Search PubMed⌕ Search

Biomedical subjects

M Dougados

Publications and source records attributed to M Dougados.

At least 181 records · Page 10Linked to original sources
PubMed1997

Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee.

OBJECTIVE: Several reported studies suggest that repeated intra-articular injections of hyaluronan result in sustained relief from pain and functional disability in patients with knee osteoarthritis. Several in vivo data suggest that hyaluronan might have a beneficial structural effect in osteoarthritis. The objective of the study was to evaluate the potential structure-modifying effects of Hyalgan (500-730 kDa molecular weight), a highly-purified sodium hyaluronate. DESIGN: Patients with painful knee osteoarthritis (ACR criteria) were enrolled in a prospective, controlled study of 1-year duration. After randomization, either conventional therapy or three cycles (every 3 months) of three intra-articular injections of Hyalgan (once a week during 2 weeks) were given. Clinical outcome was added using pain visual analog score (VAS), functional impairment: Lequesne's index, quality of life: arthritis impact measurement scale (AIMS2) and structural outcome using X-rays: joint space narrowing and arthroscopy: global assessment using VAS, SFA scoring and grading systems. RESULTS: Of the 39 recruited patients, 36 completed the 1-year trial (19 in the Hyalgan group and 17 in the control group). There was no difference between groups at entry. Between-group comparison for changes in clinical parameters reached statistical significance for the quality of life index (AIMS2: -0.4 +/- 0.7 vs 0.2 +/- 0.9 in the Hyalgan and control groups respectively, P < 0.05). Deterioration in the structural parameters was less in the Hyalgan group, with a statistically significant difference for two of the three evaluated parameters (overall assessment of chondropathy: +5.1 +/- 12.7 vs 16.7 +/- 18.3, P = 0.016; SFA scoring system: +3.7 +/- 7.3 vs +9.0 +/- 11.5, P = 0.05) in the Hyalgan and control groups, respectively. CONCLUSIONS: This study supports existing data concerning the favorable symptomatic effect of intra-articular injections of Hyalgan in osteoarthritis of the knee and suggests that repeated intra-articular injections of Hyalgan might delay the structural progression of the disease. Other studies are required to confirm these results and to determine the long-term monitoring of osteoarthritic patients using such local therapy.

Analysis of Variance↗
PubMed1997

Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months. A randomized controlled trial.

Spa therapy is frequently used in daily rheumatological practice, but its benefit remains to be evaluated. A prospective randomized controlled study was conducted in 1993 in patients with osteoarthritis of the hip, knee or lumbar spine. Treatment was either spa therapy at Vichy (France) of 3 weeks duration (spa group) or usual therapy (control group). Assessment criteria were pain (visual analogue scale), functional impairment (Lequesne's index for hip or knee disease, Main and Waddell's for lumbar spinal diseases), quality of life index [revised Arthritis Impact Measurement Scale (AIMS2)], and analgesic and/or non-steroidal anti-inflammatory drug (NSAID) consumption. Patients were included by randomization into one of the two arms (spa or control) and assessment criteria were collected before spa therapy or the control period, and 3 and 24 weeks thereafter. A total of 188 patients (lumbar spine 95, knee 64, hip 29) were included in the study (spa group 91, control group 97). Changes in the assessment criteria after a 6 month follow-up period showed improvement in terms of pain, functional impairment and quality of life, with a reduced intake of symptomatic drugs (NSAID and analgesic drugs) in the spa group. This study suggests that spa therapy of 3 weeks duration has a prolonged, beneficial, symptomatic effect in osteoarthritis.

Aged↗
PubMed1997

Radiographic assessment in osteoarthritis.

Plain film radiographs are widely used to quantify disease progression in osteoarthritis. Various methods proposed for assessing radiological progression include individual radiographic features (e.g., osteophytes), composite indices (e.g., Kellgren and Lawrence grading), and quantitative measures (e.g., joint space width measurement). We discuss the metrologic properties of these methods and suggest means for improving the quality of radiography in clinical trials.

Clinical Trials as Topic↗
PubMed1997

Recommendations for a core set of outcome measures for future phase III clinical trials in knee, hip, and hand osteoarthritis. Consensus development at OMERACT III.

Significant progress has been made in outcome measurement procedures for osteoarthritis (OA) clinical trials, and guidelines have been established by the US Food and Drug Administration, European League Against Rheumatism, the World Health Organization/International League of Associations for Rheumatology, and the Group for the Respect of Ethics and Excellence in Science. However, there remains a need for further international harmonization of measurement procedures used to establish beneficial effects in Phase III clinical trials. A key objective of the OMERACT III conference was to establish a core set of outcome measures for future phase III clinical trials. During the conference, using a combination of discussion and polling procedures, a consensus was reached by at least 90% of participants that the following 4 domains should be evaluated in future phase III trials of knee, hip, and hand OA: pain, physical function, patient global assessment, and, for studies of one year or longer, joint imaging (using standardized methods for taking and rating radiographs, or any demonstrably superior imaging technique). These evidence based preferences, achieved with a high degree of consensus, establish an international standard for future phase III trials and will also facilitate metaanalysis and Cochrane Collaborative Project goals.

Clinical Trials, Phase III as Topic↗
PubMed1997

Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee.

The place of arthroscopy-assisted synovectomy in the treatment of inflammatory synovitis of the knee was evaluated by studying 26 patients who underwent this procedure between November 1992 and September 1995. Half the patients had rheumatoid arthritis. Twenty-three patients (28 knees) were reevaluated after a mean follow-up of 32 months (range, 4-50 months). The arthroscopic synovectomy was done either as the first-line synovectomy procedure, after failure of triamcinolone hexacetonide injection into the joint, or as the second-line synovectomy procedure, after failure of osmic acid or yttrium-90 synovectomy. Except in one patient with severe arthritis, arthroscopic synovectomy produced statistically significant improvements regarding pain (visual scale), function (Lequesne's index), range of flexion, amount of joint fluid and knee circumference. The range of extension of the knee was normal at baseline and remained so after the procedure. Overall efficacy was similar for first-line and second-line procedures. Results were rated good to very good by 71% of the patients and 61% of the physicians overall and the overall improvement in knee arthritis as perceived by the patients was 60%. The procedure was well tolerated in 93% of cases. The mean time needed to achieve a stable improvement was 3.2 weeks for pain, 4.7 weeks for swelling and 3.6 weeks for range of motion. One case each of hemarthrosis and stiffness of the knee were recorded, with a full recovery in both cases. Arthroscopic synovectomy is effective and safe but more burdensome and expensive than osmic acid or radiation synovectomy, and consequently deserves a place of choice in patients who have failed to respond to either of the last two methods.

Adult↗
PubMed1997

Hip axis length measurement using dual-energy X-ray absorptiometry.

Hip axis length (HAL) has been reported, in the United States, to influence the risk of hip fractures independently from age and proximal femoral bone mineral density. Last-generation dual-energy X-ray absorptiometry units can perform automatic hip axis length measurements. The present study was designed to evaluate the feasibility of this measurement in clinical practice and to establish the range of normal values obtained in French women using single- and fan-beam absorptiometry. Short-term reproducibility determined by performing two measurements with repositioning in 50 women was 1.67%. Long-term reproducibility calculated based on five measurements taken at six-month intervals in 60 women was 1.5%. No statistically significant differences were found between hip axis length on the right and left sides in 50 women. Mean values calculated based on measurements in 190 women aged 54 +/- 12 years (single-beam absorptiometry) and in 50 women aged 80 +/- 5 years (fan-beam absorptiometry) were 10.4 +/- 0.6 cm and 11.5 +/- 0.7 cm, respectively. Hip axis length was correlated with height but not with age or femoral neck bone mineral density. Our data are consistent with studies conducted in the United States. The interpretation of hip axis length measurements requires knowledge of the type of X-ray beam used (single or fan-shaped). Whether hip axis length predicts the hip fracture risk in Europeans remains to be demonstrated.

Absorptiometry, Photon↗
PubMed1997

Preliminary core sets for endpoints in ankylosing spondylitis. Assessments in Ankylosing Spondylitis Working Group.

An international working group was formed to select core sets to be used as endpoints in clinical trials in ankylosing spondylitis (AS). The results of the first steps of the selection of these core sets are described. The definition of the settings for which the core set will be intended are defined. The methods used to select the core sets were a combination of literature search, nominal group discussions, and plenary discussions. The following settings were defined: disease controlling antirheumatic therapy (DC-ART), symptom modifying antirheumatic drugs (SMARD)/physical therapy, and clinical record keeping. Over 110 variables used as endpoints in AS were found in the literature. The preliminary core set for DC-ART consists of physical function, pain, spinal mobility, patient global assessment, peripheral joints/entheses, x-ray spine. The selected core set for SMARD/physical therapy includes physical function, pain, spinal mobility, spinal stiffness, and patient global assessment. The core set for clinical record keeping includes all measures of the SMARD/physical therapy core set completed by peripheral joints/entheses, and acute phase reactants. Three preliminary core sets for AS have been defined. Further research will be performed to select specific measures for all domains.

Antirheumatic Agents↗
PubMed1997

Bone assessment in patients with ileal pouch-anal anastomosis for inflammatory bowel disease.

BACKGROUND: Patients with ulcerative colitis are at risk of low bone mineral density (BMD). Proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis diminishes the risk of bone disease. The aims of this study were to assess the mechanism of low BMD and to measure bone density changes after IPAA. METHODS: Twenty patients with IPAA for ulcerative colitis, of mean(s.d.) age 38(9) (range 21-58) years, had measurements of lumbar spine and femoral neck BMD by dual energy X-ray absorptiometry, a mean(s.d.) 28(23) (range 3-84) months after proctocolectomy. Serum levels of calcium, phosphate, parathyroid hormone, osteocalcin and 25-hydroxy vitamin D were determined. Fifteen patients were followed for 28(12) (range 8-50) months. RESULTS: At baseline, six patients had spine BMD more than two standard deviations below the normal value, and three had vertebral crush fractures. Mean vitamin D values were normal and no patient had osteomalacia. BMD increased with time elapsed since IPAA (spine: r = 0.71, P = 0.005). During follow-up, mean(s.d.) changes in bone density were +2.3(3.8) and +2.1(5.6) per cent per year at the spine and femoral neck respectively. CONCLUSION: These results suggest that in patients with IPAA for ulcerative colitis, low BMD is not associated with vitamin D malabsorption and may be reversible after surgery.

Adult↗
PubMed1997

Radiographic features predictive of radiographic progression of hip osteoarthritis.

OBJECTIVES: To evaluate potential radiographic predictors of hip osteoarthritis progression. PATIENTS AND METHODS: A prospective, longitudinal two-year study was conducted in patients meeting American College of Rheumatology criteria for hip osteoarthritis. Hip osteoarthritis progression was defined as a greater than 0.5-mm decrease in joint space width measured using a magnifying glass marked at intervals of 0.1 mm, at the site of maximum joint space narrowing, by a single investigator who was blinded to the chronological order of the radiographs. Radiographic parameters determined at study entry were as follows: presence of osteophytes, osteosclerosis, and subchondral cysts; femoral head migration (superolateral, superomedial, concentric); and severity (joint space width in mm, Kellgren and Lawrence grade, subjective evaluation of joint space narrowing). RESULTS: In the 463 study patients, joint space width decreased from 2.2 +/- 0.8 at baseline to 1.7 +/- 1.0 mm after two years (P < 0.0001). Radiographic progression was seen in 148 patients (32%). Radiologic parameters predictive of disease progression in the multivariate analyses were as follows: CONCLUSION: Our data suggest that a number of baseline radiological features including distribution of joint space loss, subchondral bone production, and severity of joint space loss are predictive of progression of hip osteoarthritis.

Aged↗
PubMed1996

[Criteria of response to treatment of rheumatoid arthritis].

Rheumatoid arthritis is a chronic inflammatory rheumatic disease with clinical and biological signs of inflammation, responsible for bone and cartilage defects. These latter are responsible for irreversible functional impairment. Because of the lack of effective therapy of the disease, there is a need for clinical, biological and radiological outcome variables to assess the symptomatic and structural severity of the disease. Different consensual meetings of the international rheumatological community dramatically facilitated uniformization of the medical language in this field by providing simple accurate tools to be used in daily practice.

Arthritis, Rheumatoid↗
PubMed1996

Broadband ultrasound attenuation imaging: a new imaging method in osteoporosis.

The purpose of this study was to evaluate the usefulness in osteoporosis of a new ultrasound imaging device able to create a parametric image of broadband ultrasound attenuation (BUA) at the os calcis. Three regions of interest were located in the great tuberosity of the os calcis. Precision was evaluated in 37 patients. Calcaneal bone mineral density (BMD) and BUA were compared in 33 patients. In 236 patients (including 77 with osteoporotic fractures), BUA and lumbar and femoral BMD measurements were performed. The measurements were compared using correlation coefficients. Their clinical value was estimated by comparisons of the results between patients with fractures and age-matched controls, using comparisons of the means, areas under the ROC curves, and logistic regression. Precision was in a 1.4-3.3% range. Local BUA and BMD were highly correlated (r = 0.88). Significant correlations were found between BUA and lumbar (r = 0.56) and femur (r = 0.66) BMD. In multiple regression, years since menopause and weight were significant predictors of BUA. Patients with fractures had lower BUA and BMD than age-matched controls. BUA showed the largest difference between the two populations (13-16%). Areas under the ROC curves were similar for BUA and BMD. Logistic regression after adjustment for confounding factors showed that BUA discriminated between fracture and nonfracture subjects. Broadband ultrasound attenuation imaging improves the reproducibility of ultrasound measurements. It may be useful in osteoporosis, due to its good discriminating value.

Adult↗
PubMed1996

Synovial fluid cell analysis.

Arthrocentesis has to be considered as a part of the clinical examination. A reasonable amount of aspirated synovial fluid is the best argument in favour of an objective articular disorder. Moreover some very simple evaluations are very helpful to make a diagnosis and to distinguish some particularities of rheumatic diseases. Such evaluations have to include both bacterial and synovial fluid analysis. Moreover, when performing synovial fluid analysis, a search for microcrystals is also performed. Haemarthrosis can easily be distinguished from a traumatic tap if the investigator is observing carefully the synovial fluid entering in the syringe. The diseases responsible for haemarthrosis differ with the age of patients: chondrocalcinosis, together with osteoarthrosis, is the most frequent aetiology in the elderly; disorders of haemostasis and synovial tumours are mostly observed in children and young adults. Paucicellular (< 1000 cells/mm3) synovial fluid is observed in different 'mechanical' disorders. In the case of purulent synovial fluid the primary diagnosis is septic arthritis. However, the most common aetiology is probably crystal-induced acute arthritis. Differential cell count analysis performed in case of 'inflammatory' (> 1000 or 2000 cells/mm3) synovial fluid usually shows a predominance of polymorphonuclear cells. However, high cellularity may sometimes be associated with a predominance of other cells, i.e. lymphocytes, monocytes, eosinophils. In this situation, such a simple evaluation (differential cell count analysis) is very helpful in making a diagnosis, e.g. eosinophilic arthritis, or to distinguish some particularities of rheumatic diseases, e.g. absence of cartilage breakdown in case of lymphocytic arthritis.

Crystallization↗
PubMed1996

Bone effects of dydrogesterone in ovariectomized rats: a biologic, histomorphometric, and densitometric study.

It has been suggested that progesterone might affect bone metabolism. Dydrogesterone (DD) has a chemical structure very close to that of natural progesterone, without androgenic effects. We compared the effect of a daily treatment with DD and estradiol (E2, 40 micrograms/kg) on 70 female rats (8 weeks old), divided in seven groups: controls; ovariectomized (OVX); OVX + E2, OVX + DD 2.5 mg/kg; OVX + DD 5 mg/kg; OVX + E2 + DD 2.5 mg/kg; and OVX + E2 + DD 5 mg/kg. Two months later we studied estradiol, osteocalcin, and acid phosphatases (TRAP) levels; histomorphometric parameters at the trabecular part of the femur; and bone mineral density of the tibiae (trabecular and cortical areas) and caudal vertebrae (cortical bone) by dual energy X-ray absorptiometry (Hologic QDR 2000). In the OVX group, we found a nonsignificant increase of osteocalcin and TRAP, a decrease in the trabecular bone volume, and an increase in the intertrabecular distance. These variations were not seen in the groups treated with E2 (with or without DD). DD had no effect on trabecular architecture parameters. It induced a dose-dependent increase in the osteoclast number (TRAP + cells), without increase in trabecular separation. There was no difference in bone density of caudal vertebrae between the different groups, nor of the tibial density between the OVX and OVX + DD groups. The bone densities were not different in the control and E2-treated groups, with or without DD. During dydrogesterone treatment, there is an increase in osteoclast number, without an apparent increase in osteoclast function. Dydrogesterone did not prevent bone loss due to ovariectomy in rats, and it did not affect the protective effect of estradiol.

Analysis of Variance↗