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Notre-Dame-de-l'Île-Perrot, Canada

Kouz J.,McGill University | Vincent C.,University of Montreal | Leong A.,McGill University | Dorais M.,StatSciences Inc. | Rakel A.,University of Montreal
Liver Transplantation | Year: 2014

Post transplant weight gain is common after orthotopic liver transplantation. We sought to determine the extent of weight gain at 5 years after transplantation in patients with nonalcoholic fatty liver disease (NAFLD) cirrhosis versus patients with other types of cirrhosis (non-NAFLD). We studied 126 liver transplants performed between 2005 and 2007 at Saint Luc Hospital, University of Montreal. Seventeen of the 126 patients (13.5%) had NAFLD cirrhosis. Ascites volume was difficult to assess, so we used the body mass index (BMI) at 3 months as the reference BMI. All patients gained weight after transplantation, but BMI increased significantly more and earlier among the NAFLD patients [4.8 versus 1.5 kg/m2 at 1 year (P=0.001), 5.0 versus 2.3 kg/m2 at 2 years (P=0.01), and 5.6 versus 2.6 kg/m2 at 5 years (P=0.009)] in comparison with non-NAFLD patients in unadjusted analyses. The greatest BMI increase over time was investigated with univariate and multivariate logistic regression analyses. The BMI increase was divided into tertiles for each period of time observed. The greatest BMI increase over time was defined as the top tertile of BMI increase. After adjustments for potential confounders (ie, total cholesterol, diabetes, and length of hospital stay), NAFLD was no longer associated with a risk of a greater BMI increase [odds ratio (OR)=3.73 at 1 year (P-0.11), OR=2.15 at 2 years (P=0.34), and OR=2.87 at 5 years (P=0.30)]. These findings suggest the need for multidisciplinary, early, and close weight monitoring for all patients. All patients could benefit from pretransplant counseling regarding weight gain and its consequences. Liver Transpl 20:1266-1274, 2014. © 2014 AASLD. Source

Roubille C.,University of Montreal | Martel-Pelletier J.,University of Montreal | Raynauld J.-P.,University of Montreal | Abram F.,ArthroLab Inc. | And 3 more authors.
Arthritis Research and Therapy | Year: 2015

Introduction: To evaluate the impact of meniscal extrusion (Ext) on knee osteoarthritis (OA) structural progression and on response to strontium ranelate (SrRan) treatment at 36months in patients with (+) or without (-) Ext, in association (+) or not (-) with bone marrow lesions (BML) in the medial compartment using X-rays (JSW) and qMRI. Methods: Patients from the qMRI substudy of the SEKOIA trial (SrRan 1g/day, n=113; SrRan 2g/day, n=105; placebo, n=112) were stratified based on whether meniscal extrusion and/or BML were present or not in the medial compartment. Results: In the placebo group, Ext+patients (n=26) had more JSW loss (p=0.002) and cartilage volume loss in the global knee (p=0.034) and plateau (p=0.005), and medial compartment (p=0.0005) than Ext- patients (n=86). Ext-BML+ patients (n=18) demonstrated more JSW loss (p=0.003) and cartilage volume loss in the global (p=0.020) and medial femur (p=0.055) than Ext-BML- (n=68). Compared to Ext+BML- (n=14), Ext+BML+ patients (n=12) had more cartilage volume loss in the global femur (p=0.028), with no change in JSW. The JSW loss (p=0.0004) and cartilage volume loss (global knee, p=0.033, medial compartment, p=0.0005) were greater when Ext and BML were simultaneously present in the medial compartment. SrRan 2g/day treatment demonstrated a reduction in OA knee structural progression with qMRI, but not with JSW, in which less cartilage volume loss was found in the plateaus (p=0.007) in Ext+patients (n=15), and in the medial plateau (p=0.046) in patients in whom both Ext and BML were co-localized. Conclusion: The findings of this study are novel and could have an impact on future strategies regarding clinical trials. Indeed, data first argue for a combined, cumulative effect of meniscal extrusion and bone marrow lesions on cartilage loss and, secondly, they showed that SrRan may have protective effects in OA patients with meniscal extrusion as well as when both meniscal extrusion and BML are co-localized. © Roubille et al.; licensee BioMed Central. Source

Pelletier J.-P.,University of Montreal | Roubille C.,University of Montreal | Raynauld J.-P.,University of Montreal | Abram F.,ArthroLab Inc. | And 3 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objective: To explore, using MRI, the disease-modifying effect of strontium ranelate (SrRan) treatment on cartilage volume loss (CVL) and bone marrow lesions (BMLs) in a subset of patients from a Phase III clinical trial in knee osteoarthritis (OA) (SrRan Efficacy in Knee OsteoarthrItis triAl (SEKOIA)). Material and methods: Patients with primary symptomatic knee OA were randomised to receive either SrRan 1 g/day or 2 g/day or placebo (SEKOIA study). A subset of these patients had MRIs at baseline, 12, 24 and 36 months to assess the knee cartilage volume and BMLs. Missing values were imputed and the analyses were adjusted according to Bonferroni. Results: In this MRI subset, the distribution of patients (modified intention-to-treat; n=330) was 113, 105 and 112 for SrRan 1 g/day, 2 g/day and placebo, respectively. The groups were fairly balanced at baseline regarding demographics, clinical symptoms or imaging characteristics. Treatment with SrRan 2 g/day significantly decreased CVL on the plateaus at 12 (p=0.002) and 36 (p=0.003) months compared with placebo. Of note, in the medial femur and plateau, SrRan 1 g/day, but not SrRan 2 g/day, had more CVL than placebo. In patients with BML in the medial compartment at baseline, the BML score at 36 months was decreased in both treatment groups compared with the placebo group (SrRan 1 g/day, p=0.002 and SrRan 2 g/day p=0.001, respectively), and CVL significantly decreased with SrRan 2 g/day (p=0.023) in the plateau compared with placebo. Conclusions: In knee OA patients, treatment with SrRan 2 g/day was found to have beneficial effects on structural changes by significantly reducing CVL in the plateau and BML progression in the medial compartment. © 2013 BMJ Publishing Group Ltd & European League Against Rheumatism. Source

Wildi L.M.,University of Montreal | Raynauld J.-P.,University of Montreal | Martel-Pelletier J.,University of Montreal | Beaulieu A.,Laval University | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective To determine the effect of chondroitin sulphate (CS) treatment on cartilage volume loss, subchondral bone marrow lesions (BML), synovitis and disease symptoms in patients with knee osteoarthritis (OA). Methods In this pilot multicentre, randomised, doubleblind, controlled trial in primary knee OA, 69 patients with clinical signs of synovitis were randomised to receive CS 800 mg or placebo once daily for 6 months followed by an open-label phase of 6 months in which patients in both groups received CS 800 mg once daily. Cartilage volume and BML were assessed by MRI at baseline and at 6 and 12 months; synovial membrane thickness was assessed at baseline and at 6 months. Results The CS group showed significantly less cartilage volume loss than the placebo group as early as 6 months for the global knee (p=0.030), lateral compartment (p=0.015) and tibial plateaus (p=0.002), with significance persisting at 12 months. Significantly lower BML scores were found for the CS group at 12 months in the lateral compartment (p=0.035) and the lateral femoral condyle (p=0.044). Disease symptoms were similar between the two groups. Conclusion CS treatment significantly reduced the cartilage volume loss in knee OA starting at 6 months of treatment, and BML at 12 months. These findings suggest a joint structure protective effect of CS and provide new in vivo information on its mode of action in knee OA. Source

Raynauld J.-P.,University of Montreal | Martel-Pelletier J.,University of Montreal | Haraoui B.,University of Montreal | Choquette D.,University of Montreal | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2011

Objective: To identify predictive factors for total knee replacement (TKR) using data from MRI of knee osteoarthritis patients in a phase III multicentre disease-modifying osteoarthritis drug (DMOAD) study. Methods: Knee osteoarthritis patients from a 2-year clinical trial evaluating licofelone versus naproxen were investigated for the incidence of TKR of the study knee. Patients (n=161) who completed the study according to protocol were selected. Incidence of TKR was assessed blindly to the treatment following telephone interviews (n=123). Results: 18 TKR (14.6%) were performed in 4-7 years following enrolment in the original study. More TKR were performed within the naproxen than the licofelone group (61% vs 39%, p=0.232). Baseline score of bone marrow lesions (BML) in the medial compartment (p=0.0001), medial joint space width (JSW) as assessed by standardised radiographs (p=0.0008), presence of severe medial meniscal tear (p=0.004), medial meniscal extrusion (p=0.013), and C-reactive protein level (p=0.049) were strong predictors of TKR. Changes at the end of the study also yielded strong predictors: change in cartilage volume of the medial compartment (p=0.005) and of the global knee (p=0.034), reduction in the JSW of greater than 7% (p=0.009), and WOMAC pain (p=0.009) and function (p=0.023) scores. Multivariate analysis showed that baseline severe medial meniscal tear (p=0.023) and presence of medial BML (p=0.025) were the strongest independent long-term predictors of TKR. Conclusion: This study shows that in the context of osteoarthritis trials, clinical data and structural changes identified by MRI allow prediction of a 'hard' outcome such as TKR. The findings support the usefulness and predictive value of MRI in defining study outcome in DMOAD trials. Source

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