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1. Can remission in rheumatoid arthritis be assessed without laboratory tests or a formal joint count? possible remission criteria based on a self-report RAPID3 score and careful joint examination in the ESPOIR cohort

Author

Bernard Combe, Bruno Fautrel, Isabel Castrejón, Maxime Dougados, Francis Guillemin, Theodore Pincus, Division of Rheumatology (NYU Hospital - Rheumato), New York University Langone Medical Center (NYU Langone Medical Center), NYU System (NYU)-NYU System (NYU), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Institut de Génétique Moléculaire de Montpellier (IGMM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Nancy, Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale (INSERM), Rhumatologie, Université Paris Diderot - Paris 7 (UPD7), CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Montpellier (UM)-Université Montpellier 1 (UM1), Division of Rheumatology ( NYU Hospital - Rheumato ), New York University Hospital, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - IURC, Université Montpellier 1 ( UM1 ) -Université de Montpellier ( UM ), Institut de Génétique Moléculaire de Montpellier ( IGMM ), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Cancéropôle du Grand Est-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris Diderot - Paris 7 ( UPD7 ), Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 ( AIDMP ), and Maladies chroniques, santé perçue, et processus d'adaptation ( APEMAC )

Subjects
Male, MESH: Antirheumatic Agents, MESH: Remission Induction, [SDV]Life Sciences [q-bio], Severity of Illness Index, Arthritis, Rheumatoid, Disability Evaluation, 0302 clinical medicine, Cohen's kappa, Remission criteria, Surveys and Questionnaires, Immunology and Allergy, MESH : Female, 030212 general & internal medicine, MESH : Joints, MESH: Treatment Outcome, MESH: Arthritis, Rheumatoid, MESH: Middle Aged, MESH : Physical Examination, Remission Induction, MESH: Disability Evaluation, MESH : Questionnaires, MESH : Adult, Middle Aged, Joint examination, MESH : Antirheumatic Agents, 3. Good health, MESH: Diagnostic Self Evaluation, MESH: Joints, C-Reactive Protein, Treatment Outcome, Rheumatoid arthritis, Antirheumatic Agents, Cohort, MESH : Severity of Illness Index, Female, MESH : Sensitivity and Specificity, Adult, musculoskeletal diseases, medicine.medical_specialty, MESH : Male, Immunology, MESH : Disability Evaluation, MESH : Treatment Outcome, Sensitivity and Specificity, 03 medical and health sciences, Diagnostic Self Evaluation, MESH: Physical Examination, Rheumatology, Internal medicine, MESH: Severity of Illness Index, MESH: C-Reactive Protein, medicine, Humans, MESH : Middle Aged, Physical Examination, 030203 arthritis & rheumatology, MESH : Remission Induction, MESH: Humans, [ SDV ] Life Sciences [q-bio], MESH : Diagnostic Self Evaluation, business.industry, MESH: Questionnaires, MESH : Humans, MESH: Adult, MESH : C-Reactive Protein, medicine.disease, MESH: Sensitivity and Specificity, MESH: Male, MESH : Arthritis, Rheumatoid, Physical therapy, Joints, business, MESH: Female, Rheumatism, Kappa
Abstract

Objective.To explore 5 possible criteria for remission in rheumatoid arthritis (RA) based on a patient self-report index, the Routine Assessment of Patient Index Data (RAPID3), with a careful joint examination and possible physician global estimate (DOCGL), but without a formal joint count or laboratory test.Methods.The ESPOIR early RA cohort of 813 French patients recruited in 2002–2005 was analyzed to identify patients in remission 6 months after enrollment, according to 2 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria: Boolean ≤ 1 for total tender joint count-28, swollen joint count-28, C-reactive protein, and patient global estimate (PATGL), and Simplified Disease Activity Index (SDAI) ≤ 3.3. Agreement with 7 other remission criteria was analyzed — Disease Activity Score-28 (DAS28) ≤ 2.6, Clinical Disease Activity Index (CDAI) ≤ 2.8, and 5 candidate criteria based on RAPID3, joint examination, and DOCGL: “RAPID3R” (RAPID3 ≤ 3.0); “RAPID3R+SJ1” (RAPID3 ≤ 3.0, ≤ 1 swollen joint); “RAPID3R+SJ1+D1” (RAPID3 ≤ 3.0, ≤ 1 swollen joint, DOCGL ≤ 1); “RAPID3R+SJ0” (RAPID3 ≤ 3.0, 0 swollen joints); and “RAPID3R+SJ0+D1” (RAPID3 ≤ 3.0, 0 swollen joints, DOCGL ≤ 1), according to kappa statistics, sensitivity, and specificity. Residual global, articular, and questionnaire abnormalities according to each criteria set were analyzed.Results.Among 813 ESPOIR patients, 720 had complete data to compare all 9 possible criteria. Substantial agreement with the Boolean criteria was seen for SDAI, CDAI, RAPID3R+SJ1, RAPID3R+SJ1+D1, RAPID3R+SJ0, and RAPID3R+SJ0+D1 (92.2%–94.7%, kappa 0.67–0.79), versus only moderate agreement for DAS28 or RAPID3R (79.9%–85.8%, kappa 0.46–0.55).Conclusion.Remission according to CDAI and RAPID3R+SJ1, but not DAS28 or RAPID3R, is similar to that of the ACR/EULAR criteria. RAPID3 scores require a complementary careful joint examination for clinical decisions, do not preclude formal joint counts or other indices, and may be useful in busy clinical settings.

Published
2013
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2. 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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3. 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

4. Effect of adherence to European treatment recommendations on early arthritis outcome: data from the ESPOIR cohort

Author

Bruno Fautrel, Cécile Escalas, Bernard Combe, Philippe Ravaud, Pierre Durieux, Marie Dalichampt, Francis Guillemin, Maxime Dougados, Institut de Génétique Moléculaire de Montpellier ( IGMM ), Centre National de la Recherche Scientifique ( CNRS ) -Université de Montpellier ( UM ), Rhumatologie, Université Paris Diderot - Paris 7 ( UPD7 ), 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 ), Centre de Recherche des Cordeliers ( CRC (UMR_S 872) ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Service de rhumatologie [CHU Cochin], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP), Modèles et méthodes de l'évaluation thérapeutique des maladies chroniques, Université Paris Diderot - Paris 7 ( UPD7 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Centre d'Investigation Clinique ( CIC - Brest ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut de Génétique Moléculaire de Montpellier (IGMM), Centre National de la Recherche Scientifique (CNRS)-Université de Montpellier (UM), Université Paris Diderot - Paris 7 (UPD7), 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), Centre de Recherche des Cordeliers (CRC (UMR_S 872)), Université Paris Descartes - Paris 5 (UPD5)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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), Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Pierre et Marie Curie - Paris 6 (UPMC)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), Université de Montpellier ( UM ) -Centre National de la Recherche Scientifique ( CNRS ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), and Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]

Subjects
Male, MESH: Antirheumatic Agents, MESH : Prospective Studies, MESH: Logistic Models, MESH : Arthrography, 0302 clinical medicine, MESH: Practice Guidelines as Topic, Epidemiology, Clinical endpoint, MESH: Arthrography, Immunology and Allergy, MESH : Female, 030212 general & internal medicine, Prospective Studies, Arthrography, MESH : Propensity Score, MESH : Joints, MESH: Treatment Outcome, education.field_of_study, MESH: Middle Aged, MESH : Prognosis, Middle Aged, Prognosis, MESH: Patient Compliance, MESH : Antirheumatic Agents, 3. Good health, MESH: Joints, MESH : Practice Guidelines as Topic, Treatment Outcome, Antirheumatic Agents, Cohort, Practice Guidelines as Topic, Disease Progression, Female, MESH: Disease Progression, Cohort study, medicine.medical_specialty, MESH : Male, Immunology, Population, MESH: Arthritis, MESH : Treatment Outcome, General Biochemistry, Genetics and Molecular Biology, MESH: Prognosis, MESH : Patient Compliance, 03 medical and health sciences, Rheumatology, Internal medicine, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, medicine, Humans, MESH : Middle Aged, education, Propensity Score, 030203 arthritis & rheumatology, MESH: Humans, business.industry, Arthritis, MESH : Humans, MESH : Arthritis, MESH : Disease Progression, MESH: Propensity Score, medicine.disease, MESH: Prospective Studies, MESH: Male, Logistic Models, Propensity score matching, Physical therapy, Patient Compliance, Observational study, Joints, business, MESH: Female, Rheumatism, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, MESH : Logistic Models
Abstract

ObjectiveTo assess the association of adherence to the 2007 recommendations of the European League Against Rheumatism (EULAR) for managing early arthritis and radiographic progression and disability in patientsMethodsThe authors conducted a prospective population-based cohort study. The ESPOIR cohort was a French cohort of 813 patients with early arthritis not receiving disease-modifying antirheumatic drugs (DMARDs). Adherence to the 2007 EULAR recommendations was defined by measuring adherence to three of the recommendations concerning the initiation and early adjustment of DMARDs. The study endpoints were radiographic progression, defined as the presence of at least one new erosion between baseline and 1 year, and disability as a heath assessment questionnaire score ≥1 at 2 years. A propensity score of being treated according to the recommendations was developed.ResultsAfter adjustment for propensity score, treatment centre and the main confounding factors, patients without recommendation adherence were at increased risk of radiographic progression at 1 year, and of functional impairment at 2 years (OR 1.98, (95% CI: 1.08 to 3.62 and OR: 2.36, (95% CI: 1.17 to 4.67), respectively).ConclusionsEarly arthritis patients whose treatment adhered to the 2007 EULAR recommendations seemed to benefit from such treatment in terms of risk of clinical and radiographic progression. Using a propensity score of being treated according to recommendations in observational studies may be useful in assessing the potential impact of these recommendations on outcome.

Published
2012
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5. Serum IL-6 and IL-21 are associated with markers of B cell activation and structural progression in early rheumatoid arthritis: results from the ESPOIR cohort

Author

Pascale Roux-Lombard, Alain Cantagrel, Xavier Mariette, Gilles Chiocchia, Jacques-Eric Gottenberg, Beatrice Ducot, Cédric Lukas, Alain Saraux, Jean-Michel Dayer, Service de rhumatologie, Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Bicêtre, Division of Immunology and Allergy, University Hospital, Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Cochin ( UM3 (UMR 8104 / U1016) ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Rhumatologie ( Toulouse - Rhumato ), CHU Toulouse [Toulouse], Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Centre d'Investigation Clinique ( CIC - Brest ), Université de Brest ( UBO ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Immunologie et d'Allergologie ( SIA - GENEVE ), Hôpitaux Universitaires de Genève ( HUG ), Hôpital Bicêtre-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Cochin (IC UM3 (UMR 8104 / U1016)), Centre National de la Recherche Scientifique (CNRS)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre de Rhumatologie (Toulouse - Rhumato), Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Centre d'Investigation Clinique (CIC - Brest), Université de Brest (UBO)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Immunologie et d'Allergologie (SIA - GENEVE), Hôpitaux Universitaires de Genève (HUG), Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Bicêtre, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre

Subjects
Male, MESH : Prospective Studies, Arthritis, Lymphocyte Activation, MESH : Early Diagnosis, Arthritis, Rheumatoid, 0302 clinical medicine, MESH: Early Diagnosis, Outcome Assessment, Health Care, Immunology and Allergy, MESH : Female, Prospective Studies, Biological Markers/blood, MESH : Joints, ddc:616, 0303 health sciences, B-Lymphocytes, MESH: Arthritis, Rheumatoid, MESH: Middle Aged, biology, medicine.diagnostic_test, Interleukin, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Adult, Middle Aged, Connective tissue disease, 3. Good health, MESH: Joints, Hyperalgesia, Rheumatoid arthritis, Erythrocyte sedimentation rate, Female, Adult, medicine.medical_specialty, MESH: Interleukins, MESH : Outcome Assessment (Health Care), MESH : Interleukin-6, MESH : Male, Immunology, General Biochemistry, Genetics and Molecular Biology, MESH : B-Lymphocytes, 03 medical and health sciences, Outcome Assessment (Health Care), Rheumatology, Internal medicine, MESH: B-Lymphocytes, medicine, MESH : Hyperalgesia, Hyperalgesia/pathology/physiopathology, Rheumatoid factor, Humans, MESH : Middle Aged, Joints/pathology/physiopathology, Arthritis, Rheumatoid/blood/diagnosis/immunology, Interleukin 6, MESH: Lymphocyte Activation, MESH: Outcome Assessment (Health Care), MESH : Lymphocyte Activation, 030304 developmental biology, B-Lymphocytes/immunology/metabolism/pathology, 030203 arthritis & rheumatology, MESH: Humans, business.industry, Interleukin-6, Interleukins, MESH : Humans, MESH: Biological Markers, MESH: Adult, Interleukins/blood, medicine.disease, MESH: Hyperalgesia, MESH: Interleukin-6, MESH: Male, MESH: Prospective Studies, MESH : Biological Markers, Early Diagnosis, MESH : Arthritis, Rheumatoid, biology.protein, Joints, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Interleukin-6/blood, business, MESH : Interleukins, MESH: Female, Biomarkers
Abstract

International audience; OBJECTIVE: To identify a specific pattern of serum cytokines that correlates with the diagnosis, activity and severity of rheumatoid arthritis (RA) in patients with early RA as well as with the level of serum markers of B cell activation. METHODS: Serum interleukin (IL)-1β, IL-1 receptor antagonist (IL1-Ra), IL-2, IL-4, IL-6, IL-10, IL-17, IL-21, monocyte chemotactic protein 1 (MCP-1), tumour necrosis factor α and interferon γ levels were measured in the (ESPOIR) Etude et Suivi des POlyarthrites Indifférenciées Récentes early arthritis cohort, which included patients with at least two swollen joints for >6 weeks and

Published
2012
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6. Reproducibility of joint swelling assessment by sonography in patients with long-lasting rheumatoid arthritis (SEA-Repro study part II)

Author

Christophe Hudry, Jérémie Sellam, Maxime Dougados, M.A. D'Agostino, F. Etchepare, Cécile Hacquard, Isabelle Chary Valckenaere, Gérard Chalès, Jean David Albert, Sandrine Jousse-Joulin, Laurent Grange, Alain Saraux, Thierry Marhadour, Jacques Bentin, Damien Loeuille, Philippe Gaudin, Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Service de Rhumatologie, CHU Brugmann, CHU Brugmann, Belgium, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [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 ), Physiopathologie, Pharmacologie et Ingénierie articulaires (PPIA), Université Henri Poincaré - Nancy 1 (UHP)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), 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 Pitié Salpêtrière] (GRC-08 EEMOIS), Université de Rennes 1 (UR1), 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 ), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Service de rhumatologie, Hôpital Sud, Service de Rhumatologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Ambroise Paré, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Université de Rennes 1 ( UR1 ), 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 ), Physiopathologie, Pharmacologie et Ingénierie articulaires ( PPIA ), Université Henri Poincaré - Nancy 1 ( UHP ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP]

Subjects
Male, Settore MED/16 - REUMATOLOGIA, MESH: Synovitis, MESH : Aged, Severity of Illness Index, Arthritis, Rheumatoid, 0302 clinical medicine, Cohen's kappa, Rheumatoid, Immunology and Allergy, [ SDV.IMM ] Life Sciences [q-bio]/Immunology, MESH : Female, 030212 general & internal medicine, Disease activity, MESH : Joints, Ultrasonography, MESH : Synovitis, MESH: Aged, MESH: Arthritis, Rheumatoid, Synovitis, MESH: Middle Aged, medicine.diagnostic_test, Doppler, Middle Aged, Reference Standards, MESH : Ultrasonography, Doppler, MESH: Reproducibility of Results, MESH: Joints, Rheumatoid arthritis, [SDV.IMM]Life Sciences [q-bio]/Immunology, MESH : Severity of Illness Index, Female, MESH: Reference Standards, Long lasting, medicine.medical_specialty, MESH : Male, Immunology, Physical examination, 03 medical and health sciences, Rheumatology, MESH: Severity of Illness Index, Ultrasound, medicine, Humans, In patient, MESH : Middle Aged, Aged, 030203 arthritis & rheumatology, Reproducibility, MESH: Humans, business.industry, MESH : Reproducibility of Results, Arthritis, MESH : Humans, Reproducibility of Results, Ultrasonography, Doppler, medicine.disease, MESH: Male, Surgery, Sonographer, MESH : Arthritis, Rheumatoid, MESH : Reference Standards, MESH: Ultrasonography, Doppler, Joints, Nuclear medicine, business, MESH: Female
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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7. Reproducibility of joint swelling assessments in long-lasting rheumatoid arthritis: Influence on disease activity score-28 values (SEA-repro study part I)

Author

Laurent Grange, Jean-David Albert, Christophe Hudry, Jérémie Sellam, F. Etchepare, Cécile Hacquard, Sandrine Jousse-Joulin, M.A. D'Agostino, Maxime Dougados, Thierry Marhadour, Alain Saraux, Philippe Gaudin, Gérard Chalès, Isabelle Chary Valckenaere, Jacques Bentin, Damien Loeuille, Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], 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 ), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Physiopathologie, Pharmacologie et Ingénierie articulaires (PPIA), Université Henri Poincaré - Nancy 1 (UHP)-Centre National de la Recherche Scientifique (CNRS), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Rhumatologie, CHU Brugmann, CHU Brugmann, Belgium, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), 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, Hôpital Sud, Université de Rennes 1 (UR1), 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 ), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Ambroise Paré, Centre de Recherche Saint-Antoine (CR Saint-Antoine), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Pierre et Marie Curie - Paris 6 (UPMC), Service de Rhumatologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Pitié-Salpêtrière [APHP], CHU Cochin [AP-HP]-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), 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), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Cochin [AP-HP], Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, Université de Rennes 1 ( UR1 ), 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 ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Ambroise Paré, Physiopathologie, Pharmacologie et Ingénierie articulaires ( PPIA ), Université Henri Poincaré - Nancy 1 ( UHP ) -Centre National de la Recherche Scientifique ( CNRS ), Centre de Recherche Saint-Antoine ( CR Saint-Antoine ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Pitié-Salpêtrière [APHP], Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP], Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité ( CRESS (U1153 / UMR_A 1125) ), and Institut National de la Recherche Agronomique ( INRA ) -Université Sorbonne Paris Cité ( USPC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, Settore MED/16 - REUMATOLOGIA, MESH: Synovitis, MESH : Aged, Arthritis, Severity of Illness Index, Arthritis, Rheumatoid, 0302 clinical medicine, Cohen's kappa, Rheumatoid, [ SDV.IMM ] Life Sciences [q-bio]/Immunology, Immunology and Allergy, MESH : Female, MESH : Joints, Ultrasonography, MESH : Synovitis, MESH: Aged, MESH: Arthritis, Rheumatoid, MESH: Middle Aged, Synovitis, Disease activity score-28, Technician, Middle Aged, Reference Standards, Reproducibility, MESH: Reproducibility of Results, MESH: Joints, Rheumatoid arthritis, [SDV.IMM]Life Sciences [q-bio]/Immunology, MESH : Severity of Illness Index, MESH: Reference Standards, Female, musculoskeletal diseases, medicine.medical_specialty, MESH : Male, Immunology, Rheumatoid Arthritis, Disease activity, 03 medical and health sciences, Rheumatology, MESH: Severity of Illness Index, Severity of illness, medicine, Humans, MESH : Middle Aged, Joint swelling, Aged, 030203 arthritis & rheumatology, MESH: Humans, business.industry, MESH : Reproducibility of Results, MESH : Humans, Reproducibility of Results, medicine.disease, MESH: Male, MESH : Reference Standards, MESH : Arthritis, Rheumatoid, Physical therapy, Joints, business, MESH: Female, 030215 immunology
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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8. The Inactivation Principle: Mathematical Solutions Minimizing the Absolute Work and Biological Implications for the Planning of Arm Movements

Author

Frédéric Jean, Bastien Berret, Thierry Pozzo, Jean-Paul Gauthier, Charalambos Papaxanthis, Christian Darlot, Autard, Delphine, Motricité - Plasticité, Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Nationale Supérieure des Télécommunications (ENST), École Nationale Supérieure de Techniques Avancées (ENSTA Paris), Istituto Italiano di Tecnologia (IIT), Laboratoire des Sciences de l'Information et des Systèmes (LSIS), Aix Marseille Université (AMU)-Université de Toulon (UTLN)-Arts et Métiers Paristech ENSAM Aix-en-Provence-Centre National de la Recherche Scientifique (CNRS), This work is in part supported by the Centre National d'Etudes Spatiales and the Conseil Régional de Bourgogne, Centre National de la Recherche Scientifique (CNRS)-Arts et Métiers Paristech ENSAM Aix-en-Provence-Université de Toulon (UTLN)-Aix Marseille Université (AMU), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Ecole Nationale Supérieure des Télécommmunications [Paris] ( ENST Paris ), ENST Paris, École Nationale Supérieure de Techniques Avancées ( Univ. Paris-Saclay, ENSTA ParisTech ), Istituto Italiano di Tecnologia ( IIT ), Laboratoire des Sciences de l'Information et des Systèmes ( LSIS ), and Aix Marseille Université ( AMU ) -Université de Toulon ( UTLN ) -Arts et Métiers Paristech ENSAM Aix-en-Provence-Centre National de la Recherche Scientifique ( CNRS )

Subjects
Male, MESH: Range of Motion, Articular, MESH : Physical Exertion, MESH : Movement, Optimality criterion, [SDV.MHEP.PHY] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Computer science, MESH: Muscle Contraction, MESH: Gravitation, MESH : Models, Biological, MESH: Movement, Kinematics, MESH: Postural Balance, MESH : Gravitation, 0302 clinical medicine, Neuroscience/Motor Systems, MESH : Feedback, MESH : Biomechanics, Range of Motion, Articular, MESH: Arm, MESH : Joints, lcsh:QH301-705.5, Postural Balance, MESH: Biomechanics, 0303 health sciences, Neuroscience/Behavioral Neuroscience, Ecology, [ SDV.MHEP.PHY ] Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], MESH: Feedback, MESH : Adult, Biomechanical Phenomena, Mathematical theory, MESH: Joints, Computational Theory and Mathematics, Modeling and Simulation, Arm, Research Article, Gravitation, Muscle Contraction, Computer Science/Systems and Control Theory, Adult, MESH : Male, Movement, Physical Exertion, Computational Biology/Computational Neuroscience, MESH: Psychomotor Performance, Models, Biological, MESH : Arm, Feedback, MESH: Physical Exertion, 03 medical and health sciences, Cellular and Molecular Neuroscience, MESH : Postural Balance, Control theory, [SDV.MHEP.PHY]Life Sciences [q-bio]/Human health and pathology/Tissues and Organs [q-bio.TO], Genetics, Humans, Neuroscience/Theoretical Neuroscience, Molecular Biology, Ecology, Evolution, Behavior and Systematics, Simulation, 030304 developmental biology, MESH: Humans, MESH : Humans, Work (physics), MESH: Models, Biological, Motor control, MESH: Adult, MESH : Psychomotor Performance, Function (mathematics), Optimal control, MESH: Male, Term (time), MESH : Range of Motion, Articular, lcsh:Biology (General), MESH : Muscle Contraction, Joints, 030217 neurology & neurosurgery, Mathematics, Psychomotor Performance
Abstract

An important question in the literature focusing on motor control is to determine which laws drive biological limb movements. This question has prompted numerous investigations analyzing arm movements in both humans and monkeys. Many theories assume that among all possible movements the one actually performed satisfies an optimality criterion. In the framework of optimal control theory, a first approach is to choose a cost function and test whether the proposed model fits with experimental data. A second approach (generally considered as the more difficult) is to infer the cost function from behavioral data. The cost proposed here includes a term called the absolute work of forces, reflecting the mechanical energy expenditure. Contrary to most investigations studying optimality principles of arm movements, this model has the particularity of using a cost function that is not smooth. First, a mathematical theory related to both direct and inverse optimal control approaches is presented. The first theoretical result is the Inactivation Principle, according to which minimizing a term similar to the absolute work implies simultaneous inactivation of agonistic and antagonistic muscles acting on a single joint, near the time of peak velocity. The second theoretical result is that, conversely, the presence of non-smoothness in the cost function is a necessary condition for the existence of such inactivation. Second, during an experimental study, participants were asked to perform fast vertical arm movements with one, two, and three degrees of freedom. Observed trajectories, velocity profiles, and final postures were accurately simulated by the model. In accordance, electromyographic signals showed brief simultaneous inactivation of opposing muscles during movements. Thus, assuming that human movements are optimal with respect to a certain integral cost, the minimization of an absolute-work-like cost is supported by experimental observations. Such types of optimality criteria may be applied to a large range of biological movements., Author Summary When performing reaching and grasping movements, the brain has to choose one trajectory among an infinite set of possibilities. Nevertheless, because human and animal movements provide highly stereotyped features, motor strategies used by the brain were assumed to be optimal according to certain optimality criteria. In this study, we propose a theoretical model for motor planning of arm movements that minimizes a compromise between the absolute work exerted by the muscles and the integral of the squared acceleration. We demonstrate that under these assumptions agonistic and antagonistic muscles are inactivated during overlapping periods of time for quick enough movements. Moreover, it is shown that only this type of criterion can predict these inactivation periods. Finally, experimental evidence is in agreement with the predictions of the model. Indeed, we report the existence of simultaneous inactivation of opposing muscles during fast vertical arm movements. Therefore, this study suggests that biological movements partly optimize the energy expenditure, integrating both inertial and gravitational forces during the motor planning process.

Published
2008
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9. Motor compensation and recovery for reaching in stroke patients

Author

Roby-Brami, Agnès, Feydy, A., Combeaud, M., Biryukova, E. V., Bussel, B., Levin, M. F., Neurophysique et physiologie du système moteur (NPSM), Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS), Department of Neurological Rehabilitation, Hôpital Raymond Poincaré [AP-HP], Plasticité cérébrale et adaptations des fonctions visuelles et motrices, Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Higher Nervous Activity, Russian Academy of Sciences [Moscow] (RAS), School of rehabilitation, Rehabilitation Institute of Montreal, AP-HP Hôpital Raymond Poincaré [Garches], Neurophysique et physiologie du système moteur ( NPSM ), Université Paris Descartes - Paris 5 ( UPD5 ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Russian Academy of Sciences [Moscow] ( RAS ), and Lamotte D'Incamps, Boris

Subjects
Adult, Male, MESH : Case-Control Studies, MESH : Movement, MESH : Male, Movement, Posture, MESH : Aged, MESH: Movement, MESH: Psychomotor Performance, Motor Activity, MESH: Cerebrovascular Accident, MESH : Biomechanics, Humans, MESH : Middle Aged, MESH : Female, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Longitudinal Studies, MESH: Longitudinal Studies, MESH : Joints, MESH: Biomechanics, Aged, MESH : Longitudinal Studies, MESH: Aged, MESH: Middle Aged, MESH: Humans, MESH : Humans, MESH : Posture, Stroke Rehabilitation, MESH: Adult, MESH: Posture, MESH : Psychomotor Performance, MESH : Adult, Middle Aged, MESH: Case-Control Studies, MESH: Motor Activity, MESH: Male, Biomechanical Phenomena, Stroke, MESH: Joints, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Case-Control Studies, Female, Joints, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], MESH : Cerebrovascular Accident, MESH : Motor Activity, MESH: Female, Psychomotor Performance
Abstract

OBJECTIVES: To examine the mechanisms of alternative strategies developed by stroke patients to compensate their motor impairment and their role in recovery. MATERIAL AND METHODS: The three-dimensional kinematics of the upper limb were quantified during unconstrained reaching movements in seven healthy individuals and in 15 stroke patients. Nine patients were followed-up. Individual observations were correlated with anatomical and functional brain imaging described elsewhere (Feydy et al. Stroke 2002;33:1610). RESULTS: Healthy subjects used mainly elbow extension and shoulder flexion, scaled to movement distance. Patients with hemiparesis because of stroke used different patterns of joint recruitment with different scaling rules. Patients with the greatest impairment compensated by recruiting extra degrees of freedom, particularly trunk bending. Improvement was because of a restoration towards a normal movement pattern (recovery) and/or to a reinforcement of compensation, which led to a poorer outcome. CONCLUSION: Individual behavioural data are necessary to discuss the mechanisms of functional improvement following stroke with respect to recovery and/or compensation.

Published
2003

10. Hand orientation for grasping and arm joint rotation patterns in healthy subjects and hemiparetic stroke patients

Author

Nezha Bennis, Stéphane Jacobs, Agnès Roby-Brami, Mindy F. Levin, Neurophysique et physiologie du système moteur (NPSM), Université Paris Descartes - Paris 5 (UPD5)-Centre National de la Recherche Scientifique (CNRS), Department of Neurological Rehabilitation, Hôpital Raymond Poincaré [AP-HP], School of rehabilitation, Rehabilitation Institute of Montreal, Lamotte D'Incamps, Boris, AP-HP Hôpital Raymond Poincaré [Garches], Neurophysique et physiologie du système moteur ( NPSM ), and Université Paris Descartes - Paris 5 ( UPD5 ) -Centre National de la Recherche Scientifique ( CNRS )

Subjects
Male, Elbow, MESH : Aged, Wrist, Rotation, MESH : Rotation, MESH : Paresis, 0302 clinical medicine, MESH: Rotation, Orientation (geometry), MESH: Cerebrovascular Accident, MESH : Biomechanics, MESH : Female, MESH: Arm, MESH : Joints, MESH: Biomechanics, MESH: Aged, MESH: Middle Aged, Hand Strength, General Neuroscience, 05 social sciences, MESH : Hand, Middle Aged, MESH : Adult, Biomechanical Phenomena, Paresis, Stroke, MESH: Joints, medicine.anatomical_structure, MESH: Hand Strength, MESH : Brain Damage, Chronic, Arm, Brain Damage, Chronic, Female, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], medicine.symptom, MESH : Hand Strength, MESH : Orientation, Adult, medicine.medical_specialty, MESH : Male, MESH: Orientation, 050105 experimental psychology, MESH : Arm, MESH: Hand, 03 medical and health sciences, MESH: Paresis, Physical medicine and rehabilitation, Orientation, Motor system, medicine, Humans, 0501 psychology and cognitive sciences, MESH : Middle Aged, [SDV.NEU] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Molecular Biology, Aged, MESH: Humans, business.industry, MESH : Humans, MESH: Adult, Hand, Horizontal plane, MESH: Male, Hemiparesis, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Physical therapy, Joints, Shoulder joint, Neurology (clinical), MESH: Brain Damage, Chronic, business, MESH : Cerebrovascular Accident, MESH: Female, 030217 neurology & neurosurgery, Developmental Biology
Abstract

We previously demonstrated that the hand orientation for grasping (azimuth) is strongly coupled to arm movement direction in the horizontal plane. The question is whether this coupling is directly controlled or secondary to a regulation of the arm angular configuration. To this purpose, we quantified hand orientation and arm joint rotations during unconstrained reaching movements in healthy subjects and in patients with hemiparesis due to stroke since they use altered joint rotation patterns for reaching. Seven healthy subjects and eight patients with a right hemiparesis participated (four had a moderate and four had a mild disorder). Four electromagnetic sensors were used to measure hand orientation and to compute the wrist, elbow and shoulder joint angles. Hand azimuth at the time of grasping was correlated to arm movement direction in all the healthy and hemiparetic individuals. In healthy subjects, a regression analysis of the arm joint rotations suggested that the coupling between hand azimuth and movement direction was not due to a correlation with a particular degree of freedom. Patients used different hand orientations for grasping and different joint rotation patterns that varied according to their level of disability and the use of compensatory strategies. The findings observed in both healthy subjects and patients with stroke show that the coupling of hand azimuth for grasping to movement direction was controlled independently of the set of joint rotations used for reaching. This suggests that it is a basic synergy directly controlled by the motor system.

Published
2003

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