Publications by authors named "Gilles Avenel"

10 Publications

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Microbiological diagnosis of suspected vertebral osteomyelitis with a focus on the yield of percutaneous needle biopsy: a 10-year cohort study.

Eur J Clin Microbiol Infect Dis 2021 Feb 8;40(2):297-302. Epub 2020 Sep 8.

Department of Rheumatology, Rouen University Hospital, F-76000, Rouen, France.

This study aims to evaluate in patients hospitalized for vertebral osteomyelitis (VO) the effectiveness of bacteriological diagnosis and the yield of percutaneous needle biopsy (PNB) and to identify factors associated with the result of PNB. This retrospective, two-centre study was conducted between 2000 and 2009. Data on patients with VO were retrieved from the diagnosis database and confirmed by checking medical records. A total of 300 patients with VO were identified; 31 received antibiotics without bacteriological diagnosis, and 269 patients with spondylodiscitis imaging were included. Eighty-three (30.9%) and 18 (6.7%) infections were documented by blood cultures and by bacteriological samples other than PNB, respectively; 168 patients with no bacteriological diagnosis had PNB. Of these, 92 (54.8%) were positive and identified the pathogen and 76 (45.2%) were negative. The most common bacteria were Staphylococcus aureus (34.3%), Streptococcus spp. (20.6%) and coagulase-negative staphylococcus (14.8%). After multivariate analysis, the only factor associated with negative PNB was previous antibiotic intake (OR: 2.31 [1.07-5.00]). When VO was suspected on imaging, bacteriological investigation identified the microorganism in 209/300 (70%) of the cases. The yield of PNB was 54.8%. The only predictor of PNB negativity was previous antibiotic intake. Therefore, we believe that a second PNB should be done after a sufficient delay withdrawal of antibiotics if the first sample was negative. The study was retrospectively registered by the local ethics committee (N°E2019-61).
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http://dx.doi.org/10.1007/s10096-020-04022-3DOI Listing
February 2021

Relapse in rheumatoid arthritis patients undergoing dose reduction and withdrawal of biologics: are predictable factors more relevant than predictive parameters? An observational prospective real-life study.

BMJ Open 2019 12 18;9(12):e031467. Epub 2019 Dec 18.

Rouen University Hospital, Department of Rheumatology, Rouen, France.

Objective: To determine predictive/predictable factors of relapse in rheumatoid arthritis (RA) patients undergoing biologic Disease-Modifying Anti-Rheumatic Drugs (bDMARDs) dose reduction/discontinuation.

Patients And Methods: RA patients receiving the same bDMARD for more than 1 year, in Simplified Disease Activity Index (SDAI) remission, were selected in an observational monocentric real-life study. The 18-month follow-up included spacing (6 months) and withdrawal (12 months) periods of bDMARD. Clinical, biological and ultrasonographic (US) parameters were collected regularly. Relapse was defined by SDAI>11.

Results: Fifty-three RA patients (mean age: 58 years; 72% women; median duration: 11 years) were enrolled. Forty-two received anti-cytokinic bDMARD targeting tumour necrosis factor (n=39) or interleukin-6R (n=3) and 11 were treated by abatacept. The number of relapses during the spacing and discontinuation periods were 19 and 20, respectively. After 18 months of follow-up, among the 53 patients, 12 maintained bDMARD-free remission, 39 had relapsed and 2 were lost of follow-up. Median time to relapse was 11.8 months. In multivariate analysis, baseline factors predictive of relapse were corticosteroid intake, female gender, longer disease duration and no methotrexate intake with bDMARD. Concerning the survival analysis, also taking into account the factors of predictability, the main risk factor of relapse after discontinuation was an increase of SDAI >0 during the spacing period (p=0.03). US findings were not contributive.

Conclusion: In the context of RA in remission under bDMARDs, variation of SDAI during the dose-reduction phase is more relevant than baseline parameters to predict success of drug withdrawal.
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http://dx.doi.org/10.1136/bmjopen-2019-031467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937076PMC
December 2019

Impact of assessment of bone status before corrective surgery of lumbar spine in patients over 50 years old.

Open Access Rheumatol 2019 6;11:111-115. Epub 2019 May 6.

Rheumatology Department, Rouen University Hospital, 76000 Rouen, France.

There is absence of data on the prevalence of osteoporosis before corrective surgery of the lumbar spine. We do not know the impact of bone assessment before corrective spine surgery, regarding the prevalence of osteoporosis, risk factors for osteoporosis, and prescription of osteoporotic treatment. Our objective was to evaluate the impact of assessment of bone status before corrective surgery of the lumbar spine. This retrospective study was conducted over a period of 30 months. Patients included were over 50 years old and had been referred to rheumatology consultation prior to corrective surgery of the lumbar spine with osteosynthesis, for scoliosis or spondylolisthesis. Assessment of bone status consisted in looking for risk factors for osteoporotic fracture, performing bone densitometry with the calculation of TBS (trabecular bone score) and the possible introduction of treatment for osteoporosis. Data were collected on complications related to bone fragility during follow-up. Twenty-eight patients with a median age of 71.2 years (55.5-84.8) were included; 89% were women. T score was <-2.5 in 14.3% (4/28) and -1 to -2.5 in 42.9% (12/28) on at least one of the three sites analyzed. Fifty percent of patients had a TBS <1.2, a history of more than four falls per year, a duration of more than 20 s in the Timed Up and Go Test, and/or sedation treatment. Vitamin-calcium supplementation and treatment for osteoporosis were prescribed in 71.4% and 17.8% of cases, respectively. During follow-up, 3 patients had one or more osteoporotic vertebral fractures and 4 patients had loosening of implanted devices. Despite a low prevalence of densitometric osteoporosis and therapeutic management, one in four patients had a bone complication, suggesting the superiority of TBS as an indicator of bone status.
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http://dx.doi.org/10.2147/OARRR.S197218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510387PMC
May 2019

Impact of ACR 2010 fibromyalgia criteria fulfillment on disease activity evaluation in patients with axial spondyloarthritis treated with infliximab.

Joint Bone Spine 2019 01 20;86(1):113-114. Epub 2018 Apr 20.

Department of rheumatology, Rouen University Hospital Charles-Nicolle, CHU de Rouen, 1, rue de Germont, 76000 Rouen, France; Inserm U905, CIC/CRB 1404, 76000 Rouen, France; Department of rheumatology, Elbeuf-Louviers-Val-de-Reuil Hospital, 76503 Saint-Aubin-lès-Elbeuf, France.

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http://dx.doi.org/10.1016/j.jbspin.2018.04.001DOI Listing
January 2019

Soluble alpha-enolase activates monocytes by CD14-dependent TLR4 signalling pathway and exhibits a dual function.

Sci Rep 2016 Mar 30;6:23796. Epub 2016 Mar 30.

INSERM, U905 &Normandy University, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.

Rheumatoid arthritis (RA) is the most common form of chronic inflammatory rheumatism. Identifying auto-antigens targeted by RA auto-antibodies is of major interest. Alpha-enolase (ENO1) is considered to be a pivotal auto-antigen in early RA but its pathophysiologic role remains unknown. The main objective of this study was to investigate the in vitro effects of soluble ENO1 on peripheral blood mononuclear cells (PBMC) from healthy donors and RA patients in order to determine the potential pathogenic role of ENO1. ELISA, transcriptomic analysis, experiments of receptor inhibition and flow cytometry analysis were performed to determine the effect, the target cell population and the receptor of ENO1. We showed that ENO1 has the ability to induce early production of pro-inflammatory cytokines and chemokines with delayed production of IL-10 and to activate the innate immune system. We demonstrated that ENO1 binds mainly to monocytes and activates the CD14-dependent TLR4 pathway both in healthy subjects and in RA patients. Our results establish for the first time that ENO1 is able to activate in vitro the CD14-dependent TLR4 pathway on monocytes involving a dual mechanism firstly pro-inflammatory and secondly anti-inflammatory. These results contribute to elucidating the role of this auto-antigen in the pathophysiologic mechanisms of RA.
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http://dx.doi.org/10.1038/srep23796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824496PMC
March 2016

Prophylactic Injection of Recombinant Alpha-Enolase Reduces Arthritis Severity in the Collagen-Induced Arthritis Mice Model.

PLoS One 2015 24;10(8):e0136359. Epub 2015 Aug 24.

INSERM, U905, Rouen, France; Normandy University, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France; Rouen University Hospital, Department of Rheumatology, Rouen, France.

Objective: To evaluate the ability of the glycolytic enzyme alpha-enolase (ENO1) or its immunodominant peptide (pEP1) to reduce the severity of CIA in DBA/1 mice when injected in a prophylactic way.

Methods: Mice were treated with mouse ENO1 or pEP1 one day prior to collagen II immunization. Clinical assessment was evaluated using 4 parameters (global and articular scores, ankle thickness and weight). Titers of serum anti-ENO1, anti-cyclic citrullinated peptides (anti-CCP) and anti-CII (total IgG and IgG1/IgG2a isotypes) antibodies were measured by ELISA at different time-points. Disease activity was assessed by histological analysis of both anterior and hind paws at the end of experimentation.

Results: Prophylactic injection of 100 μg of ENO1 reduced severity of CIA. Serum levels of anti-CII antibodies were reduced in ENO1-treated mice. Concordantly, ENO1-treated mice joints presented less severe histological signs of arthritis. ENO1 did not induce a shift toward a Th2 response since IgG1/IgG2a ratio of anti-CII antibodies remained unchanged and IL-4 serum levels were similar to those measured in the control group.

Conclusions: Pre-immunization with ENO1 or its immunodominant peptide pEP1 reduces CIA severity at the clinical, immunological and histological levels. Effects of pEP1 were less pronounced. This immunomodulatory effect is associated with a reduction in anti-CII antibodies production but is not due to a Th1/Th2 shift.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136359PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547710PMC
May 2016

Occurrence of Sweet syndrome under anti-TNF.

Clin Rheumatol 2015 Nov 21;34(11):1993-4. Epub 2015 Aug 21.

Department of Rheumatology, CHU de Rouen, Hôpitaux de Rouen, Inserm U905, University of Rouen, 147 avenue du Maréchal Juin, 76230, Bois-Guillaume, Rouen, France.

We report the occurrence of Sweet's syndrome in a patient treated with adalimumab for Crohn's disease. The imputability of adalimumab is at issue.
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http://dx.doi.org/10.1007/s10067-015-3054-3DOI Listing
November 2015

Arthritis due to metastasis.

Joint Bone Spine 2015 Jan 22;82(1):66-7. Epub 2014 Sep 22.

Rhumatologie & Inserm, U905 (I.R.I.B.) CIC 1404, CHU Hôpitaux de Rouen, 1, rue de Germont, 76031 Rouen cedex 1, France.

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http://dx.doi.org/10.1016/j.jbspin.2014.07.004DOI Listing
January 2015

Paradoxical adverse events of anti-tumour necrosis factor therapy for spondyloarthropathies: a retrospective study.

Rheumatology (Oxford) 2009 Jul 24;48(7):761-4. Epub 2009 Apr 24.

Department of Pharmacy, University of Medicine-Pharmacy, Rouen University Hospital and Inserm U905 (IFRMP 23), Institute for Biomedical Research, University of Rouen, Rouen,France.

Objectives: Several paradoxical adverse events (PAEs), e.g. IBDs, acute anterior uveitis (AAU) and psoriasis, have been described in patients taking anti-TNF drugs. This retrospective study aimed to describe the different PAEs that have occurred in a population of SpA patients treated with anti-TNF drugs, and to determine whether they are drug specific.

Methods: Since 2000, we have followed 296 patients with SpA [198 AS, 21 SpA associated with IBD (9 ulcerative colitis, 12 Crohn's disease) and 77 psoriatic arthritis] treated with at least one anti-TNF drug (infliximab, etanercept or adalimumab), and 112 SpA patients treated only with conventional DMARDs who served as controls. Considering the cumulative time of exposure to each anti-TNF agent, the frequencies of new-onset PAEs in exposed patients were calculated.

Results: Respective cumulative exposure times were 287, 290 and 62 patient-years for infliximab, etanercept and adalimumab. We observed the following PAEs: five psoriasis (three under infliximab and one with etanercept or adalimumab), three AAU (1/100 patient-years, all under etanercept) and four IBD (three under etanercept and one under infliximab). There was no significant association among any of these PAEs and a specific anti-TNF agent; nor significant difference in the overall PAEs among patients receiving anti-TNF drugs or controls (P = 0.303), the latter experiencing two psoriasis and three AAU.

Conclusions: Undesirable side effects--IBD, AAU and psoriasis--may appear with anti-TNF drugs. Even if they are, a priori, paradoxical, no evidence supports any PAEs to be anti-TNF agent-specific in SpA.
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http://dx.doi.org/10.1093/rheumatology/kep083DOI Listing
July 2009

Atypical forms of syphilis: two cases.

Joint Bone Spine 2009 May 16;76(3):293-5. Epub 2009 Mar 16.

Service de Rhumatologie, CHU-Hôpitaux de Rouen, & Inserm, U905, IFRMP23, Institut de Biologie Clinique, Rouen, France.

Syphilis is a sexually transmitted disease caused by the spirochete Treponema pallidum. A chancre usually develops initially. Organ involvement and neurological complications may occur, sometimes several years after the initial exposure. We managed two patients with syphilis responsible for joint or neurological manifestations, diagnosed in 2008. One patient presented with oligoarthritis involving the knees and right elbow, coinciding with a maculopapular and pustular eruption. In the other patient, meningoradiculitis involving the T8, T9, and T10 metameres prompted a test for Lyme disease, which was weakly positive, leading to evaluation for false-positivity due to a cross-reaction. Neither patient was infected with the HIV.
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http://dx.doi.org/10.1016/j.jbspin.2008.10.012DOI Listing
May 2009