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Thibault T, Rajillah A, Bourredjem A, Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Besancenot JF, Martin T, Magy-Bertrand N, Samson M, Arnaud L, Amoura Z, Devilliers H. Health-related quality of life, remission and low lupus disease activity state in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1447-1455. [PMID: 37589711 DOI: 10.1093/rheumatology/kead407] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To measure the association between SLE remission and scores of patients-reported outcome (PRO) measures. METHODS We performed a prospective cohort study of SLE patients with a 2-year follow-up, using Lupus Patient-Reported Outcome (LupusPRO), Lupus Quality of Life (LupusQoL), Systemic Lupus Erythematosus Quality of Life (SLEQOL) and 36-item Short Form (SF-36) questionnaires. Remission was defined as remission off treatment (ROFT) and remission on treatment (RONT) according to the definitions of remission in SLE consensus. Mixed models accounting for repeated measures were used to compare groups as follow: ROFT and RONT vs no remission and lupus low disease activity state (LLDAS) vs no LLDAS. RESULTS A total of 1478 medical visits and 2547 PRO questionnaires were collected during the follow-up from the 336 recruited patients. A between-group difference in PRO scores reaching at least 5 points on a 0-100 scale was obtained in the following domains: lupus symptoms (LLDAS: +5 points on the 0-100 scale, RONT: +9, ROFT: +5), lupus medication (LLDAS: +5, RONT: +8, ROFT: +9), pain vitality (LLDAS: +6, RONT: +9, ROFT: +6) of LupusPRO; role emotional (LLDAS: +5, RONT: +8), role physical (RONT: +7 and ROFT: +7), bodily pain (RONT: +6), mental health (RONT: +5) and social functioning (RONT: +6) of SF-36. In contrast, a between-group difference reaching at least 5 points was not achieved for any of the LupusQoL and SLEQOL domains. CONCLUSIONS RONT, ROFT and LLDAS were associated with significant and clinically relevant higher QoL in most PRO domains of the LupusPRO (disease specific) and SF-36 (generic) questionnaires, but not with LupusQoL and SLEQOL disease-specific questionnaires.
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Affiliation(s)
- Thomas Thibault
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Abdessamad Rajillah
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, 57070, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Inserm UMR_S 1116, CHRU de Nancy, University of Lorraine, Nancy, France
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Hôpital Croix Rousse, Lyon, France
- Research on Healthcare Performance, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpital Louis Pasteur, Colmar, France
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Strasbourg University Hospital, Strasbourg, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
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Thibault T, Bourredjem A, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Audia S, Arnaud L, Amoura Z, Devilliers H. The mediating effect of fatigue in impaired quality of life in systemic lupus erythematosus: mediation analysis of the French EQUAL cohort. Rheumatology (Oxford) 2023; 62:3051-3058. [PMID: 36655762 DOI: 10.1093/rheumatology/kead020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/22/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Mediation analyses were conducted to measure the extent to which musculoskeletal (MSK) flares and depression affected physical health through excessive fatigue. METHODS Mediation analyses were performed in a large multicentre cohort of SLE patients. Domains of the LupusQoL and SLEQOL questionnaires were selected as outcomes, MSK flares according to the SELENA-SLEDAI flare index (SFI-R) score and depression defined by Center for Epidemiologic Studies-Depression scale (CES-D) scale as exposures and different fatigue domains from MFI-20 and LupusQoL questionnaires as mediators. For each model, total, direct, indirect effects and proportion of effect mediated by fatigue (i.e. proportion of change in health-related quality of life) were determined. RESULTS Of the 336 patients, 94 (28%) had MSK flares at inclusion and 99 (29.5%) were considered with depression. The proportion of the total effect of MSK flares on physical health impairment explained by fatigue ranged from 59.6% to 78% using the LupusQOL 'Physical health' domain and from 51.1% to 73.7% using the SLEQOL 'Physical functioning' domain, depending on the fatigue domain selected. The proportion of the total effect of depression on physical health impairment explained by fatigue ranged from 68.8% to 87.6% using the LupusQOL 'Physical health' domain and from 79.3% to 103.2% using the SLEQOL 'Physical functioning' domain, depending on the fatigue domain selected. CONCLUSIONS The effect of MSK flares and depression on physical health impairment is largely mediated by fatigue. Thus, the patient's perception of disease activity as measured by physical health is largely influenced by fatigue. In addition, fatigue has a significant negative impact on quality of lifeof SLE patients with depression. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.
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Affiliation(s)
- Thomas Thibault
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, France
| | - Denis Wahl
- Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Nancy, France
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Hôpital Croix Rousse, Lyon, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpital Louis Pasteur, Colmar, Alsace, France
| | - Jean-Loup Pennaforte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Strasbourg University Hospital, Strasbourg, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Sylvain Audia
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
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Cortese D, Martinez C, Dindoyal A, Alamome I, Dragan R, Chapiro J, Blaison G, Hinschberger O. [Acquired alpha-thalassemia in an 86-year-old patient with myelodysplastic syndrome]. Rev Med Interne 2023; 44:89-91. [PMID: 36646614 DOI: 10.1016/j.revmed.2022.12.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/15/2022] [Accepted: 12/24/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Alpha thalassemia-myelodysplastic syndrome (ATMDS) is one of the possible complications related to the genetic instability typical of clonal hemopoietic disorders such as myelodysplastic syndromes (MDS). Hemoglobin H acquisition, which is hemoglobin without alpha chains and with 4 beta chains is the hallmark of this disease. OBSERVATION An 86-year-old male with chronic, microcytic anemia was referred due to a fall in his hemoglobin level. The blood smear was remarkable for intense anisocytoses and poikilocytosis. Bone marrow analysis was followed by a diagnosis of MDS with a good prognostic score. Peripheral blood coloration with brilliant cresyl blue showed "golf ball-like" erythrocytes. Hemoglobin electrophoresis is notable for the presence of H hemoglobin. The new generation sequencing confirmed the diagnosis of ATMDS showing a non-sense mutation in the gene ATRX. CONCLUSION The diagnosis of ATMDS should be considered in the presence of the association of MDS, microcytic anemia and marked blood smear abnormalities such as anisocytosis and poikilocytosis. A little less than 10% of all MDS are complicated by ATMDS.
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Affiliation(s)
- D Cortese
- Service de médecine interne et immunologie clinique, Hôpitaux Civils de Colmar, Colmar, France.
| | - C Martinez
- Service de médecine interne et immunologie clinique, Hôpitaux Civils de Colmar, Colmar, France
| | - A Dindoyal
- Service de médecine interne et immunologie clinique, Hôpitaux Civils de Colmar, Colmar, France
| | - I Alamome
- Laboratoire d'hématologie, Hôpitaux Civils de Colmar, Colmar, France
| | - R Dragan
- Service d'hématologie clinique, Hôpitaux Civils de Colmar, Colmar, France
| | - J Chapiro
- Service d'hématologie clinique, Hôpitaux Civils de Colmar, Colmar, France
| | - G Blaison
- Service de médecine interne et immunologie clinique, Hôpitaux Civils de Colmar, Colmar, France
| | - O Hinschberger
- Service de médecine interne et immunologie clinique, Hôpitaux Civils de Colmar, Colmar, France
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Diaz P, Hurstel R, Dragan R, Blaison G. Anémie hémolytique auto-immune induite au vénétoclax, à propos d’un cas. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Thibault T, Bourredjem A, Maurier F, Wahl D, Muller G, Aumaître O, Blaison G, Pennaforte J, Martin T, Magy-Bertrand N, Audia S, Arnaud L, Amoura Z, Devilliers H. Effet médiateur de la fatigue entre les poussées articulaires et l’altération de la qualité de vie au cours du lupus systémique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Aqodad Z, Blaison G. Œdème papillaire … et si c’était une bartonellose ! Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moyon Q, Pineton de Chambrun M, Gousseff M, Mathian A, Hie M, Urbanski G, Verlicchi F, Faguer S, Dossier A, Lega JC, Riviere S, Saadoun D, Graveleau J, Lucchini-Lecomte MJ, Christides C, Le Moal S, Bibes B, Malizia G, Ruivard M, Blaison G, Alric L, Agard C, Soubrier M, Viallard JF, Levesque H, Rivard GE, Tieulie N, Hot A, Lovey PY, Hanslik T, Lhote F, Eble V, Álvarez Troncoso J, Aujayeb A, Quentric P, Taieb D, Cohen-Aubart F, Lambert M, Amoura Z. Intravenous Immunoglobulins Tapering and Withdrawal in Systemic Capillary Leak Syndrome (Clarkson Disease). J Allergy Clin Immunol Pract 2022; 10:2889-2895. [PMID: 35870726 DOI: 10.1016/j.jaip.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The systemic capillary leak syndrome (SCLS), also known as Clarkson disease, is a very rare condition characterized by recurrent life-threatening episodes of vascular hyperpermeability in the presence of a monoclonal gammopathy. Extended intravenous immunoglobulin (IVIG) treatment is associated with fewer recurrences and improved survival, but the optimal treatment dosage and duration remain unknown. OBJECTIVE We aim to evaluate the safety of IVIG tapering and withdrawal in patients with SCLS. METHODS We conducted a retrospective multicenter study including all adult patients with monoclonal gammopathy-associated SCLS from the EurêClark registry who received at least 1 course of IVIG. The primary end point was overall survival according to IVIG withdrawal. RESULTS Fifty-nine patients of mean ± SD age 51 ± 13 years were included. Overall cumulative probabilities of 2-, 5-, 10- and 15-year survival were 100%, 85%, 72%, 44%, respectively. The IVIG was withdrawn at least once in 18 patients (31%; W+ group) and never in 41 patients (69%; W- group). Cumulative probabilities of 10-year survival in W+ versus W- groups were 50% and 83% (log rank test, P = .02), respectively. Relapse rate and the median number of relapses in the W+ versus the W- groups were 72% versus 58% (P = 0.3) and 2.5 (0.3-4) versus 1 (0-2) (P = .03), respectively. The IVIG tapering was not statistically associated with increased person-year incidence of attacks using a mixed linear model. CONCLUSIONS The IVIG withdrawal was associated with increased mortality and higher rate of recurrence in SCLS patients. The IVIG tapering might be cautiously considered in stable SCLS patients.
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Affiliation(s)
- Quentin Moyon
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France.
| | - Marie Gousseff
- Service de médecine interne, Centre Hospitalier (CH) Bretagne Atlantique, Vannes, France
| | - Alexis Mathian
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Miguel Hie
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d'Immunologie Clinique, Centre Hospitalier Universitaire (CHU) d'Angers, Angers, France
| | | | - Stanislas Faguer
- Département de Néphrologie Et Transplantation D'organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, équipe 12), CHU de Toulouse, Toulouse, France
| | - Antoine Dossier
- Service de médecine interne, CHU Bichat, APHP, Paris, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, CHU Lyon Sud, Pierre-Bénite, Lyon; Univ Lyon 1, UMR CNRS 5558 Laboratoire de Biologie et Biométrie Evolutive
| | - Sophie Riviere
- Service de médecine interne, Hôpital S(t)-Eloi, CHRU, Montpellier, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology- Immunopathology-Immunotherapy (I3), Paris, France
| | | | | | | | | | | | | | - Marc Ruivard
- Service de médecine interne, Hôpital d'Estaing, CHU de Clermont-Ferrand, France
| | - Gilles Blaison
- Service de médecine interne, Hôpital Pasteur, Colmar, France
| | - Laurent Alric
- Service de médecine interne, Pôle digestif, CHU Rangueil, Toulouse 3 University, Toulouse, France
| | - Christian Agard
- Nantes Université, CHU Nantes, service de médecine interne, F-44000 Nantes, France
| | - Martin Soubrier
- Service de rhumatologie, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, France
| | | | - Hervé Levesque
- Service de médecine interne, Normandie Université, UNIROUEN, 76031 Rouen, France
| | | | | | - Arnaud Hot
- Service de médecine interne, CHU Edouard Herriot, Lyon, France
| | | | - Thomas Hanslik
- Université Versailles Saint Quentin, APHP, CHU Ambroise Paré, Service de médecine interne, Boulogne-Billancourt, France
| | - François Lhote
- Service de médecine interne, Hôpital Delafontaine, Saint-Denis, France
| | | | - Jorge Álvarez Troncoso
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Newcastle, UK
| | - Paul Quentric
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Dov Taieb
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Marc Lambert
- Univ. 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), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France; Univ. 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), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France
| | - Zahir Amoura
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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Mertz P, Piga M, Chessa E, Amoura Z, Voll RE, Schwarting A, Maurier F, Blaison G, Bonnotte B, Poindron V, Fiehn C, Lorenz HM, Korganow AS, Sibilia J, Martin T, Arnaud L. Fatigue is independently associated with disease activity assessed using the Physician Global Assessment but not the SLEDAI in patients with systemic lupus erythematosus. RMD Open 2022; 8:rmdopen-2022-002395. [PMID: 36123013 PMCID: PMC9486369 DOI: 10.1136/rmdopen-2022-002395] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/27/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse whether reported fatigue, one of the most challenging manifestations of systemic lupus erythematosus (SLE), may bias the assessment of disease activity in SLE according to the Physician Global Assessment (PGA). METHODS Patients from the Lupus BioBank of the upper Rhein database, a cross-sectional multicentre collection of detailed clinical and biological data from patients with SLE, were included. Patients had to fulfil the 1997 American College of Rheumatology criteria for SLE and the PGA (0-3 scale) at the time of inclusion had to be available. Fatigue was assessed according to the Fatigue Scale for Motor and Cognitive Functions. Univariate and multivariate regression models were built to determine which variables were associated with the PGA. RESULTS A total of 350 patients (89% female; median age: 42 years, IQR: 34-52) were included. The median Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index (SELENA-SLEDAI) score was 4 (IQR: 2-6). Of these 350 patients, 257 (73%) reported significant fatigue. The PGA (p=0.004) but not the SELENA-SLEDAI (p=0.43) was significantly associated with fatigue. Both fatigue and SELENA-SLEDAI were independently associated with the PGA in two different multivariate models. CONCLUSION Fatigue is independently associated with disease activity assessed using the PGA but not the SLEDAI. These findings highlight the fact that the PGA should capture only objectively active disease manifestations in order to improve its reliability.
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Affiliation(s)
- Philippe Mertz
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
| | - Matteo Piga
- Rheumatology Unit, AOU University Clinic and University of Cagliari, 09042 Cagliari, Italy
| | - Elisabetta Chessa
- Rheumatology Unit, AOU University Clinic and University of Cagliari, 09042 Cagliari, Italy
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Centre national de Référence Lupus et SAPL, Assistance Publique–Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié–Salpêtrière, Paris, France
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, I.st Department of Internal Medicine Universitätsmedizin Mainz Langenbeckstr, 1 55131 Mainz, Germany
| | - Francois Maurier
- Internal Medicine Unit, Hôpitaux Privés de Metz Site Belle Isle 2 rue Belle Isle, 57045 Metz, France
| | - Gilles Blaison
- Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de Colmar, 39 avenue de la Liberté 68000 Colmar, France
| | - Bernard Bonnotte
- Service de médecine interne et immunologie clinique, CHU Dijon Bourgogne, 2, boulevard Mal-de-Lattre-de-Tassigny, 21000 Dijon, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Christoph Fiehn
- ACURA Centre for Rheumatic Diseases, Rotenbachtalstr, 5 Baden-Baden, DE 76530, Germany
| | - Hanns-Martin Lorenz
- Division of Rheumatology. Dept. of Medicine V University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, INF 410 69120 Heidelberg, Germany
| | - Anne-Sophie Korganow
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Jean Sibilia
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
| | - Thierry Martin
- Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA,Service d’immunologie clinique Nouvel hôpital civil, 1 place de l’hôpital, 67091 Strasbourg Cedex, France
| | - Laurent Arnaud
- Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, 1 Avenue Molière BP 83049, 67098 Strasbourg Cedex, France,Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA
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9
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Thietart S, Karras A, Augusto JF, Philipponnet C, Carron PL, Delbrel X, Mesbah R, Blaison G, Duffau P, El Karoui K, Smets P, London J, Mouthon L, Guillevin L, Terrier B, Puéchal X. Evaluation of Rituximab for Induction and Maintenance Therapy in Patients 75 Years and Older With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. JAMA Netw Open 2022; 5:e2220925. [PMID: 35802372 PMCID: PMC9270693 DOI: 10.1001/jamanetworkopen.2022.20925] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Older patients are underrepresented in studies of rituximab for the treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Little is known about outcomes and adverse events associated with the use of rituximab therapy among patients 75 years and older with ANCA-associated vasculitis. OBJECTIVE To examine outcomes and adverse events associated with the use of rituximab therapy in patients 75 years and older with ANCA-associated vasculitis, specifically granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study involved 93 patients 75 years and older with ANCA-associated vasculitis from 36 university and nonuniversity hospitals in France. Data were obtained from the French Vasculitis Study Group database between January 1, 2000, and July 1, 2018, and a call for observation sent to French Vasculitis Study Group members on June 6, 2019. Data analysis was performed from November 15 to December 31, 2021. Inclusion criteria included a diagnosis of GPA or MPA according to European Medicines Agency classification criteria and receipt of treatment with rituximab after age 75 years. Patients were excluded if they were missing relevant clinical or biological data. Data on race and ethnicity were not reported because inclusion of this information was not authorized by the ethics committee. EXPOSURE At least 1 infusion of rituximab as induction or maintenance therapy. MAIN OUTCOMES AND MEASURES Occurrence of remission, relapse, drug discontinuation, death, and serious infections (including types of serious infections). RESULTS Of 238 patients screened, 93 were included (median [IQR] age, 79.4 [76.7-83.1] years; 51 women [54.8%]); 52 patients (55.9%) had a diagnosis of GPA, and 41 (44.1%) had a diagnosis of MPA. Thirty patients (32.3%) received rituximab as induction therapy in combination with high-dose glucocorticoid regimens, 27 (29.0%) received rituximab as maintenance therapy, and 36 (38.7%) received rituximab as both induction and maintenance therapy. The median (IQR) follow-up was 2.3 (1.1-4.0) years. Among 66 patients who received rituximab as induction therapy, 57 (86.4%) achieved remission, and 2 (3.0%) experienced relapses. The incidence of serious infection was significantly higher when rituximab was used as induction therapy vs maintenance therapy (46.6 [95% CI, 24.8-79.7] per 100 patient-years vs 8.4 [95% CI, 3.8-15.9] per 100 patient-years; P = .004). Most infections (12 of 22 [54.5%]) were gram-negative bacterial infections. The incidence of death was 19.7 (95% CI, 7.2-42.9) per 100 patient-years among those who received rituximab as induction therapy and 5.3 (95% CI, 1.9-11.6) per 100 patient-years among those who received rituximab as maintenance therapy. CONCLUSIONS AND RELEVANCE In this cohort study, rituximab therapy was associated with achievement and maintenance of remission in most patients 75 years and older with ANCA-associated vasculitis. The incidence of serious infections and death was high when rituximab was used as induction therapy in combination with high-dose glucocorticoid regimens but not when rituximab was used as maintenance therapy. Efforts might focus on reducing serious infections during the first months of therapy.
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Affiliation(s)
- Sara Thietart
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Geriatrics, Sorbonne Université, Assistance Publique–Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique–Hôpitaux de Paris, Université de Paris Cité, Paris, France
| | - Jean-François Augusto
- Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire, Angers, France
| | - Carole Philipponnet
- Department of Nephrology, Centre Hospitalier Universitaire, Clermont-Ferrand, France
| | - Pierre-Louis Carron
- Department of Nephrology, Dialysis, and Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Grenoble, France
| | - Xavier Delbrel
- Department of Internal Medicine, Centre Hospitalier de Pau, Pau, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier, Boulogne-sur-Mer, France
| | - Gilles Blaison
- Department of Internal Medicine, Louis Pasteur Colmar Hospital, Colmar, France
| | - Pierre Duffau
- Department of Internal Medicine, Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Khalil El Karoui
- Department of Nephrology and Renal Transplantation, Hôpital Henri-Mondor, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Perrine Smets
- Department of Internal Medicine, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Jonathan London
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Department of Internal Medicine, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
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10
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Schlencker A, Messer L, Ardizzone M, Blaison G, Hinschberger O, Dahan E, Sordet C, Walther J, Dory A, Gonzalez M, Kleinlogel S, Bramont-Nachman A, Barrand L, Payen-Revol I, Sibilia J, Martin T, Arnaud L. Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. Lupus Sci Med 2022; 9:9/1/e000700. [PMID: 35568439 PMCID: PMC9109107 DOI: 10.1136/lupus-2022-000700] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
Objective Among the most significant challenges in SLE are the excessive diagnosis delay and the lack of coordinated care. The aim of the study was to investigate patient pathways in SLE in order to improve clinical and organisational challenges in the management of those with suspected and confirmed SLE. Methods We conducted a cross-sectional study of patients with SLE, healthcare providers and other representative stakeholders. Focus groups were conducted, and based on the collected data the most impactful disruption points in SLE patient pathways were identified. A novel framework to improve individual patient pathways in SLE was developed, discussed and validated during a consensus meeting with representative stakeholders. Results Six thematic clusters regarding disruption in optimal patient pathways in SLE were identified: appropriate and timely referral strategy for SLE diagnosis; the need for a dedicated consultation during which the diagnosis of SLE would be announced, and following which clarifications and psychological support offered; individualised patient pathways with coordinated care based on organ involvement, disease severity and patient preference; improved therapeutic patient education; prevention of complications such as infections, osteoporosis and cancer; and additional patient support. During the consensus meeting, the broader panel of stakeholders achieved consensus on these attributes and a framework for optimising SLE patient pathways was developed. Conclusions We have identified significant disruption points and developed a novel conceptual framework to improve individual patient pathways in SLE. These data may be of valuable interest to patients with SLE, their physicians, health organisations as well as policy makers.
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Affiliation(s)
- Aurelien Schlencker
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Auto-immunes Rares (CRMR RESO), Strasbourg, France
| | - Laurent Messer
- Service de Rhumatologie, Hôpitaux Civils de Colmar, Colmar, France
| | - Marc Ardizzone
- Service de Rhumatologie, GHR Mulhouse Sud-Alsace, Mulhouse, France
| | - Gilles Blaison
- Service de médecine interne, Centre de compétence Maladies auto-immunes rares, Hôpitaux Civils de Colmar, Colmar, France
| | - Olivier Hinschberger
- Service de médecine interne, Centre de compétence Maladies auto-immunes rares, Hôpitaux Civils de Colmar, Colmar, France
| | - Etienne Dahan
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Christelle Sordet
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Auto-immunes Rares (CRMR RESO), Strasbourg, France
| | - Julia Walther
- Service de pharmacie stérilisation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Anne Dory
- Service de pharmacie stérilisation, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Maria Gonzalez
- Service de Pathologie Professionnelle et de Médecine du Travail, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Stéphanie Kleinlogel
- Service de Pathologie Professionnelle et de Médecine du Travail, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Aurélia Bramont-Nachman
- Service de Pathologie Professionnelle et de Médecine du Travail, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Jean Sibilia
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France.,Centre National de Références des Maladies Auto-immunes Rares (CRMR RESO), Strasbourg, France
| | - Thierry Martin
- Centre National de Références des Maladies Auto-immunes Rares (CRMR RESO), Strasbourg, France.,Service d'immunologie clinique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux universitaires de Strasbourg, Strasbourg, France .,Centre National de Références des Maladies Auto-immunes Rares (CRMR RESO), Strasbourg, France
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11
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Pineton de Chambrun M, Moyon Q, Faguer S, Urbanski G, Mathian A, Zucman N, Werner M, Luyt CE, Verlicchi F, Amoura Z, Gousseff M, Mauhin W, Hot A, Lega JC, Lambert M, Riviere S, Dossier A, Ruivard M, Lhote F, Blaison G, Merceron S, Zapella N, Alric L, Agard C, Lacout M, Saadoun D, Graveleau J, Soubrier M, Haroche J, Boileau J, Lucchini-Lecomte MJ, Hanslik T, Christides C, Levesque H, Talasczka A, Bulte C, Hachulla E, Decaux O, Sonneville R, Ibouanga F, Arnulf B, Benedit M, Viallard JF, Tieulie N, Haddad F, Moulin B, Cohen-Aubert F, Lovey PY, le Moal S, Bibes B, Rivard GE, Rondeau E, Malizia G, Debourdeau P, Abgueguen P, Bosseray A, Devaquet J, Presne C, Liferman F, Limal N, Argaud L, Hernu R, de la Salle S, Faguer S, Urbanski G, Zucman N, Werner M, Luyt CE, Moyon Q, Verlicchi F, Troncoso JÁ, Harty J, Godmer P, Hie M, Papo T, Hatron PY, Mathian A, Amoura Z. The consequences of COVID-19 pandemic on patients with monoclonal gammopathy-associated systemic capillary leak syndrome (Clarkson disease). J Allergy Clin Immunol Pract 2022; 10:626-629. [PMID: 34890829 PMCID: PMC8648572 DOI: 10.1016/j.jaip.2021.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France,Corresponding author: Marc Pineton de Chambrun, MD, MSc, Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, Équipe 12), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d’Immunologie Clinique, Centre Hospitalier Universitaire, Angers, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, APHP, DMU ESPRIT, Université de Paris, Colombes, France
| | - Marie Werner
- Service de Réanimation Chirurgicale Adulte, AP-HP, Hôpital Bicêtre, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
| | | | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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12
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Arnaud L, Mertz P, Amoura Z, Voll RE, Schwarting A, Maurier F, Blaison G, Bonnotte B, Poindron V, Fiehn C, Lorenz HM, Korganow AS, Sibilia J, Martin T. Patterns of fatigue and association with disease activity and clinical manifestations in systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:2672-2677. [PMID: 33175957 DOI: 10.1093/rheumatology/keaa671] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/05/2020] [Revised: 09/10/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The prevalence of fatigue is high in patients with systemic lupus erythematosus (SLE). In this study, we used latent class analysis to reveal patterns of fatigue, anxiety, depression and organ involvement in a large international cohort of SLE patients. METHODS We used the Lupus BioBank of the upper Rhein to analyse patterns of fatigue using latent class analysis (LCA). After determining the optimal number of latent classes, patients were assigned according to model generated probabilities, and characteristics of classes were compared. RESULTS A total of 502 patients were included. Significant fatigue, anxiety and depression were reported by 341 (67.9%), 159 (31.7%) and 52 (10.4%) patients, respectively. LCA revealed a first cluster (67.5% of patients) with low disease activity [median (25th-75th percentile interquartile range) Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI: 2 (0-4)], significant fatigue (55.5%, P < 0.0001), low anxiety (11.8%, P < 0.0001) and depression (0.9%, P < 0.0001). Cluster 2 (25.3%) also comprised patients with low disease activity [SELENA-SLEDAI: 2 (0-6)], but those patients had a very high prevalence of fatigue (100%, P < 0.0001), anxiety (89%, P < 0.0001) and depression (38.6%, P < 0.0001). Cluster 3 (7.2%) comprised patients with high disease activity [SELENA-SLEDAI: 12 (8-17), P < 0.0001] and high fatigue (72.2%, P < 0.0001) with low levels of anxiety (16.7%, P < 0.0001) and no depression (0%, P < 0.0001). CONCLUSION LCA revealed three patterns of fatigue with important practical implications. Based on these, it is crucial to distinguish patients with active disease (in whom remission will be achieved) from those with no or mild activity but high levels of fatigue, depression and anxiety, for whom psychological counselling should be prioritized.
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Affiliation(s)
- Laurent Arnaud
- Service de Rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France.,Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France
| | - Philippe Mertz
- Service de Rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France.,Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Centre national de Référence Lupus et SAPL, Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Reinhard E Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, Ist Department of Internal Medicine, Universitätsmedizin Mainz, Mainz, Germany
| | - François Maurier
- Internal Medicine Unit, Hôpitaux Privés de Metz Site Belle Isle, Metz, France
| | - Gilles Blaison
- Service de Médecine Interne, Centre de Compétence en Maladies Auto-Immunes et Systémiques Rares, Hôpitaux Civils de Colmar, Colmar, France
| | - Bernard Bonnotte
- Service de Médecine Interne et Immunologie Clinique, CHU Dijon Bourgogne, Dijon, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France.,Service d'Immunologie Clinique, Nouvel Hôpital Civil, Strasbourg, France
| | | | - Hanns-Martin Lorenz
- Division of Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anne-Sophie Korganow
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France.,Service d'Immunologie Clinique, Nouvel Hôpital Civil, Strasbourg, France
| | - Jean Sibilia
- Service de Rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France.,Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS, European Reference Networks (ERN) ReCONNET and RITA, Strasbourg, France.,Service d'Immunologie Clinique, Nouvel Hôpital Civil, Strasbourg, France
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13
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Meyer A, Guffroy A, Blaison G, Dieudonne Y, Amoura Z, Bonnotte B, Fiehn C, Kieffer P, Lorenz HM, Magy-Bertrand N, Maurier F, Pennaforte JL, Peter HH, Schwarting A, Sibilia J, Arnaud L, Martin T, Voll RE, Korganow AS. Systemic lupus erythematosus and neutropaenia: a hallmark of haematological manifestations. Lupus Sci Med 2021; 7:7/1/e000399. [PMID: 32616563 PMCID: PMC7333801 DOI: 10.1136/lupus-2020-000399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 12/26/2022]
Abstract
Objective Systemic lupus is a chronic autoimmune disease characterised by its phenotypic heterogeneity. Neutropaenia is a frequent event in SLE occurring in 20%–40% of patients depending on the threshold value of neutrophil count. On a daily basis, the management of neutropaenia in SLE is difficult with several possible causes. Moreover, the infectious consequences of neutropaenia in SLE remain not well defined. Methods 998 patients from the Lupus BioBank of the upper Rhein (LBBR), a large German and French cohort of patients with SLE, mostly of Caucasian origin (83%), were included in this study. Neutropaenia was considered when neutrophil count was below 1800×106/L. An additional analysis of detailed medical records was done for 65 LBBR patients with neutropaenia. Results 208 patients with neutropaenia (21%) were compared with 779 SLE patients without neutropaenia. Neutropaenia in SLE was significantly associated with thrombocytopaenia (OR 4.11 (2.57–10.3)), lymphopaenia (OR 4.41 (2.51–11.5)) and low C3 (OR 1.91 (1.03–4.37)) in multivariate analysis. 65 representative patients with neutropaenia were analysed. Neutropaenia was moderate to severe in 38%, chronic in 31%, and both severe and chronic in 23% of cases. Moderate to severe and chronic neutropaenia were both associated with lymphopaenia and thrombopaenia. Chronic neutropaenia was also associated anti-Ro/SSA antibodies and moderate to severe neutropaenia with oral ulcers. Conclusion This study is to date the largest cohort to describe neutropaenia in SLE. Neutropaenia displays a strong association with other cytopaenias, suggesting a common mechanism. Chronic neutropaenia is associated with anti-Ro/SSA antibodies with or without identified Sjögren’s disease.
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Affiliation(s)
- Aurore Meyer
- Department of Clinical Immunology and Internal Medicine, National Reference Center for autoimmune diseases (RESO), Strasbourg University Hospital, Strasbourg, France.,UFR Médecine, Université de Strasbourg, Strasbourg, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for autoimmune diseases (RESO), Strasbourg University Hospital, Strasbourg, France .,UFR Médecine, Université de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpitaux Civils de Colmar, Colmar, Alsace, France
| | - Yannick Dieudonne
- Department of Clinical Immunology and Internal Medicine, National Reference Center for autoimmune diseases (RESO), Strasbourg University Hospital, Strasbourg, France.,UFR Médecine, Université de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, Institut E3M, Assistance Publique Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié Salpêtrière, Paris, France
| | - Bernard Bonnotte
- Department of Clinical Immunology and Internal Medicine, CHU Dijon Bourgogne, Dijon, France
| | | | - Pierre Kieffer
- Department of Internal Medicine, Centre hospitalier de Mulhouse, Mulhouse, France
| | - Hannes Martin Lorenz
- Department of Medicine V, University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, Heidelberg, Germany
| | | | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz, Metz, France
| | | | - Hans-Hartmut Peter
- Department of Rheumatology and Clinical Immunology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Jean Sibilia
- Department of Rheumatology, National Reference Center for autoimmune diseases (RESO), Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Laurent Arnaud
- UFR Médecine, Université de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Department of Rheumatology, National Reference Center for autoimmune diseases (RESO), Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Thierry Martin
- Department of Clinical Immunology and Internal Medicine, National Reference Center for autoimmune diseases (RESO), Strasbourg University Hospital, Strasbourg, France.,UFR Médecine, Université de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Reinhard Edmund Voll
- Department of Rheumatology and Clinical Immunology, Medical Center - Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for autoimmune diseases (RESO), Strasbourg University Hospital, Strasbourg, France.,UFR Médecine, Université de Strasbourg, Strasbourg, France.,INSERM UMR - S1109, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
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14
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Giorgiutti S, Dieudonne Y, Hinschberger O, Nespola B, Campagne J, Rakotoarivelo HN, Hannedouche T, Moulin B, Blaison G, Weber JC, Dalmas MC, De Blay F, Lipsker D, Chantrel F, Gottenberg JE, Dimitrov Y, Imhoff O, Gavand PE, Andres E, Debry C, Hansmann Y, Klein A, Lohmann C, Mathiaux F, Guffroy A, Poindron V, Martin T, Korganow AS, Arnaud L. Prevalence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis and spatial association with quarries in a French Northeast region. Arthritis Rheumatol 2021; 73:2078-2085. [PMID: 33881225 DOI: 10.1002/art.41767] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 04/08/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Silica is one of the strongest environmental substances linked with autoimmunity. The aim of this study was to assess the prevalence of granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and renal limited vasculitis (RLV) in a French northeast region, and their geospatial association with quarries. METHODS Potential ANCA-Associated Vasculitis (AAV) cases were identified using three sources: hospital records, immunology laboratories and the National Health Insurance System. Patients who resided in Alsace on January 1, 2016 and fulfilled ACR AAV criteria or Chapel Hill Consensus Conference 2012 definition were included. Incomplete case ascertainment was corrected using capture-recapture analysis. The spatial association between the number of cases and quarries in each administrative entity was assessed using geographical weighted regression (GWR). RESULTS From 910 potential AAV cases, we identified 185 patients meeting inclusion criteria: 120 GPA, 35 MPA, 30 RLV. The number of cases missed by any source was 6.4 (95%CI 3.6-11.5). Accordingly, the 2016 estimated prevalence in Alsace was 65.5 cases per million inhabitants (95%CI 47.3-93.0) for GPA, 19.1 (95%CI 11.3-34.3) for MPA, and 16.8 (95%CI 8.7-35.2) for RLV. The risk of AAV was significantly increased in communes with quarries (OR: 2.51 [95%CI: 1.66-3.80]) and GWR revealed a significant spatial association between quarries and GPA cases (p = 0.039), and, regarding ANCA serotype, between quarries and both PR3-AAV (p = 0.04) and MPO-AAV (p = 0.03)." CONCLUSION In a region with a high density of quarries, the spatial association of AAV with quarries supports the role of silica as a specific environmental factor.
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Affiliation(s)
- Stéphane Giorgiutti
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yannick Dieudonne
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Olivier Hinschberger
- Department of Internal Medicine, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - Benoît Nespola
- Laboratory of Immunology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Julien Campagne
- Department of Internal Medicine, Hôpitaux Privés de Metz, F-57000, Metz, France
| | | | - Thierry Hannedouche
- Department of Nephrology and Dialysis, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Bruno Moulin
- Department of Nephrology and Transplantation, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Jean-Christophe Weber
- Department of Internal Medicine, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Marie-Caroline Dalmas
- Department of Internal Medicine, Endocrinology and Nutrition, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Frédéric De Blay
- Department of Pneumology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Dan Lipsker
- Department of Dermatology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - François Chantrel
- Department of Nephrology, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yves Dimitrov
- Department of Nephrology, Centre Hospitalier de Haguenau, F-67500, Haguenau, France
| | - Olivier Imhoff
- Department of Nephrology, Clinique Saint-Anne, F-67000, Strasbourg, France
| | | | - Emmanuel Andres
- Department of Internal Medicine, Diabetology and Metabolic Diseases, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Christian Debry
- Department of Otorhinolaryngology, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Yves Hansmann
- Department of Infectious Diseases, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
| | - Alexandre Klein
- Department of Nephrology, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Caroline Lohmann
- Department of Microbiology, Hôpital Emile Muller, groupe hospitalier de la région de Mulhouse et Sud Alsace, F-68070, Mulhouse, France
| | - François Mathiaux
- Department of Biochemistry, Hôpitaux Civils de Colmar, F-68024, Colmar, France
| | - Aurélien Guffroy
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Vincent Poindron
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Thierry Martin
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Anne-Sophie Korganow
- Department of Clinical Immunology and Internal Medicine, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Tertiary Center for Primary Immunodeficiency, Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France.,Université de Strasbourg, INSERM UMR - S1109, F-67000, Strasbourg, France
| | - Laurent Arnaud
- Department of Rheumatology, National Reference Center for Systemic Autoimmune Diseases (CNR RESO), Hôpitaux Universitaires de Strasbourg, F-67000, Strasbourg, France
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15
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Felten R, Devauchelle-Pensec V, Seror R, Duffau P, Saadoun D, Hachulla E, Pierre Yves H, Salliot C, Perdriger A, Morel J, Mékinian A, Vittecoq O, Berthelot JM, Dernis E, Le Guern V, Dieudé P, Larroche C, Richez C, Martin T, Zarnitsky C, Blaison G, Kieffer P, Maurier F, Dellal A, Rist S, Andres E, Contis A, Chatelus E, Sordet C, Sibilia J, Arnold C, Tawk MY, Aberkane O, Holterbach L, Cacoub P, Saraux A, Mariette X, Meyer N, Gottenberg JE. Interleukin 6 receptor inhibition in primary Sjögren syndrome: a multicentre double-blind randomised placebo-controlled trial. Ann Rheum Dis 2021; 80:329-338. [PMID: 33208345 DOI: 10.1136/annrheumdis-2020-218467] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [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: 06/30/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES No immunomodulatory drug has been approved for primary Sjögren's syndrome, a systemic autoimmune disease affecting 0.1% of the population. To demonstrate the efficacy of targeting interleukin 6 receptor in patients with Sjögren's syndrome-related systemic complications. METHODS Multicentre double-blind randomised placebo-controlled trial between 24 July 2013 and 16 July 2018, with a follow-up of 44 weeks, involving 17 referral centres. Inclusion criteria were primary Sjögren's syndrome according to American European Consensus Group criteria and score ≥5 for the EULAR Sjögren's Syndrome Disease activity Index (ESSDAI, score of systemic complications). Patients were randomised to receive either 6 monthly infusions of tocilizumab or placebo. The primary endpoint was response to treatment at week 24. Response to treatment was defined by the combination of (1) a decrease of at least 3 points in the ESSDAI, (2) no occurrence of moderate or severe activity in any new domain of the ESSDAI and (3) lack of worsening in physician's global assessment on a Visual Numeric Scale ≥1/10, all as compared with enrolment. RESULTS 110 patients were randomised, 55 patients to tocilizumab (mean (SD) age: 50.9 (12.4) years; women: 98.2%) and 55 patients to placebo (54.8 (10.7) years; 90.9%). At 24 weeks, the proportion of patients meeting the primary endpoint was 52.7% (29/55) in the tocilizumab group and 63.6% (35/55) in the placebo group, for a difference of -11.4% (95% credible interval -30.6 to 9.0) (Pr[Toc >Pla]=0.14). CONCLUSION Among patients with primary Sjögren's syndrome, the use of tocilizumab did not improve systemic involvement and symptoms over 24 weeks of treatment compared with placebo. TRIAL REGISTRATION NUMBER NCT01782235.
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Affiliation(s)
- Renaud Felten
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | | | - Raphaèle Seror
- Rheumatology, Université Paris-Sud BU Kremlin-Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | - Pierre Duffau
- Internal Medicine, CHU de Bordeaux, Bordeaux, Aquitaine, France
| | - David Saadoun
- University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Eric Hachulla
- Internal Medicine, Regional and University Hospital Centre Lille Internal Medicine Service, Lille, Hauts-de-France, France
| | - Hatron Pierre Yves
- Internal Medicine, Regional and University Hospital Centre Lille Internal Medicine Service, Lille, Hauts-de-France, France
| | - Carine Salliot
- Rheumatology, Regional Hospital Centre Orleans La Source Hospital, Orleans, Centre, France
| | - Aleth Perdriger
- Rheumatology, University Hospital Centre Rennes, Rennes, Bretagne, France
| | - Jacques Morel
- CHU Lapeyronie, Montpellier, Languedoc-Roussillon, France
| | - Arsène Mékinian
- Internal Medicine, Hospital Saint-Antoine, Paris, Île-de-France, France
| | - Olivier Vittecoq
- Rheumatology, University Hospital Centre Rouen, Rouen, Normandie, France
| | | | | | | | - Philippe Dieudé
- Rheumatology, Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France
| | - Claire Larroche
- Internal Medicine, Hospital Avicenne, Bobigny, Île-de-France, France
| | - Christophe Richez
- Rheumatology, CHU Bordeaux GH Pellegrin, Bordeaux, Aquitaine, France
| | - Thierry Martin
- Internal Medicine, CHU Strasbourg, Strasbourg, Alsace, France
| | - Charles Zarnitsky
- Rheumatology, Hôpital Jacques Monod, Montivilliers, Normandy, France
| | | | - Pierre Kieffer
- Internal Medicine, CH Mulhouse, Mulhouse, Grand Est, France
| | - François Maurier
- Internal Medicine, Sainte Blandine Hospital, Metz, Lorraine, France
| | - Azeddine Dellal
- Rheumatology, GHI Le Raincy-Montfermeil, Montfermeil, Île-de-France, France
| | - Stephanie Rist
- Rheumatology, Regional Hospital Centre Orleans La Source Hospital, Orleans, Centre, France
| | - Emmanuel Andres
- Internal Medicine, CHU Strasbourg, Strasbourg, Alsace, France
| | - Anne Contis
- Internal Medicine, CHU de Bordeaux, Bordeaux, Aquitaine, France
| | - Emmanuel Chatelus
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | - Christelle Sordet
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | - Jean Sibilia
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
| | | | - Mira Y Tawk
- DRCI, CHU Strasbourg, Strasbourg, Alsace, France
| | | | - Lise Holterbach
- Public Health, Methods in Clinical Research Team, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Patrice Cacoub
- University Hospital Pitié Salpêtrière, Paris, Île-de-France, France
| | - Alain Saraux
- Rheumatology, Hospital Cavale-Blanche, Brest, Bretagne, France
| | - Xavier Mariette
- Rheumatology, Université Paris-Sud BU Kremlin-Bicêtre, Le Kremlin-Bicetre, Île-de-France, France
| | - Nicolas Meyer
- Public Health, Methods in Clinical Research Team, Hopitaux universitaires de Strasbourg, Strasbourg, Alsace, France
| | - Jacques-Eric Gottenberg
- Rheumatology, CHU Strasbourg, Centre National de Référence des maladies auto-immunes et systémiques rares Est/Sud-Ouest (RESO), Strasbourg, Alsace, France
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16
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Bourse Chalvon N, Orquevaux P, Giusti D, Gatouillat G, Tabary T, Tonye Libyh M, Chrusciel J, Drame M, Stockton-Bliard G, Amoura Z, Arnaud L, Lorenz HM, Blaison G, Bonnotte B, Magy-Bertrand N, Revuz S, Voll RE, Hinschberger O, Schwarting A, Pham BN, Martin T, Pennaforte JL, Servettaz A. Absence of Anti-Glomerular Basement Membrane Antibodies in 200 Patients With Systemic Lupus Erythematosus With or Without Lupus Nephritis: Results of the GOODLUPUS Study. Front Immunol 2020; 11:597863. [PMID: 33381119 PMCID: PMC7768036 DOI: 10.3389/fimmu.2020.597863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 11/10/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Anti-glomerular basement membrane (GBM) antibodies are pathogenic antibodies first detected in renal-limited anti-GBM disease and in Goodpasture disease, the latter characterized by rapidly progressive crescentic glomerulonephritis combined with intra-alveolar hemorrhage. Studies have suggested that anti-GBM antibody positivity may be of interest in lupus nephritis (LN). Moreover, severe anti-GBM vasculitis cases in patients with systemic lupus erythematosus (SLE) have been described in the literature, but few studies have assessed the incidence of anti-GBM antibodies in SLE patients. Objective The main study objective was to determine if positive anti-GBM antibodies were present in the serum of SLE patients with or without proliferative renal damage and compared to a healthy control group. Methodology This retrospective study was performed on SLE patients’ sera from a Franco-German European biobank, developed between 2011 and 2014, from 17 hospital centers in the Haut-Rhin region. Patients were selected according to their renal involvement, and matched by age and gender. The serum from healthy voluntary blood donors was also tested. Anti-GBM were screened by fluorescence enzyme immunoassay (FEIA), and then by indirect immunofluorescence (IIF) in case of low reactivity detection (titer >6 U/ml). Results The cohort was composed of 100 SLE patients with proliferative LN (27% with class III, 67% with class IV, and 6% with class V), compared to 100 SLE patients without LN and 100 controls. Patients were mostly Caucasian and met the ACR 1997 criteria and/or the SLICC 2012 criteria. Among the 300 tested sera, no significant levels of anti-GBM antibodies were detected (>10 U/ml) by the automated technique, three sera were found “ambivalent” (>7 U/ml): one in the SLE with LN group and two in the SLE without LN group. Subsequent IIF assays did not detect anti-GBM antibodies. Conclusion Anti-GBM antibodies were not detected in the serum of Caucasian patients with SLE, even in case of renal involvement, a situation favoring the antigenic exposure of glomerular basement membranes. Our results reaffirm the central role of anti-GBM antibodies as a specific diagnostic biomarker for Goodpasture vasculitis and therefore confirm that anti-GBM antibody must not be carried out in patients with SLE (with or without LN) in the absence of disease-suggestive symptoms.
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Affiliation(s)
- Nellie Bourse Chalvon
- Département de médecine interne, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Pauline Orquevaux
- Département de médecine interne, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Delphine Giusti
- Département d'immunologie biologique (laboratoire d'immunologie), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Gregory Gatouillat
- Département d'immunologie biologique (laboratoire d'immunologie), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Thierry Tabary
- Département d'immunologie biologique (laboratoire d'immunologie), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Marcelle Tonye Libyh
- Département d'immunologie biologique (laboratoire d'immunologie), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Jan Chrusciel
- Département d'information médicale et d'évaluation des performances, santé publique, Centre Hospitalier de Troyes, Troyes, France
| | - Moustapha Drame
- Département de Délégation à la Recherche Clinique et à l'Innovation, University Hospital of Martinique, Fort-de-France, Martinique
| | | | - Zahir Amoura
- Service de Médecine interne, Assistance Publique Hôpitaux de Paris (APHP), Paris, France
| | - Laurent Arnaud
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hanns-Martin Lorenz
- Division of Rheumatology, Clinic for Hematology, Oncology and Rheumatology, Department of Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Gilles Blaison
- Département de médecine interne, Hôpital Pasteur, Colmar, France
| | - Bernard Bonnotte
- Département de Médecine Interne et d'immunologie Clinique, Centre Hospitalier Regional Universitaire De Dijon, Dijon, France
| | - Nadine Magy-Bertrand
- Département de médecine interne, Centre Hospitalier Universitaire de Besançon, Besancon, France
| | - Sabine Revuz
- Département de médecine interne, Hôpital Belle-Isle, Metz, France
| | - Reinhard Edmund Voll
- Department of Rheumatology and Clinical Immunology, Medical Center, University of Freiburg, Freiburg, Germany
| | - Oliver Hinschberger
- Département de médecine interne, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace (GHRMSA), Mulhouse, France
| | - Andreas Schwarting
- Universitäres Centrum für Autoimmunität Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | - Bach Nga Pham
- Département d'immunologie biologique (laboratoire d'immunologie), Centre Hospitalier Universitaire de Reims, Reims, France
| | - Thierry Martin
- Immunologie Clinique et Médecine Interne, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Loup Pennaforte
- Département de médecine interne, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Amelie Servettaz
- Département de médecine interne, Centre Hospitalier Universitaire de Reims, Reims, France
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Aubertin N, Bach-Bunner M, Bouldoires B, Parent X, Blaison G. Étude rétrospective monocentrique visant à mettre en évidence une valeur seuil significativement différente de cryoglobulinémie entre les patients présentant des symptômes cliniques liés à la cryoglobulinémie et ceux chez qui elle est asymptomatique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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18
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Amari S, Blaison G, Groza M, Hautecloque G, Bouldoires B. Une uvéite postérieure bilatérale associée à un tableau clinique complexe révèlent une encéphalite à GFAP. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Seve P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Berthier S, Arnaud L, Bourredjem A, Amoura Z, Devilliers H. Disease-specific quality of life following a flare in systemic lupus erythematosus: an item response theory analysis of the French EQUAL cohort. Rheumatology (Oxford) 2020; 59:1398-1406. [PMID: 31620787 DOI: 10.1093/rheumatology/kez451] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/28/2019] [Revised: 07/30/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To explore, at an item-level, the effect of disease activity (DA) on specific health-related quality of life (HRQoL) in SLE patients using an item response theory longitudinal model. METHODS This prospective longitudinal multicentre French cohort EQUAL followed SLE patients over 2 years. Specific HRQoL according to LupusQoL and SLEQOL was collected every 3 months. DA according to SELENA-SLEDAI flare index (SFI) and revised SELENA-SLEDAI flare index (SFI-R) was evaluated every 6 months. Regarding DA according to SFI and each SFI-R type of flare, specific HRQoL of remitting patients was compared with non-flaring patients fitting a linear logistic model with relaxed assumptions for each domain of the questionnaires. RESULTS Between December 2011 and July 2015, 336 patients were included (89.9% female). LupusQoL and SLEQOL items related to physical HRQoL (physical health, physical functioning, pain) were most affected by musculoskeletal and cutaneous flares. Cutaneous flares had significant influence on self-image. Neurological or psychiatric flares had a more severe impact on specific HRQoL. Patient HRQoL was impacted up to 18 months after a flare. CONCLUSION Item response theory analysis is able to pinpoint items that are influenced by a given patient group in terms of a latent trait change. Item-level analysis provides a new way of interpreting HRQoL variation in SLE patients, permitting a better understanding of DA impact on HRQoL. This kind of analysis could be easily implemented for the comparison of groups in a clinical trial. TRIAL REGISTRATION ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904812.
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Affiliation(s)
- Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Site Belle Isle, Metz
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, CHRU de Nancy.,Inserm UMR_S 1116 at Lorraine University, Nancy
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Centre Dijon, Dijon
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand
| | - Pascal Seve
- Department of Internal Medicine, University Hospital, Hôpital Croix Rousse, Lyon
| | - Gilles Blaison
- Department of Internal Medicine, Hopital Louis Pasteur, Colmar, Alsace
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Strasbourg University Hospital, Strasbourg
| | | | - Sabine Berthier
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon
| | - Laurent Arnaud
- Department of Rheumatology, Hôpitaux Universitaires de Strasbourg.,INSERM UMR-S 1109, Strasbourg
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitie-Salpetriere University Hospital, Paris, France
| | - Hervé Devilliers
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon
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20
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Arnaud L, Gavand PE, Voll R, Schwarting A, Maurier F, Blaison G, Magy-Bertrand N, Pennaforte JL, Peter HH, Kieffer P, Bonnotte B, Poindron V, Fiehn C, Lorenz H, Amoura Z, Sibilia J, Martin T. Predictors of fatigue and severe fatigue in a large international cohort of patients with systemic lupus erythematosus and a systematic review of the literature. Rheumatology (Oxford) 2020; 58:987-996. [PMID: 30597077 DOI: 10.1093/rheumatology/key398] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/01/2018] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Fatigue is reported in up to 90% of patients with SLE. This study was conducted to identify the determinants associated with fatigue in a large cohort of patients with SLE, as well as to provide a systematic review of the literature. METHODS Patients from the Lupus BioBank of the upper Rhein, a large German-French cohort of SLE patients, were included in the FATILUP study if they fulfilled the 1997 ACR criteria for SLE and had Fatigue Scale for Motor and Cognitive Functions scores collected. Multivariate logistic regression analyses were performed to assess the determinants of fatigue and severe fatigue. RESULTS A total of 570 patients were included (89.1% female). The median age was 42 years (interquartile range 25-75: 34-52). The median value of the SAfety of Estrogens in Lupus Erythematosus National Assessment (SELENA)-SLEDAI was 2 (0-4). Fatigue was reported by 386 patients (67.7%) and severe fatigue by 209 (36.7%). In multivariate analyses, fatigue was associated with depression [odds ratio (OR): 4.72 (95% CI: 1.39-16.05), P = 0.01], anxiety [OR: 4.49 (95% CI: 2.60-7.77), P < 0.0001], glucocorticoid treatment [OR: 1.59 (95% CI 1.05-2.41), P = 0.04], SELENA-SLEDAI scores [OR: 1.05 (95% CI: 1.00-1.12) per 1 point increase, P = 0.043] and age at sampling [OR: 1.01 (95% CI: 1.00-1.03) per 1 year increase, P = 0.03]. Severe fatigue was independently associated with anxiety (P < 0.0001), depression (P < 0.0001), glucocorticoid treatment (P = 0.047) and age at sampling (P = 0.03). CONCLUSION Both fatigue and severe fatigue are common symptoms in SLE, and are strongly associated with depression and anxiety. Disease activity and the use of glucocorticoids were also independently associated with fatigue, although more weakly.
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Affiliation(s)
- Laurent Arnaud
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS
| | - Pierre Edouard Gavand
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | - Rheinardt Voll
- Klinik für Rheumatologie und Klinische Immunologie & Center of Chronic Immunodeficiency (CCI) Universitätsklinikum, Freiburg
| | - Andreas Schwarting
- I.st Department of Internal Medicine, Universitätsmedizin, Mainz, Germany
| | | | - Gilles Blaison
- Service de médecine interne - Centre de compétence en maladies auto-immunes et systémiques rares, Hôpitaux Civils de COLMAR, Colmar
| | | | | | - Hans-Harmut Peter
- Freiburg University Hospital, Uniklinikum Medizinische Klinik Abt, Rheumatologie and Klinische Immunologie, Freiburg, Germany
| | - Pierre Kieffer
- Centre de compétence des maladies autoimmunes et systemiques rares, Service de médecine interne et soins continus du, centre hospitalier de Mulhouse, Mulhouse
| | - Bernard Bonnotte
- CHU Dijon Bourgogne, Service de médecine interne et immunologie clinique, France
| | - Vincent Poindron
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
| | | | - Hannes Lorenz
- Department of Medicine V, University Hospital Heidelberg, Center for Rheumatic Diseases Baden-Baden, Heidelberg, Germany
| | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, Assistance Publique-Hôpitaux de Paris (APHP), Groupement Hospitalier Pitié-Salpêtrière, Paris
| | - Jean Sibilia
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service de rhumatologie, INSERM UMR-S1109, Hôpital de Hautepierre, Strasbourg, France
| | - Thierry Martin
- Centre National de Référence des Maladies Autoimmunes Systémiques Rares Est Sud-Ouest (RESO)-LUPUS.,Service d'immunologie clinique Nouvel hôpital civil, Strasbourg, France
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21
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Martin M, Martinez C, Arnaud L, Weber JC, Poindron V, Blaison G, Kieffer P, Bonnotte B, Berthier S, Wahl D, Maurier F, Pennaforte JL, Bielefeld P, Magy-Bertrand N, Devilliers H, Martin T. Association of antiphospholipid antibodies with active digital ulceration in systemic sclerosis. RMD Open 2019; 5:e001012. [PMID: 31673412 PMCID: PMC6802995 DOI: 10.1136/rmdopen-2019-001012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/23/2019] [Accepted: 09/06/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Mickaël Martin
- Internal Medicine, Poitiers University Hospital, Poitiers, France
| | | | - Laurent Arnaud
- Rheumatology, National Reference Center for Rare Autoimmune Diseases (RESO), Strasbourg University Hospital, Strasbourg, France
| | - Jean-Christophe Weber
- Internal Medicine, National Reference Center for Rare Autoimmune Diseases (RESO), Strasbourg University Hospital, Strasbourg, France
| | - Vincent Poindron
- Clinical Immunology, National Reference Center for Rare Autoimmune Diseases (RESO), Strasbourg University Hospital, Strasbourg, France
| | - Gilles Blaison
- Internal Medicine, Colmar Civilian Hospitals, Colmar, France
| | - Pierre Kieffer
- Internal Medicine, Mulhouse Regional Hospital Center, Mulhouse, France
| | - Bernard Bonnotte
- Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Sabine Berthier
- Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Denis Wahl
- Vascular Medicine, Regional Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vandoeuvre-Les-Nancy, France.,Medicine Faculty, University of Lorraine, Vandoeuvre-Les-Nancy, France
| | - Francois Maurier
- Internal Medicine, Metz-Thionville Regional Hospital Center, Metz, France
| | | | - Philip Bielefeld
- Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Hervé Devilliers
- Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Thierry Martin
- Clinical Immunology, National Reference Center for Rare Autoimmune Diseases (RESO), Strasbourg University Hospital, Strasbourg, France
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22
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Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Pennaforte JL, Martin T, Magy-Bertrand N, Berthier S, Arnaud L, Bourredjem A, Amoura Z, Devilliers H. Réponses aux items des questionnaires spécifiques de qualité de vie dans les 18 mois suivant une poussée de lupus érythémateux systémique : une analyse en théorie de la réponse à l’item de la cohorte française EQUAL. Rev Epidemiol Sante Publique 2019. [DOI: 10.1016/j.respe.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Dollat M, Chaigne B, Cormier G, Costedoat-Chalumeau N, Lifermann F, Deroux A, Berthoux E, Dernis E, Sené T, Blaison G, Lambotte O, Terrier B, Sellam J, De Saint-Martin L, Chiche L, Dupin N, Mouthon L. Extra-haematological manifestations related to human parvovirus B19 infection: retrospective study in 25 adults. BMC Infect Dis 2018; 18:302. [PMID: 29973155 PMCID: PMC6033229 DOI: 10.1186/s12879-018-3227-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/29/2018] [Indexed: 01/19/2023] Open
Abstract
Background To describe extra-haematological manifestations associated with human parvovirus B19 (HPV-B19) infection. Methods We conducted a nationwide multicentre study to retrospectively describe the characteristics and outcome of extra-haematological manifestations in French adults. Results Data from 25 patients followed from 2001 to 2016 were analysed. Median age was 37.9 years (range: 22.7–83.4), with a female predominance (sex ratio: 4/1). Only 3 patients had an underlying predisposing condition (hemoglobinopathy or pregnancy). The most common manifestations were joint (80%) and skin (60%) involvement. Four patients (16%) had renal involvement (endocapillary proliferative or membranoproliferative glomerulonephritis, focal segmental glomerulosclerosis). Three patients (12%) had peripheral nervous system involvement (mononeuritis, mononeuritis multiplex, Guillain-Barré syndrome) and 2 (8%) presented muscle involvement. Other manifestations included hemophagocytic lymphohistiocytosis (n = 1), myopericarditis and pleural effusion (n = 1), and lymphadenopathy and splenomegaly mimicking lymphoma with spleen infarcts (n = 1). Immunological abnormalities were frequent (56.5%). At 6 months, all patients were alive, and 54.2% were in complete remission. In 2 patients, joint involvement evolved into rheumatoid arthritis. Six patients (24%) received intravenous immunoglobulin (IVIg), with a good response in the 3 patients with peripheral nervous system involvement. Conclusions HPV-B19 infection should be considered in a wide range of clinical manifestations. Although the prognosis is good, IVIg therapy should be discussed in patients with peripheral nerve involvement. However, its efficacy should be further investigated in prospective studies.
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Affiliation(s)
- Marion Dollat
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Grégoire Cormier
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Nathalie Costedoat-Chalumeau
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - François Lifermann
- Service de Médecine Interne, Centre Hospitalier de Dax - Côte d'Argent, Dax, France
| | - Alban Deroux
- Service de Médecine Interne, Centre Hospitalier Universitaire Grenoble Alpes, Université Grenoble Alpes, Grenoble, France
| | - Emilie Berthoux
- Service de Médecine Interne, Centre Hospitalier Saint-Joseph Saint-Luc, Lyon, France
| | - Emmanuelle Dernis
- Service de Rhumatologie, Centre Hospitalier - Le Mans, Le Mans, France
| | - Thomas Sené
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Gilles Blaison
- Service de Médecine Interne, Centre Hospitalier Louis Pasteur, Colmar, France
| | - Olivier Lambotte
- Service de Médecine Interne et Immunologie, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Benjamin Terrier
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | - Jérémie Sellam
- Service de Rhumatologie, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie, Paris, France
| | - Luc De Saint-Martin
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares Nord et Ouest, Centre Hospitalier Régional et Universitaire de Brest, Université de Bretagne Occidentale, Brest, France
| | - Laurent Chiche
- Service de Médecine Interne, Hôpital Européen, Marseille, France
| | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Systémiques Autoimmunes Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France. .,Service de médecine interne, Hôpital Cochin, 27, rue du faubourg Saint-Jacques, 75679, Paris Cedex 14, France.
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Groza M, Meyer A, Rondeau-Lutz M, Blaison G. Caractéristiques des myopathies inflammatoires idiopathiques chez les patients âgés. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Danion F, Sparsa L, Arnaud L, Alsaleh G, Lefebvre F, Gies V, Martin T, Lukas C, Durckel J, Ardizzone M, Javier RM, Kleinmann JF, Moreau P, Blaison G, Goetz J, Chatelus E, Gottenberg JE, Sibilia J, Sordet C. Long-term efficacy and safety of antitumour necrosis factor alpha treatment in rhupus: an open-label study of 15 patients. RMD Open 2017; 3:e000555. [PMID: 29435362 PMCID: PMC5761296 DOI: 10.1136/rmdopen-2017-000555] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/04/2017] [Accepted: 10/21/2017] [Indexed: 11/03/2022] Open
Abstract
Background The efficacy of antitumour necrosis factor alpha (anti-TNF-α) treatment is well recognised in rheumatoid arthritis (RA) but remains controversial in systemic lupus erythematosus (SLE). Therefore, the role of anti-TNF-α treatment in 'Rhupus', a disease sharing features of RA and SLE, is still debated. Objective To evaluate the efficacy and tolerance of anti-TNF-α in patients with rhupus. Methods Fifteen patients with rhupus with Disease Activity Score 28 (DAS 28) >3.2 despite conventional disease-modifying anti-rheumatic drugs were included in an open-label study. Patients were monitored at months (M) 3, 6, 12, 24 and 60 with SLE Disease Activity Index (SLEDAI) and DAS 28. Statistical analyses were performed using Bayesian methods and Prob >97.5% was considered significant. Results Twelve patients were treated with etanercept for a median duration of 62.5 (range: 6-112) months and three patients by adalimumab during 36.0 (range: 4-52) months. At baseline, median DAS 28 and SLEDAI were 5.94 (4.83-8.09) and 6 (4-8), respectively. DAS 28 and SLEDAI decreased significantly after 3 months, respectively, to 3.70 (1.80-6.42) and 4 (0-6) (Prob >99.9%, for both). These changes persisted at M6, M12, M24 and M60 (Prob >99.9%, for all). Median prednisone dose decreased significantly from 15 (5-35) mg/day to 5 (0-20) mg/day after 6 months and over the follow-up (Prob >99.9%, for all). Tolerance was acceptable, with a severe infection rate of 3.0 per 100 patient-years. Conclusion This pilot study suggests that anti-TNF-α is effective in patients with rhupus with refractive arthritis and has an acceptable safety profile.
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Affiliation(s)
- François Danion
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Laetitia Sparsa
- Department of Rheumatology, Centre de compétence maladies rares et autoimmunes, Centre Hospitalier de Mulhouse, Mulhouse, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Ghada Alsaleh
- UMR 1109 Immuno-Rhumatologie Moléculaire, INSERM, Strasbourg, France
| | - François Lefebvre
- Department of Public Health, Hopitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Vincent Gies
- UPR 3572 Immunopathology and Therapeutic Chemistry, CNRS, Strasbourg, France
| | - Thierry Martin
- UPR 3572 Immunopathology and Therapeutic Chemistry, CNRS, Strasbourg, France.,Department of Internal Medicine, Centre de références des maladies rares et auto immunes, Hopitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Cédric Lukas
- Department of Rheumatology, Lapeyronie Hospital, Montpellier University, Montpellier, France
| | - Jean Durckel
- Department of Radiology, Hopitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Marc Ardizzone
- Department of Rheumatology, Centre de compétence maladies rares et autoimmunes, Centre Hospitalier de Mulhouse, Mulhouse, France
| | - Rose-Marie Javier
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Jean-François Kleinmann
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Paul Moreau
- Department of Rheumatology, Hopital Louis Pasteur, Colmar, Alsace, France
| | - Gilles Blaison
- Department of Internal Medicine, Hopital Louis Pasteur, Colmar, Alsace, France
| | - Joelle Goetz
- Department of Immunology, Hopitaux universitaires de Strasbourg, Strasbourg, France
| | - Emmanuel Chatelus
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France.,UPR 3572 Immunopathology and Therapeutic Chemistry, CNRS, Strasbourg, France
| | - Jean Sibilia
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France.,UMR 1109 Immuno-Rhumatologie Moléculaire, INSERM, Strasbourg, France
| | - Christelle Sordet
- Department of Rheumatology, Centre de référence des maladies rares et auto immunes, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
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Gavand P, Schwarting A, Voll R, Maurier F, Blaison G, Fiehn C, Jl. P, Lorenz H, Amoura Z, Sibilia J, Poindron V, Martin T. Étude descriptive de la cohorte franco–allemande LBBR de patients ayant un lupus erythémateux systémique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Devilliers H, Besancenot J, Audia S, Maurier F, Broussolle C, Magy-Bertrand N, Wahl D, Pennaforte J, Martin T, Aumaître O, Blaison G, Amoura Z. Facteurs sociodémographiques et cliniques influençant la qualité de vie générique et spécifique au cours du lupus systémique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Guison J, Groza M, Stoica O, Blaison G. Un cas d’encéphalomyélite aiguë disséminée post-infectieuse découvert devant une rétention vésicale fébrile. Rev Med Interne 2017; 38:278-281. [DOI: 10.1016/j.revmed.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/07/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
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Kleinmann J, Tubach F, Le Guern V, Mathian A, Richez C, Saadoun D, Sacré K, Sellam J, Seror R, Amoura Z, Andres E, Audia S, Bader-Meunier B, Blaison G, Bonnotte B, Cacoub P, Caillard S, Chiche L, Chosidow O, Costedoat-Chalumeau N, Daien C, Daugas E, Derdèche N, Doria A, Fain O, Fakhouri F, Farge D, Gabay C, Guillo S, Hachulla E, Hajjaj-Hassouni N, Hamidou M, Houssiau F, Jourde-Chiche N, Kone-Paut I, Ladjouz-Rezig A, Lambotte O, Lipsker D, Mariette X, Martin Silva N, Martin T, Maurier F, Meckenstock R, Mekinian A, Meyer O, Mohamed S, Morel J, Moulin B, Mulleman D, Papo T, Poindron V, Puéchal X, Punzi L, Quartier P, Sailler L, Smail A, Soubrier M, Sparsa A, Tazi Mezalek Z, Zakraoui L, Zuily S, Sibilia J, Gottenberg J. Recommandations francophones, internationales et multidisciplinaires d’experts pour l’utilisation de biomédicaments dans le lupus érythémateux systémique : le groupe de travail du CRI-IMIDIATE. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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de Cambourg G, Mahé A, Banea S, Moulinas C, Blaison G. Granulomatose avec polyangéite révélée par une ulcération cutanée mimant un pyoderma gangrenosum : à propos de 2 cas. Rev Med Interne 2016; 37:632-5. [DOI: 10.1016/j.revmed.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/31/2015] [Accepted: 12/07/2015] [Indexed: 11/28/2022]
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31
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Meyer A, Chifflot H, Chatelus E, Kleinmann JF, Ronde-Ousteau C, Klein D, Jégu J, Geny B, Hirshi S, Canuet M, Blaison G, Kieffer P, Lipsker D, Martin T, Sauleau E, Velten M, Sibilia J. Brief Report: Spatial Heterogeneity of Systemic Sclerosis in France: High Prevalence in the Northeast Region. Arthritis Rheumatol 2016; 68:1731-7. [DOI: 10.1002/art.39613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 01/21/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Alain Meyer
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Hélène Chifflot
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Emmanuel Chatelus
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Jean-François Kleinmann
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | | | | | | | - Bernard Geny
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Sandrine Hirshi
- Centre de Compétence des Maladies Pulmonaires Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Matthieu Canuet
- Centre de Compétence des Maladies Pulmonaires Rares and Centre de Compétences des Hypertensions Pulmonaires Sévères, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Gilles Blaison
- Centre de Compétence des Maladies Auto-immunes Rares, Centre Hospitalier; Colmar France
| | | | - Dan Lipsker
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Thierry Martin
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | - Erik Sauleau
- Hôpitaux Universitaires de Strasbourg; Strasbourg France
| | | | - Jean Sibilia
- Centre de Référence des Maladies Auto-immunes Rares, Hôpitaux Universitaires de Strasbourg; Strasbourg France
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Levesque K, Morel N, Maltret A, Baron G, Masseau A, Orquevaux P, Piette JC, Barriere F, Le Bidois J, Fermont L, Fain O, Theulin A, Sassolas F, Pezard P, Amoura Z, Guettrot-Imbert G, Le Mercier D, Georgin-Lavialle S, Deligny C, Hachulla E, Mouthon L, Ravaud P, Villain E, Bonnet D, Costedoat-Chalumeau N, Bezanahary H, Bienvenu B, Blaison G, Blanche P, Bonnotte B, Cathebras P, Christides C, Cohen F, Cohen L, Devaud E, Diot E, Duhaut P, Dulac Y, Godeau B, Gournay V, Gronier C, Guillevin L, Hamidou M, Haroche J, Hayem G, Heitz F, Isnard R, Jallouli M, Korganow AS, Le Jeunne C, Lhote F, Lucron H, Lusson JR, Magnier S, Ninet J, Pangaud N, Papo T, Pellegrin JL, Pennaforte JL, Pouchot J, Sarrot-Reynauld F, Schleinitz N, Seve P, Stos B, Vital-Durand D, Wechsler B. Description of 214 cases of autoimmune congenital heart block: Results of the French neonatal lupus syndrome. Autoimmun Rev 2015; 14:1154-60. [DOI: 10.1016/j.autrev.2015.08.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 08/05/2015] [Indexed: 01/12/2023]
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Taheri O, Blaison G, Sawaf K, Potelon P, De Briel D, Martinot M, Dupré N. Toxocarose révélée par des nodules pulmonaires excavés et une hyperéosinophilie chez une patiente présentant des douleurs mammaires atypiques. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.047] [Citation(s) in RCA: 2] [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: 11/28/2022]
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Vallet H, Riviere S, Lambert M, Deroux A, Bielfeld P, Seve P, Fraison J, Perard L, Schoindre Y, Papo T, Kaplanski G, Sellam J, Le Hoang T, Fain O, Marie I, Sene D, Mariette X, Blaison G, Hachulla E, Perlat A, Wechsler B, Cacoub P, Bodaghi B, Saadoun D. SAT0269 Efficacy and Safety of Anti-TNF Alpha in BehÇEt Disease: Preliminary Results of A French Multicenter Registry of 92 Patients. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Devilliers H, Besancenot JF, Maurier F, Martin T, Seve P, Wahl D, Kaminsky P, Pennaforte JL, Blaison G, Aumaitre O, Magy-Bertrand N, Amoura Z. Relation entre le tabagisme et la qualité de vie au cours du lupus systémique : résultats préliminaires de l’étude EQUAL sur 296 patients. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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36
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Devilliers H, Amoura Z, Maurier F, Pasquali JL, Broussolle C, Wahl D, Kaminsky P, Pennaforte JL, Blaison G, Aumaitre O, Magy-Bertrand N, Besancenot JF. Déterminants de la qualité de vie liée au lupus systémique en France : résultats préliminaires de l’étude EQUAL sur 328 patients. Rev Med Interne 2014. [DOI: 10.1016/j.revmed.2014.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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Martinot M, Oswald L, Parisi E, Etienne E, Argy N, Grawey I, De Briel D, Zadeh MM, Federici L, Blaison G, Koebel C, Jaulhac B, Hansmann Y, Christmann D. Immunoglobulin deficiency in patients with Streptococcus pneumoniae or Haemophilus influenzae invasive infections. Int J Infect Dis 2014; 19:79-84. [DOI: 10.1016/j.ijid.2013.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/25/2022] Open
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Petrosyan I, Blaison G, Andrès E, Federici L. Anaemia in the elderly: an aetiologic profile of a prospective cohort of 95 hospitalised patients. Eur J Intern Med 2012; 23:524-8. [PMID: 22863429 DOI: 10.1016/j.ejim.2012.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 03/09/2012] [Accepted: 03/15/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Anaemia is a significant problem in the elderly, and the cause of anaemia in approximately one third of the general population is unidentified. To date, only a few studies have focused on hospitalised patients. PATIENTS AND METHODS We prospectively included anaemic patients (according to OMS criteria) aged 65 years and older who were hospitalised in the internal medicine department. The typical clinical data were collected, and a standardised set of biological tests, including cupraemia was performed. RESULTS Of 360 total patients, 191 (53%) patients were anaemic; however, 96 patients were excluded because their data were incomplete. Of the remaining 95 patients that were included, 45 were men (47.4%) and 50 were women (52.6%); the mean patient age was 79.7 years (66-101 years). At least one cause of anaemia was diagnosed in 87 of the 95 (91.6%) patients, and anaemia was multifactorial in 44 of the 95 (46.3%) cases. The five most prominent causes of anaemia were inflammation (62.1%), iron deficiency (30.5%), folic acid deficiency (21%), chronic renal failure (17.9%) and cobalamin deficiency (11.6%). Microcytosis was present in only 27.5% of the patients who had an iron deficiency, and macrocytosis was present in only 7.4% of the patients who had a folic acid and/or cobalamin deficiency. The cause of anaemia could not be identified for 8 of the patients. The cupraemia was normal in all the patients. CONCLUSION A predefined protocol for older hospitalised patients was ability to identify the aetiology of anaemia in 91.6% of the cases; strikingly, anaemia was frequently caused by more than one factor (43.5%). Diagnostic orientation based on the mean corpuscular volume does not appear to correlate with mean cellular volume profile. Finally, anaemia caused by an unknown aetiology is rare and copper deficiency was not documented in any case.
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Affiliation(s)
- Inessa Petrosyan
- Department of Internal Medicine, Hôpitaux Civils de Colmar, Colmar, France
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Garaud JC, Schickel JN, Blaison G, Knapp AM, Dembele D, Ruer-Laventie J, Korganow AS, Martin T, Soulas-Sprauel P, Pasquali JL. B cell signature during inactive systemic lupus is heterogeneous: toward a biological dissection of lupus. PLoS One 2011; 6:e23900. [PMID: 21886837 PMCID: PMC3160348 DOI: 10.1371/journal.pone.0023900] [Citation(s) in RCA: 39] [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] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 07/27/2011] [Indexed: 11/18/2022] Open
Abstract
Systemic lupus erythematosous (SLE) is an autoimmune disease with an important clinical and biological heterogeneity. B lymphocytes appear central to the development of SLE which is characterized by the production of a large variety of autoantibodies and hypergammaglobulinemia. In mice, immature B cells from spontaneous lupus prone animals are able to produce autoantibodies when transferred into immunodeficient mice, strongly suggesting the existence of intrinsic B cell defects during lupus. In order to approach these defects in humans, we compared the peripheral B cell transcriptomas of quiescent lupus patients to normal B cell transcriptomas. When the statistical analysis is performed on the entire group of patients, the differences between patients and controls appear quite weak with only 14 mRNA genes having a false discovery rate ranging between 11 and 17%, with 6 underexpressed genes (PMEPA1, TLR10, TRAF3IP2, LDOC1L, CD1C and EGR1). However, unforced hierarchical clustering of the microarrays reveals a subgroup of lupus patients distinct from both the controls and the other lupus patients. This subgroup has no detectable clinical or immunological phenotypic peculiarity compared to the other patients, but is characterized by 1/an IL-4 signature and 2/the abnormal expression of a large set of genes with an extremely low false discovery rate, mainly pointing to the biological function of the endoplasmic reticulum, and more precisely to genes implicated in the Unfolded Protein Response, suggesting that B cells entered an incomplete BLIMP1 dependent plasmacytic differentiation which was undetectable by immunophenotyping. Thus, this microarray analysis of B cells during quiescent lupus suggests that, despite a similar lupus phenotype, different biological roads can lead to human lupus.
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Affiliation(s)
- Jean-Claude Garaud
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | | | | | - Anne-Marie Knapp
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Doulaye Dembele
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Illkirch-Graffenstaden, France
| | - Julie Ruer-Laventie
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | - Anne-Sophie Korganow
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Thierry Martin
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Pauline Soulas-Sprauel
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
| | - Jean-Louis Pasquali
- CNRS UPR 9021, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
- Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Université de Strasbourg, Strasbourg, France
- * E-mail:
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Foessel L, Besancenot JF, Blaison G, Magy-Bertrand N, Jaussaud R, Etienne Y, Maurier F, Audia S, Martin T. Clinical spectrum, treatment, and outcome of patients with type II mixed cryoglobulinemia without evidence of hepatitis C infection. J Rheumatol 2011; 38:716-22. [PMID: 21239761 DOI: 10.3899/jrheum.100898] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The clinical spectrum, etiologies, and best therapeutic approaches of type II mixed cryoglobulinemia (MC) not associated with hepatitis C virus (HCV) infection have been poorly described to date. We studied the clinical presentation and outcome of patients with type II MC with no evidence of HCV. METHODS This was a multicenter retrospective study on the clinical presentation and outcome of patients with type II MC without evidence of HCV infection. Only patients with symptomatic MC were included. RESULTS Thirty-three patients were included (median followup 67.2 mo). Extensive investigations for associated diseases were performed at presentation. MC was related to an autoimmune disease in 14 patients, to a lymphoid malignancy in 4 patients, and to an infectious disease in 2 patients, while MC was classified as essential (primary) in 13. Essential MC tended to be more severe than secondary disease with, in particular, more frequent renal and peripheral nerve involvement. Most patients were treated with steroid with or without immunosuppressive agents, mainly cyclophosphamide. These treatments were unable to induce sustained remission. One patient was successfully treated with lenalidomide. Seven patients with nonmalignant MC were treated with rituximab; 2 had a sustained complete remission, 3 improved greatly but relapsed within 5 months, and 2 experienced a disease flare. CONCLUSION An important proportion of non HCV-related type II MC remains essential. Efforts should be made to find other etiologies than HCV, because treatments with steroid and immunosuppressants are not satisfactory, especially in severe forms. In these situations anti-CD20 therapy may present the best option but should be used with caution. New agents such as lenalidomide remain to be evaluated.
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Affiliation(s)
- Laure Foessel
- Department of Clinical Immunology, National Referral Center or Autoimmune Diseases, University of Strasbourg, Strasbourg, France
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Cordonnier P, Iltis C, Martinez C, Blaison G, Martinot M. Neuroborréliose après une borréliose de Lyme primaire traitée par azithromycine. Med Mal Infect 2010; 40:493-5. [DOI: 10.1016/j.medmal.2009.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 09/05/2009] [Accepted: 10/28/2009] [Indexed: 11/29/2022]
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42
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Staebler J, Gutbub AM, Pelsy C, Blaison G, Lacombe P, Federici L. Maladie de Rendu-Osler et AVC : une embolie septique jusqu’à preuve du contraire. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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43
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Federici L, Blondet C, Imperiale A, Sibilia J, Pasquali JL, Pflumio F, Goichot B, Blaison G, Weber JC, Christmann D, Constantinesco A, Andrès E. Value of (18)F-FDG-PET/CT in patients with fever of unknown origin and unexplained prolonged inflammatory syndrome: a single centre analysis experience. Int J Clin Pract 2010; 64:55-60. [PMID: 18479364 DOI: 10.1111/j.1742-1241.2008.01774.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The aim of our study was to evaluate the diagnostic contribution of (18)F-fluoro-deoxyglucose ((18)F-FDG)-positron emission tomography (PET)/computed tomography (CT) in patients with fever of unknown origin (FUO) or unexplained prolonged inflammatory syndrome (UPIS) in real life. PATIENTS AND METHODS We performed a retrospective study including 14 patients with FUO or UPIS hospitalised in our institution (Strasbourg University Hospital, France) between January 2005 and July 2006. (18)F-FDG-PET/CT was considered helpful when abnormal results allowed an accurate diagnosis. RESULTS (18)F-FDG-PET/CT was helpful in half the patients (7/14) for final diagnosis. A diagnosis was reached in 87.5% of the patients (7/8) with an abnormal (18)F-FDG-PET/CT but only in 50% of the patients (3/6) with a normal (18)F-FDG-PET/CT. Conventional chest and abdominal CT was performed in 13 patients before ordering (18)F-FDG-PET/CT. We considered that (18)F-FDG-PET/CT was essential to establish the final diagnosis in only 23% of the patients (3/13) since neither chest nor abdominal CT identified abnormalities consistent with the final diagnosis. However, among the three patients, two were diagnosed with large vessel vasculitis and one patient with local prosthetic infection. CONCLUSIONS Our study supports the potential interest of (18)F-FDG-PET/CT in the diagnostic workup of FUO and UPIS as it helped establish a fine diagnosis in half of the cases. However, (18)F-FDG-PET/CT appeared to be essential to the final diagnosis in only 23% of the cases. In our opinion, this protocol should be performed as a second level test, especially when conventional CT is normal or is unable to discriminate between active and silent lesions.
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Affiliation(s)
- L Federici
- Department of Internal Medicine, Medical Clinic B, University Hospital of Strasbourg, Strasbourg, France
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Federici L, Hue M, Barats JC, Blaison G, Mazurier I, Lissalde GL. Hémophilie acquise et anticorps « non inhibiteur » anti-facteur VIII. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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45
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Brabant-Viau A, Salmon JH, Pasquali JL, Pruna L, Blaison G, Kieffer P, Magy-Bertrand N, Besancenot JF, Pennaforte JL. Myosite orbitaire idiopathique : à propos de 24 cas dans la région Grand-Est. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Woehl JM, Parent X, Blaison G. Insuffisance cardiaque compliquant un « hungry bone syndrome ». Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.10.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Etienne E, Hanser AM, Woehl-Kremer B, Mohseni-Zadeh M, Blaison G, Martinot M. Macroenzymes : macro-ASAT et macro-CPK. Deux observations et revue de la littérature. Rev Med Interne 2009; 30:963-9. [DOI: 10.1016/j.revmed.2009.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 05/12/2009] [Accepted: 06/21/2009] [Indexed: 11/25/2022]
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48
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Belizna C, Hamidou M, Faller B, Blaison G, Lavigne C, Godin M, Marie I, Thuillez C, Levesque H. Cryofibrinogénémie et insuffisance rénale. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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49
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Garaud JC, Schickel JN, Poindron V, Martin T, Blaison G, Pasquali JL. Analyse du transcriptome des lymphocytes B de patients atteints de lupus systémique quiescent. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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50
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Foessel L, Dupond JL, Blaison G, Jaussaud R, Besancenot JF, Bonnotte B, Martin T. Cryoglobulinémies mixtes de type II non liées au virus de l’hépatite C. Rev Med Interne 2009. [DOI: 10.1016/j.revmed.2009.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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