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M Dougados

Publications and source records attributed to M Dougados.

At least 253 records · Page 14Linked to original sources
PubMed1991

[Evaluation of the Amor criteria for spondylarthropathies and European Spondylarthropathy Study Group (ESSG). A cross-sectional analysis of 2,228 patients].

Two sets of criteria have been proposed to discriminate spondylarthropathies (SA) from other rheumatic diseases. To evaluate their performance, we conducted a cross-sectional study in the patients observed during one week in 28 French Departments of Rheumatology by 91 staff-teaching physicians. The physicians had to apply these criteria to all their patients and had to classify them as definite SA, definite other rheumatic disease or possible SA. The analysis performed on the 2,088 patients with a definite diagnosis (124 SA and 1,964 controls) showed the following results: (table; see text) Of the 140 patients with possible SA, 37 fulfilled both sets of criteria, 22 the ESSG criteria alone and 12 the Amor criteria alone. These data suggest that a) the overall performance of these two sets of criteria is similar; b) this performance is better in the group of patients with a definite diagnosis; c) the patients without a definite diagnosis require a longer follow-up to assess the clinical relevance of these two sets of criteria.

Cross-Sectional Studies↗
PubMed1990

[How to evaluate the long-term course of osteoarthritis. Tests for trials of fundamental treatments (spine excluded)].

The best assessment tests for long term trials on osteoarthritis (OA) of the hip and knee are the following, in order of relevance value (consensus of french experts): 1) the loss of joint space thickness on successive radiographies; 2, 3) the indices of the severity for OA of the hip and knee; the investigator's overall opinion; 4) the patient's overall opinion (visual analogue scale of handicap); 5, 6, 7) the pain level (visual analogue scale); the time for going up and down a standard flight of stairs and the time of pain in this distance; the limitation of two articular movements; 8) the increase of either analgesics or NSAIDs consumption; 9) concerning OA of fingers, the number of joints newly involved on successive radiographies. At present, only the radiological tests 1 and 9 are validated. The clinical tests 2 to 8, valuable for short term trials, have yet to be validated for long term follow-up. Recommended duration of trials is three years. A rigorous organisation is necessary to avoid erroneous inclusions: all data recorded in the pre-inclusion visit have to be checked by the principal investigator. Since we have not yet a validated chondroprotective agent as a reference drug, the trial must be randomised, double blind, placebo controlled, parallel group study.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

[Hormonal contraception and lupus].

The choice of an optimal contraceptive method (OC) therapy is a significant problem in female SLE patients. In view of the influence of sex hormones on the evolution of SLE, oral contraceptive (OC) therapy has to be efficient, reversible and safe, without aggravating disease activity and causing metabolic and vascular side effects. Ethinyl estradiol-containing preparations, even at 30 micrograms/day, have been shown to trigger a crisis or unmask SLE, and they exert adverse metabolic and vascular effects. Therefore, combination estrogen-progestogen compounds must be avoided in women with SLE. Pure progestogen OC preparations do not stimulate SLE activity, but norsteroids have harmful metabolic effects and microprogestogens are not sufficiently reliable. In light of the decreased level of plasma androgens in female SLE patients, an attempt to modulate the hormonal milieu by lowering the estrogen to androgen ratio, while ensuring contraception was attempted using cyproterone acetate. This agent markedly lowered plasma estrogens and was effective and well tolerated, but its long-term effect on bone mineralization remains to be evaluated. Chlormadinone acetate, a 17-OH progesterone derivative, was proven effective and devoid of any metabolic or vascular side effects, and should be recommended as the safest routine OC therapy in women with SLE.

Chlormadinone Acetate↗
PubMed1990

[Criteria of the classification of spondylarthropathies].

A system of classification criteria of spondyloarthropathies was experimented in three studies. They have permitted to measure its specificity which is 86.6 p. cent and its sensitivity which is 90 p. cent. This system permits to compare theory and clinical practice and also to classify disease not yet classified. The positive and negative predictive values of these tests remain to be validated and assessed, with a multicenter study including patients affected or not with spondyloarthropathy, in order to determine whether they can also be used as a diagnosis tool.

Arthritis↗
PubMed1990

[Sex hormone metabolism in acute systemic lupus erythematosus].

The numerous clinical and experimental data suggesting a lupus-induced modulation of sex hormones prompted the study of sex hormone metabolism in these patients. Some hormonal abnormalities were reported in female patients: a) over production of 16-alpha-hydroxylated estradiol derivatives with potent peripheral estrogenic activities; b) under production of the following androgens: testosterone, dihydrotestosterone, dihydroandrosterone, dihydroandrosterone sulfate, delta 4-androstenedione. Moreover, some observations suggest an excessive transformation of androgens into estrogens: increased oxidation of testosterone on C17, skin lesions, abnormal skin, aromatase activity responsible for estradiol synthesis.

Acute Disease↗
PubMed1989

[Methods of evaluating chondroprotective treatment].

A chondroprotective therapy is a basic treatment of osteo-arthritis aimed at stopping pathological processes involved in articular cartilage degradation. Assessing the clinical benefit of such treatment is difficult, as it is related to individual characteristics (primary or secondary osteo-arthritis, anatomical location and/or evolutive stage), to the duration of treatment and to the efficacy criteria utilized. Whether this assessment can be made in a single patient or requires studies of patient populations is debated.

Cartilage, Articular↗
PubMed1989

Assessment of efficacy and acceptability of low dose cyclosporin in patients with rheumatoid arthritis.

The efficacy of cyclosporin in a double blind, placebo controlled trial of four months' duration has previously been reported by us. To assess the benefit-to-risk of cyclosporin this study was followed by a one year open trial including 49 of the previous 52 patients. Cyclosporin was given at an initial dosage of 5 mg/kg/day and then modulated on the basis of efficacy and renal toxicity. During the study the drug had to be discontinued in 32 patients: because of inefficacy in 10, side effects in 11, both in nine, and in two because of unrelated events. The significant clinical improvement noted at four months persisted through one year in the 17 patients who continued to receive treatment. Nephrotoxicity of the drug (24 patients) required constant and close monitoring as well as modulation of daily drug dosage during the trial. This study indicated that cyclosporin might be valuable in the treatment of patients with advanced rheumatoid arthritis, in whom other second line agents have failed.

Arthritis, Rheumatoid↗
PubMed1988

[Plasma levels of vitamins A and E in hyperostosis, ankylosing spondylarthritis and rheumatoid polyarthritis].

In animal and man, chronic intoxication with vitamin A or retinoids may be responsible for vertebral hyperostosis and periosteal appositions. Vertebral hyperostosis is found in hyperostotic disease but also in the course of ankylosing spondylarthritis. Therefore, we felt it would be interesting to study blood retinol levels in 22 patients with hyperostotic disease, 29 patients with ankylosing spondylarthritis, 18 patients with rheumatoid polyarthritis and 21 reference patients. The Kurskal-Wallis test has demonstrated a significant difference of blood retinol levels between these four groups (p less than 0.0001). The blood retinol level was more elevated during hyperostotic disease (3.63 +/- 1.13 mumol/l) than in the reference group (2.94 +/- 0.76) and was, on the contrary, lower during ankylosing spondylarthritis (2.57 +/- 0.66) and rheumatoid polyarthritis (2.32 +/- 0.64). This study confirms the elevation of blood retinol during the course of hyperostotic disease; such a abnormality was not demonstrated in the course of ankylosing spondylarthritis, and on the contrary, suggest that a decreased blood retinol level may be observed during chronic inflammatory rheumatic diseases such as rheumatoid polyarthritis or ankylosing spondylarthritis.

Adult↗