Adalimumab-associated multiple sclerosis.
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Adalimumab↗
Biomedical subjects
Jean-Pierre Valat
Publications and source records attributed to Jean-Pierre Valat.
Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS).
UNLABELLED: The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. METHODS: Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. CONCLUSIONS AND RECOMMENDATIONS: For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).
Activities of Daily Living↗
Epidural corticosteroid injections for sciatica: placebo effect, injection effect or anti-inflammatory effect?
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Anti-Inflammatory Agents↗
[Are there any differences in the cardiovascular tolerance between classical NSAIDs and coxibs?].
Three placebo-controlled studies have demonstrated deleterious cardiovascular (CV) effects of rofecoxib, celecoxib, and pare/valdecoxib. It remains to be determined whether this CV toxicity is specific to coxibs, or shared with all non-steroidal anti-inflammatory drugs (NSAIDs). Seven meta-analyses show that, in comparison with non-specific NSAIDs, the risk of thrombotic CV accident is increased with rofecoxib and celecoxib, but not with valdecoxib or lumiracoxib. Concerning the risk of thrombotic CV accident, seven of the ten observational studies which have evaluated the risk have found an increased risk for the non-specific NSAIDs in comparison with non-exposed subjects. The seven observational studies, which evaluated the risk of coxibs, have all found an increased risk with rofecoxib, and two with celecoxib. Three studies out of six have shown on increase of risk with rofecoxib and one study out of five with celecoxib. Two of the three studies, which have compared rofecoxib with celecoxib, have found on increased risk with rofecoxib. Concerning the risk of arterial hypertension, aedemas or congestive cardiac insufficiency, a meta-analysis and a randomised trial have shown a deleterious effect of rofecoxib in comparison with celecoxib and non-specific NSAIDs. Two studies have shown a deleterious effect of the non-selective NSAIDs and three a deleterious effect of rofecoxib in comparison with non-exposed subjects. Three studies have demonstrated a deleterious effect of rofecoxib in comparison with non-specific NSAIDs. No study has shown any deleterious effect of celecoxib in comparison with subjects non-exposed or exposed to non-specific NSAIDs. These studies suggest that all the NSAIDs, specific or not, increase the CV and renal risk. This risk seems variable from a compound to another one and must be evaluated, for each patient, according to the susceptibility and associated risk factors. While waiting for other long-term controlled studies, the available data show the existence of a risk of CV secondary effect linked to the class of NSAIDs, specific (coxibs) or not.
Age Factors↗
Characteristics of patients with spinal tuberculosis in a French teaching hospital.
OBJECTIVE: To investigate the characteristics of patients managed for spinal tuberculosis at the rheumatology department of the Tours Teaching Hospital, France, between 1986 and 2003. METHODS: Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded. RESULTS: The annual incidence of spinal tuberculosis was stable throughout the study period. There were 24 patients, 15 women and nine men with a mean age of 61 years; 15 patients were of French descent, three were of Portuguese descent, two were Asian, and four were North-African. Risk factors consisted of alcohol abuse in one patient, diabetes in two patients, glucocorticoid therapy in two patients, and a history of tuberculosis in six patients; none of the patients had AIDS. The cervical spine was involved in two patients, the thoracic spine in 11 patients, and the lumbar spine in 12 patients. Mean time from symptom onset to diagnosis was 4.3 months (range, 1-12 months). Percutaneous vertebral biopsy established the diagnosis in 16 of the 20 patients who underwent this procedure. CONCLUSION: The annual incidence of spinal tuberculosis remained unchanged throughout the study period and was not influenced by immigration or the AIDS epidemic. The typical patient was an elderly Caucasian woman of French descent. Reactivation of untreated or inadequately treated tuberculosis was probably the main mechanism.
Aged↗
Is epidural lipomatosis associated with abnormality of body fat distribution? A case report.
CASE REPORT: To report a case of epidural lipomatosis in a patient with abnormal adipose tissue distribution, glucose intolerance and mixed hyperlipidemia. A 63-year-old male patient presented with low back pain radiating to the left calf on standing and walking (walking distance <100 m). He weighed 97.5 kg, was 1.73 m tall (BMI 32.6 kg/m2) and had a waist circumference of 113 cm. He had a glucose intolerance after a 75-g glucose oral load test. CT-Myelography revealed voluminous epidural lipomatosis around L4-L5 and L5-S1. Low calorie diet and reduction in alcohol intake achieved a weight loss of 17.5 kg in 7 months (80 kg, BMI 25.8 kg/m2, waist circumference 94 cm) and dramatic improvement in low back pain, walking distance (>500 m) and reduction of lipomatosis on CT-scan. Our case suggests a relationship between central obesity phenotype and epidural lipomatosis. Specific insulin resistance treatment might be proposed for these patients if this hypothesis is confirmed in further studies.
Body Fat Distribution↗
Factors involved in progression to chronicity of mechanical low back pain.
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Chronic Disease↗
A randomized, double-blind, placebo controlled triphosphate in study of oral adenosine subacute low back pain.
OBJECTIVE: To assess the efficacy and safety of oral adenosine triphosphate (ATP) in subacute low back pain. METHODS: This was a randomized, double-blind, parallel group, placebo controlled clinical trial. The patients were given either ATP 90 mg once daily (n=81) or placebo (n=80) for one month. The patients were assessed 3 times during the study period, at days 0, 7, and 30. The primary outcome measure was the Roland-Morris Disability Questionnaire (RDQ) at day 30. Secondary measures of efficacy included visual analog scale (VAS) pain, overall assessments of efficacy by both patient and investigator, and number of dextropropoxyphene and acetaminophen combination tablets used as rescue analgesic. RESULTS: Regarding the RDQ, the mean values dropped from 10.3 +/-2.8 at baseline to 7.5 +/-3.8 (day 7) and 5.2 +/-5.2 (day 30) in the ATP group, and from 11.0 +/- 3.5 to 9.1 +/- 4.2 (day 7) and 6.1 +/- 4.3 (day 30) in the placebo group. The difference between the 2 groups was statistically significant at day 7 (p= 0.02) but not at day 30 (p=0.2). In other words, the mean changes from baseline were 2.8 +/- 3.1 and 2.0 +/- 2.6 at day 7 (p=0.06), and 5.1 +/- 3.9 and 5.0 +/- 4.2 at day 30 (p=0.78) in the ATP group and the placebo group, respectively. There were no statistically significant differences in the VAS pain and overall assessments of efficacy between groups at any time point during the study. Conversely, there was a significant difference in the use of the rescue analgesic between groups, in favor of ATP (p=0.04). Oral ATP was well tolerated. CONCLUSION: Oral ATP might have an early acting effect in subacute low back pain.
Adenosine Triphosphate↗
Ossification of the posterior longitudinal ligament of the cervical spine and SAPHO syndrome.
We describe a case of cervical cord compression due to ossification of the posterior longitudinal ligament of the spine (OPLLS) in a 43-year-old Vietnamese patient with SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis, and osteitis). Idiopathic OPLLS is mainly reported in 50- to 60-year-old men, particularly in Japanese, with a prevalence of 2%. Cervical myelopathy may occur. In addition to OPLLS in patients of Asian origin, the condition has also been described in association with ossifying diseases, including ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) but not previously, to our knowledge, with SAPHO syndrome.
Acquired Hyperostosis Syndrome↗
Compliance among general practitioners in France with recommendations not to prescribe bed rest for acute low back pain.
UNLABELLED: Acute low back pain is a very common reason for general practitioner visits. OBJECTIVE: To evaluate practices among French general practitioners regarding the prescription of bed rest in patients with low back pain. METHODS: 2000 general practitioners were to include the first three patients presenting within the first 3 d of onset of acute low back pain without nerve root pain. The characteristics of the pain, social and demographic characteristics of the patients, and treatments prescribed by the physicians were recorded. RESULTS: 5355 patients were included, of whom more than half had a history of one or more episodes of low back pain. The mean pain severity score on a 100-mm visual analog scale was 57.2 +/- 22.7 mm. Bed rest was recommended to 27.6% of the patients, for a mean duration of 4.4 d. Patients to whom bed rest was recommended were significantly more likely than the other patients to have chronic low back pain (32.1% vs. 26.5%) and received a greater number of medications. Bed rest was associated with significantly poorer outcomes in the multivariable analysis adjusting for confounding factors. CONCLUSION: Recommendations to avoid bed rest in patients with acute low back pain are widely followed in France. Furthermore, our results confirm that bed rest is associated with poorer outcomes.
Adult↗
[Is it possible to rate digestive toxicities of NSAIDs?].
EPIDEMIOLOGICAL STUDIES: Most often case-control studies, based on serious GI complications reported in hospitalization statistics are available to compare the gastro-intestinal (GI) safety and tolerability of the various NSAIDs currently on the market. Based on pooled data regarding 5 medicinal products among the most widely used and best documented (ibuprofen, diclofenac, naproxen, indomethacin and piroxicam), the relative result consistency of these studies is striking, thus these 5 NSAIDs may be legitimately classified from the least gastro-toxic (ibuprofen) to the most gastrotoxic (piroxicam). MISSING DATA: But epidemiological survey results may be questioned. Indeed, the volume of prescriptions written, individual dosages and the route of administration are not well documented. Above all, the disease justifying the prescription of an NSAID is never specified. Yet, it is likely that some major anti-inflammatory agents are prescribed more often, at higher doses in patients more seriously and chronically affected, and thus more likely to develop serious gastro-intestinal adverse effects. Data for recently marketed NSAIDs are less comprehensive, with the number of subjects exposed to these new NSAIDs being low, and the validity of the results reported, limited. Regarding currently marketed specific cyclo-oxygenase 2 inhibitors, recent cohort studies demonstrating that the relative risk of ulcer is about half compared to subjects treated with traditional NSAIDs are available. IN SUMMARY: The epidemiological survey results can only be extrapolated to individual clinical practice with great caution.
Anti-Inflammatory Agents, Non-Steroidal↗
Bed rest or normal activity for patients with acute low back pain: a randomized controlled trial.
BACKGROUND: The management of common low back pain has two principal objectives: to relieve acute pain and to attempt prevention of transition to chronicity. Several studies have shown the ineffectiveness of prolonged periods of bed rest. OBJECTIVE: To compare 4 days of bed rest with continued normal daily activity in acute low back pain, taking into account the type of work (physical or sedentary labor). METHODS: This open, comparative multicenter study enrolled 281 ambulatory patients, ages 18 to 65 years, with low back pain (onset < 72 hours). The subjects did not have pain radiating below the buttocks and did not have work-related injuries. They were randomized into two treatment groups: one instructed to continue normal activity (insofar as the pain allowed), and the other prescribed 4 days of bed rest. After inclusion, patients were seen at three visits: on day 6 or 7, after 1 month, and after 3 months. RESULTS: On day 6 or 7, pain intensity was similar for both groups, as was the overall judgment of the treatment by patients and physicians. At 1 and 3 months, the groups again had equivalent intensity of back pain, functional disability, and vertebral stiffness. A higher proportion of patients in the bed rest group than in the normal activity group had an initial sick leave (86% vs 52%; P < 0.0001). This difference was greater for the patients whose work was sedentary. CONCLUSIONS: For patients with acute low back pain, normal activity is at least equivalent to bed rest. The findings of this study indicate that prescriptions for bed rest, and thus for sick leaves, should be limited when the physical demands of the job are similar to those for daily life activities.
Activities of Daily Living↗
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↗