Showing papers by "Maxime Dougados published in 1999"

Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis.

Abstract: Our aim was to determine whether C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) is more appropriate in measuring disease activity in ankylosing spondylitis (AS). We studied 191 consecutive outpatients with AS in The Netherlands, France, and Belgium. Patients were attending secondary and tertiary referral centers. The external criterion for disease activity was: physician and patient assessment of disease activity on a visual analog scale (VAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). In each measure we defined 3 levels of disease activity: no activity, ambiguous activity, and definite disease activity. The patients with AS (modified New York criteria) were divided into 2 groups: those with spinal involvement only (n=149) and those who also had peripheral arthritis and/or inflammatory bowel disease (IBD) (n=42). For each criterion of disease activity, the patients with no activity and with definite activity were included in receiver operator curves and used to determine cutoff values with the highest sensitivity and specificity. We also calculated Spearman correlations. The median CRP and ESR were 16 mg/l and 13 mm/h, respectively, in the spinal group and 25 mg/l and 21 mm/h, respectively, in the peripheral/IBD group. In both groups the Spearman correlation coefficients between CRP and ESR were around 0.50. There was moderate to poor correlation between CRP, ESR, and the 3 disease activity variables (0.06-0.48). Sensitivity for both ESR and CRP was 100% for physician assessment and between 44 and 78% for patient assessment of disease activity and the BASDAI, while specificity was between 44 and 84% for all disease activity measures. The positive predictive values of CRP and ESR in our setting were low (0.15-0.69). We conclude that neither CRP nor ESR is superior to assess disease activity.

Selection of instruments in the core set for DC-ART, SMARD, physical therapy, and clinical record keeping in ankylosing spondylitis. Progress report of the ASAS Working Group. Assessments in Ankylosing Spondylitis.

Abstract: To select specific instruments for each domain of the core set for endpoints in ankylosing spondylitis (AS), we gathered all instruments described in the literature to assess the domains chosen as endpoints in AS and sent them to 43 members of the Assessments in Ankylosing Spondylitis (ASAS) Working Group The following domains were taken into account: function, pain, spinal mobility, patient global assessment, morning stiffness, peripheral joints and entheses, acute phase reactants, x-ray spine, x-ray hips, fatigue For each instrument the members were asked to judge if the instrument was feasible and relevant If an instrument was judged to be not feasible or not relevant by more than 50% of the respondents the instrument was deleted from the list These data were presented during an ASAS workshop and the final decisions were about which instruments to include in the core set This process was repeated separately for the settings disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD) and physical therapy, and clinical record keeping The response rate to the questionnaire was 72% For each domain one or more instruments were selected, except for Entheses and Fatigue The chosen instruments were similar for the 3 above settings Core sets of specific instruments were selected for the OMERACT filter test for relevance and feasibility For all these instruments the remaining aspects of the OMERACT filter (truth and discrimination) should be assessed by literature review and if needed by additional research It is recommended to use these instruments in all research projects in AS

Combination therapy in early rheumatoid arthritis: a randomised, controlled, double blind 52 week clinical trial of sulphasalazine and methotrexate compared with the single components

Abstract: Objectives—To investigate the potential clinical benefit of a combination therapy Methods—205 patients fulfilling the ACR criteria for rheumatoid arthritis (RA), not treated with disease modifying antirheumatoid drugs previously, with an early ( 30), rheumatoid factor and/or HLA DR 1/4 positive disease were randomised between sulphasalazine (SASP) 2000 (maximum 3000) mg daily (n = 68), or methotrexate (MTX) 75 (maximum 15) mg weekly (n = 69) or the combination (SASP + MTX) of both (n = 68) Results—The mean changes in the DAS during the one year follow up of the study was ˛115, ˛087, ˛126 in the SASP, MTX, and SASP + MTX group respectively (p = 0019) However, there was no statistically significant diVerence in terms of either EULAR good responders 34%, 38%, 38% or ACR criteria responders 59%, 59%, 65% in the SASP, MTX, and SASP + MTX group respectively Radiological progression evaluated by the modified Sharp score was very modest in the three groups: mean changes in erosion score: +24, +24, +19, in narrowing score: +23, +21, +16 and in total damage score: +46, +45, +35, in the SASP, MTX, and SASP + MTX groups respectively Adverse events occurred more frequently in the SASP + MTX group 91% versus 75% in the SASP and MTX group (p = 0025) Nausea was the most frequent side eVect: 32%, 23%, 49% in the SASP, MTX, and SASP + MTX groups respectively (p = 0007) Conclusion—This study suggests that an early initiation therapy of disease modifying drug seems to be of benefit However, this study was unable to demonstrate a clinically relevant superiority of the combination therapy although several outcomes were in favour of this observation The tolerability of the three treatment modalities seems acceptable (Ann Rheum Dis 1999;58:220‐225)

Effects of joint lavage and steroid injection in patients with osteoarthritis of the knee: results of a multicenter, randomized, controlled trial.

Abstract: Objective To evaluate the efficacy of joint lavage and intraarticular steroid injection, alone and in combination, in the treatment of patients with symptomatic knee osteoarthritis (OA). Methods Ninety-eight patients with painful tibiofemoral OA were enrolled in a prospective, randomized, controlled, 2 × 2 factorial–design trial of 6 months' duration. The 4 treatment groups consisted of 1) intraarticular placebo (1.5 ml of 0.9% normal saline), 2) intraarticular corticosteroids (3.75 mg of cortivazol in 1.5 ml), 3) joint lavage and intraarticular placebo, and 4) joint lavage and intraarticular corticosteroid. Outcome measures evaluated at baseline, week 1, week 4, week 12, and week 24 included severity of pain (100-mm visual analog scale [VAS]), global status (100-mm VAS), and Lequesne's functional index. Results No interaction between steroid injection and joint lavage was demonstrated. Patients who had undergone joint lavage had significantly improved pain VAS scores at week 24 (P = 0.020). In contrast, corticosteroid injection had no long-term effect (P = 0.313); corticosteroid injection was associated with a decrease in pain only at week 1 (P = 0.003) and week 4 (P = 0.020). After week 4, Lequesne's functional index was not significantly improved regardless of the assigned treatment. Conclusion Compared with placebo, both treatments significantly relieved pain but did not improve functional impairment. The effects of the 2 treatments were additive. Cortivazol provided short-term relief of pain (up to week 4). The effects of joint lavage persisted up to week 24.

Interpreting the clinical significance of the differential inhibition of cyclooxygenase-1 and cyclooxygenase-2

Abstract: The International Consensus Meeting on the Mode of Action of COX-2 Inhibition (ICMMAC) brought together 17 international experts in arthritis, gastroenterology and pharmacology on 5 6 December 1997. The meeting was convened to provide a definition of COX-2 specificity and to consider the clinical relevance of COX-2-specific agents. These compounds are a new class of drugs that specifically inhibit the enzyme COX-2 while having no effect on COX-1 across the whole therapeutic dose range. The objectives of the meeting were to review the currently available data regarding the roles and biology of COX-1 and COX-2, and to foster a consensus definition on COX-2 specificity. At the present time, no guidelines exist for the in vitro and in vivo assessment of COX specificity, and it was felt that consensus discussion might clarify some of these issues. The meeting also reviewed recent clinical data on COX-2-specific inhibitors. The following article reflects discussion at this meeting and provides a consensus definition of COX-2-specific inhibitors.

Defining disease activity in ankylosing spondylitis: is a combination of variables (Bath Ankylosing Spondylitis Disease Activity Index) an appropriate instrument?

Abstract: Objective Disease activity has been defined using a self-administered instrument, focusing on fatigue, axial pain, peripheral pain, enthesopathy and morning stiffness [Bath Ankylosing Spondylitis Disease Activity Index (BASDAI)]. This validated instrument is simple and takes 40 s to complete, but whether the index is an accurate expression of the component parts, or whether additional weighting would enhance its efficacy, is unclear. Methods Four hundred and seventy-three patients with ankylosing spondylitis received placebo or active non-steroidal anti-inflammatory drug (NSAID) for 6 weeks, and changes between entry and completion were captured by BASDAI and the individual components. Principle component analysis (PCA) was used to explore the best combinations of variables in decreasing order of explained total dispersion and to assess whether a single sum (or algebraic expression) best defined disease activity status. Results At entry, the correlation between BASDAI and the first axis was 0.99, 0.11 with the second, and zero thereafter. Data at study end and relating to change revealed a 100% correlation (R = 1) between the first axis and the sum, with zero for the remainder. Conclusions The data support BASDAI as being a valid and appropriate composite to define disease activity in ankylosing spondylitis. Developed as a simple sum of its components, BASDAI has excellent content validity.

Osteoporosis, body composition, and bone turnover in ankylosing spondylitis.

Abstract: Objective. To study the prevalence of osteoporosis (OP) and osteopenia in ankylosing spondylitis (AS) and to investigate the relationship between symptomatic and structural severity, the indices of bone turnover, and body composition. Methods. Eighty patients with AS were enrolled prospectively: 52 men (65%) and 28 women, mean age 36.7 years ± 11.5 (range 18-67); they were studied clinically, radiologically, and by dual energy x-ray absorptiometry. Sixty-three underwent biological assessment of bone turnover markers. Results. OP and osteopenia as defined by the World Health Organization (T score < -2.5 SD and between-1 and -2.5 SD, respectively) were observed in 15 (18.7%) and 25 patients (31.2%) at the lumbar spine and in 11 (13.7%) and 33 patients (41.2%) at the femoral neck, respectively. Patients with OP had a lower body mass index (BMI) and fat mass percentage. There was a trend to a lower disease duration in patients with OP at the spine than in healthy subjects. Bone resorption markers (urinary D-pyridinoline or C-telopeptide concentrations) were increased in 34 patients (53.9%). Bone turnover markers were positively correlated with C-reactive protein concentration and Larsen radiological hip score; they were negatively correlated with Schober index and fat mass percentage. Conclusion. (1) OP is frequent in AS and can be observed in early stages of the disease. (2) Patients with AS are more susceptible to develop OP when they have low BMI, low fat mass percentage, and active and severe disease. OP was observed in parallel with increased bone resorption.

Ankylosing spondylitis: what is the optimum duration of a clinical study? A one year versus a 6 weeks non-steroidal anti-inflammatory drug trial.

Abstract: Objective. To consider the relevance of the duration of a clinical trial in ankylosing spondylitis: long-term (i.e. 1 yr) vs short-term (i.e. 6 weeks) assessment of a non-steroidal anti-inflammatory drug (NSAID) placebo controlled study. Methods. The design was a prospective, multicentre, double-blind, placebo-controlled study of 6 weeks duration with a 12 months double-blind extension. Study drugs were placebo (n = 121) or active NSAID (n = 352). A decrease of at least 50% in pain and/or global assessment and/or functional impairment during the study defined the response to treatment. The percentage of patients discontinuing the study drug over time (life table analysis) permitted the evaluation of both the efficacy and toxicity. Results. Among the 473 recruited patients, the percentage of responders was similar at I yr and week 6 with a highly statistically significant difference in favour of the active NSAID groups when compared to placebo (at 1 yr, 17% in the placebo group vs 37, 50 and 43% in the piroxicam 20 mg, meloxicam 15 mg and meloxicam 22.5 mg, respectively, for the patient's overall assessment) without any statistically significant difference between the three active groups. However, evaluation of the patients discontinuing the study drug during the I yr of the study permitted the detection of a statistically significant difference between the active NSAID groups. A lower percentage of patients taking meloxicam 22.5 mg had to discontinue the study drug when compared to either meloxicam 15 mg or piroxicam 20 mg (37% vs 53% and 53%, respectively, P < 0.05). By 52 weeks, drug-related upper gastrointestinal adverse events occurred in 13, 32, 20 and 18% in the placebo, piroxicam 20 mg. meloxicam 15 mg and meloxicam 22.5 mg groups, respectively. Some of the adverse events occurred only after week 6. Conclusion. This study suggests that a I yr trial might be of optimum value compared to a 6 week assessment in order to define better the efficacy and tolerability of NSAIDs in ankylosing spondylitis.

Individual smallest detectable difference in bone mineral density measurements.

Abstract: Bone mineral density (BMD) measurement is a major outcome measure in osteoporosis. The BMD changes observed must exceed the variability inherent in the measurement process to be considered related to disease progression. The objective of the study was to estimate short-term variability of BMD measurement and to propose a cut-off value for the smallest detectable BMD changes for an individual. To estimate the short-term variability, 70 healthy postmenopausal women aged 53 +/- 4 years (group 1) and 57 elderly osteoporotic postmenopausal women aged 80 +/- 6 years (group 2) had two repeated BMD measurements of the lumbar spine (L2-L4) and the proximal femur with dual-energy X-ray absorptiometry, with complete repositioning within 1 h. Cut-offs derived from short-term variability were either estimated from the coefficient of variation (CV) (which is a function of the measured value) or from the standard deviation (SD), and applied to 330 postmenopausal women (group 3) who had BMD measurements at baseline and 2 years later. The short-term intrasubject variability was greater at the lumbar spine in group 2 versus group 1 (0.0123 vs. 0.0059 g/cm2, p < 10-4), whereas it was not at the femoral neck (0.0098 vs. 0.0076 g/cm2, p = 0.28). There was no statistically significant correlation between short-term intrasubject variability (SD) and BMD as demonstrated with an analysis of covariance (p values ranging from 0.17 to 0.90). Cut-offs estimated with SD and CV were individually applied to group 3 patients. Using these two cut-offs, discrepancies in assessment of progression were observed in 1.7-8.6% of cases. Short-term BMD variability is constant in a wide range of BMD values. Consequently, to determine cut-off values for the smallest detectable differences in BMD at the individual level, precision errors should be based on SD (expressed in absolute units) rather than on CV (expressed in percentage).

Clinical relevance of C-reactive protein in axial involvement of ankylosing spondylitis.

Abstract: To evaluate C-reactive protein (CRP) as a potential useful criterion of symptomatic severity of ankylosing spondylitis (AS), we conducted both a cross sectional and a longitudinal (6 week) clinical study in 443 patients with axial involvement in AS. During the 6 weeks of the study, patients received either a placebo or an active nonsteroidal antiinflammatory drug (NSAID). At baseline, CRP was increased in 173 patients (39%). A multivariate analysis in which CRP was the dependent variable and all clinical assessment criteria (pain, range of motion, functional disability, hemoglobin, platelet count) the independent variables showed that range of motion and laboratory signs of inflammation were the most significant variables to explain the CRP values. A similar multivariate analysis conducted on the changes in the variables during the 6 weeks of the study concluded that night pain and laboratory signs of inflammation were the most significant variables explaining the changes in CRP values. The capacity of CRP to discriminate between an active NSAID and a placebo was moderate. This study suggests than an increase in CRP in patients with AS with axial involvement is not a rare phenomenon and might be correlated with the clinical severity of the disease. This outcome measure does not seem to be of great interest in the short term evaluation of fast acting drugs. However, the longterm clinical significance of such an increase in CRP remains to be investigated.

A comparative study of the usefulness of the Bath Ankylosing Spondylitis Functional Index and the Dougados Functional Index in the assessment of ankylosing spondylitis.

Abstract: To determine whether the Bath Ankylosing Spondylitis Functional Index (BASFI, score 0-10) or Dougados Functional Index (DFI, score 0-40) is superior in measuring physical function in ankylosing spondylitis (AS) we studied 191 consecutive outpatients with AS in the Netherlands, France, and Belgium. The participating centers are secondary and tertiary referral centers. The external criterion for disease activity (DA) was: both patient and physician assessment of disease activity on a visual analog scale (VAS) and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The external criterion for damage was 2 radiological scores of the spine; BASRI-s (Bath Ankylosing Spondylitis Radiology Index-spine) and a modified SASSS (Stoke Ankylosing Spondylitis Spine Score). Median scores for BASFI and DFI were 2.5 (range 0-10) and 8.5 (range 0-35), respectively. Spearman correlation coefficient between both indexes was 0.89. The average correlation with disease activity variables was 0.42 for BASFI and 0.41 for DFI. For both BASFI and DFI the correlation with BASRI-s was 0.42 and with SASSS 0.36. When distinguishing between patients with high and low disease activity, sensitivity for both indexes was between 76 and 94%, while specificity was between 66 and 87% for all 3 DA measures. Average misclassification between BASFI, DFI and DA was 23 and 27%, respectively. Both BASFI and DFI correlate equally well with disease activity and damage.

Ankylosing spondylitis: plenary discussion and results of voting on selection of domains and some specific instruments.

Abstract: 1003 Participants of the OMERACT Conference received the aims and outline of the ankylosing spondylitis (AS) module before the meeting, together with the key paper on selection of domains by the Assessments in Ankylosing Spondylitis (ASAS) Working Group, as well as a summary of the consensus procedure on selection of specific instruments1,2. After presentation of the papers in the plenary session, followed by selection of a core set based on cluster analysis, the audience was given the opportunity to discuss the presented data3. The majority of the audience agreed on the proposed core sets by the ASAS Working Group and on the selection of the specific instruments. A few items were brought for amendment. One important issue was the domain “fatigue.” This was put on the list as a potentially important domain for the disease controlling antirheumatic therapy (DC-ART) core set, but was left out during the further process of selection of specific instruments because no available instrument was considered relevant by more than 50% of the ASAS members2. The audience strongly recommended that despite this, fatigue should remain on the research agenda. Another item brought for amendment, “entheses,” had been included under the domain “peripheral joints and entheses”; however, no specific instrument was recommended to assess the entheses, because again no available instrument was considered relevant by at least 50% of the ASAS members. Some participants judged enthesopathy as one of the 4 key areas in AS: axial involvement, peripheral joints, extraspinal and extraarticular manifestations, and enthesopathy. It was decided that further research should be done on instruments to assess involvement of entheses in AS, an important and rather specific feature of AS (Table 1). To ensure uniformity between the core sets for the various settings, it was concluded that a common core should be defined for all 3 settings. This core was the set defined for the symptom modifying antirheumatic drugs (SMARD)/ physical therapy setting. In addition, a few other domains were to be added for clinical record keeping and other domains for the DC-ART setting. This could be achieved by defining domains “spinal stiffness” and “acute phase reactants” (not originally included definitely by the ASAS group) unconditionally in the core set for DC-ART. Figure 1 shows the included domains for the 3 settings. Also, the process and the results of the selection of the specific instruments were endorsed by the audience as a starting point for further research2. Thereafter an attempt was made to address the remaining issues about preferences for either erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and preferences for either the Bath Ankylosing Spondylitis Function Index (BASFI) or Dougados Functional Index Ankylosing Spondylitis: Plenary Discussion and Results of Voting on Selection of Domains and Some Specific Instruments

Radiological scoring methods in ankylosing spondylitis: reliability and sensitivity to change over one year.

Abstract: Our aim was to compare reliability and sensitivity to change of different radiological scoring methods in ankylosing spondylitis (AS). Two trained observers scored 30 AS radiographs twice with an interval of 4 weeks. The same two observers scored 187 AS radiographs in pairs, at baseline and after one year followup, to measure change and agreement on change. The sacroiliac (SI) joints were scored in 5 grades by the New York method and the SASSS (Stoke Ankylosing Spondylitis Spine Score). Hips were graded 0-5 (according to Larsen). Cervical and lumbar spine were graded (0-4, Bath Ankylosing Spondylitis Radiological Index, BASRI), and scored in detail (0-72, SASSS). SASSS of the cervical and lumbar spine scored on the anterior sites of the vertebrae proved most reliable, with both intra and interobserver intraclass correlation coefficients (ICC) between 0.87 and 0.97. BASRI was only moderately reliable, with Cohen's kappa ranging between 0.50 and 0.82 for intra, and 0.38-0.64 for interobserver reliability. Similarly, SI joint scores (New York, SASSS) showed intraobserver kappa between 0.56 and 0.84, and interobserver reliability with kappa between 0.37 and 0.47. Larsen hip scores proved unreliable: moderate intraobserver kappa of 0.47-0.58 and low interobserver kappa of 0.29. After retraining, interobserver kappa did not improve (0.45 and 0.17). In retrospect, a one year period was too short to measure sensitivity to change. Observers agreed that no change occurred in up to 89% of cases. A measurable change of deterioration or improvement occurred rarely. We conclude that in AS, only the SASSS method for the spine and the BASRI reached good reliability. Other methods for spine, SI joints, and hips were moderately reliable at best. There was moderate to good agreement on no change between the observers. No method showed change over a period of one year in a considerable number of patients.

Treatment of patients with Paget's disease of bone.

Abstract: Paget's disease is a progressive bone disease, monostotic or polyostotic, characterised by hypertrophy of affected bones and accelerated disorganised bone remodelling It results in bone deformities and pain, with a risk for articular and neurological complications, and fractures The risk of complications, and thus the therapeutic decision, is a function of the age of the patient, and the severity and the activity of the disease Bisphosphonates are first-line therapy for Paget's disease, and the advent of the new bisphosphonates permits a dramatic improvement in treatment The optimal treatment regimen should obtain normalisation or quasi-normalisation of markers of bone remodelling This result has the potential for a long-term control of the disease

Outcome variables in Ankylosing spondylitis : Evaluation of their relevance and discriminant capacity

Abstract: The clinical status of ankylosing spondylitis (AS) can be defined by several domains (e.g., pain, function, metrology, laboratory) and subcomponents within each domain (e.g., pain using visual analog scale, Schober's within metrology). Our aim was (1) To define groups of highly correlated variables in order to determine the most relevant; and (2) to evaluate the capacity of different clinical and biological variables that best discriminate between placebo and active nonsteroidal drugs in AS. Patients with active AS (n=423) were followed prospectively over 6 weeks while receiving placebo (n=121) or active nonsteroidal antiinflammatory drugs (n=352). Eighteen variables were studied, including global assessment, pain, stiffness, functional indices, metrology, disease activity index, and laboratory markers. Statistics included (1) Evaluation of the relevance of the different domains by multivariate analysis (CART tree-structure classification; variable clustering); and (2) evaluation of the discriminant capacity by univariate analysis [i.e., differences in the standardized response mean (SRM) (mean change/SD) between placebo and active drug. A value > or =0.60 was considered relevant]. Four clusters were identified (patient's subjective perception, inflammatory symptoms, metrology, laboratory data) with multiple correlation R2 revealing the most relevant variables to be the Bath Ankylosing Spondylitis Functional Index (BASFI; 0.75), night pain (0.62), Schober's test (0.58), and platelet count (0.55), respectively, within each cluster. In terms of discriminant power (SRM) the patient perceived global status (0.84), lumbar pain (0.73), night pain (0.71), physician global assessment (0.66), and BASFI (0.65) were most relevant in the univariate analysis. Among the 4 most relevant domains are subjective perception, inflammatory symptoms, metrology, and laboratory. Multivariate analysis of the data reveals that the spinal pain and the patient global assessment are the variables that best discriminate between placebo and active nonsteroidal drug in short term studies.

Accuracy and precision of 62 bone densitometers using a European Spine Phantom.

Abstract: Dual-energy absorptiometry (DXA) is widely used for bone mineral density measurements. Different types of devices are available. Differences between devices from either the same manufacturer or different manufacturers can lead to difficulties in clinical practice when patients are followed on different machines. We calculated the accuracy and precision of 62 DXA devices from two manufacturers (51 Hologic, 11 Lunar) using a European Spine Phantom (ESP, semi-anthropomorphic). The ESP was measured 5 times on each device without repositioning. Accuracy was assessed by comparing bone mineral density (BMD, g/cm2) values measured on each device with the actual value of the phantom. Precision was assessed by the coefficient of variation (CVsd), using the root mean square average. The limits of agreement were estimated from the differences between each replicate measurement of BMD and the estimated true value for a particular manufacturer, according to Bland and Altman. The results confirm the difference between devices from different manufacturers (18.5%). Mean CVsd values were 0.57% and 0.64% for Hologic and Lunar respectively. The limits of agreement among devices from the same manufacturer were 0.026 g/cm2 and 0.025 g/cm2 for Hologic and Lunar respectively. Differences in extreme results between devices from the same manufacturer were on average 5.4% and 3.6% for Hologic and Lunar respectively. Results of different devices from the same manufacturer are highly comparable, although unpredictable differences exist that may be clinically relevant.

Arthroscopic evaluation of post-traumatic patellofemoral chondropathy.

Abstract: OBJECTIVE To evaluate clinically and arthroscopically post-traumatic patellofemoral chondropathy. METHODS Fifty-nine patients with post-traumatic patellofemoral chondropathy were included in a cross sectional study and 46 of them completed a 6 month longitudinal study. Evaluation of the disease, performed once in the cross sectional study and twice (at entry and after 6 months) in the longitudinal study, included clinical and arthroscopic variables evaluating disease activity and severity. Arthroscopy was performed under local anesthesia in an outpatient procedure using a small arthroscope. Chondropathy was evaluated by the overall assessment of the investigator using a visual analog scale, and by the Societe Francaise d'Arthroscopie (SFA) scoring system (SFA score: 0-100). Synovitis was assessed by the "synovitis score," which represents a composite index taking into account intensity, extent and location of synovial abnormalities. RESULTS In the cross sectional study, severity of chondropathy correlated with age, body mass index, disease duration, functional impairment (Lequesne's index and maximum number of steps descended), patellofemoral crepitus on active motion, limitation of flexion, and presence and amount of synovitis. Knee effusion correlated with the presence of synovitis, but no correlation was found between pain or functional impairment and presence or amount of synovitis. In the longitudinal study, no statistically significant change in chondropathy was observed after 6 months followup despite a statistically significant improvement in pain, function, and knee effusion after this period. However, a statistically significant correlation was found between the progression of patellofemoral chondropathy and the presence and amount of synovitis at baseline. Synovitis was present at baseline in 10 patients. Changes in SFA scores were 1.2 +/- 1.6 and -0.1 +/- 1.0 in the groups of patients with and without synovitis, respectively (p = 0.0062). CONCLUSION These data suggest that synovitis might have a deleterious effect on the evolution of post-traumatic patellofemoral chondropathy or might be a marker for active cartilage breakdown.

Intensified-dose (4 gm/m2) cyclophosphamide and granulocyte colony-stimulating factor administration for hematopoietic stem cell mobilization in refractory rheumatoid arthritis.

Abstract: Objective. To evaluate the feasibility, safety, and efficacy of intensified-dose cyclophosphamide (IDCYC), followed by granulocyte colony-stimulating factor (G-CSF) administration for collection of peripheral blood hematopoietic stem cells (HSC), for patients with severe, refractory rheumatoid arthritis (RA). Methods. Four patients with severe refractory RA were enrolled in this open study. They received a single infusion of CYC (4 gm/m 2 ) at day 0 followed by G-CSF (5 mg/kg/day) from day 6 until the last day of leukapheresis (performed at the time of hematopoietic recovery) to harvest peripheral blood HSC. Patients were monitored for disease activity, adverse effects, and hematopoietic reconstitution following this procedure. Results. For all patients, administration of IDCYC induced an early, dramatic improvement of disease activity. Long-term followup indicates that partial disease relapse was observed for all patients. No adverse effect was directly attributable to the treatment procedure. For most patients, HSC collection was sufficient to provide a graft enriched in CD341 cells by positive selection as well as an unselected rescue graft. Conclusion. Patients with severe, refractory RA

Are radiological joint space widths of normal hips asymmetrical

Abstract: BACKGROUND—To be certain that the joint space width is abnormal in the case of hip joint pain when compared with the contralateral hip requires knowledge of physiological dissymmetry. AIM OF THE STUDY—To assess interindividual variability and dissymmetry in pelvic radiological joint space width. METHODS—Pelvic radiographs of subjects without hip joint disease. Measurement with a 0.1 mm graduated magnifying glass and 0.5 mm graduated flat ruler at the hip superointermediate site (vertical going through the femoral head centre). After randomisation of the side to measure, analysis of nine groups of 19 plain films by one investigator blind for the result of the contralateral side. RESULTS—The difference between the left and right hip was plotted against the corresponding mean for all 171 normal subjects This shows the frequency and the limits of the asymmetry at each measurement site. The asymmetry is independent of interindividual variability of the joint space width and greater than the measurement error in most subjects. CONCLUSION—This study confirms the interindividual variability of hip joint space width, shows the frequency of hip joint space asymmetry and defines its limit. Keywords: hip joint; joint space width; measurement

Concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime-labelled leucocytes and ileocolonoscopy in patients with spondyloarthropathies and without clinical evidence of inflammatory bowel disease.

Abstract: OBJECTIVE To study the concordance between abdominal scintigraphy using technetium-99m hexamethylpropylene amine oxime (99mTc-HMPAO)-labelled leucocytes (ASTLL) and ileocolonoscopy in patients with spondyloarthropathies (SpA) and without clinical evidence of inflammatory bowel disease (IBD). PATIENTS AND METHODS Fifteen patients with SpA (European Spondylarthropathy Study Group 1991 criteria) without clinical evidence of IBD were studied prospectively with ASTLL and ileocolonoscopy. RESULTS This cohort consisted of seven men and eight women aged 31.8+/-10.5 yr (18-47) [mean age +/- S.D. (range)] and with a disease duration of 6.0+/-4.4 yr (0.4-15). ASTLL showed abnormal uptake in four patients. Ileocolonoscopy was abnormal in five patients, showing acute inflammatory lesions in one patient with reactive arthritis, undifferentiated chronic inflammatory lesions in two cases, and features indistinguishable from those of Crohn's disease in two cases. ASTLL was negative in two cases in which ileocolonoscopy showed inflammatory lesions and was positive (terminal ileum) in one case with normal ileocolonoscopy. The concordance between the two examinations was statistically significant (kappa = 0.53; P = 0.008). CONCLUSION ASTLL may be an interesting tool to detect subclinical gut inflammation in patients with SpA.