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Bruno Fautrel

Publications and source records attributed to Bruno Fautrel.

32 records · Page 2Linked to original sources
PubMed2005

What is the impact of adolescent arthritis and rheumatism? Evidence from a national sample of Canadians.

OBJECTIVE: Adolescent arthritis or rheumatism (AAR) has been shown to influence the activities, mental health, and healthcare utilization of affected individuals. However, these effects have never been estimated in a population-based sample. We examined the association of AAR with health status, health services use, health behaviors, and activity limitations. We also investigated the effect of socioeconomic status and family background on respondents with AAR. METHODS: The 1996 National Population Health Survey is a nationally representative survey exploring the health status and behaviors of Canadians. Among the 26,012 individuals aged 12 to 19 with complete responses on the presence of chronic illnesses, the 213 self-reporting arthritis or rheumatism (AAR) were compared to: (1) all other adolescents as a single group; or (2) the group of 9161 adolescents reporting other chronic diseases (OCD) but not AAR, and the group of 16,638 adolescents without chronic disease (WCD). Between-group differences were examined for the following variables: health status; use of health services; presence of activity limitations in school, work, or at home; and school enrollment and work status. RESULTS: Compared to those without, respondents with AAR reported more diagnoses of non-AAR chronic illnesses. Depression among AAR individuals was more prevalent than among non-AAR individuals, as was suffering from moderate or severe pain. Those with AAR were more likely than WCD individuals to use physician services, hospital services, and pain relief medications. AAR patients were more likely to be limited in their activities, and less likely to be enrolled in school than OCD or WCD individuals. CONCLUSION: This study indicates a broad range of effects of AAR in a nationally representative sample. Arthritis or rheumatism affected measures of mental health, health service use, and the school, work, and home activities of affected individuals, compared to individuals without chronic disease or with other chronic disease.

Activities of Daily Living↗
PubMed2005

Valuing a hypothetical cure for rheumatoid arthritis using the contingent valuation methodology: the patient perspective.

OBJECTIVE: A willingness-to-pay (WTP) survey measures the value of a given intervention in money terms. We examined the WTP of Canadian patients with rheumatoid arthritis (RA) for a hypothetical cure for RA under private and public scenarios. The validity of the survey was explored by studying the association between WTP and variables thought to be associated with WTP and randomly-varied variables of the survey materials. METHODS: A telephone survey was carried out in a sample of 121 patients with RA from 5 rheumatologists affiliated with the McGill University Health Centre. In advance, patients had been sent a 4-page brochure providing a comprehensive description of the disease (including photos or no photos). The hypothetical cure for RA was presented through 2 scenarios: a private insurance implying an annual premium and a public coverage requiring additional income taxes. The survey included questions related to their WTP, socioeconomic status (ability to pay), general health, opinion about the performance of the healthcare system, and their opinion about the difficulty of the survey. For elicitation of WTP, patients were randomized to one of 3 payment cards. Mailed questionnaires concerning RA health status were also completed. A series of univariate comparisons and multivariate ordered logit regressions were carried out to examine the association of WTP and patient and study variables. RESULTS: Patients were willing to pay annually significantly more for the private program (mean 1190 Canadian dollars) than for the public program (mean 502 Canadian dollars). Annual WTP was associated with age, household income, site of care (private program), private health insurance, opinion about the performance of the public healthcare system (public program), and presence of brochure photos. The payment card did not affect WTP for either program. CONCLUSION: The WTP survey was well understood and accepted by the patients with RA. Although measures of RA-specific health status (e.g., Health Assessment Questionnaire) were not found to be associated with WTP, many variables thought to be associated with WTP were found to be related in the expected directions. Since WTP for the private program was higher than that for the public program, our study design did not fully capture altruistic valuations of RA patients. Thus, our estimates represent a lower bound on patients' WTP for an RA cure.

Arthritis, Rheumatoid↗
PubMed2004

Costs of workups for the diagnosis of early arthritis: results of a nationwide survey.

OBJECTIVE: To evaluate the costs of workups to diagnose early arthritis. METHODS: In 2000, the French Society for Rheumatology conducted a survey of a representative sample of French and Belgian rheumatologists (n = 239). The respondents were asked to consider 2 hypothetical scenarios, 1 describing undifferentiated arthritis and the other more suggestive of rheumatoid arthritis. They were then asked what diagnostic workup they would order. Costs for each study were determined in 2001 euros, according to the French public health system fee schedules. RESULTS: In total, 151 rheumatologists participated in the study (63%). The mean +/- SD diagnostic costs were 406.5 +/- 194.3 euro for the case with no diagnostic clues, and 280.7 +/- 154.3 euro for the case suggestive of early RA. Responses were very heterogeneous. The 2 main sources of expenditure were immunology tests and imaging. Hospital staff physicians tended to order more expensive workups, and costs tended to vary inversely with physician experience. The most important predictor of cost was diagnostic doubt, as estimated by the number of diagnoses proposed by respondents in each case; each additional diagnosis cost an additional 19.1-26.1 euro. CONCLUSION: Diagnostic workups after a first medical visit for early polyarthritis result in substantial direct costs. This observation and the great variability observed in physicians' practices point out the need for consensus on the appropriate workups for these patients.

Adult↗
PubMed2003

Anti-tumor necrosis factor alpha therapy in fifteen patients with AA amyloidosis secondary to inflammatory arthritides: a followup report of tolerability and efficacy.

OBJECTIVE: Because anti-tumor necrosis factor alpha (anti-TNF) has emerged as a highly effective treatment for numerous inflammatory arthritides, which are a common cause of AA amyloidosis, we retrospectively evaluated the safety and efficacy of anti-TNF in a nationwide study. METHODS: The rheumatology departments of all French teaching hospitals were contacted by mail to obtain the files of patients with histologically proven secondary AA amyloidosis and renal involvement who were treated with anti-TNF. Efficacy was assessed as a sustained decrease in 24-hour proteinuria and a stable/improved glomerular filtration rate (GFR). RESULTS: Among the 15 patients studied, the 24-hour proteinuria was 4.5 +/- 3.6 gm (mean +/- SD), creatininemia was 178.4 +/- 74.9 micromoles/liter, and GFR was 46 +/- 23 ml/minute before starting anti-TNF. Ten patients received infliximab, 4 received etanercept, and 1 received both types of treatment. The mean followup was 10.4 months. No severe adverse events were recorded; one episode of herpes zoster in the first branch of the trigeminal nerve occurred after one infusion of infliximab. Amyloidosis progressed in 7 patients and was stabilized in 5 patients. Three patients (receiving infliximab alone, infliximab plus methotrexate [MTX], or etanercept plus MTX) experienced rapid, dramatic, and sustained decreases in proteinuria (>or=80%), with the GFR increasing 15-78%. CONCLUSION: Anti-TNF was well-tolerated and safe in the 15 patients with AA amyloidosis and renal involvement. The pathogenic role of TNF in AA amyloidosis, the sustained proteinuria decrease in 3 patients, and the stabilization of renal parameters in 5 other patients make anti-TNF a promising candidate to treat AA amyloidosis secondary to inflammatory arthritides.

Adult↗
PubMed2002

A pilot study on the recovery from paresis after lumbar disc herniation.

BACKGROUND: Although the existence of a motor defect in discogenic sciatica is a sign of severity, the literature does not provide evidence for an immediate requirement for surgery. OBJECTIVE: To assess the course of sciatica with discogenic paresis and to determine possible prognostic factors for recovery or improvement. STUDY DESIGN: This open prospective multicenter study included patients with discogenic sciatica with paresis that had been developing for less than 1 month and was rated < or =3 on a 5-grade scale. Pain, the strength of 11 muscles, return to work, and analgesic intake were assessed at 1, 3, and 6 months. Recovery and improvement were defined by pain not exceeding 20 mm or < or =50% of the initial pain score and a score of either 5 (recovery) or 4 (improvement) for the weakest muscle at inclusion. RESULTS: Sixty-seven patients were enrolled; 39 (58%) patients were treated surgically and 28 (42%) medically. Surgically treated patients differed from medically treated patients by a higher rate of extruded herniation, a higher number of paretic muscles (6.3 vs. 5; P = 0.051), and a longer course of sciatica (31.4 vs. 17.3 days; P = 0.034). At 6 months, 7 (10.4%) patients were lost to follow-up; 32 (53.3%) had improved, including 18 (30%) recovered, 33 (85%) back to work and having a professional activity, and 22 (39%) still taking analgesics. The only significant difference between recovered and not recovered patients was mean age at inclusion (43 vs. 51 years, P = 0.034). There were no significant differences between improved and not improved patients. Moreover, the outcome was not different in the two treatment groups: there were 17 (53%) improvements in surgically treated patients, including 8 (25%) recoveries, and 14 (56%) improvements in medically treated patients, including 8 (40%) recoveries. CONCLUSION: This pilot study showed no difference between surgical or medical management for recovery or improvement in patients with discogenic paresis. These results need confirmation by a randomized study.

Adult↗
PubMed2002

Bronchiectasis in a patient with CREST syndrome.

Bronchiectasis is an uncommon pulmonary manifestation of systemic sclerosis (SSc). We report the case of a 70-year-old woman with CREST syndrome and vasculitis who developed multifocal symptomatic bronchiectasis. The bronchiectasis and immunosuppressive therapy precipitated severe lower respiratory tract infection, which was fatal within a few months. The concomitant occurrence of bronchiectasis and SSc raises the possibility of a pathophysiological relationship. Several hypotheses can be put forward to explain the occurrence of bronchial wall damage leading to bronchiectasis. Whatever the mechanism, cases of bronchiectasis in patients with SSc should be reported to make physicians aware of the substantial risk associated with this combination.

Aged↗
PubMed2002

Cost of illness studies in rheumatic diseases.

Knowledge about the economic burden of rheumatic diseases has progressed during recent years. In addition to the increasing number of studies published, the Economics Working Group of the Outcome Measures in Rheumatoid Arthritis Clinical Trial (OMERACT) Conference has produced substantial work to improve methodological standards for the economic evaluation of rheumatic diseases. Some of their preliminary results are presented in this review. Recent data have confirmed two main conclusions of previous studies: the total economic burden of rheumatic diseases is often more substantial than other chronic conditions, including cardiovascular diseases and cancer; and the impact of the disability caused by musculoskeletal diseases is significant on both direct (long-term care in osteoporosis for example) and indirect costs (productivity loss in chronic patients). Besides that, cost-effectiveness studies have provided valid information to improve disease management, especially for patients with rheumatoid arthritis or chronic low back pain.

Costs and Cost Analysis↗
PubMed2002

Amyloid arthropathy in the course of multiple myeloma.

OBJECTIVE: Primary amyloidosis is classical in the course of multiple myeloma (MM), but peripheral amyloid arthropathy is unusual. We evaluated the frequency and effect of amyloid arthropathy in a single center series of patients with MM. METHODS: Retrospective analysis of cases of peripheral joint amyloidosis in a cohort of patients with MM. RESULTS: Between 1978 and 1996, 11 patients (6 women, 5 men, mean age 59 yrs) were diagnosed with biopsy proven amyloid arthropathy in a cohort of 311 patients with MM. Arthritis was the first symptom of amyloidosis in all patients and occurred within the 6 months after MM diagnosis in most patients (7/11). Nine patients had light chain MM and X light chain was more common than kappa (6 vs 5). Shoulder hypertrophic arthropathy and rheumatoid arthritis-like polyarthritis were the 2 most common involved sites. In most cases, joint involvement was responsible for major limitations in activities of daily living. Amyloid deposits were clearly visible on magnetic resonance images (MRI), which also showed inflammatory synovitis in some cases. Control of MM was often associated with improvement of amyloid arthropathy, but additional rheumatological treatment--oral low dose prednisone or joint steroid injection--was often needed to achieve more complete relief. Amyloid arthropathy was not associated with decreased survival, except for patients with concomitant cardiac involvement. CONCLUSION: This series provides reliable information on amyloid arthropathy, especially regarding functional effects, anatomical lesions on MRI, and therapeutic options.

Age Distribution↗
PubMed2002

Recommendations for the prevention of osteoporosis and fragility fractures. International comparison and synthesis.

OBJECTIVES: This review included the following objectives: a) to synthesize recommendations made by public agencies in Western countries concerning screening for osteoporosis; b) to compare these recommendations and sort out the similarities and discrepancies; and c) to propose a strategy for the fight against osteoporosis and fragility fractures. METHODS: Eleven reports published by publicly financed agencies were included in the analysis: three international, four North American and four European agencies. Transcriptions of recommendations and arguments were classified using criteria for evaluation of screening technologies. RESULTS: Of eight reports that made a recommendation on mass screening, four made a recommendation against the use of densitometry, two remained vague with a conditionally positive recommendation, and two made no recommendation, arguing insufficient scientific evidence. Concerning screening of asymptomatic women in the perimenopause period, recommendations were uniformly opposed to the use of bone densitometry in five of nine reports, and the other four made no recommendation, arguing insufficient scientific evidence. Some of the discrepancies can be explained by the different definitions given to osteoporosis and by the confusion of terms between screening and diagnostic testing. A strategy is proposed to ensure that all women who are at risk of osteoporosis and fragility fracture have access to preventive measures. This strategy is based on the complementarity and coordination of roles between health promotion interventions and clinical interventions. CONCLUSIONS: Prevention of osteoporosis and fragility fractures is an attainable goal. Existing resources are currently badly targeted. Compromises must be negotiated between the different stakeholders and biomedical disciplines to achieve efficiency and accessibility in the reduction of fragility fractures. A first compromise to reconcile social and scientific realities would be to use a best-evidence synthesis instead of an evidence-based medicine approach in future analyses and recommendations by public authorities. A second compromise would be to recognize the complementary roles of public health and clinical professionals toward the common objective of preventing fragility fractures.

Absorptiometry, Photon↗
PubMed2002

Use of complementary and alternative therapies by patients self-reporting arthritis or rheumatism: results from a nationwide canadian survey.

OBJECTIVE: Arthritis or rheumatism (A/R) often leads patients to experiment with complementary and alternative medicine (CAM); we investigated the factors associated with use of CAM. METHODS: The source of the data is the cross sectional household component of the 1996-97 National Population Health Survey of the health status and behaviors of Canadians. The survey sample is based on 66,000 persons aged 20 years and older, representing 21 million adults. Cross tabulations were used to estimate the percentage of adults with A/R who used CAM. Multivariate logistic regression was used to identify those characteristics associated with the use of CAM in the year preceding the survey. RESULTS: In 1996-97, among the 3.3 million Canadian adults aged 20 years or older who self-reported arthritis, 22% utilized CAM in the past year. CAM users tended to be younger and with higher education and household income. They reported more pain, consumed more analgesics, and tended to be more depressed. The coexistence of back or bowel disorders, cancer, sinusitis, or food allergies with arthritis was also related to CAM use. Moreover, CAM users also used more traditional health resources. CONCLUSION: Our results indicate that patients with A/R consulting CAM providers self-report more intense symptoms than nonusers and often have other chronic conditions. They do not seem to reject the traditional health care system, but supplement it with CAM, possibly to fulfill needs insufficiently satisfied by traditional health care providers.

Adult↗
PubMedDate not supplied

[Focus on biological agents in rheumatoid arthritis: newer treatments and therapeutic strategies].

Tumour necrosis factor (TNF)-alpha and interleukin (IL)-1 are major regulators of inflammation. TNFalpha inhibitors have been shown to be effective in treating some inflammatory diseases such as rheumatoid arthritis. TNFalpha inhibitors include soluble receptor antagonists (etanercept) and monoclonal antibodies (infliximab, adalimumab). IL-1 inhibitors (anakinra) were also developed, used in therapeutics and licensed in France. TNFalpha inhibitors can be added to background regimens of methotrexate in second-line treatments. Etanercept and adalimumab can be administered alone, especially to patients who have experienced methotrexate toxicity or who do not show clinical and/or radiological improvement. The use of these new agents may optimise rheumatoid arthritis treatment and delay disease progression, particularly when first-line treatments are disappointing. This paper reviews recent data on biological therapies for rheumatoid arthritis: tolerance and their ability to modify the course of disease and prevent radiological damage.

Anti-Inflammatory Agents, Non-Steroidal↗