BACKGROUND:IL-5 is a key mediator of severe eosinophilic asthma (SEA) and also may contribute to airway remodeling. RESEARCH QUESTION:Can mepolizumab, an anti-IL-5 antibody, modify airway remodelling in adult patients with SEA? STUDY DESIGN AND METHODS:Thirty-seven patients who were eligible for mepolizumab were included prospectively. Mepolizumab 100 mg was administered subcutaneously every 4 weeks for 12 months. Bronchial biopsies and bronchoalveolar lavage (BAL) were performed at baseline, 6 months, and 12 months. Clinical and functional outcomes, airway remodeling, and inflammatory markers were assessed at each time point. RESULTS:At 12 months, mepolizumab was shown to improve asthma control and FVC before bronchodilation and reduce the number of exacerbations, oral corticosteroid courses, and hospitalizations. These clinical and functional improvements were associated with a reduction in reticular basement membrane thickness (P < 0.0001), airway smooth muscle (ASM) mass (P = .0066), and proliferating cell nuclear antigen-positive ASM cells (P < .0001) in the bronchial mucosa at both 6 and 12 months. BAL fluid showed reduced levels of tenascin-C at 6 and 12 months and of fibulin-1 at 12 months. Blood eosinophil counts decreased significantly (P < .0001), and eosinophils were almost completely depleted in BAL fluid (P = .023) at 12 months. Submucosal eosinophilia was reduced to a lesser extent (P = .063). INTERPRETATION:In addition to its antiinflammatory effects, mepolizumab also may attenuate structural airway changes in SEA, which could contribute to its clinical benefits. CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov; No.: NCT03797404; URL: www. CLINICALTRIALS:gov.

BACKGROUND:French and International anal cancer screening recommendations for at-risk populations, published in 2024, are based on cytology and/or high-risk human papillomavirus (HPV) detection on anal smears. Biological markers to triage the patients most at-risk for anal cancer are crucial in prioritising patients needing high-resolution anoscopy consultations, which are frequently overwhelmed. METHODS:The AIN3 cohort is a French national multicenter study including patients with a history of high-grade anal lesions (AIN3). Patients were followed-up for at least 3 years, with anal smears and clinical examinations performed yearly. Levels of ZNF582 and ASCL1 gene methylation were quantified using real-time PCR on anal smears collected at the time of inclusion. FINDINGS:Overall, 514 anal smears were contributive for host-cell DNA methylation analysis. Patients' mean age was 50.8 years and 40% were women. Among the 41% who were living with HIV, 91% were men. Median follow-up duration was 48 months, and 22 patients (4%) developed anal cancer during follow-up. Higher methylation levels of ZNF582 and ASCL1 were significantly associated with high-grade squamous cell intraepithelial lesion (HSIL) cytology, p16-Ki67 dual-staining positivity, and high-risk HPV and HPV16 positivity on the same anal smear. Both methylation markers showed an AUC of 0.72 for discrimination between HSIL and non-HSIL cytology on the same anal smear. Higher methylation levels of both markers were significantly associated with evolution to anal cancer in univariate and multivariable analyses adjusted for age and HIV status (p < 0.001). When assessing the AUC over 1 and 3 years of follow-up, methylation markers demonstrated superior predictive value for anal cancer compared to other markers. INTERPRETATION:We have demonstrated the predictive value of host-cell DNA methylation marker levels in anal smears with regard to evolution to anal cancer in a very high-risk population. FUNDING:This study was funded by the Agence Nationale de Recherche sur le Sida et les hépatites virales (ANRS) I Maladies Infectieuses Emergentes.

Introduction Physical restraint (PR) is prescribed in patients receiving invasive mechanical ventilation in the intensive care unit (ICU) to avoid unplanned removal of medical devices. However, it is associated with an increased risk of delirium. We hypothesise that a restrictive use of PR, as compared with a systematic use, could reduce the duration of delirium in ICU patients receiving invasive mechanical ventilation.Methods and analysis The Restrictive use of Restraints and Delirium Duration in ICU (R2D2-ICU) study is a national multicentric, parallel-group, randomised (1:1) open-label, controlled, superiority trial, which will be conducted in 10 ICUs. A total of 422 adult patients requiring invasive mechanical ventilation for an expected duration of at least 48 hours and eligible for prescription of PR will be randomly allocated within 6 hours from intubation to either the restrictive PR use group or the systematic PR use group, until day 14, ICU discharge or death, whichever comes first. In both groups, PR will consist of the use of wrist straps. The primary endpoint will be delirium or coma-free days, defined as the number of days spent alive in the ICU without coma or delirium within the first 14 days after randomisation. Delirium will be assessed using the Confusion Assessment Method-ICU twice daily. Key secondary endpoints will encompass agitation episodes, opioid, propofol, benzodiazepine and antipsychotic drug exposure during the 14-day intervention period, along with a core outcome set of measures evaluated 90 days postrandomisation.Ethics and dissemination The R2D2-ICU study has been approved by the Comité de Protection des Personnes (CPP) ILE DE FRANCE III—PARIS (CPP19.09.06.37521) on June 10th, 2019). Participant recruitment started on 25 January 2021. Results will be published in international peer-reviewed medical journals and presented at conferences.Trial registration number NCT04273360.

The increase in worldwide travel is making imported malaria a growing health concern in non-endemic countries. Most data on the pathophysiology of malaria come from endemic areas. Little is known about cytokine profiles during imported malaria. This study aimed at deciphering the relationship between cytokine host response and malaria severity among imported cases in France. This study reports cytokine profiles in adults with Plasmodium falciparum malaria included in the PALUREA prospective study conducted between 2006 and 2010. The patients were classified as having uncomplicated malaria (UM) or severe malaria (SM), with this last further categorized as very severe malaria (VSM) or less severe malaria (LSM). At hospital admission, eight blood cytokines were assayed in duplicate using Luminex ® technology: interleukin (IL)-1α, IL-1β, IL-2, IL-4, IL-10, tumor necrosis factor (TNF)α, interferon (IFN)γ, and macrophage migration inhibitory factor (MIF). These assays were repeated on days 1 and 2 in the SM group. Of the 278 patients, 134 had UM and 144 SM. At hospital admission, over half the patients had undetectable levels of IL-1α, IL-1β, IL-2, IL-4, IFNγ, and TNFα, while IL-10 and MIF were significantly higher in the SM vs. the UM group. Higher IL-10 was significantly associated with higher parasitemia (R = 0.32 [0.16–0.46]; P = 0.0001). In the SM group, IL-10 elevation persisting from admission to day 2 was significantly associated with subsequent nosocomial infection. Of eight tested cytokines, only MIF and IL-10 were associated with disease severity in adults with imported P. falciparum malaria. At admission, many patients had undetectable cytokine levels, suggesting that circulating cytokine assays may not be helpful as part of the routine evaluation of adults with imported malaria. Persisting high IL-10 concentration was associated with subsequent nosocomial infection, suggesting its possible interest in immune monitoring of most severe patients.

Little is known on headaches long-term persistence after bacterial meningitis and on their impact on patients’ quality of life. In an ancillary study of the French national prospective cohort of community-acquired bacterial meningitis in adults (COMBAT) conducted between February 2013 and July 2015, we collected self-reported headaches before, at onset, and 12 months (M12) after meningitis. Determinants of persistent headache (PH) at M12, their association with M12 quality of life (SF 12), depression (Center for Epidemiologic Studies Depression Scale) and neuro-functional disability were analysed. Among the 277 alive patients at M12 87/274 (31.8

Background Therapeutic alliance represents a rarely studied object when it relates to nurses and care provided by a nursing team in acute care hospitalization. Objective The objective was to study how factors might influence the therapeutic alliance built between nurses and aides and adult inpatients in an acute care unit of sectorial general psychiatry. Method This is a prospective, observational and cross-sectional study using a therapeutic alliance measurement scale. Therapeutic alliance (TA) score was measured with a STAR-P scale in a sample of 240 patients. Results The median score found is 33.4 (+/- 7.8) out of a maximum theoretical score of 48. The global score of TA in patients aged 60 years old or more is significantly higher than the score of patients between 18 and 29 years old (p=0.021). The lack of external follow-up in the three months after hospital release is not associated with TA global score (p=0.73). If inpatients, no matter what their diseases or types of care are, under legal obligation or not, consider their TA is rather good after their hospital stay. Only sociodemographic factors like age, housing conditions (insecure or sustainable), having a job or not, living alone or with a partner affect TA and follow-up. Conclusion Results evoke concepts of anomie and attachment, that seem to play an important role in the lack of follow-up after hospital stay, and indicate the mandatory global approach to care and an involvement of health professionals as well as social beings, where empathy must find its place. Contexte L'alliance therapeutique represente un objet tres peu etudie quand il concerne les infirmiers et les soins prodigues par une equipe infirmiere et dans le cadre de l'hospitalisation en soins aigus. Objectif L'objectif etait d'etudier l'influence de facteurs sur l'alliance therapeutique construite entre les infirmier(e)s et les aides-soignant(e)s et les patients adultes hospitalises dans un service de soins aigus en psychiatrie generale de secteur. Methode Il s'agit d'une etude prospective, observationnelle et transversale utilisant une echelle de mesure de l'alliance therapeutique. Le score d'alliance therapeutique (AT) a ete mesure a l'aide de l'echelle STAR-P sur un echantillon de 240 patients. Resultats Le score moyen obtenu est de 33,4 (+/- 7,8) sur un score maximum theorique de 48. Le score global d'AT des patients ages de 60 ans ou plus, est significativement plus eleve que celui des patients ayant entre 18 et 29 ans (p = 0,021). L'absence de suivi ambulatoire au cours des trois mois suivant la sortie d'hospitalisation n'est pas associee au score global d'AT (p = 0,73). Si les patients hospitalises, quelques soit leurs troubles et les differentes formes de soins, sous obligation legale ou non, jugent plutot bonne l'AT a l'issue de leur hospitalisation. Seuls des facteurs sociaux-demographiques comme, l'age, les conditions d'hebergement (precaire ou durable), avoir ou non un emploi, vivre seul ou avec un partenaire influent sur l'AT et le suivi. Conclusion Les resultats convoquent les concepts d'anomie et d'attachement, qui semblent jouer un role important dans l'absence de suivi post-hospitalisation, ce qui indiquent la necessaire approche globale des soins et une implication des professionnels de sante mais aussi du social ou l'empathie doit trouver sa place.

BACKGROUND: In patients with noncirrhotic chronic portal vein thrombosis (PVT), the benefit of long-term anticoagulation is unknown. We assessed the effects of rivaroxaban on the risk of venous thromboembolism and portal hypertension-related bleeding in such patients. METHODS: In this multicenter, controlled trial, we randomly assigned patients with noncirrhotic chronic PVT without major risk factors for thrombosis to receive either rivaroxaban 15 mg/day or no anticoagulation. The primary end point was 2-year thrombosis-free survival. Secondary end points included the occurrence of site-specific thromboses and major bleeding events. RESULTS: A total of 111 participants were enrolled in the trial, with a mean age of 50.4±13.2 years; 58% of participants were men. An unplanned interim analysis was requested by the independent data safety monitoring board (DSMB) after 10 thrombotic events occurred. The thrombosis incidence rate was 0 per 100 person-years in the rivaroxaban group and 19.71 per 100 person-years (95% confidence interval, 7.49 to 31.92) in the no anticoagulation group (log-rank P=0.0008) after a median follow-up of 11.8 months. Based on the interim analysis, the DSMB recommended switching patients from the no anticoagulation group to anticoagulation. After a median follow-up of 30.3 months (intraquartile range, 24.3 to 47.8), major bleeding occurred in two patients receiving rivaroxaban and in one patient not receiving anticoagulation. No deaths occurred. CONCLUSIONS: After a median follow-up of 11.8 months, among patients with noncirrhotic chronic PVT without major risk factors for thrombosis, daily rivaroxaban reduced the incidence of venous thromboembolism and did not increase major bleeding events. (Funded by grants from the French Ministry of Health and the Association de Malades des Vaisseaux du foie; ClinicalTrials.gov number, NCT02555111.)

Invasive pneumococcal disease (IPD) is responsible for substantial mortality and morbidity worldwide. We aimed to identify host and bacterial factors associated with 30-day mortality in 18-year-old patients hospitalized with IPD in France from 2013 to 2015. This study analyzed data collected from consecutives IPD cases included in two parallel multi-center cohort studies: COMBAT study (280 patients with pneumococcal community-acquired bacterial meningitis) and SIIP study (491 patients with non-meningitis IPD). Factors associated with 30-day mortality were identified using logistic regression. Among the 771 enrolled patients (median age 66 years, IQR [52.0–79.7]), 592/767 (77.2%) had at least one chronic disease. Patients with meningitis were younger (60.2 vs 70.9 years; p < 0.001) and had fewer chronic diseases than those with non-meningitis IPD (73.3% vs 79.4%; p = 0.05). Non-vaccine serotypes were more frequent in meningitis patients than in those with other IPD (36.1% vs 23.1%; p < 0.001). The overall 30-day mortality was 16.7% and patients with concurrent meningitis and extra-cerebral IPD had the highest 30-day mortality rate (26.5%). On multivariate analyses, older age, history of malignant solid tumor, meningeal IPD and serotypes previously identified with high mortality potential were independently associated with 30-day mortality. Of the serotypes with high mortality potential, 80% were included in licensed (PCV13 or PPV23) vaccines. We observed an effect of both host factors and pneumococcal serotypes on 30-day mortality in IPD. This highlights the need for a focused strategy to vaccinate at-risk patients. ClinicalTrial. Gov identification number: NCT01730690

Les anticancéreux oraux ont bouleversé les pratiques hospitalières et de ville. Une meilleure coordination et un accompagnement du patient dans la gestion de son médicament et des effets indésirables par le médecin traitant, pharmacien d'officine, et infirmier libéral, pourraient améliorer la situation. L'étude CHIMORAL a évalué un modèle de coordination par les réseaux territoriaux de santé. Une étude ici-ailleurs, prospective, multicentrique, comparant une prise en charge coordonnée à une prise en charge habituelle. Le critère principal était le recours à la structure hospitalière pour effet indésirable dans les 6 mois suivant l'initiation du traitement. Deux-cent quatre vingt patients inclus. Au total, 92 % ont eu au moins un effet indésirable, avec un nombre médian plus important dans le groupe coordonné (12,5 vs 9,0, p = 0,02). Pas de différence de recours à l'hôpital selon les bras (p = 0,502). Augmentation du recours aux soins de ville pour effet indésirable dans le groupe coordonné (27 % vs 16 %, p = 0,009). Pas d'impact observé sur les taux de progression, la qualité de vie et l'observance. Le taux de survie globale à 6 mois est numériquement plus élevé dans le groupe coordonné (87 % vs 76 %, p = 0,064). Ce modèle ne fait pas ressortir de différence sur le critère principal. L'absence de randomisation, la sélection des patients, la perte de puissance, et les initiatives locales de suivi de ces patients, ont pu biaiser l'analyse. Un grand nombre de recours au système de soins a été observé. Ces résultats confortent le besoin de parcours de soins dédié pour le patient avec anticancéreux oral. Oral anticancer drugs have disrupted hospital and community practices. A better coordination and patient support for medication and adverse events management by primary care providers (general practitioner, community pharmacist and liberal nurse) could improve the situation. The CHIMORAL study evaluated a model of coordination by territorial health networks. A here and elsewhere, prospective and multicentric study, comparing coordinated care with standard care. Primary outcome was the use of the hospital structure for adverse events within 6 months of initiating treatment. In all, 283 patients were included. 92% had at least one adverse event, with a higher median number in the coordinated group (12.5 vs. 9.0, P = 0.02). No difference in hospital use by arm (P = 0.502). Increase in the use of community care for adverse events in the coordinated group (27% vs. 16%, P = 0.009). No observed impact on progression rates, quality of life and treatment adherence. The overall survival rate at 6 months is numerically higher in the coordinated group (87% vs. 76%, P = 0.064). This model does not show any difference on the primary endpoint. The lack of randomization, patient selection, power loss, and local initiatives to monitor these patients may have biased the analysis. A large number of uses of the healthcare system were observed. These results confirm the need for a dedicated care pathway for the patient with oral anticancer drugs.

Introduction > Oral anticancer drugs hove disrupted hospital and community practices. A better coordination and patient support for medication and adverse events management by primary core providers (general practitioner, community pharmacist and liberal nurse) could improve the situation. The CHIMORAL study evaluated a model of coordination by territorial health networks. Methods > A here and elsewhere, prospective and multicentric study, comparing coordinated core with standard care. Primary outcome was the use of the hospital structure for adverse events within 6 months of initiating treatment. Results > In all, 283 patients were included. 92% had at least one adverse event, with a higher median number in the coordinated group (12.5 vs. 9.0, P = 0.02). No difference in hospital use by arm (P = 0.502). Increase in the use of community care for adverse events in the coordinated group (27% vs. 16%, P = 0.009). No observed impact on progression rates, quality of life and treatment adherence. The overall survival rate at 6 months is numerically higher in the coordinated group (87% vs. 76%, P = 0.064). Discussion > This model does not show any difference on the primary endpoint. The lack of randomization, patient selection, power loss, and local initiatives to monitor these patients may hove biased the analysis. A large number of uses of the healthcare system were observed. These results confirm the need for a dedicated care pathway for the patient with oral anticancer drugs.

Background Reports are conflicting on whether serum uric acid (sUA) levels are independently associated with increased cardiovascular (CV) death risk. Methods This post hoc analysis assessed the relationship between sUA levels and CV death risk score in 7531 patients from the cross-sectional, multinational EURIKA study (NCT00882336). Patients had at least one CV risk factor but no clinical CV disease. Ten-year risk of CV death was estimated using SCORE-HDL and SCORE algorithms, categorized as low (<1%), intermediate (1% to <5%), high (≥5% to <10%) or very high (≥10%). Results Mean serum sUA levels increased significantly with increasing CV death risk category in the overall population and in subgroups stratified by diuretics use or renal function (all P < 0.0001). Multivariate ordinal logistic regression analyses, adjusted for factors significantly associated with CV death risk in univariate analyses (study country, body mass index, number of CV risk factors and comorbidities, use of lipid lowering therapies, antihypertensives and antidiabetics), showed a significant association between sUA levels and SCORE-HDL category in the overall population (OR: 1.39 [95% CI: 1.34–1.44]) and all subgroups (using diuretics: 1.32 [1.24–1.40]; not using diuretics: 1.46 [1.39–1.53]; estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2: 1.30 [1.22–1.38]; eGFR ≥ 60 ml/min/1.73 m2: 1.44 [1.38–1.51]; all P < 0.0001). Similar results were obtained when using SCORE. Conclusions Higher sUA levels are associated with progressively higher 10-year CV death risk score in patients with at least one CV risk factor but no CV disease.

BACKGROUND: Blood test results required for the evaluation of anemia are considered difficult to interpret after red blood cell transfusion. However, this hypothesis is neither supported by a strong physiological rationale nor is it evidence based. METHODS: We conducted a prospective multicenter study to compare the values of key assays prior to and after a course of red blood cell transfusion in the emergency or internal medicine units in 4 university hospitals. The following parameters were measured prior to and within 48 to 72 hours after transfusion: complete blood count with reticulocyte count, direct Coombs' test, ferritin, transferrin saturation, soluble transferrin receptor, serum and erythrocyte folate, cobalamin, lactate dehydrogenase, bilirubin, haptoglobin, and C-reactive protein. We investigated the impact of transfusion on these parameters and assessed whether abnormal values prior to the transfusion became normal after transfusion (or conversely). RESULTS: There were 77 patients included in the study. Changes in mean values of mean corpuscular volume, soluble transferrin receptor, erythrocyte folate, cobalamin, haptoglobin, lactate dehydrogenase, C-reactive protein, and direct Coombs' test were not statistically significant. Changes in reticulocyte count, ferritin, transferrin saturation, serum folate, and total bilirubin concentrations were statistically significant, but they remained in the same diagnostic category (normal or abnormal) in 79% to 98% of the cases; 97% of patients with iron deficiency still had low ferritin or transferrin saturation after a transfusion. CONCLUSION: Blood tests performed after a one-time red blood cell transfusion can be used to establish the cause of anemia when they have not been performed before. (C) 2018 Elsevier Inc. All rights reserved.

Objective: Shoulder dystocia is a major obstetric emergency defined as a failure of delivery of the fetal shoulder(s). This study evaluated whether an obstetric maneuver, the push back maneuver performed gently on the fetal head during delivery, could reduce the risk of shoulder dystocia. Study design: We performed a multicenter, randomized, single-blind trial to compare the push back maneuver with usual care in parturient women at term. The primary outcome, shoulder dystocia, was considered to have occurred if, after delivery of the fetal head, any additional obstetric maneuver, beginning with the McRoberts maneuver, other than gentle downward traction and episiotomy was required. Results: We randomly assigned 522 women to the push back maneuver group (group P) and 523 women to the standard vaginal delivery group (group S). Finally, 473 women assigned to group P and 472 women assigned to group S delivered vaginally. The rate of shoulder dystocia was significantly lower in group P (1.5%) than in group S (3.8%) (odds ratio [OR] 0.38 [0.16-0.92]; P= 0.03). After adjustment for predefined main risk factors, dystocia remained significantly lower in group P than in group S. There were no significant between-group differences in neonatal complications, including brachial plexus injury, clavicle fracture, hematoma and generalized asphyxia. Conclusion: In this trial in 945 women who delivered vaginally, the push back maneuver significantly decreased the risk of shoulder dystocia, as compared with standard vaginal delivery. (C) 2018 Elsevier B.V. All rights reserved.

The members of the Palurea Study Group were provided in such a way that they could not be indexed as collaborators on PubMed. The publisher apologizes for this error and is pleased to list the members of the group here:

Au cours du paludisme grave chez l'enfant en zone d'endémie, les coinfections ont fait l'objet de plusieurs études, et semblent aggraver le pronostic. En revanche, au cours du paludisme d'importation de l'adulte, les données sur l'épidémiologie et l'impact de ces coinfections sont rares. Les objectifs de notre étude sont de décrire les coinfections communautaires au cours des accès palustres graves (APG) d'importation chez l'adulte, et d'identifier les facteurs associés à leur survenue. Étude multicentrique observationnelle dans 52 centres de réanimation en France, ancillaire d'une étude rétrospective (2000–2006) et d'une étude prospective (2006–2010). Un APG était défini selon les critères de l'OMS 2000 adaptés au paludisme d'importation. Une coinfection communautaire était définie comme une infection diagnostiquée dans les 48 heures suivant l'admission en réanimation. Les données cliniques et démographiques étaient collectées à partir des dossiers standardisés. Les facteurs associés aux coinfections communautaires étaient identifiés par analyses uni- et multi-variées. La fusion des 2 bases a permit de colliger 555 patients admis en réanimation pour APG d'importation. L'âge moyen était de 44 ans, la population était majoritairement masculine (69 %). Tous les patients étaient traités par quinine intraveineuse. Cent-dix-neuf patients (21 %) ont présenté au moins une coinfection, dont 42 (35 %) communautaire et 77 (65 %) nosocomiale. Parmi les coinfections communautaires, on retrouvait 18 pneumopathies (43 %), 13 bactériémies (31 %), et 5 infections urinaires (12 %). Les principaux germes identifiés étaient Escherichia coli (n = 7), Streptococcus pneumoniae (n = 5), Pseudomonas aeruginosa (n = 4), et des streptocoques autres (n = 4). En analyse multivariée, 3 variables présentes à l'admission étaient indépendamment associées à la présence d'une coinfection communautaire le sexe masculin (OR 3,41, IC 95 % [1,75–6,78]), une détresse respiratoire définie par le critère OMS modifié (OR 2,96, IC 95 % [1,42–6,08]) et une acidose définie par le critère OMS (OR 2,33, IC 95 % [1,04–5,07]). La mortalité intrahospitalière était de 9 % (n = 55) sur l'ensemble de la cohorte sans différence significative entre les patients présentant une coinfection communautaire versus le reste de la cohorte. Sur une large population d'adulte admis en réanimation pour un APG d'importation, 21 % présentent au moins une coinfection, dont 1/3 d'origine communautaire, notamment des pneumopathies et des bactériémies. En analyse multivariée, le sexe masculin, la présence d'une détresse respiratoire ou d'une acidose sont associées à la survenue d'un coinfection communautaire. Ces données peuvent contribuer orienter le clinicien à identifier les patients les plus à risque et à optimiser leur traitement.

L’objectif de cette étude était de comparer la prévalence des ASCA chez les patients atteints de spondyloarthrite (SpA) et d’explorer le lien entre statut ASCA et phénotype de la maladie. Nous avons réalisé une étude cas-témoin incluant des patients atteints de SpA selon les critères du Groupe européen d’étude des spondyloarthropathies (ESSG, European Spondyloarthropathy Study Group) pour la SpA. Ont été collectées aux fins d’analyse les données relatives au sexe, à l’âge, à la durée de la maladie, aux caractéristiques cliniques ou associées de la SpA, aux traitements et au statut HLA-B27 et ASCA. Un groupe de patients témoins sans SpA a également été analysé. Au total, 235 patients atteints de SpA et 54 patients témoins ont été étudiés. L’âge médian des patients atteints de SpA (53,6 % d’hommes, 52,2 % porteurs de HLA-B27) était de 46,0 ans (IQR 35,0–57,0). La durée de la maladie était de 60,0 mois (IQR 24,0–156,0). Une maladie inflammatoire chronique de l’intestin (MICI) a été observée chez 11 % des patients atteints de SpA. La présence d’ASCA était significativement plus importante chez les patients atteints de SpA que chez les témoins (25,5 % [IC 95 % 20,1–31,6] [IgG : 9,8 % ; IgA : 21,7 %] contre 7,4 % [IC 95 % 2,1–17,9], p = 0,004). L’analyse multivariée a montré que la présence d’ASCA était associée à une atteinte périphérique (OR : 3,30 [1,26–8,62], p = 0,015), à l’existence d’une MICI (OR : 3,43 [1,15–10,20], p = 0,026), à une uvéite passée ou actuelle (OR : 4,36 [1,08–17,64], p = 0,039) et à une arthrite (OR : 3,78 [1,57–9,15], p = 0,003). Nos résultats ont apporté la preuve que les patients atteints de SpA avaient une prévalence d’ASCA supérieure et que la présence d’ASCA pouvait être associée à un phénotype particulier, notamment l’atteinte périphérique et l’uvéite.

Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol.

Plusieurs études ont suggéré que l’obésité pouvait avoir une influence négative sur la réponse aux anti-TNFα mais il n’existe aucune donnée sur la réponse au rituximab (RTX). Nous avons voulu déterminer si l’indice de masse corporelle (IMC) pouvait affecter la réponse au RTX dans la PR. Nous avons analysé de manière rétrospective les données de 114 patients atteints de PR et traités par RTX. La variation à 6 mois du Disease Activity Score (DAS28), du score douleur sur l’échelle visuelle analogique (EVA), de la vitesse de sédimentation (VS), du taux de protéine C-réactive (CRP), du nombre d’articulations douloureuses (NAD) et du nombre d’articulations gonflées (NAG) par rapport aux valeurs initiales était analysée. Le critère principal de jugement était la diminution du DAS28 ≥ 1,2. Les critères secondaires étaient la bonne réponse EULAR et la rémission EULAR. L’IMC médian initial (intervalle interquartile) était de 26,8 (1,8–23,23–31) kg/m2. Le nombre de patients avec un IMC normal, en surpoids et obèses était respectivement de 38, 41 et 35. À 6 mois, le nombre de patients atteints de PR qui rapportaient une diminution du DAS28 ≥ 1,2 ainsi qu’une bonne réponse thérapeutique EULAR et une rémission EULAR était respectivement de 44 (38,6 %), 27 (23,7 %) et 24 (21,1 %). En analyse univariée, l’IMC médian était similaire chez les sujets répondeurs et non répondeurs pour une diminution du DAS28 ≥ 1,2 (26,9 [1,1–24,24–30] vs. 26,8 [2–6,6–23,23–31], p = 0,78), une bonne réponse EULAR (27,7 [3–7,7–24,24–30] vs. 26,7 [3–5,5–22,22–31], p = 0,57) et une rémission EULAR (26,9 [1–8,8–24,24–30] vs. 26,8 [2–5,5–23,23–31], p = 0,94). L’analyse multivariée ajustée confirmait l’absence de corrélation entre l’IMC et les différents critères de réponse au RTX. L’IMC était seulement négativement corrélé à une baisse du ΔNAG (p = 0,0276) et du ΔNAD (p = 0,0233). L’IMC n’avait aucun impact négatif sur la réponse au RTX dans la PR. Ces données constituent une aide dans le choix d’une biothérapie pour les patients obèses atteints de PR.