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Biomedical subjects

M Dougados

Publications and source records attributed to M Dougados.

At least 163 records · Page 9Linked to original sources
PubMed1999

Osteoporosis, body composition, and bone turnover in ankylosing spondylitis.

OBJECTIVE: To study the prevalence of osteoporosis (OP) and osteopenia in ankylosing spondylitis (AS) and to investigate the relationship between symptomatic and structural severity, the indices of bone turnover, and body composition. METHODS: Eighty patients with AS were enrolled prospectively: 52 men (65%) and 28 women, mean age 36.7 years +/- 11.5 (range 18-67); they were studied clinically, radiologically, and by dual energy x-ray absorptiometry. Sixty-three underwent biological assessment of bone turnover markers. RESULTS: OP and osteopenia as defined by the World Health Organization (T score < -2.5 SD and between -1 and -2.5 SD, respectively) were observed in 15 (18.7%) and 25 patients (31.2%) at the lumbar spine and in 11 (13.7%) and 33 patients (41.2%) at the femoral neck, respectively. Patients with OP had a lower body mass index (BMI) and fat mass percentage. There was a trend to a lower disease duration in patients with OP at the spine than in healthy subjects. Bone resorption markers (urinary D-pyridinoline or C-telopeptide concentrations) were increased in 34 patients (53.9%). Bone turnover markers were positively correlated with C-reactive protein concentration and Larsen radiological hip score; they were negatively correlated with Schober index and fat mass percentage. CONCLUSION: (1) OP is frequent in AS and can be observed in early stages of the disease. (2) Patients with AS are more susceptible to develop OP when they have low BMI, low fat mass percentage, and active and severe disease. OP was observed in parallel with increased bone resorption.

Adolescent↗
PubMed1999

[Pericardial and myocardial adiastole in rheumatoid polyarthritis].

The authors describe a case of clinical, echocardiographic and haemodynamic adiastole in a man with severe rheumatoid arthritis with a previous history of pericardial effusion. The adiastole was mixed, fibrous pericarditis, confirmed by ultra fast CT scan and at surgery; myocardial adiastole was suspected on finding thickening of the ventricular walls (in the absence of hypertension and coronary artery disease) and, unfortunately, confirmed by the persistence of adiastole despite very satisfactory pericardectomy. The authors underline the involvement of the three cardiac tunics in rheumatoid arthritis and the value of different diagnostic methods in the differentiation between constrictive pericarditis and restrictive cardiomyopathy.

Arrhythmias, Cardiac↗
PubMed1998

Biochemical markers as predictors of bone mineral density changes after GnRH agonist treatment.

To evaluate bone biochemical markers as predictors of the efficacy of a hormone replacement therapy (HRT), we studied the bone changes induced by the cessation and return of ovarian function in 28 patients treated for 6 months with a GnRH agonist. This model reproduced the effects observed in postmenopausal women with high bone turnover treated with HRT. At the end of the treatment, Z scores were 1.8 +/- 0.3 for Crosslaps (CTx) and deoxypyridinoline (D-Pyr), and 1.1 +/- 0.2 for bone alkaline phosphatase (B-ALP) and osteocalcin (OC). This indicated an imbalance in bone remodeling with a high bone resorption. Bone mineral density (BMD) fell by 4.2 +/- 2.5%. The changes in BMD between the 6th and 12th months were 0. 34 +/- 2.24 and -1.73 +/- 3.25% at the lumbar spine and the femoral neck, respectively. Biochemical markers except urinary calcium and hydroxyproline measured at 6 months were positively correlated with the BMD changes at the lumbar spine. After the resumption of menstruation, 13 of 28 women displayed positive spine BMD changes between the 6th and 12th months; in this group, bone biochemical markers measured at 6 months were significantly higher (P = 0.02). Stepwise regression analysis showed that the association of B-ALP and D-Pyr measured at 6 months explained 40% of BMD variance and the association of B-ALP, PTH, and estradiol 56%. We conclude that measuring individual biochemical bone markers can help to predict the bone effect of an increase in the circulating estradiol in women with ovarian deficiency.

Adult↗
PubMed1998

Spondylarthropathy treatment: progress in medical treatment, physical therapy and rehabilitation.

The monitoring and treatment of the diseases belonging to the concept of spondylarthropathy are related more to their clinical presentation, for example axial versus peripheral involvement, than to the precise diagnosis, for example, ankylosing spondylitis versus psorìatic arthritis. For each clinical presentation the treatment comprises local and systemic routes of administration but also drug and non-drug therapies.

Antirheumatic Agents↗
PubMed1998

Inter-observer reliability of the arthroscopic quantification of chondropathy of the knee.

BACKGROUND: Several scoring systems have been proposed in order to quantify the degree of cartilage damage observed by arthroscopy of the knee in patients with osteoarthritis. OBJECTIVE: To evaluate the inter-observer reliability of five different scoring systems of arthroscopic evaluation for chondropathy in osteoarthritis of the knee and to evaluate the utility of a training session between different observations on these scoring systems. METHODS: Videotapes of knee arthroscopies on five patients with osteoarthritis demonstrating different levels of severity of cartilage damage of the medial tibiofemoral compartment were analyzed by nine observers prior to (pre-training evaluation) and 2 months after a 6 h training session (post-training evaluation) by the following scoring systems: (1) cartilage deterioration by a 100 mm visual analogue scale (VAS), (2) overall assessment of degeneration in the entire medial compartment (cartilage, meniscus, osteophyte) using a 100 mm VAS, (3) French Society of Arthroscopy (SFA) Scoring System, (4) SFA Grading System, (5) American College of Rheumatology (ACR) Scoring System. RESULTS: At the pre-training evaluation, the SFA grading system produced the highest coefficient of reliability (r = 0.94), the other systems recording levels of < or = 0.80. At the post-training evaluation, the coefficient of reliability was r > 0.80 for four of the five scoring systems, with lack of improvement in the ACR Scoring System. CONCLUSION: There was an improved and acceptable inter-observer reliability for at least 2 months follow-up in four of five evaluated scoring systems of arthroscopically graded osteoarthritis of the knee following a training session. A scoring system using a 100 mm VAS may produce the best inter-observer reliability. These results show that scoring chondropathy is possible and demonstrate the importance of training in the analysis of articular cartilage breakdown.

Arthroscopy↗
PubMed1998

Clinical evaluation of spine morphometric X-ray absorptiometry.

A new method for vertebral height measurements, morphometric X-ray absorptiometry (MXA) based on dual-energy X-ray absorptiometry, has been proposed. This technique overcomes some limitations of morphometric radiography (MRX): the effective radiation dose is low, some sources of geometric distortion are eliminated, such as dependence on patient position, magnification gradient, and the effect of scoliosis is minimized. The purpose of this study was to compare morphometric parameters obtained by both methods (MXA and MRX), and to evaluate the agreement between morphometric evaluations and qualitative reading for vertebral fracture diagnosis. The evaluation was performed with an Hologic QDR 2000 device in 67 women without vertebral fractures and 31 women with vertebral fractures (according to a qualitative assessment). The reproducibility of the image analysis was <4% and comparable to MRX. The estimated bias between the two methods was on average 10 mm, and was a function of the vertebral height, according to the Bland and Altman method. The agreement between MXA and other methods for vertebral fracture diagnosis was poor for the thoracic level above T7, due to a lack of resolution and rib interposition. Agreement was also low for T10, due to the motion of the diaphragm muscle. MXA cannot currently be used for the diagnosis of thoracic vertebral fracture in clinical practice. Technological improvements are necessary to make this promising method useful as a screening tool to evaluate the presence of thoracic vertebral fractures.

Absorptiometry, Photon↗
PubMed1998

Variability in knee radiographing: implication for definition of radiological progression in medial knee osteoarthritis.

OBJECTIVES: (1) To assess reproducibility of medial knee joint space width (JSW) measurement in healthy subjects and osteoarthritic (OA) patients. (2) To define minimal relevant radiological change in knee JSW based on the reproducibility of its measurement. PATIENTS AND METHODS: (1) Healthy volunteers: in the first part of the study, 20 knees of healthy adult volunteers were radiographed in the weightbearing, anteroposterior extended view, twice, two weeks apart, using three different radiographic procedures: (a) without guidelines, (b) with guidelines and without fluoroscopy, (c) with guidelines and fluoroscopy. (2) Knee OA patients: in the second part of the study, 36 knees of OA patients were radiographed twice with guidelines and without fluoroscopy. JSW was measured blindly using a graduated magnifying glass. Based on the Bland and Altman graphic approach, cut off points defining minimal relevant radiological change are proposed. RESULTS: Standard deviation (SD) of differences in JSW measurement between two sets of knee radiographs in healthy subjects were 0.66 mm for radiography performed without guidelines, 0.37 mm for radiography performed with guidelines and without fluoroscopy, and 0.31 mm for radiography with guidelines and fluoroscopy. SD of differences in JSW measurement in OA patients were 0.32 mm for radiography performed with guidelines and without fluoroscopy. A minimal relevant change in JSW between two radiographs performed in healthy subjects can be defined by a change of at least 1.29 or 0.59 mm when radiographs are taken without guidelines, and with guidelines and fluoroscopy, respectively. When radiographs are taken with guidelines and without fluoroscopy, the change must be at least 0.73 mm. A similar figure, 0.64 mm was observed in knee OA patients. CONCLUSION: Definition of radiological progression varies greatly according to the radiographic procedure chosen. Use of guidelines reduces the threshold of progression required to consider that change between two measures is relevant.

Adult↗
PubMed1998

Osteoarthritis of the hip: agreement between joint space width measurements on standing and supine conventional radiographs.

OBJECTIVE: To assess the effect of standing position on joint space width (JSW) measurements of the hips with and without osteoarthritis (OA) on pelvic radiographs. METHODS: Adult patients aged 18 or more had pelvic anteroposterior conventional radiographs standing and supine performed by a single radiologist in the same radiology unit according to standardised guidelines. JSW measurements in mm were made by a single reader blind to patients' identity and type of view, using a 0.1 mm graduated magnifying glass directly laid over the radiograph, at the narrowest point for OA hips or at the vertical joint space for non-OA hips. Agreement of JSW between both views was assessed using the Bland and Altman graphical analysis. RESULTS: JSW was greater on standing than supine radiographs, for example, 7.1% for OA hips. Mean (SD) differences and limits of agreement (mm) between both views were 0.08 (0.27) and -0.46 to 0.62 for the 70 non-OA hips, 0.02 (0.31) and -0.60 to 0.64 for the 46 OA hips. Corresponding 95% confidence intervals of mean difference were 0.02, -0.14 mm and -0.07, -0.11 mm. CONCLUSIONS: Measurements of JSW of the hip on pelvic standing and supine radiographs are concordant. Changes less than or equal to 0.64 mm between the two views are similar or inferior to radiological progression of OA.

Adult↗
PubMed1998

Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees.

PURPOSE: To determine the validity and the reliability of T1-weighted three-dimensional gradient-echo magnetic resonance (MR) imaging for quantification of articular cartilage abnormalities of osteoarthritic knees. MATERIALS AND METHODS: Forty-three patients (mean age, 63 years) with knee osteoarthritis (American College of Rheumatology criteria) of the medial tibiofemoral compartment underwent a prospective, cross-sectional study. Knees were examined with a T1-weighted three-dimensional gradient-echo sequence (1.4-mm contiguous sections), with use of a 0.2-T dedicated MR unit, before arthroscopic exploration. The tibiofemoral articular cartilage abnormalities were quantified blindly on both the MR and arthroscopic images with the French Society of Arthroscopy (SFA) score (0-100) and grading scheme (five grades). RESULTS: There was a statistically significant correlation between the SFA-arthroscopic score and the SFA-MR score (r = .83) and between the SFA-arthroscopic grade and the SFA-MR grade (weighted kappa = 0.84). The deepest cartilage lesions graded with arthroscopy and MR imaging showed correlation in the medial femoral condyle (weighted kappa = 0.83) and in the medial tibial plateau (weighted kappa = 0.84). The intraobserver reliability of the SFA-MR score was higher (r = .94) than the interobserver reliability (r = .80). CONCLUSION: Quantification of chondropathy with MR imaging is feasible and well correlated with anatomic cartilage breakdown.

Aged↗
PubMed1998

[Follow-up of the patient with spondyloarthropathy].

Spondylarthropathies consist of several disorders: reactive arthritis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, a subgroup of juvenile chronic arthritis, and ankylosing spondylitis. Their clinical presentation may consist in the following inter-related features: axial involvement, peripheral articular involvement, enthesiopathic lesions, extra-articular disease. The monitoring of these diseases is related more to their clinical presentation than to the precise diagnosis. Modalities for monitoring peripheral arthritis are similar to those of rheumatoid arthritis (essentially based on the number of tender and swollen joints). The modalities of the monitoring of extra-articular features (uveitis, psoriasis,...) are specific to these clinical features and can be categorized in 2 ways: the first one consists in considering the occurrence of the episodes (for example, number of acute anterior uveitis per year), the second one consists in the evaluation of the severity of the clinical features (for example the area of psoriatic skin lesions). Numerous tools have been proposed to evaluate the axial involvement of the disease. The international rheumatologic community (ILAR for International League Against Rheumatism) via specific task force (ASAS for Assessment in Ankylosing Spondylitis) tried to standardize the medical language (at least in clinical research studies) by giving recommendations to evaluate specific domains and within each domain specific tools. Currently, it is generally agreed that pain and functional impairment are the two main domains to consider. For each of these domains, different tools have been proposed (for example the ASFI: Ankylosing Spondylitis Functional Index and the BASFI: Bath Ankylosing Functional Index are both tools proposed to evaluate the functional impairment). The domain "range of motion" is probably one of the most important for long term outcome in clinical research studies and for facilitating the orthopedic indications in daily practice. Finally, radiological tools permitting the evaluation of the structural damage of the disease are available. They take into account the presence and/or the severity of hip and sacroiliac involvement and also the extent of the spinal syndesmophytes. Longitudinal studies are required to evaluate their clinical relevance.

Disability Evaluation↗
PubMed1997

[Diagnosis of early rheumatoid polyarthritis].

The diagnosis of rheumatoid arthritis is mainly based on the clinical findings showing in typical cases a bilateral symmetrical polysynovitis predominantly on the small hand and feet joints, without any other extra-rheumatological feature. Even this clinical presentation is very suggestive of the diagnosis, other diagnoses of diseases life and or function threatening (septic arthritis, viral arthritis, arthritis related to hemopathy, systemic vasculitis ...) have to be systematically evocated. The interest of an early diagnosis of rheumatoid arthritis is to facilitate the treatment and the monitoring of the patients since such treatment seems to be more efficient when initiated at an early stage of the disease.

Adult↗
PubMed1997

[The concept of reactive arthritis].

More than fifty years after the clinical syndrome was described by Reiter, Fiessinger and Leroy, the diagnostic criteria of what has now been termed reactive arthritis are still under debate. Reactive arthritis can be defined as an aseptic inflammatory joint disease occurring either in a patient with a bacterial infection located in a distant organ or with a particular genetic predisposition. The lack of specific criteria has led to a certain degree of liberty in interpreting the three basic elements of reactive arthritis: clinical presentation, "distant" infection, genetic predisposition. It is generally accepted that limiting the diagnosis of reactive arthritis only to patients with the classic oculo-uretro-synovial manifestations is unsatisfactory. The question remains open as to whether only patients presenting both inflammatory joint disease and spondylarthropathy have reactive arthritis or whether any undetermined etiology of arthritis is sufficient if the patient also has a "distant" infection and a specific genetic predisposition (HLA B27). Two new elements further complicate the situation. The first is the recent demonstration that the synovial fluid in patients with reactive arthritis might contain microbial antigens. The second is that longterm antibiotics (more than 3 months) could have a beneficial effect. Asking when the diagnosis should be entertained is thus not a moot question. Although we still have no clear answer, it is reasonable to state that the diagnosis of reactive arthritis should be retained only in patients with both inflammatory joint disease and criteria compatible with spondylarthropathy. Clinical research is required to determine whether the germ is actually present or not within the joint and to assess the effect of long-term antibiotherapy.

Arthritis, Reactive↗