المؤلفون: Pauline Richebé, Guillaume Coiffier, Pascal Guggenbuhl, Denis Mulleman, Marion Couderc, Emanuelle Dernis, Valentine Deprez, Carine Salliot, Saik urien, Rachel Brault, Adeline Ruyssen-Witrand, Emmanuel Hoppe, Emmanuel Chatelus, Christian hubert roux, Sebastien Ottaviani, Marie Baufrere, Alexia Michaut, Loic Pauvele, Christelle Darrieutort-Laffite, Daniel Wendling, Pascal Coquerelle, Géraldine Bart, Elisabeth Gervais, Vincent Goeb, Marc Ardizzone, Edouard Pertuiset, Sophie Derolez, Jean Marc Ziza, René-Marc Flipo, Sophie Godot, Raphaele Seror

المساهمون: Hôpitaux Universitaires Paris-Sud, Centre hospitalier de Dinan, CHU Pontchaillou [Rennes], Nutrition, Métabolismes et Cancer (NuMeCan), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre Hospitalier Le Mans (CH Le Mans), CHU Amiens-Picardie, Service de Rhumatologie [Orléans], Centre Hospitalier Régional d'Orléans (CHRO), CHU Orléans, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre hospitalier universitaire de Poitiers (CHU Poitiers), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM), Les Hôpitaux Universitaires de Strasbourg (HUS), AP-HP - Hôpital Bichat - Claude Bernard [Paris], Centre hospitalier universitaire de Nantes (CHU Nantes)

المصدر: Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases, 2022, pp.annrheumdis-2022-222143. ⟨10.1136/ard-2022-222143⟩

مصطلحات موضوعية: Rheumatology, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Epidemiology, Arthritis, Immunology, Infectious, Immunology and Allergy, General Biochemistry, Genetics and Molecular Biology

الوصف: ObjectivesTo describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments.MethodsFor this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded.ResultsOverall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0–14)). Knee was the most frequent site (n=160 (38.9%)), andStaphylococcussp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; pStaphylococcus aureusNJSA compared withStreptococcussp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%).ConclusionPrognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dbf0f699cbc2f5fd1122d61a11d1ba1eTest
https://pubmed.ncbi.nlm.nih.gov/35820674Test

المؤلفون: Stéphane Varin, Grégoire Cormier, Lucie Planche, Benoit Le Goff, Guillaume Coiffier, Jean-David Albert, Christelle Darrieutort-Laffite, Yves Maugars

المصدر: Annals of the Rheumatic Diseases. 78:837-843

مصطلحات موضوعية: Adult, Male, Visual analogue scale, medicine.medical_treatment, Immunology, Equivalence Trials as Topic, Punctures, Methylprednisolone, General Biochemistry, Genetics and Molecular Biology, Injections, Intra-Articular, Rotator Cuff, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Rheumatology, Tendinitis, Shoulder Pain, Humans, Immunology and Allergy, Medicine, Therapeutic Irrigation, Glucocorticoids, Saline, Ultrasonography, Interventional, Pain Measurement, 030203 arthritis & rheumatology, Pain, Postoperative, 030222 orthopedics, Dry needling, business.industry, Calcinosis, Calcific tendinitis, Middle Aged, medicine.disease, Acute Pain, Treatment Outcome, Anesthesia, Tendinopathy, Female, Saline Solution, Subacromial bursa, business, Follow-Up Studies, medicine.drug, Calcification

الوصف: ObjectiveSteroid injections are common after an ultrasound-guided puncture and lavage (UGPL) of calcific tendonitis of the rotator cuff. However, steroids may prevent calcification resorption and negatively affect tendon healing. Our study was designed to determine whether saline solution was non-inferior to steroids in the prevention of acute pain reactions in the week following UGPL.MethodsThis was a randomised, double-blinded, controlled non-inferiority trial with 12-month follow-up. We included 132 patients (66 in each group) with symptomatic calcification measuring more than 5 mm. Patients received 1 mL of saline or steroid (methylprednisolone 40 mg) in the subacromial bursa at the end of UGPL. Primary outcome was the maximal pain during the week following the procedure with a prespecified non-inferiority margin of 10 mm (0–100 visual analogue scale). Secondary outcomes included pain at rest and during activity, function (disabilities of the arm, shoulder and hand score) and radiological evolution of the calcification over the 12-month follow-up.ResultsThe estimated mean difference in the first week’s maximal pain between these two groups was 11.76 (95% CI 3.78 to 19.75). Steroids significantly improved VAS pain at rest and during activities, as well as function at 7 days and 6 weeks. They did not change the rate of calcification resorption, which occurred in 83% and 74% of patients at 12 months in the saline and steroid groups.ConclusionNon-inferiority of saline when compared with steroids could not be established. However, steroid injection improved pain in the 6 weeks following the procedure, and function in the 3 months after, with no significant effect on calcification resorption.Trial registration numberNTC02403856.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::dcece3babe2a404951bc62970e939b9fTest
https://doi.org/10.1136/annrheumdis-2018-214971Test

المؤلفون: B. Le Goff, Christelle Darrieutort-Laffite, J. De Lima, Régis Brion, Catherine Chevalier, J B Herman, Frédéric Blanchard

المصدر: Annals of the Rheumatic Diseases. 80:413.1-413

مصطلحات موضوعية: Pathology, medicine.medical_specialty, Rheumatology, Apatite crystals, business.industry, Immunology, Immunology and Allergy, Medicine, Calcific tendinopathy, business, General Biochemistry, Genetics and Molecular Biology

الوصف: Background:Calcific tendonitis of the rotator cuff is due to carbonated apatite deposits in the shoulder tendons. During the evolution of the disease, an acute inflammatory episode may occur leading to the disappearance of the calcification. Although hydroxyapatite crystals-induced inflammation has been previously studied with synthetic crystals, no data are available with calcifications extracted from patients suffering from calcific tendinopathy. The objective of the study was to explore the inflammatory properties of human calcifications and the pathways involved.Objectives:The objective of the study was to explore the inflammatory properties of human calcifications and the pathways involved.Methods:Human calcifications were obtained from patients treated for their shoulder pain related to a calcific tendinopathy of the rotator cuff. Calcifications were extracted by ultrasound-guided lavage and aspiration as previously described [1]. Human calcifications and synthetic hydroxyapatite (sHA) were used in vitro to stimulate human monocytes and macrophages, the human myeloid cell line THP-1 and human tenocytes. The release of IL-1β, IL-6 and IL-8 by cells was quantified by ELISA. Gene expression of pro- and anti-inflammatory cytokines was evaluated by quantitative PCR. NF-kB activation and NLRP3 involvement was assessed in THP-1 cells using a NF-kB inhibitor and a Caspase 1 inhibitor. The inflammatory properties were then assessed in vivo using a mouse air pouch model. The membrane thickness and infiltrate were assessed 6 and 24 hours after the injection of human calcifications or synthetic hydroxyapatite using hematoxylin and eosin staining. Macrophages, neutrophils and lymphocytes infiltrates were assessed by immunohistochemistry. Total RNA was extracted from the membranes and expression of IL-1β, IL-6 and TNFβ was quantified by PCR.Results:Human calcifications were able to induce a significant release of IL-1β when incubated with monocytes, macrophages and THP-1 only if they were first primed with LPS (lipopolysaccharide) for monocytes and macrophages or PMA (Phorbol 12-myristate 13-acetate) for THP-1. No IL-1β was detected in tenocytes’ supernatants. Stimulation of THP-1 by human calcifications led to similar levels of IL-1β when compared to synthetic hydroxyapatite although these levels were significantly inferior in monocytes and macrophages. IL-6 and IL-8 levels were not increased in the supernatants after crystal stimulation. Patient’s crystals enhanced mRNA expression of pro-IL-1β, as well as IL-18, NF-kB and TGFβ when IL-6 and TNFα expression were not. IL-1β production was reduced by the inhibition NF-kB as well as Caspase 1 indicating the role of NLRP3 inflammasome. In vivo, injection of human calcifications or synthetic hydroxyapatite in air pouch led to significant increase in membrane thickness with an infiltrate mainly composed of macrophages. Significant overexpression of IL-1β was only observed in the synthetic hydroxyapatite group.Conclusion:As synthetic hydroxyapatite, human calcifications were able to induce an inflammatory response resulting in the production of IL-1β after NF-kB activation and through NLRP3 inflammasome. In some experiments, IL-1β induction was lower with human calcifications compared to synthetic apatite. Differences in size, shape and protein content may explain this observation.References:[1]Darrieutort-Laffite C, Arnolfo P, Garraud T, Adrait A, Couté Y, Louarn G, et al. Rotator Cuff Tenocytes Differentiate into Hypertrophic Chondrocyte-Like Cells to Produce Calcium Deposits in an Alkaline Phosphatase-Dependent Manner. J Clin Med. 2019 Sep 26;8(10):1544. doi: 10.3390/jcm8101544.Acknowledgements:Fondation Arthritis, Recherche et Rhumatismes and French Society for Rheumatology for their financial supportDisclosure of Interests:None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::5443020e047ba8052350547fb3fa2cb6Test
https://doi.org/10.1136/annrheumdis-2021-eular.2624Test

المؤلفون: E. Correia, Frédéric Blanchard, Christelle Darrieutort-Laffite, B. Le Goff, Paul Arnolfo

المصدر: Annals of the Rheumatic Diseases. 79:1762.1-1763

مصطلحات موضوعية: medicine.medical_specialty, biology, business.industry, Immunology, Calcific tendinitis, Tendonitis, Periostin, medicine.disease, Placebo, Gastroenterology, General Biochemistry, Genetics and Molecular Biology, Rheumatology, Osteoprotegerin, Methylprednisolone, Internal medicine, biology.protein, Immunology and Allergy, Medicine, Osteopontin, business, Calcification, medicine.drug

الوصف: Background:Calcific tendonitis of the rotator cuff is a frequent cause of chronic shoulder pain. It is due to apatite deposits within the tendons. Little data are currently available about proteins associated to crystals within deposits.Objectives:The aim of the study was to quantify 6 proteins in calcific powders obtained from patients who have undergone an ultrasound-guided percutaneous lavage (UGPL) of their calcification and to look for correlations between their concentration and patient characteristics.Methods:Calcific powders were obtained from patients included in the CALCECHO trial whose main objective was to compare post-procedure pain between two groups: methylprednisolone or placebo injected at the end of the lavage [1]. Based on preliminary proteomic data and literature data, the following proteins have been selected and quantified by ELISA: Pigment-epithelium Derived Factor (PEDF), Osteopontin (OPN), Periostin (POSTN), Activin A (ACT A), Osteoprotegerin (OPG) and Bone Morphogenic Protein-2 (BMP-2). The level of each protein was expressed in µg per pg of the total proteins present in the sample. These proteins have been selected for their link to the mineralization. Correlations between the level of each protein and radiographic and ultrasound appearance of the calcific deposits were sought. We also looked for correlations between level of each protein and duration of pain or response to UGPL (Mann-Whitney test).Results:Sixty-six samples were studied: mean age was 48.9 (+/- 9.7) and 68% were female. Mean duration of shoulder pain was 30 months with a mean VAS pain of 68/100 (+/-14). Mean calcification size was 1.8 cm. Results of ELISA were as follows: mean level of PEDF at 1097 pg/µg, mean level of OPG at 135 pg/µg, mean level of POSTN at 6.9 pg/µg, mean level of ACT A at 19.6 pg/µg and mean level of OPN at 49.6 pg/µg although BMP-2 was undetectable. There was no correlation between level of proteins and the size of the calcification or the duration of pain. There was no difference in protein levels between type A and type B calcifications on radiography (classification of the French Society for Arthroscopy). In contrast, levels of POSTN and OPN were significantly higher in nodular calcifications compared to the homogenous (p=0.003 and p=0.01 respectively) or fragmented types (p=0.03 and p=0.04 respectively). Furthermore, calcifications without acoustic shadowing were enriched in POSTN compared to those with (p=0.04). Finally, the periostin level was significantly higher in calcifications that have responded well to UGPL (p=0.02).Conclusion:In this cohort of patients treated by UGPL, we observed higher levels of POSTN and OPN in the less dense calcifications and POSTN enrichment appeared to be associated with a better response to UGPL. Considering these data, further studies will be necessary to better understand the role of this protein in calcific tendonitis.References:[1]Darrieutort-Laffite C, Varin S, Coiffier G, Albert JD, Planche L, Maugars Y, Cormier G, Le Goff B. Are Corticosteroid Injections Needed After Needling and Lavage of Calcific Tendinitis: A Randomized, Double-Blind, Non-Inferiority Trial. Ann Rheum Dis. 2019 Jun;78(6):837-843.Disclosure of Interests:None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::dd3516f2fe03a39e21da6b7a4781b4d9Test
https://doi.org/10.1136/annrheumdis-2020-eular.2632Test

المؤلفون: Raphaèle Seror, Géraldine Bart, Guillaume Coiffier, Christelle Darrieutort-Laffite, Benoit Le Goff, Marion Couderc

المساهمون: Service de néphrologie [Rennes], Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020]), CHU Le Kremlin-Bicêtre (Rheumatology Department), Department of Rheumatology, Physiopathologie des Adaptations Nutritionnelles (PhAN), Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Sarcomes osseux et remodelage des tissus calcifiés - Phy-Os [Nantes - INSERM U1238] (Phy-Os), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université Bretagne Loire (UBL), Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Université de Rennes (UR)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes], Institut National de la Recherche Agronomique (INRA)-Université de Nantes (UN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Bretagne Loire (UBL)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)

المصدر: Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases, BMJ Publishing Group, 2019, pp.annrheumdis-2019-215887. ⟨10.1136/annrheumdis-2019-215887⟩
Annals of the Rheumatic Diseases, 2019, pp.annrheumdis-2019-215887. ⟨10.1136/annrheumdis-2019-215887⟩

مصطلحات موضوعية: 0301 basic medicine, medicine.medical_specialty, medicine.drug_class, medicine.medical_treatment, Immunology, Antibiotics, Population, Arthritis, Synovectomy, General Biochemistry, Genetics and Molecular Biology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Randomized controlled trial, law, medicine, Humans, Immunology and Allergy, Prospective Studies, education, ComputingMilieux_MISCELLANEOUS, 030203 arthritis & rheumatology, Arthritis, Infectious, education.field_of_study, business.industry, medicine.disease, Anti-Bacterial Agents, 3. Good health, Surgery, 030104 developmental biology, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Infectious arthritis, Drainage, Septic arthritis, business, Interphalangeal Joint

الوصف: Gjika et al 1 recently reported the non-inferiority of 2-week versus 4-week antibiotic therapy after systematic surgical washing (with or without synovectomy) in the management of septic arthritis. Although this randomised, controlled trial adds important new insights to the management of patients with infectious arthritis, it has several drawbacks that limit generalisation of the results. First, the patients included in this study were not representative of a usual population of native joint septic arthritis patients. These patients had mainly septic arthritis affecting the small joints (metatarsophalangeal, metacarpophalangeal and proximal interphalangeal joints in 85% of cases). Moreover, in most cases, contamination occurred after direct inoculation following skin invasion (bite/scratch or post-traumatic), with only 4% of patients with systemic signs of infection. Finally, patients were included on the basis of having been treated with surgical drainage, the indications for which are largely centre dependent. These characteristics are probably explained by the monocentric design of the study. Native joint septic arthritis affects mainly …

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6d09a46878b2b8314d9bab7ff8777c70Test
https://doi.org/10.1136/annrheumdis-2019-215887Test

المؤلفون: B. Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Y. Maugars, A. Colombey

المصدر: Annals of the Rheumatic Diseases. 75:854.1-854

مصطلحات موضوعية: musculoskeletal diseases, 0301 basic medicine, medicine.medical_specialty, Facet (geometry), Immunology, General Biochemistry, Genetics and Molecular Biology, Facet joint, 03 medical and health sciences, 0302 clinical medicine, Lumbar, Rheumatology, Iodinated contrast, Joint capsule, medicine, Immunology and Allergy, Fluoroscopy, 030203 arthritis & rheumatology, medicine.diagnostic_test, business.industry, Surgery, Vertebra, 030104 developmental biology, medicine.anatomical_structure, Arthrogram, Nuclear medicine, business

الوصف: Background Facet joint-mediated pain has been identified as a common cause of lumbar pain. Steroid injections are currently made to treat them, they are usually performed under fluoroscopy or computed tomography guidance. Ultrasound (US) is also appropriate to study facet joints and some studies showed feasibility and efficacy of facet joint injections performed under US-guidance through a transversal approach. On a longitudinal view, facet joints are easy-to-identify as a series of lumps with the joint capsule appearing as a thin hypoechoic line that envelops the joint. Objectives Considering the good visibility of these joints and their capsule on the longitudinal view, we studied the feasibility of US-guided facet joint injections using a longitudinal inline approach. Methods Patients referred to our rheumatology department to receive facet joint injections under fluoroscopy were included. To realize the injection, we first located the accurate lumbar level on a longitudinal median view going through the spinous processes. Facet joints were identified as previously described placing the probe 2–3 cm away from the median line. Then, the needle was inserted to reach the hypoechoic line corresponding to the capsule or, if not visible, the top of the lump formed by the inferior articular process of the superior vertebra overlying the superior articular process of the vertebra below it. When we obtained the bone contact, we injected iodinated contrast medium followed by cortivazol. Finally, we made a lumbar X-ray to analyze the needle position and the quality of the arthrography. The first objective was to assess the number of injections realized in front of the joint. For secondary objectives, we assessed the number of accurate arthrography, the duration of the procedure and the occurrence of adverse events. During US examination, the visibility of the capsule and the presence of osteophytes were collected. Results Thirty-eight patients have been included by two operators. We excluded four patients because of a poor visibility of the spinal structures. Mean age was 58,4 years (range, 30–82) and mean BMI was 25,2 kg/m 2 (range, 18–34). US showed osteophytes in 42% and the joint capsule was inconstantly visible (25%). One-hundred and forty-four injections were performed (72 at the L4-L5 level and 72 at the L5-S1 level) and 141 X-ray were analyzed. One-hundred and twenty-three injections (87%) were accurately realized in front of the joint, i.e. in front of the inferior articular process of the superior vertebra. However, a proper arthrogram was obtained in only 35 cases (25%). Mean procedure duration was 8.5 minutes for four injections. Six patients (18%) reported transient pain exacerbation and no severe complication occurred during the first month after the procedure. Conclusions With a longitudinal inline approach, US-guided facet joint injections were feasible and 87% injections were realized right in front of the joint. However, we obtained a correct arthrogram in only 25%. The depth of the target-point, the inconstant visualization of the capsule and the obliquity of the needle probably explain this result. Additional studies will be necessary to improve the accuracy of the technique. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::fa34206a99abef4991856bc5249a2c58Test
https://doi.org/10.1136/annrheumdis-2016-eular.3648Test

المؤلفون: Géraldine Bart, B. Le Goff, Joëlle Glémarec, Christelle Darrieutort-Laffite, Y. Maugars

المصدر: Annals of the Rheumatic Diseases. 73:298.1-298

مصطلحات موضوعية: Sciatica, medicine.medical_specialty, Cobb angle, Injection Procedure, business.industry, Visual analogue scale, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Epidural space, Surgery, medicine.anatomical_structure, Lumbar, Rheumatology, medicine, Clinical endpoint, Immunology and Allergy, medicine.symptom, business

الوصف: Background Ultrasound (US) is widely used in rheumatology to study and guide infiltration of peripheral joints. This imaging modality can also provide useful information about the anatomy of the lumbar spine. Studies have shown that US examination of the spine was an useful tool to help perform epidural anesthesia [1]. Objectives To determine if the identification of the optimum puncture level by a pre-puncture US examination of the lumbar spine may facilitate epidural corticosteroid injection in patients with a presumed difficult puncture. Methods We performed a prospective randomized single-blind controlled study (NCT01832844). All patients referred to our unit for the treatment of sciatica due to lumbar disc herniation were evaluated. Inclusion criteria were a BMI >30 kg/m 2 and/or age >60 years and/or lumbar scoliosis (Cobb angle >10°). Patients were randomized to a US (n=40) or a control (n=40) group. The US group underwent a pre-procedure spinal US (Esaote Mylab 70; 3-11 MHz probe). Interspinous spaces and depth of the epidural space were measured. Visibility and accessibility of the epidural space was thus rated as “poor”, “moderate” or “good”. The best lumbar level to perform the injection was selected according these results. Patients of the control group underwent a fake US examination to remain blind to the group allocation and the level of injection was selected using the traditional landmark technique. An interspinous injection of 5 ml of Hydrocortisone was thus performed. Primary endpoint was the pain during the procedure assessed using the Visual Analogue Scale (VAS). Each redirection of the needle was counted. Data are presented as the mean (±SD). A Student t-test and a Pearson correlation test were used for the statistical analysis. Results Mean age was 62,5 (±16) and 33% were men. 47/80 (58%) patients were over 60 years, 41/80 (51%) had a BMI>30 kg/m 2 and 14/80 (17%) had a lumbar scoliosis. Among the 80 patients, 21 (26%) had 2 or more criteria of presumed difficult puncture. Mean epidural space depth was 49.2 mm (±13.8) and mean interspinous distance was 14.22 mm (±5.1). We found a positive correlation between epidural space depth and BMI (p Conclusions US evaluation of the interspinous space and epidural depth is feasible even in obese or old patients. Identification of the optimum puncture level by a pre-puncture US decreased the pain during the epidural injection procedure. This benefit was greater in patients over 60 years. US of the lumbar spine represents an additional technique at the rheumatologist9s disposal to help guiding lumbar spine injections. References Grau T, Leipold RW, Conradi R, et al. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169-75. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.3841

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::35b63463ea002c96002f5a82ee949b48Test
https://doi.org/10.1136/annrheumdis-2014-eular.3841Test

المؤلفون: Y. Maugars, B. Le Goff, Christelle Darrieutort-Laffite

المصدر: Annals of the Rheumatic Diseases. 72:A721.4-A722

مصطلحات موضوعية: Sciatica, medicine.medical_specialty, business.industry, Immunology, Ultrasound, General Biochemistry, Genetics and Molecular Biology, Sagittal plane, Epidural space, Rheumatology, Surgery, Lumbar, medicine.anatomical_structure, Interquartile range, Internal medicine, medicine, Immunology and Allergy, medicine.symptom, Ultrasonography, business, Nuclear medicine

الوصف: Background Epidural steroid injections are a common method used for the treatment of patients with sciatica. They are usually performed without imaging guidance using anatomical landmarks. However, injections are sometimes challenging resulting in prolonged procedure times, multiple needle passes and significant pain. Ultrasonography (US) is mainly used by rheumatologist for the guidance of peripheral joint injections. However, some studies have shown that US examination of the spine was useful before epidural anesthesia to predict which patients were at risk for a difficult procedure (1). Objectives The aim of our study was to evaluate the feasibility of a pre-procedure ultrasound examination of the spine before epidural steroid injections. Methods US examination of the lumbar spine was performed in 21 patients referred to our unit for the treatment of sciatica due to lumbar disc herniation. The scanning was performed with an Esaote My lab 70 unit using a curved-array, low-frequency (1–8 MHz) probe on a patient seated. L5-S1 intervertebral space was first located on a sagittal view, and the probe was then moved cranially. At each intervertebral level, we recorded our ability to depict the epidural space. We rated the visibility as ‘absent’, ‘poor’, ‘moderate’, ‘good’ with assigned numerical values of 0, 1, 2 and 3, respectively. We measured distance between spinous processes and depth of the epidural space in L3-L4, L4-L5 and L5-S1. Each measurement was performed 3 times and the mean was used for statistical analysis. Data are given as the median (+/- interquartile range). Differences between measurements at each lumbar levels was assessed with a Friedman’s Test and correlations between age, gender and Body mass index (BMI) and epidural visibility with a Pearson’s test. Results 21 patients (11 men and 10 women), mean age 46 years (38-60.5) were included in our study. Median weight was 73 kg (59-85) and median BMI 24.8 (20.85-27.05). Median depth of the epidural space was 44.5 mm (41.60-48.45) in L3-L4, 43.80 mm (41.35-45.85) in L4-L5 and 40.8 mm (39.2-46.9) in L5-S1. Median distance between spinous processes was 17.9 mm (12.95-20.75), 15.9 mm (13.15-17.8) and 16.4 mm (15.30-17.7) in L3-L4, L4-L5 and L5-S1, respectively. Visibility of the epidural space was significantly lower in L5-S1 (p Conclusions We accurately identified each intervertebral level, estimated depth to the epidural space, and located the most appropriate interspinous space for needle insertion. As expected, the distance between spinous processes and epidural accessibility was reduced in older patients. US might help us to predict which patients are at risk for a difficult epidural injection and help the physician to identify the optimal site of injection. Overall, US of the lumbar spine represents a new imaging modality available for the rheumatology to treat patients with lumbar conditions. References Weed JT, Taenzer AH, Finkel KJ, Sites BD. Evaluation of pre-procedure ultrasound examination as a screening tool for difficult spinal anaesthesia. Anaesthesia. 2011 Oct;66(10):925-30. Disclosure of Interest None Declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::99f7e0d8c5cd3b0b7330c572609a9dfaTest
https://doi.org/10.1136/annrheumdis-2013-eular.2135Test