{"id":7714,"date":"2018-11-10T12:16:54","date_gmt":"2018-11-10T17:16:54","guid":{"rendered":"https:\/\/themedicalxchange.com\/?p=7714"},"modified":"2022-01-25T15:15:32","modified_gmt":"2022-01-25T20:15:32","slug":"acr_7017_lenflure-du-genou-de-la-machoire-du-poignet-ou-du-coude-au-debut-de-la-polyarthrite-rhumatoide-signe-dun-pronostic-sombre","status":"publish","type":"post","link":"https:\/\/themedicalxchange.com\/fr\/2018\/11\/10\/acr_7017_lenflure-du-genou-de-la-machoire-du-poignet-ou-du-coude-au-debut-de-la-polyarthrite-rhumatoide-signe-dun-pronostic-sombre\/","title":{"rendered":"L\u2019enflure du genou, de la m\u00e2choire, du poignet ou du coude au d\u00e9but de la PR, signe d\u2019un pronostic sombre"},"content":{"rendered":"

\u00c9valuation de la topographie de l\u2019enflure articulaire<\/h2>\n

\u00ab Quand ces articulations enflent d\u00e8s le d\u00e9but de la PR, il faut envisager un traitement plus intensif pour ma\u00eetriser la maladie plus rapidement et r\u00e9duire le risque d\u2019atteinte structurale \u00bb, a affirm\u00e9 le Dr<\/sup> Patrick Durez, des Cliniques universitaires Saint-Luc, de l\u2019Institut de recherche exp\u00e9rimentale et clinique (IREC) de Bruxelles, en Belgique. Ces donn\u00e9es l\u2019ont convaincu de l\u2019int\u00e9r\u00eat clinique que pr\u00e9sente la topographie de l\u2019atteinte articulaire au d\u00e9but de la maladie.\u00a0<\/p>\n

R\u00e9sultats de l\u2019\u00e9tude AGREE, une \u00e9tude de phase III<\/h2>\n

L\u2019atteinte articulaire a \u00e9t\u00e9 \u00e9valu\u00e9e d\u2019apr\u00e8s les donn\u00e9es de l\u2019\u00e9tude AGREE, une \u00e9tude de phase III pendant laquelle l\u2019abatacept, un agent cibl\u00e9 alli\u00e9 au m\u00e9thotrexate a \u00e9t\u00e9 compar\u00e9 au m\u00e9thotrexate utilis\u00e9 seul chez des patients dont la maladie en \u00e9tait \u00e0 ses d\u00e9buts, n\u2019avait jamais \u00e9t\u00e9 trait\u00e9e et s\u2019accompagnait de facteurs pronostiques d\u00e9favorables. Pendant cette \u00e9tude, les chercheurs ont collect\u00e9 des donn\u00e9es d\u00e9taill\u00e9es sur de nombreuses caract\u00e9ristiques de d\u00e9part, dont la pr\u00e9sence ou non d\u2019enflure dans les articulations suivantes : mains, poignets, coudes, \u00e9paules, m\u00e2choire, genoux, chevilles, pieds.\u00a0<\/p>\n

Ils ont observ\u00e9 de l\u2019enflure dans les articulations suivantes, dans l\u2019ordre : mains (99 %), poignets (92 %), chevilles (79 %), genoux (69 %), pieds (66 %), coudes (48 %), \u00e9paules (34 %) et m\u00e2choire (9 %). Or l\u2019atteinte des poignets, des genoux, des coudes et de la m\u00e2choire est celle qui a \u00e9t\u00e9 le plus \u00e9troitement reli\u00e9e \u00e0 une PR agressive comme en t\u00e9moignaient l\u2019indice CDAI (Clinical Disease Activity Index<\/em>), le score DAS28 et l\u2019indice SDAI (Simple Disease Activity Index<\/em>). Par exemple, au d\u00e9but de l\u2019\u00e9tude, l\u2019indice CDAI des sujets atteints de PR s\u00e9ropositive dont la m\u00e2choire \u00e9tait tum\u00e9fi\u00e9e exc\u00e9dait de 10 points celui des sujets dont la m\u00e2choire \u00e9tait indemne (53,3 vs 43,3; p<\/em> < 0,001).<\/p>\n

Apr\u00e8s appariement de ces articulations, \u00ab un lien significatif a \u00e9t\u00e9 \u00e9tabli entre la pr\u00e9sence d\u2019enflure dans l\u2019\u00e9paule et la pr\u00e9sence d\u2019enflure dans presque toutes les autres articulations [p<\/em> < 0,001 pour le coude, le pied, la m\u00e2choire et le genou] \u00bb, a rapport\u00e9 le Dr<\/sup>\u00a0Durez. En revanche, l\u2019enflure du poignet avait un lien significatif avec l\u2019enflure du genou et de la cheville seulement, et celle du pied, avec celle de la cheville uniquement.\u00a0<\/p>\n

\n

\u00ab Un lien significatif a \u00e9t\u00e9 \u00e9tabli entre la pr\u00e9sence d\u2019enflure dans l\u2019\u00e9paule et la pr\u00e9sence d\u2019enflure dans presque toutes les autres articulations. \u00bb<\/p>\n<\/blockquote>\n

Au d\u00e9but de l\u2019\u00e9tude, il n\u2019y avait pas forc\u00e9ment de corr\u00e9lation entre l\u2019obtention de valeurs \u00e9lev\u00e9es pour l\u2019indice CDAI, l\u2019indice SDAI et le score DAS28 et l\u2019obtention d\u2019un indice HAQ-DI \u00e9lev\u00e9 (Health Assessment Questionnaire-Disability Index<\/em>). Par exemple, l\u2019indice CDAI (45,9 vs 35,3; p<\/em> < 0,001) et le score DAS28 (6,3 vs 5,6; p<\/em> < 0,001) enregistr\u00e9s chez les sujets dont les poignets \u00e9taient enfl\u00e9s d\u00e8s le d\u00e9part \u00e9taient significativement plus \u00e9lev\u00e9s que chez ceux dont les poignets ne l\u2019\u00e9taient pas, alors que l\u2019indice HAQ-DI (1,7) \u00e9tait le m\u00eame dans les deux groupes \u00a0(Fig. 1)<\/a>.<\/p>\n

Les indices HAQ-DI \u00e9taient plus \u00e9lev\u00e9s chez les sujets dont les genoux (1,8 vs 1,5; p<\/em> < 0,001) et la m\u00e2choire (1,9 vs 1,7; p<\/em> < 0,01) \u00e9taient enfl\u00e9s que chez ceux pour qui ce n\u2019\u00e9tait pas le cas. Le Dr<\/sup>\u00a0Durez a toutefois soulign\u00e9 que l\u2019atteinte de certaines articulations d\u00e8s le d\u00e9but de la maladie semble avoir un certain int\u00e9r\u00eat clinique, r\u00e9it\u00e9rant du coup qu\u2019il s\u2019agira d\u2019un domaine de recherche important \u00e0 l\u2019avenir.\u00a0<\/p>\n

Conclusion<\/h2>\n

\u00ab Nous disposons de peu d\u2019information sur l\u2019int\u00e9r\u00eat clinique que comporte l\u2019atteinte de certaines articulations en particulier \u00bb, a expliqu\u00e9 le Dr<\/sup>\u00a0Durez. Les donn\u00e9es recueillies dans cette cohorte portent \u00e0 croire que la topographie de l\u2019atteinte articulaire objectiv\u00e9e au d\u00e9but de la PR pourrait faciliter la stratification des patients en fonction de la gravit\u00e9 de leur maladie et orienter l\u2019intensit\u00e9 des premi\u00e8res interventions.<\/p>\n","protected":false},"excerpt":{"rendered":"

Chicago <\/b>\u2013 L\u2019analyse a posteriori d\u2019une \u00e9tude de phase III pr\u00e9sent\u00e9e \u00e0 la r\u00e9union annuelle de 2018 de l\u2019ACR\/ARHP a r\u00e9v\u00e9l\u00e9 que l\u2019enflure du genou, de la m\u00e2choire, du poignet ou du coude au d\u00e9but d\u2019une polyarthrite rhumato\u00efde s\u00e9ropositive (PR) est le signe d\u2019un pronostic plus d\u00e9favorable que si ces articulations sont \u00e9pargn\u00e9es. Bien qu\u2019une corr\u00e9lation ait \u00e9t\u00e9 \u00e9tablie entre l\u2019enflure de ces articulations et d\u2019autres signes d\u2019une PR agressive, les chercheurs ont jug\u00e9 ces donn\u00e9es suffisamment solides pour affirmer que l\u2019\u00e9valuation des articulations touch\u00e9es d\u00e8s le d\u00e9part pourrait guider la prise en charge de la PR.<\/p>\n","protected":false},"author":9,"featured_media":7717,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"tags":[522,510,424,346],"class_list":["post-7714","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","tag-2018-fr","tag-acr-fr-2","tag-acr-fr","tag-rhumatologie","area_tag-allergie-immunologie","area_tag-rhumatologie"],"acf":[],"yoast_head":"\nL\u2019enflure du genou, de la m\u00e2choire, du poignet ou du coude au d\u00e9but de la PR, signe d\u2019un pronostic sombre - The Medical Xchange<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/themedicalxchange.com\/fr\/2018\/11\/10\/acr_7017_lenflure-du-genou-de-la-machoire-du-poignet-ou-du-coude-au-debut-de-la-polyarthrite-rhumatoide-signe-dun-pronostic-sombre\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"L\u2019enflure du genou, de la m\u00e2choire, du poignet ou du coude au d\u00e9but de la PR, signe d\u2019un pronostic sombre - The Medical Xchange\" \/>\n<meta property=\"og:description\" content=\"Chicago \u2013 L\u2019analyse a posteriori d\u2019une \u00e9tude de phase III pr\u00e9sent\u00e9e \u00e0 la r\u00e9union annuelle de 2018 de l\u2019ACR\/ARHP a r\u00e9v\u00e9l\u00e9 que l\u2019enflure du genou, de la m\u00e2choire, du poignet ou du coude au d\u00e9but d\u2019une polyarthrite rhumato\u00efde s\u00e9ropositive (PR) est le signe d\u2019un pronostic plus d\u00e9favorable que si ces articulations sont \u00e9pargn\u00e9es. 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