Clermont-Ferrand, France
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Lazaar H.,Clermont Ferrand Teaching Hospital | Lhoste-Trouilloud A.,Clermont Ferrand Teaching Hospital | Pereira B.,Clermont Ferrand Teaching Hospital | Couderc M.,Clermont Ferrand Teaching Hospital | And 2 more authors.
BMC Musculoskeletal Disorders | Year: 2017

Background: Clinical symptoms of rheumatoid arthritis (RA) improve in the course of the day, as can synovitis activity, reported via doppler ultrasound (US). The aim of the study was to establish whether the Color Doppler (CD) scores of synovitis in RA changes throughout the day. Methods: In total, 27 patients with active RA, including 14 patients receiving corticosteroids were studied. US evaluation was performed twice in each patient, at 9 a.m. (T0) and after 4 p.m. (T1) on the same day by a single radiologist and using the same instrument. Overall, 30 joints were assessed, including grey scale and CD (S0 = no flow [no detectable CD)]; S1 = mild [CD <1/3 of the synovium]; S2 = moderate [CD <2/3]; S3 = pronounced [CD >2/3]). Results: In the total population, synovitis was detected more often in the evening than in the morning (39% vs. 33%, p = 0.02). The difference remained significant only in patients without corticosteroid administration (44% vs. 37%, p = 0.04). Moreover, a greater number of CD-positive joints were likewise found (S0 vs. S1 + S2 + S3) in the evening (57% vs. 51%, p = 0.04) in patients not receiving corticosteroids (67% vs. 41%, p = 0.002). More moderate (S2) and pronounced (S3) than mild (S1) synovitis was observed at T1 vs. T0 (39% vs. 24%, p = 0.03) in patients not receiving corticosteroids. More synovitis (40% vs 36% p = 0.02) in the dominant hand were found in the evening than in the morning. Conclusion: Synovitis and CD activity increase during the day in RA patients, especially in joints of the dominant hands and in patients without corticosteroids. © 2017 The Author(s).


Payet S.,Clermont Ferrand Teaching Hospital | Soubrier M.,Clermont Ferrand Teaching Hospital | Perrodeau E.,Strasbourg Teaching Hospital | Bardin T.,Bicetre Teaching Hospital | And 9 more authors.
Arthritis Care and Research | Year: 2014

Objective. The aim of this study was to compare the efficacy and safety of rituximab (RTX) as a function of patient age. Methods. We included all rheumatoid arthritis patients in the AutoImmunity and Rituximab registry with a 2-year followup. Results. Of the 1,709 patients, 191 were age ≥75 years, 417 were ages 65-74 years, 907 were ages 50-64 years, and 194 were age <50 years. At baseline, the elderly and very elderly patients presented with longer disease duration, a higher incidence of erythrocyte sedimentation rate and C-reactive protein level, a lower incidence of previous tumor necrosis factor α (TNFα) therapy, and a smaller number of previously used TNFα agents. Disease activity, rheumatoid factor (RF), or anti-cyclic citrullinated peptide (anti-CCP) antibodies and corticosteroid therapy were not statistically different among the groups. At 24 months, no significant difference was shown among the groups for RTX discontinuation rates (36.1% if age <50 years, 32.6% if ages 50-64 years, 34.5% if ages 65-74 years, and 32.5% if age >75 years). The reasons for discontinuation (inefficacy, adverse events) were the same in all 4 groups. Infections were more common in the elderly. Patients ages 65-75 years were more likely to be good responders than nonresponders at 1 year of followup than patients age ≥75 years (odds ratio 3.81, 95% confidence interval 1.14-12.79) after adjustment on disease duration, RF/anti-CCP positivity, corticosteroids, anti-TNF use, and baseline Disease Activity Score in 28 joints (DAS28). After the sixth month, the decrease in DAS28 score was less marked in the population age >75 years than in the group age <50 years. Conclusion. The efficacy and safety of RTX is affected by age. Copyright © 2014 by the American College of Rheumatology.


Couderc M.,Clermont Ferrand Teaching Hospital | Mathieu S.,Clermont Ferrand Teaching Hospital | Tournadre A.,Clermont Ferrand Teaching Hospital | Dubost J.-J.,Clermont Ferrand Teaching Hospital | Soubrier M.,Clermont Ferrand Teaching Hospital
Joint Bone Spine | Year: 2014

Ocular myositis is a rare disorder characterized by inflammation of single or multiple extra-ocular eye muscles presenting with painful diplopia and/or ophthalmoplegia. The etiology remains obscure and it is rarely associated with rheumatoid arthritis. We here reported the case of a 61-year-old woman treated by TNF-α blockade, namely etanercept, for rheumatoid arthritis for ten years who developed an acute ocular myositis. The patient improved after etanercept was stopped and initiation of high doses of corticosteroids. To our knowledge, this is the second report of ocular myositis occurring under TNF-α blockade treatment for rheumatoid arthritis. © 2014 Société française de rhumatologie.


Bouvier D.,Clermont Ferrand Teaching Hospital | Fournier M.,Clermont Ferrand Teaching Hospital | Dauphin J.-B.,Clermont Ferrand Teaching Hospital | Amat F.,Clermont Ferrand Teaching Hospital | And 3 more authors.
Clinical Chemistry | Year: 2012

BACKGROUND: The place of serum S100B measurement in mild traumatic brain injury (mTBI) management is still controversial. Our prospective study aimed to evaluate its utility in the largest child cohort described to date. METHODS: Children younger than 16 years presenting at a pediatric emergency department within 3 h after TBI were enrolled prospectively for blood sampling to determine serum S100B concentrations. The following information was collected: TBI severity determined by using the Masters classification [1: minimal or Glasgow Coma Scale (GCS) 15, 2: mild or GCS 13-15, and 3: severe or GCS <13]; whether hospitalized or not; good or bad clinical evolution (CE); whether cranial computed tomography (CCT) was prescribed; and related presence (CCT+) or absence (CCT-) of lesions. RESULTS: For the 446 children enrolled, the median concentrations of S100B were 0.21, 0.31, and 0.44 μg/L in Masters groups 1, 2, and 3, respectively, with a statistically significant difference between these groups (P < 0.05). In Masters group 2, 65 CCT scans were carried out. Measurement of S100B identified patients as CCT+ with 100% (95% CI 85-100) sensitivity and 33% (95% CI 20-50) specificity. Of the 424 children scored Masters 1 or 2, 21 presented "bad CE." S100B identified bad CE patients with 100% (95% CI 84-100) sensitivity and 36% (95% CI 31-41) specificity. Of the 242 children hospitalized, 81 presented an S100B concentration within the reference interval. CONCLUSIONS: Serum S100B determination during the first 3 h of management of children with mTBI has the potential to reduce the number of CCT scans, thereby avoiding unnecessary irradiation, and to save hospitalization costs. © 2012 American Association for Clinical Chemistry.


Couderc M.,Clermont Ferrand Teaching Hospital | Gottenberg J.-E.,Clermont Ferrand Teaching Hospital | Mariette X.,Clermont Ferrand Teaching Hospital | Pereira B.,Clermont Ferrand Teaching Hospital | And 9 more authors.
Rheumatology (Oxford, England) | Year: 2014

OBJECTIVE: The response rate to many therapies for RA is lower in women. The aim of this study was to analyse the influence of gender on the response to rituximab (RTX) in patients with RA.METHODS: A total of 1709 RA patients were included in the French Autoimmunity and Rituximab (AIR) registry. Disease activity assessed by the 28-joint DAS (DAS28) was recorded at baseline and at follow-up (6, 12, 18 and 24 months). Response criteria [European League Against Rheumatism (EULAR) remission defined as a DAS28 < 2.6 and EULAR response] were compared in both sexes.RESULTS: Seventy-seven per cent of the patients were female (age 61.4 years, disease duration 16 years). Approximately 78.6% of the patients were positive for RF and 75.8% for anti-CCP. Women had a longer disease duration (P < 0.001), less frequently had anti-CCP (P = 0.03) and had lower CRP levels at baseline (P < 0.001). Six months after RTX, 11% were in remission and 62% had a good to moderate EULAR response, irrespective of gender (P = 0.81 and P = 0.38, respectively). No differences were observed in terms of remission or EULAR response during the follow-up except at 12 months, when men achieved remission more frequently (18% vs 12%, P = 0.045). In the cases of anti-TNF failure, remission rates were higher in men than in women at 6, 12 and 18 months. Re-treatment delay between the first and second courses was similar in both genders (P = 0.26).CONCLUSION: In this large cohort of RA patients we found no significant differences in EULAR response to RTX between men and women during the 2-years of follow-up, but there was a previous anti-TNF exposure-dependent effect of gender on remission rate. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.


Bouvier D.,Clermont Ferrand Teaching Hospital | Castellani C.,Medical University of Graz | Fournier M.,Clermont Ferrand Teaching Hospital | Dauphin J.-B.,Clermont Ferrand Teaching Hospital | And 5 more authors.
Clinical Biochemistry | Year: 2011

Objective: Clinical and diagnostic management of traumatic brain injuries is problematic in young children. To facilitate this management, we describe blood reference ranges for the well established biomarker S100B in children younger than 3. years. Design and methods: Serum S100B concentrations were determined by electro-chemiluminescence immunoassay in a population of 186 healthy children aged 0-3. years. Results: Four age groups emerged, i.e. 0-3, 4-9, 10-24 and 25-36. months. We also found an interesting inverse correlation with head circumference. Conclusion: This study provides useful serum S100B values from the largest cohort of healthy children aged 0-3. years old. © 2011 The Canadian Society of Clinical Chemists.


Bouvier D.,Clermont Ferrand Teaching Hospital | Sapin V.,Clermont Ferrand Teaching Hospital | Bonnard-Gougeon M.,Clermont Ferrand Teaching Hospital | Marceau G.,Clermont Ferrand Teaching Hospital
Clinical Chemistry and Laboratory Medicine | Year: 2010

Background: The interference of ascorbic acid in the determination of plasma uric acid concentrations, by decreasing the formation of chromophore in Trinder's reaction, is well known. By contrast, the effects of other antioxidant vitamins, such as retinol and α-tocopherol have not been investigated. Knowledge of the analytical interaction of these antioxidants in the uric acid assay would be useful. Methods: The effect of a mix of vitamins (Cernevit®) on uric acid analysis in a patient hospitalized in a neurological intensive care unit was observed. The effects of the different antioxidant components of the mixture (retinol, α-tocopherol and ascorbic acid) on the concentration of uric acid from a pool of plasma were also tested. Results: Among the different combinations of vitamins tested, only retinol potentiated the antioxidant effect of ascorbic acid. The most marked effect was observed with 80 IU/mL of retinol and 5.7 mmol/L of ascorbic acid. Conclusions: We demonstrate for the first time the synergistic interference of ascorbic acid and retinol on the measurement of uric acid in plasma. We established that ascorbic acid interference is potentiated by regeneration of reduced ascorbic acid by retinol. Such interference must be kept in mind to avoid misinterpreting low plasma uric acid concentrations in patients in whom this analyte is critical. © 2010 by Walter de Gruyter Berlin New York.


PubMed | Clermont Ferrand Teaching Hospital
Type: Journal Article | Journal: Clinical chemistry | Year: 2012

The place of serum S100B measurement in mild traumatic brain injury (mTBI) management is still controversial. Our prospective study aimed to evaluate its utility in the largest child cohort described to date.Children younger than 16 years presenting at a pediatric emergency department within 3 h after TBI were enrolled prospectively for blood sampling to determine serum S100B concentrations. The following information was collected: TBI severity determined by using the Masters classification [1: minimal or Glasgow Coma Scale (GCS) 15, 2: mild or GCS 13-15, and 3: severe or GCS <13]; whether hospitalized or not; good or bad clinical evolution (CE); whether cranial computed tomography (CCT) was prescribed; and related presence (CCT+) or absence (CCT-) of lesions.For the 446 children enrolled, the median concentrations of S100B were 0.21, 0.31, and 0.44 g/L in Masters groups 1, 2, and 3, respectively, with a statistically significant difference between these groups (P < 0.05). In Masters group 2, 65 CCT scans were carried out. Measurement of S100B identified patients as CCT+ with 100% (95% CI 85-100) sensitivity and 33% (95% CI 20-50) specificity. Of the 424 children scored Masters 1 or 2, 21 presented bad CE. S100B identified bad CE patients with 100% (95% CI 84-100) sensitivity and 36% (95% CI 31-41) specificity. Of the 242 children hospitalized, 81 presented an S100B concentration within the reference interval.Serum S100B determination during the first 3 h of management of children with mTBI has the potential to reduce the number of CCT scans, thereby avoiding unnecessary irradiation, and to save hospitalization costs.


PubMed | Clermont Ferrand Teaching Hospital
Type: Case Reports | Journal: Joint, bone, spine : revue du rhumatisme | Year: 2014

Ocular myositis is a rare disorder characterized by inflammation of single or multiple extra-ocular eye muscles presenting with painful diplopia and/or ophthalmoplegia. The etiology remains obscure and it is rarely associated with rheumatoid arthritis. We here reported the case of a 61-year-old woman treated by TNF- blockade, namely etanercept, for rheumatoid arthritis for ten years who developed an acute ocular myositis. The patient improved after etanercept was stopped and initiation of high doses of corticosteroids. To our knowledge, this is the second report of ocular myositis occurring under TNF- blockade treatment for rheumatoid arthritis.

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