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Zimmermann F, Robin F, Caillault L, Cazalets C, Llamas-Gutierrez F, Garlantézec R, Jousse-Joulin S, Diot E, Mensi SE, Belhomme N, Jégo P, Coiffier G, Lescoat A. Sicca syndrome in systemic sclerosis: a narrative review on a neglected issue. Rheumatology (Oxford) 2023; 62:SI1-SI11. [PMID: 35866609 DOI: 10.1093/rheumatology/keac412] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 02/07/2023] Open
Abstract
SSc is an auto-immune disease characterized by life-threatening manifestations such as lung fibrosis or pulmonary arterial hypertension. Symptoms with a detrimental impact on quality of life are also reported and sicca syndrome (xerostomia, xeropthalmia) is present in up to 80% of patients with SSc. Sicca syndrome can occur in the absence of overlap with Sjögren's disease and recent studies highlight that fibrosis of minor and major salivary glands, directly linked to the pathogenesis of SSc, could be a major contributor of xerostomia in SSc. This narrative review provides an overview of the clinical presentation, diagnostic strategies, management and future perspectives on sicca syndrome in patients with SSc.
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Affiliation(s)
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1.,Department of Rheumatology, Rennes University Hospital, University Rennes; Inserm UMR 1241, Inra, Institut NUMECAN (Nutrition Metabolisms and Cancer), University Rennes
| | | | | | | | - Ronan Garlantézec
- Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | | | | | | | | | - Patrick Jégo
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
| | - Guillaume Coiffier
- Department of Internal Medicine.,Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine.,Département de Santé Publique, CHU de Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, Rennes
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Lescoat A, Robin F, Belhomme N, Ballerie A, de Saint Riquier M, Sebillot M, Albert JD, Le Gallou T, Perdriger A, Jégo P, Coiffier G, Cazalets C. Ultrasound Classification of Finger Pulp Blood Flow in Patients With Systemic Sclerosis: A Pilot Study. Arthritis Care Res (Hoboken) 2023; 75:299-306. [PMID: 34477332 DOI: 10.1002/acr.24779] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/23/2021] [Accepted: 08/31/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. METHODS Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. RESULTS In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P = 0.024), whereas cold challenge decreased FPBF (P = 0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient = -0.50, P = 0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31-19.21], P < 0.0001). CONCLUSION PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | | | - Martine Sebillot
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Jean-David Albert
- Department of Rheumatology, CHU Rennes, University of Rennes and INSERM, University of Rennes, INRA, CHU Rennes, Institut NUMECAN, Rennes, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, University of Rennes, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes and CHU Rennes, INSERM, EHESP, Institut de recherche en santé, environnement et travail, UMR S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France, and Department of Rheumatology, CH Dinan, Dinan, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes, Rennes, France
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Zimmermann F, Robin F, Cadiou S, Belhomme N, Jégo P, Coiffier G, Lescoat A. Should we really include systemic sclerosis specific antibodies in the classification criteria of Sjogren's disease? Semin Arthritis Rheum 2023; 58:152158. [PMID: 36580854 DOI: 10.1016/j.semarthrit.2022.152158] [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: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
We have read with great interest the results from Marketos et al. regarding the positivity of specific systemic sclerosis auto-antibodies in patients with sicca symptoms. Based on complementary data from the literature, we rather believe scleroderma-associated antibodies should be considered either as a yellow flag for an association between scleroderma and Sjogren, or a potential undiagnosed scleroderma, rather than an isolated Sjogren's disease.
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Affiliation(s)
- François Zimmermann
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.
| | - François Robin
- Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France
| | - Simon Cadiou
- Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France; Department of Rheumatology, CH Dinan, Dinan, France
| | - Alain Lescoat
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France; Department of Rheumatology, CHU Rennes, University of Rennes 1, Rennes, France; INSERM, Rennes University Hospital, UMR 1241, Institut NuMeCan (Nutrition Metabolisms and Cancer), University Rennes, France; CHU Rennes, Inserm, EHESP, Institut de Recherche en Santé, Environnement et Travail UMR_S 1085, Rennes, France
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Belhomme N, Lescoat A, Launey Y, Jégo P, Cavalin C, Pottier P. [Tolerating uncertainty: Towards a competence-based approach]. Rev Med Interne 2023; 44:27-30. [PMID: 36371326 DOI: 10.1016/j.revmed.2022.10.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/16/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022]
Abstract
Uncertainty in inherent to every aspects of medical practice. As the concept of uncertainty in healthcare is still to explore, deciphering the determinants and the roots of this uncertainty would benefit from the insights of various disciplines, such as epistemology, sociology, mathematics, or philosophy. The urgent need to improve physician's ability to cope with uncertainty, has been recently highlighted by the COVID-19 pandemic. Besides, the concept of uncertainty tolerance has been proposed, and could serve as a relevant basis for approaching uncertainty, in medical education. Thus, we propose at first to discuss the uncertainty tolerance framework from Hillen et al. Then, from an educational perspective, we outline some avenues regarding how uncertainty tolerance could be thought, in a competence-based approach, and discuss several educational activities, which have proven efficient in promoting uncertainty tolerance among medical practitioners abroad.
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Affiliation(s)
- N Belhomme
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
| | - A Lescoat
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Y Launey
- Réanimation chirurgicale, département d'anesthésie-réanimation-médecine Périopératoire, CHU de Rennes, université Rennes 1, Rennes, France
| | - P Jégo
- Service de médecine interne et immunologie clinique, CHU de Rennes, université Rennes 1, Rennes, France; Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - C Cavalin
- IRISSO, UMR CNRS-INRAE 7170-1427, Université Paris-Dauphine, PSL, Paris, France; Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP), Sciences Po, Paris, France; Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France
| | - P Pottier
- Service de médecine interne et immunologie clinique, CHU Nantes, Nantes, France; Faculté de médecine-pôle santé, Nantes Université, Nantes, France
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Ballerie A, Nguyen Van R, Lacut K, Galinat H, Rousseau C, Pontis A, Nédelec-Gac F, Lescoat A, Belhomme N, Guéret P, Mahé G, Couturaud F, Jégo P, Gouin-Thibault I. Apixaban and rivaroxaban in obese patients treated for venous thromboembolism: Drug levels and clinical outcomes. Thromb Res 2021; 208:39-44. [PMID: 34689080 DOI: 10.1016/j.thromres.2021.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 07/20/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Direct oral anticoagulants (DOAC) use remains challenging in obese patients treated for Venous-Thrombo-Embolism (VTE) due to the paucity of prospective and dedicated studies. OBJECTIVE To assess rivaroxaban and apixaban concentrations at different time-points after intake, in obese patients followed at a thrombosis center and treated for VTE; to define factors associated with DOAC levels outside the on-therapy ranges; and to evaluate bleeding and thrombosis rates during follow-up. METHODS Observational prospective study in two French University hospitals. Apixaban or rivaroxaban concentrations were measured after the first visit, regardless of last intake in obese patients receiving DOAC for VTE. Concentrations were compared to published reference values for non-obese patients. Demographic, clinical, biological and therapeutic data were collected. Univariate and multivariate analyses were performed to identify factors associated to DOAC concentrations outside the on-therapy ranges. RESULTS Out of the 146 patients included, 22 (15%) had DOAC concentrations outside the on-therapy ranges, mainly in the rivaroxaban group (n = 17). Age ≤ 63 years, use of rivaroxaban and time since last intake ≤8 h were associated with DOAC concentrations outside the on-therapy ranges, in multivariable analysis. During the median follow-up of 16 months, two (1%) patients receiving apixaban had recurrent VTE. No patient had major bleeding, 11 (8%) patients had minor bleeding. CONCLUSION In this specific prospective bi-centric study dedicated to VTE obese patients, use of DOACs at fixed doses led to concentrations similar to those of non-obese patients in a high proportion of patients, without any effect of the BMI, and with risk-benefit profile comparable to non-obese patients.
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Affiliation(s)
- Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France; Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Rémi Nguyen Van
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Karine Lacut
- Department of Internal Medecine and Chest Diseases, Brest University Hospital, Bretagne Occidentale University, EA 3878, CIC INSERM 1412, Brest, FCRIN INNOVTE, France
| | - Hubert Galinat
- Hematology Laboratory, Brest University Hospital, Bretagne Occidentale University, EA 3878, Brest, France
| | - Chloé Rousseau
- Clinical Investigation Center INSERM 1414, Department of Clinical Pharmacology, Rennes University Hospital, F-35033, France
| | - Adeline Pontis
- Hematology Laboratory, Rennes University Hospital, Rennes, France
| | | | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France; Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Pierre Guéret
- Hematology Laboratory, Rennes University Hospital, Rennes, France
| | - Guillaume Mahé
- Vascular Medicine Unit, Rennes University Hospital, INSERM CIC 1414, Clinical Investigation Center, Univ Rennes, M2S - EA 7470, F-35033 Rennes, France
| | - Francis Couturaud
- Department of Internal Medecine and Chest Diseases, Brest University Hospital, Bretagne Occidentale University, EA 3878, CIC INSERM 1412, Brest, FCRIN INNOVTE, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France; Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Isabelle Gouin-Thibault
- Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France; Hematology Laboratory, Rennes University Hospital, Rennes, France.
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Coirier V, Chabanne C, Jouneau S, Belhomme N, Ballerie A, Cazalets C, Sobanski V, Hachulla É, Jégo P, Lescoat A. Impact of Three Different Algorithms for the Screening of SSc-PAH and Comparison with the Decisions of a Multidisciplinary Team. Diagnostics (Basel) 2021; 11:diagnostics11101738. [PMID: 34679436 PMCID: PMC8534432 DOI: 10.3390/diagnostics11101738] [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: 08/31/2021] [Revised: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 01/29/2023] Open
Abstract
Background: to compare three existing screening algorithms of pulmonary arterial hypertension (PAH) in systemic sclerosis (SSc) with the results of a multidisciplinary team (MDT) meeting from a tertiary center. Methods: we conducted a monocentric longitudinal study from 2015 to 2018. All patients with SSc according to LeRoy’s classification were eligible. Patients were excluded in the case of missing data required by any of the three screening algorithms. The algorithms were applied for each patient at inclusion. Right heart catheterization (RHC) was performed based on the MDT decision. MDT members were all blinded from the results of the three algorithms regarding RHC recommendations. The RHC recommendations of each algorithm were compared with the MDT decision, and the impact on diagnosis and management was evaluated. Results: 117 SSc patients were consecutively included in the study, and 99 had follow-up data over the three-year duration of the study (10 deaths). Among the 117 patients, the MDT suggested RHC for 16 patients (14%), DETECT algorithm for 28 (24%), ASIG for 48 (41%) and ESC/ERS 2015 for 20 (17%). Among the 16 patients who had RHC, SSc-PAH was diagnosed in seven. Among patients with an initial recommendation of RHC based on at least one algorithm but not according to the MDT meeting, no SSc-PAH was diagnosed during the three-year follow-up. Results were unchanged when the new 2018 definition of PAH was applied instead of the previous definition. Conclusion: a MDT approach appears interesting for the screening of SSc-PAH, with a significant reduction of RHC performed in comparison with dedicated algorithms. The specific relevance of a MDT for the management and follow-up of patients with RHC recommended by existing algorithms but with no PAH warrants further studies.
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Affiliation(s)
- Valentin Coirier
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
- Correspondence:
| | - Céline Chabanne
- Department of Cardiology, Rennes University Hospital, F-35238 Rennes, France;
| | - Stéphane Jouneau
- Department of Respiratory Diseases, Rennes University Hospital, F-35238 Rennes, France;
- INSERM, EHESP, Institut de Recherche en Santé, Rennes 1 University, F-35000 Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
- INSERM, EHESP, Institut de Recherche en Santé, Rennes 1 University, F-35000 Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
- INSERM, EHESP, Institut de Recherche en Santé, Rennes 1 University, F-35000 Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
| | - Vincent Sobanski
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille. Inserm, U1286–INFINITE–Institute for Translational Research in Inflammation, Université de Lille, F-59000 Lille, France; (V.S.); (É.H.)
- Institut Universitaire de France (IUF), F-75000 Paris, France
| | - Éric Hachulla
- Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille. Inserm, U1286–INFINITE–Institute for Translational Research in Inflammation, Université de Lille, F-59000 Lille, France; (V.S.); (É.H.)
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
- INSERM, EHESP, Institut de Recherche en Santé, Rennes 1 University, F-35000 Rennes, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, F-35238 Rennes, France; (N.B.); (A.B.); (C.C.); (P.J.); (A.L.)
- INSERM, EHESP, Institut de Recherche en Santé, Rennes 1 University, F-35000 Rennes, France
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Mekinian A, Biard L, Dagna L, Jégo P, Salvarani C, Sergey M, Espitia O, Sciascia S, Hernan P, Cacoub P, Fain O, Saadoun D. OP0068 EFFICACY AND SAFETY OF TNF-Α ANTAGONISTS AND TOCILIZUMAB IN TAKAYASU ARTERITIS: MULTICENTER WORLDWIDE RETROSPECTIVE STUDY OF 209 PATIENTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:In this large worldwide TAK registry, we report 209 patients treated with TNF-α antagonists and tocilizumab aiming to compare their safety and efficacy, and determine the predictive factors of treatment response and relapse.Objectives:To assess safety and efficacy of TNF-α antagonists and tocilizumab in patients with Takayasu arteritis (TAK).Methods:We conducted a retrospective multicenter study in referral centers from France, Italy, Spain, Israel, Japan, Tunisia and Russia about biological-targeted therapies in TAK during the period from January 2017 to September 2019 for the data collection.Results:Two-hundred nine patients with TAK [median age of 29 years [7-62], and 186 (89%) females] were included. They received either TNF-α antagonists [n=132 (63%) with 172 lines; infliximab (n=109), adalimumab (n=45), golimumab (n=8), certolizumab (n=6) and etanercept (n=5)], or tocilizumab [n=77 (37%) with 121 lines; intravenous and subcutaneous in 95 and 26 cases, respectively]. A complete response at 6 months was evidenced in 101/152 (66%) on TNF-α antagonists and 75/107 (70%) on tocilizumab, respectively. Age ≥ 30 years [OR= 2.09 [1.09; 3.99]] was associated with complete response, whereas vascular signs [0.26 [0.1;0.65]], baseline prednisone ≥ 20 mg/day [0.51 [0.28;0.93]] were negatively associated with the complete response to TNF-α antagonists or tocilizumab. During a median follow-up of 36 months, 103 relapses were noted. Supra-aortic branches and thoracic aorta involvements [HR 2.44 (1.06;5.65) and 3.66 (1.18;11.4), respectively], and systemic signs at baseline [HR 2.01 (1.30;3.11)] were significantly associated with relapse. The cumulative incidence of treatment discontinuation and relapse were similar in TNFα antagonists and tocilizumab. Fifty-eight (20%) adverse effects occurred on biological-targeted therapies of whom 37 (21%) and 21 (17%), (p=0.4) on TNF-α antagonists and tocilizumab, respectivelyConclusion:This large multicenter study shows high efficacy of biological-targeted treatments in refractory TAK. Efficacy, relapse and drug retention rate were equivalent with TNF-α antagonists and tocilizumab.Disclosure of Interests:None declared
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Lescoat A, Cavalin C, Lecureur V, Jégo P. [Toward a better understanding of the etiology of systemic autoimmune diseases : should a systemic disease still be defined as a "diffuse inflammatory disease of unknown origin" in 2021? Example of crystalline silica exposure]. Rev Med Interne 2021; 42:233-236. [PMID: 33781611 DOI: 10.1016/j.revmed.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- A Lescoat
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France; Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France.
| | - C Cavalin
- Institut de Recherche Interdisciplinaire en Sciences Sociales (IRISSO), UMR CNRS-INRA 7170-1427, Université Paris-Dauphine, Paris, France; Centre d'études de l'emploi et du travail (CEET, CNAM), Noisy-le-Grand, France; Laboratoire interdisciplinaire d'évaluation des politiques publiques (LIEPP) de Sciences Po, Paris, France
| | - V Lecureur
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France
| | - P Jégo
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000 Rennes, France; Department of Internal Medicine and Clinical Immunology, CHU Rennes, University of Rennes 1, Rennes, France
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Lescoat A, Ballerie A, Lecureur V, Belhomme N, Cazalets C, Jouneau S, Paris C, Menéndez-Navarro A, Rosental PA, Jégo P, Cavalin C. The neglected association of crystalline silica exposure and systemic sclerosis. Rheumatology (Oxford) 2020; 59:3587-3588. [PMID: 33020830 DOI: 10.1093/rheumatology/keaa638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/30/2020] [Accepted: 09/04/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alain Lescoat
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Alice Ballerie
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Valérie Lecureur
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Stéphane Jouneau
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Department of Respiratory Diseases, Rennes University Hospital, Rennes, France
| | - Christophe Paris
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France.,INSERM, EHESP, Institut de Recherche en Santé, Department of Occupational Medicine, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | | | | | - Patrick Jégo
- INSERM, EHESP, Institut de Recherche en Santé, Université de Rennes, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Catherine Cavalin
- Interdisciplinary Research Institute for the Social Sciences, National Centre for Scientific Research-National Institute for Agricultural Research, France
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Ballerie A, Lescoat A, Cavalin C, Paris C, Rosental PA, Jégo P. Silice et auto-immunité. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2020.03.192] [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: 10/23/2022]
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Ballerie A, Cavalin C, Lederlin M, Nicolas A, Garlantézec R, Jouneau S, Lecureur V, Cazalets C, Belhomme N, Paris C, Rosental PA, Jégo P, Lescoat A. Association of silica exposure with chest HRCT and clinical characteristics in systemic sclerosis. Semin Arthritis Rheum 2020; 50:949-956. [DOI: 10.1016/j.semarthrit.2020.08.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022]
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Mauger C, Gouin I, Guéret P, Gac FN, Baillerie A, Lefeuvre C, Boutruche B, Bayard S, Jaquinandi V, Jégo P, Mahé G. Impact of multidisciplinary team meetings on the management of venous thromboembolism. A clinical study of 142 cases. J Med Vasc 2020; 45:192-197. [PMID: 32571559 DOI: 10.1016/j.jdmv.2020.04.011] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Numerous guidelines have been published on the management of venous thromboembolism (VTE). However, therapeutic decision-making may prove challenging in routine clinical practice. With this in mind, multidisciplinary team (MDT) meetings have been set up in Rennes University Hospital, France. This study sought to describe the situations discussed during MDT meetings and to assess whether the meetings bring about changes in the management of these patients. MATERIALS AND METHODS A retrospective single-center study conducted at the Rennes University Hospital included cases presented from the beginning of the MDT meetings (February 2015) up to May 2017. RESULTS In total, 142 cases were presented in 15 MDT meetings, corresponding to a mean of 10±4 cases per meeting. Of these, 129 related to VTE patients: 33 provoked VTEs, 22 unprovoked VTEs, 49 cancer-related VTEs, and 25 unspecified VTEs. MDT meetings led to significant changes in the anticoagulation type (therapeutic, prophylactic, or discontinuation) and duration, but not in the anticoagulant choice (direct oral anticoagulants, vitamin K antagonists, heparins, etc.). CONCLUSION Requests for MDT meetings are made for all VTE types, and these meetings have an impact on VTE management.
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Affiliation(s)
- C Mauger
- Cardiology Department, Saint Malo Hospital, Saint Malo, France; Vascular Medicine unit, Rennes University Hospital, Rennes, France.
| | - I Gouin
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Rennes 1 University, Rennes, France
| | - P Guéret
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - F Nedelec Gac
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France
| | - A Baillerie
- Departement of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - C Lefeuvre
- Oncology Department, Saint-Grégoire private hospital, Saint-Grégoire, France
| | - B Boutruche
- Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - S Bayard
- Cellular Hematology Laboratory - Bioclinical Hemostasis, Rennes, France; Pediatric Department, University Hospital, Rennes, France
| | - V Jaquinandi
- Vascular Medicine unit, Rennes University Hospital, Rennes, France
| | - P Jégo
- UMR INSERM U1085, Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Rennes, France
| | - G Mahé
- Vascular Medicine unit, Rennes University Hospital, Rennes, France; INSERM CIC 14 14, Rennes, France.
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Mekinian A, Saadoun D, Jerome.Connault@chu-Nantes.Fr JCNF, I-Quere@chu-Montpellier.Fr IQMF, Jégo P, Nicolas.Limal@aphp.Fr NLF, Wxv W, Gottenberg JE, Vautier M, Lea.Savey@aphp.Fr LSF, Cacoub P, Fain O. AB0509 SUSPENSIVE EFFICACY OF TOCILIZUMAB IN TREATMENT-NAÏVE PATIENTS WITH TAKAYASU ARTERITIS: TOCITAKA FRENCH PROSPECTIVE MULTICENTER OPEN-LABELLED TRIAL. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:To assess long term efficacy of tocilizumab in treatment-naive patients with Takayasu arteritis (TAK).Methods:In this multicenter, prospective, open-labelled trial, we aim to evaluate the benefit of adding tocilizumab to steroids in treatment-naïve patients with TAK, on discontinuation of steroids after 6 months of tocilizumab treatment, and to assess relapse-free survival following tocilizumab discontinuation.Results:Thirteen patients with TAK were included, with a median age of 32 years [19-45] and 12 (92%) females. Six (54%) patients met the primary end-point. Among 11 (85%) patients which achieved remission at 6 months, 6 (54%) have reached primary endpoint.. Among the 5 remaining patients which continued steroids, 3 had a prednisone-equivalent dosage < 5mg/day. A significant decrease of disease activity was observed after 6 months of tocilizumab therapy: decrease of median NIH scale (3 [3-4] at baseline, versus 1 [0-2] after 6 months; p <0.001), ITAS-2010 score (5 [2-7] versus 3 [0-8]; p = 0.002), and ITAS-A score (7 [4-10] versus 4 [1-15]; p = 0.0001)]. All patients discontinued tocilizumab after 7 infusions, and no other immunosuppressive drugs was introduced, except for 1 patient which received methotrexate. After 9 and 12 months, respectively 7 (54%) and 6 (50%) patients achieved remission with less than 7.5 mg/day of prednisone, and 9 (69%) and 9 (75%) with doses <10 mg/day. During the 12 months follow-up after tocilizumab discontinuation, a relapse occurred among 5 patients (45%) out of 11 in which achieved remission after 6 months of tocilizumab.No severe AEs were considered related to study treatment and none required tocilizumab interruption or dose reduction. No deaths have occurred during the study period.Conclusion:Tocilizumab seems an effective steroid sparing therapy in TAK but its effect appears to be suspensive.Disclosure of Interests:Arsene Mekinian: None declared, david Saadoun: None declared, jerome.connault@chu-nantes.fr jerome.connault@chu-nantes.fr: None declared, i-quere@chu-montpellier.fr i-quere@chu-montpellier.fr: None declared, Patrick Jégo: None declared, nicolas.limal@aphp.fr nicolas.limal@aphp.fr: None declared, wxv wxv: None declared, Jacques-Eric Gottenberg Grant/research support from: BMS, Pfizer, Consultant of: BMS, Sanofi-Genzyme, UCB, Speakers bureau: Abbvie, Eli Lilly and Co., Roche, Sanofi-Genzyme, UCB, Mathieu Vautier: None declared, lea.savey@aphp.fr>; lea.savey@aphp.fr>;: None declared, Patrice cacoub: None declared, olivier fain: None declared
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De Saint Riquier M, Ballerie A, Robin F, Belhomme N, Cazalets C, Droitcourt C, Perdriger A, Yelnik CM, Hachulla E, Sobanski V, Jégo P, Coiffier G, Lescoat A. THU0352 DIAGNOSTIC PERFORMANCES OF HAND ULTRASOUND PARAMETERS AND THEIR IMPACT ON THE 2013 ACR/EULAR CLASSIFICATION CRITERIA FOR SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Recent studies have highlighted that ultrasound (US) examination could offer a better assessment of hand manifestations of systemic sclerosis (SSc). Indeed, US allows a simultaneous evaluation of vascular, fibrotic and inflammatory hand features of the disease. Power Doppler US can especially explore macrovascular involvement characterized by an obliteration of digital arteries or ulnar arteries. Ulnar artery occlusion (UAO) is especially frequent in SSc patients and could be a relevant marker of the severity of SSc-associated vasculopathy. Among other hand manifestations of SSc, US evaluation can notably explore tenosynovial involvement such as fibrotic tenosynovitis (TS), which is considered to be SSc-specific.Objectives:This study aims to assess the diagnostic performances of these hand US parameters for the diagnosis of SSc.Methods:244 patients with suspected SSc were consecutively included. They all had US evaluation assessing the presence of fibrotic TS and UAO. The final diagnosis of SSc was based on the evaluation of an expert, independently from US results and from any pre-established classification criteria.Results:166 patients were finally diagnosed as SSc. 62 SSc and 8 non-SSc patients had UAO (uni or bilateral) (p=0.001). 23 SSc patients and 1 non-SSc patient had US fibrotic TS (p=0.007). A US SSc-pattern (presence of UAO and/or fibrotic TS) was reported in 73 SSc patients and 9 non-SSc patients (p<0.001). UAO had an area under ROC curve (AUC) for the diagnosis of SSc of 0.618 (95%CI 0.539-0.697); with Se= 0.373 (0.304-0.449) and spe=0.862 (0.751-0.928). The presence of a US fibrotic TS had an AUC of 0.561 (0.480-0.643); with Se= 0.139 (0.094-0.199) and spe=0.983 (0.909-0.997). The US-SSc pattern had a AUC of 0.641 (0.563-0.695), with Se=0.440 (0.367-0.516) and spe=0.845 (0.731-0.916). When used as a diagnostic tool, the original 2013 classification criteria had an AUC of 0.982 (0.969-0.996) with Se= 0.946 (0.900-0.971) and spe=0.931 (0.836-0.973). Including UAO and fibrotic TS in this classification had few impact (AUC of 0.979 (0.962-0.996) with Se= 0.940 (0.893-0.967) and and spe=0.931 (0.836-0.973)) but allows the substitution of some items (such as capillaroscopy) by US parameters with similar performances for diagnosis.Conclusion:The use of hand US parameters may help to refine the diagnostic strategy of SSc and their inclusion in addition with the items of the ACR/EULAR classification could be discussed.Disclosure of Interests:Marine de Saint Riquier: None declared, Alice Ballerie: None declared, François ROBIN: None declared, Nicolas Belhomme: None declared, Claire Cazalets: None declared, Catherine Droitcourt: None declared, Aleth Perdriger: None declared, Cécile Marie Yelnik: None declared, Eric Hachulla Speakers bureau: speaking fees from Actelion Pharmaceuticals,GlaxoSmithKline, and Bayer outside of the current study, Vincent Sobanski: None declared, Patrick Jégo: None declared, Guillaume Coiffier: None declared, Alain LESCOAT: None declared
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Lescoat A, Ballerie A, Lelong M, Morzadec C, Jouneau S, Jégo P, Vernhet L, Fardel O, Lecureur V. AB0158 IMPACT OF JAK INHIBITORS ON MACROPHAGE POLARISATION: PERSPECTIVES FOR SYSTEMIC SCLEROSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Macrophage can adopt various phenotypes and activation states according to their surrounding microenvironment. M1 or inflammatory macrophages are generated under IFNɣ/LPS signaling and express the membrane marker CD86. Different subtypes of M2 macrophages are also described: M2a macrophages (generated under IL4/IL13 signaling) and characterized by a high expression of CD206 and pro-fibrotic properties and, M2c macrophages (generated under IL10 and/or glucorticoid signaling), considered as anti-inflammatory resolving macrophages. There is growing interest in the role of macrophages in the pathogenesis of Systemic Sclerosis (SSc). Recent studies highlight that macrophages from fibrotic tissues such as lung or skin from SSc patients have a M2 phenotype whereas, in blood-monocytes derived macrophages (MDM), SSc MDM have a mixed signature associating M1 and M2 characteristics. Jak inhibitors are treatments used in rheumatoid arthritis and that can variously target signals that could be involved both in M1 and in M2 polarisation.Objectives:This study evaluates the impact of three Jak inhibitors on the polarisation state of human MDM in vitro.Methods:Blood monocytes form healthy donors (HD) were differentiated with M-CSF (for 7 days) in MDM and pre-treated by ruxolitinib (Jak2-Jak1 inhibitor), tofacitinib (Jak3 inhibitor) or itacitinib (Jak1 inhibitor) (1µM for all). They were then polarised into M1i (IFNɣ, 20µg/mL), M1Li (IFNɣ+LPS, 20µg/mL), M2a (IL4+IL13; 20µg/ML), M2c (IL10, 20µg/mL) and M2c(dex) (IL10+dexamethasone, 10 nM). The impact of each Jak inhibitor on phenotype (flow cytometry), gene expression (qPCR) and cytokine secretion (ELISA) was evaluated in each polarisation state.Results:Concerning phenotypes, all Jak inhibitors reduced the expression of the M1i and M1Li marker CD86, but ruxolitinib had a higher effect. Only ruxolitinib reduced the expression of the M1i marker MHCII. All Jak inhibitors reduced the expression of CD206 in M2a. They had no impact on the expression of CD163, CD204 in any M2 conditions. Key M1 genes were repressed by all Jak inhibitors, such as CXCL10, IL6 or TNFα with a more significant effect of ruxolitinib. All Jak inhibitors reduced the gene expression of CXCL13 and SOCS3 in M2c. Secretion levels of IL6 and CCL18 were also repressed, with a more significant effect of ruxolitinib.Conclusion:Jak inhibitors can limit M1 and M2 polarisation state in vitro, with a more significant effect of the Jak2-Jak1 inhibitor ruxolitinib. The relevance of these results in MDM from SSc patients and in vivo models of SSc is still to be determined.Disclosure of Interests:Alain LESCOAT: None declared, Alice Ballerie: None declared, Marie Lelong: None declared, Claudie Morzadec: None declared, Stéphane Jouneau Grant/research support from: AIRB, Boehringer Ingelheim, LVL Medical, Novartis, Roche, Bellorophon Therapeutics, Biogen, Fibrogen, Galecto Biotech, Gilead Sciences, Pharm-Olam, Pliant Therapeutics, Savara Pharmaceuticals/Serendex Pharmaceuticals, Consultant of: Actelion, AIRB, AstraZeneca, Bristol-Myers Squibb, Boehringer Ingelheim, Chiesi, Genzyme, GlazoSmithKline, LVL Medical, Mundipharma, Novartis, Pfizer, Roche, Sanofi, Patrick Jégo: None declared, Laurent Vernhet: None declared, Olivier Fardel: None declared, Valérie Lecureur: None declared
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de Saint Riquier M, Ballerie A, Robin F, Belhomme N, Cazalets C, Droitcourt C, Perdriger A, Yelnik CM, Hachulla E, Sobanski V, Jégo P, Coiffier G, Lescoat A. Hand ultrasound for the diagnosis of scleroderma: a scoring strategy including US items and items from the EULAR/ACR classification. Clin Exp Rheumatol 2020; 38 Suppl 125:140-147. [PMID: 32865172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate the diagnostic value of hand ultrasound (US) in systemic sclerosis (SSc) and to explore its relevance within a combined diagnostic approach. METHODS 224 patients with suspected SSc were consecutively included. They all had US evaluation assessing the presence of fibrotic tenosynovitis (fibrotic TS) and ulnar artery occlusion (UAO). The final diagnosis of SSc was based on the clinical evaluation of a board of experts independently of any pre-established classification criteria. RESULTS 166 patients were finally diagnosed as SSc according to the experts as reference standard. 62 SSc and 8 non-SSc patients had UAO (uni or bilateral) (p=0.001). 23 SSc patients and 1 non-SSc patient had US fibrotic TS (p=0.007). A US SSc-pattern (presence of UAO and/or fibrotic TS) was reported in 73 SSc patients and 9 non-SSc patients (p<0.001). UAO had an area under ROC curve (AUC) for the diagnosis of SSc of 0.618 (95%CI 0.539- 0.697); with Se=0.373 (0.304-0.449) and Sp=0.862 (0.751-0.928). Fibrotic TS had an AUC of 0.561 (0.480-0.643); with Se=0.139 (0.094-0.199) and Sp=0.983 (0.909-0.997). The US-SSc pattern had a AUC of 0.641 (0.563- 0.695), with Se=0.440 (0.367-0.516) and Sp=0.845 (0.731-0.916). A scoring system including these US parameters and items from ACR/EULAR classification criteria had an AUC of 0.979 (0.962-0.996)) and allows the substitution of capillaroscopy by US parameters with similar performances. CONCLUSIONS The use of hand US parameters may help to refine the diagnostic strategy of SSc and their inclusion in a combined diagnostic approach could be discussed.
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Affiliation(s)
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - François Robin
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes, France
| | - Catherine Droitcourt
- Université de Rennes; CHU Rennes, Department of Dermatology; INSERM, CIC 1414, Rennes; REPERES Pharmacoepidemiology and access to Health Care, University Rennes 1 and French School of Public Health, UPRES EA 7449, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, CHU Rennes, Université de Rennes, France
| | - Cécile Marie Yelnik
- Université de Lille, U995, Lille Inflammation Research International Centre; and CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Vincent Sobanski
- Université de Lille, U995, Lille Inflammation Research International Centre; CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille; Inserm, Lille; and Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, CHU Rennes, Université de Rennes; and Inserm U 1241, Université de Rennes, France
| | - Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, CHU Rennes, Université de Rennes; and Université de Rennes, CHU Rennes, Inserm, EHESP, IRSET (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France.
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Lescoat A, Cavalin C, Ballerie A, Lecureur V, Sesé L, Cazalets C, Lederlin M, Coiffier G, Belhomme N, Paris C, Garlantézec R, Jouneau S, Jégo P. Silica Exposure and Scleroderma: More Bridges and Collaboration between Disciplines Are Needed. Am J Respir Crit Care Med 2020; 201:880-882. [PMID: 31881815 PMCID: PMC7124714 DOI: 10.1164/rccm.201911-2218le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Alain Lescoat
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Catherine Cavalin
- Université Paris-DauphineParis, France
- Laboratoire interdisciplinaire d’évaluation des politiques publiques de Sciences PoParis, France
- Centre d’études de l’emploi et du travailNoisy-le-Grand, France
| | - Alice Ballerie
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Valérie Lecureur
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
| | - Lucile Sesé
- Epidemiology of Allergic and Respiratory Diseases, IPLESP, Inserm and Sorbonne UniversitéParis, France
- AP-HP, Hôpital AvicenneBobigny, France
| | | | | | - Guillaume Coiffier
- CHU Rennes, University of RennesRennes, France
- Inserm U 1241, University of RennesRennes, France
| | | | - Christophe Paris
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- Consultations de pathologies professionnelles et environnementales, CHU RennesRennes, Franceand
| | - Ronan Garlantézec
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
| | - Stéphane Jouneau
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- Rennes University HospitalRennes, France
| | - Patrick Jégo
- University of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085Rennes, France
- CHRU RennesRennes, France
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Lescoat A, Ballerie A, Lelong M, Augagneur Y, Morzadec C, Jouneau S, Jégo P, Fardel O, Vernhet L, Lecureur V. Crystalline Silica Impairs Efferocytosis Abilities of Human and Mouse Macrophages: Implication for Silica-Associated Systemic Sclerosis. Front Immunol 2020; 11:219. [PMID: 32133004 PMCID: PMC7039938 DOI: 10.3389/fimmu.2020.00219] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/27/2020] [Indexed: 12/14/2022] Open
Abstract
Inhalation of crystalline silica (SiO2) is a risk factor of systemic autoimmune diseases such as systemic sclerosis (SSc) and fibrotic pulmonary disorders such as silicosis. A defect of apoptotic cell clearance (i.e., efferocytosis, a key process in the resolution of inflammation) is reported in macrophages from patients with fibrotic or autoimmune diseases. However, the precise links between SiO2 exposure and efferocytosis impairment remain to be determined. Answering to this question may help to better link innate immunity and fibrosis. In this study, we first aim to determine whether SiO2 might alter efferocytosis capacities of human and mouse macrophages. We secondly explore possible mechanisms explaining efferocytosis impairment, with a specific focus on macrophage polarization and on the RhoA/ROCK pathway, a key regulator of cytoskeleton remodeling and phagocytosis. Human monocyte-derived macrophages (MDM) and C57BL/6J mice exposed to SiO2 and to CFSE-positive apoptotic Jurkat cells were analyzed by flow cytometry to determine their efferocytosis index (EI). The effects of ROCK inhibitors (Y27632 and Fasudil) on EI of SiO2-exposed MDM and MDM from SSc patients were evaluated in vitro. Our results demonstrated that SiO2 significantly decreased EI of human MDM in vitro and mouse alveolar macrophages in vivo. In human MDM, this SiO2-associated impairment of efferocytosis, required the expression of the membrane receptor SR-B1 and was associated with a decreased expression of M2 polarization markers (CD206, CD204, and CD163). F-actin staining, RhoA activation and impairment of efferocytosis, all induced by SiO2, were reversed by ROCK inhibitors. Moreover, the EI of MDM from SSc patients was similar to the EI of in vitro- SiO2-exposed MDM and Y27632 significantly increased SSc MDM efferocytosis capacities, suggesting a likewise activation of the RhoA/ROCK pathway in SSc. Altogether, our results demonstrate that SiO2 exposure may contribute to the impairment of efferocytosis capacities of mouse and human macrophages but also of MDM in SiO2-associated autoimmune diseases and fibrotic disorders such as SSc; in this context, the silica/RhoA/ROCK pathway may constitute a relevant therapeutic target.
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Affiliation(s)
- Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Alice Ballerie
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Marie Lelong
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Yu Augagneur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Claudie Morzadec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Stéphane Jouneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Respiratory Diseases, Rennes University Hospital, Rennes, France
| | - Patrick Jégo
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
| | - Olivier Fardel
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
- Pôle Biologie, Rennes University Hospital, Rennes, France
| | - Laurent Vernhet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
| | - Valérie Lecureur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) – UMR_S 1085, Rennes, France
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Agard C, Bonnard G, Samson M, de Moreuil C, Lavigne C, Jégo P, Connault J, Artifoni M, Le Gallou T, Landron C, Roblot P, Magnant J, Belizna C, Maillot F, Diot E, Néel A, Hamidou M, Espitia O. Giant cell arteritis-related aortitis with positive or negative temporal artery biopsy: a French multicentre study. Scand J Rheumatol 2019; 48:474-481. [PMID: 31766965 DOI: 10.1080/03009742.2019.1661011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To compare the clinical presentation and outcome of giant cell arteritis (GCA)-related aortitis according to the results of temporal artery biopsy (TAB).Method: Patients with GCA-related aortitis diagnosed between 2000 and 2017, who underwent TAB, were retrospectively included from a French multicentre database. They all met at least three American College of Rheumatology criteria for the diagnosis of GCA. Aortitis was defined by aortic wall thickening > 2 mm on computed tomography scan and/or an aortic aneurysm, associated with an inflammatory syndrome. Patients were divided into two groups [positive and negative TAB (TAB+, TAB-)], which were compared regarding aortic imaging characteristics and aortic events, at aortitis diagnosis and during follow-up.Results: We included 56 patients with TAB+ (70%) and 24 with TAB- (30%). At aortitis diagnosis, patients with TAB- were significantly younger than those with TAB+ (67.7 ± 9 vs 72.3 ± 7 years, p = 0.022). Initial clinical signs of GCA, inflammatory parameters, and glucocorticoid therapy were similar in both groups. Coronary artery disease and/or lower limb peripheral arterial disease was more frequent in TAB- patients (25% vs 5.3%, p = 0.018). Aortic wall thickness and type of aortic involvement were not significantly different between groups. Diffuse arterial involvement from the aortic arch was more frequent in TAB- patients (29.1 vs 8.9%, p = 0.03). There were no differences between the groups regarding overall, aneurism-free, relapse-free, and aortic event-free survival.Conclusion: Among patients with GCA-related aortitis, those with TAB- are characterized by younger age and increased frequency of diffuse arterial involvement from the aortic arch compared to those with TAB+, without significant differences in terms of prognosis.
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Affiliation(s)
- C Agard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - G Bonnard
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, University of Burgundy, Dijon, France
| | - C de Moreuil
- Department of Internal Medicine, University Hospital of Brest, University of Bretagne Occidentale, Brest, France
| | - C Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - P Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - J Connault
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Artifoni
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - T Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes University, Rennes, France
| | - C Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - P Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers University, Poitiers, France
| | - J Magnant
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - C Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - F Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - E Diot
- Department of Internal Medicine, University Hospital of Tours, Tours University, Tours, France
| | - A Néel
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - M Hamidou
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
| | - O Espitia
- Department of Internal Medicine, University Hospital of Nantes, Nantes University, Nantes, France
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Ballerie A, Alix L, Bajeux E, Jégo P, Lescoat A, Hue B. The collaboration of clinical pharmacists and physicians for medication safety. Lancet 2019; 394:2240. [PMID: 31868628 DOI: 10.1016/s0140-6736(19)32608-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Alice Ballerie
- Unité de Médecine interne polyvalente, Site Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France
| | - Lilian Alix
- Unité de Médecine post-urgences, Site Saint-Laurent, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France
| | - Emma Bajeux
- Service d'Epidémiologie et de Santé publique, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France
| | - Patrick Jégo
- Unité de Médecine Interne et Immunologie Clinique, Site hôpital sud, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France
| | - Alain Lescoat
- Université de Rennes, Inserm, École des hautes études en santé publique (EHESP), Institut de recherche en santé, environnement et travail, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France
| | - Benoît Hue
- Unité de Médecine interne polyvalente, Site Pontchaillou, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France; Service de Pharmacie, Centre Hospitalier Universitaire de Rennes, Rennes 35000, France.
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21
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Lescoat A, Cavalin C, Ehrlich R, Cazalets C, Ballerie A, Belhomme N, Coiffier G, de Saint Riquier M, Rosental PA, Hachulla E, Sobanski V, Jégo P. The nosology of systemic sclerosis: how lessons from the past offer new challenges in reframing an idiopathic rheumatological disorder. Lancet Rheumatol 2019; 1:e257-e264. [PMID: 38229382 DOI: 10.1016/s2665-9913(19)30038-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 11/24/2022]
Abstract
Systemic sclerosis is a rare connective tissue disease characterised by a wide range of clinical manifestations. Compared with previous sets of criteria, the 2013 American College of Rheumatology and European League Against Rheumatism (ACR/EULAR) classification of systemic sclerosis encompasses a broader and more relevant spectrum of the condition. Nonetheless, clinical and prognostic heterogeneity persists among patients fulfilling these criteria. The next task in the classification of systemic sclerosis is the development of new subset criteria that can successfully identify subgroups of patients with distinct prognostic or pathophysiological features. In this Viewpoint we describe the history of systemic sclerosis over the past century with the objective of highlighting the effect of previous nosological debates on efforts to understand and manage this disorder. Rather than seeking to present a systematic review of possible subgrouping for systemic sclerosis in relation to prognosis, we aim to clarify how nosological considerations have influenced our understanding of the cause and prognosis of this so-called idiopathic rheumatological disorder and how aetiological, prognostic, and pathophysiological hypotheses have helped to describe clusters within the disease. By reflecting on past nosological debates and endeavours, we identify challenges for the current initiative to develop a new subgrouping of systemic sclerosis.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France.
| | - Catherine Cavalin
- Interdisciplinary Research Institute for the Social Sciences, Université Paris-Dauphine, Université Paris Sciences et Lettres, Paris, France; Centre for European Studies and Comparative Politics, Sciences Po, Paris, France; Laboratory for Interdisciplinary Evaluation of Public Policies, Sciences Po, Paris, France; The Employment and Labour Research Centre, Noisy-le-Grand, France
| | - Rodney Ehrlich
- Centre for Occupational and Environmental Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claire Cazalets
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital, University of Rennes 1, Rennes, France; French National Institute of Health and Medical Research Unit 1241, University of Rennes 1, Rennes, France
| | - Marine de Saint Riquier
- Department of Rheumatology, Rennes University Hospital, University of Rennes 1, Rennes, France
| | | | - Eric Hachulla
- Lille Inflammation Research International Center, University of Lille, Lille, France; French National Institute of Health and Medical Research, University of Lille, Lille, France; Département de Médecine Interne et Immunologie Clinique, Lille University Hospital, Lille, France; Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Vincent Sobanski
- Lille Inflammation Research International Center, University of Lille, Lille, France; French National Institute of Health and Medical Research, University of Lille, Lille, France; Département de Médecine Interne et Immunologie Clinique, Lille University Hospital, Lille, France; Centre National de Référence Maladies Systémiques et Auto-Immunes Rares du Nord et Nord-Ouest de France, Lille, France
| | - Patrick Jégo
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, University of Rennes 1, Rennes, France; École des Hautes Études en Santé Publique, Research Institute for Environmental and Occupational Health, French National Institute of Health and Medical Research Unit 1085, Rennes University Hospital, University of Rennes 1, Rennes, France
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22
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Lescoat A, Ballerie A, Belhomme N, Cazalets C, de Carlan M, Droitcourt C, Perdriger A, Jégo P, Coiffier G. Synovial involvement assessed by power Doppler ultra-sonography in systemic sclerosis: results of a cross-sectional study. Rheumatology (Oxford) 2019; 57:2012-2021. [PMID: 30053245 DOI: 10.1093/rheumatology/key214] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To characterize hand synovial manifestations assessed by power Doppler ultrasonography (PDUS) in a cohort of unselected patients fulfilling the 2013 ACR/EULAR classification criteria for SSc and to evaluate the associations of these synovial manifestations with the main general clinical and biological features of SSc. Methods One hundred and three SSc patients were consecutively included and underwent PDUS evaluation of both hands assessing synovial and tenosynovial manifestations according to the OMERACT definitions. Clinical, biological and immunological SSc characteristics were recorded at the same time. Results Thirty-three patients (32%) had ultrasonographic synovial/tenosynovial involvement. The two main PDUS features were Doppler-positive/inflammatory synovitis (n = 18, 17.5%) and sclerosing tenosynovitis (TS) (n = 19, 18.4%). Inflammatory synovitis was more frequent in the wrist and MCP joints. Sclerosing TS was more frequent in men [odds ratio (OR) = 6.32, 95% CI: 2.17, 18.41; P = 0.001] and was associated with anti-RNA polymerase III antibodies (OR = 10.93, 95% CI: 1.84, 65.12; P = 0.01), diffuse SSc (OR = 18.24, 95% CI: 4.80, 69.32; P < 0.0001), interstitial lung disease (OR = 6.09, 95% CI: 1.86, 19.98; P = 0.001) and inflammatory arthralgia (OR = 14.64, 95% CI: 2.58, 83.10; P = 0.002). Inflammatory TS or synovitis were associated with CRP levels >5 mg/l (OR = 5.50, 95% CI: 1.81, 16.70; P = 0.001), pericarditis (OR = 7.81, 95% CI: 1.58, 38.71; P = 0.017) and inflammatory arthralgia (OR = 15.96, 95% CI: 2.80, 91.02; P = 0.002). Inflammatory synovitis and sclerosing TS were not significantly associated within an individual patient (OR = 2.77, 95% CI: 0.88, 8.70; P > 0.05). Conclusions Ultrasonographic synovial involvement is frequent in patients fulfilling the 2013 ACR/EULAR classification criteria and PDUS may have a part to play in a more accurate and precise description of musculoskeletal manifestations of the disease, especially as the question of a treat-to-target approach is arising for SSc.
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Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S, Rennes, France
| | - Alice Ballerie
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Marine de Carlan
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Centre Hospitalier Universitaire de Rennes, Inserm, CIC, Rennes, France.,REPERES Pharmacoepidemiology and Access to Health Care, University of Rennes 1, Rennes, France.,French School of Public Health, UPRES EA, Rennes, France
| | - Aleth Perdriger
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rennes, Rennes, France.,Universitaire de Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S, Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Centre Hospitalier Universitaire de Rennes, Rennes, France.,UMR INSERM U 1241, University of Rennes, Rennes, France
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Cavalin C, Lescoat A, Ballerie A, Belhomme N, Jégo P, Jouneau S, Lecureur V, Lederlin M, Paris C, Rosental PA. Beyond silicosis, is the world failing on silica hazards? Lancet Respir Med 2019; 7:649-650. [PMID: 31109828 DOI: 10.1016/s2213-2600(19)30174-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Catherine Cavalin
- Interdisciplinary Research Institute for the Social Sciences, National Centre for Scientific Research-National Institute for Agricultural Research 7170-1427, Paris-Dauphine University, 75775 Paris, France.
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Lescoat A, Yelnik CM, Coiffier G, Wargny M, Lamotte C, Cazalets C, Belhomme N, Ballerie A, Hatron P, Launay D, Perdriger A, Sobanski V, Hachulla E, Jégo P. Ulnar Artery Occlusion and Severity Markers of Vasculopathy in Systemic Sclerosis: A Multicenter Cross‐Sectional Study. Arthritis Rheumatol 2019; 71:983-990. [DOI: 10.1002/art.40799] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 12/06/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Alain Lescoat
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
| | - Cécile Marie Yelnik
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | - Christophe Lamotte
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | | | | | - Pierre‐Yves Hatron
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - David Launay
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | | | - Vincent Sobanski
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Eric Hachulla
- University Lille, INSERM U 995, CHU Lille, Centre de Référence des Maladies Autoimmunes Systémiques Rares du Nord et Nord‐Ouest de France Lille France
| | - Patrick Jégo
- CHU Rennes, University of Rennes, INSERM, EHESP, Institut de Recherche en Santé, Environnement et Travail (IRSET) Rennes France
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Lescoat A, Lederlin M, Ballerie A, Belhomme N, Cavalin C, Jégo P, Jouneau S. Interstitial Lung Disease and Mediastinal Lymph Nodes: A Computed Tomography-based Biomarker beyond Nosological and Etiological Borders? Am J Respir Crit Care Med 2019; 199:1038-1040. [PMID: 30653924 PMCID: PMC6467315 DOI: 10.1164/rccm.201811-2123le] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alain Lescoat
- 1 University of Rennes 1 Rennes, France.,2 CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085 Rennes, France
| | - Mathieu Lederlin
- 1 University of Rennes 1 Rennes, France.,3 INSERM U1099 Rennes, France.,4 Centre Hospitalier Universitaire de Rennes Rennes, France
| | - Alice Ballerie
- 1 University of Rennes 1 Rennes, France.,2 CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085 Rennes, France
| | | | - Catherine Cavalin
- 5 Université Paris-Dauphine Paris, France.,6 Centre d'Études Européennes et de Politique Comparée de Sciences Po Paris, France.,7 Laboratoire Interdisciplinaire d'Évaluation des Politiques Publiques de Sciences Po Paris, France and.,8 Centre d'Études de l'Emploi et du Travail Noisy-le-Grand, France
| | - Patrick Jégo
- 1 University of Rennes 1 Rennes, France.,2 CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085 Rennes, France
| | - Stéphane Jouneau
- 1 University of Rennes 1 Rennes, France.,2 CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085 Rennes, France
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Ballerie A, Lescoat A, Augagneur Y, Lelong M, Morzadec C, Cazalets C, Jouneau S, Fardel O, Vernhet L, Jégo P, Lecureur V. Efferocytosis capacities of blood monocyte-derived macrophages in systemic sclerosis. Immunol Cell Biol 2018; 97:340-347. [PMID: 30426551 DOI: 10.1111/imcb.12217] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/18/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/15/2022]
Abstract
A defect in the apoptotic cell clearance (efferocytosis) by phagocytic cells may participate in autoimmunity and chronic inflammation. The mechanisms leading to the emergence of autoimmunity in systemic sclerosis (SSc) are still to be determined. In this study, the efferocytosis capacities of blood monocyte-derived macrophages (MDM) from patients with SSc were evaluated. Blood monocytes obtained from patients with SSc and healthy donors (HD) were differentiated in vitro into macrophages. The capacities of MDM to engulf CFSE+ apoptotic Jurkat human T lymphocytes were compared between SSc MDM and HD using flow cytometry. The expression of classical engulfing receptors in SSc MDM and HD MDM was also evaluated and their involvement in the modulation of efferocytosis was confirmed using a siRNA approach. The mean phagocytic index (PI) reflecting efferocytosis capacities of SSc MDM (PI = 19.3 ± 3.0; n = 21) was significantly decreased in comparison with the PI of HD MDM (PI = 35.9 ± 3.0; n = 31; P < 0.001). In comparison with HD, SSc MDM exhibited a downregulated expression of scavenger receptor (SR)-B1, SR-A1 and integrin β5 (ITGβ5). In HD MDM, the extinction of these receptors was followed by a reduction of efferocytosis only for the repression of ITGβ5, suggesting a possible selective role of this integrin in the impaired efferocytosis observed in SSc. As efferocytosis may be at the crossroads of inflammation, autoimmunity and fibrosis, in showing impaired efferocytosis capacities of blood MDM in SSc, our study offers new pathogenesis considerations for the involvement of macrophages in the autoimmune processes driving this disorder.
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Affiliation(s)
- Alice Ballerie
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France.,Department of Internal Medicine, Rennes University Hospital, 35000, Rennes, France
| | - Alain Lescoat
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France.,Department of Internal Medicine, Rennes University Hospital, 35000, Rennes, France
| | - Yu Augagneur
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France
| | - Marie Lelong
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France
| | - Claudie Morzadec
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France
| | - Claire Cazalets
- Department of Internal Medicine, Rennes University Hospital, 35000, Rennes, France
| | - Stéphane Jouneau
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France.,Department of Respiratory Diseases, Rennes University Hospital, 35000, Rennes, France
| | - Olivier Fardel
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France.,Pôle Biologie, Rennes University Hospital, 35033, Rennes, France
| | - Laurent Vernhet
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France
| | - Patrick Jégo
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France.,Department of Internal Medicine, Rennes University Hospital, 35000, Rennes, France
| | - Valérie Lecureur
- Univ Rennes, CHU Rennes, INSERM, EHESP, IRSET (Institut de recherche en santé, environnement et travail) - UMR_S 1085, 35000, Rennes, France
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Lescoat A, Dupuy A, Belhomme N, Stock N, Sebillot M, Decaux O, Jégo P, Droitcourt C. Atypical bortezomib-induced neutrophilic dermatosis. Ann Hematol 2018; 98:1315-1316. [PMID: 30315343 DOI: 10.1007/s00277-018-3519-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/07/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alain Lescoat
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France. .,Univeristy of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France. .,Department of Internal Medicine, Pontchaillou University Hospital, 2 rue Henri Le Guilloux, 35033, Rennes cedex 9, France.
| | - Alain Dupuy
- Department of Dermatology, CHU Rennes, University of Rennes 1, INSERM CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, Rennes, France
| | - Nicolas Belhomme
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Nathalie Stock
- Department of Pathology, CHU Rennes, University of Rennes 1, Rennes, France
| | - Martine Sebillot
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Olivier Decaux
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.,Univeristy of Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Catherine Droitcourt
- Department of Dermatology, CHU Rennes, University of Rennes 1, INSERM CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, Rennes, France
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28
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Lescoat A, Coiffier G, de Carlan M, Droitcourt C, Ballerie A, Cazalets C, Perdriger A, Jégo P. Combination of Capillaroscopic and Ultrasonographic Evaluations in Systemic Sclerosis: Results of a Cross-Sectional Study. Arthritis Care Res (Hoboken) 2018; 70:938-943. [PMID: 28898558 DOI: 10.1002/acr.23413] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 09/05/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To compare microvascular damages on nailfold capillaroscopy (NFC) with macrovascular manifestations evaluated by hand power Doppler ultrasonography (PDUS) in systemic sclerosis (SSc) patients, and to assess the associations of these damages with the main digital manifestations of the disease: digital ulcers, acroosteolysis, and calcinosis. METHODS NFC, hand radiographs, and PDUS were systematically performed in 64 unselected SSc patients. PDUS evaluation with assessment of ulnar artery occlusion (UAO) and finger pulp blood flow (FPBF) were performed blinded for the results of radiographs and NFC. RESULTS UAO and pathologic FPBF were associated with severe capillary loss (<4 capillaries/mm) on NFC (odds ratio [OR] 4.04 [95% confidence interval (95% CI) 1.23-13.29]; P < 0.05, and OR 3.38 [95% CI 1.03-11.05]; P < 0.05, respectively). Digital ulcer history was associated with UAO (OR 10.71 [95% CI 3.36-34.13]; P < 0.0001), pathologic FPBF (OR 7.67 [95% CI 2.52-23.28]; P < 0.0001), late NFC pattern (OR 6.33 [95% CI 2.03-19.68]; P = 0.001), and severe capillary loss (OR 8.52 [95% CI 2.15-33.78]; P = 0.001). Acroosteolysis was also associated with UAO (OR 15.83 [95% CI 3.95-63.54]; P < 0.0001), pathologic FPBF (OR 5.52 [95% CI 1.71-17.90]; P = 0.003), late NFC pattern (OR 6.86 [95% CI 2.18-21.53]; P = 0.001), and severe capillary loss (OR 7.20 [95% CI 2.16-24.02]; P = 0.001). Calcinosis on radiographs was associated with late NFC pattern (OR 5.41 [95% CI 1.82-16.12]; P = 0.002), severe capillary loss (OR 12.69 [95% CI 3.14-51.26]; P < 0.0001), and UAO (OR 3.19 [95% CI 1.14-8.92]; P = 0.025). Combination of UAO and severe capillary loss in the same patient was especially associated with digital ulcer history (OR 18.60 [95% CI 2.24-154.34]; P = 0.001) and acroosteolysis (OR 10.83 [95% CI 2.56-45.88]; P = 0.001). CONCLUSION Microvascular damages evaluated by NFC and macrovascular features like UAO assessed by PDUS show concordant associations with the main digital manifestations of the disease.
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Affiliation(s)
- Alain Lescoat
- CHU Rennes, University of Rennes, and UMR INSERM U1085, Research Institute in Health, Environment, and Occupation, Rennes, France
| | | | | | | | | | | | - Aleth Perdriger
- CHU Rennes, University of Rennes, and UMR INSERM U991, Rennes, France
| | - Patrick Jégo
- CHU Rennes, University of Rennes, and UMR INSERM U1085, Research Institute in Health, Environment, and Occupation, Rennes, France
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Belhomme N, Jouneau S, Bouzillé G, Decaux O, Lederlin M, Guillot S, Perlat A, Jégo P. Role of serum immunoglobulins for predicting sarcoidosis outcome: A cohort study. PLoS One 2018; 13:e0193122. [PMID: 29641520 PMCID: PMC5894960 DOI: 10.1371/journal.pone.0193122] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Sarcoidosis is a systemic granulomatous disease which carries variable outcomes. Serum protein electrophoresis is an easily accessible and routinely performed examination at diagnosis, in order to search for hypergammaglobulinemia, which is frequently found, and to rule out other granulomatous diseases such as common variable immunodeficiency. We aimed to assess the impact of baseline immunoglobulin level on the outcome of sarcoidosis. Methods We conducted a retrospective cohort-study, at Rennes University Hospital, in which all newly diagnosed patients for whom a serum protein electrophoresis had been performed at baseline were enrolled, from 2006 to 2014. The main outcome was the need for corticosteroid treatment within 2 years from diagnosis, the secondary outcome was the occurrence of relapse among treated patients. Results Eighty patients were included in the study, and 41.25% of them exhibited an elevated globulins rate. In univariate analysis, an elevated ACE level >70 U/l, Afro-Caribbean origin, and extra-pulmonary involvement, were associated with the need for corticosteroid treatment. In multivariate analysis, only ACE elevation (OR = 1.03, IC95% 1.01–1.05, p = 0.009) and extra-pulmonary involvement (OR = 5.8, IC95% 1.4–24, p = 0.015) were significant. Immunoglobulin level was not associated with the main outcome. Regarding the secondary outcome, none of the studied features were predictive of relapse among the 34 treated patients followed for two years. Conclusions There was no relation between the immunoglobulin level at diagnosis and the evolution of sarcoidosis. An elevated ACE level and the presence of initial extra-pulmonary involvement were both associated with a more severe course of the disease necessitating a corticosteroid treatment.
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Affiliation(s)
- Nicolas Belhomme
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
- * E-mail:
| | - Stéphane Jouneau
- University of Rennes 1, Rennes, France
- Department of Respiratory Medicine, Rennes University Hospital, Rennes, France. University of Rennes 1, Rennes, France
- INSERM-IRSET UMR1085, Rennes, France
| | - Guillaume Bouzillé
- INSERM, U1099, Rennes, France
- Université de Rennes 1, LTSI, Rennes, France
- CHU Rennes, CIC Inserm 1414, Rennes, France
- CHU Rennes, Centre de Données Cliniques, Rennes, France
| | - Olivier Decaux
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
| | - Mathieu Lederlin
- University of Rennes 1, Rennes, France
- INSERM, U1099, Rennes, France
- Department of Radiology, Rennes University Hospital, Rennes, France
| | - Stéphanie Guillot
- Department of Respiratory Physiology, Rennes University Hospital, Rennes, France
| | - Antoinette Perlat
- Internal Medicine Department, Rennes University Hospital, Rennes, France
| | - Patrick Jégo
- Internal Medicine Department, Rennes University Hospital, Rennes, France
- University of Rennes 1, Rennes, France
- INSERM-IRSET UMR1085, Rennes, France
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Lescoat A, Ballerie A, Augagneur Y, Morzadec C, Vernhet L, Fardel O, Jégo P, Jouneau S, Lecureur V. Distinct Properties of Human M-CSF and GM-CSF Monocyte-Derived Macrophages to Simulate Pathological Lung Conditions In Vitro: Application to Systemic and Inflammatory Disorders with Pulmonary Involvement. Int J Mol Sci 2018; 19:ijms19030894. [PMID: 29562615 PMCID: PMC5877755 DOI: 10.3390/ijms19030894] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 12/23/2022] Open
Abstract
Macrophages play a central role in the pathogenesis of inflammatory and fibrotic lung diseases. However, alveolar macrophages (AM) are poorly available in humans to perform in vitro studies due to a limited access to broncho-alveolar lavage (BAL). In this study, to identify the best alternative in vitro model for human AM, we compared the phenotype of AM obtained from BAL of patients suffering from three lung diseases (lung cancers, sarcoidosis and Systemic Sclerosis (SSc)-associated interstitial lung disease) to human blood monocyte-derived macrophages (MDMs) differentiated with M-CSF or GM-CSF. The expression of eight membrane markers was evaluated by flow cytometry. Globally, AM phenotype was closer to GM-CSF MDMs. However, the expression levels of CD163, CD169, CD204, CD64 and CD36 were significantly higher in SSc-ILD than in lung cancers. Considering the expression of CD204 and CD36, the phenotype of SSc-AM was closer to MDMs, from healthy donors or SSc patients, differentiated by M-CSF rather than GM-CSF. The comparative secretion of IL-6 by SSc-MDMs and SSc-AM is concordant with these phenotypic considerations. Altogether, these results support the M-CSF MDM model as a relevant in vitro alternative to simulate AM in fibrotic disorders such as SSc.
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Affiliation(s)
- Alain Lescoat
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France
| | - Alice Ballerie
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France
| | - Yu Augagneur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
| | - Claudie Morzadec
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
| | - Laurent Vernhet
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
| | - Olivier Fardel
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Pôle Biologie, Rennes University Hospital, 35203 Rennes, France
| | - Patrick Jégo
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France
| | - Stéphane Jouneau
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Department of Respiratory Diseases, Rennes University Hospital, 35203 Rennes, France
| | - Valérie Lecureur
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France; (A.L.); (A.B.); (Y.A.); (C.M.); (L.V.); (O.F.); (P.J.); (S.J.)
- Correspondence: ; Tel: +33-(0)-223-234-788
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Coirier V, Langner-Lemercier S, Jégo P. [Syncope, loss of consciousness, and seizures in the adults]. Rev Prat 2018; 68:e91-e97. [PMID: 30869305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Valentin Coirier
- Service de médecine interne, CHU de Rennes, 35033 Rennes Cedex 9, France
| | | | - Patrick Jégo
- Service de médecine interne, CHU de Rennes, 35033 Rennes Cedex 9, France
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Coirier V, Langner-Lemercier S, Jégo P. [Difficult diagnosis syncopes]. Rev Prat 2018; 68:e98. [PMID: 30869306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Valentin Coirier
- Service de médecine interne, CHU de Rennes, 35033 Rennes Cedex 9, France
| | | | - Patrick Jégo
- Service de médecine interne, CHU de Rennes, 35033 Rennes Cedex 9, France
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Lescoat A, Jégo P, Lecureur V. M-CSF and GM-CSF monocyte-derived macrophages in systemic sclerosis: the two sides of the same coin? Ann Rheum Dis 2018; 78:e19. [PMID: 29439999 DOI: 10.1136/annrheumdis-2018-213112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/25/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Alain Lescoat
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France.,Médecine Interne, CHU Rennes, Rennes, France
| | - Patrick Jégo
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France.,Médecine Interne, CHU Rennes, Rennes, France
| | - Valérie Lecureur
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, F-35000 Rennes, France
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Coirier V, Lescoat A, Chabanne C, Fournet M, Coiffier G, Jouneau S, Polard E, Jégo P. Pulmonary arterial hypertension in four patients treated by leflunomide. Joint Bone Spine 2018; 85:761-763. [PMID: 29329993 DOI: 10.1016/j.jbspin.2017.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 09/06/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022]
Abstract
Pulmonary arterial hypertension (PAH) is a rare disorder that can be drug-induced, mostly following treatment by appetite-suppressant drugs. We report four cases of patients who developed PAH following a treatment by leflunomide for rheumatoid arthritis, psoriatic arthritis or undetermined connective tissue disease. All patients described a progressive dyspnea from grade II to IV of NYHA classification; clinical examination found signs of heart failure. PAH was finally diagnosed and confirmed by right heart catheterisation. Haemodynamic explorations found pre-capillary pulmonary hypertension with mean pulmonary arterial pressure above 25mmHg, and pulmonary capillary wedge pressure under 15mmHg. Explorations of this pre-capillary pulmonary hypertension were conducted according to international guidelines: pulmonary or chronic thromboembolic aetiologies were excluded after ventilation/perfusion lung scan and high-resolution computed tomography. All other etiologic explorations were negative. Imputability of leflunomide was finally retained. Leflunomide was stopped for all patients; three of them received specific PAH treatments. A favourable clinical and/or haemodynamic evolution was observed for all patients. The conclusions of the investigations conducted by our pharmacovigilance centre were communicated to the European Medicines Agency, leading to the addition of "pulmonary hypertension" in the paragraph "special warning and precautions of use" of the package leaflet of leflunomide.
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Affiliation(s)
- Valentin Coirier
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France.
| | - Alain Lescoat
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
| | - Céline Chabanne
- Department of Cardiology, Rennes University Hospital, 35203 Rennes, France
| | - Maxime Fournet
- Department of Cardiology, Rennes University Hospital, 35203 Rennes, France
| | - Guillaume Coiffier
- Department of Rheumatology, Rennes University Hospital, 35203 Rennes, France
| | - Stéphane Jouneau
- Department of Pneumology, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
| | - Elisabeth Polard
- Department of Pharmacovigilance, Rennes University Hospital, 35203 Rennes, France
| | - Patrick Jégo
- Department of Internal Medicine, Rennes University Hospital, 35203 Rennes, France; UMR INSERM U1085, Research Institute in Health, Environment and Occupation/Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), Universisty of Rennes 1, 35203 Rennes, France
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35
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Coirier V, Lescoat A, Fournet M, Cazalets C, Coiffier G, Jouneau S, Chabanne C, Jégo P. [Screening for pulmonary arterial hypertension in patients with systemic sclerosis: Comparison of DETECT algorithm to decisions of a multidisciplinary team, in a competence centre]. Rev Med Interne 2017; 38:502-507. [PMID: 28545856 DOI: 10.1016/j.revmed.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a severe complication of systemic sclerosis and detecting PAH efficiently remains challenging. The DETECT study has offered in 2013 a composite screening tool for PAH. The objective of our study was to compare the indication of right heart catheterisation (RHC) as suggested by the DETECT algorithm with the decisions of a multidisciplinary team. METHODS This prospective monocentric non-interventional study consecutively included systemic sclerosis patients when data required to apply DETECT algorithm were available. We evaluate the number of RHC as requested by this algorithm and confronted it with the indications of RHC suggested by a multidisciplinary group blinded for the result of DETECT algorithm. RESULTS In total, 117 systemic sclerosis patients were included. When DETECT algorithm was applied to all patients, RHC was suggested by this algorithm for 70 patients, whereas only 15 indications were required by the multidisciplinary group; among those patients only 7 had PAH. When DETECT algorithm was applied only to the 42 patients with DLCO<60% and disease duration of more than 3 years, RHC was suggested for 31 patients whereas only 13 were indicated by the multidisciplinary group; among those patients only 7 had PAH. CONCLUSION The DETECT algorithm is able to efficiently detect all PAH patients finally diagnosed by our multidisciplinary team. However, it increases by 3 the number of RHC that should be performed.
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Affiliation(s)
- V Coirier
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France.
| | - A Lescoat
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - M Fournet
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - C Cazalets
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France
| | - G Coiffier
- Service de rhumatologie, CHU de Rennes, 35203 Rennes, France
| | - S Jouneau
- Service de pneumologie, CHU de Rennes, 35203 Rennes, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
| | - C Chabanne
- Service de cardiologie, CHU de Rennes, 35203 Rennes, France
| | - P Jégo
- Service de médecine interne, hôpital Sud, CHU de Rennes, BP 90347, 16, boulevard de Bulgarie, 35203 Rennes cedex 2, France; UMR Inserm U1085, institut de recherche sur la santé, l'environnement et le travail (IRSET), université de Rennes 1, 35203 Rennes, France
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Lescoat A, Coiffier G, Rouil A, Droitcourt C, Cazalets C, de Carlan M, Perdriger A, Jégo P. Vascular Evaluation of the Hand by Power Doppler Ultrasonography and New Predictive Markers of Ischemic Digital Ulcers in Systemic Sclerosis: Results of a Prospective Pilot Study. Arthritis Care Res (Hoboken) 2017; 69:543-551. [PMID: 27390194 DOI: 10.1002/acr.22965] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the relevance of power Doppler ultrasonography (PDUS) as a predictive tool of 1-year digital ulcer (DU) occurrence in systemic sclerosis (SSc). METHODS A total of 55 SSc patients and 19 controls underwent PDUS of both hands to evaluate the prevalence of ulnar artery occlusion (UAO) at baseline. Finger pulp blood flow (FPBF) of the third and fourth fingers was also assessed and considered as pathologic if a defect of the Doppler signal on a finger pulp was observed. All patients were clinically re-evaluated 6 and 12 months later and new ischemic DU occurrences in the meantime were retrospectively recorded. Patients were also asked to call if new DUs occurred between consultations. RESULTS PDUS parameters were normal in all controls. The prevalence of UAO was 36.4% and was bilateral in 70% of the SSc cases. A total of 56.4% of SSc patients had a pathologic FPBF. UAO and pathologic FPBF were associated with a history of multiple DU episodes (odds ratio [OR] 8.98 [95% confidence interval (95% CI) 2.52-32.01], P < 0.001, and OR 4.69 [95% CI 1.30-16.93], P = 0.014, respectively) and the occurrence of new DUs during the followup in the univariable model (OR 8.73 [95% CI 2.00-38.16], P = 0.005, and OR 12.65 [95% CI 1.50-106.77], P = 0.005, respectively). The association of UAO and pathologic FPBF in the same patient was a predictive factor of new DUs in the multivariable analysis (P = 0.015). CONCLUSION This study suggests that UAO and pathologic FPBF are associated with a history of multiple DUs and are predictors of new ischemic DUs. These parameters could be used as prognostic factors and considered in further studies evaluating DU treatment strategies.
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Affiliation(s)
| | | | - Alban Rouil
- CHU Rennes, University of Rennes, Rennes, France
| | | | | | | | | | - Patrick Jégo
- CHU Rennes, University of Rennes, Rennes, France
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Lescoat A, Cavalin C, Macchi O, Jégo P, Rosental PA. Silica-associated systemic sclerosis in 2017: 60 years after Erasmus, where do we stand? Clin Rheumatol 2017; 36:1209-1210. [PMID: 28213786 DOI: 10.1007/s10067-017-3576-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Alain Lescoat
- UMR INSERM U1085, Research Institute in Health, Environment and Occupation / Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), University of Rennes 1, Rennes, France. .,Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France.
| | - Catherine Cavalin
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,Laboratory for Interdisciplinary Evaluation of Public Policies, Sciences Po, Paris, France.,Centre for Employment Studies, Noisy-le-Grand, France
| | - Odile Macchi
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,Centre for Historical Research, CNRS-EHESS, Paris, France
| | - Patrick Jégo
- UMR INSERM U1085, Research Institute in Health, Environment and Occupation / Institut de Recherche sur la Santé, l'Environnement et le Travail (IRSET), University of Rennes 1, Rennes, France.,Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Paul-André Rosental
- Silicosis project, ERC Advanced Grant, Centre for European Studies, Sciences Po, Paris, France.,National Institute for Demographic Studies (INED), Paris, France
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Coiffier G, Lescoat A, Droitcourt C, Cazalets C, Albert J, Jégo P, Perdriger A. SAT0205 Ultrasonographic Features of The Hands in Patients with Systemic Sclerosis Reflect Visceral Manifestations of The Disease. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4902] [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: 11/04/2022]
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Lescoat A, Coiffier G, Droitcourt C, Cazalets C, Albert JD, Perdriger A, Jégo P. SAT0207 Ulnar Artery Occlusion Evaluated by Power Doppler Ultrasonography Is Associated with Acro-Osteolysis in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4936] [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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Lescoat A, Coiffier G, Rouil A, Droitcourt C, Cazalets C, De Carlan M, Perdriger A, Jégo P. SAT0206 Vascular Evaluation of The Hand by Power Doppler Ultrasonography Provides New Predictive Markers of Ischaemic Digital Ulcers in Systemic Sclerosis. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4920] [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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Espitia O, Samson M, Le Gallou T, Connault J, Landron C, Lavigne C, Belizna C, Magnant J, de Moreuil C, Roblot P, Maillot F, Diot E, Jégo P, Durant C, Masseau A, Brisseau JM, Pottier P, Espitia-Thibault A, Santos AD, Perrin F, Artifoni M, Néel A, Graveleau J, Moreau P, Maisonneuve H, Fau G, Serfaty JM, Hamidou M, Agard C. Comparison of idiopathic (isolated) aortitis and giant cell arteritis-related aortitis. A French retrospective multicenter study of 117 patients. Autoimmun Rev 2016; 15:571-6. [PMID: 26903476 DOI: 10.1016/j.autrev.2016.02.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of the study was to compare clinical/imaging findings and outcome in patients with idiopathic (isolated aortitis, IA) and with giant cell arteritis (GCA)-related aortitis. METHODS Patients from 11 French internal medicine departments were retrospectively included. Aortitis was defined by aortic wall thickening >2mm and/or an aortic aneurysm on CT-scan, associated to inflammatory syndrome. Patients with GCA had at least 3 ACR criteria. Aortic events (aneurysm, dissection, aortic surgeries) were reported, and free of aortic events-survival were compared. RESULTS Among 191 patients with non-infectious aortitis, 73 with GCA and 44 with IA were included. Patients with IA were younger (65 vs 70 years, p=0.003) and comprised more past/current smokers (43 vs 15%, p=0.0007). Aortic aneurisms were more frequent (38% vs 20%, p=0.03), and aortic wall thickening was more pronounced in IA. During follow-up (median=34 months), subsequent development of aortic aneurysm was significantly lower in GCA when compared to IA (p=0.009). GCA patients required significantly less aortic surgery during follow-up than IA patients (p=0.02). Mean age, sex ratio, inflammatory parameters, and free of aortic aneurism survival were equivalent in patients with IA ≥ 60 years when compared to patients with GCA-related aortitis. CONCLUSIONS IA is more severe than aortitis related to GCA, with higher proportions of aortic aneurism at diagnosis and during follow-up. IA is a heterogeneous disease and its prognosis is worse in younger patients <60 years. Most patients with IA ≥ 60 years share many features with GCA-related aortitis.
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Affiliation(s)
- Olivier Espitia
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, University Hospital of Dijon, Dijon, France
| | - Thomas Le Gallou
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Jérôme Connault
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Cedric Landron
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Christian Lavigne
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Cristina Belizna
- Department of Internal Medicine, University Hospital of Angers, Angers, France
| | - Julie Magnant
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Claire de Moreuil
- Department of Internal Medicine, University Hospital of Brest, Brest, France
| | - Pascal Roblot
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | | | - Elisabeth Diot
- Department of Internal Medicine, CHRU of Tours, Tours, France
| | - Patrick Jégo
- Department of Internal Medicine, University Hospital of Rennes, Rennes, France
| | - Cécile Durant
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - A Masseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Jean-Marie Brisseau
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Pierre Pottier
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | | | | | - François Perrin
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Mathieu Artifoni
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Antoine Néel
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Julie Graveleau
- Department of Medicine, Hospital of Saint-Nazaire, Saint-Nazaire, France
| | - Philippe Moreau
- Department of Hematology, Hospital of Lorient, Lorient, France
| | - Hervé Maisonneuve
- Department of Hematology, Hospital of La Roche sur Yon, La Roche sur Yon, France
| | - Georges Fau
- Department of Radiology, University Hospital of Nantes, Nantes, France
| | | | - Mohamed Hamidou
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France
| | - Christian Agard
- Department of Diagnostic Cardio-vascular Imaging, University hospital of Nantes, Nantes, France.
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Valence M, Decaux O, Revest M, Jégo P, Tattevin P. Association of tuberculosis and deep venous thromboembolism in patients with autoimmune diseases. Eur J Intern Med 2015; 26:e23-4. [PMID: 25912822 DOI: 10.1016/j.ejim.2015.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/09/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Marion Valence
- Internal Medicine, Hôpital Sud, University Hospital, Rennes, France; Infectious Diseases and Intensive Care Unit, University Hospital, Rennes, France
| | - Olivier Decaux
- Internal Medicine, Hôpital Sud, University Hospital, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, University Hospital, Rennes, France
| | - Patrick Jégo
- Internal Medicine, Hôpital Sud, University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, University Hospital, Rennes, France.
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Fillatre P, Decaux O, Jouneau S, Revest M, Gacouin A, Robert-Gangneux F, Fresnel A, Guiguen C, Le Tulzo Y, Jégo P, Tattevin P. Incidence of Pneumocystis jiroveci pneumonia among groups at risk in HIV-negative patients. Am J Med 2014; 127:1242.e11-7. [PMID: 25058862 DOI: 10.1016/j.amjmed.2014.07.010] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [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] [Received: 11/19/2013] [Revised: 06/20/2014] [Accepted: 07/09/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Pneumocystis jiroveci pneumonia in human immunodeficiency virus (HIV)-negative immunocompromised patients is associated with high mortality rates. Although trimethoprim-sulfamethoxazole provides a very effective prophylaxis, pneumocystosis still occurs and may even be emerging due to suboptimal characterization of patients most at risk, hence precluding targeted prophylaxis. METHODS We retrospectively analyzed all cases of documented pneumocystosis in HIV-negative patients admitted in our institution, a referral center in the area, from January 1990 to June 2010, and extracted data on their underlying condition(s). To estimate incidence rates within each condition, we estimated the number of patients followed-up in our area for each condition by measuring the number of patients admitted with the corresponding international classification diagnostic code, through the national hospital discharge database (Program of Medicalization of the Information System [PMSI]). RESULTS From 1990 to 2010, 293 cases of pneumocystosis were documented, of which 154 (52.6%) tested negative for HIV. The main underlying conditions were hematological malignancies (32.5%), solid tumors (18.2%), inflammatory diseases (14.9%), solid organ transplant (12.3%), and vasculitis (9.7%). Estimated incidence rates could be ranked in 3 categories: 1) high risk (incidence rates >45 cases per 100,000 patient-year): polyarteritis nodosa, granulomatosis with polyangiitis, polymyositis/dermatopolymyositis, acute leukemia, chronic lymphocytic leukemia, and non-Hodgkin lymphoma; 2) intermediate risk (25-45 cases per 100,000 patient-year): Waldenström macroglobulinemia, multiple myeloma, and central nervous system cancer; and 3) low risk (<25 cases per 100,000 patient-year): other solid tumors, inflammatory diseases, and Hodgkin lymphoma. CONCLUSIONS These estimates may be used as a guide to better target pneumocystosis prophylaxis in the groups most at risk.
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Affiliation(s)
- Pierre Fillatre
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France
| | | | - Stéphane Jouneau
- Pneumologie, Hôpital Pontchaillou, Rennes, France; IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France
| | - Matthieu Revest
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Arnaud Gacouin
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France
| | - Florence Robert-Gangneux
- IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France; Parasitologie-Mycologie, Hôpital Pontchaillou, Rennes, France
| | - Annie Fresnel
- Medical Information Department, Hôpital Pontchaillou, Rennes, France
| | - Claude Guiguen
- IRSET, UMR-INSERM 1085, Université Rennes 1, Rennes, France; Parasitologie-Mycologie, Hôpital Pontchaillou, Rennes, France
| | - Yves Le Tulzo
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France
| | | | - Pierre Tattevin
- Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, Rennes, France; CIC-Inserm-0203, Faculté de Médecine, Université Rennes 1, Rennes, France; INSERM U835, Faculté de Médecine, Université Rennes 1, Rennes, France.
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Valence M, Perlat A, Jagut JL, Sulpice L, Turlin B, Grosbois B, Jégo P. Une cause rare de douleurs lombaires. Rev Med Interne 2012; 33:165-6. [DOI: 10.1016/j.revmed.2011.02.014] [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: 01/05/2011] [Revised: 01/22/2011] [Accepted: 02/12/2011] [Indexed: 10/18/2022]
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Perlat A, Frin M, Decaux O, Cador B, Cazalets C, Sébillot M, Jégo P, Grosbois B. Unité d’assistance diagnostique et thérapeutique rapide : bilan d’activité et impact sur les relations médecine générale et médecine interne hospitalière. Rev Med Interne 2010; 31:776-9. [DOI: 10.1016/j.revmed.2010.08.021] [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: 03/05/2010] [Revised: 08/16/2010] [Accepted: 08/24/2010] [Indexed: 10/19/2022]
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Abstract
Stress at work, as shown by a number of human studies, may lead to a variety of negative and durable effects, such as impaired psychological functioning (anxiety, depression...). Horses share with humans this characteristic of working on a daily basis and are submitted then to work stressors related to physical constraints and/or more "psychological" conflicts, such as potential controversial orders from the riders or the requirement to suppress emotions. On another hand, horses may perform abnormal repetitive behaviour ("stereotypies") in response to adverse life conditions. In the present study, we investigated whether the type of work the horses are used for may have an impact on their tendency to show stereotypic behaviour (and its type) outside work. Observations in their box of 76 horses all living in the same conditions, belonging to one breed and one sex, revealed that the prevalence and types of stereotypies performed strongly depended upon the type of work they were used for. The stereotypies observed involved mostly mouth movements and head tossing/nodding. Work constraints probably added to unfavourable living conditions, favouring the emergence of chronic abnormal behaviours. This is especially remarkable as the 23 hours spent in the box were influenced by the one hour work performed every day. To our knowledge, this is the first evidence of potential effects of work stressors on the emergence of abnormal behaviours in an animal species. It raises an important line of thought on the chronic impact of the work situation on the daily life of individuals.
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Affiliation(s)
- Martine Hausberger
- Université de Rennes 1, UMR 6552 Ethologie Animale et Humaine, Unité Mixte de Recherche CNRS, Campus de Beaulieu, Rennes, France.
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Perlat A, Decaux O, Jégo P. [Limb pain and pain in extremities. Diagnosis orientation]. Rev Prat 2008; 58:1821-1827. [PMID: 19143156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Antoinette Perlat
- Service de médecine interne, Hôpital Sud-CHU de Rennes, 35056 Rennes, France.
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Decaux O, Goulard A, Cazalets C, Cador B, Perlat A, Jégo P, Grosbois B. Le diagnostic des cancers solides dans un service de médecine interne: étude descriptive de 114 cas consécutifs. Rev Med Interne 2007; 28:737-41. [PMID: 17574310 DOI: 10.1016/j.revmed.2007.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2007] [Accepted: 05/09/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE A deterioration of the general condition, a prolonged fever or an unexplained inflammatory syndrome are frequent reasons for hospitalization in a internal medicine unit. In these situations, it is not rare to make a diagnosis of cancer. PATIENTS AND METHODS A descriptive study was carried out over a three years period (1st October 1999 to 30th September 2002) in an internal medicine unit. Every week, all patients in whom a cancer was diagnosed were enrolled in the study. RESULTS During this period, 165 patients were identified (3.8% of the in-patients). A histological proof was obtained in 114 patients. Digestive and bronchopulmonary cancers were the most frequent. The first signs were very varied but digestive disorders and ferriprive anaemia were the most frequent. The number of investigations necessary to diagnosis were weak (1.56 procedures) when a sign was identified but were high (5.12 procedures) when no information was provided by interview, clinical examination or usual biological tests. CONCLUSION Diagnosis of cancer is an usual situation in an internal medicine unit. Interview and clinical examination are essential in the diagnostic step. It could decrease the number of procedures. Internal unit services are fully concerned by the announcement of cancer.
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Affiliation(s)
- O Decaux
- Service de médecine interne, hôpital Sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 02, France
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Revest M, Decaux O, Cazalets C, Verohye JP, Jégo P, Grosbois B. [Thoracic infectious aortitis: microbiology, pathophysiology and treatment]. Rev Med Interne 2006; 28:108-15. [PMID: 16979269 DOI: 10.1016/j.revmed.2006.08.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2006] [Revised: 08/06/2006] [Accepted: 08/08/2006] [Indexed: 01/16/2023]
Abstract
BACKGROUND Thoracic infectious aortitis are currently rare. They are always lethal without any treatment. The microorganisms involved are numerous with particular pathophysiological characteristics for each bacterium. Treatment is difficult and must associate medical and surgical care. RECENT FINDINGS Bacterial epidemiology of infectious aortitis has been profoundly modified with the large use of antibiotics. Syphilitic aortitis were frequent in the beginning of the twentieth century but its incidence has dramatically fallen. It still exists and its clinical presentation must be known to begin an adequate treatment. Other bacterial aetiologies of these aortitis are more classical with high frequencies of Staphylococcus aureus and Streptococcus, which are often associated with infective endocarditis. Among Gram-negative bacteria, Salmonella spp are the most frequently met microorganisms. Atherosclerosis represents the principal risk factor of these infectious aortitis. It provokes arterial parietal damage useful for bacterial attach. A saccular aneurysm of infective origin can then appear. Treatment must consist on antibiotics before surgery; Tuberculous aortitis are also possible but are much more rare. CONCLUSION Thoracic infectious aortitis are very rare but must be known because of their poor prognosis. Treatment is difficult and prevention of atherosclerosis which is the most important risk factor of these diseases is therefore of greatest importance.
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Affiliation(s)
- M Revest
- Département de médecine de l'adulte, service de médecine interne du Professeur-Grosbois, CHU hôpital Sud, 16, boulevard de Bulgarie, BP 90347, 35203 Rennes cedex 02, France
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Revest M, Decaux O, Frouget T, Cazalets C, Cador B, Jégo P, Grosbois B. Les aortites syphilitiques. Expérience d'un service de médecine interne. Rev Med Interne 2006; 27:16-20. [PMID: 16337718 DOI: 10.1016/j.revmed.2005.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Accepted: 10/20/2005] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Infectious aortitis remains a rare disease. It is characterized by an endarteritis of infectious origin generally followed by the development of a so called mycotic aneurysm. Those infectious aneurysms account for 0.5 to 1.3% of all aortic aneurysms. Of the infectious agents, Treponema pallidum has a particular place. Cardiovascular syphilitic infection was very common at the beginning of the XX(th) century with a prevalence of 6.9% of all autopsies. In 1950-1960, the prevalence had decreased to less than 1%. Since 1990, syphilis was considered as disappeared. EXEGESIS we report syphilitic aortitis in four patients. Diagnosis, treatment, and prognosis are detailed. CONCLUSION A syphilitic infection of the aorta should be looked for in every patient suffering from an inflammatory or infectious disease of aorta.
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Affiliation(s)
- M Revest
- Service de médecine interne, hôpital Sud, 16, boulevard de Bulgarie, 35203 Rennes cedex 02, France
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