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Biomedical subjects

D Wendling

Publications and source records attributed to D Wendling.

At least 73 records · Page 4Linked to original sources
PubMed1998

Factors linked to disease activity in a French cohort of patients with spondyloarthropathy.

OBJECTIVE: To identify risk factors associated with disease activity, in a group of patients with spondyloarthropathy (SpA) living in France. METHODS: Patients fulfilling the ESSG or Amor criteria for SpA were enrolled in a cross sectional multicenter study. Disease activity was assessed using a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Univariate and multivariate analyses were used to identify a link between BASDAI and disease characteristics, genetic factors, and environmental factors such as infectious events, mental stress, working conditions, and dietary factors. RESULTS: We studied 293 patients. On multivariate analysis, BASDAI appeared to be mainly linked to disease duration (negative correlation), the absence of sacroiliitis, and the "frequency of meals taken out of home" (negative correlation). CONCLUSION: Disease activity in a French population of patients with SpA appeared to be linked mainly to a shorter disease duration and a peripheral pattern of arthritis, as well as to dietary habits. The underlying links between this last environmental factor and disease activity remained hypothetical and could only reflect a nontested social factor.

Adult↗
PubMed1997

[Bronchiectasis and rheumatoid arthritis. Incidence and etiopathogenic aspects. Review of the literature].

Many pleural and pulmonary manifestations are described in rheumatoid arthritis, due to the disease itself or drug-induced. A literature review revealed 289 reports of bronchiectasis since 1928, the respiratory symptoms preceding the articular features in 90%. Although the frequency of bronchiectasis in the general population is difficult to assess, and thus maybe underestimated, the prevalence in rheumatoid arthritis seems higher. Thus the recent studies, using modern processes such as high resolution computed tomography of the lungs, assess this association to about 25%. Nevertheless, the methodology of these studies is open to criticism, so the high frequency must be qualified. The pathogenic and aetiological factors remain unknown, and miscellaneous hypotheses, especially immunological, have been suggested. The relationship between both affections can not be asserted, but the association is unlikely to be fortuitous.

Arthritis, Rheumatoid↗
PubMed1997

Spondylodiscitis in SAPHO syndrome. A series of eight cases.

OBJECTIVE: To determine the frequency, clinical features, and radiological and bone scintigraphic changes of spondylodiscitis in patients with SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis). METHODS: The study was retrospective. Data from patients with the diagnostic criteria of SAPHO syndrome were analysed for clinical features, biological data (HLA B antigen), and pelvic and spine x rays. Spine computed tomography (CT) or magnetic resonance imaging (MRI) were also examined in some cases. RESULTS: 25 patients with a diagnosis of SAPHO were seen since 1985. Eight had spondylodiscitis. These included five with palmoplantar pustulosis, one with pustular psoriasis, one with psoriasis vulgaris, and one with chronic recurrent multifocal osteomyelitis without skin disease. The skin lesion occurred before the spondylodiscitis in four cases. Chest wall involvement was observed in four cases and sacroiliac joint lesions only in the case with osteomyelitis. HLA B27 was always negative and HLA B8 was found in four cases. Radiological findings consisted of erosive or sclerosing remodelling of endplates with a narrowed disc space; a reduced height of the vertebral body was also observed in some cases. These spinal lesions occurred in the three vertebral segments. Multiple sites of spondylodiscitis in the same patient were common. Bone scan showed mildly increased uptake and CT and MRI were useful for detecting signs of infection such as abscess. Enhanced signals on T2 weighted sequence or after injection of gadolinium were often observed. Follow up study of most of these patients suggests that the prognosis of spondylodiscitis in the SAPHO syndrome is favourable. CONCLUSIONS: Despite few description in the literature, spondylodiscitis in the SAPHO syndrome is common (32% in this series). These radiological findings are similar to the discovertebral changes of spondylodiscitis in ankylosing spondylitis, thus giving support to the relations between SAPHO syndrome and spondylarthropathies. However, this does not mean that the pathogenic mechanisms are the same in these two conditions.

Acne Vulgaris↗
PubMed1997

Evaluation of a French version of the Bath Ankylosing Spondylitis Disease Activity Index in patients with spondyloarthropathy.

OBJECTIVE: To develop a French version of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and to determine its metric properties in patients with all forms of spondyloarthropathies (SpA). METHODS: A French version of BASDAI was obtained after a translation and back-translation process. Patients fulfilling the European Spondylarthropathy Study Group or Amor criteria for SpA were included. BASDAI of Day 0, Day 1, and, when treatment was changed, Day 8, and other clinical and biological disease activity variables were recorded, along with assessment of disease activity by the physician or the patient. Scalability, reproducibility, sensitivity to change, internal consistency and redundancy, and construct validity of the index were assessed. RESULTS: We studied 293 patients. Good scalability, reproducibility, construct, and internal validity were observed for BASDAI. Sensitivity to change could not be assessed. CONCLUSION: The French version of BASDAI exhibited good metric properties in patients with all forms of SpA, confirming its utility in further clinical research in SpA. However, sensitivity to changes due to drug therapy remains to be assessed.

Adult↗
PubMed1996

[Osteoporosis in ankylosing spondylitis].

Bone formation is classically observed in ankylosing spondylitis, but osteoporosis can also occur. This condition has been recognized for years on radiographs. Compared with controls, osteoporosis in ankylosing spondylitis is responsible for increasing the incidence of vertebral compression fractures and also explains spinal fractures after trauma, mainly observed at the cervical level. Measurement of bone mass is useful in diagnosing osteoporosis commonly observed in the lumbar spine and the femoral neck but not in the appendicular skeleton. Osteoporosis is seen early in the disease whereas increased bone mass is observed later or due to syndesmophyte formation. Osteoporosis in ankylosing spondylitis is probably a multi-factorial condition. Contributing factors are spine immobility secondary to ankylosis, inflammatory cytokines which enhance bone resorption, prolonged use of nonsteroidal antiinflammatory drugs and a deficit in sex hormone secretion. Furthermore, there is no alteration in calcium or phosphorus metabolism in ankylosing spondylitis. Finally, a study of bone morphometrics in the iliac crest region is required to better explain osteoporosis in ankylosing spondylitis.

Absorptiometry, Photon↗
PubMed1996

Serum secretory immunoglobulins in ankylosing spondylitis.

Humoral mucosal immunity may be implicated in pathophysiology of ankylosing spondylitis (AS). The aim of the study was to evaluate serum levels of IgA, IgM and secretory IgA (sIgA), secretory IgM (sIgM) as well as free secretory component (FSC) in patients with AS compared to controls and rheumatoid arthritis (RA) patients. Levels of sIgA, sIgM and FSC were measured with a specific ELISA in 37 AS patients, 45 controls and 27 RA. The results were as follows: Serum levels of IgA were higher in AS vs controls and in RA vs controls (p = 0.01). Levels of sIgA were higher in AS vs controls (p = 0.01), but higher in RA vs AS (p = 10(-4)). There was no difference of sIgM in AS vs controls, FSC levels were higher in AS vs controls, and higher in AS patients with elevated CRP. In view of elevated FSC, this increase of sIgA in AS may have been due to excessive production of mucosal IgA after bacterial stimulation according to the current hypothesis of the disease.

Adult↗
PubMed1996

[Use of methotrexate in spondylarthropathies. Review of the literature].

Methotrexate (MTX) is one of the most effective treatments of rheumatoid arthritis. It has also been used in other conditions such as spondylarthropathies (SPA). The literature concerning MTX in SPA was reviewed. Thus, MTX has been mainly prescribed in psoriatic arthritis and Reiter's syndrome with success for dermatological manifestations of these diseases. However, only a few controlled trials have been conducted in psoriatic arthritis and only one placebo controlled study did not demonstrate a real beneficial effect. Furthermore, it seems that MTX has no influence on the radiological outcome of psoriatic arthritis. There has been no controlled study upon the efficacy of MTX in Reiter's syndrome, ankylosing spondylitis or arthropathy associated with inflammatory bowel diseases. Such studies in SPA are required to evaluate the responding conditions, the efficacy, the side-effects, and the effective dose of MTX.

Antimetabolites↗
PubMed1996

Sarcoidosis and spondylarthropathy. Three case-reports.

Coexistent sarcoidosis and seronegative spondylarthropathy have rarely been reported. We add three new cases to the nine previously published. Two men and one woman with sarcoidosis met Amor's criteria for spondylarthropathy. The diagnosis of sarcoidosis was based on histologic findings in two cases and on roentgenographic and laboratory test findings in one case. The features of each of the two diseases were unremarkable. The two diagnoses were confirmed at about the same time. Osteoarticular manifestations of sarcoidosis are reviewed. Our case-reports illustrate the diagnostic difficulties raised by discovery of sacroiliitis in a patient with sarcoidosis: sarcoid osteitis, infection, or a spondyloarthropathy can be the cause of the sacroiliac lesions. Moreover, the pelvic and spinal manifestations of sarcoidosis can mimick a spondylarthropathy. Coexistence of sarcoidosis and spondylarthropathy is probably due to chance, since there are no shared predisposing genetic factors and the number of reported cases is small.

Aged↗
PubMed1996

Proximal paraparesis following spinal anesthesia.

A 70-year-old man with prostatic cancer extending to the urinary bladder underwent transurethral resection of the bladder neck under spinal anesthesia and developed weakness of the proximal lower limbs a few hours after the procedure. The weakness persisted for several months. Because there were no local surgical complications (hematoma, infectious epiduritis, abscess) or bone metastases responsible for nerve root or spinal cord compression, a causal relation between the neurologic deficit and the spinal anesthesia was considered likely. Neurologic deficits are uncommon after spinal anesthesia and can be produced by complications of the surgical procedure (direct nerve injury, hematoma, abscess), arachnoiditis, neurotoxicity of disinfectants or of preservatives added to solutions of anesthetic drugs, or spinal cord ischemia. Precipitating factors for spinal cord ischemia include faulty patient position during the procedure, intraoperative arterial hypotension and injection of vasoconstricting agents.

Aged↗
PubMed1996

Rheumatoid arthritis and bronchiectasis. A retrospective study of fourteen cases.

Since 1928, 288 cases of rheumatoid arthritis and bronchiectasis have been reported in the medical literature. The interactions between these two conditions and the etiopathogenic mechanisms they involve remain unclear. During a retrospective study of 100 rheumatoid arthritis patients and 80 bronchiectasis patients, we identified 14 additional patients with both conditions. There were 10 females and four males (ratio 2.5/1). Bronchiectasis was confirmed either by computed tomography of the chest or by bronchography. The respiratory manifestations antedated the joint disease in 12 patients, by a mean interval of 28.5 years. An infectious cause was identified in six cases. Neither the age at onset nor the duration of rheumatoid arthritis were influenced by the presence of bronchiectasis. Seven patients had 15 extraarticular manifestations suggesting potentially severe joint disease. The flares of joint and respiratory symptoms were concomitant in six patients. In six patients, the respiratory manifestations worsened after onset of the joint disease. Tests for rheumatoid factors were positive in 73% of cases. Panhypogammaglobulinemia was found in one case. Ten patients underwent lung function tests, which showed evidence of nonspecific obstructive disease. Overall, our findings are consistent with previous reports in the literature. In patients with predisposing immunogenetic factors, bronchiectasis may be involved in the genesis of rheumatoid arthritis.

Adult↗
PubMed1995

[Rheumatoid arthritis: its relationship with HLA DR molecules].

Over the last two decades, much progress has been made in our understanding of the genetics of rheumatoid arthritis since the discovery of a link between the HLA DR4 antigen and rheumatoid arthritis in 1974. In molecular biology, the precise alleles of the HLA DRB1 gene which encode for different specific molecules have been identified. They have been used to link rheumatoid arthritis to certain HLA DRB1 subtypes recognized as "high risk" alleles. It has been hypothesized that the shared epitope would be one way for a molecular approach to susceptibility of allelic variants in rheumatoid arthritis. More recently, the notion that high risk DRB1 alleles might contribute to disease severity has also been put forward. HLA DRB1 alleles carrying a risk of rheumatoid arthritis would have two properties: they could serve as a marker of the risk of developing the disease and of disease severity both essential elements for the clinician.

Arthritis, Rheumatoid↗
PubMed1995

[Rheumatic manifestations of parvovirus B19 infection].

Parvoviruses are small single-strand DNA viruses. Human parvovirus (PV B19) was isolated in the 1970s and recognized as a pathogen in the 80s. Its role was first demonstrated in acute erythroblastopenia in patients with chronic haemolytic anaemia, then in epidemic megalerythema. More recently PVB19 has been shown to be the aetiologic agent in fetal loss and chronic infection in immunodepressed patients. Further attention has focused on rheumatologic manifestations, particularly in prolonged joint diseases raising the problem of differential diagnosis and a possible pathogenic relationship with rheumatoid arthritis and systemic lupus erythematosus. Clinically, subjects with parvovirus B19 infection have flu-like manifestations of joint pain and myalgia lasting for about 1 week. Generally, the joint pain is symmetrical, of inflammatory type usually involving proximal joints (phalangeal joints in two-thirds of the cases). Acute back pain or associated extra-articular signs are often absent. Signs regress spontaneously in 10 to 15 days although longer periods have been observed. Diagnosis can be confirmed by ELISA identification of specific IgM antibodies. Nonsteroid antiinflammatory drugs are generally effective.

Adult↗