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Yelnik CM, Xie X, Guerra MM, Costedoat-Chalumeau N, Khosroshahi A, Kamen DL, Schwartz N, Katz P, Minett M, Amoss RT, Fu A, Guettrot-Imbert G, Lazaro E, Le Guern V, Oates J, Dall'Era M, Yazdany J, Molto A, Kim MY, Salmon JE. Prevalence of clinically meaningful antiphospholipid antibodies in patients with systemic lupus erythematosus varies by race and ethnicity. Ann Rheum Dis 2024; 83:404-406. [PMID: 37875285 PMCID: PMC10922457 DOI: 10.1136/ard-2023-224952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Cécile M Yelnik
- Département de Médecine Interne et d'Immunologie Clinique, Universite de Lille, Lille, France
| | - Xianhong Xie
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Marta M Guerra
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Cochin Hospital, Paris, France
- ECAMO Team (INSERM U-1153), CRESS - Université Paris Cité, Paris, France
| | - Arezou Khosroshahi
- Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - Diane L Kamen
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Noa Schwartz
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Patricia Katz
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Margaret Minett
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - R Toby Amoss
- Lowance Center for Human Immunology, Emory University, Atlanta, Georgia, USA
| | - April Fu
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Estibaliz Lazaro
- Department of Internal Medicine, Haut Lévêque Hospital, Bordeaux, France
- ImmunoconcEpT Lab, Bordeaux University, Bordeaux, France
| | | | - Jim Oates
- Division of Rheumatology and Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maria Dall'Era
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Jinoos Yazdany
- Department of Medicine/Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Anna Molto
- ECAMO Team (INSERM U-1153), CRESS - Université Paris Cité, Paris, France
- Department of Rheumatology, Cochin Hospital, Paris, France
| | - Mimi Y Kim
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jane E Salmon
- Department of Medicine/Rheumatology, Hospital for Special Surgery, New York, New York, USA
- Department of Medicine, Weill Cornell Medicine, New York, New York, USA
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2
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Zuily S, Lefèvre B, Sanchez O, Empis de Vendin O, de Ciancio G, Arlet JB, Khider L, Terriat B, Greigert H, Robert CS, Louis G, Trinh-Duc A, Rispal P, Accassat S, Thiery G, Montani D, Azarian R, Meneveau N, Soudet S, Le Mao R, Maurier F, Le Moing V, Quéré I, Yelnik CM, Lefebvre N, Martinot M, Delrue M, Benhamou Y, Parent F, Roy PM, Presles E, Goehringer F, Mismetti P, Bertoletti L, Rossignol P, Couturaud F, Wahl D, Thilly N, Laporte S. Effect of weight-adjusted intermediate-dose versus fixed-dose prophylactic anticoagulation with low-molecular-weight heparin on venous thromboembolism among noncritically and critically ill patients with COVID-19: the COVI-DOSE trial, a multicenter, randomised, open-label, phase 4 trial. EClinicalMedicine 2023; 60:102031. [PMID: 37350990 PMCID: PMC10250778 DOI: 10.1016/j.eclinm.2023.102031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 06/24/2023] Open
Abstract
Background Venous thromboembolism is a major complication of coronavirus disease 2019 (COVID-19). We hypothesized that a weight-adjusted intermediate dose of anticoagulation may decrease the risk of venous thromboembolism COVID-19 patients. Methods In this multicenter, randomised, open-label, phase 4, superiority trial with blinded adjudication of outcomes, we randomly assigned adult patients hospitalised in 20 French centers and presenting with acute respiratory SARS-CoV-2. Eligible patients were randomly assigned (1:1 ratio) to receive an intermediate weight-adjusted prophylactic dose or a fixed-dose of subcutaneous low-molecular-weight heparin during the hospital stay. The primary outcome corresponded to symptomatic deep-vein thrombosis (fatal) pulmonary embolism during hospitalization (COVI-DOSE ClinicalTrials.gov number: NCT04373707). Findings Between May 2020, and April 2021, 1000 patients underwent randomisation in medical wards (noncritically ill) (80.1%) and intensive care units (critically ill) (19.9%); 502 patients were assigned to receive a weight-adjusted intermediate dose, and 498 received fixed-dose thromboprophylaxis. Symptomatic venous thromboembolism occurred in 6 of 502 patients (1.2%) in the weight-adjusted dose group and in 10 of 498 patients (2.1%) in the fixed-dose group (subdistribution hazard ratio, 0.59; 95% CI, 0.22-1.63; P = 0.31). There was a twofold increased risk of major or clinically relevant nonmajor bleeding: 5.9% in the weight-adjusted dose group and 3.1% in the fixed-dose group (P = 0.034). Interpretation In the COVI-DOSE trial, the observed rate of thromboembolic events was lower than expected in patients hospitalized for COVID-19 infection, and the study was unable to show a significant difference in the risk of venous thromboembolism between the two low-molecular-weight-heparin regimens. Funding French Ministry of Health, CAPNET, Grand-Est Region, Grand-Nancy Métropole.
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Affiliation(s)
- Stéphane Zuily
- Vascular Medicine Division, Université de Lorraine, CHRU-Nancy, Rare Vascular and Systemic Autoimmune Diseases Regional Referral Center, France
- Inserm, UMR 1116 DCAC, F-54000 Nancy, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
| | - Benjamin Lefèvre
- Department of Infectious and Tropical Diseases, Université de Lorraine, CHRU-Nancy, APEMAC, F-54000 Nancy, France
| | - Olivier Sanchez
- Department of Respiratory and Intensive Care Medicine, Université Paris Cité, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- Inserm, Innovative Therapies in Haemostasis, Paris, France
| | | | | | - Jean-Benoît Arlet
- Internal Medicine Department, AP-HP, Hôpital Européen Georges Pompidou, APHP, F-75015 Paris, France
| | - Lina Khider
- Vascular Medicine Department, Université de Paris, AP-HP, Hôpital Européen Georges Pompidou, F-75015 Paris, France
| | - Béatrice Terriat
- Department of Vascular Medicine and Angiology, Dijon University Hospital, F-21000 Dijon, France
| | - Hélène Greigert
- Department of Vascular Medicine and Angiology, Dijon University Hospital, F-21000 Dijon, France
| | - Céline S Robert
- Department of Infectious Diseases, CHR Metz-Thionville, F-57000 Metz, France
| | - Guillaume Louis
- Intensive Care Unit, CHR Metz-Thionville, F-57000 Metz, France
| | - Albert Trinh-Duc
- Internal Medicine Department, CH St Esprit, F-47000 Agen, France
| | - Patrick Rispal
- Internal Medicine Department, CH St Esprit, F-47000 Agen, France
| | - Sandrine Accassat
- Department of Vascular Medicine, CHU Saint-Etienne, F-42000 Saint-Etienne, France
| | - Guillaume Thiery
- Medical Intensive Care Unit, CHU Saint-Etienne, F-42000 Saint-Etienne, France
| | - David Montani
- Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Pulmonary Hypertension National Referral Center, F-94270 Le Kremlin-Bicêtre, France
| | - Réza Azarian
- Department of Respiratory Medicine, CH Versailles, F-78150 Le Chesnay, France
| | - Nicolas Meneveau
- Department of Cardiology, Université de Franche-Comté, CHU Jean Minjoz, EA 3929, F-25000 Besancon, France
| | - Simon Soudet
- Department of Vascular Medicine, CHU Amiens-Picardie, F-80000 Amiens, France
| | - Raphaël Le Mao
- Department of Internal Medicine, Vascular Medicine and Pulmonology, CHU Brest, F-29200 Brest, France
| | - François Maurier
- Department of Internal Medicine, UNEOS, F-57070 Metz-Vantoux, France
| | - Vincent Le Moing
- Department of Infectious and Tropical Diseases, CHRU Montpellier, F-34000 Montpellier, France
| | - Isabelle Quéré
- Department of Vascular Medicine, CHU Montpellier, IDESP, F-34000 Montpellier, France
| | - Cécile M Yelnik
- Department of Internal Medicine and Clinical Immunology, Université de Lille, CHU Lille, Inserm UMR 1167, North and North-West Systemic and Autoimmune Disease National Referral Center (CeRAINO), F-59000 Lille, France
| | - Nicolas Lefebvre
- Department of Tropical and Infectious Diseases, Hôpitaux Universitaires de Strasbourg, F-67000 Strasbourg, France
| | - Martin Martinot
- Department of Tropical and Infectious Diseases, Hôpitaux Civils de Colmar, F-68000 Colmar, France
| | - Maxime Delrue
- Hematology Laboratory and Thrombosis Unit, Lariboisière Hospital, APHP, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Université, Université de Rouen Normandie, Inserm UMR 1096, F-76000 Rouen, France
| | - Florence Parent
- Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, AP-HP, Hôpital Bicêtre, Pulmonary Hypertension National Referral Center, F-94270 Le Kremlin-Bicêtre, France
| | - Pierre-Marie Roy
- Department of Emergency Medicine, Université d'Angers, CHU Angers, F-49000 Angers, France
| | - Emilie Presles
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, France
| | - François Goehringer
- Department of Infectious and Tropical Diseases, CHRU-Nancy, F-54000 Nancy, France
| | - Patrick Mismetti
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, Service de Médecine Vasculaire et Thérapeutique, France
| | - Laurent Bertoletti
- Université Jean Monnet, Inserm, CIC-1408, CHU Saint-Etienne, Service de Médecine Vasculaire et Thérapeutique, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
| | - Patrick Rossignol
- Université de Lorraine, Inserm, CIC-P 1433, CHRU-Nancy, Inserm UMR 1116, F-CRIN INI-CRCT, F-54000 Nancy, France
- Department of Medical Specialties and Nephrology-Hemodialysis, Princess Grace Hospital, and Centre d'Hémodialyse Privé de Monaco, Monaco
| | - Francis Couturaud
- Department of Internal Medicine and Chest Diseases, Université de Bretagne Occidentale, CHU Brest, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- Inserm UMR 1304 GETBO, F-29200 Brest, France
| | - Denis Wahl
- Vascular Medicine Division, Université de Lorraine, CHRU-Nancy, Rare Vascular and Systemic Autoimmune Diseases Regional Referral Center, France
| | - Nathalie Thilly
- Département Méthodologie, Promotion, Investigation, Université de Lorraine, CHRU-Nancy, APEMAC, , F-54000 Nancy, France
| | - Silvy Laporte
- Université Jean Monnet, Inserm, U1059 SAINBIOSE, France
- F-CRIN INNOVTE Network, F-42000 Saint-Etienne, France
- CHU Saint-Etienne, Unité de Recherche Clinique, Innovation, Pharmacologie, France
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Nguyen Y, Yelnik CM, Morel N, Paule R, Stammler R, Plaçais L, Sacré K, Godeau B, Maillard H, Launay D, Morell-Dubois S, Dupré A, Lefèvre G, Devloo C, Dufrost V, Benhamou Y, Levesque H, Leroux G, Piette JC, Mouthon L, Hachulla É, Lambert M, Guern VL, Costedoat-Chalumeau N. Determination of four homogeneous subgroups of patients with antiphospholipid syndrome: a cluster analysis based on 509 cases. Rheumatology (Oxford) 2022:6747168. [PMID: 36190346 DOI: 10.1093/rheumatology/keac548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Antiphospholipid syndrome (APS) is a heterogeneous disease with different phenotypes. Using an unsupervised hierarchical cluster analysis, we aimed to determine distinct homogeneous phenotypes among APS patients. METHODS We performed an observational, retrospective study of APS patients enrolled in the French multicentre 'APS and SLE' registry who meet the Sydney classification criteria. The clustering process involved an unsupervised multiple correspondence analysis followed by a hierarchical ascendant clustering analysis; it used 27 variables selected to cover a broad range of APS clinical and laboratory manifestations. RESULTS These analyses included 509 patients, mainly women (77.8%). Mean (± SD) age at APS diagnosis was 36.2 ± 14.6 years, and mean follow-up since diagnosis 10.3 ± 8.5 years. This hierarchical classification cluster analysis yielded four homogeneous groups of patients: cluster 1, mostly with venous thromboembolism without any associated autoimmune disease; cluster 2, older, lowest proportion of women, history of arterial events, and/or with migraines, arterial hypertension, diabetes mellitus, or dyslipidaemia; cluster 3, younger, highest proportion of women, associated SLE or other autoimmune diseases, and a history of venous thromboembolism or pregnancy morbidity; and cluster 4, mainly with a history of catastrophic antiphospholipid syndrome, aPL-associated nephropathy, and pregnancy morbidity, with frequent triple positivity and more deaths (16.7%). CONCLUSIONS Our study applied an unsupervised clustering method to distinguish four homogeneous APS patient subgroups that were predominantly venous; arterial; associated with SLE or another autoimmune disease; and arterial microthrombotic. Heterogeneous pathophysiological mechanisms may explain these findings.
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Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
| | - Cécile M Yelnik
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Nathalie Morel
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Romain Stammler
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Léo Plaçais
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Karim Sacré
- Department of Internal Medicine, Hôpital Bichat, AP-HP Nord, Université de Paris, Paris, France
| | - Bertrand Godeau
- Department of Internal Medicine, Hôpital Mondor, AP-HP, Université de Paris-Est Créteil, Créteil, France
| | - Hélène Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Sandrine Morell-Dubois
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Anastasia Dupré
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Guillaume Lefèvre
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Cécile Devloo
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Virginie Dufrost
- Department of Internal Medicine, CHU de Rouen, UniRouen, Inserm, U1096, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Luc Mouthon
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Marc Lambert
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
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4
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Yelnik CM, Martin C, Ledoult E, Sanges S, Sobanski V, Farhat M, Morell-Dubois S, Maillard H, Drumez E, Launay D, Hachulla E, Lambert M. Dyslipidemia is insufficiently treated in antiphospholipid syndrome patients. Lupus 2022; 31:1379-1384. [PMID: 35822929 DOI: 10.1177/09612033221114275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although dyslipidemia is a strong risk factor for thrombosis in antiphospholipid syndrome (APS), it has been poorly studied. This study aimed to assess lipids profile and risk factors for unachieved cholesterol levels in a real-life APS population. METHODS Inclusion criteria were: APS diagnosis according to international classification criteria, referring to the out-patients clinic of our tertiary care center for their follow-up, and having a blood sample collection for lipids levels determination. Cholesterol level targets for each patient were defined according to 2019 ESC/EAS guidelines for the management of dyslipidemia. RESULTS Between January 2020 and April 2021, 114 APS patients were included (male 37 (32.5%); mean age 49 ± 14 years). Among them, 40 (35.1%) had a history of dyslipidemia, 48 (42.1%) were under lipid-lowering therapies, and 59 (51.8%) had a history of cardiovascular disease (CVD). Mean levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride were, respectively, 110 ± 40 mg/dL, 60±20 mg/dL, and 120 (80-190) mg/dL. Unachieved LDL-C levels were found in 77 (67.5%) patients of whom 53 had history of CVD. Overall, 90 (78.9%) had protective HDL-C and 31 (27.2%) had hypertriglyceridemia. In the multivariate analysis, independent risk factors for unachieved LDL-C levels were older age and history of CVD; triple aPL negativity, defined as complete disappearance of aPL over time in APS patients who were previously positive in accordance to international criteria, was an independent protective factor for unachieved LDL-C. CONCLUSION Our finding suggested that dyslipidemia is frequent in APS patients and mainly insufficiently treated, especially in patients with history of CVD, who are at highest risk of future CV events.
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Affiliation(s)
- Cécile M Yelnik
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, UMR 1167, RID-AGE, Lille, France
| | - Claire Martin
- 27023University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Emmanuel Ledoult
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Sébastien Sanges
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Vincent Sobanski
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Meryem Farhat
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Sandrine Morell-Dubois
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France
| | - Hélène Maillard
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France
| | - Elodie Drumez
- 27023University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - David Launay
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Eric Hachulla
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Marc Lambert
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, UMR 1167, RID-AGE, Lille, France
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5
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Morel N, Bonnet C, Mehawej H, Le Guern V, Pérard L, Roumier M, Brezin A, Godeau B, Haroche J, Benhamou Y, Lambert M, Yelnik CM, Maillard N, Bodaghi B, Piette JC, Costedoat-Chalumeau N. CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME AND POSTERIOR OCULAR INVOLVEMENT: Case Series of 11 Patients and Literature Review. Retina 2021; 41:2332-2341. [PMID: 33840791 DOI: 10.1097/iae.0000000000003185] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome. METHODS Retrospective case series of patients presenting with catastrophic antiphospholipid syndrome and posterior segment ocular manifestations. The main outcomes were the type of posterior segment manifestations at catastrophic antiphospholipid syndrome diagnosis, specifically retinal vascular occlusion, vasculitis, or choroidopathy, and the final best-corrected visual acuity. RESULTS This study included 23 patients (11 cases treated by the authors and 12 published case reports); 21 (91%) of them female. Their median age at diagnosis was 28 years (range, 16-79 years). Ophthalmologic manifestations were usually bilateral (n = 19, 83%) and involved vascular occlusive retinopathy (n = 17, 74%), choroidopathy (n = 11, 48%), or retinal vasculitis (n = 1, 4%). Final best-corrected visual acuity was not significantly worse than the best-corrected visual acuity at diagnosis (P = 0.16). Retinal vascular occlusions were associated with poorer final visual acuity than choroidopathy (P = 0.002). After a median follow-up of 14 months (range, 2-132 months), nearly half the patients (n = 11, 48%) had permanent vision loss including best-corrected visual acuity of <20/400 for 4 patients. CONCLUSION Posterior ophthalmic manifestations of catastrophic antiphospholipid syndrome were mainly bilateral retinal vascular occlusion, which had the worst visual prognosis, followed by choroidopathy and retinal vasculitis. Permanent visual loss was common.
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Affiliation(s)
- Nathalie Morel
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Clémence Bonnet
- Université Paris-Descartes, Paris, France
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Hanane Mehawej
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
| | - Laurent Pérard
- Centre Hospitalier Saint Joseph Saint Luc, Internal Medicine Department, Centre Hospitalier Saint Joseph Saint Luc, Lyon, France
| | | | - Antoine Brezin
- Ophthalmology Department, AP-HP, Cochin Hospital, Paris, France
| | - Bertrand Godeau
- Internal Medicine Department, AP-HP, Henri Mondor Hospital, Creteil, France
| | - Julien Haroche
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, Vascular and Thrombosis Unit, Normandie Université, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Marc Lambert
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Cécile M Yelnik
- Internal Medicine Department, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University Lille, INSERM U1167, CHU Lille, Lille, France
| | - Nicolas Maillard
- Department of Internal Medicine, CHU, de Saint-Etienne, France; and
| | - Bahram Bodaghi
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Charles Piette
- Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Louisiana Pitié-Salpêtrière Hospital, Paris, France
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de Référence Maladies Auto-immunes et Systémiques Rares de l'Ile de France, AP-HP, Cochin Hospital, Paris, France
- AP-HP, Cochin Hospital, Internal Medicine department, Centre de référence maladies auto-immunes et systémiques rares de l'Ile de France, INSERM U 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Université Paris Descartes-Sorbonne Paris Cité, Paris, France
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6
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Pokeerbux MR, Yelnik CM, Faure E, Drumez E, Bruandet A, Labreuche J, Assaf A, Goffard A, Garabedian C, Poissy J, Desbordes J, Garrigue D, Scherpereel A, Faure K, Lambert M. National early warning score to predict intensive care unit transfer and mortality in COVID-19 in a French cohort. Int J Clin Pract 2021; 75:e14121. [PMID: 33650136 PMCID: PMC7995084 DOI: 10.1111/ijcp.14121] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 02/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND No risk stratification tool has been validated in hospitalised patients with coronavirus disease 2019 (COVID-19), despite a high rate of intensive care requirement and in-hospital mortality. We aimed to determine whether the National Early Warning Score (NEWS) at admission can accurately predict in-hospital mortality and ICU transfer. METHODS This was a retrospective cohort study from January 24 to April 16, 2020, at Lille University Hospital. All consecutive adult patients with laboratory-confirmed COVID-19 who were initially admitted to non-ICU wards were included. The primary outcome was a composite criterion consisting of ICU transfer or in-hospital mortality. We evaluated the prognostic performance of NEWS by calculating the area under (AUC) the receiver operating characteristic curve, the optimal threshold value of NEWS, and its association with the primary outcome. RESULTS Of the 202 COVID-19 patients, the median age was 65 (interquartile range 52-78), 38.6% were women and 136 had at least one comorbidity. The median NEWS was 4 (2-6). A total of 65 patients were transferred to the ICU or died in the hospital. Compared with patients with favourable outcome, these patients were significantly older, had more comorbidities and higher NEWS. The AUC for NEWS was 0.68 (0.60-0.77) and the best cutoff value was 6. Adjusted odds ratio for NEWS ≥ 6 as an independent predictor was 3.78 (1.94-7.09). CONCLUSIONS In hospitalised COVID-19 patients, NEWS was an independent predictor of ICU transfer and in-hospital death. In daily practice, NEWS ≥ 6 at admission may help to identify patients who are at risk to deteriorate.
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Affiliation(s)
| | - Cécile M. Yelnik
- Internal Medicine DepartmentUniv. LilleINSERM U1167CHU LilleLilleFrance
| | - Emmanuel Faure
- Infectious Disease DepartmentUniv. LilleINSERM U1019CHU LilleCNRS UMR9017LilleFrance
| | - Elodie Drumez
- Department of BiostatisticsUniv. LilleULR 2694 ‐ METRICS : Évaluation des technologies de santé et des pratiques médicalesCHU LilleLilleFrance
| | | | - Julien Labreuche
- Department of BiostatisticsUniv. LilleULR 2694 ‐ METRICS : Évaluation des technologies de santé et des pratiques médicalesCHU LilleLilleFrance
| | - Ady Assaf
- Infectious Disease DepartmentUniv. LilleINSERM U1019CHU LilleCNRS UMR9017LilleFrance
| | - Anne Goffard
- Virology DepartmentUniv. LilleINSERM U1019CHU LilleCNRS UMR 9017LilleFrance
| | | | - Julien Poissy
- Univ. LilleINSERM U1285CHU LilleIntensive Care UnitCNRSUMR 8576UGSF ‐ Unité de Glycobiologie Structurale et FonctionnelleLilleFrance
| | | | | | - Arnaud Scherpereel
- Department of Pulmonary and Thoracic OncologyUniv. LilleCHU LilleLilleFrance
| | - Karine Faure
- Infectious Disease DepartmentUniv. LilleINSERM U1019CHU LilleCNRS UMR9017LilleFrance
| | - Marc Lambert
- Internal Medicine DepartmentUniv. LilleINSERM U1167CHU LilleLilleFrance
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Yelnik CM, Bruckert É. [Hypercholesterolemia, from screening to treatment: Who, why and how to manage]. Rev Med Interne 2020; 42:707-713. [PMID: 33308860 DOI: 10.1016/j.revmed.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 10/22/2022]
Abstract
Hypercholesterolemia refers to dyslipidemia with an increased circulating cholesterol levels. This is the most common dyslipidemia and is associated with an increased risk of developing atheromatous cardiovascular diseases. One of the major challenges in primary prevention is to define the threshold for therapeutic intervention that allow to obtain a significant clinical benefit without unnecessarily expose the patient to potential side effects of lipid-lowering treatments. It is also important to recall to screen patient for heterozygous familial hypercholesterolemia, a common genetic disease of lipid metabolism responsible for particularly severe and early coronary disease. In this article, the issues of hypercholesterolemia screening, the definition of therapeutic targets and expected benefits as well as the modalities of therapeutic management (by also addressing the problem of statin intolerance) will be addressed.
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Affiliation(s)
- C M Yelnik
- Université Lille, Inserm, U1167 Risk factors and molecular determinants of aging-related diseases, 59000 Lille, France; Service de médecine interne, d'immunologie clinique et de médecine polyvalente-post urgence, centre national de référence maladies systémiques et auto-immunes rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), CHU de Lille, 59000 Lille, France.
| | - É Bruckert
- Hôpital Pitié-Salpêtrière, Sorbonne université, institut hôpital-universitaire cardiométabolique et service d'endocrinologie-métabolisme, 75000 Paris, France
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8
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Yelnik CM, Nguyen Y, Le Guern V, Hachulla E, Lambert M. Thrombocytopenia in primary antiphospholipid syndrome, a marker of high-risk patients? Eur J Intern Med 2020; 74:106-107. [PMID: 32035702 DOI: 10.1016/j.ejim.2020.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/15/2020] [Accepted: 01/23/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Cécile M Yelnik
- Univ. Lille, INSERM U995, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and MusculoskeletalDiseases (ReCONNECT), F-59000 Lille, France.
| | - Yann Nguyen
- Université Paris Descartes-Sorbonne Paris Cité, INSERM U1153, Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, F-75000 Paris, France
| | - Véronique Le Guern
- Université Paris Descartes-Sorbonne Paris Cité, INSERM U1153, Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, F-75000 Paris, France
| | - Eric Hachulla
- Univ. Lille, INSERM U995, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and MusculoskeletalDiseases (ReCONNECT), F-59000 Lille, France
| | - Marc Lambert
- Univ. Lille, INSERM U995, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and MusculoskeletalDiseases (ReCONNECT), F-59000 Lille, France
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9
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Eschwège V, Yelnik CM, Zuily S, Wahl D. Brief Report on the 10th Meeting of the European Forum on Antiphospholipid Antibodies. Curr Rheumatol Rep 2018; 20:63. [DOI: 10.1007/s11926-018-0767-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Yelnik CM, Lambert M, Drumez E, Le Guern V, Bacri JL, Guerra MM, Laskin CA, Branch DW, Sammaritano LR, Morel N, Guettrot-Imbert G, Launay D, Hachulla E, Hatron PY, Salmon JE, Costedoat-Chalumeau N. Bleeding complications and antithrombotic treatment in 264 pregnancies in antiphospholipid syndrome. Lupus 2018; 27:1679-1686. [PMID: 30016929 DOI: 10.1177/0961203318787032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose The purpose of this study was to evaluate the safety of antithrombotic treatments prescribed during pregnancy in patients with antiphospholipid syndrome (APS). Methods This international, multicenter study included two cohorts of patients: a retrospective French cohort and a prospective US cohort (PROMISSE study). Inclusion criteria were (1) APS (Sydney criteria), (2) live pregnancy at 12 weeks of gestation (WG) with (3) follow-up data until six weeks post-partum. According to APS standard of care, patients were treated with aspirin and/or low-molecular weight heparin (LMWH) at prophylactic (pure obstetric APS) or therapeutic doses (history of thrombosis). Major bleeding was defined as abnormal blood loss during the pregnancy and/or post-partum period requiring intervention for hemostasis or transfusion, or during the peripartum period greater than 500 mL and/or requiring surgery or transfusion. Other bleeding events were classified as minor. Results Two hundred and sixty-four pregnancies (87 prospectively collected) in 204 patients were included (46% with history of thrombosis, 23% with associated systemic lupus). During pregnancy, treatment included LMWH ( n = 253; 96%) or low-dose aspirin ( n = 223; 84%), and 215 (81%) patients received both therapies. The live birth rate was 89% and 82% in the retrospective and prospective cohorts, respectively. Adverse pregnancy outcomes occurred in 28% of the retrospective cohort and in 40% of the prospective cohort. No maternal death was observed in either cohort. A combined total of 45 hemorrhagic events (25%) occurred in the retrospective cohort, but major bleeding was reported in only six pregnancies (3%). Neither heparin nor aspirin alone nor combined therapy increased the risk of hemorrhage. We also did not observe an increased rate of bleeding in the case of a short interval between last LMWH (less than 24 hours) or aspirin (less than five days) doses and delivery. Only emergency Caesarean section was significantly associated with an increased risk of bleeding (odds ratio (OR) 5.03 (1.41-17.96); p=.016). In the prospective cohort, only one minor bleeding event was reported (vaginal bleeding). Conclusion Our findings support the safety of antithrombotic therapy with aspirin and/or LMWH during pregnancy in high-risk women with APS, and highlight the need for better treatments to improve pregnancy outcomes in APS. PROMISSE Study ClinicalTrials.gov identifier: NCT00198068.
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Affiliation(s)
- C M Yelnik
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - M Lambert
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - E Drumez
- 2 CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Département de Biostatistique, University of Lille, France
| | - V Le Guern
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - J-L Bacri
- 4 Service de Médecine Interne, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - M M Guerra
- 5 Rheumatology, Hospital for Special Surgery, New York, USA
| | - C A Laskin
- 6 University of Toronto and Trio Fertility, Toronto, Canada
| | - D W Branch
- 7 University of Utah and Intermountain Healthcare, Salt Lake City, USA
| | | | - N Morel
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - G Guettrot-Imbert
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France
| | - D Launay
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - E Hachulla
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - P-Y Hatron
- 1 INSERM U995 LIRIC-Inflammation Research International Centre, CHU Lille, Département de Médecine Interne et d'Immunologie clinique, Centre National de Référence Maladies Systémiques et Auto-Immunes Rares, European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases (ReCONNECT), University of Lille, France
| | - J E Salmon
- 5 Rheumatology, Hospital for Special Surgery, New York, USA
| | - N Costedoat-Chalumeau
- 3 Service de Médecine Interne, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares, Hôpital Cochin, Paris, France.,8 Université Paris Descartes-Sorbonne Paris Cité, Paris, France.,9 INSERM U 1153, Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), Paris, France
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11
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Scanvion Q, Morell-Dubois S, Yelnik CM, Bene J, Gautier S, Lambert M. Comment on: Failure of rivaroxaban to prevent thrombosis in four patients with anti-phospholipid syndrome. Rheumatology (Oxford) 2018; 57:938-939. [DOI: 10.1093/rheumatology/kex463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Quentin Scanvion
- CHU Lille, Internal Medicine Department, National Reference Center for Rare Autoimmune Systemic Diseases, Lille, F-59000, France
| | - Sandrine Morell-Dubois
- CHU Lille, Internal Medicine Department, National Reference Center for Rare Autoimmune Systemic Diseases, Lille, F-59000, France
| | - Cécile M Yelnik
- CHU Lille, Internal Medicine Department, National Reference Center for Rare Autoimmune Systemic Diseases, Lille, F-59000, France
| | - Johana Bene
- CHU Lille, Pharmacology Department, Centre Régional de PharmacoVigilance, Université Lille Nord de France, Lille, F-59000, France
| | - Sophie Gautier
- CHU Lille, Pharmacology Department, Centre Régional de PharmacoVigilance, Université Lille Nord de France, Lille, F-59000, France
| | - Marc Lambert
- CHU Lille, Internal Medicine Department, National Reference Center for Rare Autoimmune Systemic Diseases, Lille, F-59000, France
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Yelnik CM, Richey M, Haiduc V, Everett S, Zhang M, Erkan D. Cardiovascular Disease Prevention Counseling Program for Systemic Lupus Erythematosus Patients. Arthritis Care Res (Hoboken) 2017; 69:1209-1216. [PMID: 27748044 DOI: 10.1002/acr.23128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/31/2016] [Accepted: 10/11/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine if a cardiovascular disease (CVD) prevention counseling program for lupus patients decreases the prevalence of CVD risk factors. METHODS The assessment phase of a 3-year CVD prevention counseling program included the evaluation of CVD risk factors, diet, exercise habits, and medications. The education phase included discussion of the above risk factors, as well as CVD and thrombosis prevention strategies. Patients were prospectively followed every 3-6 months for risk assessment and continued education by a nurse practitioner and a medical doctor. RESULTS Between March 2009 and December 2014, 121 patients were included. At baseline, abnormal blood pressure, blood glucose, cholesterol profile, and body mass index were found in 50 (41%), 7 (6%), 82 (68%), and 77 (64%) patients, respectively. During the 3-year followup, among those with abnormal baseline values, prevalence of abnormal blood pressure significantly decreased (odds ratio [OR] 0.94, 95% confidence interval [95% CI] 0.92-0.96, P < 0.0001) with significant mean ± SD systolic blood pressure improvement (-6.12 ± 2.16 mm Hg; P < 0.05). The prevalence of abnormal cholesterol profile significantly decreased (OR 0.90, 95% CI 0.92-0.96) with significant improvements in mean ± SD high-density lipoprotein (+5.4 ± 0.36 mg/dl; P < 0.0001) and triglyceride levels (-12.6 ± 5.40 mg/dl; P < 0.05), and no significant change in blood glucose and body mass index was observed. At baseline, 100 (83%) and 95 (79%) patients had poor diet and physical activity, respectively; during the followup, both significantly improved in the entire population. CONCLUSION Our data suggest that a CVD prevention counseling program decreases the prevalence of some CVD risk factors in lupus patients.
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Affiliation(s)
| | - Monica Richey
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Virginia Haiduc
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Sotiria Everett
- Population and Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Meng Zhang
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Doruk Erkan
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Abstract
Cognitive disorders have frequently been described in the field of antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Nevertheless, the relationship between those disorders and antiphospholipid antibodies (aPL) remains unclear and seems to involve various mechanisms. Overlap with systemic lupus erythematosus, the small sample size of studies, and discrepancies in antiphospholipid antibodies and cognitive impairment determinations complicate analyses of the literature data. In this paper, we summarize current knowledge on epidemiologic, clinical data, imaging findings and treatment of cognitive dysfunction associated with aPL. We separately analyzed data on aPL-positive carriers without history of clinical feature of APS, APS patients without overlaps autoimmune disease, and SLE-associated aPL patients.
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Affiliation(s)
- Cécile M Yelnik
- Internal Medicine Department, University of Lille, UFR Medicine, Lille, France.
| | - Elizabeth Kozora
- Department of Medicine, National Jewish Health, 1400 Jackson St., Denver, CO 80206, United States; Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, United States; Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.
| | - Simone Appenzeller
- Department of Medicine, Faculty of Medical Science, State University of Campinas, Campinas, Brazil.
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Sanges S, Yelnik CM, Sitbon O, Benveniste O, Mariampillai K, Phillips-Houlbracq M, Pison C, Deligny C, Inamo J, Cottin V, Mouthon L, Launay D, Lambert M, Hatron PY, Rottat L, Humbert M, Hachulla E. Pulmonary arterial hypertension in idiopathic inflammatory myopathies: Data from the French pulmonary hypertension registry and review of the literature. Medicine (Baltimore) 2016; 95:e4911. [PMID: 27684828 PMCID: PMC5265921 DOI: 10.1097/md.0000000000004911] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Occurrence of pulmonary arterial hypertension (PAH) in idiopathic inflammatory myopathies (IIMs) without extensive interstitial lung disease (ILD) has rarely been described in the medical literature. This study aimed to report all cases with association of PAH and IIM in the French Pulmonary Hypertension (PH) Registry, to identify IIM features associated with the presence of PAH, and to describe treatment modalities of these patients.All cases of IIM-PAH were retrieved from the French PH Registry, which gathers PH patients prospectively enrolled by 27 referral hospital centers across France. Patients were excluded if they had an extensive ILD or overlap syndrome. Characteristics of IIM-PAH patients were compared with a control group of IIM patients without PH.Among the 5223 PH patients in the Registry, 34 had a diagnosis of IIM. Among them, 3 IIM-PAH patients (2 females and 1 male) had no evidence of extensive ILD or overlap syndrome, and were included in this study. In these 3 patients, dermatomyositis (DM) was the only identified IIM. One patient had autoantibodies classically associated with IIM (anti-Ku). PAH had always developed after IIM onset, was severe in all cases, and led to a marked functional impairment.By pooling our cases with 6 patients previously reported in the literature, and comparing them with a control cohort of 35 IIM patients without PH, we identify several IIM characteristics possibly associated with PAH occurrence, including DM subtype (78% vs 46%; P = 0.02), skin involvement (P = 0.04), anti-SSA antibodies (P = 0.05), and peripheral microangiopathy (P = 0.06).Overall, IIM-PAH patients were managed by corticosteroids and/or immunosuppressants, either alone or combined with PAH therapy. Patients did not seem to respond to IIM treatment alone.Our study reports for the first time the rare but possible association of PAH and IIM in a large prospective PH Registry. In that setting, PAH seems associated with DM, skin involvement, peripheral microangiopathy, and anti-SSA positivity. The best therapeutic strategy for IIM-PAH remains to be defined.
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Affiliation(s)
- Sébastien Sanges
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
| | - Cécile M. Yelnik
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
| | - Olivier Sitbon
- University Paris-Sud, Faculté de Médecine, Université Paris-Saclay
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre
- INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson
| | - Olivier Benveniste
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Neuromusculaires, Hôpital La Pitié-Salpêtrière, AP-HP, INSERM U974, Université Paris VI Pierre et Marie Curie, Paris
| | - Kuberaka Mariampillai
- Département de Médecine Interne et Immunologie Clinique, Centre National de Référence Maladies Neuromusculaires, Hôpital La Pitié-Salpêtrière, AP-HP, INSERM U974, Université Paris VI Pierre et Marie Curie, Paris
| | - Mathilde Phillips-Houlbracq
- Clinique Universitaire de Pneumologie, Centre Hospitalier Universitaire, Grenoble, France
- Université Joseph Fourier, Grenoble
| | - Christophe Pison
- Clinique Universitaire de Pneumologie, Centre Hospitalier Universitaire, Grenoble, France
- Université Joseph Fourier, Grenoble
| | - Christophe Deligny
- Service de médecine interne et rhumatologie 3C/5D, Centre Hospitalier Universitaire Pierre Zobda-Quitman
| | - Jocelyn Inamo
- Département de Cardiologie, Centre Hospitalier Universitaire Pierre Zobda-Quitman, Fort-de-France, Martinique
| | - Vincent Cottin
- Hospices Civils de Lyon, Service de Pneumologie, Centre de Compétence de l’Hypertension Pulmonaire, Centre de Référence des Maladies Pulmonaires Rares, Lyon
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence des Vascularites Nécrosantes et de la Sclérodermie Systémique, Université Paris Descartes, Hôpital Cochin, Paris, France
| | - David Launay
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
| | - Marc Lambert
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
| | - Pierre-Yves Hatron
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
| | - Laurence Rottat
- University Paris-Sud, Faculté de Médecine, Université Paris-Saclay
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre
- INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson
| | - Marc Humbert
- University Paris-Sud, Faculté de Médecine, Université Paris-Saclay
- AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre
- INSERM UMR_S999, LabEx LERMIT, Centre Chirurgical Marie-Lannelongue, Le Plessis-Robinson
| | - Eric Hachulla
- University of Lille, INSERM U995, LIRIC, Lille Inflammation Research International Center
- CHU Lille, Département de Médecine Interne et Immunologie Clinique
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille
- Correspondence: Eric Hachulla, Service de Médecine Interne, Hôpital Claude-Huriez, CHRU Lille, Rue Michel Polonovski, F-59037 Lille Cedex, France (e-mail: )
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15
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Yelnik CM, Urbanski G, Drumez E, Sobanski V, Maillard H, Lanteri A, Morell-Dubois S, Caron C, Dubucquoi S, Launay D, Duhamel A, Hachulla E, Hatron PY, Lambert M. Persistent triple antiphospholipid antibody positivity as a strong risk factor of first thrombosis, in a long-term follow-up study of patients without history of thrombosis or obstetrical morbidity. Lupus 2016; 26:163-169. [PMID: 27432808 DOI: 10.1177/0961203316657433] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction The long-term risk of first thrombosis and benefit of prophylaxis in antiphospholipid antibody (aPL) carriers without history of thrombosis or obstetrical morbidity is poorly known. This study aimed to evaluate the long-term rate and risk factors associated with a first thrombosis in those patients. Patients and methods After a prior study ended in December 2005 and was already published, we extended the follow-up period of our cohort of aPL carriers. Results Ninety-eight of the 103 patients of the previous study were included. The annual first thrombosis rate was 2.3% per patient-year during a median of 13 years (6-17). None of the baseline characteristics was predictive of risk of first thrombosis, but persistent aPL over time were associated with an increased risk. The stronger association was found in triple aPL-positive carriers: OR 3.38 (95% CI: 1.24-9.22). Of note, conversely to our previous findings, no benefit of aspirin prophylaxis was observed. Conclusion The risk of first thrombosis in aPL carriers without history of thrombosis or obstetrical morbidity was significant, persisted linearly over time and was associated with persistent aPL. This risk was especially increased in triple aPL-positive carriers, in whom a close follow-up seems to be necessary. Nevertheless, the benefit of aspirin prophylaxis remained unclear.
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Affiliation(s)
- C M Yelnik
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - G Urbanski
- 2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - E Drumez
- 3 Département de biostatistiques, EA2694, Université Lille 2, CHRU Lille, France
| | - V Sobanski
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - H Maillard
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - A Lanteri
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - S Morell-Dubois
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - C Caron
- 4 Laboratoire d'Hémostase, Centre de Biologie-Pathologie-Génétique, CHRU Lille, France
| | - S Dubucquoi
- 1 Université Lille 2, UFR Médecine, Lille, France.,5 Institut d'Immunologie, Centre de Biologie-Pathologie-Génétique, CHRU Lille, France
| | - D Launay
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - A Duhamel
- 3 Département de biostatistiques, EA2694, Université Lille 2, CHRU Lille, France
| | - E Hachulla
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - P Y Hatron
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - M Lambert
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
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