1
|
Jarrot PA, Mirouse A, Ottaviani S, Cadiou S, Salmon JH, Liozon E, Parreau S, Michaud M, Terrier B, Gavand PE, Trefond L, Lavoiepierre V, Keraen J, Rekassa D, Bouldoires B, Weitten T, Roche D, Poulet A, Charpin C, Grobost V, Hermet M, Pallure M, Wackenheim C, Karkowski L, Grumet P, Rogier T, Belkefi N, Pestre V, Broquet E, Leurs A, Gautier S, Gras V, Gilet P, Holubar J, Sivova N, Schleinitz N, Durand JM, Castel B, Petrier A, Arcani R, Gramont B, Guilpain P, Lepidi H, Weiller PJ, Micallef J, Saadoun D, Kaplanski G. Polymyalgia rheumatica and giant cell arteritis following COVID-19 vaccination: Results from a nationwide survey. Hum Vaccin Immunother 2024; 20:2334084. [PMID: 38563792 PMCID: PMC10989707 DOI: 10.1080/21645515.2024.2334084] [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: 01/17/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
We conducted a national in-depth analysis including pharmacovigilance reports and clinical study to assess the reporting rate (RR) and to determine the clinical profile of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) in COVID-19-vaccinated individuals. First, based on the French pharmacovigilance database, we estimated the RR of PMR and GCA cases in individuals aged over 50 who developed their initial symptoms within one month of receiving the BNT162b2 mRNA, mRNA-1273, ChAdOx1 nCoV-19, and Ad26.COV2.S vaccines. We then conducted a nationwide survey to gather clinical profiles, therapeutic management, and follow-up data from individuals registered in the pharmacovigilance study. A total of 70 854 684 COVID-19 vaccine doses were administered to 25 260 485 adults, among which, 179 cases of PMR (RR 7. 1 cases/1 000 000 persons) and 54 cases of GCA (RR 2. 1 cases/1 000 000 persons) have been reported. The nationwide survey allowed the characterization of 60 PMR and 35 GCA cases. Median time to the onset of first symptoms was 10 (range 2-30) and 7 (range 2-25) days for PMR and GCA, respectively. Phenotype, GCA-related ischemic complications and -large vessel vasculitis as well as therapeutic management and follow-up seemed similar according to the number of vaccine shots received and when compared to the literature data of unvaccinated population. Although rare, the short time between immunization and the onset of first symptoms of PMR and GCA suggests a temporal association. Physician should be aware of this potential vaccine-related phenomenon.
Collapse
Affiliation(s)
- Pierre-André Jarrot
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
| | - Adrien Mirouse
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Sébastien Ottaviani
- Department of Rheumatology, DMU Locomotion, Hôpital Bichat-Claude Bernard, APHP, Université de Paris, Paris, France
| | - Simon Cadiou
- Department of Rheumatology, CHU de Rennes, Université de Rennes 1, Rennes, France
| | - Jean-Hugues Salmon
- Department of Rheumatology, Hôpital de La Maison Blanche, Université de Reims, Reims, France
| | - Eric Liozon
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Simon Parreau
- Department of Internal Medicine, Hôpital Universitaire de Limoges, Limoges, France
| | - Martin Michaud
- Department of Internal Medicine, Clinique Saint-Exupery, Toulouse, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Disease, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre, Université Paris Cité, Paris, France
| | | | - Ludovic Trefond
- Department of Internal Medicine, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Virginie Lavoiepierre
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jeremy Keraen
- Department of Internal Medicine, Hôpital de Cornouaille, Quimper, France
| | - Daniel Rekassa
- Department of Rehabilitation, Centre Thermal, Greoux Les Bains, France
| | | | - Thierry Weitten
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Damien Roche
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Antoine Poulet
- Department of Internal Medicine, Hôpital Saint-Joseph, Marseille, France
| | - Caroline Charpin
- Department of Rheumatology, Hôpital Saint-Joseph, Marseille, France
| | - Vincent Grobost
- Department of Internal Medicine, Hôpital Estaing, Clermont-Ferrand, France
| | - Marion Hermet
- Department of Internal Medicine, Hôpital de Vichy, Vichy, France
| | - Magali Pallure
- Department of Rheumatology, Hôpital de Cannes Simone Veil, Cannes, France
| | - Chloe Wackenheim
- Department of Internal Medicine, Medipole Hôpital Privé, Villeurbanne, France
| | - Ludovic Karkowski
- Department of Internal Medicine, Hôpital d’Instruction des Armées Sainte-Anne, Toulon, France
| | - Pierre Grumet
- Department of Internal Medicine, Hôpital des Alpes du Sud, Gap, France
| | - Thomas Rogier
- Department of Internal Medicine and Systemic Disease, Hôpital François Mitterand, Dijon, France
| | - Nabil Belkefi
- Department of Internal Medicine, CH de Melun, Melun, France
| | - Vincent Pestre
- Department of Internal Medicine and Infectious Disease, CH d’Avignon, Avignon, France
| | | | - Amélie Leurs
- Department of Internal Medicine and Infectious Disease, CH de Dunkerque, Dunkerque, France
| | - Sophie Gautier
- Department of Pharmacology, centre régional de pharmacovigilance Nord Pas de Calais, CHRU de Lille, Lille, France
| | - Valérie Gras
- Department of Clinical Pharmacology, Centre régional de pharmacovigilance, service de pharmacologie clinique, CHU Amiens-Picardie, Amiens, France
| | - Pierre Gilet
- Regional Center of Pharmacovigilance, CHRU de Nancy, Hôpital Central, Nancy, France
| | - Jan Holubar
- Department of Internal Medicine, CHU de Nîmes, Nîmes, France
| | - Nadia Sivova
- Department of Internal Medicine, CH de Tourcoing, Tourcoing, France
| | - Nicolas Schleinitz
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean-Marc Durand
- Department of Internal Medicine, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Brice Castel
- Department of Internal Medicine, CH de Tarbes, Tarbes, France
| | | | - Robin Arcani
- Department of Internal Medicine and Therapeutics Department, Hôpital de La Timone, Marseille, France
| | - Baptiste Gramont
- Department of Internal Medicine, CHU de Saint-Etienne, Saint-Etienne, France
| | - Philippe Guilpain
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Hubert Lepidi
- Pathological Laboratory, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | | | - Joelle Micallef
- Department of Clinical Pharmacology and pharmacosurveillance, Regional Pharmacovigilance Center of Marseille, Hôpital de La Timone, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l’Amylose inflammatoire (CEREMAIA), Sorbonne Universités, Paris, France
- INSERM, UMR_S 959 Lab, Immunology, Immunotherapeutics, Paris, France
- DMU 3ID, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Gilles Kaplanski
- Department of Internal Medicine and Clinical Immunology, Hôpital de La Conception, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
- Centre for Cardiovascular and Nutrition Research (C2VN), INRA 1260, INSERM UMR_S1263, Aix-Marseille University, Marseille, France
| |
Collapse
|
2
|
Bouvet J, Broner J, Arnaud E, Dumain C, Holubar J, Costa D, Fesler P, Fages M, Goulabchand R. [Easing the patients' trajectories from private practice to hospital: One-year experiment of the RAPIDO project]. Rev Med Interne 2023:S0248-8663(23)00128-5. [PMID: 37150638 DOI: 10.1016/j.revmed.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Internal medicine departments manage patients referred by emergency departments or private practitioners. Considering the overcrowding of emergency departments and lack of beds for inpatients, this specialty must be part of an "ambulatory shift", particularly by strengthening the links between community and hospital medicine. Our objective was to evaluate a new care pathway in internal medicine at Nîmes university hospital. METHODS Our department has developed the RAPIDO project (Réseau d'Aide à la PrIse en Charge Diagnostique et d'Orientation). The referring general practitioner contacts a senior internist on a dedicated phone line. After careful evaluation, he may offer a consultation within 15 days. A summary report is then given to the patient. RESULTS Between November 2020 and November 2021, 254 patients were seen via RAPIDO. The average call-consultation time period was 6.4 (±4.5) days, for symptoms lasting for 2 weeks to 3 months in 43% (n=109) of cases. The reason for the call was a suspicion of systemic disease in 28% of cases (n=84), or a dysfunction of an organ in 16%. A diagnosis was made in 89% of cases. The budget of the whole procedure was balanced. CONCLUSION A quick internal medicine consultation pathway for general practitioners seems to be a relevant, feasible and economically viable healthcare trajectory, which can be transposed to any type of healthcare institution, as soon as sufficient human resources are dedicated.
Collapse
Affiliation(s)
- Julie Bouvet
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France.
| | - Jonathan Broner
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Erik Arnaud
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Cyril Dumain
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Jan Holubar
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - David Costa
- Département universitaire de médecine générale, université de Montpellier-Nîmes, Nîmes, France
| | - Pierre Fesler
- Département de médecine interne et hypertension artérielle, CHU de Montpellier, université de Montpellier, Montpellier, France
| | - Marion Fages
- Département d'information médicale, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - Radjiv Goulabchand
- Service de médecine interne, CHU de Nîmes, université de Montpellier, Nîmes, France
| |
Collapse
|
5
|
Holubar J, Broner J, Arnaud E, Hallé O, Mura T, Chambert B, Sotto A, Roubille C, Gaujoux-Viala C, Goulabchand R. Diagnostic performance of 18 F-FDG-PET/CT in inflammation of unknown origin: A clinical series of 317 patients. J Intern Med 2022; 291:856-863. [PMID: 35018669 DOI: 10.1111/joim.13452] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammation of unknown origin (IUO) is a challenging situation in internal medicine. OBJECTIVES To describe the final diagnoses in IUO and assess the helpfulness of 18 F-fluorodesoxyglucose positron emission tomography with computerized tomography (18 F-FDG-PET/CT) in the diagnosis strategy. RESULTS A total of 317 IUO patients with 18 F-FDG-PET/CT were enrolled. A diagnosis was reached in 228 patients: noninfectious inflammatory diseases (NIID) (37.5%), infectious diseases (18.6%), malignancies (7.9%), and non-systemic-inflammatory miscellaneous diseases (7.9%). The two leading causes of NIID were polymyalgia rheumatica and giant cell arteritis. 18 F-FDG-PET/CT results were classified as true positive in 49.8% of patients and contributory in 75.1% of overall IUO patients (after the complete investigation set and a prolonged follow-up). In multivariate analysis, only C-reactive protein minimum level (≥50 mg/L) was associated with the contributory status of 18 F-FDG-PET/CT. CONCLUSION Within the wide spectrum of IUO underlying diseases, 18 F-FDG-PET/CT is helpful to make a diagnosis and to eliminate inflammatory diseases. Obese patients constitute a specific group needing further studies.
Collapse
Affiliation(s)
- Jan Holubar
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Jonathan Broner
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Olivier Hallé
- Internal Medicine Department 2, CH Ales-Cevennes, Ales, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Benjamin Chambert
- Department of Nuclear Medicine, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Albert Sotto
- Department of Infectious and Tropical Diseases, CHU Nîmes, University of Montpellier, Nîmes, France
| | - Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, Montpellier University Hospital, University of Montpellier, PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Cecile Gaujoux-Viala
- Department of Rheumatology, CHU Nîmes, Nîmes, France.,University of Montpellier, INSERM UA11 Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University of Montpellier, Nîmes, France.,IRMB, University of Montpellier, INSERM, Montpellier, France
| |
Collapse
|
6
|
Dumain C, Broner J, Arnaud E, Dewavrin E, Holubar J, Fantone M, de Wazières B, Parreau S, Fesler P, Guilpain P, Roubille C, Goulabchand R. Patients' Baseline Characteristics, but Not Tocilizumab Exposure, Affect Severe Outcomes Onset in Giant Cell Arteritis: A Real-World Study. J Clin Med 2022; 11:jcm11113115. [PMID: 35683507 PMCID: PMC9181652 DOI: 10.3390/jcm11113115] [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: 04/18/2022] [Revised: 05/17/2022] [Accepted: 05/27/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives: Giant cell arteritis (GCA) is associated with severe outcomes such as infections and cardiovascular diseases. We describe here the impact of GCA patients’ characteristics and treatment exposure on the occurrence of severe outcomes. Methods: Data were collected retrospectively from real-world GCA patients with a minimum of six-months follow-up. We recorded severe outcomes and treatment exposure. In the survival analysis, we studied the predictive factors of severe outcomes occurrence, including treatment exposure (major glucocorticoids (GCs) exposure (>10 g of the cumulative dose) and tocilizumab (TCZ) exposure), as time-dependent covariates. Results: Among the 77 included patients, 26% were overweight (BMI ≥ 25 kg/m2). The mean cumulative dose of GCs was 7977 ± 4585 mg, 18 patients (23%) had a major GCs exposure, and 40 (52%) received TCZ. Over the 48-month mean follow-up period, 114 severe outcomes occurred in 77% of the patients: infections—29%, cardiovascular diseases—18%, hypertension—15%, fractural osteoporosis—8%, and deaths—6%. Baseline diabetes and overweight were predictive factors of severe outcomes onset (HR, 2.41 [1.05−5.55], p = 0.039; HR, 2.08 [1.14−3.81], p = 0.018, respectively) independently of age, sex, hypertension, and treatment exposure. Conclusion: Diabetic and overweight GCA patients constitute an at-risk group requiring tailored treatment, including vaccination. The effect of TCZ exposure on the reduction of severe outcomes was not proved here.
Collapse
Affiliation(s)
- Cyril Dumain
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Jonathan Broner
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Erik Arnaud
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Emmanuel Dewavrin
- Intensive Care Medicine Department, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France;
| | - Jan Holubar
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Myriam Fantone
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
| | - Benoit de Wazières
- Department of Internal Medicine and Geriatrics, CHU Nîmes, University of Montpellier, 30029 Nîmes, France;
| | - Simon Parreau
- Department of Internal Medicine, Limoges University Hospital Center, 87042 Limoges, France;
| | - Pierre Fesler
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Philippe Guilpain
- Department of Internal Medicine and Multi-Organic Diseases, St. Eloi Hospital, CHU Montpellier, 34295 Montpellier, France;
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, Lapeyronie Hospital, CHU Montpellier, 34090 Montpellier, France; (P.F.); (C.R.)
- PhyMedExp, INSERM U1046, CNRS UMR 9214, University of Montpellier, 34295 Montpellier, France
| | - Radjiv Goulabchand
- Internal Medicine Department, CHU Nîmes, University of Montpellier, 30029 Nîmes, France; (C.D.); (J.B.); (E.A.); (J.H.); (M.F.)
- Institute for Regenerative Medicine & Biotherapy, St. Eloi Hospital, University of Montpellier, INSERM, 34295 Montpellier, France
- Correspondence: ; Tel.: +33-(0)4-66683241
| |
Collapse
|