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Biomedical subjects

B Combe

Publications and source records attributed to B Combe.

114 records · Page 7Linked to original sources
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

The French early arthritis registry.

This report is focused on two French multicenter cohorts of patients with early rheumatoid arthritis (RA). The first one is a community-based study which was started in 1993. It was mainly designed to identify prognostic factors of joint destruction, disability and remission in patients with early RA. The 3-year and 5-year results have been recently reported. Briefly, progression of joint damage was best predicted at baseline by radiographic scores, ESR, CRP, rheumatoid factor and DRB1*04 genes, and disability by disease activity including the HAQ score. Recently, the French Society of Rheumatology initiated a large national multicenter registry (800 patients), the "ESPOIR cohort study", that could serve as a database to allow investigations not only on diagnostic and prognostic markers, but also on etiologic, pathogenic and medico-economic factors among patients with early inflammatory arthritis who could later develop RA. The objectives, design and organization of this early arthritis registry are described.

Activities of Daily Living↗
PubMedDate not supplied

The efficiency of switching from infliximab to etanercept and vice-versa in patients with rheumatoid arthritis.

OBJECTIVE: To determine whether it may be successful to try another TNF-alpha antagonist (infliximab or etanercept) when one has failed due to non response or the development of side effects. METHODS: In a cohort of 282 patients with rheumatoid arthritis treated with infliximab or etanercept, we observed 38 patients who had received both agents. RESULTS: Twenty-four patients received infliximab first and 14 received etanercept first. Discontinuation was due to a lack of efficiency for 29 patients and to the occurence of an adverse effect for 9 patients. For 25 out of the 38 patients, the switch was a success according to the global physician's assessment 3 months after switching. This result was correlated to a significant decrease of DAS 28 measurements and CRP values (p < 0.05). The response after switching was recorded as a success for 18 out of the 24 patients who were treated with infliximab first, and for 12 out of the 14 patients who were treated with etanercept first. There was no statistical difference concerning the response after the switch between the two groups. Among the 29 patients who discontinued the first anti TNF-alpha treatment due to lack of efficiency, only 6 did not respond to the second anti TNF-alpha treatment. Only one out of the 9 patients who stopped a first anti TNF-alpha treatment after developing a side effect underwent an adverse event with the second anti TNF-alpha treatment. CONCLUSION: Our study suggests that switching between TNF-alpha antagonists seems to be relevant, regardless of which one was used first. It is legitimate to try to switch TNF-alpha blockers before contemplating other therapeutic strategies.

Adult↗
PubMedDate not supplied

The B cell repertoire in rheumatoid arthritis. II. Analysis of rheumatoid factors bearing the IdRQ cross-reactive idiotype.

With the view of studying whether rheumatoid factors (RFs) produced in rheumatoid arthritis (RA) were different from those synthesized in physiological situations, we analyzed the usage of a cross-reactive idiotype (IdRQ) previously reported to be specific for RA RFs. Using EBV immortalization of circulating B cells, we prepared monoclonal RFs from patients with RA and matched controls. In both groups between 1/2 and 2/3 of the monoclonal RFs bore IdRQ. Using limiting dilution analysis, we studied the frequencies of the EBV-activated B cells able to synthesize immunoglobulins bearing IdRQ. In patients and in controls, on average, 1/3 of the RF-secreting cells used IdRQ and around 2/3 of the synthesized IgM bearing IdRQ were devoid of RF activity. These results show that precursor cells containing the germline gene encoding IdRQ are present in similar quantities in RA patients and healthy individuals, and that the IdRQ cross-reactive idiotype, although interesting for the study of the B cell repertoire, is probably not useful as a marker for susceptibility to RA.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Treatment of rheumatoid polyarthritis with IgG eluted from the placenta. Results of an open study on 31 patients].

Thirty-one patients presenting classical or defined, severe and active rheumatoid polyarthritis (RP) unresolved by most of the usual basic treatments (due to inefficacy or safety problems) were treated with human placental IgG preparations (HPIgG) in an open study. Various therapeutic protocols were tested to determine the most efficacious dosage. Favorable results were noted in 62% of cases. Improvement was generally rapid, often occurring after the first week of treatment. Rheumatoid nodules subsided by more than 50% and were resolved in two of nine cases. A decrease in dosage of analgesics or anti-inflammatories was possible in seven of 31 cases. Remission of RP of duration exceeding six months after withdrawal of HPIgG treatment was noted in six of 18 favorable results (33.3%). Best results were seen with intravenous administration of 1,500 mg per day seven days per month. No clinical or immunological effects were seen in a control group treated with venous globulins (1,500 mg/day for seven days). Safety was very satisfactory: four withdrawals from treatment due to proteinuria (3 cases) or phlebitis (1 case); these adverse reactions subsided rapidly. Immunostimulation of lymphocyte function was seen in all patients treated with HPIgG. The mode of action of HPIgG is currently under study. HPIgG may act as polyspecific antibodies against class II HLA antigens thus opening up the possibility of a new type of therapeutic immunomodulation in man.

Adult↗