المؤلفون: Frédéric Blanchard, B. Le Goff, Aurélie Najm, Paul Arnolfo, T Garraud, Christelle Darrieutort-Laffite

المصدر: Abstracts.

مصطلحات موضوعية: business.industry, Scleraxis, Phosphodiesterase, chemistry.chemical_element, Calcium, Phenotype, Tendon, Tenomodulin, Staining, Andrology, medicine.anatomical_structure, chemistry, medicine, Rotator cuff, business

الوصف: Career situation of first and presenting author Resident. Introduction Calcific tendinopathy represents 10% to 42% of chronic painful shoulders. These calcium deposits are composed of carbonated apatite. Although the disease is frequent, its origin stays still largely unknown. Our previous results showed that calcific deposits are surrounded by chondrocyte-like cells expressing TNAP (Tissue Nonspecific Alkaline Phosphatase) and ENPP1 (Ectonucleotidepyrophosphatase/phosphodiesterase 1), two key enzymes involved in the mineralization process. Objectives To study the ability of cells extracted from rotator cuff tendons to produce apatite crystals and to analyze the phenotype of these mineralizing cells. Methods Tenocytes were extracted from rotator cuff tendons removed during shoulder total replacement. To evaluate their ability to mineralize, they were cultured in an osteogenic medium (OM) for 21 days. Mineral deposition then was assessed by staining with Alizarin red. Tenocytes total RNA was extracted and analyzed by RT-qPCRs. TNAP enzymatic activity was also assessed in the cells. A TNAP inhibitor was used to delineate its implication in the mineralization process. Results Tendon samples were obtained from 5 patients (age 69.6±5.13 years). Cells extracted from these tendons expressed collagen I, collagen III, Scleraxis and Mkx (Mohawk homeobox), as expected for tenocytes. However, Tenomodulin was very weakly expressed and lost after passage 1. These cells were able to mineralize in the OM although no mineralization was observed in the control medium. qPCR analyses showed a significant increase of TNAP and ENPP1 expression by cells cultured in OM (p Conclusions Tenocyte-like cells extracted from tendons of the rotator cuff are able to induce mineralization in an osteogenic medium. The cells express genes associated with a hypertrophic chondrocyte phenotype (TNAP, COL10 and MMP13) and TNAP seems to have a crucial role in the induced mineralization. These results suggest that tenocytes could differentiate into hypertrophic chondrocyte which induce TNAP-dependent apatite deposition in calcific tendonitis. Acknowledgements This study was supported by Inserm and the French Society of Rheumatology. Disclosure of Interest None declared.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::51240f83d4c3bae4a1881771adfcb93dTest
https://doi.org/10.1136/annrheumdis-2018-ewrr2019.99Test

المؤلفون: Grégoire Cormier, Guillaume Coiffier, B. Le Goff, Christelle Darrieutort-Laffite, Jean-David Albert, Stéphane Varin

المصدر: THURSDAY, 14 JUNE 2018.

مصطلحات موضوعية: Percutaneous, business.industry, Radiography, medicine.medical_treatment, Methylprednisolone acetate, Placebo, medicine.disease, medicine.anatomical_structure, Anesthesia, medicine, Rotator cuff, Subacromial bursa, business, Saline, Calcification

الوصف: Background Rotator cuff calcific tendinopathy is a common condition causing up to 20% of the painful shoulder. Ultrasound guided percutaneous lavage (UGPL) is indicated after failure of conservative treatments. Steroids injections in the subacromial bursa (SAB) are usually performed after the lavage to prevent the pain induced by the procedure. However, some suggested that this injection could prevent the inflammatory reaction leading to the disappearance of the calcific deposit. Moreover, its efficacy to prevent post-procedure pain has never been demonstrated. Objectives The goal of this study was to evaluate the effect of a steroid injection in the SAB after UGPL on the pain and the radiographic evolution of the calcification. Methods This was a multicentric prospective double blinded randomised controlled study. We included patients with shoulder pain for more than 3 months and a type A or B calcification >5 mm on X-Ray. Patients were treated with UGPL using a single needle technic. At the end of the procedure, they received a blind injection of either 2 mL of methylprednisolone acetate or 2 mL of serum saline. The primary outcome was the maximal VAS pain (0–100) the first week following UGPL. Secondary outcomes were the evolution of VAS pain at 7 days, 6 weeks and 3 months and the radiographic changes of the calcification at 3 months. Results We included 134 patients, mean age 49.8 (±9.7) years, 89 females (67.4%). Calcifications involved the supraspinatus, infraspinatus and subscapularis in 114 (85%), 14 (10%) and 6 patients (5%) respectively. Calcifications were type A and type B in 42,5% and 57,5% of the cases respectively and mean size of the calcification was 1,5 cm (±0,5). Backflow of calcific material was obtained in 107 patients (81.1%). Maximum pain during the first week following UGPL was 71.5 [CI95%:63.9–79.20] in the serum saline group versus 59.8 [CI95%:52.2–67.41] in the steroid group with a mean difference of 11.7 [CI95%:3.7–19.7]. More patients in the placebo group needed to take NSAID (12.1% versus 6.1%) and paracetamol (16.7% versus 9.1%) during the first week. VAS pain at rest and during activities decreased significantly more in the steroid group compared to the placebo: VAS pain during activity was 72.02 [62.98–81.06], 26.63 [17.60–35.67], 32.30 [23.11–41.49] and 43.27 [34.18–52.37] in the steroid group versus 72.46 [63.41–81.51], 48.22 [39.14–57.31], 51.44 [42.26–60.62] and 51.09 [41.95–60.24] in the placebo group at day 0, 7, 6 weeks and 3 months respectively (figure 1). At 3 months no difference was found in the radiographic evolution: 62.1% of the patients treated with steroid and 64.8% treated with serum saline had more than 50% of resorption of their calcification. Conclusions Our study shows that steroid injection in the SAB leads to a significant decrease of maximal pain the following week. This treatment also decreases significantly the pain during the 3 first months after UGPL. Importantly, we found no difference between the 2 groups in the radiographic evolution of the calcification at 3 months. Overall, steroids injections in the SAB can be recommended after UGPL. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::219b20233bbfecc6e03a86fc3e2f7998Test
https://doi.org/10.1136/annrheumdis-2018-eular.7349Test

المؤلفون: Pierre Layrolle, Aurélie Najm, T Garraud, Frédéric Blanchard, B. Le Goff, Christelle Darrieutort-Laffite

المصدر: Poster presentations.

مصطلحات موضوعية: Pathology, medicine.medical_specialty, biology, business.industry, Acid phosphatase, medicine.disease, Chondrocyte, Staining, medicine.anatomical_structure, Proteoglycan, medicine, biology.protein, Fibrocartilage, Immunohistochemistry, business, Von Kossa stain, Calcification

الوصف: Introduction Calcific tendinopathy is a frequent cause of chronic painful shoulders. It is caused by deposits of carbonated apatite in rotator cuff tendons. Although the disease is frequent, molecular and cellular mechanisms involved in this pathological mineralization process are not currently identified. Objectives The objective of the study was to analyse calcified tendon samples to understand the organisation of the deposits and to characterise the cells potentially involved in their formation. Methods Samples were collected from cadaveric subjects. They were fixed in formalin 4%, decalcified in EDTA, dehydrated and embedded in paraffin. Some samples were not decalcified to allow a better characterisation of the calcific deposits. Hematoxylin and eosin (HE), Safranin O/Fast Green (SO/FG), Von Kossa (no decalcified samples) and Tartrate-Resistant Acid Phosphatase (TRAP) staining were performed. Immunohistochemistry using anti-Runx2, anti-Sox9, anti-Collagen II and X, anti-CD31 and CD68 antibodies has been performed. We used also used anti-TNAP (Tissue Nonspecific Alkaline Phosphatase) and ENPP1 (Ectonucleotide Pyrophosphatase/Phosphodiesterase 1) antibodies. Indeed, these two enzymes are essential in the physiological mineralization: extracellular inorganic pyrophosphates are provided by ENPP1 then hydrolyzed by TNAP to promote mineralization. Results Five calcified samples were collected On HE staining, voluminous calcium deposits were encapsulated by a fibrocartilaginous tissue. In one sample, we observed an intra-tendinous osseous metaplasia. This fibrocartilaginous area presented a red coloration (proteoglycan specific) on SO/FG staining but was collagen II negative whereas the fibrocartilage at the tendon attachment was strongly positive. Within this area, cells with round nuclei and pericellular lacunae were observed as previously described (Uhthoff, 1975). These cells expressed Runx2 and Sox9 suggesting a chondrocyte differentiation but only a small number of them expressed type X collagen, hypertrophic chondrocytes-specific marker. These cells also expressed ENPP1 and TNAP. Interestingly, extracellular TNAP deposits were also present at the periphery of the deposits. We identified vessels surrounding the deposits on 4 of the 5 calcified samples. Finally, no CD68 positive cells or TRAP positive cells were detected around the deposits. Conclusions Histological analyses of whole calcified tendon tissues showed a fibrocartilaginous area surrounding the calcium deposits with chondrocyte-like cells expressing ENPP1 and TNAP suggesting their crucial role in the deposition of apatite crystals. Further analyses are necessary to understand the origin of these cells and the regulatory factors involved in their differentiation. Reference . Uhthoff HK. Calcifying tendinitis, an active cell-mediated calcification. Virchows Arch a Pathol Anat Histol1975;366(1):51–8. Disclosure of interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::311a5680f43308a19599bd8146b47d6fTest
https://doi.org/10.1136/annrheumdis-2018-ewrr2018.61Test

المؤلفون: Pierre Layrolle, Frédéric Blanchard, Christelle Darrieutort-Laffite, Aurélie Najm, B. Le Goff, T Garraud

المصدر: Oral Presentations.

مصطلحات موضوعية: Pathology, medicine.medical_specialty, business.industry, Cartilage, H&E stain, Anatomy, medicine.disease, Staining, Tendon, medicine.anatomical_structure, medicine, Immunohistochemistry, Fibrocartilage, Von Kossa stain, business, Calcification

الوصف: Background Calcific tendinopathy is one of the most frequent causes of shoulder pain. Calcific deposits lead to chronic discomfort in daily and professional activity. These deposits are composed of carbonated apatite. Although the disease is frequent, its origin stays still largely unknown. Molecular and cellular mechanisms involved in this pathological mineralization process are not clearly identified. Objectives The objective of the study was to analyze calcified tendinous samples to understand the organization of the deposits and to characterize the cells potentially involved in their formation. Methods Samples were collected from cadaveric subjects. Ultrasound was first used to detect calcified tendons. Then, tendons were collected and fixed in formalin 4% during 48h. They were first analyzed with micro-CT to know the distribution of the calcific deposits. Samples were then decalcified in EDTA, dehydrated and embedded in paraffin. Some samples were not decalcified to allow a better characterization of the calcific deposits. Several histological staining were performed: hematoxylin and eosin (HE), Safranin O/Fast Green (SO/FG) and Von Kossa (no decalcified samples). Immunohistochemistry using anti-Runx2, anti-Sox9, anti-Collagen II and anti-caspase III antibodies has been performed to characterize the cells and tissue around the calcifications. Results Six samples were collected (1 normal and 5 calcified). On HE staining, three different histological patterns were observed. Little calcifications disseminated between tendinous fibers (N=2), voluminous ones encapsulated by a fibrous tissue (N=2) and in one sample an intra-tendinous osseous metaplasia. In the fibrous peripheral area of larger calcifications, we observed cells with round nuclei, different from tenocytes. These cells expressed Runx2 and Sox9 suggesting a chondrocyte phenotype. On SO/FG staining, this peripheral area presented a red coloration (proteoglycan specific) as the fibrocartilage at the tendon attachment. However, collagen II clearly present in the fibrocartilage was not present in these areas. As pathological calcification in cartilage can be associated with chondrocytes apoptosis, we sought for anti-Caspase III expression in the cells of the peripheral area. None of the chondrocyte-like cells located around the larger calcifications expressed Caspase III. Finally, one sample had an osseous metaplasia within the tendon with Runx2 positive cells. Conclusions Histological analyses of whole calcified tendon tissues showed three different patterns of calcific deposits. We can hypothesize that these patterns correspond to different stages of the disease. Chondrocyte-like cells were observed around larger deposits and could be involved in the mineralization process. Interestingly, they differ from the cells of the fibrocartilage as they did not express collagen II. Further analyses are necessary to characterize their phenotype and understand the steps leading to these deposits within the tendon. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::c0852038f139c08a00415fb8ae37bdc2Test
https://doi.org/10.1136/annrheumdis-2017-eular.4682Test

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

المصدر: Poster Presentations.

مصطلحات موضوعية: medicine.medical_specialty, Health professionals, business.industry, Educational resources, Injection site, Physical therapy, Medicine, In patient, Risks and benefits, business, Asepsis, Guided learning, Video sharing

الوصف: Background Ultrasound (US) guided injections are becoming widespread in the treatment of rheumatic articular disorders. US allows a real time assessment of the needle progression and increase the accuracy of the injection. Video sharing platforms can be sources of information and learning material for healthcare professionals as for patients. Objectives We conducted this cross-sectional study to assess the quality of educational resources on US-guided articular and periarticular injections published on video sharing platforms. Methods YouTube, Dailymotion and Vimeo were searched using predefined keywords on US-guided shoulder, elbow, wrist, hand, hip, knee, ankle, and foot injections. The videos were classified according to their source. We determined the injection site and the explanations shown for each site. We collected information on patient positioning, equipment, needle, ultrasound settings and teaching material used by the author. When demonstration was performed live in patient, the compliance with the rules of asepsis and the accuracy of the injection were evaluated. Overall, videos were evaluated for quality on a 5-point ordinal global quality scale (GQS) (from 1 = poor quality to 5 = excellent quality). Results are given as median (min-max). Results We found 69979 results with the keywords. We screened 2802 videos by titles and included 153 videos (10.05 hours). Most of videos were published on Youtube (92.2%) and 82.4% included oral explanation. 53.6% videos were published by medical advertisement or profit companies and only 9.2% videos by university, professional organization or physician group. Among the 41.2% videos showing live demonstration of injection on the patient only 25.4% followed the strict rules of asepsis. When the videos included US cineloops of injection, 10.4% of them were outside the target. Very few videos gave details about information on the pathophysiology of the disease (6.5%), the risk (0.7%), the benefice (11.2%) or the products used for the injection (58.2%). Overall, 3.3% of the videos were classified as “Excellent quality” on the GQS, 24.2% as “Good quality”, 23.5% as “Moderate quality”, 34.6% as “Generally poor quality” and 14,4% “Poor quality”. We compared the characteristics of the good quality videos (GQS score ≥4) versus the one rated ≤3. Better quality videos were longer (1.3 min ((0.07–1.05) versus 3.62 (0.32–40.43) min), had oral explanation (95% versus 77%; p=0.008). They more frequently showed the clinical and US site of injection and accurately reached their target (90% versus 68%). They were significantly more viewed (m2719 (13–80195) versus 856 (11–60174); p=0.026) and more liked (1 (0–80) versus 7 (0–58) (p=0.002)). However, some poor quality videos had more than 60000 views. Quality of the video created by medical advertisement or profit companies were not different from those coming from university but significantly better than those from individual physician or with unknown origin (p=0.011). Conclusions Our study reveals a generally a low quality of US guided learning videos available on the most popular video sharing platforms. We observed a lack of information on the treatment, its risks and benefits. Strict aseptic techniques are rarely followed and the injection can be outside the target. Finally, we identified characteristics associated with the quality of the video that can be used to improve their educational impact in the future. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::bed6b10c6d68fb2591314ed60ded55aeTest
https://doi.org/10.1136/annrheumdis-2017-eular.6396Test

المؤلفون: B. Le Goff, Christelle Darrieutort-Laffite, D Huguet

المصدر: Poster Presentations.

مصطلحات موضوعية: musculoskeletal diseases, Subluxation, Pathology, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Ultrasound, Arthroscopy, musculoskeletal system, medicine.disease, Biceps, Tendon, medicine.anatomical_structure, Bicipital groove, Medicine, Rotator cuff, Radiology, Tendinopathy, business

الوصف: Background Disorders of the long head of the biceps brachii tendon (LHBt) are commonly recognized as a source of shoulder pain. Ultrasound (US) is thought to be of limited value in the diagnosis of partial-thickness tear and non-tear abnormalities of the LHBt because of the difficulty to assess its intra-articular proximal portion. Brasseur recently described that placing the arm in extension/external rotation increased LHBt intra-articular portion visibility. Objectives The goal of this study was to determine if the systematic assessment of the intra-articular portion of the tendon, from the rotator interval to its glenoid insertion, with the arm placed in extension/external rotation could increase US sensitivity. Methods This was a cross-sectional study. All patients referred for the treatment of a rotator cuff disease (rupture, tendinopathy, calcific deposit) with an available MRI were included. US was performed blinded from the results of the clinical or MRI using a Sonosite Edge with a 6–13 MHz probe. LHBt was studied at different level: in the bicipital groove, at the rotator interval, over the upper pole of the humerus head to its insertion on the superior glenoid tubercule. To increase the visibility of the proximal portion, we placed the arm in extension/external rotation as described by Brasseur [1]. Diagnosis of tendinopathy were tendon enlargement, hypoechogenicity and an increase in the interfibrillar distance. Subluxation or dislocation of the LHBt was defined as a partial or total loss of contact between the tendon and its groove. Tearing of tendon was defined as discontinuity or absence of tendon fibers. Fluid collection was defined as an anechoic ring around the tendon >2 mm. Abnormalities of the LBHt on MRI was retrieved from the report. LBHt abnormalities detected on arthroscopy were used as the gold standard. Results We included 129 patients, 57 female (44%), and mean age 54 years (33–73). Seventy-five (58%) had a rotator cuff tear and 54 (42%) a tendinopathy. Arthroscopy found LHBt pathological changes in 39% of the case. The summary of the findings obtained with MRI, US (distal and proximal) and arthroscopy are summarised in table 1. We calculated the sensitivity/specificity of MRI and US (at the proximal and distal level) in the detection of LHBt changes using arthroscopy as gold standard (Table 2). Conclusions US has a good specificity but a poor sensitivity in the detection of LHB tendon changes even when a systematic and carreful study of the proximal part of the tendon is undertaken. If detection of distal changes of the tendon in the inter-tubercular groove seems feasible with US, the involvement of the more proximal, intra-articular part of the tendon remains challenging. MRI sensitivity remains also poor. Overall, arthroscopy still remains the gold standard to detect LHB tendon intra-articular pathology. References Brasseur, The biceps tendons: from the top and from the bottom. Journal of ultrasound (2012) 15, 29–38. Disclosure of Interest None declared

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::054ead33d1d05137cd6dffd0a19438a2Test
https://doi.org/10.1136/annrheumdis-2017-eular.4468Test