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1. Strategies for the assessment of competences during rheumatology training across Europe: results of a qualitative study

Author

Sofia Ramiro, Francisca Sivera, Brigitte Michelsen, Kim Lauper, Maddalena Larosa, Alexandre Sepriano, Ladislav Šenolt, Alessia Alunno, Paul Studenic, Ana Maria Gherghe, Catherine Haines, Russka Shumnalieva, Aurélie Najm, Cecilia Mercieca, Peter Korsten, Ledio Collaku, Samir Mehmedagić, Ivan Pajen, Tue Kragstrup, Liis Puis, Laura Kuusalo, Claire Daien, Mangel Zsolt, Richard Conway, Mira Merashli, Julija Zepa, Snezana M. Perchinkova, Victoria Sadovici-Bobeica, Marloes von Onna, Olga Brzezińska, Anton Povzun, Ivan Jeremic, Ulrika Ursinyova, Blaž Burja, Diego Benavent, Aikaterina Chatzidionysiou, Yesim Ozguler, Yuzaiful Yusof, Olena Zimba, Lauper, Kim, Institute of Infection, Immunity and Inflammation [Glasgow, UK], University of Glasgow, Università degli Studi di Perugia (UNIPG), Universidad Miguel Hernández [Elche] (UMH), Leiden University Medical Center (LUMC), and King‘s College London

Subjects
Male, Online discussion, Gout, Epidemiology, lcsh:Medicine, Autoimmunity, 0302 clinical medicine, Sjøgren’s syndrome, Immunology and Allergy, Medicine, 030212 general & internal medicine, MESH: Qualitative Research, Qualitative Research, media_common, ddc:616, Teamwork, Synovitis, Health services research, Focus Groups, Europe, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Sjogren's syndrome, Outcomes research, MESH: Educational Measurement, Female, MESH: Clinical Competence, Clinical Competence, Ankylosing spondylitis, medicine.medical_specialty, media_common.quotation_subject, [SHS.EDU]Humanities and Social Sciences/Education, Immunology, education, Chondrocalcinosis, Early rheumatoid arthritis, Education, Formative assessment, 03 medical and health sciences, Rheumatology, MESH: Rheumatology, Spondyloarthritis, Tcells, Rheumatoid arthritis, Synovial fluid, Treatment, Humans, Quality (business), Sjøgren's syndrome, 030203 arthritis & rheumatology, Medical education, MESH: Humans, business.industry, lcsh:R, Focus group, MESH: Male, MESH: Focus Groups, MESH: Europe, Educational Measurement, business, MESH: Female, Qualitative research
Abstract

ObjectivesTo gain insight into current methods and practices for the assessment of competences during rheumatology training, and to explore the underlying priorities and rationales for competence assessment.MethodsWe used a qualitative approach through online focus groups (FGs) of rheumatology trainers and trainees, separately. The study included five countries—Denmark, the Netherlands, Slovenia, Spain and the United Kingdom. A summary of current practices of assessment of competences was developed, modified and validated by the FGs based on an independent response to a questionnaire. A prioritising method (9 Diamond technique) was then used to identify and justify key assessment priorities.ResultsOverall, 26 participants (12 trainers, 14 trainees) participated in nine online FGs (2 per country, Slovenia 1 joint), totalling 12 hours of online discussion. Strong nationally (the Netherlands, UK) or institutionally (Spain, Slovenia, Denmark) standardised approaches were described. Most groups identified providing frequent formative feedback to trainees for developmental purposes as the highest priority. Most discussions identified a need for improvement, particularly in developing streamlined approaches to portfolios that remain close to clinical practice, protecting time for quality observation and feedback, and adopting systematic approaches to incorporating teamwork and professionalism into assessment systems.ConclusionThis paper presents a clearer picture of the current practice on the assessment of competences in rheumatology in five European countries and the underlying rationale of trainers’ and trainees’ priorities. This work will inform EULAR Points-to-Consider for the assessment of competences in rheumatology training across Europe.

Published
2020
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2. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2

Author

Massimo Galli, Dieter Wiek, Pedro Machado, Annamaria Iagnocco, Iain B. McInnes, Tanja Stamm, Hans W J Bijlsma, Gerd R Burmester, Bernard Combe, Hendrik Schulze-Koops, Peter J. M. Openshaw, Laure Gossec, Josef S Smolen, Ulf Mueller-Ladner, Féline P B Kroon, Loreto Carmona, Xavier Mariette, John D. Isaacs, Robert Landewé, Clinical Immunology and Rheumatology, AII - Inflammatory diseases, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Zuyderland MC, University College of London [London] (UCL), Leiden University Medical Center (LUMC), Utrecht Brain Center [UMC], University Medical Center [Utrecht], Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Instituto de Salud Musculoesqueletica (InMusc), Hôpital Lapeyronie [Montpellier] (CHU), Università degli Studi di Milano = University of Milan (UNIMI), Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Università degli studi di Torino = University of Turin (UNITO), Newcastle Upon Tyne Hospitals NHS Foundation Trust, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Immunologie des maladies virales, auto-immunes, hématologiques et bactériennes (IMVA-HB), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Immunologie des Maladies Virales et Autoimmunes (IMVA - U1184), Université Paris-Sud - Paris 11 (UP11)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Institut National de la Santé et de la Recherche Médicale (INSERM), University of Glasgow, Kerckhoff-Klinik, National Heart and Lung Institute [London] (NHLI), Imperial College London-Royal Brompton and Harefield NHS Foundation Trust, Medizinische Universität Wien = Medical University of Vienna, Deutsche Rheuma-Liga Bundesverband e.V, Ludwig Maximilian University [Munich] (LMU), Salvy-Córdoba, Nathalie, and Universiteit Leiden

Subjects
antirheumatic agents, MESH: Coronavirus Infections, Quality indicators, Disease, MESH: Rheumatic Diseases, 0302 clinical medicine, Epidemiology, MESH: Musculoskeletal Diseases, Medicine, Immunology and Allergy, MESH: COVID-19, 030212 general & internal medicine, skin and connective tissue diseases, Potential impact, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Health services research, epidemiology, health services research, patient care team, quality indicators, health care, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Betacoronavirus, MESH: Immunosuppressive Agents, medicine.medical_specialty, MESH: Pandemics, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Immunology, MESH: Societies, Medical, Context (language use), General Biochemistry, Genetics and Molecular Biology, 03 medical and health sciences, Rheumatology, MESH: Rheumatology, MESH: SARS-CoV-2, MESH: Clinical Laboratory Techniques, 030203 arthritis & rheumatology, MESH: Humans, business.industry, Health care, MESH: COVID-19 Testing, Living document, MESH: Pneumonia, Viral, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Family medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, business, MESH: Glucocorticoids
Abstract

International audience; The provisional EULAR recommendations address several aspects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus, and the disease caused by SARS-CoV-2, COVID-19 and are meant for patients with rheumatic and musculoskeletal diseases (RMD) and their caregivers. A task force of 20 members was convened by EULAR that met several times by videoconferencing in April 2020. The task force finally agreed on five overarching principles and 13 recommendations covering four generic themes: (1) General measures and prevention of SARS-CoV-2 infection. (2) The management of RMD when local measures of social distancing are in effect. (3) The management of COVID-19 in the context of RMD. (4) The prevention of infections other than SARS-CoV-2. EULAR considers this set of recommendations as a ‘living document’ and a starting point, which will be updated as soon as promising new developments with potential impact on the care of patients with RMD become available.

Published
2020
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3. Does methotrexate improve TNF inhibitor drug survival in elderly patients with RA?

Author

Martin Soubrier, Clément Lahaye, Unité de Nutrition Humaine (UNH), Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), CHU Clermont-Ferrand, Service de Rhumatologie [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], and CHU Clermont-Ferrand-CHU Clermont-Ferrand

Subjects
musculoskeletal diseases, Oncology, medicine.medical_specialty, MESH: Antirheumatic Agents, MESH: Biological Products, medicine.medical_treatment, Population, MEDLINE, Arthritis, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Internal medicine, MESH: Rheumatology, medicine, skin and connective tissue diseases, education, 030304 developmental biology, 030203 arthritis & rheumatology, MESH: Aged, 0303 health sciences, education.field_of_study, MESH: Arthritis, Rheumatoid, MESH: Humans, business.industry, medicine.disease, 3. Good health, TNF inhibitor, Drug survival, MESH: Methotrexate, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatoid arthritis, Methotrexate, business, medicine.drug
Abstract

Methotrexate is commonly used in combination with biologic DMARDs in the treatment of rheumatoid arthritis on the basis that the combined therapy has synergistic benefits. New data challenge this concept in the treatment of older adults and highlight the uncertainty of the mode of action of methotrexate in this population.

Published
2020
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4. Chronic Hepatitis E in Rheumatology and Internal Medicine Patients

Author

Alain Cantagrel, Christoph Höner zu Siederdissen, Sven Pischke, Marc Lütgehetmann, Ansgar W. Lohse, Jean-Marie Peron, Heiner Wedemeyer, Christoph Iking-Konert, Vincent Mallet, Robert Thimme, Robert A. de Man, Dominik Bettinger, Johann von Felden, Moritz von Wulffen, Sophie Fournier, Gabriella Pár, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), German Centre for Infection Research (DZIF), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Toulouse III - Paul Sabatier (UT3), Université de Toulouse (UT), Hannover Medical School [Hannover] (MHH), Universitäts Klinikum Freiburg = University Medical Center Freiburg (Uniklinik), University of Freiburg [Freiburg], University of Pecs, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie du système immunitaire (Inserm U1223), and Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, MESH: Methotrexate / adverse effects, 0301 basic medicine, MESH: Antiviral Agents / therapeutic use, medicine.medical_treatment, lcsh:QR1-502, MESH: Arthritis / complications, lcsh:Microbiology, chemistry.chemical_compound, 0302 clinical medicine, Recurrence, Risk Factors, MESH: Risk Factors, [SDV.MHEP.MI]Life Sciences [q-bio]/Human health and pathology/Infectious diseases, disease-modifying antirheumatic drugs (DMARDs), Prednisone, MESH: Immunocompromised Host, Hepatitis, Chronic, MESH: Ribavirin / therapeutic use, virus diseases, Immunosuppression, Middle Aged, Hepatitis E, Europe, Infectious Diseases, MESH: RNA, Viral, Rheumatoid arthritis, RNA, Viral, Female, 030211 gastroenterology & hepatology, medicine.drug, Adult, medicine.medical_specialty, MESH: Internal Medicine, ribavirin, Antiviral Agents, Article, Immunocompromised Host, MESH: Hepatitis E / drug therapy, 03 medical and health sciences, Psoriatic arthritis, Rheumatology, MESH: Rheumatology, Virology, Internal medicine, Internal Medicine, medicine, Humans, chronic hepatitis E, Aged, Retrospective Studies, Immunosuppression Therapy, MESH: Hepatitis, Chronic / drug therapy, MESH: Humans, business.industry, Arthritis, Ribavirin, MESH: Retrospective Studies, Retrospective cohort study, medicine.disease, digestive system diseases, MESH: Recurrence, Methotrexate, 030104 developmental biology, chemistry, hepatitis E, MESH: Europe, business
Abstract

Objectives: Hepatitis E virus (HEV) infection is a pandemic with regional outbreaks, including in industrialized countries. HEV infection is usually self-limiting but can progress to chronic hepatitis E in transplant recipients and HIV-infected patients. Whether other immunocompromised hosts, including rheumatology and internal medicine patients, are at risk of developing chronic HEV infection is unclear. Methods: We conducted a retrospective European multicenter cohort study involving 21 rheumatology and internal medicine patients with HEV infection between April 2014 and April 2016. The underlying diseases included rheumatoid arthritis (n = 5), psoriatic arthritis (n = 4), other variants of chronic arthritis (n = 4), primary immunodeficiency (n = 3), systemic granulomatosis (n = 2), lupus erythematosus (n = 1), Erdheim&ndash, Chester disease (n = 1), and retroperitoneal fibrosis (n = 1). Results: HEV infection lasting longer than 3 months was observed in seven (33%) patients, including two (40%) patients with rheumatoid arthritis, three (100%) patients with primary immunodeficiency, one (100%) patient with retroperitoneal fibrosis and one (100%) patient with systemic granulomatosis. Patients with HEV infection lasting longer than 3 months were treated with methotrexate without corticosteroids (n = 2), mycophenolate mofetil/prednisone (n = 1), and sirolimus/prednisone (n = 1). Overall, 8/21 (38%) and 11/21 (52%) patients cleared HEV with and without ribavirin treatment, respectively. One patient experienced an HEV relapse after initially successful ribavirin therapy. One patient (5%) was lost to follow-up, and no patients died from hepatic complications. Conclusion: Rheumatology and internal medicine patients, including patients treated with methotrexate without corticosteroids, are at risk of developing chronic HEV infection. Rheumatology and internal medicine patients with abnormal liver tests should be screened for HEV infection.

Published
2019
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5. Recommendations of the French Society for Rheumatology regarding TNFα antagonist therapy in patients with ankylosing spondylitis or psoriatic arthritis: 2007 update

Author

Pham, Thao, Fautrel, Bruno, Dernis, Emmanuelle, Goupille, Philippe, Guillemin, Francis, Le Loët, Xavier, Ravaud, Philippe, Claudepierre, Pascal, Miceli-Richard, Corinne, De Bandt, Michel, Breban, Maxime, Maillefert, Jean-Francis, Masson, Charles, Saraux, Alain, Schaeverbeke, Thierry, Wendling, Daniel, Mariette, Xavier, Combe, Bernard, Renseigné, Non, Service de Rhumatologie [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Département d'épidémiologie, biostatistique et recherche clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], CHU Bordeaux [Bordeaux], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Service de Rhumatologie [CHU Pitié Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Antirheumatic Agents, medicine.medical_specialty, Health Status, MESH: Societies, Medical, MESH: Professional Practice, Arthritis, Severity of Illness Index, MESH: Antibodies, Monoclonal, 03 medical and health sciences, Psoriatic arthritis, 0302 clinical medicine, MESH: Practice Guidelines as Topic, Rheumatology, MESH: Rheumatology, MESH: Severity of Illness Index, Internal medicine, medicine, MESH: Arthritis, Psoriatic, Humans, Spondylitis, Ankylosing, 030212 general & internal medicine, BASDAI, MESH: Health Status, Societies, Medical, Leflunomide, 030203 arthritis & rheumatology, Ankylosing spondylitis, MESH: Humans, Tumor Necrosis Factor-alpha, business.industry, Arthritis, Psoriatic, Antibodies, Monoclonal, Professional Practice, MESH: Spondylitis, Ankylosing, medicine.disease, Infliximab, 3. Good health, Discontinuation, Surgery, MESH: France, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Tumor Necrosis Factor-alpha, Antirheumatic Agents, Practice Guidelines as Topic, France, business, medicine.drug
Abstract

International audience; OBJECTIVE: To update French Society for Rheumatology guidelines regarding the use of tumor necrosis factor alpha (TNFalpha) antagonists for treating patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA). METHODS: We used the method recommended by Shekelle et al. to update the original recommendations: a limited group of experts selected the items that required updating, the relevant literature was critically appraised, and the experts developed new wording for the recommendations, which was then subjected to internal and external validation. As with the original recommendations, three topics were addressed, namely, indications of TNFalpha antagonist therapy, treatment initiation, and treatment adjustment and follow-up. RESULTS: Four criteria should be used to evaluate the indication of TNFalpha antagonist therapy. First, the patient must have a definitive diagnosis of AS or PsA. Thus, patients with AS must meet modified New York criteria or exhibit characteristic involvement of the sacroiliac joints, spine, or peripheral sites documented by radiographs or computed tomography (structural damage) or by magnetic resonance imaging (inflammation). Patients with PsA must meet validated criteria such as the Moll and Wright or CASPAR criteria. The second criterion is active disease for more than 1month, with a BASDAI >or=4 in patients with predominantly axial disease or a tender/swollen joint count >or=3, and with a physician assessment of disease activity of >or=4/10. The third criterion is failure of at least three non-steroidal anti-inflammatory drugs in patients with axial disease or of disease-modifying antirheumatic drug (DMARD) therapy (methotrexate, salazopyrine, or leflunomide) in patients with peripheral disease. Fourth, the patient must be free of contraindications to TNFalpha antagonist therapy. Four recommendations pertain to the initiation of TNFalpha antagonist therapy: a workup should be performed prior to treatment initiation; there is no evidence that one TNFalpha antagonist is more effective than the others, so decisions about drug selection should be shared with the patient and guided by available safety data and the patient's profile; there is no proof that greater effectiveness can be achieved by routinely combining a conventional DMARD; and patients should receive regular standardized follow-up. The last four recommendations deal with adjusting TNFalpha antagonist therapy: the treatment objective is a 2-point or greater improvement in the BASDAI in patients with axial disease and a 30% or greater improvement in the tender/swollen joint counts in patients with peripheral disease; there is no evidence to support the introduction of DMARD therapy in non-responders, who can be switched to another TNFalpha antagonist or, when on infliximab, given higher dosages or more closely spaced injections; patients who fail to tolerate one TNFalpha antagonist can be switched to another TNFalpha antagonist if allowed by the nature of the adverse event; and when a remission is achieved, reduction or discontinuation of concomitant anti-inflammatory therapy should be considered, followed in the event of a prolonged remission by a reduction in the dosage of the TNFalpha antagonist.

Published
2007
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6. Updating the OMERACT Filter: Implications for Patient-reported Outcomes

Author

M. Voshaar, Anne Lyddiatt, Wilma Smeets, Amye L. Leong, James W. May, T.K. Kvien, Pamela Montie, Maarten Boers, John R. Kirwan, Dorcas E. Beaton, Peter Tugwell, Susan J. Bartlett, Lyn March, Vibeke Strand, Ernest Choy, Ailsa Bosworth, Laure Gossec, Sarah Hewlett, Pam Richards, Peter Brooks, Francis Guillemin, Maarten de Wit, Robert Landewé, Enkeleida Nikaï, Institute for Work and Health (IWH), University of Toronto-St. Michael's Hospital-Institute of Medical Sciences, Department of Clinical Epidemiology and Biostatistics, VU University Medical Center [Amsterdam], National Rheumatoid Arthritis Society (NRAS), Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), EULAR standing committee of People with Arthritis/Rheumatism in Europe (PARE), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Université Sorbonne Paris Cité (USPC), Dpt of Clinical Immunology & Rheumatology [Amsterdam], Amsterdam and Atrium Medical Center, Institute of Bone & Joint Research, Royal North Shore Hospital (RNSH)-The University of Sydney, Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, University of Ottawa [Ottawa], Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Stanford University School of Medicine [Stanford], Stanford University [Stanford], University of Ottawa [Ottawa] (uOttawa), CHU Cochin [AP-HP], Institute for Work and Health ( IWH ), University Medical Center, National Rheumatoid Arthritis Society ( NRAS ), Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Université de Lorraine ( UL ) -Université de Lorraine ( UL ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université de Lorraine ( UL ) -Université Paris Descartes - Paris 5 ( UPD5 ), Université Sorbonne Paris Cité ( USPC ), Royal North Shore Hospital ( RNSH ) -The University of Sydney [Sydney], Amsterdam institute for Infection and Immunity, Clinical Immunology and Rheumatology, Epidemiology and Data Science, Rheumatology, and CCA - Innovative therapy

Subjects
medicine.medical_specialty, MESH: Self Report, International studies, Immunology, Alternative medicine, MESH : Rheumatic Diseases, MESH : Self Report, MESH : Randomized Controlled Trials as Topic, Outcome (game theory), Filter (software), Session (web analytics), MESH: Patient Participation, law.invention, MESH: Rheumatic Diseases, Randomized controlled trial, Rheumatology, law, Rheumatic Diseases, MESH: Rheumatology, MESH : Outcome and Process Assessment (Health Care), Immunology and Allergy, Medicine, Humans, Good practice, MESH : Rheumatology, OUTCOME AND PROCESS ASSESSMENT, Randomized Controlled Trials as Topic, RANDOMIZED CONTROLLED TRIALS, Medical education, MESH: Humans, business.industry, MESH : Reproducibility of Results, MESH : Humans, Reproducibility of Results, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Patient Participation, MESH: Reproducibility of Results, Outcome and Process Assessment, Health Care, MESH: Randomized Controlled Trials as Topic, PATIENT-REPORTED OUTCOMES, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Self Report, Patient Participation, business, Working group, MESH: Outcome and Process Assessment (Health Care)
Abstract

Objective.At a previous Outcome Measures in Rheumatology (OMERACT) meeting, participants reflected on the underlying methods of patient-reported outcome (PRO) instrument development. The participants requested proposals for more explicit instrument development protocols that would contribute to an enhanced version of the “Truth” statement in the OMERACT Filter, a widely used guide for outcome validation. In the present OMERACT session, we explored to what extent these new Filter 2.0 proposals were practicable, feasible, and already being applied.Methods.Following overview presentations, discussion groups critically reviewed the extent to which case studies of current OMERACT Working Groups complied with or negated the proposed PRO development framework, whether these observations had a more general application, and what issues remained to be resolved.Results.Several aspects of PRO development were recognized as particularly important, and the need to directly involve patients at every stage of an iterative PRO development program was endorsed. This included recognition that patients contribute as partners in the research and not merely as subjects. Correct communication of concepts with the words used in questionnaires was central to their performance as measuring instruments, and ensuring this understanding crossed cultural and linguistic boundaries was important in international studies or comparisons.Conclusion.Participants recognized, endorsed, and were generally already putting into practice the principles of PRO development presented in the plenary session. Further work is needed on some existing instruments and on establishing widespread good practice for working in close collaboration with patients.

Published
2014
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7. Updating the OMERACT filter: implications of filter 2.0 to select outcome instruments through assessment of 'truth': content, face, and construct validity

Author

Daniel E. Furst, Dorcas E. Beaton, Tore K Kvien, Laure Gossec, George Wells, Désirée van der Heijde, Peter Tugwell, Jasvinder A. Singh, Maarten Boers, Turid Heiberg, Philip G. Conaghan, Lee S. Simon, Philip J. Mease, Robert Landewé, Annelies Boonen, Vibeke Strand, John R. Kirwan, Cátia Duarte, M.A. D'Agostino, Sarah Hewlett, Francis Guillemin, Mikkel Østergaard, Maxime Dougados, Clifton O. Bingham, Ernest Choy, Amsterdam institute for Infection and Immunity, Clinical Immunology and Rheumatology, Department of Clinical Epidemiology and Biostatistics, VU University Medical Center [Amsterdam], Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Institute for Work and Health (IWH), University of Toronto-St. Michael's Hospital-Institute of Medical Sciences, Maastricht University Medical Center (MUMC), Maastricht University [Maastricht], Section of Musculoskeletal Diseasee, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), CHU Cochin [AP-HP], Østfold University College, Leiden University Medical Center (LUMC), Université Sorbonne Paris Cité (USPC), Dpt of Clinical Immunology & Rheumatology [Amsterdam], Amsterdam and Atrium Medical Center, Center for Rheumatology and Spine Diseases, Copenhagen (Center for Rheumatology and Spine Diseases), Stanford University School of Medicine [Stanford], Stanford University [Stanford], University of Ottawa [Ottawa] (uOttawa), Epidemiology and Data Science, Rheumatology, CCA - Innovative therapy, University Medical Center, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Ambroise Paré, Institute for Work and Health ( IWH ), Maastricht University Medical Center ( MUMC ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ), Université de Lorraine ( UL ) -Université de Lorraine ( UL ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université de Lorraine ( UL ) -Université Paris Descartes - Paris 5 ( UPD5 ), Université Sorbonne Paris Cité ( USPC ), Center for Rheumatology and Spine Diseases, Copenhagen ( Center for Rheumatology and Spine Diseases ), University of Ottawa [Ottawa], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Maastricht University Medical Centre (MUMC), Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA), Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Stanford School of Medicine [Stanford], Stanford Medicine, Stanford University-Stanford University, Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, and RS: CAPHRI - Effectiveness of Diagnosis and Intervention in patients with Rheumatic Diseases

Subjects
musculoskeletal diseases, Settore MED/16 - REUMATOLOGIA, Immunology, MESH : Rheumatic Diseases, Truth Disclosure, Outcome (game theory), Article, MESH: Rheumatic Diseases, CONSTRUCT VALIDITY, CONTENT VALIDITY, Rheumatology, Rheumatic Diseases, MESH: Rheumatology, MESH : Outcome and Process Assessment (Health Care), Content validity, Humans, Immunology and Allergy, Medicine, MESH : Rheumatology, OUTCOME AND PROCESS ASSESSMENT, Face validity, RANDOMIZED CONTROLLED TRIALS, Information retrieval, MESH: Humans, business.industry, Avaliação de Resultados e Processos, MESH : Reproducibility of Results, MESH : Humans, Reproducibility of Results, Construct validity, Reumatologia, OMERACT, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, humanities, MESH : Truth Disclosure, Health Care, MESH: Reproducibility of Results, Outcome and Process Assessment, Health Care, Doenças Reumáticas, Filter (video), Face (geometry), MESH: Truth Disclosure, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Working group, business, FACE VALIDITY, MESH: Outcome and Process Assessment (Health Care)
Abstract

Objective.The Outcome Measures in Rheumatology (OMERACT) Filter provides guidelines for the development and validation of outcome measures for use in clinical research. The “Truth” section of the OMERACT Filter requires that criteria be met to demonstrate that the outcome instrument meets the criteria for content, face, and construct validity.Methods.Discussion groups critically reviewed a variety of ways in which case studies of current OMERACT Working Groups complied with the Truth component of the Filter and what issues remained to be resolved.Results.The case studies showed that there is broad agreement on criteria for meeting the Truth criteria through demonstration of content, face, and construct validity; however, several issues were identified that the Filter Working Group will need to address.Conclusion.These issues will require resolution to reach consensus on how Truth will be assessed for the proposed Filter 2.0 framework, for instruments to be endorsed by OMERACT.

Published
2014
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8. Validation of a Self-administered Inflammatory Arthritis Detection Tool for Rheumatology Triage

Author

Peter Tugwell, Mary J. Bell, George A. Wells, Vivian P. Bykerk, Francis Guillemin, Ruben Tavares, McMaster University [Hamilton, Ontario], University of Ottawa [Ottawa] (uOttawa), Hospital for Special Surgery, Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Sunnybrook Health Sciences Centre, and University of Ottawa [Ottawa]

Subjects
Male, Inflammatory arthritis, Logistic regression, Arthritis, Rheumatoid, 0302 clinical medicine, MESH: Aged, 80 and over, MESH: Osteoarthritis, Scoring algorithm, Lupus Erythematosus, Systemic, Immunology and Allergy, 030212 general & internal medicine, Aged, 80 and over, MESH: Aged, MESH: Arthritis, Rheumatoid, MESH: Middle Aged, Intensive treatment, Middle Aged, MESH: Predictive Value of Tests, MESH: Diagnostic Self Evaluation, Waiting list, Female, MESH: Pain, Algorithms, Case identification, MESH: Spondylarthropathies, MESH: Triage, Adult, medicine.medical_specialty, Immunology, Pain, MESH: Algorithms, Sensitivity and Specificity, Diagnostic Self Evaluation, 03 medical and health sciences, Rheumatology, Predictive Value of Tests, Internal medicine, MESH: Rheumatology, Osteoarthritis, medicine, Humans, MESH: Lupus Erythematosus, Systemic, Aged, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH: Adult, medicine.disease, Triage, MESH: Sensitivity and Specificity, MESH: Male, Physical therapy, Spondylarthropathies, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Objective.The benefits of early intensive treatment of inflammatory arthritis (IA) are dependent on timely and accurate case identification. In our study, a scoring algorithm for a self-administered IA detection tool was developed and validated for the rheumatology triage clinical setting.Methods.A total of 143 consecutive consenting adults, newly referred to 2 outpatient rheumatology practices, completed the tool. A scoring algorithm was derived from the best-fit logistic regression model using age, sex, and responses to the 12 tool items as candidate predictors of the rheumatologists' blinded classification of IA. Bootstrapping was used to internally validate and refine the model.Results.The 30 IA cases were younger than the 113 non-cases (p < 0.0001) and included clinical diagnoses of early IA (n = 10), rheumatoid arthritis (n = 9), and spondyloarthropathies (n = 11). Non-cases included osteoarthritis (n = 46), pain syndromes (n = 19), systemic lupus erythematosus (n = 5), and miscellaneous, noninflammatory musculoskeletal complaints (n = 43). The best-fit model included younger age, male sex, “trouble making a fist,” “morning stiffness,” “ever told you have RA,” and “psoriasis diagnosis.” The overall predictive performance (standard error, SE) of the derivation model was 0.91 (0.03). Internal validation of the derivation model across 200 bootstrap samples resulted in a mean predictive performance (SE) of 0.904 (0.002). The refined tool had a mean predictive performance (SE) of 0.915 (0.002), a sensitivity of 0.855 (0.005), and specificity of 0.873 (0.003).Conclusion.A simple, self-administered tool was developed and internally validated for the sensitive and specific detection of IA in a rheumatology waiting list sample. The tool may be used to triage IA from rheumatology referrals.

Published
2013
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9. Improving agreement in assessment of synovitis in rheumatoid arthritis

Author

Peter P. Cheung, Emmanuel Chatelus, François Pouyol, Adeline Ruyssen-Witrand, Laure Gossec, Mélanie Gilson, Sandrine Guis, Martin Soubrier, Nathalie Balandraud, Thierry Marhadour, Pascal Richette, Ghislaine Gill, Isabelle Chary-Valckenaere, Stephan Pavy, Emmanuelle Dernis, Vincent André, Gérard Chalès, Gaël Mouterde, Maxime Dougados, National University Health System, Université Paris Descartes - Faculté de Médecine (UPD5 Médecine), Université Paris Descartes - Paris 5 (UPD5), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Centre Hospitalier du Mans, Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), CHU Pontchaillou [Rennes], Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Rhumatologie, Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de Référence pour les Maladies Systémiques Autoimmunes Rares, CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie, Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Roger Salengro, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), AP-HP, pôle appareil locomoteur, Service de rhumatologie, Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 (UPD7), Hôpital Purpan [Toulouse], CHU Toulouse [Toulouse], CHU Gabriel Montpied (CHU), CHU Clermont-Ferrand, National University Health System [Singapore] (NUHS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Roger Salengro [Lille], Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), CHU Gabriel Montpied [Clermont-Ferrand], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université Paris Descartes - Faculté de Médecine ( UPD5 Médecine ), Université Paris Descartes - Paris 5 ( UPD5 ), Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), Ingénierie Moléculaire et Physiopathologie Articulaire ( IMoPA ), Université de Lorraine ( UL ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Université Joseph Fourier - Grenoble 1 ( UJF ) -CHU Grenoble, Centre de résonance magnétique biologique et médicale ( CRMBM ), Aix Marseille Université ( AMU ) -Assistance Publique - Hôpitaux de Marseille ( APHM ) -Centre National de la Recherche Scientifique ( CNRS ), CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Lariboisière-Université Paris Diderot - Paris 7 ( UPD7 ), and CHU Gabriel Montpied ( CHU )

Subjects
Male, MESH: Synovitis, MESH : Aged, Arthritis, MESH: Observer Variation, Severity of Illness Index, MESH : Consensus, Arthritis, Rheumatoid, MESH : Cross-Sectional Studies, [ SDV.BBM.BC ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], 0302 clinical medicine, Medicine, MESH : Female, 030212 general & internal medicine, skin and connective tissue diseases, MESH : Joints, MESH : Synovitis, Observer Variation, MESH: Aged, MESH: Arthritis, Rheumatoid, Synovitis, MESH: Middle Aged, medicine.diagnostic_test, Swollen joints, MESH : Adult, Middle Aged, 3. Good health, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biomolecules [q-bio.BM], MESH: Reproducibility of Results, MESH: Joints, Rheumatoid arthritis, MESH : Severity of Illness Index, Female, Clinical Competence, MESH: Clinical Competence, Clinical competence, Adult, musculoskeletal diseases, medicine.medical_specialty, Validation study, Consensus, MESH : Male, Physical examination, [ SDV.BBM.BM ] Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, 03 medical and health sciences, MESH: Cross-Sectional Studies, Rheumatology, MESH: Rheumatology, MESH: Severity of Illness Index, Humans, MESH : Middle Aged, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], MESH: Consensus, MESH : Rheumatology, Aged, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH : Reproducibility of Results, MESH : Humans, Reproducibility of Results, MESH: Adult, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, MESH : Observer Variation, medicine.disease, MESH : Clinical Competence, MESH: Male, Cross-Sectional Studies, MESH : Arthritis, Rheumatoid, Physical therapy, Joints, Treatment decision making, business, MESH: Female
Abstract

International audience; Synovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience.; Eighteen rheumatologists from French university rheumatology units participated in three 30 minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa.; Global agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%.; Consensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists.

Published
2013
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10. EULAR definition of erosive disease in light of the 2010 ACR/EULAR rheumatoid arthritis classification criteria

Author

Tore K Kvien, David T. Felson, Cédric Lukas, Ewa Stanislawska-Biernat, Josef S Smolen, Robert Landewé, Alan J. Silman, Paul Emery, Bernard Combe, Maxime Dougados, Daniel Aletaha, Angela Zink, Désirée van der Heijde, Iain B. McInnes, Clifton O. Bingham, Annette H M van der Helm-van Mil, Rachel Knevel, Gerd Burmester, Department of Rheumatology, Leiden University Medical Center (LUMC), University of North Carolina [Chapel Hill] (UNC), University of North Carolina System (UNC), Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin / Charite - University Medicine Berlin, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie [CHU Cochin], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), University of Leeds, Tufts University School of Medicine [Boston], Diakonhjemmet Hospital, Academic Medical Center - Academisch Medisch Centrum [Amsterdam] (AMC), University of Amsterdam [Amsterdam] (UvA), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, ARC Epidemiology Unit, The University of Manchester, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Centre d'Investigation Clinique INSERM 1412 (CIC 1412 - BREST), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Lymphocyte B et Auto-immunité (LBAI), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), The University of North Carolina at Chapel Hill, Charité - University Medicine, Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Recherche Agronomique ( INRA ), Service de Rhumatologie [CHU Cochin], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Academic Medical Center [Amsterdam] ( AMC ), University of Amsterdam [Amsterdam] ( UvA ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Centre d'Investigation Clinique INSERM 1412 ( CIC 1412 - BREST ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Lymphocyte B et Auto-immunité ( LBAI ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), and CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato )

Subjects
musculoskeletal diseases, medicine.medical_specialty, MESH: Antirheumatic Agents, Inflammatory arthritis, [SDV]Life Sciences [q-bio], Immunology, MESH : Europe, Arthritis, Metatarsophalangeal joints, Context (language use), General Biochemistry, Genetics and Molecular Biology, Arthritis, Rheumatoid, [ SDV.MHEP.RSOA ] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatology, Internal medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, MESH: Rheumatology, medicine, Humans, Immunology and Allergy, skin and connective tissue diseases, MESH : Rheumatology, MESH : Joints, MESH : Evidence-Based Medicine, MESH: Arthritis, Rheumatoid, Evidence-Based Medicine, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, MESH : Humans, medicine.disease, MESH : Antirheumatic Agents, Europe, MESH: Joints, medicine.anatomical_structure, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Antirheumatic Agents, Rheumatoid arthritis, Cohort, MESH : Arthritis, Rheumatoid, Physical therapy, Joints, MESH: Europe, business, Rheumatism, MESH: Evidence-Based Medicine, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; The aim of this report was to propose a definition for erosive disease in the context of inflammatory arthritis in light of the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) criteria for use in clinical practice and studies. A EULAR task force was formed including 16 rheumatologists and one rheumatology fellow. The process was both evidence based and consensus based, and included, between March 2010 and April 2012, analyses of data from two cohorts, two face-to-face meetings, one online voting and one teleconference. The Leiden Early Arthritis Cohort and the French ESPOIR cohort were used for the evidence-based part. The outcome measures, which were initiation of methotrexate therapy, or any disease-modifying antirheumatic drug therapy within the first year of disease and arthritis persistency over 5 years, were studied with the aim to give the best definition of erosive disease. A decision was made to select a definition with a high specificity and focus on patients who did not otherwise fulfil the 2010 ACR/EULAR RA criteria (

Published
2013

11. Diagnostic accuracy of ACR/EULAR 2010 criteria for rheumatoid arthritis in a 2-year cohort

Author

Sophie Varache, Divi Cornec, Alain Saraux, Pierre Youinou, Jean-Baptiste Thorel, Valérie Devauchelle-Pensec, Gérard Chalès, Sandrine Jousse-Joulin, Emmanuel Nowak, Johanne Morvan, Catherine Le Henaff-Bourhis, Sylvie Hoang, Antoine Martin, Jean-Marie Berthelot, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Physiopathologie des Adaptations Nutritionnelles (PhAN), Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Pôle Ostéoarticulaire, Centre hospitalier universitaire de Nantes (CHU Nantes), Service d'Anatomie et de Cytologie Pathologiques [Avicenne], Université Paris 13 (UP13)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire, Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Avicenne [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris 13 (UP13), Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique )

Subjects
MESH: Antirheumatic Agents, Arthritis, Arthritis, Rheumatoid, Cohort Studies, 0302 clinical medicine, Immunology and Allergy, Longitudinal Studies, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, skin and connective tissue diseases, MESH: Longitudinal Studies, MESH: Cohort Studies, Societies, Medical, MESH: Arthritis, Rheumatoid, MESH: Follow-Up Studies, MESH: Predictive Value of Tests, Europe, Antirheumatic Agents, Predictive value of tests, Rheumatoid arthritis, Cohort, Algorithms, Cohort study, musculoskeletal diseases, medicine.medical_specialty, Immunology, MESH: Societies, Medical, MESH: Algorithms, Sensitivity and Specificity, 03 medical and health sciences, Rheumatology, Predictive Value of Tests, Internal medicine, MESH: Rheumatology, medicine, MESH: United States, Humans, 030203 arthritis & rheumatology, MESH: Humans, business.industry, medicine.disease, United States, MESH: Sensitivity and Specificity, MESH: Prospective Studies, MESH: Europe, Nuclear medicine, business, Rheumatism, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Follow-Up Studies
Abstract

Objective.To evaluate the diagnostic accuracy of the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) and 1987 ACR criteria for rheumatoid arthritis (RA), and the respective role of the algorithm and scoring of the ACR/EULAR.Methods.In total, 270 patients with recent-onset arthritis of < 1 year duration were included prospectively between 1995 and 1997 and followed for 2 years. RA was defined as the combination, at completion of followup, of RA diagnosed by an office-based rheumatologist and treatment with a disease-modifying antirheumatic drug or glucocorticoid. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the criteria sets in the overall population, in the subgroup meeting the tree condition for ACR/EULAR scoring, and in the overall population classified according the full tree.Results.At baseline, 111 of the 270 patients had better alternative diagnoses and 16 had erosions typical for RA; of the 143 remaining patients, 52 had more than 6 ACR/EULAR 2010 points (indicating definite RA) and 91 had fewer than 6 points. After 2 years, 11/16 patients with erosions and 40/52 with more than 6 points had RA. 100 of the 270 patients met the reference standard for RA. Sensitivity, specificity, PPV, and NPV of the ACR/EULAR (full tree) were 51/100 (51%), 153/170 (90%), 51/68 (75.4%), and 153/202 (75.7%), respectively. Diagnostic accuracies of the ACR/EULAR score and ACR 1987 criteria were not statistically different.Conclusion.Much of the improvement of the ACR/EULAR criteria was ascribable to the use of exclusion criteria in the algorithm.

Published
2011
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12. Diagnosis of peripheral psoriatic arthritis: recommendations for clinical practice based on data from the literature and experts opinion

Author

Bernard Combe, Carine Salliot, Philippe-M. Goupille, Thierry Schaeverbeke, Alain Cantagrel, Daniel Wendling, J.-F. Maillefert, Emmanuelle Dernis, Pascal Claudepierre, Carle Paul, F. Lavie, Xavier Le Loët, Jacques Tebib, René-Marc Flipo, Alain Saraux, Philippe Gaudin, Service de rhumatologie, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Service de Rhumatologie, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble-Hôpital Michallon, Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Hôpital Claude Huriez [Lille], CHU Lille-CHU Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), CHU Bordeaux [Bordeaux], Service d'immunologie et rhumatologie, Hospices Civils de Lyon (HCL)-Hôpital Edouard Herriot [CHU - HCL], Hospices Civils de Lyon (HCL), Département de Rhumatologie[Montpellier], and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie

Subjects
MESH: Expert Testimony, medicine.medical_specialty, Health Planning Guidelines, Alternative medicine, MEDLINE, Delphi method, Arthritis, Rheumatoid, Diagnosis, Differential, 03 medical and health sciences, Psoriatic arthritis, 0302 clinical medicine, Rheumatology, MESH: Practice Guidelines as Topic, MESH: Diagnosis, Differential, Internal medicine, MESH: Rheumatology, medicine, Humans, Psoriasis, MESH: Arthritis, Psoriatic, Spondylitis, Ankylosing, 030212 general & internal medicine, Expert Testimony, 030203 arthritis & rheumatology, MESH: Arthritis, Rheumatoid, MESH: Psoriasis, Evidence-Based Medicine, MESH: Humans, business.industry, Arthritis, Psoriatic, MESH: Biological Markers, medicine.disease, MESH: Spondylitis, Ankylosing, MESH: Health Planning Guidelines, 3. Good health, Clinical Practice, Radiography, MESH: Joints, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Family medicine, Radiological weapon, Practice Guidelines as Topic, Physical therapy, Joints, business, Rheumatism, Biomarkers, MESH: Evidence-Based Medicine
Abstract

International audience; OBJECTIVE: To propose French recommendations for the clinical, biological and radiological diagnosis of peripheral psoriatic arthritis (PsA) in daily practice based on data from the literature and expert opinion. METHOD: The strategy was the following: the choice of four questions, concerning this topic by the scientific committee according to the Delphi method, forming the basis of the recommendations. The Systematic literature research based on Medline, Cochrane and abstracts from the annual meetings of the French society of rheumatology (SFR), American college of rheumatology (ACR) and European ligue against rheumatism (EULAR). An experts committee of rheumatologists elaborated, validated specifying the strength and the degree of agreement of each recommendation. RESULTS: The questions selected were: (1) What clinical data should be collected to assist in the diagnosis of psoriatic arthritis? (2) What laboratory tests, immunological tests, and genetic tests should be performed to assist in the diagnosis of psoriatic arthritis? (3) What are the radiological investigations useful in the diagnosis of psoriatic arthritis? (4) What classification and/or diagnosis criteria can assist in the diagnosis of psoriatic arthritis? A literature search identified 1627 abstracts and 33 articles were included and analyzed. Four recommendations relative to the diagnosis were drafted and validated by a final vote of the experts committee. CONCLUSION: Recommendations concerning the diagnosis of PsA for daily practice were developed and validated on the basis of data from the literature and expert opinion. They should help to establish the diagnosis of PsA in daily practice.

Published
2009
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13. How to perform a critical analysis of a randomised controlled trial

Author

Candice Estellat, David J. Torgerson, Philippe Ravaud, Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques (U738 / UMR_S738), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Diderot - Paris 7 (UPD7), Department of Health Sciences, University of York [York, UK], Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), and Gillet, Catherine

Subjects
media_common.quotation_subject, Applied psychology, MEDLINE, Randomization, 030204 cardiovascular system & hematology, law.invention, External validity, 03 medical and health sciences, 0302 clinical medicine, Bias, Randomized controlled trial, Rheumatology, law, MESH: Rheumatology, Intervention (counseling), Medicine, Humans, 030212 general & internal medicine, Reliability (statistics), media_common, Randomized Controlled Trials as Topic, Selection bias, MESH: Humans, Evidence-Based Medicine, Sample size, business.industry, Evidence-based medicine, 3. Good health, MESH: Randomized Controlled Trials as Topic, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Data Interpretation, Statistical, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Data Interpretation, Statistical, MESH: Evidence-Based Medicine, Medical literature
Abstract

International audience; Given the large amount of medical literature of varying methodological quality, care must be taken when translating the results of randomised controlled trials into clinical practice. To assist in this translation process, we provide a method that involves answering three main questions: 'Can I trust the results?' 'How do I understand the results?' and 'To whom do the results apply?' To answer the first question, we describe important items that help in judging the reliability of the findings. For the second question, we address the clinical and statistical significance of results by looking at the size and precision of the effect. Finally, we raise the issue of external validity and of reporting adverse effects to determine which patients may best benefit from the new intervention.

Published
2009
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14. The gap between practice and guidelines in the choice of first-line disease modifying antirheumatic drug in early rheumatoid arthritis: results from the ESPOIR cohort

Author

Thierry Schaeverbeke, Violaine Foltz, Philippe Ravaud, Carine Roy, Nathalie Rincheval, Jean Sibilia, Pierre Bourgeois, Sylvie Rozenberg, Mathilde Benhamou, Bruno Fautrel, Gillet, Catherine, Service de Rhumatologie [CHU Pitié Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre de coordination, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Département d'épidémiologie, biostatistique et recherche clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Physiopathologie des arthrites, Université Louis Pasteur - Strasbourg I, Service de rhumatologie, CHU Bordeaux [Bordeaux], An unrestricted grant from Merck Sharp and Dohme (MSD) was allocated for the first 5 years of ESPOIR cohort. Two additional grants from INSERM were obtained to support part of the biological database. The French Society of Rheumatology, Abbott, Amgen and Wyeth also supported the ESPOIR cohort study., Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)

Subjects
Male, rheumatoid arthritis, MESH: Antirheumatic Agents, Time Factors, medicine.medical_treatment, Arthritis, Arthritis, Rheumatoid, 0302 clinical medicine, MESH: Practice Guidelines as Topic, MESH: Early Diagnosis, Immunology and Allergy, 030212 general & internal medicine, Prospective Studies, Disease management (health), Practice Patterns, Physicians', skin and connective tissue diseases, guideline adherence, MESH: Aged, MESH: Arthritis, Rheumatoid, MESH: Middle Aged, Uncertainty, Middle Aged, 3. Good health, earlyarthritis, MESH: Young Adult, Rheumatoid arthritis, Antirheumatic Agents, Cohort, Practice Guidelines as Topic, Female, France, clinical practice guideline, MESH: Uncertainty, Cohort study, Adult, musculoskeletal diseases, medicine.medical_specialty, first-line DMARD, Adolescent, Immunology, Article, 03 medical and health sciences, Young Adult, Rheumatology, Internal medicine, MESH: Rheumatology, medicine, Humans, Disease-modifying antirheumatic drug, Medical prescription, MESH: Physician's Practice Patterns, Aged, 030203 arthritis & rheumatology, MESH: Adolescent, MESH: Humans, business.industry, MESH: Time Factors, MESH: Adult, medicine.disease, MESH: Prospective Studies, MESH: Male, MESH: France, Early Diagnosis, disease management, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Physical therapy, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, business, MESH: Female
Abstract

Objective.To compare rheumatologists’ prescription for first disease modifying antirheumatic drug (DMARD) in early rheumatoid arthritis (RA) in real-life settings with 2 clinical practice guidelines (CPG), the French Society of Rheumatology/STPR 2004 and EULAR/ESCISIT 2007, and thus assess the gap between practices and guidelines.Method.ESPOIR was a French multicenter cohort study of 813 patients with early arthritis between 2002 and 2005. “Definite” and “probable” RA were defined according to ACR criteria and the level of diagnostic certainty. The objectives were to assess conformity between the observed first-line DMARD prescribed for those patients and the DMARD recommended in the guidelines; and to conduct a mail survey of patients’ usual rheumatologists to investigate the reasons for their nonconformity with guidelines.Results.In total 627 patients with definite or probable RA were identified. Conformity rates were 58% for STPR guidelines and 54% for EULAR guidelines. At 6 months, 83 (34%) patients with early RA did not receive any DMARD. Main determinants associated with conformity to guidelines were disease activity and presence of severity-predictive factors. The main reason leading to a discrepancy between guidelines and daily practice appeared to be diagnostic uncertainty, i.e., the difficulty to reliably assess RA diagnosis as early as the first visits to the rheumatologist.Conclusion.There is a substantial gap between CPG and rheumatologists’ daily practice concerning the first DMARD to prescribe in early RA. This is explained mainly by diagnostic uncertainty. More attention should be paid in future guidelines to the diagnostic difficulties of early RA.

Published
2009
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15. TNFalpha antagonist therapy in ankylosing spondylitis and psoriatic arthritis: recommendations of the French Society for Rheumatology

Author

Pham, Thao, Guillemin, Francis, Claudepierre, Pascal, Luc, Mathieu, Miceli-Richard, Corinne, Fautrel, Bruno, De Bandt, Michel, Breban, Maxime, Goupille, Philippe, Maillefert, Jean-Francis, Masson, Charles, Saraux, Alain, Schaeverbeke, Thierry, Wendling, Daniel, Mariette, Xavier, Combe, Bernard, Renseigné, Non, Service de Rhumatologie [Hôpital de la Conception - APHM], Assistance Publique - Hôpitaux de Marseille (APHM)-Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Service de rhumatologie [CHU Henri Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, Service de rhumatologie, Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Bordeaux [Bordeaux], Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, Service de Rhumatologie [CHU Pitié Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
medicine.medical_specialty, Anti-Inflammatory Agents, Disease, 03 medical and health sciences, Psoriatic arthritis, 0302 clinical medicine, Rheumatology, Sulfasalazine, Internal medicine, MESH: Rheumatology, medicine, MESH: Arthritis, Psoriatic, Humans, Spondylitis, Ankylosing, 030212 general & internal medicine, BASDAI, Leflunomide, 030203 arthritis & rheumatology, Ankylosing spondylitis, MESH: Humans, business.industry, Tumor Necrosis Factor-alpha, Arthritis, Psoriatic, medicine.disease, MESH: Spondylitis, Ankylosing, 3. Good health, MESH: France, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Anti-Inflammatory Agents, MESH: Tumor Necrosis Factor-alpha, Methotrexate, France, business, medicine.drug
Abstract

International audience; OBJECTIVES: To develop recommendations for TNFalpha antagonist therapy in patients with spondyloarthropathies. METHODS: The Delphi consensus procedure was used to select questions, to which evidence-based answers were sought in the literature. Expert opinion was used when needed to estimate the risks and benefits of TNFalpha antagonists. TNFalpha antagonists exert potent antiinflammatory effects but fail to provide a definitive cure. RESULTS: Recommendations were developed for patients with ankylosing spondylitis (AS) or psoriatic arthritis (PsA). The following criteria for TNFalpha antagonist therapy were selected: definitive diagnosis of AS or PsA, active disease for at least 4 consecutive weeks documented during two physician visits, overall physician's assessment of disease activity>/=4/10 and BASDAI>/=4/10 in axial disease or at least three tender and swollen joints in peripheral disease, failure to respond adequately to at least three nonsteroidal antiinflammatory drugs given in optimal dosages for at least 3 months in axial disease or at least one disease-modifying antirheumatic drug (methotrexate, leflunomide, sulfasalazine) for at least 4 months, with local glucocorticoid injections if appropriate, in peripheral disease. Effectiveness and safety should be evaluated by a rheumatologist. The frequency of monitoring depends on the drug. Lack of effectiveness should be defined as inadequate improvement after 6-12 weeks, with a less than two-point decrease in the BASDAI in axial disease or a less than 30% decrease in the tender and swollen joint counts in peripheral disease. CONCLUSION: These clinical practice recommendations should help rheumatologists in their everyday decisions regarding the use of TNFalpha antagonist therapy in patients with AS or PsA.

Published
2005
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16. Validation of ACR/EULAR definition of remission in rheumatoid arthritis from RA practice: the ESPOIR cohort

Author

Nathalie Rincheval, Bernard Combe, Bin Zhang, David T. Felson, Clinical Epidemiology Research and Training Unit (BOSTON - Clin Epid Research), Boston University School of Medicine (BUSM), Boston University [Boston] (BU)-Boston University [Boston] (BU), Institut de Génétique Moléculaire de Montpellier (IGMM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Arthritis Research UK Epidemiology Unit (MANCHESTER - Arthritis Research), University of Manchester [Manchester], Clinical Epidemiology Research and Training Unit ( BOSTON - Clin Epid Research ), Boston University School, Institut de Génétique Moléculaire de Montpellier ( IGMM ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Arthritis Research UK Epidemiology Unit ( MANCHESTER - Arthritis Research ), Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, Centre d'Investigation Clinique ( CIC - Brest ), and Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, MESH: Remission Induction, [SDV]Life Sciences [q-bio], MESH : Aged, Arthritis, Cohort Studies, Arthritis, Rheumatoid, 0302 clinical medicine, Medicine, Immunology and Allergy, MESH : Female, 030212 general & internal medicine, skin and connective tissue diseases, MESH: Cohort Studies, MESH: Aged, MESH: Arthritis, Rheumatoid, Clinical Trials as Topic, MESH: Middle Aged, Remission Induction, MESH : Adult, Middle Aged, MESH: Predictive Value of Tests, 3. Good health, Editorial, MESH: Young Adult, Rheumatoid arthritis, Cohort, Female, Cohort study, Research Article, Adult, musculoskeletal diseases, medicine.medical_specialty, MESH: Clinical Trials as Topic, Adolescent, MESH : Male, Immunology, MESH : Young Adult, MESH : Cohort Studies, 03 medical and health sciences, Young Adult, Rheumatology, Predictive Value of Tests, Internal medicine, MESH : Adolescent, MESH: Rheumatology, Humans, MESH : Middle Aged, MESH : Predictive Value of Tests, MESH : Rheumatology, Aged, 030203 arthritis & rheumatology, MESH: Adolescent, MESH : Remission Induction, MESH: Humans, [ SDV ] Life Sciences [q-bio], business.industry, MESH : Humans, MESH: Adult, medicine.disease, MESH: Male, Clinical trial, MESH : Clinical Trials as Topic, MESH : Arthritis, Rheumatoid, Physical therapy, Observational study, business, MESH: Female, Rheumatism
Abstract

International audience; INTRODUCTION: In development of the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) rheumatoid arthritis (RA) remission definitions using clinical trials data, one criterion used to compare different remission definitions was whether, compared with those not in remission, those in remission had evidence of later disease stability defined by x-ray and functional status. Validation of the RA remission criteria using observational study data is necessary before recommending their use in practice. METHODS: Using data from those who met RA criteria in the ESPOIR cohort, we matched each person in remission with a person not in remission and then carried out analyses comparing later stability of x-ray and health assessment questionnaire (HAQ) between the two groups. We compared the predictive validity of the same candidate definitions of remission evaluated in the ACR/EULAR process. To minimize potential bias and produce more stable results, we used a bootstrap resampling approach to select those not in remission, repeating the sample matching analysis process 500 times. RESULTS: Results were similar to those of clinical trials analyzed for the ACR/EULAR remission criteria. Specifically, the ACR/EULAR remission definitions using either an simple disease activity index (SDAI) ≤ 3.3, clinical disease activity index (CDAI) ≤ 2.8 or a definition of remission requiring tender joint count, swollen joint count, patient global assessment all ≤ 1 performed as well or better than other candidate definitions of remission in terms of predicting later x-ray and function stability. CONCLUSIONS: ACR/EULAR definitions of remission developed for trials are similarly valid in observational studies in RA and could be used in practice.

Published
2012
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17. Are joint and soft tissue injections painful? Results of a national French cross-sectional study of procedural pain in rheumatological practice

Author

Pierre Marie, Serge Perrot, Catherine Payen-Champenois, Françoise Laroche, C. Poncet, Physiopathologie et Pharmacologie Clinique de la Douleur (LPPD), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), DOCS International, BMS, and BMC, Ed.

Subjects
Male, lcsh:Diseases of the musculoskeletal system, Sports medicine, Cross-sectional study, MESH: Pain Measurement, Zygapophyseal Joint, Injections, Intra-Articular, 0302 clinical medicine, Epidemiology, Synovial Fluid, Medicine, Orthopedics and Sports Medicine, MESH: Knee, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, MESH: Pain, Postoperative, Intraoperative Complications, MESH: Biopsy, Fine-Needle, Pain Measurement, MESH: Aged, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Pain, Postoperative, MESH: Middle Aged, MESH: Pain Threshold, Soft tissue, Middle Aged, MESH: Injections, Intramuscular, Arthralgia, 3. Good health, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Joint Diseases, MESH: Intraoperative Complications, Female, France, Joint Diseases, MESH: Spine, musculoskeletal diseases, Adult, Pain Threshold, medicine.medical_specialty, Biopsy, Fine-Needle, Injections, Intramuscular, MESH: Arthralgia, 03 medical and health sciences, MESH: Cross-Sectional Studies, Rheumatology, Internal medicine, MESH: Rheumatology, MESH: Synovial Fluid, Threshold of pain, Research article, Humans, Knee, Aged, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH: Zygapophyseal Joint, MESH: Adult, MESH: Injections, Intra-Articular, MESH: Male, MESH: Prospective Studies, Spine, MESH: France, Cross-Sectional Studies, Orthopedic surgery, Physical therapy, lcsh:RC925-935, business, MESH: Female
Abstract

Background Joint, spinal and soft tissue injections are commonly performed by rheumatologists in their daily practice. Contrary to other procedures, e.g. performed in pediatric care, little is known about the frequency, the intensity and the management of procedural pain observed in osteo-articular injections in daily practice. Methods This observational, prospective, national study was carried out among a French national representative database of primary rheumatologists to evaluate the prevalence and intensity of pain caused by intra-and peri-articular injections, synovial fluid aspirations, soft tissue injections, and spinal injections. For each physician, data were collected over 1 month, for up to 40 consecutive patients (>18-years-old) for whom a synovial fluid aspiration, an intra or peri-articular injection or a spinal injection were carried out during consultations. Statistical analysis was carried out in order to compare patients who had suffered from pain whilst undergoing the procedure to those who had not. Explanatory analyses were conducted by stepwise logistic regression with the characteristics of the patients to explain the existence of pain. Results Data were analysed for 8446 patients (64% female, mean age 62 ± 14 years) recruited by 240 physicians. The predominant sites injected were the knee (45.5%) and spine (19.1%). Over 80% of patients experienced procedural pain which was most common in the small joints (42%) and spine (32%) Pain was severe in 5.3% of patients, moderate in 26.6%, mild in 49.8%, and absent in 18.3%. Pain was significantly more intense in patients with severe pain linked to their underlying pathology and for procedures performed in small joints. Preventative or post-procedure analgesia was rarely given, only to 5.7% and 36.3% of patients, respectively. Preventative analgesia was more frequently prescribed in patients with more severe procedural pain. Conclusion Most patients undergoing intra-or peri-articular injections, synovial fluid aspirations and spine injections suffer from procedural pain. Most patients experience usually mild procedural pain and procedural pain management is uncommonly provided by physicians. Specific research and guidelines for the management of procedural pain related to rheumatologic care should be established to improve the quality of care provided by physicians.

Published
2010
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18. Determining a low disease activity threshold for decision to maintain disease-modifying antirheumatic drug treatment unchanged in rheumatoid arthritis patients

Author

Frédéric Lioté, Daniel Wendling, Jean Marie Berthelot, Jean Francis Maillefert, Francis Guillemin, Michel De Bandt, Olivier Meyer, Xavier Le Loët, Alain Saraux, Bernard Combe, Bruno Fautrel, René-Marc Flipo, Service de Rhumatologie, Centre hospitalier d'Aulnay sous Bois, CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de rhumatologie (hôpital général, CHU Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, Université de Nantes (UN)-IFR26-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Centre Viggo-Petersen, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest)-Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST ), Agents pathogènes et inflammation - UFC (EA 4266) (API), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service de rhumatologie [CHU Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Physiopathologie et biothérapies des maladies inflammatoires et autoimmunes, Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'investigation clinique - Epidémiologie clinique [Nancy] (CIC-EC), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Ecole de Santé Publique [Nancy], Faculté de Médecine [Nancy], Université de Lorraine (UL)-Université de Lorraine (UL), The research project was funded by an unrestricted grant from Sanofi-Aventis France., STPR group of the French Society of Rheumatology, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), and BMC, Ed.

Subjects
Male, MESH: Antirheumatic Agents, medicine.medical_treatment, Arthritis, Arthritis, Rheumatoid, 0302 clinical medicine, MESH: Practice Guidelines as Topic, immune system diseases, Immunology and Allergy, 030212 general & internal medicine, Practice Patterns, Physicians', skin and connective tissue diseases, media_common, [SDV.MHEP.RSOA] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, MESH: Arthritis, Rheumatoid, 3. Good health, MESH: Reproducibility of Results, Antirheumatic Agents, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatoid arthritis, Practice Guidelines as Topic, Female, Adult, Drug, musculoskeletal diseases, medicine.medical_specialty, media_common.quotation_subject, Immunology, Disease activity, 03 medical and health sciences, Rheumatology, MESH: Rheumatology, Internal medicine, Research article, medicine, Humans, Disease-modifying antirheumatic drug, MESH: Physician's Practice Patterns, 030203 arthritis & rheumatology, MESH: Humans, business.industry, Reproducibility of Results, MESH: Adult, medicine.disease, MESH: Male, Expert opinion, Physical therapy, business, MESH: Female
Abstract

International audience; INTRODUCTION: The aim of this study was to determine a low disease activity threshold--a 28-joint disease activity score (DAS28) value--for the decision to maintain unchanged disease-modifying antirheumatic drug (DMARD) treatment in rheumatoid arthritis patients, based on expert opinion. METHODS: Nine hundred and sixty-seven case scenarios with various levels for each component of the DAS28 (resulting in a disease activity score between 2 and 3.2) were presented to 44 panelists. For each scenario, panelists had to decide whether or not DMARD treatment (excluding steroids) could be maintained unchanged. In each scenario, for decision, the participants were given the DAS28 parameters, without knowledge of the resultant DAS28. The relationship between panelists' decision, DAS28 value, and components of the score were analysed by multiple logistic regression analysis. Each panelist analysed 160 randomised scenarios. Intra-rater and inter-rater reproducibility were assessed. RESULTS: Forty-four panelists participated in the study. Inter-panelist agreement was good (kappa = 0.63; 95% confidence interval = 0.61 to 0.65). Intra-panelist agreement was excellent (kappa = 0.87; 95% confidence interval = 0.82 to 0.92). Quasi-perfect agreement was observed for DAS28 < or = 2.4, less pronounced between 2.5 and 2.9, and almost no agreement for DAS28 > 3.0. For values below 2.5, panelists agreed to maintain unchanged DMARDs; for values above 2.5, discrepancies occurred more frequently as the DAS28 value increased. Multivariate analysis confirmed the relationship between panelist's decision, DAS28 value and components of the DAS28. Between DAS28 of 2.4 and 3.2, a major determinant for panelists' decision was swollen joint count. Female and public practice physicians decided more often to maintain treatment unchanged. CONCLUSIONS: As a conclusion, panelists suggested that in clinical practice there is no need to change DMARD treatment in rheumatoid arthritis patients with DAS28 < or = 2.4.

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