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1. Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study

Author

Jacquemin, Charlotte, Servy, Hervé, Molto, Anna, Sellam, Jérémie, Foltz, Violaine, Gandjbakhch, Frédérique, Hudry, Christophe, Mitrovic, Stéphane, Fautrel, Bruno, and Gossec, Laure

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundPhysical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). ObjectiveThe objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. MethodsThis multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. ResultsA total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. ConclusionsPatients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases.

Published
2018
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2. Évaluation globale standardisée systématique des rhumatismes inflammatoires chroniques : intérêts et limites

Author

Fogel, Olivier, Caillet-Portillo, Damien, Najm, Aurélie, Baillet, Athan, Claudepierre, Pascal, Conort, Ornella, Dernis, Emmanuelle, Fayet, Françoise, Gossec, Laure, Goupille, Philippe, Hudry, Christophe, Letarouilly, Jean-Guillaume, Lukas, Cédric, Marotte, Hubert, Molto, Anna, Pouplin, Sophie, Senbel, Eric, Sordet, Christelle, Tournadre, Anne, Truchetet, Marie-Elise, Wendling, Daniel, Ruyssen-Witrand, Adeline, and Dougados, Maxime

Published
2025
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3. Standardized reporting for systematic global evaluation of axial spondyloarthritis: An evidence-based and consensus-driven initiative

Author

Ruyssen-Witrand, Adeline, Caillet-Portillo, Damien, Najm, Aurélie, Fogel, Olivier, Baillet, Athan, Claudepierre, Pascal, Conort, Orenella, Dernis, Emmanuelle, Fayet, Françoise, Gossec, Laure, Goupille, Philippe, Hudry, Christophe, Letarouilly, Jean-Guillaume, Lukas, Cédric, Marotte, Hubert, Molto, Anna, Pouplin, Sophie, Senbel, Eric, Sordet, Christelle, Tournadre, Anne, Truchetet, Marie-Elise, Wendling, Daniel, and Dougados, Maxime

Published
2024
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4. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry

Author

Strangfeld, Anja, Schäfer, Martin, Gianfrancesco, Milena A, Lawson-Tovey, Saskia, Liew, Jean W, Ljung, Lotta, Mateus, Elsa F, Richez, Christophe, Santos, Maria J, Schmajuk, Gabriela, Scirè, Carlo A, Sirotich, Emily, Sparks, Jeffrey A, Sufka, Paul, Thomas, Thierry, Trupin, Laura, Wallace, Zachary S, Al-Adely, Sarah, Bachiller-Corral, Javier, Bhana, Suleman, Cacoub, Patrice, Carmona, Loreto, Costello, Ruth, Costello, Wendy, Gossec, Laure, Grainger, Rebecca, Hachulla, Eric, Hasseli, Rebecca, Hausmann, Jonathan S, Hyrich, Kimme L, Izadi, Zara, Jacobsohn, Lindsay, Katz, Patricia, Kearsley-Fleet, Lianne, Robinson, Philip C, Yazdany, Jinoos, Machado, Pedro M, Dahou, Brahim, Pinheiro, Marcelo, Ribeiro, Francinne M, Chassin-Trubert, Anne-Marie, Ibáñez, Sebastián, Dong, Lingli, Cajas, Lui, Hamoud, Hesham, Avouac, Jérôme, Belin, Véronique, Borie, Raphaël, Chazerain, Pascal, Chevalier, Xavier, Claudepierre, Pascal, Clavel, Gaëlle, Colette-Cedoz, Marie-Eve, Combe, Bernard, Constant, Elodie, Costedoat-Chalumeau, Nathalie, Desmurs, Marie, Devauchelle-Pensec, Valérie, Devaux, Mathilde, Dhote, Robin, Dieudonné, Yannick, Domont, Fanny, Duret, Pierre-Marie, Ebbo, Mikaël, Ebstein, Esther, Mahou, Soumaya El, Fautrel, Bruno, Felten, Renaud, Flipo, René-Marc, Foltz, Violaine, Froissart, Antoine, Galland, Joris, Gaud-Listrat, Véronique, Georgin-Lavialle, Sophie, Giraud-Morelet, Aude, Quitrec, Jeanine S Giraudet-Le, Goupille, Philippe, Govindaraju-Audouard, Sophie, Grados, Franck, Guillaume-Czitrom, Séverine, Hermet, Marion, Hittinger-Roux, Ambre, Hudry, Christophe, Kone-Paut, Isabelle, La Batide Alanore, Sylvain, Lafforgue, Pierre, Lahalle, Sophie, Lambrecht, Isabelle, Langlois, Vincent, Larbre, Jean-Paul, Ledoult, Emmanuel, Leroux, Christophe, Liote, Frédéric, Maria, Alexandre TJ, Marotte, Hubert, Mekinian, Arsène, Melki, Isabelle, Messer, Laurent, Michel, Catherine, and Morel, Gauthier

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Autoimmune Disease, Infectious Diseases, Coronaviruses, Arthritis, Emerging Infectious Diseases, Inflammatory and immune system, Cardiovascular, Good Health and Well Being, Aged, Antirheumatic Agents, COVID-19, Comorbidity, Female, Global Health, Glucocorticoids, Humans, Male, Middle Aged, Odds Ratio, Registries, Rheumatic Diseases, Rheumatology, SARS-CoV-2, antirheumatic agents, autoimmune diseases, epidemiology, glucocorticoids, outcome assessment, health care, COVID-19 Global Rheumatology Alliance, Immunology, Public Health and Health Services, Arthritis & Rheumatology, Clinical sciences
Abstract

ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.

Published
2021

5. 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

Author

Wendling, Daniel, Hecquet, Sophie, Fogel, Olivier, Letarouilly, Jean-Guillaume, Verhoeven, Frank, Pham, Thao, Prati, Clément, Molto, Anna, Goupille, Philippe, Dernis, Emmanuelle, Saraux, Alain, Ruyssen-Witrand, Adeline, Lukas, Cédric, Miceli-Richard, Corinne, Hudry, Christophe, Richette, Pascal, Breban, Maxime, Gossec, Laure, Dougados, Maxime, and Claudepierre, Pascal

Published
2022
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6. Actualisation 2022 des recommandations de la Société française de rhumatologie (SFR) pour la prise en charge en pratique courante des malades atteints de spondyloarthrite, incluant le rhumatisme psoriasique

Author

Wendling, Daniel, Hecquet, Sophie, Fogel, Olivier, Letarouilly, Jean-Guillaume, Verhoeven, Frank, Pham, Thao, Prati, Clément, Molto, Anna, Goupille, Philippe, Dernis, Emmanuelle, Saraux, Alain, Ruyssen-Witrand, Adeline, Lukas, Cédric, Miceli-Richard, Corinne, Hudry, Christophe, Richette, Pascal, Breban, Maxime, Gossec, Laure, Dougados, Maxime, and Claudepierre, Pascal

Published
2022
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7. COVID-19 outcomes in patients with inflammatory rheumatic and musculoskeletal diseases treated with rituximab: a cohort study

Author

Aeschlimann, Florence, Agard, Christian, Ait-Abdallah, Nassim, Albert, Jean-David, Alcais, Didier, Allain, Jean-Sébastien, Allanore, Yannick, Amador-Borreiro, Blanca, Amoura, Zahir, Andre, Emma, Arbault, Anaïs, Arlet, Jean-Benoît, Arnaud, Laurent, Arniaud, Denis, Arty-Hue, Herliette, Atlan, Lucie, Audemard-Verger, Alexandra, Audoin-Pajot, Christine, Audren, Victor, Bach-Bunner, Maxime, Bacquet-Deschryver, Hélène, Bader-Meunier, Brigitte, Balandraud, Nathalie, Balblanc, Jean-Charles, Bally, Stéphane, Banal, Frédéric, Barbery, Pierre, Barnetche, Thomas, Barrelet, Audre, Basch, André, Baumier, Vincent, Bayer, Guillaume, Bayle, Sophie, Beauvais, Catherine, Beinat, Rudie, Belin, Véronique, Belkhir, Rakiba, Benainous, Ruben, Belot, Alexandre, Benammar, Mohammed, Benhamou, Mathilde, Benhamou, Ygal, Benmansour, Ahmed, Bennet, Pascal, Bernoux-Manat, Brigitte, Berthet, Elise, Berthoux, Emilie, Bertolini, Ewa, Bigot, Adrien, Bisson-Vaivre, Aurélia, Blaison, Gilles, Bolla, Gilles, Bonidan, Olivier, Bonnet, Christine, Borie, Raphaël, Bossert, Marie, Boudou, Laurence, Bouhour, Françoise, Bouiller, Kévin, Bouldoires, Bastien, Boussoualim, Karima, Bouvard, Eric, Brondino, Regine, Buchlin, Pierre, Cabantous, Laurence, Cacoub, Patrice, Cadiou, Simon, Carteni, Maurizio, Carbasse, Aurélia, Castel, Brice, Cathebras, Pascal, Caumont, Hervé, Celant, Annalisa, Chaigne, Benjamin, Chaillous, Benoît, Champy, Romuald, Charcot, Agnès, Charles, Pierre, Charlot-Lambrecht, Isabelle, Charpin, Caroline, Chatelus, Emmanuel, Chaudier, Bernard, Chertok, Pascale, Chevalier, Xavier, Chevreau, Maxime, Chotard, Emilie, Chu Miow Lin, Delphine, Clavel, Gaëlle, Clavel-Osorio, Cyril, Cohen, Fleur, Cohen, Gregory, Colette-Cedoz, Marie-Eve, Collercandy, Nived, Colombey, Antoine, Comarmond, Chloé, Combe, Bernard, Comparon, Céline, Constant, Elodie, Coquerelle, Pascal, Corli, Justine, Corre, Clémence, Costedoat-Chalumeau, Nathalie, Couret, Marie, Courvoisier, Natacha, Coury-Lucas, Fabienne, Coutarel, Cécile, Coutier, Fabrice, Damade, Richard, Daver-Malaterre, Laurence, Dehimat, Sarahe, Delahousse, Michel, Barrois-Delattre, Emilie, Denarie, Delphine, Deprouw, Camille, Dernis, Emanuelle, Deroux, Alban, Desbarbieux, Renaud, Descamps, Elise, Deslandre, Chantal, Desmurs, Marie, Despaux, Jacques, Desplats, Marie, Detree, Frédérick, Devauchelle-Pensec, Valérie, Dhote, Robin, Dieude, Philippe, Dieudonne, Yannick, Diot, Elisabeth, Direz, Guillaume, Djeddi, Djamal-Dine, Douvier, Sarah, Drouet, Béatrice, Drumez, Elodie, Duc, Catherine, Ducornet, Angélique, Dufauret-Lombard, Carine, Duhamel, Alain, Dumaine, Cécile, Dumel, Anne-Elisabeth, Dumoulin-Richez, Chantal, Duquesne, Agnès, Durand, Géraldine, Durandin-Truffinet, Mariane, Duret, Pierre-Marie, Duval, Maïka, Ebbo, Mikaël, Ebstein, Esther, Economu-Dubosc, Andra, Emilie, Stéphanie, Euvrard, Romain, Evon, Philippe, Fabre, Sylvie, Fagedet, Dorothée, Farhat, Meryem, Fauconier, Marion, Fechtenbaum, Jacques, Felten, Renaud, Fernandes, Fanny, Ferreira-Maldent, Nicole, Feurer, Elodie, Fichet, Amandine, Flaisler, Françoise, Florens, Nans, Foltz, Violaine, Fontanges, Elisabeth, Foret, Jennifer, Fougerousse, Anne-Claire, Fouque-Aubert, Anne, Foutrier-Morello, Catherine, Francois-Pradier, Hélène, Frantzen, Léa, Fritz, Pierre, Froissart, Antoine, Fulpin, Jean, Fuzibet, Piera, Gaches, Francis, Gagneux-Lemoussu, Laurence, Penhoat-Gahier, Mélanie, Galland, Joris, Gandjbakhch, Frédérique, Garnier, Nicole, Garraud, Thomas, Garrot, Jean-François, Gastaldi, Romain, Gaud-Listrat, Véronique, Gauthier-Prieur, Maud, Georgescu, Dana, Gerard, Nathalie, Gervais, Elisabeth, Gibert, Christelle, Gibert, Eric, Gill, Ghislaine, Gillard, Jérôme, Gilson, Mélanie, Gimonnet, Pauline, Giraudet-Le Quintrec, Jeanine-Sophie, Giraud-Morelet, Aude, Glace, Baptiste, Glanowski, Camille, Godeau, Bertrand, Gombert, Bruno, Gonnet-Gracia, Camille, Goulenok, Tiphaine, Goupille, Philippe, Gourmelen, Olivier, Govindaraju-Audouard, Sophie, Grados, Franck, Grall-Lerosey, Martine, Grardel, Bruno, Grasland, Anne, Grateau, Gilles, Groza, Monica, Guillaud, Constance, Guillaume, Séverine, Guillibert, Caroline, Guillot, Xavier, Guilpain, Philippe, Gury, Aline, Guyot, Marie-Hélène, Hacquard-Bouder, Cécile, Havard, Marie-Noelle, Hellier, Jean-Pierre, Hennequin, Pascal, Henriot, Basile, Henry, Julien, Hentgen, Véronique, Hermet, Marion, Herasse, Muriel, Hernandez, Julie, Hie, Miguel, Hilliquin, Pascal, Hinschberger, Olivier, Hittinger-Roux, Ambre, Holubar, Jan, Hudry, Christophe, Huguenel, Serge, Jaccard, Clara, Jacquemier, Jean-Michel, Jamard, Bénédicte, Jan, Catherine, Jean, Sylvie, Jouvray, Mathieu, Juge, Pierre-Antoine, Juillard, Laurent, Jullien, Denis, Kabala, Anna, Kabchou, Abdelkrim, Karkowski, Ludovic, Karman, Françoise, Kemiche, Farid, Keraen, Jérémy, Kieffer, Pierre, Kone-Paut, Isabelle, Koreichi, Abdeldajallil, Kostine, Marie, La Batide Alanore, Sylvain, Lafforgue, Pierre, Lahalle, Sophie, Lambert, Marc, Lambrecht, Isabelle, Lanot, Sylvain, Lanteri, Aurélia, Larbre, Jean-Paul, Latourte, Augustin, Lavigne, Christian, Le Guen Guegan, Sophie, Le Guenno, Guillaume, Leguy, Diane, Lebrun, Agnès, Ledoult, Emmanuel, Legoupil, Nathalie, Legrand, Erick, Lejeune, Charlotte, Leloire, Olivier, Leroux, Christophe, Leroy, Rémi, Leroy-Gouix, Marie, Leturcq, Tifenn, Leurs, Amélie, Leveque-Michaud, Céline, Limbach, François-Xavier, Liote, Frédéric, Lohse, Anne, Lozac'h, Pierre, Lucas, Virginie, Madelon, Aurélie, Magy-Bertrand, Nadine, Mahevas, Matthieu, Maillard, Hélène, Maillet, Thibault, Malochet-Guinamand, Sandrine, Mangon, Quentin, Marchou-Lopez, Sylvie, Margarit, Nathalie, Marhadour, Thierry, Mariette, Xavier, Martin, Claire, Mathian, Alexis, Maurier, François, Maury, Frédéric, Mazet-Guillaume, Betty, Mazouyez, Arnaud, Mazyad, Hassan, Mehsen-Cetre, Nadia, Meinzer, Ulrich, Melki, Isabelle, Messer, Laurent, Miceli, Corinne, Michaud, Martin, Michel, Catherine, Michel, Matthias, Michon, Mathilde, Milesi-Lecat, Anne-Marie, Molto, Anna, Moly, Marie, Moranne, Olivier, Morel, Gautier, Morel, Hugo, Morel, Jacques, Morin, Franck, Moulinier, Laurence, Moulis, Guillaume, Moura, Bertrand, Nguyen, Minh, Nicolas-Vullierme, Sabine, Nielly, Hubert, Nocturne, Gaétane, Nottez, Aurore, Ollagnon, Henri-Olivier, Pacaud-Vitoux, Isabelle, Pagnier, Anne, Paris, Caroline, Parrot, Antoine, Pascart, Tristan, Pascaud-Mansour, Yasmina, Paulin, Lætitia, Pavy, Stephan, Perard, Laurent, Pers, Yves-Marie, Pha, Micheline, Pichon, Maud, Pierreisnard, Audrey, Pizana, Gabrielle, Poignant, Sylvaine, Poix, Elsa, Portier, Agnès, Poulet, Antoine, Plassard, Samira, Pugnet, Grégory, Puyraimond-Zemmour, Déborah, Quartier-Dit-Maire, Pierre, Quenet, Marion, Queyrel, Viviane, Raffray, Loïc, Remy, Philippe, Renard, Myriam, Rene, Jessica, Revuz, Sabine, Rey, Bénédicte, Richard-Colmant, Gaëlle, Riviere, Etienne, Riviere, Sébastien, Robin, Sophie, Rohmer, Julien, Roitg, Isabelle, Romier, Mélanie, Rolland, Michel, Roriz, Mélanie, Rosenberg, Carole, Rossi, Linda, Roth, Olivier, Rouidi, Sid-Ahmed, Roumier, Mathilde, Rousiere, Mickaël, Rousselin, Clémentine, Rouviere, Bénédicte, Roux, Christian, Roux, Fabienne, Roux, Marielle, Roux, Nicolas, Rouzaud, Diane, Rozenberg, Sylvie, Sacco, Isabelle, Sadji, Fatiha, Sailler, Laurent, Salliot, Carine, Salmon, Jean-Hugues, Saraux, Alain, Schmidt, Jean, Seguier, Julie, Sellam, Jérémie, Senbel, Eric, Sene, Thomas, Senet, Patricia, Seve, Pascal, Sicaud, Aurélie, Smets, Perrine, Sobanski, Vincent, Sordet, Christelle, Sornay-Rendu, Elisabeth, Souchaud-Debouverie, Odile, Sparsa, Lætitia, Spielmann, Lionel, Steib, Sarah, Stavris, Chloé, Straus, Catherine, Strotz, Victor, Szafors, Paulina, Taffignon-Clave, Séverine, Simoens, Justine, Theillac, Claire, Tenenbaum, Nora, Thomachot, Benoît, Tieulie, Nathalie, Tiriau, Soizic, Tison, Alice, Toussirot, Eric, Trefond, Ludovic, Trijau, Sophie, Trouillier, Sébastien, Trouvin, Anne-Priscille, Truchetet, Marie-Elise, Ulrich, Marc, Vaquier, Jacques, Veillard, Eric, Veillon, Laurent, Vial, Guillaume, Viallard, Jean-François, Victor, Judith, Vidon, Claire, Vidon, Mathias, Vigne, Camille, Virone, Alexandre, Warzocha, Ursula, Wendling, Daniel, Werle, Claude, Wibaux, Cécile, Willems, Alexandra, Wisniewski, Michel, Woessner, Juliette, Xerri-Campano, Bernadette, Avouac, Jérôme, Hachulla, Eric, Seror, Raphaèle, Georgin-Lavialle, Sophie, El Mahou, Soumaya, Pertuiset, Edouard, Pham, Thao, Marotte, Hubert, Servettaz, Amélie, Domont, Fanny, Chazerain, Pascal, Devaux, Mathilde, Claudepierre, Pascal, Langlois, Vincent, Mekinian, Arsène, Maria, Alexandre Thibault Jacques, Banneville, Béatrice, Fautrel, Bruno, Pouchot, Jacques, Thomas, Thierry, Flipo, René-Marc, and Richez, Christophe

Published
2021
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8. Critères d’évaluation à collecter pour optimiser la prise en charge de routine de la spondyloarthrite axiale : proposition fondée sur des preuves et une rencontre d’experts

Author

Baillet, Athan, Romand, Xavier, Pflimlin, Arnaud, Dalecky, Mickael, Claudepierre, Pascal, Flipo, René-Marc, Ruyssen-Witrand, Adeline, Gaudin, Philippe, Gossec, Laure, Molto, Anna, Lukas, Cédric, Pouplin, Sophie, Soubrier, Martin, Wendling, Daniel, Fayet, Françoise, Hudry, Christophe, Senbel, Eric, Schwartz, Marjorie, Hacquard-Bouder, Cécile, and Dougados, Maxime

Published
2021
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9. Data to be collected for an optimal management of axial spondyloarthritis in daily practice: Proposal from evidence-based and consensual approaches

Author

Baillet, Athan, Romand, Xavier, Pflimlin, Arnaud, Dalecky, Mickael, Claudepierrec, Pascal, Flipo, René-Marc, Ruyssen-Witrand, Adeline, Gaudin, Philippe, Gossec, Laure, Molto, Anna, Lukas, Cédric, Pouplin, Sophie, Soubrier, Martin, Wendling, Daniel, Fayet, Françoise, Hudry, Christophe, Senbel, Eric, Schwartz, Marjorie, Hacquard-Bouder, Cécile, and Dougados, Maxime

Published
2020
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16. Collecte et prise en charge de certaines comorbidités et facteurs de risque associés dans le cadre des rhumatismes inflammatoires chroniques dans la pratique quotidienne en France

Author

Gossec, Laure, Baillet, Athan, Dadoun, Sabrina, Daien, Claire, Berenbaum, Francis, Dernis, Emmanuelle, Fayet, Françoise, Hudry, Christophe, Mezieres, Maryse, Pouplin, Sophie, Richez, Christophe, Saraux, Alain, Savel, Carine, Senbel, Eric, Soubrier, Martin, Sparsa, Laëtitia, Wendling, Daniel, and Dougados, Maxime

Published
2017
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19. Collection and management of selected comorbidities and their risk factors in chronic inflammatory rheumatic diseases in daily practice in France

Author

Gossec, Laure, Baillet, Athan, Dadoun, Sabrina, Daien, Claire, Berenbaum, Francis, Dernis, Emmanuelle, Fayet, Françoise, Hudry, Christophe, Mezieres, Maryse, Pouplin, Sophie, Richez, Christophe, Saraux, Alain, Savel, Carine, Senbel, Eric, Soubrier, Martin, Sparsa, Laëtitia, Wendling, Daniel, and Dougados, Maxime

Published
2016
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24. Erratum to “2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis” [Joint Bone Spine 2022;89:105344]

Author

Wendling, Daniel, Hecquet, Sophie, Fogel, Olivier, Letarouilly, Jean-Guillaume, Verhoeven, Frank, Pham, Thao, Prati, Clément, Molto, Anna, Goupille, Philippe, Dernis, Emmanuelle, Saraux, Alain, Ruyssen-Witrand, Adeline, Lukas, Cédric, Miceli-Richard, Corinne, Hudry, Christophe, Richette, Pascal, Breban, Maxime, Gossec, Laure, Dougados, Maxime, and Claudepierre, Pascal

Published
2022
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25. Development and psychometric validation of a patient-reported outcome measure to assess fears in rheumatoid arthritis and axial spondyloarthritis: the Fear Assessment in Inflammatory Rheumatic diseases (FAIR) questionnaire

Author

Gossec, Laure, Chauvin, Pierre, Saraux, Alain, Hudry, Christophe, Cukierman, Gabrielle, de Chalus, Thibault, Dreuillet, Caroline, Saulot, Vincent, Tong, Sabine, Russo-Marie, Françoise, Joubert, Jean-Michel, and Berenbaum, Francis

Published
2018
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34. Exploring remission concept in axial spondyloarthritis through the perception of rheumatologists using vignettes and priority ratings.

Author

Aouad, Krystel, Wendling, Daniel, Breban, Maxime, Dadoun, Sabrina, Hudry, Christophe, Moltó, Anna, Pertuiset, Edouard, and Gossec, Laure

Subjects
C-reactive protein, PAIN measurement, CROSS-sectional method, NONSTEROIDAL anti-inflammatory agents, ANKYLOSIS, PHYSICIANS' attitudes, SPONDYLOARTHROPATHIES, RHEUMATOLOGISTS, CASE studies, DESCRIPTIVE statistics, FATIGUE (Physiology), DISEASE remission, SYMPTOMS
Abstract

Objectives The optimal treatment target in axial spondyloarthritis (axSpA) is remission; however, a consensual definition of remission is lacking. Our objective was to explore rheumatologists' perception of remission using vignette cases and a priority exercise. Methods A cross-sectional survey of rheumatologists' perceptions of remission in axSpA was performed in 2020 using (i) 36 vignette cases, with a single clinical picture and three varying parameters [axial pain (ranging from 2 to 5 on a 0–10 scale)], fatigue (2–8), and morning stiffness (<15 min, 30 min or 1 h), assessed as remission yes/no; and (ii) prioritization of elements to consider for remission from a list of 12 items: BASDAI, ASDAS, elements of BASDAI and ASDAS including CRP, NSAID use, extra-articular manifestations (EAMs), and other explanations of symptoms, e.g. fibromyalgia. Analyses were descriptive. Results Overall, 200 French rheumatologists participated in 2400 vignette evaluations. Of these, 463 (19%) were classified as remission. The six vignette cases representing 56% of all remission cases had <15 min duration of morning stiffness and axial pain ≤3/10, regardless of fatigue levels. Prioritized items for remission were: morning stiffness (75%), EAMs (75%), NSAID use (71%), axial pain (68%) and CRP (66%). Conclusions When conceptualizing remission in axSpA, rheumatologists took into account morning stiffness and axial pain as expected; the link between remission and fatigue was much weaker. Furthermore, rheumatologists also included EAMs and NSAID use in the concept of remission. Consensus is needed for definition of remission in axSpA. [ABSTRACT FROM AUTHOR]

Published
2022
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35. Maintenance of infliximab treatment in ankylosing spondylitis: Results of a one-year randomized controlled trial comparing systematic versus on-demand treatment

Author

Breban, Maxime, Ravaud, Philippe, Claudepierre, Pascal, Baron, Gabriel, Henry, Yves-Dominique, Hudry, Christophe, Euller-Ziegler, Liana, Pham, Thao, Solau-Gervais, Elisabeth, Chary-Valckenaere, Isabelle, Marcelli, Christian, Perdriger, Aleth, Le Loët, Xavier, Wendling, Daniel, Fautrel, Bruno, Fournié, Bernard, Combe, Bernard, Gaudin, Philippe, Jousse, Sandrine, Mariette, Xavier, Baleydier, Alain, Trape, Gérard, and Dougados, Maxime

Published
2008

37. MTX optimization or adding bDMARD equally improve disease activity in rheumatoid arthritis: results from the prospective study STRATEGE.

Author

Gaujoux-Viala, Cécile, Hudry, Christophe, Zinovieva, Elena, Herman-Demars, Hélène, and Flipo, René-Marc

Subjects
*RESEARCH, *PATIENT aftercare, *BIOLOGICAL products, *SCIENTIFIC observation, *ORAL drug administration, *FUNCTIONAL status, *MEDICAL cooperation, *METHOTREXATE, *ANTIRHEUMATIC agents, *TREATMENT effectiveness, *RHEUMATOID arthritis, *DISEASE susceptibility, *DESCRIPTIVE statistics, *SYMPTOMS, *DRUG side effects, *LONGITUDINAL method, *PROBABILITY theory
Abstract

Objectives The STRATEGE (Therapeutic Strategy in Patients Treated With Methotrexate for Rheumatoid Arthritis) study aimed to describe treatment strategies in current practice in RA biologic DMARD (bDMARD)-naïve patients with an inadequate response to MTX therapy, and to compare clinical efficacy of the different therapeutic strategies on disease activity after 6 months. Methods The main inclusion criteria of this prospective, observational, multicentre study were confirmed RA diagnosis, treatment by MTX monotherapy and need for therapeutic management modification. Results The 722 patients included had a mean (s. d.) RA duration of 5.3 (6.7) years, a mean DAS28 of 4.0 (1.1); they were all receiving MTX monotherapy, 68% oral, at a mean dose of 15.0 (4.1) mg/week. Two major strategies were identified: (i) MTX monotherapy dose and/or route optimization (72%) and (ii) bDMARD initiation ± MTX (16%). MTX dosing was modified for 70% of patients, maintained (dose and route) for 28% of patients and interrupted for 2%. bDMARDs were started when the MTX mean dose was 17.4 mg/week, 56% parenterally; MTX was maintained concomitantly for 96% of patients. Six-month follow-up results adjusted by propensity score showed that both options were equally successful in improving disease activity and physical function, with 63 and 68% of good-to-moderate EULAR responses, respectively. Conclusion The STRATEGE study shows the importance of initial MTX treatment optimization before initiation of a biological treatment and emphasizes the importance of treat-to-target strategy. Trial registration ClinicalTrials.gov NCT02288520. [ABSTRACT FROM AUTHOR]

Published
2022
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39. Impact of persistence with tumour necrosis factor inhibitors on healthcare resource utilization and costs in chronic inflammatory joint diseases.

Author

Belhassen, Manon, Tubach, Florence, Hudry, Christophe, Woronoff‐Lemsi, Macha, Levy‐Bachelot, Laurie, Van Ganse, Eric, and Fautrel, Bruno

Subjects
JOINT diseases, TUMOR necrosis factors, MAGNETIC resonance imaging, ANKYLOSING spondylitis, PROPENSITY score matching, PSORIATIC arthritis
Abstract

Aim: To assess persistence with subcutaneous (SC) tumour necrosis factor (TNF) inhibitors as well as the impact of persistence on healthcare resource utilization (HCRU) and costs in patients with chronic inflammatory joint diseases. Methods: In this cohort study using population‐based French claims data (from 2011 to 2014), we measured persistence with SC TNF inhibitors within 12 months (M0‐12) following treatment initiation in treatment‐naïve and treatment‐experienced users (divided into three cohorts: rheumatoid arthritis [RA], ankylosing spondylitis [AS] and psoriatic arthritis [PsA]). Persistent patients were propensity score matched to nonpersistent patients at M12. The impact of persistence status on HCRU and costs was assessed during M12‐24. Results: Of treatment‐naïve (n = 3,804) and treatment‐experienced (n = 2,279) users, only 56.1% and 46.8% were persistent at M12, respectively. Nonpersistent patients had more outpatient visits, computerized tomography scans, spine or joint magnetic resonance imaging procedures and disease‐related hospitalizations, while persistent patients had more rheumatologist visits. Nonpersistent patients had lower drug costs but higher nondrug‐related healthcare and hospitalization costs than persistent patients. In AS and PsA, overall healthcare costs were similar in persistent and nonpersistent patients. In RA, overall healthcare costs were lower in persistent patients (15,753€ vs 17,590€ in treatment‐naïve and 17,622€ vs 21,177€ in treatment‐experienced). Conclusion: Persistence with SC TNF inhibitors within first 12 months following treatment initiation was low in both treatment‐naïve and treatment‐experienced patients. Differences were observed in distribution of costs between persistent and nonpersistent patients, showing that nonpersistence with SC TNF inhibitors can lead to increased HCRU and higher costs. [ABSTRACT FROM AUTHOR]

Published
2021
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40. Detection of Flares by Decrease in Physical Activity, Collected Using Wearable Activity Trackers in Rheumatoid Arthritis or Axial Spondyloarthritis: An Application of Machine Learning Analyses in Rheumatology.

Author

Gossec, Laure, Guyard, Frédéric, Leroy, Didier, Lafargue, Thomas, Seiler, Michel, Jacquemin, Charlotte, Molto, Anna, Sellam, Jérémie, Foltz, Violaine, Gandjbakhch, Frédérique, Hudry, Christophe, Mitrovic, Stéphane, Fautrel, Bruno, and Servy, Hervé

Subjects
RHEUMATOID arthritis diagnosis, PILOT projects, RESEARCH, RHEUMATOLOGY, RESEARCH methodology, EVALUATION research, MEDICAL cooperation, SPONDYLOARTHROPATHIES, COMPARATIVE studies, EXERCISE, RHEUMATOID arthritis, RESEARCH funding, LONGITUDINAL method
Abstract

Objective: Flares in rheumatoid arthritis (RA) and axial spondyloarthritis (SpA) may influence physical activity. The aim of this study was to assess longitudinally the association between patient-reported flares and activity-tracker-provided steps per minute, using machine learning.Methods: This prospective observational study (ActConnect) included patients with definite RA or axial SpA. For a 3-month time period, physical activity was assessed continuously by number of steps/minute, using a consumer grade activity tracker, and flares were self-assessed weekly. Machine-learning techniques were applied to the data set. After intrapatient normalization of the physical activity data, multiclass Bayesian methods were used to calculate sensitivities, specificities, and predictive values of the machine-generated models of physical activity in order to predict patient-reported flares.Results: Overall, 155 patients (1,339 weekly flare assessments and 224,952 hours of physical activity assessments) were analyzed. The mean ± SD age for patients with RA (n = 82) was 48.9 ± 12.6 years and was 41.2 ± 10.3 years for those with axial SpA (n = 73). The mean ± SD disease duration was 10.5 ± 8.8 years for patients with RA and 10.8 ± 9.1 years for those with axial SpA. Fourteen patients with RA (17.1%) and 41 patients with axial SpA (56.2%) were male. Disease was well-controlled (Disease Activity Score in 28 joints mean ± SD 2.2 ± 1.2; Bath Ankylosing Spondylitis Disease Activity Index score mean ± SD 3.1 ± 2.0), but flares were frequent (22.7% of all weekly assessments). The model generated by machine learning performed well against patient-reported flares (mean sensitivity 96% [95% confidence interval (95% CI) 94-97%], mean specificity 97% [95% CI 96-97%], mean positive predictive value 91% [95% CI 88-96%], and negative predictive value 99% [95% CI 98-100%]). Sensitivity analyses were confirmatory.Conclusion: Although these pilot findings will have to be confirmed, the correct detection of flares by machine-learning processing of activity tracker data provides a framework for future studies of remote-control monitoring of disease activity, with great precision and minimal patient burden. [ABSTRACT FROM AUTHOR]

Published
2019
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44. Relationship between optimism and quality of life in patients with two chronic rheumatic diseases: axial spondyloarthritis and chronic low back pain: a cross sectional study of 288 patients.

Author

Kreis, Sarah, Molto, Anna, Bailly, Florian, Dadoun, Sabrina, Fabre, Stéphanie, Rein, Christopher, Hudry, Christophe, Zenasni, Franck, Rozenberg, Sylvie, Pertuiset, Edouard, Fautrel, Bruno, and Gossec, Laure

Subjects
QUALITY of life, LUMBAR pain, OPTIMISM, PERSONALITY, CHRONIC pain
Abstract

Background: Axial Spondyloarthritis (AxSpA) and chronic low back pain are rheumatic diseases that impact patients' health-related quality of life (HRQoL). In other chronic conditions, HRQoL was positively associated with dispositional optimism, a personality trait. The objective was to explore the relationship between optimism and HRQoL in these two diseases. Method: A cross-sectional study was performed in 2 tertiary care hospitals and 2 private practices in France. Patients had definite AxSpA or chronic low back pain according to the rheumatologist. A generic HRQoL questionnaire (Short Form, SF-12) with physical and mental composite scores (PCS and MCS respectively) and an optimism questionnaire (the Life Orientation Test-revised, LOT-R) were collected. Analyses included non-parametric correlations and multiple regression analyses to study the effect of optimism on PCS and MCS. Results: In all, 288 (199 AxSpA and 89 low back pain) patients were included: mean age, 47.3 ± 11.9 years, 48.6 % were males. Pain levels (0-10) were 4.5 ± 2.4 and 4.3 ± 2.4 in AxSpA and LOW BACK PAIN patients, respectively. HRQoL was similarly altered in both diseases, for both physical and mental composite scores (mean PCS: 43.7 ± 8.2 vs. 41.9 ± 7.1; mean MCS: 45.9 ± 7.8 vs. 46.7 ± 8.1 for AxSpA and low back pain respectively). Optimism was moderate and similar in both populations. Optimism was positively correlated to MCS in both diseases (rho = 0.54 and 0.58, respectively, both p <0.01) and these relations persisted in multivariate analyses (beta = 1.03 and 1.40, both p <0.0001). Conclusions: Optimism was similar in these 2 chronic diseases and was an explanatory factor of the mental component of HRQoL, but not physical HRQoL. Physical HRQoL may reflect more the disease process than character traits. [ABSTRACT FROM AUTHOR]

Published
2015
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45. Outcome of Hepatitis E Virus Infection in Patients With Inflammatory Arthritides Treated With Immunosuppressants.

Author

Bauer, Hélène, Luxembourger, Cécile, Gottenberg, Jacques-Eric, Fournier, Sophie, Abravanel, Florence, Cantagrel, Alain, Chatelus, Emmanuel, Claudepierre, Pascal, Hudry, Christophe, Izopet, Jacques, Fabre, Sylvie, Lefevre, Guillaume, Marguerie, Laurent, Martin, Antoine, Messer, Laurent, Molto, Anna, Pallot-Prades, Béatrice, Pers, Yves-Marie, Roque-Afonso, Anne-Marie, and Roux, Christian

Published
2015
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46. Fears and Beliefs in Rheumatoid Arthritis and Spondyloarthritis: A Qualitative Study.

Author

Berenbaum, Francis, Chauvin, Pierre, Hudry, Christophe, Mathoret-Philibert, Florence, Poussiere, Maud, De Chalus, Thibault, Dreuillet, Caroline, Russo-Marie, Françoise, Joubert, Jean-Michel, and Saraux, Alain

Subjects
RHEUMATOID arthritis, RHEUMATOID arthritis treatment, SPONDYLOARTHROPATHIES, DISEASE susceptibility, QUALITATIVE research, PATIENTS
Abstract

Objectives: To explore beliefs and apprehensions about disease and its treatment in patients with rheumatoid arthritis and spondyloarthritis. Methods: 25 patients with rheumatoid arthritis and 25 with spondyloarthritis participated in semi-structured interviews about their disease and its treatment. The interviews were performed by trained interviewers in participants' homes. The interviews were recorded and the main themes identified by content analysis. Results: Patients differentiated between the underlying cause of the disease, which was most frequently identified as a hereditary or individual predisposition. In patients with rheumatoid arthritis, the most frequently cited triggering factor for disease onset was a psychological factor or life-event, whereas patients with spondyloarthritis tended to focus more on an intrinsic vulnerability to disease. Stress and overexertion were considered important triggering factors for exacerbations, and relaxation techniques were frequently cited strategies to manage exacerbations. The unpredictability of the disease course was a common source of anxiety. Beliefs about the disease and apprehensions about the future tended to evolve over the course of the disease, as did treatment expectations. Conclusions: Patients with rheumatoid arthritis and spondyloarthritis hold a core set of beliefs and apprehensions that reflect their level of information about their disease and are not necessarily appropriate. The physician can initiate discussion of these beliefs in order to dispel misconceptions, align treatment expectations, provide reassurance to the patient and readjust disease management. Such a dialogue would help improve standards of care in these chronic and incapacitating diseases. [ABSTRACT FROM AUTHOR]

Published
2014
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47. Factors influencing concordance between clinical and ultrasound findings in rheumatoid arthritis.

Author

Le Boedec, Marion, Jousse-Joulin, Sandrine, Ferlet, Jean-François, Marhadour, Thierry, Chales, Gérard, Grange, Laurent, Hacquard-Bouder, Cécile, Loeuille, Damien, Sellam, Jérémie, Albert, Jean-David, Bentin, Jacques, Chary-Valckenaere, Isabelle, D'Agostino, Maria-Antonietta, Etchepare, Fabien, Gaudin, Philippe, Hudry, Christophe, Dougados, Maxime, and Saraux, Alain

Published
2013
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48. Adherence to and patient's knowledge of self-management of subcutaneous biologic therapy in chronic inflammatory rheumatic diseases: results of a multicentre cross-sectional study.

Author

Gaud-Listrat V, Lopez-Medina C, Hudry C, Nguyen M, Lebrun-Foisnet A, Sacchi A, Labatide Alanore S, Dernis E, Le Devic P, Fechtenbaum J, Richard-Miceli C, Le Goux P, Dadoun S, Moltό A, Blanchais-Behr A, Neveu S, Benhamou M, Giraud B, Roux C, and Dougados M

Subjects
Biological Therapy adverse effects, Chronic Disease, Cross-Sectional Studies, Humans, Medication Adherence, Antirheumatic Agents adverse effects, Arthritis, Rheumatoid drug therapy, Rheumatology, Self-Management
Abstract

Objectives: Non-adherence to biologic therapy is an issue in chronic inflammatory rheumatic diseases (CIRDs) and might be related to poor patient knowledge of the risk of these therapies. Our aim here was to evaluate the level of patient adherence to and knowledge of self-care safety skills for biologic therapy., Methods: This was a multicentre, cross-sectional study in which out-patients visited an office- or hospital-based rheumatologist. All the patients received subcutaneous biologic therapy for CIRDs. We collected data on: 1. the level of CIRD patient adherence to current subcutaneous biologic therapy using both the self-administered Compliance Questionnaire Rheumatology 5 items (CQR5) and a simple adherence question; 2. patients' knowledge of self-management of biologic therapy by the self-administered BIOSECURE questionnaire; 3. sources of information related to biologic therapy., Results: In all, 285 patients (rheumatoid arthritis, n=103; spondyloarthritis, n=153; psoriatic arthritis, n=25) were enrolled by 19 rheumatologists. The mean (SD) biologic therapy duration was 5.9 (4.9) years. Adherence to the current biologic therapy was high (79.3% and 57.5% according to the CQR5 questionnaire and the adherence question, respectively). Level of knowledge of self-care safety skills (median BIOSECURE score 71) was in the acceptable range. Level of adherence and level of knowledge of self-care safety skills for biologic therapy were not associated. Patients declared that the main sources of information were their rheumatologist (92.6%) and the rheumatology team (30.5%)., Conclusions: According to the patients' estimation, adherence to biologic therapy and the level of knowledge of self-care safety skills related to biologic therapy are acceptable, and these domains are not related (e.g. level of adherence and level of knowledge of risks).

Published
2022
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49. Reproducibility of joint swelling assessment by sonography in patients with long-lasting rheumatoid arthritis (SEA-Repro study part II).

Author

Jousse-Joulin S, d'Agostino MA, Marhadour T, Albert JD, Bentin J, Chary Valckenaere I, Etchepare F, Gaudin P, Hudry C, Chalès G, Grange L, Hacquard C, Loeuille D, Sellam J, Dougados M, and Saraux A

Subjects
Aged, Arthritis, Rheumatoid complications, Female, Humans, Male, Middle Aged, Reference Standards, Reproducibility of Results, Severity of Illness Index, Synovitis complications, Ultrasonography, Doppler, Arthritis, Rheumatoid diagnostic imaging, Joints diagnostic imaging, Synovitis diagnostic imaging
Abstract

Objective: To evaluate the intraobserver and interobserver reproducibility of B-mode and power Doppler (PD) sonography in patients with active long-standing rheumatoid arthritis (RA) comparatively with clinical data., Methods: In each of 7 patients being considered for a change in their RA treatment regimen, 7 healthcare professionals examined the 28 joints used in the Disease Activity Score 28-joint count (DAS28). Then 7 sonographers examined each of the 7 patients twice, using previously published B-mode and PD grading systems. The clinical reference standard was presence of synovitis according to at least 4/7 examiners. The sonographic reference standard was at least grade 1 (ALG1) or 2 (ALG2) synovitis according to at least 4/7 sonographers. Interobserver reproducibility of sonography was assessed versus the sonographer having the best intraobserver reproducibility. Agreement was measured by Cohen's kappa statistic., Results: Intraobserver and interobserver reproducibility of B-mode and PD used separately was fair to good. Agreement between clinicians and sonographers at all sites using B-mode, PD, and both was 0.46, 0.37, and 0.36, respectively, for grade 1 synovitis; and 0.58, 0.19, and 0.19 for grade 2 synovitis. The number of joints with synovitis was smaller by physical examination (36.7%) than by B-mode with ALG1 (58.6%; p < 0.001). The number of joints with synovitis was higher by physical examination than by PD with both ALG1 (17.8%; p < 0.0001) and ALG2 (6.6%; p < 0.0001)., Conclusion: PD findings explain most of the difference between clinical and sonographic joint assessments for synovitis in patients with long-standing RA.

Published
2010
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50. Reproducibility of joint swelling assessments in long-lasting rheumatoid arthritis: influence on Disease Activity Score-28 values (SEA-Repro study part I).

Author

Marhadour T, Jousse-Joulin S, Chalès G, Grange L, Hacquard C, Loeuille D, Sellam J, Albert JD, Bentin J, Chary Valckenaere I, d'Agostino MA, Etchepare F, Gaudin P, Hudry C, Dougados M, and Saraux A

Subjects
Aged, Arthritis, Rheumatoid complications, Arthritis, Rheumatoid physiopathology, Female, Humans, Joints physiopathology, Male, Middle Aged, Reference Standards, Reproducibility of Results, Severity of Illness Index, Synovitis complications, Synovitis physiopathology, Ultrasonography, Arthritis, Rheumatoid diagnostic imaging, Joints diagnostic imaging, Synovitis diagnostic imaging
Abstract

Objectives: To evaluate the reproducibility of clinical synovitis assessments in rheumatoid arthritis and the effect of variability on the Disease Activity Score-28 (DAS28)., Methods: Seven healthcare professionals from different cities examined the same patients with active non-early rheumatoid arthritis (RA; duration > 4 yrs), for whom a treatment change was being considered. There was no training session and the examination was to be performed as quickly as possible. The healthcare professionals assessed the 28 joints of the DAS28 in 7 patients (196 joints), then reexamined the same 28 joints in 4 of these 7 patients (112 joints), who had been rendered unrecognizable. Then 7 sonographers examined each of the 7 patients twice, using B-mode and power Doppler ultrasound (PD). The reference standards were presence of synovitis according to at least 50% of clinical examiners and 50% of sonographers. Agreement was assessed by Cohen's kappa statistic., Results: Intraobserver reliability ranged from 0.31 (least experienced research technician) to 0.77 (most experienced physician). Interobserver reliability ranged from 0.18 to 0.62. The largest difference between the lowest and the highest swollen joint counts in the same patient was 15, and the greatest variation in the DAS28 score was 0.92. Agreement between clinical and sonographic reference standards was 0.46, 0.37, and 0.36 for B-mode, PD, and both, respectively., Conclusion: Clinical inter- and intraobserver reliability is highly dependent on the examiner. Consequences on the DAS28 score can be substantial. Agreement with sonography is poor when both B-mode and PD are used but seems better, although low, when B-mode is used alone.

Published
2010
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