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Biomedical subjects

A Saraux

Publications and source records attributed to A Saraux.

At least 55 records · Page 3Linked to original sources
PubMed1998

Lymphoma with regression after methotrexate withdrawal in a patient with rheumatoid arthritis. Role for the Epstein-Barr virus.

We report a new case of large T-cell lymphoma in a rheumatoid arthritis patient under low-dose methotrexate (cumulative dose: 750 mg). Serologic tests for the Epstein-Barr virus were positive, and the viral RNA was demonstrated in the lymphoma cells. As in a few other cases reported in the literature, the clinical and laboratory test abnormalities resolved promptly after methotrexate withdrawal without anticancer therapy. The patient was still in complete remission at last follow-up four years later.

Antigens, Viral↗
PubMed1997

[Diagnostic value of the HLA phenotype in inflammatory rheumatic diseases].

OBJECTIVES: HLA phenotyping is usually considered as costly and unnecessary for the diagnosis of inflammatory rheumatoid diseases. The aim of our work was to assess the diagnostic value of HLA phenotyping compared with the diagnostic value of sex and age at the onset of disease in cases where there is a doubt between rheumatoid polyarthritis and spondyloarthropathy with peripheral involvement. METHODS: The relative prevalence of inflammatory rheumatoid diseases was calculated for 138 patients hospitalized for diagnosis of rheumatoid disease. We considered however that in these patients the etiology of the inflammatory rheumatoid disease with synovitis, after search for etiology, could be either spondyloarthropathy with peripheral involvement or early-stage rheumatoid polyarthritis. Positive and negative predictive values were calculated by comparison between these two diseases. The sensitivity of HLA B27 in spondyloarthropathy with peripheral involvement was determined in a population of 83 hospitalized patients with confirmed diagnosis. The prevalence of HLA DR4 in rheumatoid polyarthritis was determined in 375 hospitalized patients with confirmed diagnosis. Predictive values were calculated using Bayes formula. RESULTS: The analysis of the positive and negative predictive values for HLA B27 showed that the diagnostic value of this allele was much greater than age at disease onset and sex in spondyloarthropathy with peripheral involvement. For rheumatoid arthritis, comparison of the diagnostic value of HLA DR4 versus age at disease onset and sex showed the lower performance of HLA DR4. However, the positive predictive value of HLA DR4 in rheumatoid polyarthritis was similar to that for these factors and equivalent to that of HLA B27. The positive predictive value for the combinations HLA DR4+ HLA B27- and HLA B27+ HLA DR4- was 0.90 for rheumatoid polyarthritis and spondyloarthropathy with peripheral involvement respectively. CONCLUSION: The validity of these promising findings should be confirmed in prospective studies.

Age Factors↗
PubMed1997

Antiendothelial cell antibodies: useful markers of systemic sclerosis.

BACKGROUND: Systemic sclerosis (SS) encompasses a wide spectrum of clinical presentations. Antiendothelial cell antibodies (AECA) in patients with primary Raynaud's phenomenon (PRP), limited SS (lSSc), or diffuse SS (dSSc) may help to determine the long-term prognosis of the disease. METHODS: Twenty-seven normal controls, 13 patients with PRP, 36 with lSSc, and 31 with dSSc were included in the study. Sera were examined for the presence of AECA, using a cellular enzyme-linked immunosorbent assay (ELISA). Angiotensin-converting enzyme (ACE) activity, plasma von Willebrand factor antigen (vWfAg), and thrombomodulin (Tm) concentrations were also evaluated. The medical records of 50 of the lSSc and dSSc patients were reviewed and the organ system involvement noted. RESULTS: Antiendothelial cell antibodies were present in 3 patients with PRP, 16 patients with lSSc, and 26 patients with dSSc. These autoantibodies were mainly of the IgG isotype. There was no difference in ACE activity between patients and controls. In contrast, vWfAg and Tm concentrations were higher in patients with PRP relative to controls, and higher in patients with lSSc compared with those with PRP. The presence of AECA was associated with digital scars and ulcers (P < 0.004 and P < 0.003, respectively), severe RP (P < 0.01), grade 3 tortuosity of vessels (P < 0.0004), and lung involvement (P < 0.02). CONCLUSION: The significant trend for AECA to increase with disease severity across the three groups of patients studies suggests that the AECA test can identify subsets of SSc with differing prognoses.

Adolescent↗
PubMed1997

HIV infection as a risk factor for septic arthritis.

We prospectively studied the demographics, the clinical and diagnostic features, the HIV-1 serostatus and the therapeutic response for all new patients with septic arthritis (SA) admitted to the Department of Internal Medicine of the Centre Hospitalier de Kigali, Rwanda, over a 19 month period. SA was diagnosed in 24 patients (10 male, 14 female), of whom 19 (79%) were HIV-1 seropositive (HIVpos). Gonococcal arthritis was found in four patients, all HIVpos. Non-gonococcal bacterial arthritis was established in 16 patients, of whom 13 were HIVpos. Causative organisms involved in this group and the corresponding HIV-1 serostatus of the patients were: Staphylococcus aureus: 4; 2 HIVpos. 2 HIVneg: Streptococcus pneumoniae: 4; 4 HIVpos; Salmonella group B: 2; 2 HIVpos; Streptococcus group D: 1; 1 HIVpos; Klebsiella pneumoniae: 1; 1 HIVpos; undetermined: 4; 3 HIVpos; 1 HIVneg. Tuberculous arthritis was presumed in four patients, of whom two were HIVpos. HIV-1-associated SA had a classical acute presentation and an overall good prognosis Compared to a control group consisting of hospitalized patients with malaria as the sole diagnosis, patients with SA were more likely to be infected with HIV-1 (P = 0.005, or 6.3; 95% CI 1.7 22.2). Prevalence rate estimates of SA among HIVpos and HIVneg patients were 0.5 and 0.25%, respectively (P = 0.38). We conclude that HIV-1 infection appears as a risk factor for SA among patients hospitalized at the Centre Hospitalier de Kigali, but that SA cannot be used as a predictor for HIV-1 infection for hospitalized patients. SA occurs infrequently and may present at any stage of HIV-1 infection.

Adult↗
PubMed1997

The functional affinity of IgM rheumatoid factor is related to the disease duration in patients with rheumatoid arthritis.

OBJECTIVE: To determine the relevance of the functional affinity of IgM rheumatoid factor (RF) to the clinical and serological characteristics of patients with rheumatoid arthritis. METHODS: The functional affinity of IgM RF of 57 seropositive rheumatoid arthritis patients was evaluated by an enzyme linked immunosorbent assay based on the use of a chaotropic agent. The inhibition index was taken as an estimate of functional affinity. The patient group was divided into high functional affinity subgroup 1 (functional affinity < 0.5, n = 37) and low functional affinity subgroup 2 (functional affinity > 0.5, n = 20). The medical records of all patients were reviewed with a particular note of the disease activity and the articular damage score. RESULTS: The disease duration was shorter (P < 0.01) in subgroup 1 patients [7.9 (SD 6.4) years] than in subgroup 2 patients [13.4 (11.29) years], so that Ritchie's, Lee's, and Steinbrocker's indices were lower in the former than in the latter (P < 0.01, 0.001, and 0.01, respectively). In contrast, erythrocyte sedimentation rates, C reactive protein concentrations, antinuclear antibody, and HLA DR4 prevalences were similar in the two subgroups. CONCLUSIONS: Different forms of RF are present during progression of the disease.

Adult↗
PubMed1997

HLA-B27 in French patients with rheumatoid arthritis.

Aims were to determine the prevalence of the HLA-B27 phenotype in a group of patients with RA, and to evaluate the clinical, radiological and, serological characteristics of RA in relation to this phenotype. All relevant information was obtained retrospectively from the standardized clinical records of 311 RA in-patients first admitted to the Rheumatology Unit of the Brest University Medical School. In the control population of Britanny, the frequency of HLA-B27 has been shown to be 12%, while HLA-B27 was present in 30 (9.6%) of the 311 RA patients. There was no significant association between demographic, clinical, biological, or radiological characteristics of the patients on the one hand, and the presence of the HLA-B27 allele on the other. The subgroup of RA patients with HLA-B27 had however a slightly higher IgA level than that without HLA-B27. Ankylosing spondylitis were found to coexist in three patients who all were HLA-B27 positive. We conclude (1) that the prevalence of HLA-B27 is not higher in French RA patients than in the normal controls, and (2) that HLA-B27 typing is not useful in RA. HLA-B27 does not confirm nor does it reject the diagnosis of associated ankylosing spondylitis.

Adult↗
PubMed1997

Clinical, laboratory, and radiographic features of rheumatoid arthritis with and without nodules.

To determine the significance of nodules in rheumatoid arthritis, we reviewed the medical records of 420 patients who underwent standardized clinical, laboratory, and radiological investigations during a hospitalization for rheumatoid arthritis between January 1, 1981 and December 31, 1994. Sixty-six patients (16%) had nodules and 354 (84%) did not. Age and gender distributions were similar in the two groups. Disease duration was significantly longer in the nodular than in the nonnodular group (11.3 +/- 9.4 years versus 7.6 +/- 7.3 years; P = 0.0003). When patients were stratified into five-year disease duration groups, dryness of the eyes and mouth was found to be more common in the nodular group, with the difference being largest during the first five years. Patients with nodules were more likely to have vasculitis irrespective of disease duration (odds ratio, 6.08; P = 0.028). Lee's and Ritchie's indices and radiographic alterations were more severe in the nodular group, whereas tests for inflammation were not significantly different. Patients with rheumatoid factors accounted for a larger proportion of the nodular than of the nonnodular group (odds ratio 2.48; P = 0.017). When patients were dichotomized based on latex test results, nodules were not significantly associated with antiperinuclear factor or antikeratin antibodies, whereas patients with nodules were significantly more likely to have vasculitis (odds ratio 5.3; P = 0.035), antinuclear factors (odds ratio 1.82; P = 0.043), and cryoglobulinemia (odds ratio 4.86; P = 0.0029). As compared with nonnodular rheumatoid arthritis, nodular rheumatoid arthritis was associated with more severe extraarticular disease, faster radiographic progression and a greater likelihood of rheumatoid factor and antinuclear antibody production. Each of these characteristics was associated with the presence of nodules independently from disease duration and rheumatoid factor positivity.

Aged↗
PubMed1997

Prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis.

OBJECTIVE: To evaluate the prevalence of symptomatic bronchiectasis in patients with rheumatoid arthritis. METHODS: Cross-sectional retrospective study of 453 rheumatoid arthritis patients. All patients completed a questionnaire designed to detect manifestations of bronchiectasis and had a chest film taken. Computed tomography of the chest was performed in those patients whose chest film was normal. RESULTS: Thirteen patients (2.9%), all female, had symptoms that met Walker's criteria for definite (n = 7) or probable (n = 6) bronchiectasis. Symptom onset was during childhood or adolescence in 69% of cases and antedated the first symptoms of rheumatoid arthritis in all patients but one. Six of the 13 patients (46%) had chest film abnormalities suggestive of bronchiectasis, and three of the remaining seven patients had abnormal computed tomography findings, yielding a total of nine cases of bronchiectasis confirmed by imaging studies among the 13 patients with suggestive symptoms (69%). This proportion rose to 90% when the three patients who failed to come to their computed tomography appointment were excluded. CONCLUSION: Using a methodological approach similar to that previously used by pneumologists, we found a 2.9% prevalence of symptomatic bronchiectasis in a population of hospitalized rheumatoid arthritis patients, which is higher than the 0.03% prevalence previously reported in the population at large.

Adolescent↗
PubMed1997

Osteoarthritis of the pisiform-triquetral compartment. A review of eight cases of an underrecognized entity.

Seven patients (eight hands) with pain suggestive of the pisiform-triquetral compartment were studied to compare outcomes after surgical excision of the pisiform (four hands) and after conservative therapy (four hands). All patients were reevaluated by a rheumatologist who was not involved in their treatment. The efficacy of conservative therapy was mediocre in every case. Although it is reasonable to assume that the surgically-treated patients had more severe manifestations at baseline, all were free of symptoms at reevaluation, versus none of the conservatively-treated patients. After two years, excision of the pisiform yielded excellent results with no adverse effects on range of motion or grip strength. Despite the small size of our sample and the relatively low incidence of pisitriquetral osteoarthritis, our data suggest that surgery is preferable over conservative therapy in this condition.

Aged↗
PubMed1996

Raynaud's phenomenon in rheumatoid arthritis.

The aim of this study was to evaluate the prevalence of Raynaud's phenomenon in patients with rheumatoid arthritis (RA), and to relate this symptom to clinical, radiological and serological characteristics of the patients. All relevant information was retrospectively obtained from the standardized clinical records of 322 RA in-patients first admitted to the Rheumatology Unit of Brest University Medical School. Raynaud's phenomenon was found in 54 (17.2%) of 322 RA patients. There was no significant correlation between demographic, clinical or radiological characteristics. However, the subgroup of RA patients with Raynaud's phenomenon had a slightly higher prevalence of vasculitis than the subgroup without Raynaud's phenomenon. CRP level and C4 level were found to be lower in the former than in the latter group, whereas ESR and various serological findings (rheumatoid factor, antinuclear antibodies) were comparable in the two groups. We conclude that the prevalence of Raynaud's phenomenon is high in French RA in-patients, and that some clinical and biological abnormalities (vasculitis, low CRP level and low C4 level) suggest an association between Raynaud's phenomenon and vasculitis in a few cases, whereas this association might be fortuitous in the remainder.

Adult↗
PubMed1996

Spondylarthropathy with distal joint involvement.

To study whether the presence of distal joint involvement in spondylarthropathy corresponds to a particular set of the disease, one hundred and twenty six patients with spondylarthropathy were included in a retrospective study. Two groups of patients were defined according to the presence or the absence of distal joint involvement and their clinical, radiological, and biological features were compared. The patients with distal joint involvement had a later onset of spondylarthropathy and showed higher levels of biological markers of inflammation in their peripheral blood. However, no great difference appeared between the two groups of patients. Spondylarthropathy with distal joint involvement cannot be separated from spondylarthropathy without distal joint involvement and appears to be the same disease.

Adult↗
PubMed1996

Four new cases of collagenous colitis with joint symptoms.

Collagenous colitis is characterized by chronic watery diarrhea and a greater than 10 micron-thick collagen deposit in the subepithelial layer of the colonic mucosa. Rheumatic and autoimmune diseases have been reported to occur in patients with collagenous colitis. In 1993, we managed four patients with collagenous colitis and joint diseases. One had rheumatoid arthritis, one had a spondylarthropathy and two had seronegative polyarthritis without joint destruction. Three patients had dryness of the eyes and/or mouth and two had Raynaud's phenomenon. These four cases and data from a literature review provide a basis for discussing possible links between collagenous colitis and a number of joint diseases. Although some anecdotal case-reports may reflect a chance association with inflammatory joint diseases, available evidence suggests that collagenous colitis may be a cause of enteropathic arthropathy. Recent data point to an abnormality in the differentiation of fibroblasts in the colonic mucosa, although the mechanism that initiates this abnormality remains unknown.

Adult↗