthritis might induce important changes in gait, such as modifications in the coordination between legs to correct a reduced range of motion (ROM) and to produce smooth stride motions. First, we wanted to investigate the modifications of gait parameters in order to get a deeper understanding of the locomotor adaptation after a distal joint impairment. Second, we wanted to extract the mechanisms used to compensate for these impairments. In order to carry out this study, RA patients with forefoot impairment and healthy subjects were asked to walk along a straight line at two different velocities and were recorded by a motion analysis system. Patients were able to produce an efficient pattern despite a reduction of the ROM of the forefoot. At normal speed, the substantial modification of the locomotor pattern was linked to the adaptation of the lower-limb segment coordination and to the loss of ROM. Compensative mechanisms are the results of an efficient adaptation that offset the effect of the lesions. In contrast, at high speed, all of the kinematic modifications observed at natural speed vanished. It seems that pain and its associated sensory signals help to update the motor command and compel patients to adjust the descending command to the altered representation of distal mobility. Finally, the mechanical consequences of these changes are of particular interest since different levels of force exerted at the hip, knee and ankle might result in a supplementary structural alteration of these joints.

Laroche D, Pozzo T, Ornetti P, Tavernier C, Maillefert JF. · UFR STAPS, INSERM/ERM 0207, University of Burgundy, France. · Rheumatology (Oxford). · Pubmed #16249238 links to  free full text

Abstract: OBJECTIVE: To evaluate the effects of loss of range of motion (ROM) of the metatarsophalangeal (MTP) joint on the kinematic parameters of walking in rheumatoid arthritis (RA) patients. METHODS: Inclusion of RA patients with inactive disease, no synovitis of the inferior limb and reduced ROM of the MTP joints. Evaluation of the ROM of the MTP dorsal and plantar flexion, and gait analysis using a three-dimensional computerized movement analysis. Calculation of gait parameters and maximal flexion and extension of the hips and knees during walking. Analysis 1 compared the ROM of dorsal and plantar flexion in patients with or without walking pain; 2 compared the gait parameters between patients and controls; 3 investigated a relationship between gait parameters and (i) the ROM of the MTP dorsal and plantar flexion and (ii) the pain at walking; 4 investigated the relationship between the ROM of the MTP dorsal and plantar flexion and maximal flexion and extension of the hip and knee joints during walking. RESULTS: Nine patients and seven controls were included. The MTP ROM was no different in patients presenting with or without pain at walking. The walking velocity was lower and the stride length shorter in patients than in controls. The walking velocity and the stride length were positively related to the MTP dorsal flexion ROM (r(2)=0.75 and 0.67). There was a negative relationship between maximal flexion of the knee and hips during walking and the underlying MTP dorsal flexion ROM (r(2)=0.67 and 0.54). CONCLUSION: In RA patients, reduced MTP dorsal flexion mobility induces changes in the walking parameters, including the kinematics of the overlying lower limb joints. Treatment of an RA-impaired forefoot should focus on MTP mobility as well as on pain.

Ornetti P, Solau E, Gaudin P, Sibilia J, Berthelot JM, Puechal X, Tavernier C, Maillefert JF, Anonymous00229. · No affiliation provided · Ann Rheum Dis. · Pubmed #16100349 links to  free full text

This publication has no abstract.

Maillard H, Ornetti P, Grimault L, Ramon JF, Ducamp SM, Saidani T, Tavernier C, Maillefert JF. · Rheumatology Department, Dijon Teaching Hospital, Dijon, France. · Joint Bone Spine. · Pubmed #16038846 No free full text.

Abstract: OBJECTIVE: To evaluate the prevalence and risk factors of severe pyogenic infections in rheumatology patients taking infliximab in everyday practice. METHODS: Regional prospective cohort study of patients taking infliximab for rheumatoid arthritis or ankylosing spondylitis with data collection on standardized forms. The medical records of patients with severe pyogenic infections were subjected to a detailed retrospective review. Patients with and without severe pyogenic infections were compared. RESULTS: The cohort included 83 patients (55 women and 28 men). Severe pyogenic infections occurred in five (6%) patients (three women and two men), all of whom had acute or underlying risk factors. Higher values were found in these five patients for mean age (65.8 +/- 12 vs. 53.9 +/- 13 years, P = 0.04) and mean daily glucocorticoid dosage (15.5 +/- 9 vs. 6.9 +/- 7 mg/day prednisone-equivalent, P = 0.036), as compared to the other patients. CONCLUSION: Older age and high-dose glucocorticoid therapy are associated with an increased risk of severe pyogenic infection during infliximab therapy. Caution is in order when starting and monitoring infliximab therapy in patients with risk factors. Our data also emphasize the need for a careful search for risk factors before each infliximab infusion.

Chevillotte-Maillard H, Ornetti P, Mistrih R, Sidot C, Dupuis J, Dellas JA, Tavernier C, Maillefert JF. · No affiliation provided · Rheumatology (Oxford). · Pubmed #15705631 links to  free full text

This publication has no abstract.