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M Lassere

Publications and source records attributed to M Lassere.

At least 19 recordsLinked to original sources
PubMed2001

Psoriasis predicts a poor short-term outcome in patients with spondylarthropathy.

OBJECTIVE: The outcome of patients with recent-onset spondylarthropathy (SpA) is unclear. Therefore, the objective of this study was to prospectively correlate clinical and laboratory features with functional and radiologic outcome in patients with psoriatic SpA (PsS), undifferentiated SpA (uSpA), and Reiter's syndrome/reactive arthritis (ReA). METHODS: Patients presenting to an early arthritis clinic with a spondylarthropathy pattern of peripheral arthritis were selected and prospectively followed. Clinical and laboratory features were recorded at baseline, 12 months, and 24 months. Radiographs of affected joints were taken at presentation and at followup. RESULTS: The cohort consisted of 157 patients: 82 PsS, 59 uSpA, and 16 ReA. Symptom duration at presentation was progressively shorter, and the erythrocyte sedimentation rate/C-reactive protein (ESR/CRP) incrementally higher in ReA, uSpA, and PsS, respectively. There was a higher swollen joint count (SJC) in PsS compared with uSpA. In PsS, strong positive correlations were observed between ESR/CRP and articular indices. Initially, functional impairment was greater in ReA compared with uSpA and PsS but resolved completely in ReA. Clinical remission rates at 2 years were ReA 61% and uSpA 63%, compared with PsS 14%. Remission at 2 years could be predicted in SpA by disease category and presentation SJC. Baseline erosions in PsS (28%) and uSpA (5%) increased to 45% and 25%, respectively, at 2 years. CONCLUSION: These observations suggest a spectrum within the spondylarthropathy subgroups where at presentation the acute phase markers in ReA and uSpA reflect a systemic process, whereas in PsS they reflect articular manifestations. Although the clinical presentations are indistinguishable, PsS has a more aggressive clinical course with a poorer functional and radiologic outcome.

Adult↗
PubMed2001

Recent rheumatoid arthritis clinical trials using radiographic endpoints--updated research agenda.

Recent randomized controlled trials of traditional and newly developed therapies provide evidence that we have interventions that potentially slow or prevent structural damage in active rheumatoid arthritis, as measured using radiography. These trials also provide a unique opportunity for exploratory data analysis to generate hypotheses apropos the pathogenesis and determinants of radiographic progression and functional disability; they also facilitate further study of the methodological issues regarding imaging measurement.

Arthritis, Rheumatoid↗
PubMed2001

Minimal clinically important difference in radiological progression of joint damage over 1 year in rheumatoid arthritis: preliminary results of a validation study with clinical experts.

To determine the minimal clinically important difference (MCID) between hand and foot films with a 1 year interval assessed with the Sharp/van der Heijde or Larsen/Scott scoring method. Progression scores of the 2 methods were compared with the opinion of an international expert panel on clinical relevance of radiological joint damage in 4 predefined clinical settings. The expert panel consisted of 3 rheumatologists, who evaluated 46 pairs of hand and foot films, taken with 1 year intervals, of patients with early rheumatoid arthritis. Receiver operating characteristics curves analyzed the accuracy of different threshold values (progression scores) of the 2 scoring methods to detect the presence or absence of clinically important difference, as defined by the expert panel as external criterion. The threshold value with the highest accuracy was subsequently chosen as the score representing the MCID. Five Sharp/van der Heijde units and 2 Larsen/Scott units were the best cutoffs. The accompanying sensitivities ranged from 77% to 100% for the Sharp/van der Heijde method and from 73% to 84% for the Larsen/Scott method for the 4 clinical settings. The specificities were between 78% and 84% for the Sharp/van der Heijde method and between 74% and 94% for the Larsen/Scott method. The smallest progression score that can be detected apart from interobserver measurement error, the smallest detectable difference (SDD), was equal to or larger than the calculated MCID, 5 Sharp/van der Heijde units and 6 Larsen/Scott units in our study, if the mean progression scores of the same 2 observers were used. The SDD is a conservative estimate of the MCID; our panel rated progression at or below this level as clinically significant.

Arthritis, Rheumatoid↗
PubMed2001

Minimal clinically important difference in plain films in RA: group discussions, conclusions, and recommendations. OMERACT Imaging Task Force.

Analysis of progression of structural damage on an individual patient level in randomized controlled trials provides extra information in addition to the analysis on a group level. A cutoff level is required to define which patients show progression and which patients do not. The objective of the mimimal clinically important difference (MCID) module for plain films was to elaborate the various concepts to determine a MCID for plain films, and if possible, to define a MCID for specific scoring methods. The module comprised preconference reading material, a plenary session, small group discussions, and a plenary report of the group sessions, combined with interactive voting. The following conclusions and recommendations were made: the smallest detectable difference (SDD) beyond measurement error is a good starting point to define MCID; SDD is study-specific; SDD should be reported for all radiographic endpoints used in a trial as a quality control; the expert panel approach is a reasonable method to define MCID, but defined in this way MCID may be smaller than current SDD; more research is needed to validate expert panel based MCID in different datasets and with different experts; a predictive, data driven MCID is the ultimate goal, but is not yet available; the SDD can be used as a proxy for MCID until a data driven MCID is available; analysis at the group level (comparison of means or medians) should remain primary in studies that include progression of joint damage as outcome measure; the proportion of patients showing more progression than the SDD is a secondary outcome measure.

Arthritis, Rheumatoid↗
PubMed2001

Interreader agreement in the assessment of magnetic resonance images of rheumatoid arthritis wrist and finger joints--an international multicenter study.

Magnetic resonance imaging (MRI) allows direct visualization of inflammation and destruction in rheumatoid arthritis (RA) joints. However, MRI scoring methods have not yet been standardized or appropriately validated. Our aim was to examine interreader agreement for a simple system of scoring RA changes on MRI among 5 centers that had not undertaken intergroup calibration. MRI of RA wrist and metacarpophalangeal (MCP) joints were scored by experienced readers in 5 centers in different countries. In substudy 1, 5 sets of 2nd-5th MCP joints from UK [Technique A: 1.5 T, coronal and axial T1 and T2 spin-echo, -/+ fat saturation (FS), -/+ iv gadolinium (Gd)] were scored for synovitis (score 0-3) and bone lesions (0-3). In substudy 2, we evaluated 19 sets of 2nd-5th MCP joints [10 sets from UK (Technique A) and 9 sets from the US (Technique B: 1.5 T; coronal T1 spin-echo and T2* gradient-echo + FS, no Gd)] and 19 wrist joints [9 from the US (Technique B) and 10 from Denmark (Technique C: 1.0 T; coronal and axial T1 spin-echo, no FS, -/+ Gd)]. Synovitis (0-3), bone lesions (0-3), and joint space narrowing (JSN, 0-3) were scored in each MCP joint and in 3 different regions of the wrist. Bone erosions and lesions in each bone were scored 0-5. Substudy 1 served to test and redesign the score sheets. In substudy 2, the scores of synovitis and bone lesions by the 5 groups were the same or differed by only one grade in 73% and 85% of joints, respectively. On MRI that included 2 imaging planes and iv Gd (Techniques A and C), these rates were 86% (synovitis) and 97% (bone lesions). Corresponding intraclass correlation coefficients (quadratic weighted kappas) were 0.44-0.68, mean 0.58 (synovitis), and 0.44-0.69, mean 0.62 (bone lesion), i.e., in the moderate to good range. Unweighted kappa values were in the low to moderate range, generally lowest for JSN (< 0.20), better for synovitis and bone erosions, and best for bone lesions, being generally highest for MRI with 2 planes pre- and post-Gd and in MCPjoints compared with wrists. These preliminary results suggest that the basic interpretation of MRI changes in RA wrist and MCP joints is relatively consistent among readers from different countries and medical backgrounds, but that further training, calibration, and standardization of imaging protocols and grading schemes will be necessary to achieve acceptable intergroup reproducibility in assessing synovitis and bone destruction in RA multicenter studies.

Arthritis, Rheumatoid↗
PubMed2001

Magnetic resonance imaging in rheumatoid arthritis: summary of OMERACT activities, current status, and plans.

Complementing the 3 papers that precede it, this paper explains the rationale for the activities of an OMERACT working party on magnetic resonance imaging (MRI) evaluation of rheumatoid arthritis (RA), sets out provisional recommendations for the acquisition and scoring of MRI of the hand and wrist in RA, and delineates some of the many residual problems that need to be addressed.

Arthritis, Rheumatoid↗
PubMed2000

Pooled metaanalysis of radiographic progression: comparison of Sharp and Larsen methods.

Metaanalysis refers to the statistical analysis of results from individual studies for the purpose of integrating the findings. However, numerous biases can threaten the internal validity of metaanalyses. This paper specifically addresses the issue of study heterogeneity in metaanalyses of radiographic progression. It considers the validity of pooling studies that have used either the Sharp score (or its variants) or the Larsen score (or its variants) by examining whether the 2 scoring methods are sufficiently concordant for pooling in terms of content of items, scaling and measurement properties. Despite differences between the Sharp and Larsen methods, they essentially measure the construct of radiographic damage, and as long as the spectrum of radiographic damage in the pooled series is similar, then the scoring methods are robust to pooling. However, where the spectrum of damage is not similar, for example, studies of radiographic progression of early disease compared with late disease, pooling should be exercised with caution.

Arthritis, Rheumatoid↗
PubMed1999

Evaluation of a new Apo-1/Fas promoter polymorphism in rheumatoid arthritis and systemic lupus erythematosus patients.

OBJECTIVE: We looked for an association between the MvaI polymorphism, a recently reported polymorphism on the promoter of the Apo-1/Fas gene, and rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients. METHODS: Two cohorts of Caucasian RA patients (total number = 185) and one cohort of SLE patients (n = 103) were studied. The MvaI polymorphism was typed by polymerase chain reaction and followed by MvaI digestion and gel electrophoresis. RESULTS: A skewed distribution of MvaI genotypes was found in the first cohort of RA patients (n = 103) compared to the controls, as a result of increased MvaI*2 and decreased MvaI*1 homozygosity. This skewed distribution of genotypes was also observed in RA patients with either early onset of disease or with systemic involvement or progressive disease (assessed by the presence of erosions). The frequency of the MvaI*2 allele was significantly increased in female patients (P = 0.035), patients with extra-articular involvement (P = 0.04) and patients with early onset (P < 0.01), compared to the normals. To confirm these findings, the MvaI polymorphism was also examined in a second cohort of RA patients (n = 82). The results in this cohort did not replicate the associations shown in the first cohort of RA patients. Part of this inconsistency could be attributed to different populations and different parameters collected and analysed. In SLE patients, frequencies of MvaI alleles were not statistically different to the controls. However, MvaI*2 homozygosity was significantly higher in SLE patients with photosensitivity (P = 0.03) or oral ulcers (P = 0.01) than in SLE patients without these features. CONCLUSION: The role of the Apo-1/Fas gene promoter MvaI polymorphism in RA and SLE is unclear and further substantiation in larger patient samples is needed.

Adult↗
PubMed1999

Methodological issues in radiographic scoring methods in rheumatoid arthritis.

Radiographs are important endpoints in clinical trials in rheumatoid arthritis (RA). Several scoring methods exist. However, many methodological issues are unsolved and require more attention. The following issues will be addressed: the abnormalities that should be scored; joints that should be included in a scoring method; whether both right and left hands and feet should be scored; views that should be used; the order in which radiographs should be scored; how data should be evaluated; how intra/interobserver variation and sensitivity to change should be assessed; the optimum number of readers to assess radiographs; the score to be used if there are multiple readers; quality assurance, international training, a validation set of radiographs, and automated scoring of radiographs.

Arthritis, Rheumatoid↗
PubMed1999

Smallest detectable difference in radiological progression.

Omeract IV started a discussion on the development of radiological response criteria in rheumatoid arthritis (RA). Such criteria depend on the definition of what constitutes the minimum clinically important progression of damage. Because such a definition is currently not available, as a first step we have used the concept of random measurement error to determine what is the smallest detectable difference (SDD) in radiological progression between 2 radiographs of a particular patient. Baseline and 12 month radiographs (hands, wrists, feet) of 52 patients representative of the spectrum of radiological progression were selected from a randomized controlled trial of early rheumatoid arthritis (COBRA study) and were read paired and chronologically by 2 observers using the van der Heijde modified Sharp method (0-448 scale) and another 2 observers using the Scott modified Larsen method (0-200). The measurement error of progression was determined using the metric 95% limits of agreement method of Bland and Altman. In the setting of early RA the SDD is 11 modified Sharp score units and 8 modified Larsen score units if there is an equal distribution of baseline damage and progression in the sample and the mean score of the same trained observers is always used. The SDD is 15.5 modified Sharp score units and 11 modified Larsen score units if there is an equal distribution of baseline damage and progression in the sample and the mean score of any 2 trained observers is used. Other SDD were determined depending on the context of measurement. Although this exercise needs repetition in other settings, the SDD is a useful starting point in the development of radiological response criteria.

Adolescent↗
PubMed1999

Introduction to reading radiographs by the Scott modification of the Larsen method.

To examine its ability to evaluate progressive radiological damage, the Scott modification of the Larsen score was used for the hands, wrists, and feet (metatarsophalangeal joints) at time zero and at 12 months in 52 patients with early rheumatoid arthritis taking part in a therapeutic intervention study. The major practical difficulty was the technical discrepancy between initial and followup films in some patients. The metrological problems are discussed in the analysis, which compares the score on the same films using the Sharp score.

Arthritis, Rheumatoid↗
PubMed1999

A practical exercise in reading RA radiographs by the larsen and sharp methods.

A plenary radiograph reading session was conducted prior to the rheumatoid arthritis imaging group sessions to familiarize participants with radiograph scoring methods and their problems, and to introduce the concept of measurement error. After brief reviews on how to score radiographs using the Larsen and Sharp method, photographic slides of metacarpophalangeal joints of 2 patients were shown. Participants were asked to register their absolute scores on paper, and their progression scores on an interactive voting keypad, allowing immediate visualization of the results. The objectives of the session were clearly met, as evidenced by lively discussions in the groups. Participant mean scores agreed well with the expert scores. Sharp scores showed wider scatter between participants than Larsen scores. This was only partially explained by the greater score range inherent in the method. In addition, participants needed more time to score according to Sharp than Larsen. Participants were sensitized to the challenges of radiographic measurement of damage.

Arthritis, Rheumatoid↗
PubMed1999

Imaging in rheumatoid arthritis: results of group discussions.

None of the current scoring methods for radiological damage in rheumatoid arthritis (RA) is ideal. The objective for RA imaging at OMERACT IV was to start discussion about the problems and applicability of the current scoring methods for radiological damage and to start discussion on the challenge of new imaging techniques. The RA imaging module comprised preconference reading material, plenary sessions, small group discussions, and a plenary report of the group sessions, combined with interactive voting. The OMERACT filter guided the discussions. Priorities for further research in imaging studies were: (1) pathologies versus features on radiographs; (2) relation with longterm outcome; and (3) definition of minimum clinically important difference.

Arthritis, Rheumatoid↗
PubMed1999

Intraarticular variability of synovial membrane histology, immunohistology, and cytokine mRNA expression in patients with rheumatoid arthritis.

OBJECTIVE: To assess the variability of synovial histology, immunohistology, and cytokine mRNA expression at different sites within the knee joints of subjects with rheumatoid arthritis receiving slow acting antirheumatic drugs. The effects of intraarticular bupivacaine and adrenaline, and a comparison of synovial fluid cell and synovial membrane cytokine expression, were also investigated. METHODS: Arthroscopically directed synovial biopsies were taken at 3 or 4 predetermined sites from the knee joints of 11 patients. Histology for synovial lining layer, sublining cellularity and vascularity, and immunohistology for T cells, T cell subsets, and macrophages were assessed. Messenger RNA expression of interleukins 1beta, 2, 4, 6, 8, 10, granulocyte-monocyte colony stimulating factor, tumor necrosis factor-alpha, and interferon-gamma was detected using the reverse transcription/polymerase chain reaction technique. RESULTS: Synovial histology, immunohistology, and cytokine mRNA expression did not vary significantly. CD8 cell immunohistology was variable. Intraarticular bupivacaine and adrenaline did not change synovial characteristics. Synovial fluid cell and membrane cytokine expression did not match in 35% of comparisons. CONCLUSION: Biopsies from the suprapatellar pouch, medial gutter, and cartilage-pannus junction will provide a representative sample of synovial membrane pathology in patients with rheumatoid arthritis.

Adolescent↗
PubMed1999

Preliminary core set of domains and reporting requirements for longitudinal observational studies in rheumatology.

Observational and longitudinal observational studies (LOS) provide essential information about the course and outcome of rheumatic disorders that cannot be provided by randomized controlled trials, and they constitute the major clinical scientific communication in rheumatology. There has been no consensus as to the full and appropriate content of LOS. This report defines a core set of domains and reporting requirements for LOS. At the 1998 OMERACT IV Conference a consensus process evaluated the literature of rheumatology in light of the constructs, variables, and outcomes of rheumatology by using introductory lectures, nominal groups, and plenary sessions. The result of this process was to identify 5 "core" domains that should be included in every LOS: Health Status, Disease Process, Damage, Mortality, and Toxicity/Adverse Reactions. Two additional domains, Work Disability and Costs, were recognized as important, but need not be used in all LOS. Eleven subdomains were identified that divided the domains into convenient clinical and conceptual units. A set of reporting requirements was also determined. The core recommendations, which follow on the WHO ICIDH-2 outline, are not disease-specific; the substitution of different "disease process" and "damage" measures make them suitable for many rheumatic disorders. The core set is intended to serve as a core for LOS in almost all rheumatic conditions.

Decision Making↗
PubMed1997

Psychological measures: practical issues in observational studies and clinical monitoring.

Psychological measures are important because they can influence the expression of pain and physical function in patients with arthritis. A number of instruments are now available that measure psychological distress and how we as individuals manage stress. These instruments have undergone extensive validation, although more work is required to evaluate the performance of these instruments measuring change over time. One way to interpret psychological measures and to evaluate how they change over time is to use normative comparisons that are conditional on time and other relevant covariates, using statistical methods such as quantile regression. Such methods have been used to interpret the developmental, educational, and physical growth of children. We can use similar methods to interpret observational studies and to guide decisions within the context of clinical practice.

Arthritis, Rheumatoid↗
PubMed1997

Reference curves of radiographic damage in patients with rheumatoid arthritis: application of quantile regression and fractional polynomials.

OBJECTIVE: To (1) introduce the methodology of quantile regression and fractional polynomials; (2) test the application of this methodology to develop, conditional on disease duration, preliminary reference curves of radiographic damage in patients with rheumatoid arthritis (RA); and (3) prove the importance of the definition and selection of the reference group when developing reference curves. METHODS: The study design was cross sectional. The main study factors were disease duration and radiographic damage using the Larsen score. The 2 study samples were 98 patients from a multicenter trial of cyclosporine and 203 patients with RA from a teaching hospital clinic. RESULTS: Using disease duration as the time dependent covariate we constructed quantile regression reference curves of radiographic damage. The reference curves for the 2 samples differed in shape, location, and slope. CONCLUSION: Quantile regression and fractional polynomials simplify the construction of reference curves when data cannot be easily modified to meet assumptions of normality, linearity, and constant variance. Quantile reference curves provide clinicians with a useful clinical tool to measure outcome at arbitrary timepoints, to interpret change, and to set treatment objectives. However, the definition and selection of the reference used to construct the reference curves is of critical importance.

Adult↗