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Wendling D, Al Tabaa O, Chevet B, Fakih O, Ghossan R, Hecquet S, Dernis E, Maheu E, Saraux A, Besson FL, Alegria GC, Cortet B, Fautrel B, Felten R, Morel J, Ottaviani S, Querellou-Lefranc S, Ramon A, Ruyssen-Witrand A, Seror R, Tournadre A, Foulquier N, Verlhac B, Verhoeven F, Devauchelle-Pensec V. Recommendations of the French Society of Rheumatology for the management in current practice of patients with polymyalgia rheumatica. Joint Bone Spine 2024; 91:105730. [PMID: 38583691 DOI: 10.1016/j.jbspin.2024.105730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE To develop recommendations for the routine management of patients with polymyalgia rheumatica (PMR). METHODS Following standard procedures, a systematic review of the literature by five supervised junior rheumatologists, based on the questions selected by the steering committee (5 senior rheumatologists), was used as the basis for working meetings, followed by a one-day plenary meeting with the working group (15 members), leading to the development of the wording and determination of the strength of the recommendations and the level of agreement of the experts. RESULTS Five general principles and 19 recommendations were drawn up. Three recommendations relate to diagnosis and the use of imaging, and five to the assessment of the disease, its activity and comorbidities. Non-pharmacological therapies are the subject of one recommendation. Three recommendations concern initial treatment based on general corticosteroid therapy, five concern the reduction of corticosteroid therapy and follow-up, and two concern corticosteroid dependence and steroid-sparing treatments (anti-IL-6). CONCLUSION These recommendations take account of current data on PMR, with the aim of reducing exposure to corticosteroid therapy and its side effects in a fragile population. They are intended to be practical, to help practitioners in the day-to-day management of patients with PMR.
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Affiliation(s)
- Daniel Wendling
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France.
| | - Omar Al Tabaa
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France; Rhumatologie, Hôpital NOVO, Pontoise, France
| | - Baptiste Chevet
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Olivier Fakih
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Roba Ghossan
- Rhumatologie, Hôpital Cochin, AP-HP, Paris, France
| | | | | | - Emmanuel Maheu
- Service de rhumatologie, Hôpital St Antoine, AP-HP, et cabinet médical, Paris, France
| | - Alain Saraux
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France
| | - Florent L Besson
- Service de médecine nucléaire-imagerie moléculaire, Hôpitaux universitaires Paris-Saclay AP-HP, CHU Bicêtre, DMU SMART IMAGING, Le Kremlin-Bicêtre, France
| | | | - Bernard Cortet
- Service de rhumatologie, CHU de Lille, 59037 Lille, France
| | - Bruno Fautrel
- Service de rhumatologie, GH Pitié Salpêtrière, AP-HP.Sorbonne Université, INSERM UMRS 1136-5, Réseau de recherche clinique CRI-IMIDIATE, 75013 Paris, France
| | - Renaud Felten
- Service de rhumatologie et centre d'investigation clinique 1434, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Jacques Morel
- Service de rhumatologie. CHU et Université de Montpellier, Montpellier, France
| | | | - Solène Querellou-Lefranc
- Nuclear Medicine department, University Hospital, Brest, France, University of Western Brittany (UBO), Brest, France, Inserm, University of Brest, CHRU Brest, UMR 1304, GETBO, Brest cedex, France
| | - André Ramon
- Service de rhumatologie, CHU Dijon Bourgogne, Dijon, France
| | - Adeline Ruyssen-Witrand
- Centre de rhumatologie, CHU de Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Team PEPSS « Pharmacologie En Population cohorteS et biobanqueS », Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Raphaèle Seror
- Service de rhumatologie, CHU Kremlin-Bicetre, AP-HP, Paris, France
| | - Anne Tournadre
- Rhumatologie CHU Clermont-Ferrand, Université Clermont Auvergne INRAe, Clermont-Ferrand, France
| | - Nathan Foulquier
- LBAI, UMR1227, University of Brest, Inserm, CHU de Brest, Brest, France
| | | | - Frank Verhoeven
- Rhumatologie, CHU de Besançon et Université de Franche-Comté, boulevard Fleming, 25030 Besançon, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU Brest, Université de Bretagne Occidentale (University Brest), INSERM (U1227), LabEx IGO, 29200 Brest, France.
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D'Agostino J, Souki A, Lohse A, Carvajal Alegria G, Dernis E, Richez C, Truchetet ME, Wendling D, Toussirot E, Perdriger A, Gottenberg JE, Felten R, Fautrel B, Chiche L, Hilliquin P, Le Henaff C, Dervieux B, Direz G, Chary-Valckenaere I, Cornec D, Guellec D, Marhadour T, Nowak E, Saraux A, Devauchelle-Pensec V. Concordance and agreement between different activity scores in polymyalgia rheumatica. RMD Open 2024; 10:e003741. [PMID: 38490696 PMCID: PMC10946364 DOI: 10.1136/rmdopen-2023-003741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/27/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE The C reactive protein polymyalgia rheumatica activity score (CRP-PMR-AS) is a composite index that includes CRP levels and was developed specifically for PMR. As treatments such as interleukin-6 antagonists can normalise CRP levels, the erythrocyte sedimentation rate (ESR) of PMR-AS, the clinical (clin)-PMR-AS and the imputed-CRP (imp-CRP)-PMR-AS have been developed to avoid such bias. Our primary objective was to measure the correlation of these activity scores. Our secondary objective was to evaluate the concordance between different cutoffs of the PMR-ASs. METHOD Data from the Safety and Efficacy of tocilizumab versus Placebo in Polymyalgia rHeumatica With glucocORticoid dEpendence (SEMAPHORE) trial, a superiority randomised double-blind placebo-controlled trial, were subjected to post hoc analysis to compare the efficacy of tocilizumab versus placebo in patients with active PMR. The CRP-PMR-AS, ESR-PMR-AS, clin-PMR-AS and imp-CRP-PMR-AS were measured at every visit. The concordance and correlation between these scores were evaluated using kappa correlation coefficients, Bland-Altman correlations, intraclass correlation coefficients (ICCs) and scatter plots. RESULTS A total of 101 patients were included in the SEMAPHORE trial, and 100 were analysed in this study. The correlation between the PMR-ASs was excellent, as the ICC and kappa were >0.85 from week 4 until week 24 (CRP-PMR-AS ≤10 or >10). Bland-Altman plots revealed that the differences between the CRP-PMR-AS and the other threescores were low. The cut-off values for the clin-PMR-AS were similar to those for the CRP-PMR-AS 86% of the time. CONCLUSION The correlation between all the PMR-ASs was excellent, reflecting the low weight of CRP. In clinical trials using drugs that have an impact on CRP, the derived activity scores can be used. TRIAL REGISTRATION NUMBER NTC02908217.
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Affiliation(s)
- Justine D'Agostino
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Aghiles Souki
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Anne Lohse
- Hopital Nord Franche-Comte-Site de Belfort, Belfort, France
| | | | - Emanuelle Dernis
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | - Christophe Richez
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
- UMR CNRS 5164, Université de Bordeaux Collège Sciences de la Santé, Bordeaux, France
| | - Marie-Elise Truchetet
- Department of Rheumatology, Centre Hospitalier Universitaire de Bordeaux Groupe Hospitalier Pellegrin, Bordeaux, France
| | - Daniel Wendling
- Rheumatology and EA4266 Franche-Comté University, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Eric Toussirot
- INSERM Clinical Investigation Center 1431, Centre Hospitalier Universitaire de Besancon, Besancon, France
- Department of Rheumatology, Centre Hospitalier Universitaire de Besancon, Besancon, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Renaud Felten
- Department of Rheumatology, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Bruno Fautrel
- Department of Rheumatology, Assistance Publique-Hopitaux de Paris, Paris, France
- INSERM UMR-S 1136, Pierre Louis Epidemiology and Public Health Research Institute, Paris, France
| | - Laurent Chiche
- Internal Medicine, Marseille Public University Hospital System, Marseille, France
| | - Pascal Hilliquin
- Department of Rhumatology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Catherine Le Henaff
- Department of Rheumatology, Pays de Morlaix Hospital Centre, Morlaix, France
| | - Benjamin Dervieux
- Department of Rhuamtology, GHR Mulhouse Sud Alsace, Mulhouse, France
| | - Guillaume Direz
- Department of Rheumatology, Centre Hospitalier Le Mans, Le Mans, France
| | | | - Divi Cornec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Dewi Guellec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM Clinical Investigations Centre 1412, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Thierry Marhadour
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Emmanuel Nowak
- Public Agency for Clinical Research and Innovation (DRCI), Brest University Hospital, Centre Hospitalier Universitaire de Brest, Brest, France
- Centre Hospitalier Universitaire de Brest, Brest, INSERM Clinical Investigations Centre (CIC) 1412, France
| | - Alain Saraux
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, Centre Hospitalier Universitaire de Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, Brest, France
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Le Quellec A, Guyard T, Carvajal Alegria G, Ruyssen-Witrand A, Fautrel B, Flipo RM, Garrigues F, Saraux A. Prevalence and predictors of atlanto-axial subluxation in rheumatoid arthritis after 12-years' follow-up (ESPOIR Cohort). Rheumatology (Oxford) 2023; 62:2692-2699. [PMID: 36440910 DOI: 10.1093/rheumatology/keac672] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/19/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Anterior atlanto-axial subluxation (AAS), defined as an anterior atlanto-dental interval ≥3 mm, can occur in RA and carries a risk of severe neurological impairments. Our objective was to determine the prevalence and predictors of radiographic aAAS after 12 years' follow-up of patients with early polyarthritis. METHODS We studied patients enrolled in the early polyarthritis cohort ESPOIR (Study and Monitoring of Early Undifferentiated Arthritis) between 2002 and 2005 (at least two swollen joints for >6 weeks and <6 months, no other diagnosis than RA, and no previous exposure to glucocorticoids or DMARDs). All patients still in the cohort after 12 years had dynamic cervical-spine radiographs taken then read by two blinded observers. To evaluate how well combinations of tests performed at baseline and 10 years predicted aAAS after 12 years, univariate analysis and multiple logistic regression procedure were applied. RESULTS Of 323 patients followed for 12 years, 15 (4.6%; 95% CI 2.8, 6.4) had aAAS. Among baseline variables, only IgA RFs were associated (P < 0.05) with aAAS (sensitivity 60%, specificity 75%). Among data collected after 10 years, oral CS therapy during the 10-year interval, treatment by DMARDs, CRP (mg/dl) and positive tests for RFs were associated with aAAS after 12 years, but only CRP and RFs remained in a model of logistic regression (combination predicted aAAS with a sensitivity of 60% for a specificity of 90%). CONCLUSION In conclusion, the prevalence of aAAS after 12 years was 4.6% in the ESPOIR cohort, with no patients having severe aAAS. Although some factors were found to be statistically associated to AAS, the event is too rare to allow a clinical relevance.
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Affiliation(s)
| | | | | | - Adeline Ruyssen-Witrand
- Centre de Rhumatologie, CHU Toulouse, Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, University of Toulouse 3, Toulouse, France
| | - Bruno Fautrel
- Sorbonne Université - APHP, Service de Rhumatologie, CHU Pitié-Salpêtrière, Paris, France
- INSERM U1136, Paris, France
| | | | | | - Alain Saraux
- Service de Rhumatologie, CHU Brest, Brest, France
- Université de Bretagne Occidentale, INSERM (U1227), LabEx IGO, Brest, France
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Carvajal Alegria G, Nicolas M, van Sleen Y. Biomarkers in the era of targeted therapy in giant cell arteritis and polymyalgia rheumatica: is it possible to replace acute-phase reactants? Front Immunol 2023; 14:1202160. [PMID: 37398679 PMCID: PMC10313393 DOI: 10.3389/fimmu.2023.1202160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/23/2023] [Indexed: 07/04/2023] Open
Abstract
Research into giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) has become more important in the last few decades. Physicians are facing several challenges in managing the diagnosis, treatment, and relapses of GCA and PMR patients. The search for biomarkers could provide elements to guide a physician's decision. In this review, we aim to summarize the scientific publications about biomarkers in GCA and PMR in the past decade. The first point raised by this review is the number of clinical situations in which biomarkers could be useful: differential diagnosis of either GCA or PMR, diagnosis of underlying vasculitis in PMR, prediction of relapse or complications, disease activity monitoring, choice, and modification of treatments. The second point raised by this review is the large number of biomarkers studied, from common markers like C-reactive protein, erythrocyte sedimentation rate, or elements of blood count to inflammatory cytokines, growth factors, or immune cell subpopulations. Finally, this review underlines the heterogeneity between the studies and proposes points to consider in studies evaluating biomarkers in general and particularly in the case of GCA and PMR.
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Affiliation(s)
- Guillermo Carvajal Alegria
- EA6295 Nanomédicaments et Nanosondes, Université de Tours, Tours, France
- Department of Rheumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours Cedex, France
| | - Mathilde Nicolas
- Department of Rheumatology, Centre Hospitalier Régional Universitaire (CHRU) de Tours, Tours Cedex, France
| | - Yannick van Sleen
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, Netherlands
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Langbour C, Rene J, Goupille P, Carvajal Alegria G. Efficacy of Janus kinase inhibitors in rheumatoid arthritis. Inflamm Res 2023; 72:1121-1132. [PMID: 37087519 DOI: 10.1007/s00011-023-01717-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Janus kinase inhibitors (JAKis) is a new therapeutic class in autoimmune and inflammatory diseases. Four molecules are approved in rheumatoid arthritis (RA) in Europe. Recently, questions have raised about adverse events. In this context, a synthesis of the efficacy data of JAKis in RA is of use. METHOD We performed a literature review based on published articles about efficacy of JAKis in RA, including clinical trials, registries, retrospective and prospective cohorts as well as database analysis. RESULTS Based on the phase III clinical trials, JAKis are effective in comparison to placebo, methotrexate and tumour necrosis factor inhibitors. Based on registries, cohorts and post hoc analysis of phase III clinical trials, several parameters might modulate the efficacy of JAKis: the serological status, a short duration of the disease or the presence of poor prognostic factors. Preliminary data suggest that early ultrasonographic evaluation might help to predict the medium-term progression. CONCLUSION Some clinical, biological and imaging parameters seem to influence the response to JAKis and should be evaluated in larger studies. In addition to factors that might influence the efficacy of JAKis, the safety profile and risk factors should be considered before initiating JAKis in a patient.
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Affiliation(s)
- Camille Langbour
- Service de Rhumatologie, CHRU de Tours, Bd Tonnelé, 37000, Tours, France
| | - Jessica Rene
- Service de Rhumatologie, CHRU de Tours, Bd Tonnelé, 37000, Tours, France
- Université de Tours, Tours, France
| | - Philippe Goupille
- Service de Rhumatologie, CHRU de Tours, Bd Tonnelé, 37000, Tours, France
- Université de Tours, Tours, France
| | - Guillermo Carvajal Alegria
- Service de Rhumatologie, CHRU de Tours, Bd Tonnelé, 37000, Tours, France.
- Université de Tours, Tours, France.
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Carvajal Alegria G, Depinoy T, Devauchelle-Pensec V, Jousse-Joulin S, Marhadour T, Guellec D, Marcorelles P, Pers JO, Saraux A, Cornec D. Diagnostic utility of a second minor salivary gland biopsy in patients with suspected Sjögren's syndrome: A retrospective cohort study. Joint Bone Spine 2023; 90:105459. [PMID: 36108904 DOI: 10.1016/j.jbspin.2022.105459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/29/2022] [Accepted: 09/07/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether repeated minor salivary gland biopsy (MSGB) has a clinical diagnostic utility in patients with suspicion of Sjögren's syndrome (SS). METHODS Clinical, biological, pathological data and physician's diagnosis after each MSGB from patients with suspected primary or secondary SS who had benefited from 2 MSGB at Brest University Hospital between January 1st, 1990 and January 14th, 2015, were retrospectively collected. We compared the characteristics of patients with and without first positive MSGB, concordance between the MSGB, and analyzed the modifications of diagnosis after the second MSGB. RESULTS Ninety-three patients were included, first MSGB was positive for 23 and negative for 70. Patients with first positive MSGB had more often renal involvement (P<0.05) and hypergammaglobulinemia (P=0.01), anti-SSA antibodies (P<0.05) and positive second biopsy with focus score ≥ 1 or Chisholm>2 (P<0.01). The mean time between the 2 MSGB was 5.7±4.3 years. The concordance between the results of the 2 biopsies was low (κ = 0.34). MSGB influenced diagnostic's change in 10 cases where the second MSGB was always guided by new specific clinical manifestations. CONCLUSION We observed a low concordance between 2 MSGB in patients with suspected pSS in our study. Despite this variability, performing a second MSGB changed the initial diagnosis in only a minority of the patients and was particularly useful when clinical manifestations had deeply evolved.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thibaud Depinoy
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sandrine Jousse-Joulin
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Thierry Marhadour
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France
| | - Dewi Guellec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; CIC Inserm 1412, CHRU de Brest, Brest, France
| | | | - Jacques-Olivier Pers
- Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHRU de Brest, site Cavale Blanche, Brest, France; Inserm, LabEx IGO, UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.
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Carvajal Alegria G, Croft AP. Fibroblasts, a target for imaging and therapeutics in rheumatoid arthritis. Rheumatology (Oxford) 2022; 61:2726-2727. [PMID: 34791115 DOI: 10.1093/rheumatology/keab845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Guillermo Carvajal Alegria
- Groupe Innovation et Ciblage Cellulaire EA 7501, Université de Tours
- Rheumatology Department, CHRU de Tours, Tours, France
| | - Adam P Croft
- Rheumatology Research Group, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
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Quéré B, Alegria GC. Quoi de neuf dans la COVID ? Rev Rhum Ed Fr 2022; 89:2S27-2S29. [PMID: 35532524 PMCID: PMC9059275 DOI: 10.1016/s1169-8330(22)00082-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Baptiste Quéré
- Service de rhumatologie, Centre national de référence des maladies auto-immunes rares (CERAINO), université de Brest, Inserm, UMR1227, CHU Brest, LabEx IGO, Brest, France
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Foulquier N, Chevet B, Carvajal Alegria G, Saraux L, Devauchelle-Pensec V, Redou P, Saraux A. Towards a universal definition of disease activity score thresholds: the AS135 score. Clin Exp Rheumatol 2022; 41:1009-1016. [PMID: 36062781 DOI: 10.55563/clinexprheumatol/30qjog] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Many study groups have developed scores to reflect disease activity. The result of this fragmented process is a multitude of disease activity scores, even for a single disease. We aimed to identify and standardise disease activity scores in rheumatologyMETHODS: We conducted a literature review on disease activity criteria using both a manual approach and in-house computer software (BIBOT) that applies natural language processing to automatically identify and interpret important words in abstracts published in English between 1.1.1975 and 31.12.2018. We selected activity scores with cut-off values divided into four classes (remission and low, moderate and high disease activity). We used a linear interpolation to map disease activity scores to our new score, the AS135, and developed a smartphone application to perform the conversion. RESULTS A total of 108 activity criteria from various fields were identified, but it was in rheumatology that we found the most pronounced separation into four classes. We built the AS135 score modification for each selected score using a linear interpolation of the existing criteria. The score modification was defined on the interval [0,10], and values of 1, 3 and 5 were used as thresholds. These arbitrary thresholds were then associated with the thresholds of the existing criteria, and an interpolation was calculated, allowing conversion of the existing criteria into the AS135 criterion. Finally, we created a mobile application. CONCLUSIONS We developed an application for clinicians that enables the use of a single disease activity score for different inflammatory rheumatic diseases using an intuitive scale.
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Affiliation(s)
- Nathan Foulquier
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, and LATIM, Laboratoire de Traitement de l’Information Médicale, UMR 1101, IBRBS, Université de Brest, Inserm, CHU, Brest, France
| | - Baptiste Chevet
- Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| | - Guillermo Carvajal Alegria
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, and Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| | - Léa Saraux
- Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| | - Valérie Devauchelle-Pensec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, and Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France
| | - Pascal Redou
- LATIM, Laboratoire de Traitement de l’Information Médicale, UMR 1101, IBRBS, Université de Brest, Inserm, CHU, Brest, France
| | - Alain Saraux
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, and Rheumatology Unit, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINO), CHU, Brest, France.
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Queré B, Saraux A, Marhadour T, Jousse-Joulin S, Cornec D, Houssais C, Carvajal Alegria G, Quiviger M, Le Guillou M, Devauchelle-Pensec V, Guellec D. Impact de la pandémie à COVID-19 sur la prise en charge thérapeutique des patients présentant une polyarthrite rhumatoïde en Bretagne (France). Revue du Rhumatisme 2022; 89:102-104. [PMID: 34335020 PMCID: PMC8314872 DOI: 10.1016/j.rhum.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
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11
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Doaré E, Héry-Arnaud G, Devauchelle-Pensec V, Alegria GC. Healthy Patients Are Not the Best Controls for Microbiome-Based Clinical Studies: Example of Sjögren's Syndrome in a Systematic Review. Front Immunol 2021; 12:699011. [PMID: 34394092 PMCID: PMC8358393 DOI: 10.3389/fimmu.2021.699011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Introduction It has been hypothesized that gut and oral dysbiosis may contribute to the development of primary Sjögren's syndrome (pSS). The aim of this systematic review was to assemble available data regarding the oral and gut microbiota in pSS and to compare them to data from healthy individuals and patients with dry symptoms without a diagnosis of Sjögren's syndrome or lupus disease to identify dysbiosis and discuss the results. Methodology Using the PRISMA guidelines, we systematically reviewed studies that compared the oral and gut microbiota of Sjögren's patients and controls. The PubMed database and Google Scholar were searched. Results Two-hundred and eighty-nine studies were found, and 18 studies were included: 13 referred to the oral microbiota, 4 referred to the gut microbiota, and 1 referred to both anatomical sites. The most frequent controls were healthy volunteers and patients with sicca symptoms. The most common analysis method used was 16S-targeted metagenomics. The results were mostly heterogeneous, and the results regarding diversity were not always in accordance. Dysbiosis in pSS was not confirmed, and reduced salivary secretion seems to explain more microbial changes than the underlying disease. Conclusion These heterogeneous results might be explained by the lack of a standardized methodology at each step of the process and highlight the need for guidelines. Our review provides evidence that sicca patients seem to be more relevant than healthy subjects as a control group.
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Affiliation(s)
- Elise Doaré
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
| | - Geneviève Héry-Arnaud
- UMR1078, Génétique, Génomique Fonctionnelle Et Biotechnologies, INSERM, Université de Brest, EFS, IBSAM, Brest, France.,Centre Brestois d'Analyse du Microbiote, Hôpital La Cavale Blanche, CHRU de Brest, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
| | - Guillermo Carvajal Alegria
- Rheumatology Department, Reference Centre of Rare Autoimmune Diseases, Cavale Blanche Hospital and Brest University, INSERM UMR 1227, Brest, France
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Carvajal Alegria G, Cornec D, Saraux A, Devauchelle-Pensec V, Jamin C, Hillion S, Pers JO, Pochard P. Abatacept Promotes Regulatory B Cell Functions, Enhancing Their Ability to Reduce the Th1 Response in Rheumatoid Arthritis Patients through the Production of IL-10 and TGF-β. J Immunol 2021; 207:470-482. [PMID: 34244295 DOI: 10.4049/jimmunol.2000455] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
Abatacept mimics natural CD152 and competes with CD28 for binding to CD80/CD86 on APC, such as B cells, thereby preventing T cell activation. However, its potential impact on B cells has not been identified. The aim of this study was to assess whether abatacept can potentiate the immunoregulatory properties of B cells in vitro and in patients with rheumatoid arthritis (RA). T and B cells from healthy controls were purified. The suppressor properties of B cells in the presence of abatacept or control IgG1 were evaluated based on the ability of these cells to inhibit the polyclonal expansion (anti-CD3/CD28 stimulation) of T cells or their differentiation into Th1 or Th17 cells. Similar analyses were also performed with cells from RA patients before and 3 mo after abatacept initiation. Abatacept significantly potentiated regulatory B cell regulatory functions by enhancing their ability to produce IL-10 and TGF-β, resulting in the increased generation of regulatory T cells and limited T cell proliferation and differentiation into Th1 and Th17 cells. Interestingly, B cells isolated from patients that received a 3-mo treatment with abatacept had an increased ability to reduce T cell functions, confirming the above observations. Abatacept binding to CD80/CD86 induces and promotes regulatory B cell functions by enhancing the ability of these cells to produce IL-10 and TGF-β in vitro and in RA patients.
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Affiliation(s)
- Guillermo Carvajal Alegria
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Divi Cornec
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Alain Saraux
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Valérie Devauchelle-Pensec
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Christophe Jamin
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Sophie Hillion
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Jacques-Olivier Pers
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
| | - Pierre Pochard
- UMR 1227 "Lymphocytes B et Autoimmunité," Université de Brest, INSERM, LabEx IGO, Brest, France; and CHU de Brest, Brest, France
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13
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Queré B, Saraux A, Marhadour T, Jousse-Joulin S, Cornec D, Houssais C, Carvajal Alegria G, Quiviger M, Le Guillou M, Devauchelle-Pensec V, Guellec D. Impact of the COVID-19 pandemic on therapeutic management of rheumatoid arthritis in Brittany (France). Joint Bone Spine 2021; 88:105179. [PMID: 33878606 PMCID: PMC7999690 DOI: 10.1016/j.jbspin.2021.105179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/12/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - Alain Saraux
- Rheumatology department, CHU de Brest, University of Brest, Inserm, UMR1227, Lymphocytes B et autoimmunité, University of Brest, Inserm, LabEx IGO, Brest, France
| | | | | | - Divi Cornec
- Rheumatology department, CHU de Brest, University of Brest, Inserm, UMR1227, Lymphocytes B et autoimmunité, Brest, France
| | | | - Guillermo Carvajal Alegria
- Rheumatology department, CHU de Brest, University of Brest, Inserm, UMR1227, Lymphocytes B et autoimmunité, Brest, France
| | | | | | - Valérie Devauchelle-Pensec
- Rheumatology department, CHU de Brest, University of Brest, Inserm, UMR1227, Lymphocytes B et autoimmunité, Brest, France
| | - Dewi Guellec
- Rheumatology department, CHU de Brest, Inserm, CIC 1412, Brest, France.
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14
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Carvajal Alegria G, Garrigues F, Bettacchioli E, Loeuille D, Saraux A, Cornec D, Devauchelle-Pensec V, Renaudineau Y. Tocilizumab controls bone turnover in early polymyalgia rheumatica. Joint Bone Spine 2020; 88:105117. [PMID: 33301930 DOI: 10.1016/j.jbspin.2020.105117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study explores changes in the bone homeostasis by testing the N-terminal collagen type I extension propeptide (PINP) marker for osteo-formation and the carboxy-terminal region of collagen type I (CTX-I) marker for osteo-resorption in patients taking tocilizumab for polymyalgia rheumatica (PMR). METHODS Twenty patients were included in the prospective open-label TENOR study (Clinicaltrials.gov NCT01713842) and received three monthly tocilizumab infusions, followed by corticosteroids starting at week (W) 12. PINP and CTX-I were tested at inclusion (W0), after tocilizumab but before steroid initiation (W12), at the end of the protocol (W24) and were compared to healthy controls. Information regarding disease activity, bone mineral density using scanographic bone attenuation correlation (SBAC), inflammatory parameters and interleukin (IL)-6 levels were collected during the follow-up of the patients. RESULTS PMR patients were characterised by a reduction in bone mineral density and a higher level of CTX-I relative to healthy controls matched in age and sex at baseline. PINP levels increased at W12 (P< 0.001, versus W0) following tocilizumab introduction and CTX-I levels decreased at W24 and after steroid initiation (P=0.001, versus W0). Such modifications explain the altered correlation observed between PINP and CTX-I at W0 (r=0.255 at W0 versus r=0.641 in healthy controls) and its correction after treatment (r=0.760 at W12 and r=0.767 at W24). Finally, greater changes in PINP were observed in patients whose circulating IL-6 levels decreased after tocilizumab therapy. CONCLUSIONS Control of bone turnover, in part through the inhibition of the IL-6 axis, is observed during tocilizumab and subsequent steroid treatment of PMR.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France.
| | | | | | - Damien Loeuille
- Department of Rheumatology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; INSERM, CIC-EC CIE6, Nancy, France University Hospital of Nancy, Epidemiology and Clinical Evaluation, 545 Vandoeuvre-lès-Nancy, France
| | - Alain Saraux
- Rheumatology department, CHRU Cavale Blanche, Brest, France
| | - Divi Cornec
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Rheumatology department, CHRU Cavale Blanche, Brest, France; Lymphocytes B et autoimmunité, UMR1227, INSERM, Université de Bretagne Occidentale, Brest, France
| | - Yves Renaudineau
- Laboratory of immunology and immunotherapy, UMR1227, CHRU Morvan, Brest, France
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15
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Carvajal Alegria G, Boukhlal S, Cornec D, Devauchelle-Pensec V. The pathophysiology of polymyalgia rheumatica, small pieces of a big puzzle. Autoimmun Rev 2020; 19:102670. [DOI: 10.1016/j.autrev.2020.102670] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
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16
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Carvajal Alegria G, Saraux A, Devauchelle-Pensec V. Is Tocilizumab as efficient as steroids early in polymyalgia rheumatica? Semin Arthritis Rheum 2020; 50:582. [DOI: 10.1016/j.semarthrit.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
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17
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Carvajal Alegria G, van Sleen Y, Graver JC, Sandovici M, Devauchelle-Pensec V, Brouwer E, Cornec D. Aortic involvement in giant cell arteritis. Joint Bone Spine 2020; 88:105045. [PMID: 32649986 DOI: 10.1016/j.jbspin.2020.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Yannick van Sleen
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacoba Carolien Graver
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria Sandovici
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Valérie Devauchelle-Pensec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France
| | - Elisabeth Brouwer
- Vasculitis Expertise Center Groningen, Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Divi Cornec
- UMR 1227 « Lymphocytes B et Autoimmunité », Inserm, Labex IGO, University of Brest, Brest, France; Rheumatology department, CERAINO « Centre de référence des maladies auto-immunes rares », CHRU Cavale Blanche, Brest, France.
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18
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Carvajal Alegria G, Milin M, Gandjbakhch F, Saraux A, Bailly F, Jousse-Joulin S, Schaeverbeke T, Lukas C, Foltz V, Fautrel B, Devauchelle-Pensec V. A simplified radiographic score effectively predicts radiographic progression of early arthritis in a large nationwide French cohort. Rheumatology (Oxford) 2020; 59:1566-1573. [PMID: 31628807 DOI: 10.1093/rheumatology/kez450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/01/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evaluating radiographic progression is a key component of the follow-up of patients with RA. Existing scores are ill-suited to everyday clinical practice. The objective here was to validate a new simplified radiographic score (SRS) for evaluating radiographic progression in patients with early arthritis. METHODS Patients with arthritis of <6 months' duration were included in the large, prospective, nationwide, French ESPOIR cohort. Radiographs of the hands and feet were obtained at inclusion then 1 and 5 years later. The modified Sharp scores and SRS were determined by blinded readers. Interobserver reliability and intraobserver repeatability of each score, as well as agreement between the two scores, were assessed by computing the intraclass correlation coefficients. The rates of progression over the first year and the next 4 years were determined. RESULTS The 506 patients with complete data for the first 5 years were included. At inclusion, the intraclass correlation coefficient between the two scores was good for erosions (0.715, P < 0.001), joint space narrowing (0.892, P < 0.001) and the total score (0.896, P < 0.001). Agreement between the two scores was also good for radiographic progression after 1 year (0.781, P < 0.001). The SRS had good positive and negative predictive values for slow and for rapid progression. SRS determination was less time consuming. CONCLUSION The SRS is effective for monitoring radiographic progression in early arthritis and is easier to use and less time-consuming than the Sharp score. The usefulness of the SRS in clinical practice deserves further evaluation.
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Affiliation(s)
- Guillermo Carvajal Alegria
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Morgane Milin
- Rheumatology Department, Hôpital Yves Le Foll, Saint-Brieuc
| | - Frédérique Gandjbakhch
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Alain Saraux
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Florian Bailly
- Sorbonne University, Paris.,Pitié Salpêtrière Hospital, APHP, Pain Unit, Paris
| | - Sandrine Jousse-Joulin
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | | | - Cédric Lukas
- Rheumatology Department, Montpellier University, Montpellier Hospital and EA2415, Montpellier, France
| | - Violaine Foltz
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Bruno Fautrel
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Valérie Devauchelle-Pensec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
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19
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Carvajal Alegria G, Cornec D. Against the dryness—an innovative 3D acini model to test new drugs in primary Sjögren’s syndrome. Rheumatology (Oxford) 2020; 59:705-706. [DOI: 10.1093/rheumatology/kez591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/02/2019] [Accepted: 10/22/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Guillermo Carvajal Alegria
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO
- Rheumatology Department, Cavale Blanche Hospital, Brest, France
| | - Divi Cornec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO
- Rheumatology Department, Cavale Blanche Hospital, Brest, France
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20
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Carvajal Alegria G, Deloire L, Herbette M, Garrigues F, Gossec L, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A. Spinal-pelvic orientation: potential effect on the diagnosis of spondyloarthritis. Rheumatology (Oxford) 2020; 59:84-89. [PMID: 31236597 DOI: 10.1093/rheumatology/kez240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 05/15/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess associations of spinal-pelvic orientation with clinical and imaging-study findings suggesting axial SpA (axSpA) in patients with recent-onset inflammatory back pain. METHODS Spinal-pelvic orientation was assessed in DESIR cohort patients with recent-onset inflammatory back pain and suspected axSpA, by using lateral lumbar-spine radiographs to categorize sacral horizontal angle (<40° vs ⩾40°), lumbosacral angle (<15° vs ⩾15°) and lumbar lordosis (LL, <50° vs ⩾50°). Associations between these angle groups and variables collected at baseline and 2 years later were assessed using the χ2 test (or Fisher's exact) and the Mann-Whitney test. With Bonferroni's correction, P < 0.001 indicated significant differences. RESULTS Of 362 patients, 358, 356 and 357 had available sacral horizontal angle, lumbosacral angle and LL values, respectively; means were 39.3°, 14.6° and 53.0°, respectively. The prevalence of sacroiliitis on both radiographs and MRI was higher in the LL < 50° group than in the LL ⩾50° group, but the difference was not statistically significant. Clinical presentation and confidence in a diagnosis of axSpA did not differ across angle groups. No significant differences were identified for degenerative changes according to sacral horizontal angle, lumbosacral angle or LL. CONCLUSION Spinal-pelvic balance was not statistically associated with the clinical or imaging-study findings suggesting axSpA in patients with recent-onset inflammatory back pain.
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Affiliation(s)
| | | | | | | | - Laure Gossec
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, France.,Rheumatology Department, Pitie-Salpétrière Hôpital, AP-HP, Paris, France
| | | | - Antoine Feydy
- Radiology Department, Cochin Hospital, AP-HP, Paris, France
| | | | | | | | - Pascal Claudepierre
- AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie, Brest, France.,Université Paris Est Créteil, EA 7379 - EpidermE, Créteil, Brest, France
| | | | - Alain Saraux
- Rheumatology Unit, France.,INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France
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21
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Carvajal Alegria G, Voirin-Hertz M, Garrigues F, Herbette M, Deloire L, Simon A, Feydy A, Reijnierse M, van der Heijde D, Marhadour T, Saraux A. Association of lumbosacral transitional vertebra and sacroiliitis in patients with inflammatory back pain suggesting axial spondyloarthritis. Rheumatology (Oxford) 2019; 59:1679-1683. [DOI: 10.1093/rheumatology/kez520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Lumbosacral transitional vertebras (LSTVs) are common in the general population, but their potential impact on the sacroiliac joints is unclear. We aimed to determine the prevalence of LSTVs and to assess their associations with sacroiliitis by standard radiography and MRI in a population with suspected axial spondyloarthritis.
Methods
The data were from the DESIR cohort of 688 patients aged 18–50 years with inflammatory low back pain for ⩾3 months but <3 years suggesting axial spondyloarthritis. The baseline pelvic radiographs were read by two blinded readers for the presence and type (Castellvi classification) of LSTVs. Associations between LSTVs and other variables collected at baseline and at the diagnosis were assessed using the χ2 test (or Fisher's exact test) or the Mann–Whitney test.
Results
LSTV was found in 200/688 (29.1%) patients. Castellvi type was Ia in 54 (7.8%), Ib in 76 (11.0%), IIa in 20 (2.9%), IIb in 12 (1.7%), IIIa in 7 (1.0%), IIIb in 21 (3.0%) and IV in 10 (1.4%) patients. Compared with the group without LSTVs, the group with LSTVs had higher proportions of patients meeting modified New York criteria for radiographic sacroiliitis (19% vs 27%, respectively; P = 0.013) and Assessment of SpondyloArthritis international Society MRI criteria for sacroiliitis (29% vs 39%, respectively; P = 0.019).
Conclusion
In patients with inflammatory back pain suggesting axial spondyloarthritis, LSTVs are associated with both radiographic and MRI sacroiliitis.
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Affiliation(s)
| | | | | | | | | | | | - Antoine Feydy
- Radiology B Department, Paris Descartes University, Cochin Hospital, Paris, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Alain Saraux
- Rheumatology Unit, CHU Brest, Brest, France
- INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France
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22
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Marteau P, Cornec D, Gouillou M, Jousse-Joulin S, Guellec D, Costa S, Marhadour T, Carvajal Alegria G, Varache S, Gauvin Y, Boisramé S, Le Pottier L, Renaudineau Y, Pers JO, Saraux A, Devauchelle-Pensec V. Assessment of major salivary gland size in primary Sjögren's syndrome: Comparison between clinical examination and ultrasonography. Joint Bone Spine 2019; 86:627-632. [DOI: 10.1016/j.jbspin.2019.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/16/2019] [Accepted: 01/30/2019] [Indexed: 11/29/2022]
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23
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Voirin-Hertz M, Carvajal Alegria G, Garrigues F, Simon A, Feydy A, Reijnierse M, van der Heijde D, Loeuille D, Claudepierre P, Marhadour T, Saraux A. Associations of lumbar scoliosis with presentation of suspected early axial spondyloarthritis. Semin Arthritis Rheum 2019; 50:48-53. [PMID: 31277929 DOI: 10.1016/j.semarthrit.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/06/2019] [Accepted: 06/10/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Scoliosis may impact the mechanical loading and cause secondary changes of the sacroiliac joints and lumbar spine. Our goal was to look how lumbar scoliosis modify the clinical and imaging-study in patients with recent-onset inflammatory back pain (IBP) suggesting axial spondyloarthritis (axSpA). METHODS Baseline weight-bearing lumbar-spine radiographs obtained in the DESIR cohort of patients aged 18-50 years and having IBP for at least 3 months but less than 3 years suggesting axSpA were studied. After training on scoliosis detection based on Cobb's angle>10° plus Nash-Moe grade≥1, readers blinded to patient data measured spine lumbar scoliosis, sacral horizontal angle, lumbosacral angle and lumbar lordosis on the radiograph of the lumbar and scored sacroiliitis on the radiograph of the pelvis. Baseline MRIs T1 and STIR of the lumbar spine and sacroiliac joints were evaluated for respectively degenerative changes and signs of axSpA. RESULTS Of the 360 patients (50.8% females) 88.7% had lumbar pain and 69.3% met ASAS criteria for axSpA. Mean Cobb's angle was 3.2°±5.0° and 28 (7.7%) patients had lumbar scoliosis. No statistical differences were observed for radiographic sacroiliitis, MRI sacroiliitis, modified Stoke Ankylosing Spondylitis Spinal Score, Pfirmmann score, high-intensity zone, protrusion, extrusion, MODIC score between patients with and without scoliosis. In both groups, degenerative changes by MRI were rare and predominated at L4-L5 and L5-S1. CONCLUSION In patients with early IBP suggesting axSpA, lumbar scoliosis was not associated with inflammatory or degenerative changes.
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Affiliation(s)
| | | | | | | | - Antoine Feydy
- Radiology B Department, Paris Descartes University, AP-HP, Cochin Hospital, Paris, France
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Pascal Claudepierre
- AP-HP, Groupe Hospitalier Henri-Mondor, Service de Rhumatologie, Créteil 94000, France; Université Paris Est Créteil, EA 7379 - EpidermE, Créteil 94000, France
| | | | - Alain Saraux
- Rheumatology Unit, CHU Brest, BP 824, F-29609 Brest Cedex, France; INSERM 1227, Université de Bretagne Occidentale, LabEx IGO, Brest, France.
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Carvajal Alegria G, Groh M, Guellec D, Toussirot E, Rigaud J, Soubrier M, Ottaviani S, Direz G, Saraux A, Cornec D. Anti-neutrophil cytoplasmic antibody-associated chronic inflammatory arthritis without vasculitis. Data from a French nationwide survey. Autoimmun Rev 2018; 17:1268-1269. [DOI: 10.1016/j.autrev.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
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Carvajal Alegria G, Gazeau P, Hillion S, Daïen CI, Cornec DYK. Could Lymphocyte Profiling be Useful to Diagnose Systemic Autoimmune Diseases? Clin Rev Allergy Immunol 2018; 53:219-236. [PMID: 28474288 DOI: 10.1007/s12016-017-8608-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Considering the implications of B, T, and natural killer (NK) cells in the pathophysiology of systemic autoimmune diseases, the assessment of their distribution in the blood could be helpful for physicians in the complex process of determining a precise diagnosis. In primary Sjögren's syndrome, transitional and active naive B cells are increased and memory B cells are decreased compared to healthy controls and other systemic diseases. However, their utility to improve the accuracy of classification criteria has not been proven. In early untreated rheumatoid arthritis, proportions of regulatory T cells are constantly reduced, but other patterns are difficult to determine given the heterogeneity of published studies. In systemic lupus erythematosus, the lack of studies using large cohorts of patients and the diversity of the possible pathological mechanisms involved are also important impediments. Nevertheless, transitional B cell and plasma cell proportions are increased in most of the studies, the CD4/CD8 ratio is decreased, and the number of NK cells is reduced. Despite the low number of studies, anomalies of lymphocyte subset distribution was also described in ANCA-associated vasculitis, systemic scleroderma, and myositis. For now, flow cytometric analysis of lymphocyte subsets has focused mainly on specific subpopulations and is more useful for basic and translational research than for diagnostics in clinical practice. However, new modern methods such as mass cytometry and bioinformatics analyses may offer the possibility to simultaneously account for the relative proportions of multiple lymphocyte subsets and define a global profile in homogeneous groups of patients. The years to come will certainly incorporate such global lymphocyte profiling in reclassification of systemic autoimmune diseases.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France.,INSERM U1227, European University of Brest, Brest, France
| | - Pierre Gazeau
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France
| | - Sophie Hillion
- INSERM U1227, European University of Brest, Brest, France.,Laboratoire d'Immunologie et Immunothérapie, CHRU Morvan, Brest, France
| | - Claire I Daïen
- Rheumatology Department, Lapeyronie Hospital and Montpellier I University, Montpellier, France.,UMR5535, CNRS, Institute of molecular genetic, Montpellier, France
| | - Divi Y K Cornec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, BP 824, 29609, Brest cedex, France. .,INSERM U1227, European University of Brest, Brest, France.
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Carvajal Alegria G, Costa S, Jousse-Joulin S, Marcorelles P, Pers JO, Saraux A, Devauchelle-Pensec V, Cornec D. What is the agreement between pathological features of parotid gland and labial salivary gland biopsies? Ann Rheum Dis 2017; 77:e37. [PMID: 28970211 DOI: 10.1136/annrheumdis-2017-212289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/02/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Sebastian Costa
- INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France.,Laboratoire d'Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Brest, France
| | - Sandrine Jousse-Joulin
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Pascale Marcorelles
- Laboratoire d'Anatomie Pathologique et Cytologie, Hôpital Morvan, CHRU Brest, Brest, France
| | - Jacques-Olivier Pers
- INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Alain Saraux
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Valérie Devauchelle-Pensec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
| | - Divi Cornec
- Service de Rhumatologie, Hôpital de la Cavale Blanche, CHRU Brest, Brest, France.,INSERM UMR1227, Lymphocytes B et Autoimmunité, Université de Bretagne Occidentale, Brest, France
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Gazeau P, Alegria GC, Devauchelle-Pensec V, Jamin C, Lemerle J, Bendaoud B, Brooks WH, Saraux A, Cornec D, Renaudineau Y. Memory B Cells and Response to Abatacept in Rheumatoid Arthritis. Clin Rev Allergy Immunol 2017; 53:166-176. [DOI: 10.1007/s12016-017-8603-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Carvajal Alegria G, Devauchelle-Pensec V, Renaudineau Y, Saraux A, Pers JO, Cornec D. Correction of abnormal B-cell subset distribution by interleukin-6 receptor blockade in polymyalgia rheumatica. Rheumatology (Oxford) 2017; 56:1401-1406. [DOI: 10.1093/rheumatology/kex169] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Indexed: 12/29/2022] Open
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Carvajal Alegria G, Pochard P, Pers JO, Cornec D. Could abatacept directly target expanded plasmablasts in IgG4-related disease? Ann Rheum Dis 2016; 75:e73. [DOI: 10.1136/annrheumdis-2016-210400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 08/23/2016] [Indexed: 12/24/2022]
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Capaldo C, Carvajal Alegria G, Cornec D, Jousse-Joulin S, Devauchelle-Pensec V, Renaudineau Y. The active immunological profile in patients with primary Sjögren's syndrome is restricted to typically encountered autoantibodies. Clin Exp Rheumatol 2016; 34:722. [PMID: 27191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/01/2016] [Indexed: 06/05/2023]
Affiliation(s)
- Clément Capaldo
- Laboratory of Immunology and Immunotherapy, CHU Morvan, Brest, France
| | - Guillermo Carvajal Alegria
- Laboratory of Immunology and Immunotherapy, CHU Morvan, Brest; and Unit of Rheumatology, CHRU Cavale Blanche, Brest, France
| | - Divi Cornec
- Unit of Rheumatology, CHRU Cavale Blanche, Brest; and INSERM ESPRI, ERI29/EA2216, Innovative Medicines Initiative PRECISESADS, European University of Brittany, Brest, France
| | - Sandrine Jousse-Joulin
- Unit of Rheumatology, CHRU Cavale Blanche, Brest; and INSERM ESPRI, ERI29/EA2216, Innovative Medicines Initiative PRECISESADS, European University of Brittany, Brest, France
| | - Valérie Devauchelle-Pensec
- Unit of Rheumatology, CHRU Cavale Blanche, Brest; and INSERM ESPRI, ERI29/EA2216, Innovative Medicines Initiative PRECISESADS, European University of Brittany, Brest, France
| | - Yves Renaudineau
- Laboratory of Immunology and Immunotherapy, CHU Morvan, Brest; and INSERM ESPRI, ERI29/EA2216, Innovative Medicines Initiative PRECISESADS, European University of Brittany, Brest, France.
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Carvajal Alegria G, Guellec D, Mariette X, Gottenberg JE, Dernis E, Dubost JJ, Trouvin AP, Hachulla E, Larroche C, Le Guern V, Cornec D, Devauchelle-Pensec V, Saraux A. Epidemiology of neurological manifestations in Sjögren's syndrome: data from the French ASSESS Cohort. RMD Open 2016; 2:e000179. [PMID: 27110384 PMCID: PMC4838763 DOI: 10.1136/rmdopen-2015-000179] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 12/23/2022] Open
Abstract
Objectives Neurological manifestations seem common in primary Sjögren's syndrome (pSS) but their reported prevalences vary. We investigated the prevalence and epidemiology of neurological manifestations in a French nationwide multicentre prospective cohort of patients with pSS, the Assessment of Systemic Signs and Evolution in Sjögren's syndrome (ASSESS) cohort. Methods The ASSESS cohort, established in 2006, includes 395 patients fulfilling American–European Consensus Group criteria for pSS. Demographic and clinical data were compared between patient groups with and without neurological manifestations, and across patient groups with peripheral nervous system (PNS) manifestations, central nervous system (CNS) manifestations and no neurological manifestations. Results Data at inclusion were available for 392 patients, whose mean age was 58±12 years. Mean follow-up was 33.9 months. Neurological manifestations were present in 74/392 (18.9%) patients, including 63 (16%) with PNS manifestations and 14 (3.6%) with CNS manifestations. Prevalences were 9.2% for pure sensory neuropathy, 5.3% for sensorimotor neuropathy, 1.3% for cerebral vasculitis and 1.0% for myelitis. Neurological manifestations were associated with greater pSS activity as assessed using the ESSDAI (9.4±6.8 vs 4.3±4.8; p<0.001) and proportion of patients taking immunomodulatory/immunosuppressive drugs (32.4% (24/74) versus 13.8% (44/318), p=0003). New neurological symptoms were more common in patients with than without prior neurological manifestations (RR=3.918 (95% CI 1.91 to 8.05); p<0.001). Conclusions Prevalences of peripheral and central neurological manifestations in pSS are about 15% and 5%, respectively. Neurological manifestations are associated with greater pSS activity. New neurological manifestations are more common in patients with prior neurological involvement.
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Affiliation(s)
- Guillermo Carvajal Alegria
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Dewi Guellec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Xavier Mariette
- Service de rhumatologie , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, INSERM U1184 , Le Kremlin-Bicêtre , France
| | | | - Emmanuelle Dernis
- Service de rhumatologie , Centre hospitalier Le Mans , Le Mans Cedex , France
| | - Jean-Jacques Dubost
- Service de rhumatologie , CHU Gabriel Montpied , Clermont-Ferrand Cedex , France
| | | | - Eric Hachulla
- Service de médecine interne , CHU Claude Huriez , Lille Cedex , France
| | - Claire Larroche
- Service de médecine interne , Hôpital Avicenne APHP , Bobigny Cedex , France
| | - Veronique Le Guern
- Centre de référence des maladies auto-immunes rares, CHU Cochin APHP , Paris , France
| | - Divi Cornec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Valérie Devauchelle-Pensec
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
| | - Alain Saraux
- Service de rhumatologie , CHRU Cavale Blanche, EA 2216, INSERM ERI 29, Université de Bretagne occidentale , Brest Cedex , France
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Carvajal Alegria G, Uguen A, Genestet S, Marcorelles P, Saraux A, Cornec D. New onset of rheumatoid vasculitis during abatacept therapy and subsequent improvement after rituximab. Joint Bone Spine 2016; 83:605-6. [PMID: 27052429 DOI: 10.1016/j.jbspin.2015.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 08/27/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Guillermo Carvajal Alegria
- Hôpital de la Cavale Blanche, Service de Rhumatologie, BP 824, 29609 Brest cedex, France; Université de Brest, and Labex "IGO", Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, EA2216, Inserm ESPRI, ERI29, 29609 Brest, France
| | - Arnaud Uguen
- CHRU de Brest, Université de Brest, Hôpital Morvan, Service d'Anatomie Pathologique et Cytologie, EA 4685 LNB, 29609 Brest, France
| | - Steeve Genestet
- CHRU de Brest, Hôpital de la Cavale Blanche, Service d'Explorations Fonctionnelles Neurologiques, 29609 Brest, France
| | - Pascale Marcorelles
- CHRU de Brest, Université de Brest, Hôpital Morvan, Service d'Anatomie Pathologique et Cytologie, EA 4685 LNB, 29609 Brest, France
| | - Alain Saraux
- Hôpital de la Cavale Blanche, Service de Rhumatologie, BP 824, 29609 Brest cedex, France; Université de Brest, and Labex "IGO", Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, EA2216, Inserm ESPRI, ERI29, 29609 Brest, France
| | - Divi Cornec
- Hôpital de la Cavale Blanche, Service de Rhumatologie, BP 824, 29609 Brest cedex, France; Université de Brest, and Labex "IGO", Laboratoire d'Immunothérapies et Pathologies lymphocytaires B, EA2216, Inserm ESPRI, ERI29, 29609 Brest, France.
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