📇 Rhumatologue · PARIS · (75) · Hospitalier
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Praticien-chercheur
7 articles scientifiques publiés — formation continue solide
Disponibilité géographique
2 lieux d'exercice — choisissez celui qui vous arrange
Délais de RDV courts dans la région
336.2 rhumatos / 100 000 hab. — département bien doté
✨ Génération du profil synthétique IA en cours…
CDS MEDICAL RAMSAY SANTE ATLAS
15 R DE L ATLAS, 75019 PARIS
CDS DE LA POLYCLINIQUE D AUBERVILLIERS
55 R HENRI BARBUSSE, 93300 AUBERVILLIERS
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Annals of the rheumatic diseases · 2022
Arthritis research & therapy · 2022
AbstractBackgroundMethotrexate is the preferred initial disease-modifying antirheumatic drug (DMARD) for rheumatoid arthritis (RA). However, clinically useful tools for individualized prediction of response to methotrexate treatment in patients with RA are lacking. We aimed to identify clinical predictors of response to methotrexate in patients with rheumatoid arthritis (RA) using machine learning methods.MethodsRandomized clinical trials (RCT) of patients with RA who were DMARD-naïve and randomized to placebo plus methotrexate were identified and accessed through the Clinical Study Data Request Consortium and Vivli Center for Global Clinical Research Data. Studies with available Disease Activity Score with 28-joint count and erythrocyte sedimentation rate (DAS28-ESR) at baseline and 12 and 24 weeks were included. Latent class modeling of methotrexate response was performed. The least absolute shrinkage and selection operator (LASSO) and random forests methods were used to identify predictors of response.ResultsA total of 775 patients from 4 RCTs were included (mean age 50 years, 80% female). Two distinct classes of patients were identified based on DAS28-ESR change over 24 weeks: “good responders” and “poor responders.” Baseline DAS28-ESR, anti-citrullinated protein antibody (ACPA), and Health Assessment Questionnaire (HAQ) score were the top predictors of good response using LASSO (area under the curve [AUC] 0.79) and random forests (AUC 0.68) in the external validation set. DAS28-ESR ≤ 7.4, ACPA positive, and HAQ ≤ 2 provided the highest likelihood of response. Among patients with 12-week DAS28-ESR > 3.2, ≥ 1 point improvement in DAS28-ESR baseline-to-12-week was predictive of achieving DAS28-ESR ≤ 3.2 at 24 weeks.ConclusionsWe have developed and externally validated a prediction model for response to methotrexate within 24 weeks in DMARD-naïve patients with RA, providing variably weighted clinical features and defined cutoffs for clinical decision-making.
The Journal of bone and joint surgery. American volume · 2022
Background: Modular fluted tapered (MFT) stems have advanced treatment of Vancouver B2 and B3 periprosthetic femoral fractures, but series to date have been limited with respect to cohort size and follow-up duration. The purpose of this study was to determine implant survivorship, radiographic results, complications, and clinical outcomes of Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems in a large series of patients. Methods: We identified 171 Vancouver B2 (109) and B3 (62) periprosthetic femoral fractures treated with an MFT stem between 2000 and 2018 using our institutional total joint registry. The mean age was 75 years, 50% were female, and the mean body mass index was 29 kg/m2. The median stem diameter was 18 mm and median stem length was 210 mm. The cumulative incidences of revision and reoperation with death as the competing risk were calculated, radiographs were reviewed, and clinical outcomes were evaluated using the Harris hip score (HHS). The mean follow-up was 5 years. Results: The 10-year cumulative incidence of any revision was 10%. There were 17 revisions, of which only 3 were for the distal fluted portion of the MFT stem. Revision indications included periprosthetic joint infection (PJI) (n = 6) and dislocation (n = 11). The 10-year cumulative incidence of any reoperation was 15%. In addition to the above 17 revisions, there were 7 reoperations for superficial wound complications (n = 4), Vancouver B1 periprosthetic femoral fracture (n = 1), vascular occlusion (n = 1), and acetabular cartilage degeneration requiring an acetabular component (n = 1). Radiographically, there was 1 fracture nonunion. All unrevised MFT stems were radiographically well fixed. Subsidence of ≥5 mm occurred in 11%, but all implants were stable at the most recent follow-up. The mean HHS was 75 at 2 years (n = 71). Conclusions: In this large series of 171 Vancouver B2 and B3 periprosthetic femoral fractures treated with MFT stems, we found that such constructs were associated with a high rate of fracture healing and provided extremely reliable and durable implant fixation, with no revisions for aseptic loosening. Dislocation and PJI were the most common complications. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Source PubMed · Recherche par auteur (homonymes possibles, vérifier l'affiliation).
Mayo Clinic proceedings · 2022 · Journal Article
Hocaoğlu M, Davis MDP, Osei-Onomah SA, Valenzuela-Almada MO, et al.
The Journal of rheumatology · 2022 · Journal Article
Chevet B, Figueroa-Parra G, Yang JX, Hulshizer CA, et al.
Annals of the rheumatic diseases · 2022 · Journal Article
Duarte-García A, Hocaoglu M, Valenzuela-Almada M, Osei-Onomah SA, et al.
The Journal of bone and joint surgery. American volume · 2022 · Journal Article
Hannon CP, Sheehan KP, Duong SQ, Yuan BJ, et al.
Journal of Alzheimer's disease : JAD · 2022 · Journal Article
Vassilaki M, Crowson CS, Davis Iii JM, Duong SQ, et al.
Journal of clinical microbiology · 2014 · Case Reports
Westblade LF, Shams F, Duong S, Tariq O, et al.
Arthritis research & therapy · 2022 · Journal Article
Duong SQ, Crowson CS, Athreya A, Atkinson EJ, et al.
Arthritis research & therapy · 2022 · Journal Article
Duong SQ, Crowson CS, Athreya A, Atkinson EJ, et al.