Saga de la découverte de l’IL-1 et du TNF et de leurs inhibiteurs spécifiques dans la pathogénie et dans le traitement de la polyarthrite rhumatoïde

In the seventies, the molecule subsequently termed IL-1 was among the first cytokines to attract the attention of rheumatologists due to its biological role in tissue destruction and bone resorption. In the mid-eighties, cachectin/tumor necrosis factor was found to share some of these biological activities, and a strong synergism between the two cytokines became evident. While IL-1 appeared to be more important at the local level, TNF played a more prominent part at the systemic level. In 1984, we became aware of the existence of an antagonist to IL-1 - subsequently termed IL-1Ra (interleukin-1 receptor antagonist) - in urine of febrile patients; its mechanism of action was elucidated in 1987 and the molecule cloned in 1990. The natural inhibitors of TNF were identified in 1996/97 by different investigators and proved to be soluble fragments of the TNF receptor. A concept, commonly accepted at present, is that disease activity and clinical outcome are controlled by the balance between agonistic and antagonistic cytokines, and at present the principal goal is to understand the underlying mechanisms. This concept is illustrated by observations in numerous animal models. The control of IL-1 and TNF is strongly dependent on the contact between activated lymphocytes and monocytes, the main source of these cytokines. Inhibiting this interaction by interfering with ligand and counter-ligand may be a useful approach if it is possible to maintain the production of the cytokine antagonist. Apolipoproteins A-I and A-II as well as β2-integrins are molecules that block ligand/counterligand interaction. According to animal experiments and clinical data, blocking either IL-1 or TNF, or both, is beneficial. However, to determine not only the benefit but also the side effects of combination therapy in the human system, long-term clinical trials will be required.     

Efficacité des infiltrations péridurales de corticoïdes par voie périradiculaire ou interépineuse dans le traitement des sciatiques discales. Étude pilote prospective,randomisée,et à double insu

Study objectives. Pilot study comparing the short-term efficacy on pain and functional impairment of nerve root sheath versus interspinous glucocorticoid injections in patients admitted to a French rheumatology department for disk-related sciatica or femoral neuralgia. Patients and methods. Thirty patients with refractory nerve root pain (sciatica, n = 29; femoral neuralgia, n = 1) for a mean of four months were randomized to nerve root injection (n = 17) or interspinous injection (n = 13) of the same mixture of 0.10 g of lidocaine hydrochloride and 3.75 mg of cortivazol. Both injection methods were performed under analgesia and benzodiazepine sedation to maintain double blinding. Each patient was evaluated daily during the first seven days of bed rest in the hospital, then after discharge on postinjection day 28. Results. Prompt pain relief was obtained in both groups. On day 1, the mean pain scale score (0–100) fell from 70 ± 3.9 to 26 ± 5.6 in the nerve root group and from 63 ± 4 to 23 ± 4.7 in the interspinous group. These results were sustained on D7 and D28. Conclusions. The unusually high level of efficacy of glucocorticoid injection in our study may be ascribable in part to strong placebo and Hawthorne effects and in part to the intrinsic effects of the injections. Whether nerve root injection is superior over interspinous injection remains unproven.     

L’harpagophyton dans le traitement de la gonarthrose et de la coxarthrose.Résultats à quatre mois d’une étude prospective multicentrique,contrôlée en double aveugle,versus diacerhéine

Objective. To evaluate the efficacy and safety of harpagophyton in the treatment of hip and knee osteoarthritis comparatively with a slow-acting drug for osteoarthritis (diacerhein). Patients and methods. A multicenter, randomized, double-blind, parallel-group study was conducted in 122 patients with hip and/or knee osteoarthritis. Treatment duration was four months and the primary evaluation criterion was the pain score on a visual analog scale. Harpagophyton, 2610 mg per day, was compared to diacerhein, 100 mg per day. Results. At completion of the four-month treatment period, major improvements in osteoarthritis symptoms were noted in both groups, with no significant differences for the pain score, functional disability, or Lequesne’s score. Significant decreases in the use of analgesics (acetaminophen with caffeine) and nonsteroidal antiinflammatory medication (diclofenac) were seen in the harpagophyton group as compared with the diacerhein group. Adverse effects were significantly less common in the harpagophyton group. Conclusion. These data demonstrate that harpagophyton was at least as effective as the reference agent (diacerhein) in treating knee or hip osteoarthritis and decreased the need for analgesic and nonsteroidal antiinflammatory therapy.     

Analyse du risque infectieux autour du patient dans l’unité d’hémodialyse de l’hôpital Ibn Sina de Rabat par application de la méthode d’analyse des modes de défaillance,de leurs effets et de leur criticité

IntroductionHemodialysis is a technique of extra-renal purification associated with high level of risk. The objective is to assess infectious risk during a hemodialysis session on hygiene around the patient in hospital.MethodsAn a priori risk assessment by Failure Modes, Effects and Criticality Analysis method (FMECA) was carried out from May to August 2018, in order to overview infectious risk during the process of hemodialysis in the Ibn Sina Hospital (Rabat, Morocco).ResultsTwenty eight failure modes were identified during the hemodialysis process around the patient: fourteen criticality level 1, ten level 2, and four level 3. A prevention plan has been drafted. Three of the four level 3 failure modes were reduced to level 1 and one to level 2.DiscussionFMECA have enabled us to identify the potential risks, to reconsider certain procedures and to suggest measure matrix for the coverage of the most critical risks.ConclusionThis analysis makes it possible, through periodic evaluations, to enter a real quality approach, which reinforces the satisfaction of the patients as well as all the actors of the hemodialysis center.