ObjectiveTo evaluate the efficacy of tocilizumab, an antibody against IL-6 receptor, in patients with hand osteoarthritis.MethodsThis was a multicentre, 12-week, randomised, double-blind, placebo-controlled study from November 2015 to October 2018. Patients with symptomatic hand osteoarthritis (pain ≥40 on a 0–100 mm visual analogue scale (VAS) despite analgesics and non-steroidal anti-inflammatory drugs; at least three painful joints, Kellgren-Lawrence grade ≥2) were randomised to receive two infusions 4 weeks apart (weeks 0 and 4) of tocilizumab (8 mg/kg intravenous) or placebo. The primary endpoint was changed in VAS pain at week 6. Secondary outcomes included the number of painful and swollen joints, duration of morning stiffness, patients’ and physicians’ global assessment and function scores.ResultsOf 104 patients screened, 91 (45 to tocilizumab and 46 to placebo; 82% women; mean age 64.4 (SD 8.7) years) were randomly assigned and 79 completed the 12-week study visit. The mean change between baseline and week 6 on the VAS for pain (primary outcome) was −7.9 (SD 19.4) and −9.9 (SD 20.1) in the tocilizumab and placebo groups (p=0.7). The groups did not differ for any secondary outcomes at weeks 4, 6, 8 or 12. Overall, adverse events were slightly more frequent in the tocilizumab than placebo group.ConclusionTocilizumab was no more effective than placebo for pain relief in patients with hand osteoarthritis.
Our study shows an impact for only a limited number of brain dead donor resuscitation parameters on DGF duration. We also show that CIT has a much lower threshold (<16 hr) for DGF risk than previously described. Importantly, we show that recipient age is clearly a major independent risk factor for prolonged DGF, whereas donor age seems to act mostly as a dependent risk factor.
Objectives To assess long-term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK). Methods Prospective open-labeled trial in naïve patients with TAK who received steroids at the dose of 0.7 mg/kg/day and 7 infusions of 8 mg/kg/month of tocilizumab. The primary endpoint was the number of patients who discontinued steroids after 7 infusions of tocilizumab. Secondary endpoints included disease activity and the number of relapses during 18-month follow-up. Results Thirteen patients with TAK were included, with a median age of 32 years [19–45] and 12 (92%) females. Six (54%) patients met the primary end-point. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3, 4] at baseline, versus 1 [0–2] after 6 months; p < 0.001), ITAS-2010 score (5 [2–7] versus 3 [0–8]; p = 0.002), and ITAS-A score (7 [4–10] versus 4 [1–15]; p = 0.0001)]. During the 12-month follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab. Conclusion Tocilizumab seems an effective steroid sparing therapy in TAK, but maintenance therapy is necessary. Trial registration ClinicalTrials.gov NCT02101333. Registered on 02 April 2014.
Background The use of Ultrasonography (US) in rheumatology has considerably increased in the last few years. Evaluation of national osteoarticular US practice may lead to adapt trainings to increase standardization of US practice. Objectives To describe daily practice of US in French departments of rheumatology in a national multicentre longitudinal study of 3 years follow up. Methods Each year (T1, T2, T3), questionnaires were sent in order to collect informations concerning the experience of the centres in US practice and ultrasonographers’ experience and practice use. Daily US practice was evaluated by collecting data (indication and results of US examinations) for all US examination performed during one month (September to October) each year. This evaluation was repeated during 3 years. Results During the 3 years follow up, the number of centres, of ultrasonographers and of US examinations performed per month increased considerably (table). Sonographers were young (mean: 37± 7,9 years) and have been practicing US for (mean) 4 years. 96% of them at T3 had a diploma for US practice (85% at T0) and 89% of them still participated to formations on US after their diploma. 64% used systematic examination for each pathology and 56 % used scoring systems. The 2398 US examinations per month at T3 were performed for inflammatory rheumatisms (60%), mechanical diseases (30%), other indications like Horton/PMR or Gougerot-Sjogren(10%). Concerning inflammatory rheumatism, US were mostly performed for rheumatoid arthritis (RA) (42%) (equally for diagnosis and follow up), for spondyloarthropathy (28%) (essentially for diagnosis) and for unclassified rheumatism (20%). RA examination was quite consensual among rheumatologists as more than 80% of the rheumatologists examined wrists, MCP 2 to 5, PIP 2 to 5 and MTP 2 to 5 for diagnosis and wrists, MCP 2 to 5 and MTP5 for follow up. Concerning Spondyloarthritis, there was no consensus for the joints to examine, but the examination of enthesis was homogeneous with more than 80 % of the rheumatologists practicing examination of the enthesis of lateral epicondyle tendon, patellar ligament, quadricipital tendon, calcaneum tendon and plantar aponevrosis. Conclusions This national multicentre longitudinal study demonstrated the widespread of US practice among the departments of rheumatology in France in a 3 years follow up. US examinations concerned mostly inflammatory diseases and appeared homogeneous among rheumatologists for RA and for SpA enthesis examinations. Yet, this study showed that only 56% of the rheumatologists used scoring systems and further training and formations should be necessary in order to improve standardization. Disclosure of Interest None Declared
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