1
|
Dellal A, Bige N, Hilliquin P, Boffa JJ, Rondeau E, Hatron PY, Deligny C, Bally S, Maury E, Veyradier A, Buob D, Fain O, Coppo P, Mekinian A. Thrombotic microangiopathy associated with anti-neutrophil cytoplasmic antibody-associated vasculitis: a French nationwide retrospective case–control study and literature review. Rheumatology (Oxford) 2019; 58:1873-1875. [DOI: 10.1093/rheumatology/kez167] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Naike Bige
- Service de réanimation médicale, Hôpital Saint-Antoine, APHP, Paris
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
| | | | - Jean-Jacques Boffa
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Service de néphrologie, Hôpital Tenon, APHP, Paris
| | - Eric Rondeau
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Service de néphrologie, Hôpital Tenon, APHP, Paris
| | | | - Christophe Deligny
- Service de médecine interne CHU de Martinique, hôpital ZOBDA, Fort de France
| | - Stephane Bally
- Service de néphrologie, Centre hospitalier métropole Savoie, Chambéry
| | - Eric Maury
- Service de réanimation médicale, Hôpital Saint-Antoine, APHP, Paris
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
| | - Agnes Veyradier
- Service d’hématologie biologique, CHU Lariboisière, APHP, Paris
| | - David Buob
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Service d’anatomie et cytologie pathologiques, Hôpital Tenon, APHP, Paris
| | - Olivier Fain
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Saint-Antoine
| | - Paul Coppo
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Service d’hématologie clinique, Centre de référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, APHP, Paris, France
| | - Arsène Mekinian
- Sorbonne Universités, INSERM U938, Centre de Recherche Saint-Antoine (CRSA), UPMC University Paris 06, Paris
- Department of Internal Medicine, Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Saint-Antoine
| |
Collapse
|
2
|
Le Joncour A, Soudet S, Dupont A, Espitia O, Koskas F, Cluzel P, Hatron PY, Emmerich J, Cacoub P, Resche‐Rigon M, Lambert M, Saadoun D. Long-Term Outcome and Prognostic Factors of Complications in Thromboangiitis Obliterans (Buerger's Disease): A Multicenter Study of 224 Patients. J Am Heart Assoc 2018; 7:e010677. [PMID: 30571594 PMCID: PMC6405548 DOI: 10.1161/jaha.118.010677] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/08/2018] [Indexed: 01/04/2023]
Abstract
Background Data regarding long-term outcome of patients with thromboangiitis obliterans are lacking and most series come from India and Japan. In this study, we assess long-term outcome and prognostic factors in a large cohort of thromboangiitis obliterans. Methods and Results Retrospective multicenter study of characteristics and outcomes of 224 thromboangiitis obliterans patients fulfilling Papa's criteria were analyzed. Factors associated with vascular events and amputations were identified. The median age at diagnosis was 38.5 (32-46) years, 51 (23.8%) patients were female, and 81.7% were whites. After a mean follow-up of 5.7 years, vascular events were observed in 58.9%, amputations in 21.4%, and death in 1.4%. The 5-, 10-, and 15-year vascular event-free survival and amputation-free survival were 41% and 85%, 23% and 74%, and 19% and 66%, respectively. Ethnic group (nonwhite) (hazard ratio 2.35 [1.30-4.27] P=0.005) and limb infection at diagnosis (hazard ratio 3.29 [1.02-10.6] P=0.045) were independent factors of vascular event-free survival. Factor associated with amputation was limb infection (hazard ratio 12.1 [3.5-42.1], P<0.001). Patients who stopped their tobacco consumption had lower risk of amputation ( P=0.001) than those who continued. Conclusions This nationwide study shows that 34% of thromboangiitis obliterans patients will experience an amputation within 15 years from diagnosis. We identified high-risk patients for vascular complications and amputations.
Collapse
Affiliation(s)
- Alexandre Le Joncour
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
| | - Simon Soudet
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - Axelle Dupont
- Service de Biostatistique et Information médicaleAPHPHôpital Saint‐LouisParisFrance
| | | | - Fabien Koskas
- Service de chirurgie vasculaireGroupe Hospitalier Pitié‐SalpétrièreParisFrance
| | - Philippe Cluzel
- Service d'Imagerie CardiovasculaireInstitut de cardiologieGroupe Hospitalier Pitié‐SalpétrièreParisFrance
| | - Pierre Yves Hatron
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - Joseph Emmerich
- Department of Vascular Medicine and CardiologyUniversity Hospital Hotel DieuUniversity Paris‐DescartesParisFrance
| | - Patrice Cacoub
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
| | | | - Marc Lambert
- Département de Médecine Interne et Immunologie CliniqueCHU LilleLilleFrance
- Centre National de Référence des Maladies Autoimmunes et Systémiques Rares (Sclérodermie)France
| | - David Saadoun
- UPMC Univ Paris 06UMR 7211, and Inflammation‐Immunopathology‐Biotherapy Department (DHU i2B)Sorbonne UniversitésParisFrance
- UMR_S 959INSERMParisFrance
- Department of Internal Medicine and Clinical ImmunologyAP‐HPGroupe Hospitalier Pitié‐SalpêtrièreParisFrance
- Centre national de référence des maladies Autoimmunes Systémiques raresCentre National de Référence Des Maladies Autoinflammatoires et de l'AmyloseFrance
| | | |
Collapse
|
3
|
Soudet S, Fajgenbaum D, Delattre C, Forestier A, Hachulla E, Hatron PY, Launay D, Terriou L. Schnitzler syndrome co-occurring with idiopathic multicentric Castleman disease that responds to anti-IL-1 therapy: A case report and clue to pathophysiology. Curr Res Transl Med 2018; 66:83-86. [PMID: 30108026 DOI: 10.1016/j.retram.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 01/09/2023]
Abstract
Patients with HHV-8-negative/idiopathic multicentric Castleman disease (iMCD) experience systemic inflammatory symptoms and polyclonal lymphoproliferation due to an unknown etiology. Schnitzler's syndrome (SS) is characterized by recurrent urticarial rash, monoclonal IgM gammopathy, and other clinical signs of inflammation. To our knowledge, we report the first case of iMCD associated with SS and the fourth case of anakinra inducing a complete response for an iMCD patient. A forty-four year old woman with a history of a recurrent urticarial rash, presented to our hospital complaining of 6 months of night sweats, fever, chronic urticaria, iliac bone pain, and generalized lymphadenopathy. An IgM Kappa monoclonal component was measured at 7.8g/L. A lymph node biopsy revealed histopathological features consistent with the plasma cell variant of iMCD. She was diagnosed with SS and iMCD. Anti-IL-1 treatment with anakinra (100mg/day) was introduced. Within 48h, we observed improvement in the fever and the urticarial rash. By one month, we considered the patient in complete remission. Two years later, the remission is persistent while the patient is still under therapy. Though this is only the fourth reported case of anakinra in iMCD, this is yet another case demonstrating the effectiveness of anti-IL-1 blockade in SS. We hypothesize that uncontrolled cytokine production is responsible for both the SS and the iMCD. The etiologies of SS and iMCD are unknown, and future research is necessary.
Collapse
Affiliation(s)
- Simon Soudet
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.
| | - David Fajgenbaum
- Department of Medicine, Division of Translational Medicine & Human Genetics, Leonard Davis Institute of Health Economics, Orphan Disease Center, University of Pennsylvania, Philadelphia, USA
| | | | - Alexandra Forestier
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Eric Hachulla
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Pierre Yves Hatron
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France; University Lille, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France; INSERM, U995, Lille, France; Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France
| | - Louis Terriou
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| |
Collapse
|
4
|
Cornec D, Devauchelle‐Pensec V, Mariette X, Jousse‐Joulin S, Berthelot J, Perdriger A, Puéchal X, Le Guern V, Sibilia J, Gottenberg J, Chiche L, Hachulla E, Yves Hatron P, Goeb V, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Saliou P, Pers JO, Seror R, Saraux A. Severe Health‐Related Quality of Life Impairment in Active Primary Sjögren's Syndrome and Patient‐Reported Outcomes: Data From a Large Therapeutic Trial. Arthritis Care Res (Hoboken) 2017; 69:528-535. [DOI: 10.1002/acr.22974] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/14/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Divi Cornec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Valérie Devauchelle‐Pensec
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | - Xavier Mariette
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Sandrine Jousse‐Joulin
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| | | | | | | | | | - Jean Sibilia
- Hôpitaux Universitaires de Strasbourg and Université de StrasbourgStrasbourg France
| | | | | | - Eric Hachulla
- Hôpital Claude Huriez and Université Lille Nord‐de‐FranceLille France
| | | | - Vincent Goeb
- Centres Hospitaliers Régionaux Universitaires de AmiensAmiens France
| | - Gilles Hayem
- Centre Hospitalier Universitaire Ambroise ParéBoulogne France
| | - Jacques Morel
- Centre Hospitalier Universitaire LapeyronieMontpellier France
| | | | | | - Philippe Saliou
- Centres Hospitaliers Régionaux Universitaires MorvanBrest France
| | - Jacques Olivier Pers
- EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGO, and Centre Hospitalier Universitaire Morvan, and EA 2216, Université Bretagne OccidentaleBrest France
| | - Raphaèle Seror
- Assistance Publique‐Hôpitaux de Paris, Hôpitaux Universitaires Paris‐Sud, INSERM U1184, Université Paris‐SudLe Kremlin Bicêtre France
| | - Alain Saraux
- Centre Hospitalier Universitaire de la Cavale Blanche, and EA 2216, INSERM ESPRI, ERI29, Université de Brest, LabEx IGOBrest France
| |
Collapse
|
5
|
Soudet S, Lambert M, Lefèvre G, Maillard H, Huglo D, Hatron PY. Long term use of metformin in idiopathic cyclic edema, report of thirteen cases and review of the literature. Pharmacol Res 2017; 119:237-239. [PMID: 28212888 DOI: 10.1016/j.phrs.2017.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/08/2017] [Accepted: 02/08/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Idiopathic cyclic edema (ICE) is a rare cause of edema. To date, there is no standard of care. The physiopathology of ICE could be explained by an impairment of capillary permeability. In 1995, a study demonstrated the efficacy of metformin on symptoms and capillary permeability. We evaluated ICE-patients who were treated with metformin in our department. METHODS We retrospectively included patients diagnosed for ICE between January 1997 and October 2013. ICE was diagnosed in the presence of edema after excluding other etiologies. LANDIS test was used to support ICE diagnosis in all patients. The absence of edema at follow-up was considered as complete response (CR), partial decreased was considered as partial response (PR). Adverse events were recorded. RESULTS Thirteen patients have accepted to use metformin. The median treatment duration was 28.5 months [8-167] and the median follow-up of treated patients was 40.5 months [14-167]. CR was reached in 10 patients (77%), and PR in 2 patients (15%). Two patients reported side-effects as diarrheas and one of them stopped the treatment due to mild diarrhea. CONCLUSION We report the interest and tolerance of the long-term use of metformin in ICE. No severe adverse events were noticed. A prospective study is needed to confirm the efficacy of metformin in ICE-patients.
Collapse
Affiliation(s)
- S Soudet
- Department of Internal Medicine and National Center for Autoimmune Diseases, CHRU LILLE, UFR Medecine, F-59000 Lille, France, France
| | - M Lambert
- Department of Internal Medicine and National Center for Autoimmune Diseases, CHRU LILLE, UFR Medecine, F-59000 Lille, France, France
| | - G Lefèvre
- Department of Internal Medicine and National Center for Autoimmune Diseases, CHRU LILLE, UFR Medecine, F-59000 Lille, France, France
| | - H Maillard
- Department of Internal Medicine and National Center for Autoimmune Diseases, CHRU LILLE, UFR Medecine, F-59000 Lille, France, France
| | - D Huglo
- Department of Nuclear Medicine, Univ Lille Nord de France, F-59000 Lille, France
| | - P Y Hatron
- Department of Internal Medicine and National Center for Autoimmune Diseases, CHRU LILLE, UFR Medecine, F-59000 Lille, France, France.
| |
Collapse
|
6
|
Yelnik CM, Urbanski G, Drumez E, Sobanski V, Maillard H, Lanteri A, Morell-Dubois S, Caron C, Dubucquoi S, Launay D, Duhamel A, Hachulla E, Hatron PY, Lambert M. Persistent triple antiphospholipid antibody positivity as a strong risk factor of first thrombosis, in a long-term follow-up study of patients without history of thrombosis or obstetrical morbidity. Lupus 2016; 26:163-169. [PMID: 27432808 DOI: 10.1177/0961203316657433] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction The long-term risk of first thrombosis and benefit of prophylaxis in antiphospholipid antibody (aPL) carriers without history of thrombosis or obstetrical morbidity is poorly known. This study aimed to evaluate the long-term rate and risk factors associated with a first thrombosis in those patients. Patients and methods After a prior study ended in December 2005 and was already published, we extended the follow-up period of our cohort of aPL carriers. Results Ninety-eight of the 103 patients of the previous study were included. The annual first thrombosis rate was 2.3% per patient-year during a median of 13 years (6-17). None of the baseline characteristics was predictive of risk of first thrombosis, but persistent aPL over time were associated with an increased risk. The stronger association was found in triple aPL-positive carriers: OR 3.38 (95% CI: 1.24-9.22). Of note, conversely to our previous findings, no benefit of aspirin prophylaxis was observed. Conclusion The risk of first thrombosis in aPL carriers without history of thrombosis or obstetrical morbidity was significant, persisted linearly over time and was associated with persistent aPL. This risk was especially increased in triple aPL-positive carriers, in whom a close follow-up seems to be necessary. Nevertheless, the benefit of aspirin prophylaxis remained unclear.
Collapse
Affiliation(s)
- C M Yelnik
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - G Urbanski
- 2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - E Drumez
- 3 Département de biostatistiques, EA2694, Université Lille 2, CHRU Lille, France
| | - V Sobanski
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - H Maillard
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - A Lanteri
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - S Morell-Dubois
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - C Caron
- 4 Laboratoire d'Hémostase, Centre de Biologie-Pathologie-Génétique, CHRU Lille, France
| | - S Dubucquoi
- 1 Université Lille 2, UFR Médecine, Lille, France.,5 Institut d'Immunologie, Centre de Biologie-Pathologie-Génétique, CHRU Lille, France
| | - D Launay
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - A Duhamel
- 3 Département de biostatistiques, EA2694, Université Lille 2, CHRU Lille, France
| | - E Hachulla
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - P Y Hatron
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| | - M Lambert
- 1 Université Lille 2, UFR Médecine, Lille, France.,2 Service de Médecine Interne, Centre National de Référence des Maladies Systémiques Rares, Hôpital Claude Huriez, CHRU Lille, France
| |
Collapse
|
7
|
Fauchais AL, Lambert M, Launay D, Michon-Pasturel U, Queyrel V, Nguyen N, Hebbar M, Hachulla E, Devulder B, Hatron PY. Antiphospholipid antibodies in primary Sjögren’s syndrome: prevalence and clinical significance in a series of 74 patients. Lupus 2016; 13:245-8. [PMID: 15176660 DOI: 10.1191/0961203304lu1006oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study is to determine prevalence, clinical significance of antiphospholipidantibodies (aPL) including anticardiolipin antibodies (aCL), anti-b2GP1 and lupus anticoagulant (LA) in a cohort of 74 patients with primary Sjögren’s syndrome (pSS) according to revised European criteria. aPL were found in 25 (34%) patients; IgG in 23 (12 had low titres, six moderate titres and five high titres) and IgM in five (three and two had respectively moderate and high titres). Eight (11%) patients were found to have LA; anti-b2GP1 antibodies were detected only in three (4%) patients. Only two patients with LA, aPL and b2GP1 had recurrent venous thrombosis. One patient with moderate titres of aPL exhibited recurrent spontaneous foetal losses. Peripheral neuropathies without cryoglobulinemia were more frequent in the aPL group. Other systemic involvements of pSS were the same in both groups with or without aPL. Patients with aPL have more concurrentimmunological diseases such as thyroiditis and primary biliary cirrhosis and a higher prevalence of hypergammaglobulinemia (P < 0.05). Even if aPL prevalence reached 30% in pSS, titres were usually low, with a close correlation with hypergammaglobulinemia but not with antiphospholipid syndrome, which is related to positivity of both LA and aPL.
Collapse
Affiliation(s)
- A L Fauchais
- Department of Internal Medicine, Regional University Hospital of Lille, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Anquetil C, Stavris C, Chanson N, Lambert M, Hachulla E, Launay D, Hatron PY. [Hemorrhagic shock revealing multiple digestive microaneurysms in a patient with systemic lupus erythematosus: Case report and literature review]. Rev Med Interne 2016; 38:56-60. [PMID: 27036226 DOI: 10.1016/j.revmed.2016.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/02/2015] [Revised: 02/23/2016] [Accepted: 02/27/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The vascular disorders in systemic lupus erythematosus (SLE) result from various mechanisms and presentations (inflammatory disease or vasculitis, atherosclerosis). CASE REPORT We report on a 34-year-old man with cutaneous, articular, neurological and nephrologic SLE. He presented with catastrophic haemorrhage on microaneurysm rupture of the left hepatic artery. After blood transfusions and immunosuppressive treatments, his condition improves. CONCLUSION Uncommon complication in SLE patients, digestive vasculitis with microaneurysms may occur as in polyarteritis nodosa. In the literature, we identified 10 additional cases of hepatic microaneurysms in SLE patients. The main issue is an earlier diagnosis in order to give appropriate treatment and improve prognosis.
Collapse
Affiliation(s)
- C Anquetil
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - C Stavris
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - N Chanson
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - M Lambert
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| | - E Hachulla
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France; LIRIC, UMR 995, EA2686, 59000 Lille, France
| | - D Launay
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France; LIRIC, UMR 995, EA2686, 59000 Lille, France.
| | - P Y Hatron
- UFR de médecine, université de Lille, 59000 Lille, France; Service de médecine interne et immunologie clinique, hôpital Claude-Huriez, CHRU de Lille, pôle spécialités médicales et gérontologie, rue Michel-Polonovski, 59037 Lille cedex, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59037 Lille cedex, France; FHU Immune-Mediated Inflammatory Diseases and Targeted Therapies (IMMInENT), 59000 Lille, France
| |
Collapse
|
9
|
Soudet S, Delaporte E, Hatron PY. Diffuse calcinosis cutis in systemic lupus erythematosus: an exceptional complication. Lupus 2016; 25:1064-5. [DOI: 10.1177/0961203316630819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/14/2016] [Indexed: 11/15/2022]
Affiliation(s)
- S Soudet
- Department of Internal Medicine, CHRU Lille, France
| | - E Delaporte
- Department of Dermatology, CHRU Lille, France
- Faculty of Medicine, CHRU Lille, France
| | - P Y Hatron
- Department of Internal Medicine, CHRU Lille, France
- Faculty of Medicine, CHRU Lille, France
| |
Collapse
|
10
|
Devauchelle-Pensec V, Gottenberg JE, Jousse-Joulin S, Berthelot JM, Perdriger A, Hachulla E, Hatron PY, Puechal X, Le Guern V, Sibilia J, Chiche L, Goeb V, Vittecoq O, Larroche C, Fauchais AL, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Dieudé P, Pers JO, Cornec D, Seror R, Mariette X, Nowak E, Saraux A. Which and How Many Patients Should Be Included in Randomised Controlled Trials to Demonstrate the Efficacy of Biologics in Primary Sjögren's Syndrome? PLoS One 2015; 10:e0133907. [PMID: 26368934 PMCID: PMC4569343 DOI: 10.1371/journal.pone.0133907] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 02/19/2015] [Accepted: 07/03/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The goal of this study was to determine how the choice of the primary endpoint influenced sample size estimates in randomised controlled trials (RCTs) of treatments for primary Sjögren's syndrome (pSS). METHODS We reviewed all studies evaluating biotechnological therapies in pSS to identify their inclusion criteria and primary endpoints. Then, in a large cohort (ASSESS), we determined the proportion of patients who would be included in RCTs using various inclusion criteria sets. Finally, we used the population of a large randomised therapeutic trial in pSS (TEARS) to assess the impact of various primary objectives and endpoints on estimated sample sizes. These analyses were performed only for the endpoints indicating greater efficacy of rituximab compared to the placebo. RESULTS We identified 18 studies. The most common inclusion criteria were short disease duration; systemic involvement; high mean visual analogue scale (VAS) scores for dryness, pain, and fatigue; and biological evidence of activity. In the ASSESS cohort, 35 percent of patients had recent-onset disease (lower than 4 years), 68 percent systemic manifestations, 68 percent high scores on two of three VASs, and 52 percent biological evidence of activity. The primary endpoints associated with the smallest sample sizes (nlower than 200) were a VAS dryness score improvement higher to 20 mm by week 24 or variable improvements (10, 20, or 30 mm) in fatigue VAS by week 6 or 16. For patients with systemic manifestations, the ESSDAI change may be the most logical endpoint, as it reflects all domains of disease activity. However, the ESSDAI did not improve significantly with rituximab therapy in the TEARS study. Ultrasound score improvement produced the smallest sample size estimate in the TEARS study. CONCLUSION This study provides valuable information for designing future RCTs on the basis of previously published studies. Previous RCTs used inclusion criteria that selected a small part of the entire pSS population. The endpoint was usually based on VASs assessing patient complaints. In contrast to VAS dryness cut-offs, VAS fatigue cut-offs did not affect estimated sample sizes. SGUS improvement produced the smallest estimated sample size. Further studies are required to validate standardised SGUS modalities and assessment criteria. Thus, researchers should strive to develop a composite primary endpoint and to determine its best cut-off and assessment time point.
Collapse
Affiliation(s)
- Valérie Devauchelle-Pensec
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | | | - Sandrine Jousse-Joulin
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | | | - Aleth Perdriger
- Rheumatology Department, C.H.U. Hôpital Sud, 35000, Rennes, France
| | - Eric Hachulla
- Internal Medicine Department, Claude Huriez Hospital, Lille2 University, 59037, Lille Cedex, France
| | - Pierre Yves Hatron
- Internal Medicine Department, Claude Huriez Hospital, Lille2 University, 59037, Lille Cedex, France
| | - Xavier Puechal
- Internal Medicine Department, Hôpital Cochin, Paris, France
| | | | - Jean Sibilia
- Rheumatology Department, Strasbourg University Hospital, Strasbourg, France
| | - Laurent Chiche
- Internal Medicine Department, Hôpital de la Conception, 147 Bd Baille, 13005, Marseille, France
| | - Vincent Goeb
- Rheumatology Department, C.H.R.U. d’Amiens, 76 230 Bois-Guillaume, France
| | - Olivier Vittecoq
- Rheumatology Department, C.H.R.U. de Rouen, 76 230 Bois-Guillaume, France
| | - Claire Larroche
- Internal Medicine Department, Bobigny University Hospital, Paris, France
| | | | - Gilles Hayem
- Rheumatology Department, Ambroise Paré University Hospital, Paris, France
| | - Jacques Morel
- Immuno-Rhumatology Department, C.H.U. Lapeyronie, 34295 Montpellier, France
| | | | - Jean Jacques Dubost
- Rheumatology Department, Gabriel Montpied Teaching Hospital, Place H. Dunant, Clermont-Ferrand, 63000, France
| | - Philippe Dieudé
- Rheumatology Department, Bichat Claude-Bernard Hospital, Paris, France
| | - Jacques Olivier Pers
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | - Divi Cornec
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| | - Raphaele Seror
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1012, Université Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Rheumatology Department, Assistance Publique-Hôpitaux de Paris (AP-HP), INSERM U1012, Université Paris-Sud, 78 rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
| | | | - Alain Saraux
- Rheumatology Department, CHU de la Cavale Blanche, Boulevard Tanguy Prigent, 29609, Brest, France
- EA 2216, INSERM ESPRI, ERI29 Université Bretagne Occidentale, 29200, Brest, France
| |
Collapse
|
11
|
Cornec D, Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, Berthelot JM, Perdriger A, Puéchal X, Le Guern V, Sibilia J, Gottenberg JE, Chiche L, Hachulla E, Yves Hatron P, Goeb V, Hayem G, Morel J, Zarnitsky C, Jacques Dubost J, Seror R, Pers JO, Meiners PM, Vissink A, Bootsma H, Nowak E, Saraux A. Development of the Sjögren’s Syndrome Responder Index, a data-driven composite endpoint for assessing treatment efficacy. Rheumatology (Oxford) 2015; 54:1699-708. [DOI: 10.1093/rheumatology/kev114] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Indexed: 11/14/2022] Open
|
12
|
Devauchelle-Pensec V, Mariette X, Jousse-Joulin S, Berthelot JM, Perdriger A, Puéchal X, Le Guern V, Sibilia J, Gottenberg JE, Chiche L, Hachulla E, Hatron PY, Goeb V, Hayem G, Morel J, Zarnitsky C, Dubost JJ, Pers JO, Nowak E, Saraux A. Treatment of primary Sjögren syndrome with rituximab: a randomized trial. Ann Intern Med 2014; 160:233-42. [PMID: 24727841 DOI: 10.7326/m13-1085] [Citation(s) in RCA: 256] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary Sjögren syndrome (pSS) is an autoimmune disorder characterized by ocular and oral dryness or systemic manifestations. OBJECTIVE To evaluate efficacy and harms of rituximab in adults with recent-onset or systemic pSS. DESIGN Randomized, placebo-controlled, parallel-group trial conducted between March 2008 and January 2011. Study personnel (except pharmacists), investigators, and patients were blinded to treatment group. (ClinicalTrials.gov: NCT00740948). SETTING 14 university hospitals in France. PATIENTS 120 patients with scores of 50 mm or greater on at least 2 of 4 visual analogue scales (VASs) (global disease, pain, fatigue, and dryness) and recent-onset (< 10 years) biologically active or systemic pSS. INTERVENTION Randomization (1:1 ratio) to rituximab (1 g at weeks 0 and 2) or placebo. MEASUREMENTS Primary end point was improvement of at least 30 mm in 2 of 4 VASs by week 24. RESULTS No significant difference between groups in the primary end point was found (difference, 1.0% [95% CI, -16.7% to 18.7%]). The proportion of patients with at least 30-mm decreases in at least two of the four VAS scores was higher in the rituximab group at week 6 (22.4% vs. 9.1%; P = 0.036). An improvement of at least 30 mm in VAS fatigue score was more common with rituximab at weeks 6 (P < 0.001) and 16 (P = 0.012), and improvement in fatigue from baseline to week 24 was greater with rituximab. Adverse events were similar between groups except for a higher rate of infusion reactions with rituximab. LIMITATION Low disease activity at baseline and a primary outcome that may have been insensitive to detect clinically important changes. CONCLUSION Rituximab did not alleviate symptoms or disease activity in patients with pSS at week 24, although it alleviated some symptoms at earlier time points.
Collapse
|
13
|
Abstract
OBJECTIVE To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis. METHODOLOGY We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure. RESULTS RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding. CONCLUSION Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.
Collapse
|
14
|
Seror R, Gottenberg JE, Devauchelle-Pensec V, Dubost JJ, Le Guern V, Hayem G, Fauchais AL, Goeb V, Hachulla E, Hatron PY, Larroche C, Morel J, Pedriger A, Puechal X, Rist S, Saraux A, Sene D, Sibilia J, Vittecoq O, Zarnitsky C, Labetoulle M, Ravaud P, Mariette X. European League Against Rheumatism Sjögren's Syndrome Disease Activity Index and European League Against Rheumatism Sjögren's Syndrome Patient-Reported Index: a complete picture of primary Sjögren's syndrome patients. Arthritis Care Res (Hoboken) 2013; 65:1358-64. [PMID: 23436737 DOI: 10.1002/acr.21991] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 02/13/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The European League Against Rheumatism (EULAR) Sjögren's Syndrome (SS) Disease Activity Index (ESSDAI) and the EULAR SS Patient-Reported Index (ESSPRI) were recently developed. We aimed to determine whether patients' symptoms differed between patients with and without systemic involvement and if the disease-specific indices correlated with each other in primary SS. METHODS Fifteen French centers included 395 primary SS patients in the Assessment of Systemic Signs and Evolution in Sjögren's Syndrome Cohort. At enrollment, physicians completed the ESSDAI, the SS Disease Activity Index (SSDAI), and the Sjögren's Systemic Clinical Activity Index (SCAI), and patients completed the ESSPRI, the Sicca Symptoms Inventory, and the Profile of Fatigue and Discomfort. All scores were compared between patients with and without systemic involvement. Correlations between scores of systemic activity and patients' symptoms were obtained. RESULTS At enrollment, 120 (30.4%) patients had never experienced systemic complication and 155 (39.2%) patients and 120 (30.4%) patients had, respectively, only past or current systemic manifestations. Past or current systemic patients had higher levels of symptoms, except dryness. The ESSDAI did not correlate with the patient-scored ESSPRI (rho = 0.06, P = 0.30), whereas the SSDAI and the SCAI, which include subjective items, did correlate (rho = 0.28 and 0.25, respectively; P < 0.0001 for both). CONCLUSION Alterations of common patient-reported outcomes are present in all patients with primary SS, including those with systemic complications. However, patient symptoms and systemic complications are 2 different facets of primary SS. Therefore, the use of both systemic and patients' indices, such as the ESSDAI and ESSPRI, are useful. Since these 2 facets weakly overlap, one should identify which of both components is the main target of the treatment to test, when designing clinical trials in primary SS.
Collapse
Affiliation(s)
- R Seror
- Université Paris-Sud, AP-HP, Hôpitaux Universitaires Paris-Sud, INSERM U1012, Le Kremlin Bicêtre, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Marie I, Josse S, Decaux O, Diot E, Landron C, Roblot P, Jouneau S, Hatron PY, Hachulla E, Vittecoq O, Menard JF, Jouen F, Dominique S. Clinical manifestations and outcome of anti-PL7 positive patients with antisynthetase syndrome. Eur J Intern Med 2013; 24:474-9. [PMID: 23375620 DOI: 10.1016/j.ejim.2013.01.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 12/31/2012] [Accepted: 01/03/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aims of the present study were to determine both clinical manifestations and outcome of anti-PL7 patients with antisynthetase syndrome (ASS). METHODS The medical records of 15 consecutive anti-PL7 patients with biopsy proven ASS were retrospectively analyzed without prior selection. RESULTS Anti-PL7 patients exhibited polymyositis (n=14) and dermatomyositis (n=1); extra-pulmonary manifestations of ASS included: Raynaud's phenomenon (40%), mechanic's hands (33.3%), joint impairment (26.7%), pericardial effusion (20%) and esophageal/gastrointestinal involvement (20%). The outcome of myositis was as follows: remission/improvement (91.7%) and deterioration (8.3%). Fourteen patients (93.3%) experienced interstitial lung disease (ILD). ILD preceded ASS diagnosis (n=5), was identified concomitantly with ASS (n=8) and occurred after ASS diagnosis (n=1). Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n=1), progressive onset of lung signs (n=11) and asymptomatic patients exhibiting abnormalities consistent with ILD on PFT and HRCT-scan (n=2). No patient had resolution of ILD, whereas 64.3% and 35.7% experienced improvement and deterioration of ILD, respectively. ILD resulted in respiratory insufficiency requiring O2 therapy in 14.3% of cases. Two patients died. Predictive parameters of ILD deterioration were: DLCO<45% at ILD diagnosis and HRCT-scan pattern of usual interstitial pneumonia (UIP). CONCLUSION Our series mainly underscores that ILD is frequent in anti-PL7 patients, leading to high morbidity. Our study further suggests that patients with predictive factors of ILD deterioration may require more aggressive therapy, especially the group of patients with DLCO<45% at ILD diagnosis and UIP pattern on HRCT-scan.
Collapse
Affiliation(s)
- I Marie
- Department of Internal Medicine, CHU Rouen, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Marie I, Josse S, Hatron PY, Dominique S, Hachulla E, Janvresse A, Cherin P, Mouthon L, Vittecoq O, Menard JF, Jouen F. Interstitial lung disease in anti-Jo-1 patients with antisynthetase syndrome. Arthritis Care Res (Hoboken) 2013. [PMID: 23203765 DOI: 10.1002/acr.21895] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To assess the outcome of interstitial lung disease (ILD) in anti-Jo-1 patients with antisynthetase syndrome, determine predictive variables of ILD deterioration in these patients, and compare features of anti-Jo-1 patients with and without ILD. METHODS Ninety-one anti-Jo-1 patients were identified by medical records search in 4 medical centers. All of these patients had undergone pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT) scans. RESULTS Sixty-six patients (72.5%) had ILD. Patients could be divided into 3 groups according to their presenting lung manifestations: acute onset of lung disease (n = 12), progressive onset of lung signs (n = 35), and asymptomatic patients exhibiting abnormalities consistent with ILD on PFTs and HRCT scans (n = 19). Sixteen patients had resolution of ILD; 39 and 11 patients experienced improvement and deterioration of ILD, respectively. ILD led to decreased functional status, since 29.8% of patients exhibited a marked reduction of activities due to ILD and 13.6% had respiratory insufficiency requiring oxygen therapy; 5 of 6 patients died due to ILD complications. Predictive parameters of ILD deterioration were HRCT scan pattern of usual interstitial pneumonia, respiratory muscle involvement, and age ≥55 years. Furthermore, anti-Jo-1 patients with ILD, compared with those without, more frequently exhibited mechanic's hands and lower creatine kinase levels. CONCLUSION Our findings confirm that ILD is a frequent complication in anti-Jo-1 patients, resulting in high morbidity. We suggest that patients with predictive factors of ILD deterioration may require more aggressive therapy. Finally, anti-Jo-1 patients with ILD, compared with those without, may exhibit a particular clinical phenotype.
Collapse
Affiliation(s)
- I Marie
- Centre Hospitalier Universitaire Rouen and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Gottenberg JE, Seror R, Miceli-Richard C, Benessiano J, Devauchelle-Pensec V, Dieude P, Dubost JJ, Fauchais AL, Goeb V, Hachulla E, Hatron PY, Larroche C, Le Guern V, Morel J, Perdriger A, Puéchal X, Rist S, Saraux A, Sene D, Sibilia J, Vittecoq O, Nocturne G, Ravaud P, Mariette X. Serum levels of beta2-microglobulin and free light chains of immunoglobulins are associated with systemic disease activity in primary Sjögren's syndrome. Data at enrollment in the prospective ASSESS cohort. PLoS One 2013; 8:e59868. [PMID: 23717383 PMCID: PMC3663789 DOI: 10.1371/journal.pone.0059868] [Citation(s) in RCA: 132] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 02/19/2013] [Indexed: 12/31/2022] Open
Abstract
Objectives To analyze the clinical and immunological characteristics at enrollment in a large prospective cohort of patients with primary Sjögren's syndrome (pSS) and to investigate the association between serum BAFF, beta2-microglobulin and free light chains of immunoglobulins and systemic disease activity at enrollment. Methods Three hundred and ninety five patients with pSS according to American-European Consensus Criteria were included from fifteen centers of Rheumatology and Internal Medicine in the “Assessment of Systemic Signs and Evolution of Sjögren's Syndrome” (ASSESS) 5-year prospective cohort. At enrollment, serum markers were assessed as well as activity of the disease measured with the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Results Patient median age was 58 (25th–75th: 51–67) and median disease duration was 5 (2–9) years. Median ESSDAI at enrollment was 2 (0–7) with 30.9% of patients having features of systemic involvement. Patients with elevated BAFF, beta2-microglobulin and kappa, lambda FLCS had higher ESSDAI scores at enrollment (4 [2]–[11] vs 2 [0–7], P = 0.03; 4 [1]–[11] vs 2 [0–7], P< 0.0001); 4 [2]–[10] vs 2 [0–6.6], P< 0.0001 and 4 [2–8.2] vs 2 [0–7.0], P = 0.02, respectively). In multivariate analysis, increased beta2-microglobulin, kappa and lambda FLCs were associated with a higher ESSDAI score. Median BAFF and beta2-microglobulin were higher in the 16 patients with history of lymphoma (1173.3(873.1–3665.5) vs 898.9 (715.9–1187.2) pg/ml, P = 0.01 and 2.6 (2.2–2.9) vs 2.1 (1.8–2.6) mg/l, P = 0.04, respectively). Conclusion In pSS, higher levels of beta2-microglobulin and free light chains of immunoglobulins are associated with increased systemic disease activity.
Collapse
Affiliation(s)
- Jacques-Eric Gottenberg
- Rheumatology Centre National de Référence des Maladies Auto-Immunes Rares, Institut National de la Santé et de la Recherche Médicale UMRS_1109, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University Hospital, Université de Strasbourg, Strasbourg, France
- * E-mail: (JEG); (XM)
| | - Raphaèle Seror
- Rheumatology, Bicetre Hospital, Institut National de la Santé et de la Recherche Médicale U-1012, Université Paris Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Corinne Miceli-Richard
- Rheumatology, Bicetre Hospital, Institut National de la Santé et de la Recherche Médicale U-1012, Université Paris Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Joelle Benessiano
- Centre de Ressources Biologiques, Bichat Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Philippe Dieude
- Rheumatology, Bichat Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | | | - Vincent Goeb
- Rheumatology, Amiens University Hospital, Amiens, France
| | - Eric Hachulla
- Internal Medicine, Lille University Hospital, Lille, France
| | | | - Claire Larroche
- Internal Medicine, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris, Bobigny, France
| | - Véronique Le Guern
- Internal Medicine, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jacques Morel
- Rheumatology, Montpellier University Hospital, Montpellier, France
| | | | - Xavier Puéchal
- Internal Medicine, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | | | - Alain Saraux
- Rheumatology, Brest University Hospital, Brest, France
| | - Damien Sene
- Internal Medicine, Lariboisière Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Jean Sibilia
- Rheumatology Centre National de Référence des Maladies Auto-Immunes Rares, Institut National de la Santé et de la Recherche Médicale UMRS_1109, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg University Hospital, Université de Strasbourg, Strasbourg, France
| | | | - Gaétane Nocturne
- Rheumatology, Bicetre Hospital, Institut National de la Santé et de la Recherche Médicale U-1012, Université Paris Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Philippe Ravaud
- Center of Clinical Epidemiology, Hotel Dieu Hospital, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale U378, University of Paris Descartes, Faculty of Medicine, Paris, France
| | - Xavier Mariette
- Rheumatology, Bicetre Hospital, Institut National de la Santé et de la Recherche Médicale U-1012, Université Paris Sud, Assistance Publique des Hôpitaux de Paris, Paris, France
- * E-mail: (JEG); (XM)
| |
Collapse
|
18
|
Marie I, Hatron PY, Dominique S, Cherin P, Mouthon L, Menard JF. Short-term and long-term outcomes of interstitial lung disease in polymyositis and dermatomyositis: a series of 107 patients. ACTA ACUST UNITED AC 2013; 63:3439-47. [PMID: 21702020 DOI: 10.1002/art.30513] [Citation(s) in RCA: 185] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study was undertaken to assess the characteristics and outcome of interstitial lung disease (ILD) in polymyositis/dermatomyositis (PM/DM) and to determine variables predictive of ILD deterioration in PM/DM. METHODS Among 348 consecutive patients with PM/DM, 107 patients with ILD were identified by medical records search in 4 medical centers. All patients underwent pulmonary function tests (PFTs) and pulmonary high-resolution computed tomography (HRCT) scan. RESULTS ILD onset preceded PM/DM clinical manifestations in 20 patients, was identified concurrently with PM/DM in 69 patients, and occurred after PM/DM onset in 18 patients. Patients with ILD could be divided into 3 groups according to their presenting lung manifestations: patients with acute lung disease (n = 20), patients with progressive-course lung signs (n = 55), and asymptomatic patients with abnormalities consistent with ILD evident on PFTs and HRCT scan (n = 32). We observed that 32.7% of the patients had resolution of pulmonary disorders, whereas 15.9% experienced ILD deterioration. Factors that predicted a poor ILD prognosis were older age, symptomatic ILD, lower values of vital capacity and diffusing capacity for carbon monoxide, a pattern of usual interstitial pneumonia on HRCT scan and lung biopsy, and steroid-refractory ILD. The mortality rate was higher in patients with ILD deterioration than in those without ILD deterioration (47.1% versus 3.3%). CONCLUSION Our findings indicate that ILD results in high morbidity in PM/DM. Our findings also suggest that more aggressive therapy may be required in PM/DM patients presenting with factors predictive of poor ILD outcome.
Collapse
Affiliation(s)
- I Marie
- Centre Hospitalier Universitaire Rouen, INSERM U 905, University of Rouen IFRMP, and Institute for Biochemical Research, Rouen, France.
| | | | | | | | | | | |
Collapse
|
19
|
Marie I, Hatron PY, Dominique S, Cherin P, Mouthon L, Menard JF, Levesque H, Jouen F. Short-Term and Long-Term Outcome of Anti-Jo1-Positive Patients with Anti-Ro52 Antibody. Semin Arthritis Rheum 2012; 41:890-9. [DOI: 10.1016/j.semarthrit.2011.09.008] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/25/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
|
20
|
Marie I, Josse S, Decaux O, Dominique S, Diot E, Landron C, Roblot P, Jouneau S, Hatron PY, Tiev KP, Vittecoq O, Noel D, Mouthon L, Menard JF, Jouen F. Comparison of long-term outcome between anti-Jo1- and anti-PL7/PL12 positive patients with antisynthetase syndrome. Autoimmun Rev 2012; 11:739-45. [PMID: 22326685 DOI: 10.1016/j.autrev.2012.01.006] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 01/21/2012] [Indexed: 12/16/2022]
Abstract
The aims of the present study were to: compare the characteristics between antisynthetase syndrome (ASS) patients with anti-Jo1 antibody and those with anti-PL7/PL12 antibody. The medical records of 95 consecutive patients with ASS were reviewed. Seventy-five of these patients had anti-Jo1 antibody; the other patients had anti-PL7 (n=15) or anti-PL12 (n=5) antibody. At ASS diagnosis, the prevalence of myalgia (p=0.007) and muscle weakness (p=0.02) was significantly lower in the group of anti-PL7/PL12-positive patients than in those with anti-Jo1 antibody; median value of CK (p=0.00003) was also lower in anti-PL7/PL12 patients. Anti-Jo1 positive patients developed more rarely myositis resolution (21.3% vs. 46.2%); in addition, the overall recurrence rate of myositis was higher in anti-Jo1 positive patients than in patients with anti-PL7/PL12 antibody (65.9% vs. 19.4%). Anti-Jo1-positive patients, compared with those with anti-PL7/PL12 antibody, more often experienced: joint involvement (63.3%vs. 40%) and cancer (13.3% vs. 5%). By contrast, anti-PL7/PL12 positive patients, compared with those with anti-Jo1 antibody, more commonly exhibited: ILD (90% vs. 68%); in anti-PL7/PL12 positive patients, ILD was more often symptomatic at diagnosis, and led more rarely to resolution of lung manifestations (5.6% vs. 29.4%). Finally, the group of anti-PL7/PL12 positive patients more commonly experienced gastrointestinal manifestations related to ASS (p=0.02). Taken together, although anti-Jo1 positive patients with ASS share some features with those with anti-PL7/PL12 antibody, they exhibit many differences regarding clinical phenotype and long-term outcome. Our study underscores that the presence of anti-Jo1 antibody results in more severe myositis, joint impairment and increased risk of cancer. On the other hand, the presence of anti-PL7/PL12 antibody is markedly associated with: early and severe ILD, and gastrointestinal complications. Thus, our study interestingly indicates that the finding for anti-Jo1 and anti-PL7/PL12 antibodies impacts both the long-term outcome and prognosis of patients with ASS.
Collapse
Affiliation(s)
- I Marie
- Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Marie I, Guillevin L, Menard JF, Hatron PY, Cherin P, Amoura Z, Cacoub P, Bachelez H, Buzyn A, Le Roux G, Ziza JM, Brice P, Munck JN, Sarrot-Reynauld F, Piette JC, Larroche C. Hematological malignancy associated with polymyositis and dermatomyositis. Autoimmun Rev 2011; 11:615-20. [PMID: 22079677 DOI: 10.1016/j.autrev.2011.10.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 10/26/2011] [Indexed: 12/21/2022]
Abstract
The aims of this present study were to: 1) assess the characteristics of hematological malignancies in polymyositis/polymyositis (PM/DM) patients; and 2) determine predictive variables of hematological malignancies in PM/DM patients. We retrospectively reviewed the medical records of 32 patients (14 PM, 18 DM) associated with hematological malignancies. In our 32 PM/DM patients, hematological malignancy was concurrently identified (18.8%) or occurred during the course of PM/DM (31.2%); although, PM/DM more often preceded hematological malignancy onset (50%). We observed that the types of hematological malignancies varied, consisting of: B-cell lymphoma (n=20), T-cell lymphoma (n=4), Hodgkin's disease (n=2), multiple myeloma (n=1), myelodysplastic syndrome without excess of blasts (n=3), hairy cell (n=1) and acute lymphocytic leukemia (n=1). In 21 patients of our 32 patients with PM/DM-associated hematological malignancy (65.6% of cases), PM/DM paralleled the course of hematological malignancy. Finally, we observed that patients with PM/DM-associated hematological malignancies had a poor prognosis, the survival status ranging from 96.9%, 78.1% and 51.4% at 1, 3 and 5years, respectively. Interestingly, we found that patients with hematological malignancies, compared with those without were older and more frequently had DM; on the other hand, these patients less commonly exhibited: joint involvement (p=0.017), interstitial lung disease (p=0.06) and anti-Jo1 antibody (p=0.001). Taken together, our study underscores that the association between PM/DM and hematological malignancy, especially lymphoma, should not be ignored. Our findings also suggest that antisynthetase syndrome may be a protective factor of hematological malignancy in PM/DM patients.
Collapse
Affiliation(s)
- I Marie
- Department of Internal medicine, CHU Rouen, Rouen, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Mekinian A, Ravaud P, Hatron PY, Larroche C, Leone J, Gombert B, Hamidou M, Cantagrel A, Marcelli C, Rist S, Breban M, Launay D, Fain O, Gottenberg JE, Mariette X. Efficacy of rituximab in primary Sjogren's syndrome with peripheral nervous system involvement: results from the AIR registry. Ann Rheum Dis 2011; 71:84-7. [PMID: 21926185 DOI: 10.1136/annrheumdis-2011-200086] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate rituximab (RTX) in primary Sjögren's syndrome (pSS) with peripheral nervous system (PNS) involvement. METHODS Patients with pSS and PNS involvement who were included in the French AIR registry were analysed. RESULTS 17 patients (age 60 years (44-78 years); 14 were female) were analysed. Neurological improvement was noted in 11 patients (65%) at 3 months. Rankin scale decreased from 3 (1-5) to 2 (1-5), 2 (1-5) and 2 (1-6) after 3, 6 and 9 months (p=0.02). European Sjögren's Syndrome Disease Activity Index decreased from 18 (10-44) to 11 (5-20), 11 (5-29) and 12 (5-30) after 3, 6 and 9 months (p<0.05). RTX was effective in neurological involvement in 9/10 patients with vasculitis or cryoglobulinaemia (90%) (group 1) at 3 months and in 2/7 cases (29%) without cryoglobulinaemia and vasculitis (p=0.03). Rankin and European Sjögren's Syndrome Disease Activity Index scales decreased significantly in group 1. CONCLUSION RTX seems effective in cryoglobulinaemia or vasculitis-related PNS involvement in pSS.
Collapse
Affiliation(s)
- A Mekinian
- Department of Internal Medicine, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud 13, Bondy, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Martel C, Gondran G, Launay D, Lalloué F, Palat S, Lambert M, Ly K, Loustaud-Ratti V, Bezanahary H, Hachulla E, Jauberteau MO, Vidal E, Hatron PY, Fauchais AL. Active Immunological Profile Is Associated with Systemic Sjögren’s Syndrome. J Clin Immunol 2011; 31:840-7. [DOI: 10.1007/s10875-011-9553-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 05/27/2011] [Indexed: 10/18/2022]
|
24
|
Brelinski L, Cottencin O, Guardia D, Anguill JD, Queyrel V, Hatron PY, Goudemand M, Thomas P. Catatonia and systemic lupus erythematosus: a clinical study of three cases. Gen Hosp Psychiatry 2009; 31:90-2. [PMID: 19134515 DOI: 10.1016/j.genhosppsych.2008.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Revised: 06/22/2008] [Accepted: 06/23/2008] [Indexed: 11/25/2022]
Abstract
Catatonia may be encountered in psychiatric disorders, but also in general medical conditions. Cases of catatonia associated with systemic lupus erythematosus (SLE) are rare. Several articles have described this symptomatic association, as well as its management, using electroconvulsive therapy, plasma exchange or benzodiazepines. We report three cases here of patients who presented with catatonia during a lupus relapse, in whom treatment with lorazepam improved the catatonic symptomatology, thus allowing the associated condition to be treated. We touch on several points about the diagnosis, etiology and treatment of catatonia, when it is associated with SLE.
Collapse
Affiliation(s)
- Lucie Brelinski
- Consultation Liaison Psychiatry, Department of Addictology, University Hospital of Lille, 59037 Lille Cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Edmé JL, Tellart AS, Launay D, Neviere R, Grutzmacher C, Boulenguez C, Labalette M, Hachulla E, Hatron PY, Dessaint JP, Matran R, Sobaszek A. Cytokine concentrations in exhaled breath condensates in systemic sclerosis. Inflamm Res 2008; 57:151-6. [PMID: 18351434 DOI: 10.1007/s00011-007-7136-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Pulmonary fibrosis in systemic sclerosis (SSc) involves inflammatory processes in the lower respiratory tract. Analysis of exhaled breath condensate (EBC) is a non-invasive method for studying inflammatory mediators, such as cytokines, which are of interest from both physiological and therapeutic perspectives. The aim of this study was to assess and compare cytokine concentrations in the EBC of SSc patients and controls. MATERIAL AND METHODS EBC was collected from 19 SSc patients and 19 controls. We used a multiplex assay test kit to assay interleukin (IL)-2, -4, -6, -10, tumour necrosis factor-alpha, and interferon-gamma in samples concentrated by lyophilization. RESULTS Cytokine concentrations in EBC were higher in SSc patients than in controls. The stepwise analyses showed that IL-4 was the biomarker which contributed most to the discrimination between controls and patients (Wilk's Lambda = 0.55, p < 0.001). We observed significant negative correlations of EBC cytokines with total lung capacity and diffusion capacity of the lung for carbon monoxide. CONCLUSIONS These findings suggest that EBC sampling permits the non-invasive study of inflammation in SSc patients, and may be correlated with the severity of interstitial lung disease.
Collapse
Affiliation(s)
- J L Edmé
- EA Toxiques et cancérogènes professionnels (EA 2690) - CERESTE, Université de Lille 2, Lille, France.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Cottencin O, Lambert M, Queyrel V, Launay D, Morell-Dubois S, Hachulla E, Hatron PY, Goudemand M, Consoli SM. Consultation/liaison psychiatry practice: combined medical and psychiatric consultations. J Psychosom Res 2007; 63:219-20. [PMID: 17662760 DOI: 10.1016/j.jpsychores.2007.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 02/20/2007] [Revised: 05/21/2007] [Accepted: 05/21/2007] [Indexed: 10/23/2022]
Affiliation(s)
- Olivier Cottencin
- Department of Consultation/Liaison Psychiatry, University of Medicine, Paris 5, AP-HP, European Georges Pompidou Hospital, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
|
28
|
Carpentier PH, Guilmot JL, Hatron PY, Levesque H, Planchon B, Vayssairat M, Becker F. [Digital ischemia, digital necrosis]. J Mal Vasc 2005; 30:4S29-37. [PMID: 16208211] [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: 05/04/2023]
|
29
|
Brénuchon C, Launay D, Maurage CA, Queyrel V, Lambert M, N'Guyen HD, Boutry N, Hachulla E, Hatron PY, Devulder B. Myopathie hypertrophique des membres inférieurs due à des métastases musculaires d'un adénocarcinome à cellules indépendantes de la vessie. Rev Med Interne 2004; 25:839-41. [PMID: 15501357 DOI: 10.1016/j.revmed.2004.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Accepted: 07/12/2004] [Indexed: 11/19/2022]
|
30
|
Gauvrit JY, Oppenheim C, Girot M, Lambert M, Gautier C, Hatron PY, Pruvo JP, Leclerc X. High Resolution Images Obtained With Ultrasound and Magnetic Resonance Imaging of Pericarotid Fibrosis in Erdheim-Chester Disease. Circulation 2004; 110:e443-4. [PMID: 15477423 DOI: 10.1161/01.cir.0000144473.95742.9a] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Jean-Yves Gauvrit
- Department of Neuroradiology and EA 2691, University Hospital of Lille, Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Charlanne H, Hatron PY, Zerbib P, Lambert M, Launay D, Queyrel V, Hachulla E, Devulder B. Un vrai micmac! Rev Med Interne 2004; 25 Suppl 2:S244-6. [PMID: 15460464 DOI: 10.1016/s0248-8663(04)80017-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- H Charlanne
- Service de médecine interne, hôpital Huriez, CHRU de Lille, 59037 Lille cedex, France
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Brenuchon C, Lemoux O, Queyrel V, Launay D, Lambert M, Hachulla E, Hatron PY. Il faut toujours demander la main de sa fille à un père…. Rev Med Interne 2004; 25 Suppl 2:S215-7. [PMID: 15460454 DOI: 10.1016/s0248-8663(04)80007-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C Brenuchon
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille cedex, France
| | | | | | | | | | | | | |
Collapse
|
33
|
de Seze J, Dubucquoi S, Fauchais AL, Matthias T, Devos D, Castelnovo G, Stojkovic T, Ferriby D, Hachulla E, Labauge P, Lefranc D, Hatron PY, Vermersch P, Witte T. Alpha-fodrin autoantibodies in the differential diagnosis of MS and Sjögren syndrome. Neurology 2003; 61:268-9. [PMID: 12874419 DOI: 10.1212/01.wnl.0000071217.95981.0e] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J de Seze
- Department of Neurology, University of Lille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Lepers S, Hachulla E, Leleux E, Hatron PY, Prin L, Dubucquoi S. [Relevance of anti-nucleosome antibodies detected by enzyme-based immunoassays in lupus diagnosis. Comparative analysis of four commercial kits]. Pathol Biol (Paris) 2002; 50:584-90. [PMID: 12504366 DOI: 10.1016/s0369-8114(02)00359-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Among the biological assays used for the diagnosis of systemic lupus erythematosus (SLE), the detection of anti-double strand DNA antibodies (dsDNA Ab) is regarded as highly specific. However this biological parameter is negative among 20 to 40% of patients. Recent studies have revealed potential interest of the anti-nucleosome antibodies in the diagnosis of the lupus, in particular when any anti-dsDNA antibody activity could be detected. We selected 80 sera in order to evaluate four commercial anti-nucleosome enzyme-based immunoassays (EIA) kits. Their sensitivity and specificity values were compared with those obtained by the detection of anti-dsDNA Ab, carried out with both a Farr assay and two EIA kits. No anti-nucleosome EIA kits reached performances of the Farr assay for the diagnosis of lupus. On the other hand, our results show an higher diagnostic value for some anti-nucleosome EIA kits compared with 2 anti-dsDNA EIA kits. Apart from SLE, anti-nucleosome antibodies can be observed in others auto-immune diseases, in particular Sjögren's syndromes, the primary antiphospholipid syndrome, the systemic sclerosis and the mixed connective tissue disease. Compared results of the four anti-nucleosome EIA kits highlight many discordances. These variations, testifying to the absence of standardization for this new parameter, must encourage with a careful interpretation of results, according to the clinical context.
Collapse
Affiliation(s)
- S Lepers
- Laboratoire d'immunologie, faculté de médecine, CHRU de Lille, 1, place de Verdun, 59037 Lille cedex, France.
| | | | | | | | | | | |
Collapse
|
35
|
Fauchais AL, Boivin V, Hachulla E, Michon-Pasturel U, Lambert M, Queyrel V, Hebbar M, Hatron PY, Devulder B. [Psychiatric complications of corticoid therapy in the elderly over 65 years of age treated for Horton disease]. Rev Med Interne 2002; 23:828-33. [PMID: 12428485 DOI: 10.1016/s0248-8663(02)00690-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To analyse steroid psychiatric related complications in aged (> 65 years old) with temporal arteritis (TA). METHODS Retrospective cohort study. PATIENTS In a cohort of 126 elderly patients with a diagnosis of TA and followed with a mean period of 64 months, clinical and biological presentations, outcome and corticoid adverse effects were recorded throughout the follow-up period. RESULTS Twenty patients (16%), (mean age: 73 +/- 7.9 years, male n = 6) exhibited corticosteroid related psychiatric complications. Symptoms appear to be dose dependent and generally begin during the first month of treatment. Psychiatric disorders were as follow: mood disturbances (n = 8), depression (n = 6), mania (n = 3), anxiety neurosis (n = 2) and dementia (n = 1). Three patients were hospitalized in psychiatric units and 2 in nursing home. Psychiatric adverse affects appears to be more frequent with prednisone than prednisolone (P < 0.05).
Collapse
Affiliation(s)
- A L Fauchais
- Service de médecine interne A, hôpital Claude-Huriez, CHRU, 59037 Lille, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Lambert M, Hatron PY, Hachulla E, Devulder B. [An unusual pulmonary lesion in Gougerot-Sjogren's syndrome]. Rev Med Interne 2002; 23:733. [PMID: 12360757 DOI: 10.1016/s0248-8663(02)00695-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- M Lambert
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, 59037 Lille, France.
| | | | | | | |
Collapse
|
37
|
Abstract
INTRODUCTION The Cogan's syndrome is characterized by the association of vestibulo-auditory dysfunction, non syphilitic interstitial keratitis or another significant inflammatory eye lesion. Some authors consider this disease as a vasculitis, because it is frequently associated with systemic manifestations. Based on Cogan's diagnostic criteria, Cogan's syndrome may be part of other systemic diseases, as polyarteritis nodosa or Wegener's granulomatosis. EXEGESIS We report the case of a patient who presented with a Cogan's syndrome and developed further sarcoidosis. CONCLUSION If Cogan's syndrome is characterized as systemic disease because of its association with aortitis or other vasculitis, on the other hand, clinical presentation may be part of many other systemic diseases.
Collapse
Affiliation(s)
- A Laude
- Service de médecine interne A, hôpital Claude-Huriez, CHU de Lille, 1, place Verdun, 59037 Lille, France
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
PURPOSE Pregnancy in a patient with systemic sclerosis (SSc) may pose a double problem to the medical team: influence of SSc on pregnancy and consequences of pregnancy to SSc manifestations. CURRENT KNOWLEDGE AND KEY POINTS Concepts have evolved. SSc was considered for a long time not only as not very propitious for pregnancy but also as a strict contraindication for procreation because risks for the mother and the baby were thought to be major. Currently, fertility is thought to be normal. Miscarriages and small-for-gestation age infants rate do not seem to be higher in SSc. Maternal and perinatal mortality is also not higher in SSc without severe visceral manifestations, i.e. without either pulmonary hypertension, or cardiac or respiratory insufficiency. Conversely, there is a significantly higher frequency of premature infants in SSc. As regards influence of pregnancy on SSc, the greatest fear is the occurrence of renal crisis, which may be life threatening for both mother and child. Each elevation of blood pressure, even if this increase is mild, should be considered as potentially very serious. However, pregnancy itself does not seem to increase the risk of renal crisis. Consequences of pregnancy to SSc manifestations are various but usually mild. FUTURE PROSPECTS AND PROJECTS SSc is not a strict contraindication for pregnancy only if severe organ involvement, diffuse subset of SSc or recent onset of the disease has been ruled out. Physicians should be aware of specific problems, which SSc is possibly posing during pregnancy. Finally, it has been recently suggested that pregnancies could be involved in the pathogenesis of SSc through persisting microchimerism of fetal origin.
Collapse
Affiliation(s)
- D Launay
- Service de médecine interne, hôpital Claude-Huriez, CHRU Lille, rue Michel-Polonovski, 59037 Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Queyrel V, Michon-Pasturel U, Dobbelaere D, Lambert M, Hachulla E, Hatron PY, Devulder B. [A case of urinary funnelling]. Rev Med Interne 2002; 23 Suppl 2:236s-238s. [PMID: 12108198 DOI: 10.1016/s0248-8663(02)80006-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- V Queyrel
- Service de médecine interne, CHRU, hôpital Claude-Huriez, 59037 Lille, France
| | | | | | | | | | | | | |
Collapse
|
40
|
Fauchais AL, Ibaba J, Hachulla E, Delplace J, Michon-Pasturel U, Queyrel V, Lambert M, Hatron PY, Cotten A, Devulder B. [A case of losing one's head]. Rev Med Interne 2002; 23 Suppl 2:256s-259s. [PMID: 12108205 DOI: 10.1016/s0248-8663(02)80013-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- A L Fauchais
- Service de médecine interne, CHRU, hôpital Claude-Huriez, 59037 Lille, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Desauw C, Hachulla E, Boumbar Y, Bouroz-Joly J, Ponard D, Arvieux J, Dubucquoi S, Fauchais AL, Hatron PY, Devulder B. [Antiphospholipid syndrome with only antiphosphatidylethanolamine antibodies: report of 20 cases]. Rev Med Interne 2002; 23:357-63. [PMID: 11980311 DOI: 10.1016/s0248-8663(02)00570-2] [Citation(s) in RCA: 11] [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] [Indexed: 10/27/2022]
Abstract
PURPOSE The association of antiphosphatidylethanolamine antibodies (aPE) as the only antiphospholipid antibody with antiphospholipid syndrome (APS) is discussed. The aPE was described as the sole antibody in many cases suggesting APS. aPE was not included in the Sapporo criteria for the classification of APS. METHODS We investigated the clinical features of 20 patients with aPE only; 17 patients had symptoms potentially related to APS (group 1) and three had other manifestations (group 2). RESULTS There were 15 women and five men, mean age was 35 +/- 12 years at the beginning. In group 1 (n = 17), ten patients presented arterial thrombosis, nine venous thrombosis (five had both), and six microvascular thrombosis (livedo reticularis, lacunar pathology). The aPE positivity was persistent in 13 patients. A subgroup of four patients (three women) presented arteriosclerosis with peripheral arteriopathy which started before 45 years of age. They had another atherosclerosis risk factor associated with aPE persistence. In group 2 (n = 3), there was no thrombotic event, one demyelinating pathology, one microvascular pathology, and one arterial dysplasia. The aPE positivity was never confirmed. Finally, 13 patients presented an APS with aPE only, confirmed at least 8 weeks later. CONCLUSIONS Our study points out that testing for aPE would be of interest for patients when symptoms were potentially related to APS, particularly when other antiphospholipid antibodies were negative. This description questions the enlargement of the APS biological criteria defined in Sapporo. The role of aPE in atherosclerosis is considered.
Collapse
Affiliation(s)
- C Desauw
- Service de médecine interne, hôpital Claude-Huriez, CHRU, 59037 Lille, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hachulla E, Wibaux A, Hatron PY, Michon-Pasturel U, Queyrel V, Fauchais AL, Devulder B, Lefebvre MN, Yilmaz M. Home sequential high dose intravenous immunoglobulins in systemic autoimmune disease. Ann Rheum Dis 2002; 61:277-8. [PMID: 11830441 PMCID: PMC1754022 DOI: 10.1136/ard.61.3.277-a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
43
|
Legout L, Fauchais AL, Hachulla E, Queyrel V, Michon-Pasturel U, Lambert M, Hatron PY, Devulder B. [The antisynthetase syndrome: a subgroup of inflammatory myopathies not to be unrecognized]. Rev Med Interne 2002; 23:273-82. [PMID: 11928375 DOI: 10.1016/s0248-8663(01)00552-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Antisynthetase syndrome (AS) is frequently revealed by interstitial lung disease and arthritis. There are mechanic's hand, Raynaud's phenomenon and anti aminoacyl t-RNA synthetase antibodies. The anti JO-1 antibody is the most frequently identified. We report five cases of antisynthetase syndrome with particular clinical features and good response to corticosteroids. METHODS There are three women and two men with a median age of 59 years at presentation (range: 44-77). Three patients progressively developed AS: the symptoms are dyspnea (three). Raynaud's phenomenon (one), purpura (one) and hyperkeratosis, scaling and fissuring on the lateral sides of the fingers (two). Patients always had skin signs: hyperkeratosis and scaling (five), purpura (one), Raynaud's phenomenon with normal capillaroscopy (two). Lung disease is present in the five cases with interstitial lesions in CT scans (five), trouble of CO diffusion (three/three) and lymphocytic alveolitis (two/two). Moderate muscular disorders are present in five cases (moderate elevated muscular enzyme: five, positive muscle histology: two). Anti-JO-1 antibodies are present in five cases. AS is associated with connective tissue diseases: rheumatoid polyarthritis in one case and Gougerot-Sjögren in three cases. No malignant tumour is associated. Patients have received oral corticosteroid treatment (five/five) with high doses of intravenous perfusions (three/five) with, initially, a good response. For only one patient, immunosuppressive treatment was necessary because of the articular relapse. The interstitial lung disease had a good response to corticosteroids therapy alone in four cases. Because of the relapse during the tapering off of corticosteroids, corticosteroids were increased in one case and immunosuppressive therapy was required in one case. CONCLUSION The prognosis of AS depends of the interstitial lung disease. High doses of corticosteroids are required. In our study, the response to corticosteroids is good. Immunosuppressive agents must be added in severe and progressive form of interstitial lung disease in AS.
Collapse
Affiliation(s)
- L Legout
- Service de médecine interne, hôpital Claude-Huriez, CHRU, 59037 Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Delcey V, Hachulla E, Michon-Pasturel U, Queyrel V, Hatron PY, Boutry N, Lemaitre V, Vanhille P, Serratrice J, Disdier P, Juhan V, Devulder B, Thévenon A. [Camptocormia: a sign of axial myopathy. Report of 7 cases]. Rev Med Interne 2002; 23:144-54. [PMID: 11876058 DOI: 10.1016/s0248-8663(01)00530-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Camptocormia or progressive lumbar kyphosis is an anterior bend of the trunk. It appears in orthostatism or while walking and is reducible in the decubitus position. It concerns patients older than 60 years of age. It is due to a fatty degeneration of the paravertebral muscles, although the physiopathology remains unclear. METHODS We report seven cases of camptocormia revealing authentic myopathies. RESULTS Our observations concern five women and two men of 55 to 72 years of age. All patients present lumbar kyphosis and had a fatty involution of the paraspinal muscles on the muscular MRI. Four patients fulfilled the Bohan and Peter criteria of polymyositis and dermatomyositis. In the other cases paravertebral muscular biopsies led to the diagnosis of a congenital myopathy, a mitochondrial myopathy and an amyloid myopathy. Four patients received a corticosteroid-immunoglobulins or cyclosporin regimen. An improvement in the camptocormia was observed in three cases. In the other cases the treatment consisted of chemotherapy on account of severe nephrotic syndrome, a coenzyme-Q treatment for the patient with mitochondrial myopathy and only physiotherapy in the case of congenital myopathy, but without positive effect on camptocormia. CONCLUSION Camptocormia appears as a muscular symptom that may reveal an axial myopathy due to multiple and varied pathologies. Thus, the discovery of camptocormia requires an aetiological investigation in order to propose an adequate treatment, which should be associated with physiotherapy.
Collapse
Affiliation(s)
- V Delcey
- Service de médecine interne, hôpital Claude-Huriez, CHRU, 1, place de Verdun 59037 Lille, France
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Launay D, Hatron PY, Queyrel V, Leteurtre E, Beaulieu S, Lemann M, Hachulla E, Lecomte-Houcke M, Cortot A, Devulder B. [Unusual association: hepatic peliosis and Crohn's disease]. Rev Med Interne 2002; 23:198-202. [PMID: 11876065 DOI: 10.1016/s0248-8663(01)00537-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Hepatobiliary disorders occurs in about 10 to 30% of inflammatory bowel diseases. Fatty liver and gallstones are preferentially described with Crohn's disease. Conversely, peliosis hepatis has been only exceptionally reported in association with inflammatory bowel diseases. We describe here a case of peliosis hepatis complicating a misdiagnosed Crohn's disease. EXEGESIS A 24-year-old woman was referred because of a hepatomegaly and a deterioration of the general state. The patient complained about diarrhea for 3 months and about an episode of bloody stools. There was an aphthous-like lesion on the tongue. X-ray pull-through revealed a typical aspect of terminal ileitis as seen in Crohn's disease. The liver was heterogeneous. Liver biopsy revealed a peliosis hepatis. No other possible cause of peliosis hepatis was found. Therefore, in this case, peliosis hepatis, revealed by the hepatomegaly, was associated with Crohn's disease. CONCLUSION Association between Crohn's disease and peliosis hepatis has only exceptionally been described. A priori, this complication is not a pejorative feature in inflammatory bowel disease. The pathophysiological significance of this association remains unknown.
Collapse
Affiliation(s)
- D Launay
- Service de médecine interne A, hôpital Claude-Huriez, CHRU, 1, place de Verdun, 59037 Lille, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Quéméneur T, Lambert M, Fauchais AL, Queyrel V, Michon-Pasturel U, Hachulla E, Hatron PY, Devulder B. [Rheumatoid purpura in adults and parvovirus B19 infection: fortuitous association or parvovirus B19-induced vasculitis?]. Rev Med Interne 2002; 23:77-80. [PMID: 11859697 DOI: 10.1016/s0248-8663(01)00516-1] [Citation(s) in RCA: 10] [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] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Henoch-Schoenlein purpura has been reported to be associated with parvovirus B19 infection, particularly in children and rarely in adults. We report the case of a 42-year-old patient presenting with this association. EXEGESIS A 42-year-old patient was admitted to our medical center because of lower limb purpura. Henoch-Schoenlein purpura diagnosis was confirmed on histological findings (kidney biopsy) and concomitantly parvovirus B19 infection was proved by serological test (IgM+). Association of Henoch-Schoenlein purpura and parvovirus B19 infection has already been described. However, none of the reported studies demonstrated clearly the link between these two diseases. With regard to this observation, we wonder about the systematic use of the parvovirus B19 serological test in patients presenting first Henoch-Schoenlein purpura. Indeed, parvovirus B19-induced vasculitis is habitually controlled with intravenous immunoglobulins. CONCLUSION A prospective study should explore the link between Henoch-Schoenlein purpura and primary parvovirus B19 infection. Moreover, we should evaluate intravenous immunoglobulins' efficacy in Henoch-Schoenlein purpura associated with active parvovirus B19 infection in order to improve the prognosis of this disease.
Collapse
Affiliation(s)
- T Quéméneur
- Service de médecine interne, hôpital Claude-Huriez, CHRU, rue Polonovski, 59037 Lille, France
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
PURPOSE Interstitial lung disease is one of the most common respiratory manifestations in polymyositis and dermatomyositis. It still remains a severe complication of the disease, leading to death related to ventilatory insufficiency in 30-66% of patients. CURRENT KNOWLEDGE AND KEY POINTS Time onset of interstitial lung disease is variable, although interstitial lung disease onset precedes initial manifestations of polymyositis/dermatomyositis in roughly half of the patients. Moreover, clinical presentation of interstitial lung disease can be dichotomized, according to patients' pulmonary manifestations, into: 1) both acute and aggressive lung disease similar to Hamman-Rich syndrome; 2) slowly progressive lung disease; and 3) an asymptomatic pattern. The methods of choice adopted for early diagnosis of interstitial lung disease are high-resolution computed tomography scan and pulmonary function tests, which should be performed during both initial evaluation of polymyositis/dermatomyositis and follow-up. Because anti-JO1 antibody is considered to be a marker of interstitial lung disease in polymyositis/dermatomyositis, close pulmonary follow-up of anti-JO1-positive patients with polymyositis is therefore required for early detection of subclinical impairment. Furthermore, histological lung findings provide prognostic data; patients with bronchiolitis obliterans organizing pneumonia (BOOP) indeed appear to have a more favorable outcome than those with usual interstitial pneumonia or diffuse alveolar damage. Finally, as a guide to both the severity and progress of interstitial lung disease, the significance of other investigations, notably bronchoalveolar lavage, remains controversial. FUTURE PROSPECTS AND PROJECTS Specific therapy of interstitial lung disease has not yet been clearly established in polymyositis/dermatomyositis patients. Corticosteroid therapy is considered the first line of therapy for polymyositis/dermatomyositis patients with interstitial lung disease. The association of cyclophosphamide and corticosteroids may be the most effective in patients with steroid-resistant interstitial lung disease. Early diagnosis and management of this disease is therefore of the utmost importance.
Collapse
Affiliation(s)
- I Marie
- Département de médecine interne, hôpital de Boisguillaume, CHU de Rouen, 76031 Rouen, France
| | | | | | | | | |
Collapse
|
48
|
Marie I, Hachulla E, Hatron PY, Hellot MF, Levesque H, Devulder B, Courtois H. Polymyositis and dermatomyositis: short term and longterm outcome, and predictive factors of prognosis. J Rheumatol 2001; 28:2230-7. [PMID: 11669162] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To assess short term and longterm outcome of polymyositis (PM) and dermatomyositis (DM), and predictive variables of PM/DM course. METHODS The medical records of 77 consecutive patients with PM/DM were reviewed. The criteria for PM/DM diagnosis were based upon Bohan and Peter criteria. RESULTS Thirty-one patients (40%) achieved remission of PM/DM, whereas 33 (43%) improved and 13 (17%) worsened their clinical status. Short term recurrences of PM/DM (during tapering of therapy) occurred in 36 patients and longterm recurrences (after discontinuation of therapy) in 9 patients. PM/DM were associated with both decreased functional status and quality of life at longterm followup: (1) only 52% of patients considered to be in remission experienced a return to previous normal activities; and (2) 45% of the other patients with nonremitting PM/DM still had a marked reduction of activities (as shown by the disability scale of the Health Assessment Questionnaire). Overall mortality was as high as 22%, and the main causes of death were cancer and lung complications. Factors associated with PM/DM remission were younger age and shorter duration of clinical manifestations prior to therapy initiation. Variables associated with poor outcome of PM/DM were older age, pulmonary and esophageal involvement, and cancer. CONCLUSION Our series shows both high morbidity and mortality related to PM/DM, emphasizing that management of PM/DM patients at an early stage is required. Lung complications (i.e., aspiration pneumonia due to PM/DM related esophageal dysfunction and ventilatory insufficiency) were one of the main causes of death in our series, indicating that investigating for subclinical esophageal and lung impairment should become an integral part of initial PM/DM evaluation. The presence of poor prognostic factors should prompt both close followup and aggressive therapy in patients with PM/DM.
Collapse
Affiliation(s)
- I Marie
- Department of Internal Medicine, Centre Hospitalier Universitaire de Rouen-Boisguillaume, Rouen, France
| | | | | | | | | | | | | |
Collapse
|
49
|
Launay D, Hachulla E, Hatron PY, Goullard L, Onimus T, Robin S, Fauchais AL, Queyrel V, Michon-Pasturel U, Hebbar M, Saulnier F, Devulder B. Aerosolized iloprost in CREST syndrome related pulmonary hypertension. J Rheumatol 2001; 28:2252-6. [PMID: 11669165] [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] [Indexed: 02/22/2023]
Abstract
OBJECTIVE To assess the outcome of patients with CREST syndrome associated severe pulmonary hypertension treated by aerosolized iloprost in a noncomparative study. METHODS Five patients with CREST syndrome associated severe pulmonary hypertension were treated with 100 microg/day of aerosolized iloprost. New York Heart Association functional class and exercise tolerance (6 min walk test) were assessed at baseline, after one month, and then every 6 months. A right heart catheterization was performed at baseline in all but one patient. Systolic pulmonary artery pressure (PAP) was measured with Doppler echocardiography after one month and every 6 months. RESULTS The mean followup was 13.2 +/- 8.8 months (median 6, range 6-24). Subjective quality of life improved in all patients. NYHA functional class decreased from Class III to II in 3 patients, from Class III to I in one patient, and from Class IV to III in one patient. At 6 months, the distance walked in 6 min had increased from 352 +/- 48 to 437 +/- 56 m (p = 0.06). At one month the mean systolic PAP was 58 +/- 13 vs 81 +/- 9 mm Hg at baseline (p = 0.04). At 6 months the mean systolic PAP was 57 +/- 13 mm Hg (p = 0.06). The improvement of both clinical and hemodynamic status was maintained in the 2 patients treated for 2 years. Neither adverse effects nor need to increase the daily dose of iloprost were observed. One patient died of right heart failure and one patient did not experience any improvement of exercise tolerance and hemodynamics. CONCLUSION Aerosolized iloprost might be potentially useful as treatment for CREST syndrome associated pulmonary hypertension. However, patients who could benefit from this treatment will probably have to undergo careful criteria selection.
Collapse
Affiliation(s)
- D Launay
- Department of Internal Medicine, Functional Cardiac Exploration, Regional University Hospital, Lille, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The authors evaluated the long-term clinical outcome of neurosarcoidosis and determined predictive factors of disease course. Twenty-seven patients with neurosarcoidosis were followed for at least 5 years from the onset of neurologic symptoms. Patients with CNS involvement during the course of the disease had a higher Modified Oxford Handicap Scale score than those with peripheral nervous system involvement (p < 0.02). CNS involvement may be a predictive factor for a less favorable disease course. Early and intensive treatment should be considered in such cases.
Collapse
Affiliation(s)
- D Ferriby
- Department of Neurology, CHRU de Lille, France.
| | | | | | | | | | | | | | | |
Collapse
|