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Biomedical subjects

A Saraux

Publications and source records attributed to A Saraux.

89 records · Page 5Linked to original sources
PubMed1989

[Methotrexate in dermatology: current aspects].

The prescription of methotrexate (MTX) in dermatology is nowadays restricted for two main reasons: the toxicity of the drug and the availability of less toxic treatments (phototherapy and etretinate) in its main indication: psoriasis. However, MTX remains very useful in severe psoriasis, to some extent, in various dermatological diseases, such as dermatomyositis. A perfect knowledge of its adverse effects (slight on the gastrointestinal tract and bone marrow, much more serious on the liver and lung) allows a reasonable use of the drug but cannot avoid the unpredictable hypersensitivity pneumopathy.

Abnormalities, Drug-Induced↗
PubMedDate not supplied

Differences in understanding and application of 1987 ACR criteria for rheumatoid arthritis and 1991 ESSG criteria for spondylarthropathy. A pilot survey.

OBJECTIVES: To determine areas of agreement and disagreement among experts in the interpretation of the published criteria for RA (ACR) and spondylarthropathies ( ESSG). METHODS: Thirty-two experts (16 from France and 16 from 10 other countries) replied anonymously to a mailed questionnaire. RESULTS: Tenosynovitis and 'sausage-like' painless swelling of the toes were considered as criteria for RA by 18 and 14 experts, respectively. The definition of symmetry differed widely among experts (symmetry of only one group of joints was sufficient for 13). Twenty-five experts considered erosions of other joints than the wrists and fingers as a criterion for RA, 17 thought that fulfilment of criteria could be achieved cumulatively, and 19 would appreciate clarifications of the current criteria. Among possible clarifications for RA, it was frequently recommended that morning stiffness and nodules be eliminated and that new marker antibodies, X-rays of the feet, and exclusion criteria be added. Twenty-three of the 29 experts who gave an opinion (79%) agreed with the notion of SP in the absence of axial signs and sacroiliitis, 26/31 (84%) indicated that a patient can have both RA and SP, and 19/30 (63%) thought that RA and SP could be regarded as syndromes more than diseases. Only 5/32 experts relied more on the criteria than on their clinical judgement in diagnosing RA. CONCLUSIONS: There would seem to be a needfor the optimisation of RA and ESSG criteria, particularly within the context of early arthritis.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Confidence in the diagnosis of early spondylarthropathy: a prospective follow-up of 270 early arthritis patients.

OBJECTIVE: To study the confidence of office-based rheumatologists (OBR) and a college of 5 experts in their diagnosis of spondylarthropathy (SpA) for early arthritis after more than 2 years of follow-up; to determine whether at that time the degree of confidence was improved by the fulfilment of the ESSG criteria. METHODS: 270 patients with early-onset (< 1 year) arthritis were prospectively followed-up for 29+/-11 months. At the final examination, OBR and the college of 5 experts rated their confidence in the diagnosis of SpA on a 0-10 analogue scale and on a 1-4 Likert scale, respectively. RESULTS: After 29+/-11 months OBR had classified 56 patients (21%) as SpA, while a collegial diagnosis of probable (N = 32) or certain SpA (N = 14) was made for 46 patients (17%). At the final examination OBR confidence in their diagnosis (gold standard) was only 6.7+/-2.4 for all 56 cases of SpA. The cumulative fulfilment of ESSG criteria for SpA after 29+/-11 months correlated with the confidence of OBR and the experts in SpA, but improved only slightly the final confidence of OBR (7.1+/-2.3 versus 6.7+/-2.4 for all 56 SpA). Similarly, OBR confidence for the 18/56 SpA patients positive for HLA-B27 was only 7.1+/-2.0. Only 21 of these 56 patients were considered as SpA at baseline, although 37/56 (66%) had fulfilled ESSG criteria since thefirst examination. CONCLUSION: This study indicates a probable lack of consensus on the nosology of early SpA and the limited help provided by the ESSG criteria to differentiate early SpA from otherforms of arthritis at baseline.

Adolescent↗
PubMedDate not supplied

Prevalences of rheumatoid arthritis in Roman Catholic nuns and the general female population in Brittany, France: a pilot study.

OBJECTIVE: To evaluate the influence of lifestyle factors on the prevalence of rheumatoid arthritis (RA) by comparing Roman Catholic nuns and the general female population. METHOD: RA prevalence in the general population was evaluated using a standardized telephone survey in 1857 homes taken at random. Individuals who reported an inflammatory joint disease were contacted by a rheumatologist of our unit, missing data were collected from the general practitioner or rheumatologist with the patient's permission, and if necessary a physical examination was done by a rheumatologist. The 9 largest Roman Catholic nun communities in Brittany were screened using the same standardized questionnaire administered face-to-face; nuns who reported an inflammatory joint disease were interviewed and examined by rheumatologists. In both populations, RA was diagnosed when (1) the rheumatologist of our unit who interviewed the patient considered the RA classification criteria positive and (2) the rheumatologist who examined the patient gave a diagnosis of RA independently from RA classification criteria. RESULTS: Data were available for 1706 adult females in the general population and 721 nuns. Of the 20 nuns who reported RA or polyarthritis, 11 received a diagnosis of RA (prevalence 1.52%). The prevalences adjustedfor the French population after 40 years were 1.66% (95% confidence interval, 0.84-2.44) and 1.33 (0.27-2.40) among the nuns and the general female population, respectively. CONCLUSION: Although our nun population was too small for definite conclusions, we found no evidence of a difference in RA prevalence among nuns and the general female population in Brittany.

Adult↗
PubMedDate not supplied

Diagnostic value of serum and synovial procalcitonin in acute arthritis: a prospective study of 42 patients.

OBJECTIVE: To determine the diagnostic value of serum and synovial procalcitonin (PCT) for bacterial arthritis and to determine the cellular origin of synovial PCT. METHODS: A prospective study enrolled 42 patients with acute arthritis including 11 bacterial arthritis, 18 rheumatoid arthritis and 13 crystal induced arthritis. Diagnostic values of serum and synovial PCT levels were determined by a immunoluminometric assay (Lumitest PCT) and compared to those of classical inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, synovial fluid cellularity and both serum and synovial IL-6 and TNF alpha). Using fibroblast-like synoviocyte (FLS) cultures derived from rheumatoid arthritis (n = 4) and osteo-arthritis (n = 3) synovium, with or without stimulation by lipopolysaccharid or recombinant streptococcal protein 1/II, we attempted to determine whether synovial cells could be a source of PCT. RESULTS: Serum PCT was the best parameter to distinguish patients with acute bacterial arthritis from patients with crystal induced arthritis or rheumatoid arthritis. In setting of an acute arthritis serum PCT (> 0.5 ng/mL) achieved 55% sensitivity and 94% specificity for the diagnosis of bacterial arthritis, while CRP (> 50 mg/L) had 100% sensitivity but poor specificity (40%). Serum PCT appeared to be higher in patients with septic arthritis resulting from "systemic infection" than in cases resulting from direct inoculation. Synovial PCT was not useful to discriminate between infectious and non infectious arthritis in clinical practice. PCT could not be detected at significant levels in the conditioned medium from fibroblast-like synoviocyte cultures. CONCLUSION: Serum PCT is a poorly sensitive but specific marker of bacterial arthritis. Use of serum PCT in association with CRP could nevertheless be useful in an emergency situation for the diagnosis of bacterial arthritis.

Acute Disease↗
PubMedDate not supplied

[Arthritis in HIV infection. A prospective study of 76 cases in Rwanda].

A 16-month prospective study of adult patients who had been suffering from arthritis for less than one year was conducted in the Internal Medicine department of the hospital of Kigali, Rwanda. Seventy-six patients were included in the study. Out of 72 patients whose sera were tested for human immunodeficiency virus (HIV), 52 were positive, this being 72.2 percent compared with the 20.7 percent figure observed in the urban population of adults in Rwanda. Two main groups arthropathies were individualized: septic arthritis (24 patients including 19 seropositive subjects) and inflammatory rheumatism with criteria of spondyloarthropathies in some of them (34 patients, 32 tested, 28 serum positive). Thus, the finding of acute arthritis in a region with high HIV infection prevalence should suggest a possible HIV infection, especially when the arthritis itself is suggestive of this diagnosis.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The HLA B27 antigen-spondylarthropathy association. Impact on clinical expression.

To determine the impact of the HLA B27 antigen on the expression of spondylarthropathies, we conducted a retrospective cross-sectional study of the 116 spondylarthropathy patients whose HLA B27 phenotype was determined during a stay in the Morvan Hospital rheumatology department, Brest, France, between January 1, 1986, and December 31, 1994. Age at disease onset was younger in the HLA B27-positive patients (31.5 +/- 14 years versus 40 +/- 15 years; p = 0.008), who were more likely to have buttock pain (odds ratio, 4.84; p < 0.001) and roentgenographic evidence of sacroiliitis (odds ratio, 5.34; p < 0.001) and less likely to have psoriasis (odds ratio, 0.15; p < 0.0001), as compared with their HLA B27-negative counterparts. Peripheral arthritis occurred in similar proportions of patients with and without the HLA B27 antigen. Presence of HLA B27 was of little value for the diagnosis of spondylarthropathy in patients with inflammatory joint disease involving peripheral joints (sensitivity 50%, specificity 92%, positive predictive value 53%, negative predictive value 91%). Higher mean values of the erythrocyte sedimentation rate (40.3 versus 30.6 mm/h; p < 0.05) and serum C-reactive protein level (29.8 versus 16.8 mg/L, p < 0.005) were seen in patients with the HLA B27 antigen. Our data from patients with any form of spondylarthropathy show that the HLA B27 antigen is associated with earlier-onset disease, involvement of the sacroiliac joints and more severe inflammation.

Adult↗
PubMedDate not supplied

Anti-endothelial cell antibodies in patients with various forms of vasculitis.

OBJECTIVE: To determine the prevalence of anti-endothelial cell antibodies (AECA) in various forms of vasculitis and to evaluate their relationships with markers of endothelial cell (EC) injury such as thrombomodulin (TM), von Willebrand factor antigen (vWf) and protein S. METHODS: A total of 167 disease-associated sera, from 79 patients with large- or medium-sized (group I) and 88 with small-sized vessel vasculitis (group II), were examined for the presence of AECA using a cellular enzyme-linked immunosorbent assay (ELISA). These were evaluated before and after incubation with epithelial cells. EC plus epithelial cell (eC) extracts were fractionated and blotted with selected sera, and EC plus mononuclear cell extracts were dotted and blotted with lupus sera. Soluble TM, vWf and protein S levels were measured by ELISA. RESULTS: The binding of antibodies to eC was significant in group II sera (p < 0.01) but not in group I sera, so that the remaining EC-specific activity was significantly higher (p < 0.001) in the latter group than in the former. Eight antigenic specificities appeared to be specific for EC, whereas three were shared with eC. Despite absorption, the sera remained as reactive with EC and MNC as before. Taking the patient group as a whole, the levels of serum TM correlated with the titers of IgG, IgM and IgA AECA. CONCLUSION: EC-specific activity is more often encountered in group I than in group II patients. At present, the explanation for the distinct AECA specificities in these disease associated sera is not clear.

Antibodies↗