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Martel ME, Leurs A, Launay D, Behal H, Chepy A, Collet A, Sanges S, Hachulla E, Dubucquoi S, Dauchet L, Sobanski V. Prevalence of anti-Ro52-kDa/SSA (TRIM21) antibodies and associated clinical phenotype in systemic sclerosis: Data from a French cohort, a systematic review and meta-analysis. Autoimmun Rev 2024; 23:103536. [PMID: 38555075 DOI: 10.1016/j.autrev.2024.103536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVES Estimate the global prevalence of anti-Ro52-kDa/SSA (TRIM21) autoantibodies in systemic sclerosis (SSc), and describe the associated clinical phenotype, through a systematic review and meta-analysis of published reports and new data from our French cohort. METHODS Anti-TRIM21 seropositivity and associated SSc characteristics were assessed in a cross-sectional study including 300 patients of Lille University Hospital. A systematic review of the literature was performed in Pubmed and Embase, followed by a meta-analysis, using data on prevalence, clinical/demographical/biological characteristics of SSc patients and the type of assay used for anti-TRIM21 antibodies detection (PROSPERO n° CRD42021223719). FINDINGS In the cross-sectional study, anti-TRIM21 antibodies prevalence was 26% [95%CI: 21; 31]. Anti-centromere antibodies were the most frequent SSc specific autoantibodies coexisting with anti-TRIM21. Patients with anti-TRIM21 antibodies were more frequently women (91% vs 77%, p = 0.006), more likely to present an associated Sjögren's syndrome (19% vs 7%, p < 0.001), had a higher rate of pulmonary arterial hypertension (PAH) (15% vs 6%, p = 0.017) and a greater frequency of digestive complications such as dysphagia (12% vs 5%, p = 0.038) or nausea/vomiting (10% vs 3%, p = 0.009) than anti-TRIM21 negative patients. Thirty-five articles corresponding to a total of 11,751 SSc patients were included in the meta-analysis. In this population, the overall seroprevalence of anti-TRIM21 antibodies was 23% [95%CI: 21; 27] with a high degree of heterogeneity (I2: 93% Phet: <0.0001), partly explained by the methods of detection. Anti-TRIM21 seropositivity was positively associated with female sex (OR: 1.60 [95%CI: 1.25, 2.06]), limited cutaneous subset (OR: 1.29 [1.04, 1.61]), joint manifestations (OR: 1.33 [1.05, 1.68]), pulmonary hypertension (PH) (OR: 1.82 [1.42, 2.33]), and interstitial lung disease (ILD) (OR: 1.31 [1.07, 1.60]). INTERPRETATION Anti-TRIM21 antibodies frequently co-exist with usual SSc antibodies, but are independently associated to a higher risk of cardio-pulmonary complications. The presence of these autoantibodies should therefore be considered when assessing the risk of developing PH and ILD, and deserves further studies on appropriate screening and follow-up of patients.
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Affiliation(s)
- Marie-Elise Martel
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Amélie Leurs
- CH Dunkerque, Département de Médecine interne et Maladies infectieuses, F-59240 Dunkerque, France
| | - David Launay
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Hélène Behal
- CHU Lille, SEED: Statistique, évaluation, économique, data-management - Maison Régionale de la Recherche Clinique, F-59000 Lille, France
| | - Aurélien Chepy
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Aurore Collet
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Sébastien Sanges
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Eric Hachulla
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Luc Dauchet
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur Lille, U1167 - RID-AGE - Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement, F-59000 Lille, France
| | - Vincent Sobanski
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; Institut Universitaire de France (IUF), Paris, France.
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Sanges S, Tian W, Dubucquoi S, Chang JL, Collet A, Launay D, Nicolls MR. B cells in pulmonary arterial hypertension: friend, foe or bystander? Eur Respir J 2024:2301949. [PMID: 38485150 DOI: 10.1183/13993003.01949-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 04/22/2024]
Abstract
There is an unmet need for new therapeutic strategies that target alternative pathways to improve the prognosis of patients with pulmonary arterial hypertension (PAH). As immunity has been involved in the development and progression of vascular lesions in PAH, we review the potential contribution of B cells in its pathogenesis and evaluate the relevance of B cell-targeted therapies. Circulating B cell homeostasis is altered in PAH patients, with total B-cell lymphopenia, abnormal subset distribution (expansion of naïve and antibody-secreting cells, reduction of memory B cells) and chronic activation. B cells are recruited to the lungs through local chemokine secretion, and activated by several mechanisms: 1) interaction with lung vascular auto-antigens through cognate B cell receptors; 2) co-stimulatory signals provided by T follicular helper (Tfh) cells (IL-21), T helper 2 (Th2) cells and mast cells (IL-4, IL-6 and IL-13); and 3) increased survival signals provided by B cell activating factor (BAFF) pathways. This activity results in the formation of germinal centres within perivascular tertiary lymphoid organs and in the local production of pathogenic autoantibodies that target the pulmonary vasculature and vascular stabilization factors (including angiotensin-II/endothelin-1 receptors and bone morphogenetic protein receptors). B cells also mediate their effects through enhanced production of pro-inflammatory cytokines, reduced anti-inflammatory properties by regulatory B cells, IgG-induced complement activation, and IgE-induced mast cell activation. Precision-medicine approaches targeting B cell immunity are a promising direction for select PAH conditions, as suggested by the efficacy of anti-CD20 therapy in experimental models and a trial of rituximab in systemic sclerosis-associated PAH.
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Affiliation(s)
- Sébastien Sanges
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
- Both authors contributed equally and share co-first authorship
| | - Wen Tian
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
- Both authors contributed equally and share co-first authorship
| | - Sylvain Dubucquoi
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, France
| | - Jason L Chang
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
| | - Aurore Collet
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, France
| | - David Launay
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
- Both authors contributed equally and share co-last authorship
| | - Mark R Nicolls
- Veteran Affairs Palo Alto Health Care System, Palo Alto, California, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, School of Medicine, Stanford, California, USA
- Both authors contributed equally and share co-last authorship
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Astouati Q, Machet T, Houssais C, Noury JB, Allenbach Y, Gallay L, Quere B, Assan F, Benveniste O, Broner J, Duffau P, Espitia A, Grasland A, Hayem G, Guern VL, Martis N, Mariampillai K, Nocturne G, Mariette X, Meyer A, Mulleman D, Devauchelle-Pensec V, Collet A, Launay D, Hachulla E, Cornec D, Guellec D, Sanges S. Inclusion-body myositis associated with Sjögren's disease: clinical characteristics and comparison with other Sjögren-associated myositis. Rheumatology (Oxford) 2024:keae129. [PMID: 38430004 DOI: 10.1093/rheumatology/keae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVES To describe the characteristics of patients with Sjögren's disease (SjD) and inclusion-body myositis (IBM), and how they compare to SjD patients with other inflammatory myopathies (IM). METHODS Patients were retrospectively recruited from 13 French centers and included if they met the ACR/EULAR criteria for SjD and for IM. They were categorized as SjD-IBM if sub-criteria for IBM were met, or as SjD-other IM if not. RESULTS SjD-IBM patients (n = 22) were mostly females (86%), with a median [Q1; Q3] age of 54 [38.5; 64] years at SjD diagnosis, and 62 [46.5; 70] years at first IBM symptoms. Although most patients displayed glandular and immunological abnormalities, additional extra-glandular manifestations were uncommon, resulting in moderate disease activity at SjD diagnosis (ESSDAI 5.5 [1; 7.8]). Classic IBM features were frequent, such as progressive symptom onset (59%), asymmetrical (27%) and distal (32%) involvements, dysphagia (41%), low CPK (386.5 [221.8; 670.5] UI/l) and CRP (3.0 [3; 8.5] mg/l) levels. Immunosuppressants were reported as efficient in 55% of cases.Compared with SjD-IBM patients, SjD patients with other IM (n = 50) were significantly younger, displayed more frequent additional extra-glandular disease, higher ESSDAI score (11 [3; 30]), shorter delay between SjD diagnosis and myositis onset (0 [-0.5; 26]), more frequent CPK values over 1000 UI/l (36%), and less frequent classic IBM features. CONCLUSION IBM can occur in SjD patients, with muscle features reminiscent of classic sporadic IBM characteristics, but mostly affecting women. In SjD patients with muscle involvement, extra-glandular manifestations, high ESSDAI score, elevated CPK values, and shorter delay after SjD diagnosis plead against IBM.
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Affiliation(s)
- Quentin Astouati
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Thomas Machet
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Camille Houssais
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
| | - Jean-Baptiste Noury
- Reference Centre for Neuromuscular Diseases AOC, University of Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Laure Gallay
- Department of Internal Medicine and Clinical Immunology, Edouard Herriot University Hospital, Hospices Civils de Lyon, University Claude Bernard, Lyon, France
| | - Baptiste Quere
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Florence Assan
- Laboratory of Genetic Skin Diseases, Institut Imagine, INSERM UMR 1163, Paris
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Jonathan Broner
- Department of Internal Medicine, University Hospital of Nîmes, France
| | - Pierre Duffau
- Internal Medicine Department, Bordeaux University Hospital, FHU ACRONIM, Bordeaux, France. CNRS-UMR 5164 Immuno ConcEpT, Bordeaux University, Bordeaux, France
| | | | - Anne Grasland
- Department of Internal Medicine, Hôpital Louis Mourier, Université Paris Cité, AP-HP, Colombes, France
| | - Gilles Hayem
- Rheumatology Department, Paris Saint-Joseph Hospital, Paris, France
| | - Véronique Le Guern
- AP-HP, Cochin Hospital, Internal Medicine Department, Centre de référence maladies auto-immunes et systémiques rares d'île de France, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU Nice, France. Côte d'Azur University. Mediterranean Centre for Molecular Medicine, Control of gene expression (COdEX), INSERM U1065
| | - Kuberaka Mariampillai
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, APHP, Centre de Référence Maladies Neuro-Musculaires, Sorbonne University, France, Centre de Recherche en Myologie INSERM-Association Institut de Myologie, UMRS 974, Paris, France
| | - Gaëtane Nocturne
- Department of Rheumatology, Université Paris-Saclay, AP-HP, Hôpitaux Universitaires Paris-Saclay, Centre for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, AP-HP, Hôpitaux Universitaires Paris-Saclay, Centre for Immunology of Viral Infections and Autoimmune Diseases, INSERM UMR1184, Le Kremlin Bicêtre, France
| | - Alain Meyer
- Department of Rheumatology, Strasbourg University Hospital, Centre de Référence des Maladies Auto-immunes Rares, Strasbourg, France
| | - Denis Mulleman
- University of Tours, EA6295 NMNS, Tours, France Department of Rheumatology, CHRU de Tours, Tours, France
| | - Valérie Devauchelle-Pensec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Aurore Collet
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, F-59000, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
| | - Eric Hachulla
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - Divi Cornec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Dewi Guellec
- Rheumatology Department, Centre National de Référence des Maladies Auto-Immunes Rares (CERAINOM), CHU de Brest, Brest, France
- LBAI, UMR1227, Univ Brest, Inserm, Brest, France
| | - Sébastien Sanges
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord, Nord-Ouest, Méditerranée et Guadeloupe (CeRAINOM), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, F-59000, France
- INSERM, Lille, F-59000, France
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Sanges S, Sobanski V, Lamblin N, Hachulla E, Savale L, Montani D, Launay D. Pulmonary hypertension in connective tissue diseases: What every CTD specialist should know - but is afraid to ask! Rev Med Interne 2024; 45:26-40. [PMID: 37925256 DOI: 10.1016/j.revmed.2023.10.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
Pulmonary hypertension (PH) is a possible complication of connective tissue diseases (CTDs), especially systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and mixed connective tissue disease (MCTD). It is defined by an elevation of the mean pulmonary arterial pressure above 20mmHg documented during a right heart catheterization (RHC). Due to their multiorgan involvement, CTDs can induce PH by several mechanisms, that are sometimes intricated: pulmonary vasculopathy (group 1) affecting arterioles (pulmonary arterial hypertension, PAH) and possibly venules (pulmonary veno-occlusive-like disease), left-heart disease (group 2), chronic lung disease (group 3) and/or chronic thromboembolic PH (group 4). PH suspicion is often raised by clinical manifestations (dyspnea, fatigue), echocardiographic data (increased peak tricuspid regurgitation velocity), isolated decrease in DLCO in pulmonary function tests, and/or unexplained elevation of BNP/NT-proBNP. Its formal diagnosis always requires a hemodynamic confirmation by RHC. Strategies for PH screening and RHC referral have been extensively investigated for SSc-PAH but data are lacking in other CTDs. Therapeutic management of PH depends of the underlying mechanism(s): PAH-approved therapies in group 1 PH (with possible use of immunosuppressants, especially in case of SLE or MCTD); management of an underlying left-heart disease in group 2 PH; management of an underlying chronic lung disease in group 3 PH; anticoagulation, pulmonary endartectomy, PAH-approved therapies and/or balloon pulmonary angioplasty in group 4 PH. Regular follow-up is mandatory in all CTD-PH patients.
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Affiliation(s)
- S Sanges
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France.
| | - V Sobanski
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
| | - N Lamblin
- CHU de Lille, Service de Cardiologie, 59000 Lille, France; Institut Pasteur de Lille, Inserm U1167, 59000 Lille, France
| | - E Hachulla
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
| | - L Savale
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - D Montani
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France; AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - D Launay
- Université de Lille, U1286, INFINITE, Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; CHU de Lille, Département de Médecine Interne et Immunologie Clinique, 59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000 Lille, France
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Collet A, Sanges S, Ghulam A, Genin M, Soudan B, Sobanski V, Hachulla E, Dubucquoi S, Djobo B, Espiard S, Douillard C, Launay D. Steroid hormones in systemic sclerosis: associations with disease characteristics and modifications during scleroderma renal crisis. Rheumatology (Oxford) 2023:kead699. [PMID: 38141209 DOI: 10.1093/rheumatology/kead699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/16/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023] Open
Abstract
OBJECTIVE The renin-angiotensin-aldosterone system (RAAS) and glucocorticoids (GCs) are involved in vascular remodeling and fibrosis, but have not been extensively studied in systemic sclerosis (SSc). Our aim was to investigate the RAAS and GC hormones in SSc patients. METHODS Serum levels of renin (dosage and activity), aldosterone and its precursors (DOC, B, 18-OH-DOC, 18-OH-B), and GCs (cortisol, cortisone, 11-deoxycortisol, 18-OH-F) were assessed in 122 SSc patients and 52 healthy controls. After applying stringent inclusion criteria aimed at ensuring accurate hormone assessments (exclusion of interfering drugs, strict sampling conditions), we analyzed RAAS hormones in 61 patients, and GCs in 96 patients. Hormone levels were compared between patients and controls; and associations with disease characteristics were assessed in patients. RESULTS Regarding RAAS hormones, SSc patients displayed significantly lower aldosterone levels (although within normal range), similar renin levels, and higher B levels than controls. Abnormal RAAS hormone levels were associated with a more severe SSc phenotype (lung and skin fibrosis, heart and pulmonary vascular involvements, inflammation). Regarding GC hormones, SSc patients had higher levels of cortisol, 11-desoxycortisol (precursor) and 18-OH-F (metabolite) but lower levels of cortisone (inactive counterpart) than controls.RAAS hormone levels were assessed in 5 SSc patients before and during scleroderma renal crisis (SRC): concentrations varied considerably between patients, but consistently included normal/increased aldosterone levels and elevated renin levels. CONCLUSION RAAS and GC hormones are abnormally produced in SSc patients, especially in patients with severe SSc and during SRC. This could suggest a participation of these hormonal systems in SSc pathogenesis.
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Affiliation(s)
- A Collet
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, F-59000, France
| | - S Sanges
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, F-59000, France
| | - A Ghulam
- CHU Lille, Pôle de Biologie Pathologie Génétique, Service Hormonologie, Métabolisme, Nutrition, Oncologie, F59000 Lille, France
| | - M Genin
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, F-59000, France
| | - B Soudan
- CHU Lille, Pôle de Biologie Pathologie Génétique, Service Hormonologie, Métabolisme, Nutrition, Oncologie, F59000 Lille, France
| | - V Sobanski
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - E Hachulla
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
| | - S Dubucquoi
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Institut d'Immunologie, Pôle de Biologie Pathologie Génétique, Lille, F-59000, France
| | - B Djobo
- CHU Lille, Pôle de Biologie Pathologie Génétique, Service Hormonologie, Métabolisme, Nutrition, Oncologie, F59000 Lille, France
| | - S Espiard
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille, F-59000, France
| | - C Douillard
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, Lille, F-59000, France
| | - D Launay
- Univ. Lille, Lille, F-59000, France, U1286-INFINITE-Institute for Translational Research in Inflammation
- INSERM, Lille, F-59000, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, F-59000, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, F-59000, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, F-59000, France
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Gagnerie P, Sanges S, Guerreschi P, Wiel E, Lebuffe G, Sanctorum T, Jourdain M, Morell-Dubois S, Zéphir H. Training first-year medical residents to break bad news using healthcare role-play and trainees as simulated patients: Experience of the "ADIAMED" program from Lille University School of Medicine. Rev Med Interne 2023; 44:632-640. [PMID: 37923588 DOI: 10.1016/j.revmed.2023.10.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION Several studies suggest the relevance of healthcare simulation to prepare future doctors to deliver bad news. A such, we designed a role-play workshop to train first-year residents enrolled in Lille University School of Medicine to break bad news. The objective of this work is to report on our experience of this training and to assess its educational value through its capacity to satisfy residents' expectations, to induce a feeling of ease towards bad news disclosure, and to change trainees' preconceptions regarding these situations. METHODS The training consisted of a 45-minute heuristic reflective activity, aimed at identifying residents' preconceptions regarding bad news disclosure, followed by 4 30-min role-plays in which they played the parts of the physician, the patient and/or their relatives. Trainees were asked to answer 2 questionnaires (pre- and post-training), exploring previous experiences, preconceived ideas regarding bad news disclosure and workshop satisfaction. RESULTS Almost all residents felt very satisfied with the workshop, which they regarded as formative (91%) and not too stressful (89%). The majority felt "more capable" (53% vs. 83%) and "more comfortable" (27% vs. 62%) to deliver bad news, especially regarding "finding the right words" (12% vs. 22%). Trainees tended to overestimate their skills before the workshop and lowered their assessment of their performance after attending the training, especially when they played the role of a patient in the simulation. CONCLUSION Healthcare role-play seems an interesting technique for training to breaking bad news. Placing residents in the role of patients or relatives is an active approach that encourages reflexivity.
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Affiliation(s)
- P Gagnerie
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - S Sanges
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France.
| | - P Guerreschi
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Chirurgie Plastique, Inserm, CHU de Lille, 59000 Lille, France
| | - E Wiel
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Université de Lille, CHU de Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France; Pôle de l'Urgence, CHU de Lille, 59000 Lille, France
| | - G Lebuffe
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Pôle d'anesthésie réanimation - ULR 7365-GRITA - groupe de recherche sur les formes injectables et les techniques associées, Université de Lille, CHU de Lille, 59000 Lille, France
| | - T Sanctorum
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France
| | - M Jourdain
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Centre de Simulation PRESAGE, Université de Lille, 59000 Lille, France; Université de Lille, Inserm, CHU de Lille, U1190, Department of Intensive Care Medicine, 59000 Lille, France
| | - S Morell-Dubois
- Université de Lille, Inserm, CHU de Lille, Département de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France
| | - H Zéphir
- UFR3S Médecine, Université de Lille, 59000 Lille, France; Département de Neurologie, CHU de Lille, 59000 Lille, France; Université de Lille, Inserm U 1172, CHU de Lille, 59000 Lille, France
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Speca S, Farhat MM, Jendoubi M, Guerrier T, Sanges S, Staumont-Sallé D, Hachulla E, Dubucquoi S, Sobanski V, Collet A, Launay D. Intravenous immunoglobulins improve skin fibrosis in experimental models of systemic sclerosis. Sci Rep 2023; 13:15102. [PMID: 37700078 PMCID: PMC10497569 DOI: 10.1038/s41598-023-42464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/11/2023] [Indexed: 09/14/2023] Open
Abstract
Systemic sclerosis (SSc) is the most severe systemic autoimmune disease with currently no cure. Intravenous immunoglobulins (IVIg) are an attractive candidate in this disease to counteract inflammation and fibrosis but data are scarce and conflicting. This study, assessed the effects of IVIg in a murine HOCl-induced model of SSc. We showed that IVIg prevented skin inflammation and fibrosis, by mitigating the immune cell infiltration (p = 0.04), proinflammatory cytokines gene overexpression (IL1β, p = 0.04; TNFα, p = 0.04; IL6, p = 0.05), skin and dermal thickening (p = 0.003 at d21 and p = 0.0003 at d42), the expression markers of fibrosis, such as αSMA (p = 0.031 for mRNA and p = 0.05 for protein), collagen (p = 0.05 for mRNA and p = 0.04 for protein, p = 0.05 for the hydroxyproline content) and fibronectin (p = 0.033 for mRNA). Moreover, IVIg prevented HOCl-induced alterations in splenic cell homeostasis. When administered in curative mode, despite their ability to reduce skin and dermal thickness (p < 0.0001 and p = 0.0002), IVIg showed partial or more mixed effects on skin inflammation and established fibrosis. These data favor further clinical trials in SSc patients on the potential efficiency of early and/or repeated IVIg administration.
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Affiliation(s)
- Silvia Speca
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Meryem-Maud Farhat
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Département de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Manel Jendoubi
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Thomas Guerrier
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Sébastien Sanges
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Département de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Delphine Staumont-Sallé
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Service de Dermatologie, CHU Lille, Lille, France
| | - Eric Hachulla
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Département de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Sylvain Dubucquoi
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Institut d'Immunologie, Centre de Biologie Pathologie, CHU Lille, Lille, France
| | - Vincent Sobanski
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Département de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France
| | - Aurore Collet
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France
- Institut d'Immunologie, Centre de Biologie Pathologie, CHU Lille, Lille, France
| | - David Launay
- University of Lille, Inserm, CHU Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.
- Département de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), CHU Lille, Lille, France.
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Ducrocq Q, Guédon-Moreau L, Launay D, Terriou L, Morell-Dubois S, Maillard H, Lefèvre G, Sobanski V, Lambert M, Yelnik C, Farhat MM, Garcia Fernandez MJ, Hachulla E, Sanges S. Activities of Clinical Expertise and Research in a Rare Disease Referral Centre: A Place for Telemedicine beyond the COVID-19 Pandemic? Healthcare (Basel) 2023; 11:2447. [PMID: 37685481 PMCID: PMC10487162 DOI: 10.3390/healthcare11172447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Rare disease referral centres are entrusted with missions of clinical expertise and research, two activities that have to contend with numerous obstacles. Providing specialist opinions is time-consuming, uncompensated and limited by difficulties in exchanging medical data. Clinical research is constrained by the need for frequent research protocol visits. Our objective was to determine whether telemedicine (TLM) can overcome these difficulties. METHODS To better characterise the activity of clinical expertise provided by our French centre, each opinion delivered by our team was reported on a standardised form. To investigate our clinical research activity, investigators and patients were asked to complete a questionnaire on the acceptability of research protocol teleconsultations. RESULTS Regarding clinical expertise, our team delivered 120 opinions per week (representing a total of 21 h), of which 29% were delivered to patients and 69% to medical practitioners. If these were delivered using TLM, it would represent a potential weekly income of EUR 500 (tele-expertise) and EUR 775 (teleconsultations). Regarding the research activity, 70% of investigators considered the frequency of visits to be a limiting factor for patient inclusions; nearly half of the patients surveyed would be in favour of having teleconsultations in place of (40%) or in addition to (56%) in-person visits. CONCLUSION Whereas TLM has become widely used as a back-up procedure to in-person consultations during the COVID-19 pandemic, the solutions it provides to the problems encountered in performing expertise and research activities have made it a new conventional follow-up modality for patients with rare diseases.
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Affiliation(s)
- Quentin Ducrocq
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
| | - Laurence Guédon-Moreau
- Université de Lille, Faculté de Médecine et CHU de Lille, Clinique de Cardiologie et Maladies Vasculaires, F-59000 Lille, France;
| | - David Launay
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Louis Terriou
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
| | - Sandrine Morell-Dubois
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Hélène Maillard
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Guillaume Lefèvre
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- CHU Lille, Laboratoire d’Immunologie, F-59000 Lille, France
| | - Vincent Sobanski
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Marc Lambert
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
- CHU Lille, Département de Médecine Polyvalente Post-Urgences, F-59000 Lille, France
- Univ. Lille, U1167—RIDAGE—Risk Factors and Molecular Determinants of Aging-Related Diseases, F-59000 Lille, France
| | - Cécile Yelnik
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
- CHU Lille, Département de Médecine Polyvalente Post-Urgences, F-59000 Lille, France
- Univ. Lille, U1167—RIDAGE—Risk Factors and Molecular Determinants of Aging-Related Diseases, F-59000 Lille, France
| | - Meryem-Maud Farhat
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Maria José Garcia Fernandez
- Unité Matériaux et Transformations (UMET) UMR CNRS 8207, Université Lille 1, F-59655 Villeneuve d’Ascq, France;
- Inserm, CHU Lille, U1008—Controlled Drug Delivery System and Biomaterials, University Lille, F-59000 Lille, France
| | - Eric Hachulla
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Sébastien Sanges
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
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Penet T, Pokeerbux MR, Morell-Dubois S, Sanges S, Maillard H, Ledoult E, Lambert M, Yelnik C, Sobanski V, Launay D, Hachulla E, Farhat MM. Atteintes coronariennes et artérite a cellules géantes : à propos de 2 cas et revue de la littérature. Rev Med Interne 2023; 44:394-401. [PMID: 37088663 DOI: 10.1016/j.revmed.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/03/2023] [Accepted: 04/07/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Coronaritis is a rare but serious complication of giant-cell arteritis (GCA), with an estimated prevalence of less than 1%, however difficult to establish, and of early onset. METHODS We describe 2 cases of GCA presenting with coronaritis and present a review of the literature on this complication. RESULTS The first patient presented with stable angina on common trunk coronaritis with ostial stenosis. Corticosteroid combined with tocilizumab from the outset resulted in improvement. Angioplasty was performed at 6months with good outcome. The second patient presented with asymptomatic tritruncular ostial coronaritis. Corticosteroid allowed clinic-biological improvement of GCA. Two years later, he presented relapse with an acute coronary syndrome, with favorable evolution after angioplasty, increase of corticosteroids and addition of tocilizumab. CONCLUSION Patients presented were successfully treated with corticosteroids combined with tocilizumab and angioplasty of their coronary stenoses. Efficacy of tocilizumab in GCA has not been evaluated especially on coronaritis due to the rarity of this complication. Our experience and the cases reported in the literature suggest good results of angioplasty in this indication. Studies with long-term follow-up will be necessary to evaluate the risk of restenosis.
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Affiliation(s)
- T Penet
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - M R Pokeerbux
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - S Morell-Dubois
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - S Sanges
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - H Maillard
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - E Ledoult
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - M Lambert
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - C Yelnik
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - V Sobanski
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - D Launay
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - E Hachulla
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - M M Farhat
- University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, CHU de Lille, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France.
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10
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Stabler S, Lamblin C, Gaillard S, Just N, Mihailescu M, Viget N, Sy Ndiaye T, Dzeing Ella A, Brunin G, Weyrich P, Prevotat A, Chenivesse C, Le Rouzic O, Mortuaire G, Vuotto F, Faure K, Leurs A, Wallet F, Loiez C, Titecat M, Le Guern R, Hachulla E, Sanges S, Etienne N, Terriou L, Launay D, Lopez B, Bahuaud M, Batteux F, Dubucquoi S, Gesquière-Lasselin C, Labalette M, Lefèvre G. High Frequency of Specific Polysaccharide Antibody Deficiency in Adults With Unexplained, Recurrent and/or Severe Infections With Encapsulated Bacteria. Clin Infect Dis 2023; 76:800-808. [PMID: 36285530 DOI: 10.1093/cid/ciac842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/08/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Primary immunodeficiencies (PIDs) in adults are mainly revealed by recurrent and/or severe bacterial infections. The objective of this study was to evaluate a systematic research strategy of PIDs in adults with unexplained bacterial infections, with a special focus on specific polysaccharide antibody deficiency (SPAD). METHODS In this prospective multicenter study, inclusion criteria were recurrent benign upper and lower respiratory tract infections (RTIs) for at least two years (group 1), at least one upper or lower RTI requiring hospitalization (group 2), and/or at least one invasive infection documented with encapsulated bacteria (group 3). Main exclusion criteria were all local and general conditions that could explain infections. If no PID diagnosis was made, response to polysaccharide antigens was assessed using a pneumococcal polysaccharide vaccine. RESULTS From March 2015 to March 2020, 118 patients were included (37 males, median age of 41 years): 73, 17, and 28 in groups 1, 2, and 3, respectively. Forty-seven PIDs were diagnosed, giving an estimated frequency of 39.8% (95% confidence interval [CI] [30.4, 48.8]). SPAD was the most frequent diagnosis by far (n = 37/47, 78.7%), and was made in 23, 5, and 9 patients from groups 1 to 3, respectively. All SPAD patients received conjugate vaccines and, according to their infectious history, were on surveillance or treated with preventive antibiotics (n = 6) and/or with immunoglobulins replacement therapy (n = 10), the latter being dramatically efficient in all cases. CONCLUSIONS Considering its high prevalence among adults with unexplained recurrent and/or severe bacterial infections, SPAD should be screened in those patients. CLINICAL TRIALS REGISTRATION NCT02972281.
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Affiliation(s)
- Sarah Stabler
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
| | - Catherine Lamblin
- Département de pneumologie, Hôpital privé La Louvière, Lille, France
| | - Sacha Gaillard
- Département de pneumologie, Clinique Tessier, Valenciennes, France
| | - Nicolas Just
- Département de pneumologie, CH Roubaix, Roubaix, France
| | | | - Nathalie Viget
- Département de maladies infectieuses et tropicales, CH Tourcoing, Tourcoing, France
| | - Thierno Sy Ndiaye
- Département de médecine interne, CH d'Armentières, Armentières, France
| | - Arnaud Dzeing Ella
- Département de maladies infectieuses et tropicales, médecine interne et polyvalente, CH Denain, Denain, France
| | - Guillaume Brunin
- Département de réanimation, CH Boulogne, Boulogne Sur Mer, France
| | - Pierre Weyrich
- Département de maladies infectieuses, Groupement Hospitalier de l'Institut Catholique de Lille, Lille, France
| | - Anne Prevotat
- Département de pneumologie, CHU Lille, Lille, France
| | | | - Olivier Le Rouzic
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
- Département de pneumologie, CHU Lille, Lille, France
| | | | - Fanny Vuotto
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
| | - Karine Faure
- Département de maladies infectieuses et tropicales, CHU Lille, Lille, France
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
| | - Amélie Leurs
- Département de médecine interne et maladies infectieuses, CH Dunkerque, Dunkerque, France
| | | | | | - Marie Titecat
- Laboratoire de Bactériologie, CHU Lille, Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
| | - Rémi Le Guern
- Université Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017-CIIL-Center for Infection and Immunity of Lille, Lille, France
- Laboratoire de Bactériologie, CHU Lille, Lille, France
| | - Eric Hachulla
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Sébastien Sanges
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Nicolas Etienne
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Louis Terriou
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - David Launay
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
| | | | - Mathilde Bahuaud
- Laboratoire d'immunologie, CHU Cochin-Hôtel Dieu-Broca, Paris, France
| | - Frédéric Batteux
- Laboratoire d'immunologie, CHU Cochin-Hôtel Dieu-Broca, Paris, France
| | - Sylvain Dubucquoi
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
| | | | - Myriam Labalette
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
| | - Guillaume Lefèvre
- Département de médecine interne et immunologie clinique, CHU Lille, Lille, France
- Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Université de Lille, U1286 INFINITE, Institut de recherche translationnelle sur l'inflammation, Lille, France
- Institut d'Immunologie, CHU Lille, Lille, France
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Astouati Q, Provot F, Farhat MM, Launay D, Sanges S. Use of avacopan in severe forms of ANCA-associated vasculitis. Comment on "Inhibiting C5a/C5aR to treat ANCA-associated vasculitides" by Terrier et al. Joint Bone Spine 2023;90:105472. Joint Bone Spine 2023; 90:105522. [PMID: 36623800 DOI: 10.1016/j.jbspin.2023.105522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Quentin Astouati
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - François Provot
- CHU de Lille, Nephrology, Dialysis and Transplantation Department, 59000 Lille, France
| | - Meryem-Maud Farhat
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - David Launay
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France; Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; INSERM, F-59000 Lille, France
| | - Sébastien Sanges
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France; Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France; Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France; INSERM, F-59000 Lille, France.
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12
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Hadjadj J, Canzian A, Karadag O, Contis A, Maurier F, Sanges S, Sartorelli S, Denis L, de Moreuil C, Durel CA, Durupt S, Jachiet M, Rouzaud D, Salvarani C, Padoan R, Dagna L, Bonnet F, Agard C, Moulinet T, Hermet M, Sterpu R, Maria ATJ, Keraen J, Guillevin L, Jayne D, Terrier B. Use of biologics to treat relapsing and/or refractory polyarteritis nodosa: data from a European collaborative study. Rheumatology (Oxford) 2022; 62:341-346. [PMID: 35686919 DOI: 10.1093/rheumatology/keac332] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To describe the effectiveness and safety of biologics for the treatment of relapsing and/or refractory polyarteritis nodosa (PAN). METHODS A retrospective European collaborative study was conducted in patients with PAN who received biologics for relapsing and/or refractory disease. RESULTS Forty-two patients with PAN received a total of 53 biologic courses, including TNF-α blockers in 15 cases, rituximab (RTX) in 18 cases, tocilizumab (TCZ) in 10 cases and other biologics in 10 cases. TNF-α blockers and TCZ were mainly used for refractory diseases whereas RTX was mainly initiated for relapsing disease. After a median follow-up of 29 (8-50) months, remission, partial response, treatment failure and treatment discontinuation due to severe adverse events occurred in, respectively, 40%, 13%, 40% and 7% of patients receiving TNF-α blockers, 50%, none, 30% and 20% of TCZ recipients, and 33%, 11%, 56% and none of the RTX recipients. No remission was noted in patients treated with other biologics. Severe adverse events were observed in 14 (28%) patients without significant differences between the three biologics, leading to early biologics discontinuation in only three cases. CONCLUSION These results suggest that TCZ may be effective in relapsing and/or refractory PAN. Our data warrant further study to confirm these findings.
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Affiliation(s)
- Jérome Hadjadj
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Canzian
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - Omer Karadag
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Vasculitis Research Centre, Hacettepe University, Ankara, Turkey
| | - Anne Contis
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, Bordeaux
| | - François Maurier
- Department of Internal Medicine and Immunology, Groupe Hospitalier UNEOS, Metz-Vantoux
| | - Sébastien Sanges
- Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille, France
| | - Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | - Stéphane Durupt
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon.,Service de Médecine Interne, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite
| | | | - Diane Rouzaud
- Département de Médecine Interne, Hôpital Bichat, Université de Paris, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carlo Salvarani
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Azienda Unità Sanitaria Locale di Reggio Emilia-Istituto di Ricerca e Cura a Carattere Scientifico, Reggio Emilia
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Fabrice Bonnet
- Department of Internal Medicine and Infectious Diseases, Bordeaux University Hospital, Saint André Hospital, Bordeaux
| | - Christian Agard
- Internal Medicine Department, Nantes Université, CHU Nantes, Nantes
| | - Thomas Moulinet
- Department of Internal Medicine and Clinical Immunology, Center de Compétence des Maladies Autoimmunes Systémiques Rares, CHU Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France; UMR 7365, IMoPA, University of Lorraine, CNRS, Nancy
| | - Marion Hermet
- Service de Médecine Interne, Centre Hospitalier, Vichy
| | - Raluca Sterpu
- Service de Médecine Interne, Immunologie Clinique, Médecine Aigüe Polyvalente, Hôpital Antoine-Béclère-AP-HP, Clamart
| | - Alexandre Thibault Jacques Maria
- Department of Internal Medicine and Multiorgan Diseases, Referral Center for Auto-immune Diseases, Saint-Eloi Hospital Montpellier University, Montpellier
| | - Jérémy Keraen
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Loic Guillevin
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
| | - David Jayne
- Service de Médecine Interne, Centre Hospitalier Cornouaille, Quimper, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, AP-HP, APHP-CUP, Hôpital Cochin, Paris, France
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13
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Sanges S, Rice L, Tu L, Valenzi E, Cracowski JL, Montani D, Mantero J, Ternynck C, Marot G, Bujor AM, Hachulla É, Launay D, Humbert M, Guignabert C, Lafyatis R. Biomarkers of haemodynamic severity of systemic sclerosis-associated pulmonary arterial hypertension by serum proteome analysis. Ann Rheum Dis 2022; 82:365-373. [PMID: 36600187 PMCID: PMC9918672 DOI: 10.1136/ard-2022-223237] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To mine the serum proteome of patients with systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) and to detect biomarkers that may assist in earlier and more effective diagnosis and treatment. METHODS Patients with limited cutaneous SSc, no extensive interstitial lung disease and no PAH-specific therapy were included. They were classified as cases if they had PAH confirmed by right heart catheterisation (RHC) and serum collected on the same day as RHC; and as controls if they had no clinical evidence of PAH. RESULTS Patients were mostly middle-aged females with anticentromere-associated SSc. Among 1129 proteins assessed by a high-throughput proteomic assay (SOMAscan), only 2 were differentially expressed and correlated significantly with pulmonary vascular resistance (PVR) in SSc-PAH patients (n=15): chemerin (ρ=0.62, p=0.01) and SET (ρ=0.62, p=0.01). To validate these results, serum levels of chemerin were measured by ELISA in an independent cohort. Chemerin levels were confirmed to be significantly higher (p=0.01) and correlate with PVR (ρ=0.42, p=0.04) in SSc-PAH patients (n=24). Chemerin mRNA expression was detected in fibroblasts, pulmonary artery smooth muscle cells (PA-SMCs)/pericytes and mesothelial cells in SSc-PAH lungs by single-cell RNA-sequencing. Confocal immunofluorescence revealed increased expression of a chemerin receptor, CMKLR1, on SSc-PAH PA-SMCs. SSc-PAH serum seemed to induce higher PA-SMC proliferation than serum from SSc patients without PAH. This difference appeared neutralised when adding the CMKLR1 inhibitor α-NETA. CONCLUSION Chemerin seems an interesting surrogate biomarker for PVR in SSc-PAH. Increased chemerin serum levels and CMKLR1 expression by PA-SMCs may contribute to SSc-PAH pathogenesis by inducing PA-SMC proliferation.
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Affiliation(s)
- Sébastien Sanges
- Boston University School of Medicine, E5 Arthritis Center, Boston, Massachusetts, USA .,Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.,INSERM, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Lisa Rice
- Boston University School of Medicine, E5 Arthritis Center, Boston, MA, USA
| | - Ly Tu
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Eleanor Valenzi
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - David Montani
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France,AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Julio Mantero
- Boston University School of Medicine, E5 Arthritis Center, Boston, MA, USA
| | - Camille Ternynck
- Univ. Lille, CHU Lille, ULR2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France
| | - Guillemette Marot
- Univ. Lille, CHU Lille, ULR2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France,Inria ,MODAL: MOdels for Data Analysis and Learning, F-59000 Lille, France,Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, UAR 2014 - US 41 -PLBS, bilille, F-59000 Lille, France
| | - Andreea M. Bujor
- Boston University School of Medicine, E5 Arthritis Center, Boston, MA, USA
| | - Éric Hachulla
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, F-59000 Lille, France,INSERM, F-59000 Lille, France,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France,Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - David Launay
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, F-59000 Lille, France,INSERM, F-59000 Lille, France,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France,Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Marc Humbert
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France,AP-HP, Department of Respiratory and Intensive Care Medicine, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Christophe Guignabert
- Université Paris Saclay, School of Medicine, Le Kremlin-Bicêtre, France,INSERM UMR_S 999, Hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - Robert Lafyatis
- Division of Rheumatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Chepy A, Benarab S, Dezoteux F, Azib S, Launay D, Sanges S, Staumont-Sallé D, Crinquette M. Profil clinique des vascularites urticariennes anatomopathologiques : étude rétrospective. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Puigrenier S, Giovannelli J, Lamblin N, De Groote P, Fertin M, Bervar JF, Lamer A, Edmé JL, Balquet MH, Sobanski V, Launay D, Hachulla É, Sanges S. Mild pulmonary hemodynamic alterations in patients with systemic sclerosis: relevance of the new 2022 ESC/ERS definition of pulmonary hypertension and impact on mortality. Respir Res 2022; 23:284. [PMID: 36243869 PMCID: PMC9571468 DOI: 10.1186/s12931-022-02205-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background and objective The definition of pre-capillary pulmonary hypertension (PH) has been modified, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg and addition of a mandatory criterion of pulmonary vascular resistance (PVR) ≥ 2 Wood units (WU). Our objectives were: 1/ to estimate the proportion of patients reclassified as having pre-capillary PH when using the new 2022 ESC/ERS hemodynamic criteria (i.e. mPAP 21-24 mmHg and PVR ≥ 2 WU), and to describe their clinical characteristics and outcome; and 2/ to study the relationship between PVR and survival in patients with mPAP > 20 mmHg. Methods We retrospectively analyzed consecutive SSc patients included in our National Reference Center for a first right-heart catheterization between 2003 and 2018. The association between survival and PVR was studied using smoothing splines. Results We included 126 SSc patients with mPAP > 20 mmHg. Among them, 16 (13%) had a baseline mPAP value between 21 and 24 mmHg and PVR ≥ 2 mmHg and were reclassified as pre-capillary PH; 10 of which (62%) raised their mPAP ≥ 25 mmHg during follow-up. In patients with mPAP > 20 mmHg, we observed a linear relation between PVR and mortality for values < 6 WU. Conclusion A significant proportion of SSc patients is reclassified as having pre-capillary PH with the new 2022 ESC/ERS hemodynamic definition. Lowering the PVR threshold from 3 to 2 WU captures patients at risk of raising their mPAP > 25 mmHg, with a possibly less severe disease. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02205-4.
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Affiliation(s)
- Sébastien Puigrenier
- CHU Lille, Service de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), 59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000, Lille, France.,CH Boulogne-Sur-Mer, Service de Médecine Et Néphrologie, 62200, Boulogne-Sur-Mer, France
| | | | - Nicolas Lamblin
- CHU Lille, Service de Cardiologie, 59000, Lille, France.,Institut Pasteur de Lille, Inserm U1167, 59000, Lille, France
| | - Pascal De Groote
- CHU Lille, Service de Cardiologie, 59000, Lille, France.,Institut Pasteur de Lille, Inserm U1167, 59000, Lille, France
| | - Marie Fertin
- CHU Lille, Service de Cardiologie, 59000, Lille, France.,Institut Pasteur de Lille, Inserm U1167, 59000, Lille, France
| | | | - Antoine Lamer
- Univ. Lille, CHU Lille, ULR 2694-METRICS: Évaluation Des Technologies de Santé Et Des Pratiques Médicales, 59000, Lille, France
| | - Jean-Louis Edmé
- Service Des Explorations Fonctionnelles Respiratoires, CHU Lille, 59000, Lille, France.,EA 4483-IMPECS-IMPact de L'Environnement Chimique Sur La Santé Humaine, Univ. Lille, 59000, Lille, France
| | | | - Vincent Sobanski
- CHU Lille, Service de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), 59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000, Lille, France.,Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France.,, 59000, Lille, France
| | - David Launay
- CHU Lille, Service de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), 59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000, Lille, France.,Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France.,, 59000, Lille, France
| | - Éric Hachulla
- CHU Lille, Service de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), 59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000, Lille, France.,Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France.,, 59000, Lille, France
| | - Sébastien Sanges
- CHU Lille, Service de Médecine Interne Et Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes Systémiques Rares du Nord Et Nord-Ouest de France (CeRAINO), 59000, Lille, France. .,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), 59000, Lille, France. .,Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000, Lille, France. .,, 59000, Lille, France.
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16
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Sanges S, Guerrier T, Duhamel A, Guilbert L, Hauspie C, Largy A, Balden M, Podevin C, Lefèvre G, Jendoubi M, Speca S, Hachulla É, Sobanski V, Dubucquoi S, Launay D. Soluble markers of B cell activation suggest a role of B cells in the pathogenesis of systemic sclerosis-associated pulmonary arterial hypertension. Front Immunol 2022; 13:954007. [PMID: 35967377 PMCID: PMC9374103 DOI: 10.3389/fimmu.2022.954007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Soluble markers of B cell activation are interesting diagnostic and prognostic tools in autoimmune diseases. Data in systemic sclerosis (SSc) are scarce and few studies focused on their association with disease characteristics. Methods 1. Serum levels of 14 B cell biomarkers (β2-microglobulin, rheumatoid factor (RF), immunoglobulins (Ig) G, IgA, IgM, BAFF, APRIL, soluble (s)TACI, sBCMA sCD21, sCD23, sCD25, sCD27, CXCL13) were measured in SSc patients and healthy controls (HC). 2. Associations between these biomarkers and SSc characteristics were assessed. 3. The pathophysiological relevance of identified associations was explored by studying protein production in B cell culture supernatant. Results In a discovery panel of 80 SSc patients encompassing the broad spectrum of disease manifestations, we observed a higher frequency of RF positivity, and increased levels of β2-microglobulin, IgG and CXCL13 compared with HC. We found significant associations between several biomarkers and SSc characteristics related to disease phenotype, activity and severity. Especially, serum IgG levels were associated with pulmonary hypertension (PH); β2-microglobulin with Nt-pro-BNP and DLCO; and BAFF with peak tricuspid regurgitation velocity (TRV). In a validation cohort of limited cutaneous SSc patients without extensive ILD, we observed lower serum IgG levels, and higher β2-microglobulin, sBCMA, sCD23 and sCD27 levels in patients with pulmonary arterial hypertension (PAH). BAFF levels strongly correlated with Nt-pro-BNP levels, FVC/DLCO ratio and peak TRV in SSc-PAH patients. Cultured SSc B cells showed increased production of various angiogenic factors (angiogenin, angiopoietin-1, VEGFR-1, PDGF-AA, MMP-8, TIMP-1, L-selectin) and decreased production of angiopoietin-2 compared to HC. Conclusion Soluble markers of B cell activation could be relevant tools to assess organ involvements, activity and severity in SSc. Their associations with PAH could plead for a role of B cell activation in the pathogenesis of pulmonary microangiopathy. B cells may contribute to SSc vasculopathy through production of angiogenic mediators.
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Affiliation(s)
- Sébastien Sanges
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Thomas Guerrier
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, ULR2694 – METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Lucile Guilbert
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Carine Hauspie
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Alexis Largy
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Maïté Balden
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Céline Podevin
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
| | - Guillaume Lefèvre
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - Manel Jendoubi
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Silvia Speca
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
| | - Éric Hachulla
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Sylvain Dubucquoi
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Institut d’Immunologie, Lille, France
| | - David Launay
- Univ. Lille, U1286 – INFINITE – Institute for Translational Research in Inflammation, Lille, France
- INSERM, Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France
- Centre National de Référence Maladies Auto-immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Yelnik CM, Martin C, Ledoult E, Sanges S, Sobanski V, Farhat M, Morell-Dubois S, Maillard H, Drumez E, Launay D, Hachulla E, Lambert M. Dyslipidemia is insufficiently treated in antiphospholipid syndrome patients. Lupus 2022; 31:1379-1384. [PMID: 35822929 DOI: 10.1177/09612033221114275] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although dyslipidemia is a strong risk factor for thrombosis in antiphospholipid syndrome (APS), it has been poorly studied. This study aimed to assess lipids profile and risk factors for unachieved cholesterol levels in a real-life APS population. METHODS Inclusion criteria were: APS diagnosis according to international classification criteria, referring to the out-patients clinic of our tertiary care center for their follow-up, and having a blood sample collection for lipids levels determination. Cholesterol level targets for each patient were defined according to 2019 ESC/EAS guidelines for the management of dyslipidemia. RESULTS Between January 2020 and April 2021, 114 APS patients were included (male 37 (32.5%); mean age 49 ± 14 years). Among them, 40 (35.1%) had a history of dyslipidemia, 48 (42.1%) were under lipid-lowering therapies, and 59 (51.8%) had a history of cardiovascular disease (CVD). Mean levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglyceride were, respectively, 110 ± 40 mg/dL, 60±20 mg/dL, and 120 (80-190) mg/dL. Unachieved LDL-C levels were found in 77 (67.5%) patients of whom 53 had history of CVD. Overall, 90 (78.9%) had protective HDL-C and 31 (27.2%) had hypertriglyceridemia. In the multivariate analysis, independent risk factors for unachieved LDL-C levels were older age and history of CVD; triple aPL negativity, defined as complete disappearance of aPL over time in APS patients who were previously positive in accordance to international criteria, was an independent protective factor for unachieved LDL-C. CONCLUSION Our finding suggested that dyslipidemia is frequent in APS patients and mainly insufficiently treated, especially in patients with history of CVD, who are at highest risk of future CV events.
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Affiliation(s)
- Cécile M Yelnik
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, UMR 1167, RID-AGE, Lille, France
| | - Claire Martin
- 27023University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Emmanuel Ledoult
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Sébastien Sanges
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Vincent Sobanski
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Meryem Farhat
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Sandrine Morell-Dubois
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France
| | - Hélène Maillard
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France
| | - Elodie Drumez
- 27023University of Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - David Launay
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Eric Hachulla
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, U1286, INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Marc Lambert
- 27023University of Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), Lille, France.,INSERM, UMR 1167, RID-AGE, Lille, France
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18
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Ledoult E, Jendoubi M, Collet A, Guerrier T, Largy A, Speca S, Vivier S, Bray F, Figeac M, Hachulla E, Labalette M, Leprêtre F, Sebda S, Sanges S, Rolando C, Sobanski V, Dubucquoi S, Launay D. Simple gene signature to assess murine fibroblast polarization. Sci Rep 2022; 12:11748. [PMID: 35817787 PMCID: PMC9273630 DOI: 10.1038/s41598-022-15640-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/27/2022] [Indexed: 11/09/2022] Open
Abstract
We provide an original multi-stage approach identifying a gene signature to assess murine fibroblast polarization. Prototypic polarizations (inflammatory/fibrotic) were induced by seeded mouse embryonic fibroblasts (MEFs) with TNFα or TGFß1, respectively. The transcriptomic and proteomic profiles were obtained by RNA microarray and LC-MS/MS. Gene Ontology and pathways analysis were performed among the differentially expressed genes (DEGs) and proteins (DEPs). Balb/c mice underwent daily intradermal injections of HOCl (or PBS) as an experimental murine model of inflammation-mediated fibrosis in a time-dependent manner. As results, 1456 and 2215 DEGs, and 289 and 233 DEPs were respectively found in MEFs in response to TNFα or TGFß1, respectively. Among the most significant pathways, we combined 26 representative genes to encompass the proinflammatory and profibrotic polarizations of fibroblasts. Based on principal component analysis, this signature deciphered baseline state, proinflammatory polarization, and profibrotic polarization as accurately as RNA microarray and LC-MS/MS did. Then, we assessed the gene signature on dermal fibroblasts isolated from the experimental murine model. We observed a proinflammatory polarization at day 7, and a mixture of a proinflammatory and profibrotic polarizations at day 42 in line with histological findings. Our approach provides a small-size and convenient gene signature to assess murine fibroblast polarization.
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Affiliation(s)
- Emmanuel Ledoult
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France. .,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France. .,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France.
| | - Manel Jendoubi
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France
| | - Aurore Collet
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France
| | - Thomas Guerrier
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Laboratoire d'Immunologie, Pole Biologie et d'Anatomopathologie, CHU Lille, 59000, Lille, France
| | - Alexis Largy
- INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France
| | - Silvia Speca
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France
| | - Solange Vivier
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France
| | - Fabrice Bray
- CNRS, UAR 3290 - MSAP - Miniaturisation Pour La Synthèse, Univ. Lille, l'Analyse et la Protéomique, 59000, Lille, France
| | - Martin Figeac
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Univ. Lille, 59000, Lille, France
| | - Eric Hachulla
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France
| | - Myriam Labalette
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Laboratoire d'Immunologie, Pole Biologie et d'Anatomopathologie, CHU Lille, 59000, Lille, France
| | - Frédéric Leprêtre
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Univ. Lille, 59000, Lille, France
| | - Shéhérazade Sebda
- CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, US 41 - UMS 2014 - PLBS, Univ. Lille, 59000, Lille, France
| | - Sébastien Sanges
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France
| | - Christian Rolando
- CNRS, UAR 3290 - MSAP - Miniaturisation Pour La Synthèse, Univ. Lille, l'Analyse et la Protéomique, 59000, Lille, France.,Shrieking Sixties, 1-3 Allée Lavoisier, 59650, Villeneuve-d'Ascq, France
| | - Vincent Sobanski
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France.,Institut Universitaire de France (IUF), 75005, Paris, France
| | - Sylvain Dubucquoi
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Laboratoire d'Immunologie, Pole Biologie et d'Anatomopathologie, CHU Lille, 59000, Lille, France
| | - David Launay
- Inserm, U1286, 4Ème Étage Centre, Place Verdun, 59000, Lille, France.,INFINITE - Institute for Translational Research in Inflammation, Univ. Lille, 59000, Lille, France.,Service de Médecine Interne et d'Immunologie Clinique, Centre de Référence Des Maladies Auto-Immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, 59000, Lille, France
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19
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Delapierre A, Terrier B, Pillebout E, Baudart P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Le Gouellec N, Raffray L, Urbanski G, Sanges S, Maurier F, Deroux A, Mekinian A, Monteiro R, Marcelli C, Guillevin L, Maillot F, Lucas B, Aouba A, Audemard-Verger A. Clinical phenotype and cytokine profile of adult IgA vasculitis with joint involvement. Clin Rheumatol 2022; 41:1483-1491. [PMID: 35041109 DOI: 10.1007/s10067-021-05937-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Joint involvement can be observed during the course of adult IgA vasculitis (IgAV). However, clinical picture, prognosis, or pathophysiological data associated with this condition have been overlooked. We aimed to describe the clinical characteristics and outcome of IgAV patients with joint involvement and look to a specific cytokine profile. METHODS We analyzed clinical and biological data from a nationwide study that included adult IgAV patients. Presentation and outcomes of patients with or without joint involvement were compared at baseline and during follow-up. Plasma cytokine measurements of IgAV patients included in a prospective study were also analyzed using multiplex assays. RESULTS Among 260 patients, 62% had joint involvement. Among them, rheumatological manifestations included arthralgia (100%) or arthritis (16%), mostly involving the knees and ankles. In multivariate analysis, patients with joint involvement, compared to those without, were younger (p = 0.002; OR 0.87; 95% CI 0.80-0.95) and showed more frequent gastrointestinal tract involvement (p = 0.012; OR = 2.08; 95% CI 1.18-3.67). However, no difference in terms of clinical response, relapse, end-stage renal disease, or death was observed between groups. Among 13 cytokines measured, plasma interleukin (IL)-1β level was higher in patients with joint involvement compared to those without (mean ± SEM IL-1β, 3.5 ± 1.2 vs. 0.47 ± 0.1 pg/ml; p = 0.024) or healthy controls (vs. 1.2 ± 0.5 pg/ml; p = 0.076). CONCLUSION Joint involvement is frequent in adult IgAV and is associated with more frequent gastrointestinal involvement. Increased plasma IL-1β levels raise the question of targeting this cytokine in patients with chronic and/or refractory joint involvement. Key Points • Joint involvement in adult IgAV is a frequent manifestation. • Joint involvement is associated with more frequent gastrointestinal manifestations. • Interleukin-1β (IL-1β) might orchestrate joint inflammation in adult IgAV. • IL-1β might be a therapeutic target in patients with chronic and/or refractory joint involvement.
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Affiliation(s)
- Alice Delapierre
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Benjamin Terrier
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Pauline Baudart
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM, INRA, Centre de Néphrologie Et Transplantation Rénale, CHU de La Conception, AP-HM, Marseille, France
| | - Bertrand Lioger
- Department of Internal Medicine, Hôpital Saint Louis, APHP, Paris, France
| | - Nihal Martis
- Department of Internal Medicine, CHU, Nice, France
| | | | | | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Valenciennes, CH, France
| | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion, France
| | | | - Sébastien Sanges
- Département de Médecine Interne Et Immunologie Clinique, CHU Lille, 59000, Lille, France.,Univ. Lille, INSERM, U995 - LIRIC - Lille Inflammation Research International Center, Lille, France
| | | | - Alban Deroux
- Department of Internal Medicine, CHU de Grenoble, Grenoble, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Renato Monteiro
- Center of Research On Inflammation INSERM U1149, CNRS ERL8252, Paris Diderot University, Paris, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie UNIV, UNICAEN, CHU de Caen Normandie, 14 000, Caen, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Bruno Lucas
- Paris Descartes University, Cochin Institute, CNRS UMR8104, INSERM U1016, Paris, France
| | - Achille Aouba
- Department of Internal Medicine and Clinical Immunology, Normandie Univ, UNICAEN, CHU de Caen Normandie, 14000, Caen, France
| | - Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France. .,University of Tours, Tours, France.
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20
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Koether V, Silvestri V, Landel JB, Schurtz G, Sanges S. [Aortic et coronary lesions]. Rev Med Interne 2022; 43:189-191. [PMID: 35012787 DOI: 10.1016/j.revmed.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/24/2021] [Indexed: 11/16/2022]
Affiliation(s)
- V Koether
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, 59000 Lille, France; INSERM, U1286, 59000 Lille, France; CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), France
| | - V Silvestri
- Département de radiologie cardiovasculaire, institut Cœur Poumon, centre hospitalier universitaire de Lille, Lille, France
| | - J B Landel
- Hôpital Privé La Louvière, Lille, France
| | - G Schurtz
- Centre hémodynamique et service des soins intensifs de cardiologie, institut Cœur Poumon, centre hospitalier universitaire de Lille, Lille, France
| | - S Sanges
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, 59000 Lille, France; INSERM, U1286, 59000 Lille, France; CHU de Lille, département de médecine interne et immunologie clinique, 59000 Lille, France; Centre national de référence maladies systémiques et auto-immunes rares (sclérodermie systémique), 59000 Lille, France; Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), France.
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21
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Perrard N, Stabler S, Sanges S, Terriou L, Launay D, Vuotto F, Chenivesse C, Hachulla E, Labalette M, Lefèvre G. Circonstances diagnostiques et caractéristiques des déficits sélectifs en anticorps anti-polysaccharides : à propos d’une cohorte régionale de 52 patients adultes. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Antoine P, Terriou L, Lefèvre G, Kannengiesser C, Sanges S, Launay D, Sobanski V, Hachulla É, Louvet A, Willemin MC, Renaut-Marceau A, Lainey E, Sicre de Fontbrune F, Farhat MM. [Telomeropathies: A study of 15 cases]. Rev Med Interne 2021; 43:3-8. [PMID: 34649755 DOI: 10.1016/j.revmed.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/24/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Telomeres are composed of a repeated sequence of double-stranded nucleotides TTAGGG and numerous proteins including the Shelterin complex. Their main role is to maintain the stability of the genome during cell replication through a mechanism of copying the repeted sequence by the telomerase complexe. All the diseases involving a deregulation of this complex are now grouped together under the term telomeropathies. They are difficult to diagnose and manage. Our objective was to describe the clinico-biological characteristics and treatments used, in patients affected by telomeropathies previously seen by an hematologist followed at the Lille University Hospital Center. METHODS This is a retrospective, single-center study carried out within the department of internal medicine-clinical immunology, Reference center for rare autoimmune and systemic diseases at Lille University Hospital Center between 2005 and 2020 including all patients followed for telomeropathy. RESULTS Probands and relatives were included. Fifteen patients were studied from 10 independant families. Sixty percent had an heterozygous TERC gene mutation. Sixty seven percent had haematological diseases including macrocytosis, anemia and/or thrombocytopenia, 20 % had a fibrotic hepatic disease, 27 % had a fibrotic pulmonary disease. Lymphocyte immunophenotyping showed a double negative T lymphocyte population with γδ TCR expression in 5 (33 %) patients. Forty-seven percent of the patients had not received any treatment. Twenty-seven percent were on androgen therapy. Twenty percent had received cyclosporine and 13 % anti-lymphocyte serum in the context of initial misdiagnosis. CONCLUSION It is important to be aware of the complexity of telomeropathies, a differential diagnosis of immune aplastic anemia, in order to optimize management and avoid inappropriate treatments. Allografting of hematopoietic stem cells is the only potentially curative treatment. Our analysis found particularities in immunophenotyping lymphocyte not previously described to our knowledge, whose physiopathological imputability remains to be demonstrated.
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Affiliation(s)
- P Antoine
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - L Terriou
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - G Lefèvre
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France; Centre de référence national des syndromes hyperéosinophiliques (CEREO), institut d'immunologie, Université de Lille, CHU de Lille, Lille, France
| | - C Kannengiesser
- Département de génétique, pôle de biologie, AP-HP, hôpital Bichat, université de Paris, 1152 Paris, France
| | - S Sanges
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - D Launay
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - V Sobanski
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - É Hachulla
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France
| | - A Louvet
- Service des maladies de l'appareil digestif, hôpital Claude-Huriez, CHU de Lille, Lille, France
| | - M-C Willemin
- Pneumologie et oncologie thoracique, université de Lille, Inserm U1019, CHU de Lille, CIIL, Institut Pasteur, 59000 Lille, France; MESOCLIN-réseau national des centres cliniques experts pour la prise en charge des mésothéliomes pleuraux malins, domiciliation du centre coordinateur national, CHU de Lille, 59000 Lille, France
| | - A Renaut-Marceau
- Université de Lille, CNRS, Inserm, CHU de Lille, UMR9020-U1277 - CANTHER-Cancer Heterogeneity Plasticity and Resistance to Therapies, 59000 Lille, France
| | - E Lainey
- Service d'hématologie biologique, hôpital Robert-Debré, APHP, UMRS_1131, institut universitaire d'hématologie, Paris, France
| | - F Sicre de Fontbrune
- Service d'hématologie greffe, centre de référence aplasie médullaire, Assistance publique des Hôpitaux de Paris, hôpital Saint-Louis, Paris, France
| | - M-M Farhat
- Université de. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Service de médecine interne et immunologie clinique, centre de référence des maladies auto-immunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), CHU de Lille, 59000 Lille, France.
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23
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Baverez C, Sanges S. Poumon sclérodermique, quelles nouveautés ? Rev Med Interne 2021; 42:10S3-10S8. [PMID: 34598748 DOI: 10.1016/s0248-8663(21)00656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- C Baverez
- Service de médecine interne, Hospices civils de Lyon, 3, quai des Célestins, 69002 Lyon, France
| | - S Sanges
- Département de médecine interne et immunologie clinique, CHU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
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24
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Mercuzot C, Debien B, Riviere É, Martis N, Sanges S, Galland J, Kouchit Y, Fesler P, Roubille C. Impact of a simulation-based training on the experience of the beginning of residency. Rev Med Interne 2021; 42:756-763. [PMID: 34303548 DOI: 10.1016/j.revmed.2021.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/16/2021] [Accepted: 07/04/2021] [Indexed: 01/24/2023]
Abstract
INTRODUCTION We aimed to evaluate the impact of an immersive simulation session on the experience of the beginning of residency. METHODS The interventional group consisted of newly recruited residents in 2019, who participated in the workshop presenting four emergency scenarios frequently encountered during night shifts; the control group comprised residents who had begun their internship in 2018, without having participated in the simulation workshop. The level of psychological stress and self-confidence were self-estimated in the simulation group before and immediately after the workshop. During the second semester of residency, stress, self-efficacy and anxiety were evaluated in both groups with the Perceived Stress Scale (PSS), General Self-efficacy Scale (GSES), and Generalized Anxiety Disorder-7 (GAD-7) scale. RESULTS In the second semester 2020, the PSS, GSES and GAD-7 were 20.71±8.15 and 22.44±5.68 (P=0.40); 26.88±6.30 and 27.11±3.95 (P=0.87); 6.94±5.25 and 8.89±4.78 (P=0.22) for the simulation (n=17, 89.5% of participation) and control (n=9, 75%) groups, respectively. In the simulation group, the level of self-confidence had significantly improved from 1.82±0.95 before the session to 2.29±1.16 after the session (P=0.05). Interestingly, this improvement in self-confidence was significantly correlated with GAD-7 (P=0.014) and PSS (P=0.05), and tended to be correlated with GSES (P=0.09). CONCLUSION Our study showed a significant improvement in self-confidence between before and after the simulation session. Residents who experienced an improvement in self-confidence saw their stress and anxiety levels decrease during the second semester reevaluation, in favor of a prolonged benefit from the session.
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Affiliation(s)
- C Mercuzot
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France
| | - B Debien
- Medical simulation training center, Montpellier University, Montpellier, France
| | - É Riviere
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, University Hospital Centre of Bordeaux, 33600 Pessac, France; Inserm U1034, Bordeaux University, 33604 Pessac cedex, France
| | - N Martis
- Côte d'Azur University, Nice, France; Department of Internal Medicine, University Hospital of Nice, Nice, France; CNRS UMR7275, Non Coding Genome & Lung Disorders, Institute of Molecular and Cellular Pharmacology, Valbonne, France
| | - S Sanges
- UFR Médecine, Centre de Simulation PRESAGE, University Lille, 59000 Lille, France; Inserm, U1286 - INFINITE - Institute for Translational Research in Inflammation, CHU de Lille, University Lille, 59000 Lille, France; Département de Médecine Interne et Immunologie Clinique, CHU de Lille, 59037 Lille cedex, France
| | - J Galland
- Department of Internal medicine, Lariboisière Hospital, AP-HP, Paris, France; University of Paris, Paris, France
| | - Y Kouchit
- Côte d'Azur University, Nice, France; Department of Internal Medicine, University Hospital of Nice, Nice, France
| | - P Fesler
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, University of Montpellier, Montpellier, cedex 5, France
| | - C Roubille
- Department of Internal medicine, Montpellier University Hospital, Montpellier, France; Inserm U1046, CNRS UMR 9214, PhyMedExp, University of Montpellier, Montpellier, cedex 5, France.
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25
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Launay D, Sanges S, Sobanski V. Time for precision medicine in systemic sclerosis-associated pulmonary arterial hypertension. Eur Respir J 2021; 57:57/6/2100205. [PMID: 34168056 DOI: 10.1183/13993003.00205-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/05/2022]
Affiliation(s)
- David Launay
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France .,Inserm, Lille, France.,CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Sébastien Sanges
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France
| | - Vincent Sobanski
- Univ. Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), Lille, France.,Institut Universitaire de France (IUF), Lille, France
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Nicolas A, Launay D, Duprez C, Citerne I, Morell-Dubois S, Sobanski V, Hachulla É, Staumont-Sallé D, Farhat MM, Sanges S. [Impact of disease on daily activities, emotions and quality of life of patients with hereditary angioedema]. Rev Med Interne 2021; 42:608-615. [PMID: 34158189 DOI: 10.1016/j.revmed.2021.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hereditary angioedema (HAE) is characterized by recurrent attacks of swelling of various locations and severity. An impaired quality of life of patients with HAE has been reported by several studies. We aimed at examining the overall impact of the disease in patients followed for type I HAE, particularly its impact on daily life activities, emotions and quality of life. METHODS A questionnaire was distributed to patients consulting for type I HAE, collecting demographics, disease characteristics, impact on professional life, Hospital Anxiety and Depression score (HAD), SF-36 score and the McMaster Toronto Arthritis Patient Preference Disability Questionnaire (MACTAR). RESULTS The 33 patients included reported an average of 5.17 attacks over the last year. Stress was the main trigger A long-term treatment was reported by 58% of patients, 72% received specific treatment in the event of a serious attack. Sick days were reported by 33% of patients during their studies, and by 34% during work. One patient suffered from depressive symptoms and ten from anxious symptoms, according to the HAD score. The areas most impacted on the SF-36 score were general health and vitality. The mean score for MACTAR was low. CONCLUSION HAE still has a significant impact on the daily and emotional lives of patients, despite the availability of prophylactic and crisis treatments.
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Affiliation(s)
- A Nicolas
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; Centre de référence des angiœdèmes à Kinines, 59000 Lille, France
| | - D Launay
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; Centre de référence des angiœdèmes à Kinines, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France
| | - C Duprez
- University Lille, UMR 9193 - SCALab - sciences cognitives et sciences affectives, 59000 Lille, France
| | - I Citerne
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; Centre de référence des angiœdèmes à Kinines, 59000 Lille, France
| | - S Morell-Dubois
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France
| | - V Sobanski
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France
| | - É Hachulla
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France
| | - D Staumont-Sallé
- Centre de référence des angiœdèmes à Kinines, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France; Département de dermatologie, CHU Lille, 59000 Lille, France
| | - M-M Farhat
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; Centre de référence des angiœdèmes à Kinines, 59000 Lille, France
| | - S Sanges
- Département de médecine interne et immunologie clinique, CHU Lille, 59000 Lille, France; Centre de référence des angiœdèmes à Kinines, 59000 Lille, France; University Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, 59000 Lille, France; Inserm, 59000 Lille, France.
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27
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Escure G, Nudel M, Terriou L, Farhat M, Launay D, Staumont Salle D, Hachulla E, Gautier S, Sanges S. Tolérance des médicaments inducteurs de crises d’angiœdème bradykinique chez les patients atteints de déficit acquis en C1-inhibiteur : série de cas et revue de la littérature. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Ducrocq Q, Guédon L, Launay D, Terriou L, Morell-Dubois S, Maillard H, Lefèvre G, Sobanski V, Lambert M, Yelnik C, Hachulla E, Farhat M, Garcia Fernandez M, Sanges S. Activités de recours et de recherche d’un service de Médecine Interne : une place pour la télémédecine, au-delà de la pandémie COVID-19 ? Rev Med Interne 2021. [PMCID: PMC8192034 DOI: 10.1016/j.revmed.2021.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Les services de Médecine Interne mènent une importante activité de recours expert et de recherche, grevée par plusieurs obstacles. L’activité d’avis spécialisés est chronophage, non valorisée, et limitée par l’impossibilité d’échanger simplement les éléments du dossier médical. L’activité de recherche clinique est limitée par la fréquence des visites protocolaires. L’objectif de ce travail est de déterminer si la télémédecine (TLM) peut contribuer à résoudre ces difficultés. Patients et méthodes Concernant l’activité de recours, nous avons demandé aux médecins de déclarer les avis donnés à l’aide d’un formulaire standardisé, afin de déterminer s’ils validaient les critères de téléconsultation (TLC) ou de télé-expertise (TLE). Concernant l’activité de recherche, nous avons remis aux investigateurs et à 50 patients un questionnaire sur l’acceptabilité de TLC protocolaires. Résultats Concernant l’activité de recours, on dénombrait 120 avis (soit 21 h) hebdomadaires, dont 29 % aux patients et 69 % à des médecins. Soixante et un pour cent des avis aux patients validaient les critères de TLC ; 18 % des avis aux médecins ceux de TLE. Concernant l’activité de recherche, 70 % des investigateurs considéraient la fréquence des visites comme limitant les inclusions ; près de la moitié des patients serait favorable au recours à des TLC à la place (40 %) ou en plus (56 %) des visites présentielles. En termes de facturation, la TLM représente un revenu potentiel de 300 € hebdomadaires pour le TLE et 616€ hebdomadaires pour le TLC. Conclusion Si le recours à la TLM comme procédure dégradée au présentiel s’est démocratisé avec la pandémie, les solutions qu’elle apporte aux difficultés rencontrées dans les activités d’avis et de recherche peuvent contribuer à intégrer pleinement son usage dans le suivi standard des patients. Si tel était le cas, on pourrait tout à fait imaginer avec ce budget (47 632 €/an) pouvoir financer un praticien hospitalier supplémentaire à temps partiel.
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Nicolas A, Launay D, Christelle D, Isabelle C, Sandrine M, Sobanski V, Hachulla E, Staumont D, Farhat M, Sanges S. Impact de l’angiœdème héréditaire sur les activités de la vie quotidienne, la sphère émotionnelle et la qualité de vie des patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Farhat MM, Guerreschi P, Morell-Dubois S, Deken V, Labreuche J, Sanges S, Sobanski V, Hachulla E, Cottencin O, Launay D. POS1454-HPR AESTHETIC IMPAIRMENT IN PATIENTS WITH SYSTEMIC SCLEROSIS: A CASE CONTROL STUDY USING A SEMI-QUANTITATIVE SCALE FOR BODY IMAGE ASSESSMENT. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic sclerosis (SSc) is a fibrotic autoimmune disease characterized by dermatological involvement. Skin involvement can alter appearance, which can have a psychological impact(1). Assessment of body image could be central in optimizing care. Yet, data are scarce(2).Objectives:The main objective of our study was to assess aesthetic impairment measured on a visual aesthetic scale (AES) (3) in patients with SSc compared to a group of healthy subjects. Secondary objectives were to assess associations between aesthetic impairment and standardized questionnaires for aesthetic impairment as well as clinical, biological, psychological/quality of life, and functional parameters of SSc.Methods:The “Sclero-esthet” study is a descriptive single-center study of two populations: patients with SSc, included in a referral center for systemic and autoimmune diseases at Lille Hospital, France, and healthy controls.Results:This study, from January 2017 to October 2017, included 88 patients (69 [78.4%] women) with a median age of 52 years (range: 43 to 59) and 88 controls (49 [55.7%] women) with a median age of 45 years (range: 32 to 55). Perception of physical changes assessed using the AES was greater in cases than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p=0.028), with statistical correlation with ASWAP. SSc patients with anxiety or depressive symptoms had significantly higher AES scores. Cases presented poorer quality of life than controls.Conclusion:The AES appears to be a good tool to evaluate aesthetic impairment. Correlations found with psychological and quality of life parameters support the need to improve patient management in this field.References:[1]Cash TF. Body image: past, present, and future. Body Image 2004;1(1):1–5.[2]Benrud-Larson LM, Heinberg LJ, Boling C, Reed J, White B, Wigley FM. Body image dissatisfaction among women with scleroderma: extent and relationship to psychosocial function. Health Psychol mars. 2003;22(2):130–9.[3]Nguyen C, Ranque B, Baubet T, Bérezné A, Mestre-Stanislas C, Rannou F, et al. Clinical, Functional and Health-Related Quality of Life Correlates of Clinically Significant Symptoms of Anxiety and Depression in Patients with Systemic Sclerosis: A Cross-Sectional Survey. PLoS ONE 2014;9(2).[4]Heinberg LJ, Kudel I, White B, Kwan A, Medley K, Wigley F. Assessing body image in patients with systemic sclerosis (scleroderma): Validation of the Adapted Satisfaction with Appearance Scale. Body Image 2007;4(1):79–86.Disclosure of Interests:None declared
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Audemard-Verger A, Pillebout E, Amoura Z, Cacoub P, Jourde-Chiche N, Lioger B, Martis N, Moulis G, Rivière E, Baldolli A, Girard C, Goutte J, Gouellec NL, Raffray L, Urbanski G, Sanges S, Maurier F, Thervet E, Aouba A, Guillevin L, Maillot F, Terrier B. Gastrointestinal involvement in adult IgA vasculitis (Henoch-Schönlein purpura): updated picture from a French multicentre and retrospective series of 260 cases. Rheumatology (Oxford) 2021; 59:3050-3057. [PMID: 32211770 DOI: 10.1093/rheumatology/keaa104] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/20/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To describe the clinical presentation, treatments and prognosis of gastrointestinal (GI) involvement in adult IgA vasculitis (IgAV). METHODS Data from 260 adults with IgAV included in a French multicentre retrospective survey were analysed. Presentation and outcomes of patients with (GI+) and without (GI-) GI involvement were compared. RESULTS One hundred and thirty-seven (53%) patients had GI involvement. Initial manifestations were abdominal pain in 99%, intestinal bleeding in 31%, diarrhoea in 26% and acute surgical abdomen in only 4%. Abdominal imaging revealed thickening of intestinal wall in 61%, and endoscopies revealed abnormalities in 87%, mostly mucosal ulcerations. GI+ vs GI- patients were younger (46 ± 18 vs 54 ± 18 years; P = 0.0004), had more constitutional symptoms (43% vs 23%; P = 0.0005) and joint involvement (72 vs 50%; P = 0.0002), and higher CRP levels (3.7 vs 1.9 mg/dl; P = 0.001). Clinical response and relapse rates were comparable between groups, and all causes mortality (2 vs 4%) and IgAV-related mortality (1% vs 2%) as well. GI-related deaths were due to intestinal perforation and mesenteric ischaemia. CONCLUSION GI involvement is frequent in adult IgAV. GI involvement is frequent in adult IgAV. Mortality is not uncommon but does not seem to be specifically related to GI. Immunosuppressants should not be preferred as first-line therapy for GI+ patients but may be required in case of acute surgical abdomen.
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Affiliation(s)
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP)
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpétrière.,Inflammation-Immunopathology-Biotherapy Department (DHU i2B), UMR 7211, UPMC Université Paris 06, Sorbonne Universités, Paris
| | | | - Bertrand Lioger
- Department of Internal Medicine, Hopital Saint Louis, APHP, Paris
| | | | | | | | | | | | - Julie Goutte
- Department of Internal Medicine, CHU, Saint-Etienne
| | | | - Loïc Raffray
- Department of Internal Medicine, CHU, La Réunion
| | | | - Sébastien Sanges
- Département de Médecine Interne et Immunologie Clinique, CHU.,University Lille, INSERM, U995-LIRIC-Lille Inflammation Research International Centre, Lille
| | | | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP.,Université Paris Descartes
| | | | - Loïc Guillevin
- Department of Internal Medicine.,Université Paris Descartes.,National Referral Centre for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, University of Tours, Tours
| | - Benjamin Terrier
- Department of Internal Medicine.,Université Paris Descartes.,National Referral Centre for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
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Audemard-Verger A, Pillebout E, Baldolli A, Gouellec NL, Augusto JF, Jourde-Chiche N, Raffray L, Thervet E, Deroux A, Goutte J, Hummel A, Lioger B, Sanges S, Cacoub P, Amoura Z, Moulis G, Maurier F, Lavigne C, Urbanski G, Chanal J, Faguer S, Deriaz S, Feirreira-Maldent N, Diot E, Maillot F, Guillevin L, Terrier B. Impact of aging on phenotype and prognosis in IgA vasculitis. Rheumatology (Oxford) 2021; 60:4245-4251. [PMID: 33410479 DOI: 10.1093/rheumatology/keaa921] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Immunoglobulin A vasculitis (IgAV) is a small-vessel vasculitis most frequently benign in children while the disease is more severe in adults. We aimed to study the impact of age on presentation and outcome of adult IgAV. METHODS We conducted a nationwide retrospective study including 260 IgAV patients. Patients were divided into four quartiles according to the age at IgAV diagnosis: <36; 36≤age < 52; 52≤age < 63 and ≥63 years. Comparison of presentation and outcome were performed according to age of disease onset. RESULTS Mean age at diagnosis was 50.1 ± 18 years and 63% were male. IgAV diagnosed in the lowest quartile of age was associated with more frequent joint (p< 0.0001) and gastrointestinal involvement (p= 0.001). In contrast, the oldest patients had more severe purpura with necrotic lesions (p= 0.001) and more frequent renal involvement (p< 0.0001), with more frequent hematuria, renal failure, higher urine protein excretion and more frequent tubulointerstitial lesions. Patients were treated similarly in all groups of age, and clinical response and relapse rates were similar between groups. In the 127 treated patients with follow-up data for >6 months, clinical response and relapse rates were similar between the four groups. Median follow-up was of 17.2 months (9.1-38.3 months). Renal failure at the end of follow-up was significantly more frequent in the highest quartile of age (p= 0.02), but the occurrence of end-stage renal disease was similar in all groups. Last, overall and IgAV-related deaths were associated with increase age. CONCLUSION Aging negatively impacts the severity and outcome of IgAV in adults. Younger patients have more frequent joint and gastrointestinal involvement, while old patients display more frequent severe purpura and glomerulonephritis.
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Affiliation(s)
- Alexandra Audemard-Verger
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France
| | | | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, CH de Valenciennes, Valenciennes, France
| | | | - Noémie Jourde-Chiche
- Aix-Marseille Université, C2VN, INSERM, INRAE, Department of Nephrology, AP-HM, Marseille, France
| | - Loic Raffray
- Department of Internal Medicine, CHU de la Réunion, La Réunion, France.,Université de La Réunion, UMR Processus Infectieux en Milieu Insulaire Tropical (PIMIT), INSERM 1187, CNRS 9192, IRD 249, France La Réunion
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Alban Deroux
- Department of Internal Medicine, CHU de Grenoble, Grenoble, France
| | - Julie Goutte
- Department of Internal Medicine, CHU de St Etienne, St Etienne, France
| | - Aurélie Hummel
- Department of Nephrology, Hôpital Necker, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Bertrand Lioger
- Department of Internal Medicine, Hopital de Blois, Blois, France
| | - Sébastien Sanges
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, France, Lille
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpétrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DHU i2B), UMR 7211, UPMC Université Paris 06, Sorbonne Universités, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Guillaume Moulis
- Department of of Internal Medicine, CHU de Toulouse, Toulouse, France.,Clinical Investigation Center 1436, Toulouse University hospital, Toulouse, France
| | | | | | | | - Johan Chanal
- Department of Dermatology, Hôpital Tarnier, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, CHU de Toulouse, Toulouse, France
| | - Sophie Deriaz
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France
| | | | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France
| | - Francois Maillot
- Department of Internal Medicine and Clinical Immunology, CHRU Tours, Tours, France.,University of Tours, Tours, France
| | - Loïc Guillevin
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Université Paris Descartes, Paris, France.,Department of Internal Medicine, Hôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
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Sanges S, Jeanpierre E, Lopez B, Russick J, Delignat S, Carpentier B, Dubois R, Dubucquoi S, Guerrier T, Hachulla É, Hatron PY, Paris C, Susen S, Launay D, Lacroix-Desmazes S, Terriou L. Acquired Hemophilia A in IgG4-Related Disease: Case Report, Immunopathogenic Study, and Review of the Literature. Front Immunol 2020; 11:558811. [PMID: 33424828 PMCID: PMC7793697 DOI: 10.3389/fimmu.2020.558811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/16/2020] [Indexed: 12/24/2022] Open
Abstract
We report the observation of a 75-year-old patient referred for cervical lymphadenopathies. A pre-lymphadenectomy blood work revealed an asymptomatic elevation of aPTT with low factor VIII (FVIII) levels and high anti-FVIII antibodies titers, consistent with acquired hemophilia A (AHA). Histological work-up of a cervical lymphadenopathy revealed benign follicular hyperplasia with IgG4+ lymphoplasmacytic infiltration; and serum IgG4 levels were markedly elevated, compatible with IgG4-related disease (IgG4-RD). He was successfully treated with a 9-month course of prednisone, secondarily associated with rituximab when an AHA relapse occurred. As this patient presented with an unusual association of rare diseases, we wondered whether there was a link between the two conditions. Our first hypothesis was that the anti-FVIII autoantibodies could be directly produced by the proliferating IgG4+ plasma cells as a result of broken tolerance to autologous FVIII. To test this assumption, we determined the anti-FVIII IgG subclasses in our patient and in a control group of 11 AHA patients without IgG4-RD. The FVIII inhibitor was mostly IgG4, with an anti-FVIII IgG4/IgG1 ratio of 42 at diagnosis and 268 at relapse in our patient; similar values were observed in non-IgG4-RD AHA patients. As a second hypothesis, we considered whether the anti-FVIII activity could be the result of a non-specific autoantibody production due to polyclonal IgG4+ plasma cell proliferation. To test this hypothesis, we measured the anti-FVIII IgG4/total IgG4 ratio in our patient, as well as in several control groups: 11 AHA patients without IgG4-RD, 8 IgG4-RD patients without AHA, and 11 healthy controls. We found that the median [min-max] ratio was higher in AHA-only controls (2.4 10-2 [5.7 10-4-1.79 10-1]), an oligoclonal setting in which only anti-FVIII plasma cells proliferate, than in IgG4-RD-only controls (3.0 10-5 [2.0 10-5-6.0 10-5]), a polyclonal setting in which all IgG4+ plasma cells proliferate equally. Our patient had intermediate ratio values (2.7 10-3 at diagnosis and 1.0 10-3 at relapse), which could plead for a combination of both mechanisms. Although no definitive conclusion can be drawn, we hypothesized that the anti-FVIII autoantibody production in our IgG4-RD AHA patient could be the result of both broken tolerance to FVIII and bystander polyclonal IgG4+ plasma cell proliferation.
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Affiliation(s)
- Sébastien Sanges
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Emmanuelle Jeanpierre
- CHU Lille, Institut d'Hématologie Transfusion, Lille, France.,INSERM, U1011, Univ. Lille, U1011-EGID, Institut Pasteur de Lille, Lille, France
| | | | - Jules Russick
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | - Sandrine Delignat
- Centre de recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, Paris, France
| | | | | | - Sylvain Dubucquoi
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Institut d'Immunologie, Lille, France
| | - Thomas Guerrier
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Institut d'Immunologie, Lille, France
| | - Éric Hachulla
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Pierre-Yves Hatron
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Camille Paris
- CHU Lille, Institut d'Hématologie Transfusion, Lille, France.,INSERM, U1011, Univ. Lille, U1011-EGID, Institut Pasteur de Lille, Lille, France
| | - Sophie Susen
- CHU Lille, Institut d'Hématologie Transfusion, Lille, France.,INSERM, U1011, Univ. Lille, U1011-EGID, Institut Pasteur de Lille, Lille, France
| | - David Launay
- Univ. Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France.,Inserm, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | | | - Louis Terriou
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Sanges S, Rice L, Tu L, Cracowski J, Montani D, Mantero J, Ternynck C, Marot G, Hachulla E, Launay D, Humbert M, Guignabert C, Lafyatis R. Identification de biomarqueurs de sévérité hémodynamique de l’hypertension artérielle pulmonaire associée à la sclérodermie systémique par analyse du protéome sérique. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sanges S, Farhat MM, Assaraf M, Galland J, Rivière E, Roubille C, Lambert M, Yelnik C, Maillard H, Sobanski V, Lefèvre G, Launay D, Morell-Dubois S, Hachulla E. Raising rare disease awareness using red flags, role play simulation and patient educators: results of a novel educational workshop on Raynaud phenomenon and systemic sclerosis. Orphanet J Rare Dis 2020; 15:159. [PMID: 32576213 PMCID: PMC7310378 DOI: 10.1186/s13023-020-01439-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As lack of awareness of rare diseases (RDs) among healthcare professionals results in delayed diagnoses, there is a need for a more efficient approach to RD training during academic education. We designed an experimental workshop that used role-play simulation with patient educators and focused on teaching "red flags" that should raise the suspicion of an RD when faced with a patient with frequently encountered symptoms. Our objective was to report our experience, and to assess the improvement in learners' knowledge and the satisfaction levels of the participants. RESULTS The workshop consisted of 2 simulated consultations that both started with the same frequent symptom (Raynaud phenomenon, RP) but led to different diagnoses: a frequent condition (idiopathic RP) and an RD (systemic sclerosis, SSc). In the second simulated consultation, the role of the patient was played by a patient educator with SSc. By juxtaposing 2 seemingly similar situations, the training particularly highlighted the elements that help differentiate SSc from idiopathic RP. When answering a clinical case exam about RP and SSc, students that had participated in the workshop had a higher mean mark than those who had not (14 ± 3.7 vs 9.6 ± 5.5 points out of 20, p = 0.001). Participants mostly felt "very satisfied" with this training (94%), and "more comfortable" about managing idiopathic RP and SSc (100%). They considered the workshop "not very stressful" and "very formative" (both 71%). When asked about the strengths of this training, they mentioned the benefits of being put in an immersive situation, allowing a better acquisition of practical skills and a more interactive exchange with teachers, as well as the confrontation with a real patient, leading to a better retention of semiological findings and associating a relational component with this experience. CONCLUSIONS Through the use of innovative educational methods, such as role-play simulation and patient educators, and by focusing on teaching "red flags", our workshop successfully improved RP and SSc learning in a way that satisfied students. By modifying the workshop's scenarios, its template can readily be applied to other clinical situations, making it an interesting tool to teach other RDs.
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Affiliation(s)
- S Sanges
- Centre de Simulation PRESAGE, Univ. Lille, UFR Médecine, F-59000, Lille, France. .,Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France. .,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France. .,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France. .,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France.
| | - M-M Farhat
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - M Assaraf
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France
| | - J Galland
- Service de médecine interne, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, F-75010, Paris, France.,Université de Paris Diderot, F-75010, Paris, France
| | - E Rivière
- Service de médecine interne et maladies infectieuses, CHU de Bordeaux, F-33600, Pessac, France.,Centre de simulation SimBA-S de Bordeaux, CHU de Bordeaux et Université de Bordeaux, F-33000, Bordeaux, France
| | - C Roubille
- Département de médecine interne, CHU de Montpellier, hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, F-34295, Montpellier, France.,PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Cedex 5, Montpellier, France
| | - M Lambert
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - C Yelnik
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - H Maillard
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - V Sobanski
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - G Lefèvre
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France.,CHU Lille, Institut d'Immunologie, F-59000, Lille, France
| | - D Launay
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - S Morell-Dubois
- Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - E Hachulla
- Univ. Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, F-59037, Lille Cedex, France.,Centre National de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Oust de France (CeRAINO), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Sanges S, Morell-Dubois S, Farhat MM, Assaraf M, Lambert M, Sobanski V, Launay D, Hachlla E. AB1273 TEACHING RARE DISEASES THROUGH ROLE PLAY: RESULTS OF AN EXPERIMENTAL WORKSHOP ON RAYNAUD PHENOMENON. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Systemic autoimmune diseases are mostly taught through theoretical lectures, which do not allow for the acquisition of physical examination skills and semiologic confrontation.Objectives:We report herein the results of a pilot experiment using role-play to teach how to manage patients with Raynaud phenomenon (RP).Methods:We developed a workshop that consisted of two 30-minute OSCE (Objective and Structured Clinical Examination) stations. Students were divided into groups of 4 to 5 persons. On each station, 2 students were actors and 2 were observers. After a short briefing, students played a 15-minute scenario and then had a 15-minute debriefing.The first station simulated the case of a 26-year old woman referred for suspected RP. Students were instructed to perform clinical history taking and physical examination of the patient, formulated relevant diagnosis hypotheses and prescribe any additional necessary exams. Students had to suspect the diagnosis of idiopathic RP. The simulated patient was played by a trained facilitator with expertise on RP.The second station simulated the case of a 56-year-old woman referred for RP complicated by digital ulcers. Students received the same instructions as before. They had to suspect the diagnosis of systemic sclerosis. The patient role was held by a real patient with systemic sclerosis, followed by the physician who was supervising the station, who had received prior training and who agreed to participate in this training.At the end of the workshop, the students had to complete a satisfaction questionnaire.Results:A total of 21 students participated in the workshop and 17 completed the survey. The students were “very satisfied” (Likert 4/4) of this training in 94%. They considered this workshop “not very stressful” (Likert 2/4) and “very formative” (Likert 4/4) in 71%, but “a little short” (Likert 2/4) in 88%. After taking this training, all students felt “a little” (Likert 3/4, 24%) or “much more comfortable” (Likert 4/4, 76%) to manage patients with idiopathic RP; and “a little” (Likert 3/4, 65%) or “much more comfortable” (Likert 4/4, 35%) to manage patients with systemic sclerosis. All would recommend this workshop to other students.When asked about the strengths of this training, the students mentioned the benefits of being put in an immersive situation, which allowed for a better acquisition of practical skills (especially physical examination) and a more interactive exchange with teachers; as well as the confrontation with a real patient, which allowed for a better retention of semiologic findings and associated a relational component to this experience. The main weak points reported were its short duration and the stress induced by being observed during the simulation.Conclusion:This workshop suggests the interest and feasibility on a small group of students of a rare diseases awareness workshop using role-play. The evaluation of its pedagogical efficiency and its generalization on large student promotions are being considered.Acknowledgments:NoneDisclosure of Interests:Sebastien SANGES: None declared, Sandrine Morell-Dubois: None declared, Meryem-Maud Farhat: None declared, Morgane Assaraf: None declared, Marc Lambert: None declared, Vincent Sobanski: None declared, David Launay Grant/research support from: Dr. Launay reports personal fees from Actelion, grants and personal fees from Takeda, grants and personal fees from CSL Behring, outside the submitted work., Eric Hachlla: None declared
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Sanges S, Rice L, Tu L, Cracowski JL, Montani D, Mantero J, Ternynck C, Marot G, Hachlla E, Launay D, Humbert M, Guignabert C, Lafyatis R. FRI0590 BIOMARKERS OF HEMODYNAMIC SEVERITY OF SYSTEMIC-SCLEROSIS ASSOCIATED PULMONARY ARTERIAL HYPERTENSION BY SERUM PROTEOME ANALYSIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:To investigate alterations in the serum proteome of patients with systemic sclerosis (SSc)-associated pulmonary hypertension (PAH), to identify proteins that correlated with hemodynamic severity and to determine their possible pathogenic role.Methods:Patients were included if they fulfilled the following criteria: diagnosis of limited cutaneous SSc, no extensive interstitial lung disease (ILD), and no treatment with PAH-specific therapy. Patients were classified as cases if they had a definitive diagnosis of PAH confirmed by right heart catheterization (RHC) and a serum sample collected on the same day as RHC. They were classified as controls if they had no sign suggestive of PAH on echocardiography.Results:In a first exploratory step, serum expression of 1129 proteins was assessed in 15 cases and 16 controls by a high-throughput proteomic assay (SOMAscan). We identified 53 proteins differentially expressed between the 2 groups. Among these 53 candidates, only 2 correlated significantly with pulmonary vascular resistance (PVR): chemerin (p=0.01,ρ=0.62) and SET nuclear proto-oncogen (SET) (p=0.01,ρ=0.62).To validate these results, serum levels of chemerin and SET were measured by ELISA assay in 25 additional cases and 19 additional controls. Chemerin levels were confirmed to be significantly higher in cases (p=0.01) and correlated with PVR (p=0.01,ρ=0.46).In a second step, to study the potential pathophysiological role of chemerin, we performed confocal immunofluorescence analyses on explanted lungs of healthy controls, SSc-ILD without PAH and SSc-PAH patients. Chemerin receptor, CMKLR1, was significantly increased on SSc-ILD and SSc-PAH pulmonary artery smooth muscle cells (PA-SMC).We then tested the effect of chemerin on PA-SMC proliferation by stimulating PA-SMCs from idiopathic pulmonary arterial hypertension (iPAH) patients with serum from SSc patients with and without PH, in the presence or absence of a CMKLR1 inhibitor. PA-SMCs from iPAH were confirmed to have higher mRNA expression of CMKLR1 than controls (p=0.03). Serum from SSc-PH patients induced a significantly higher PA-SMC proliferation (p=0.005) than serum from controls. This difference was no longer significant (p=0.69) when adding the CMKLR1 inhibitor α–NETA.Conclusion:Chemerin is a surrogate biomarker for PVR in SSc-PAH. Increased chemerin and its receptor, CMKLR1, contribute to the SSc-PAH pathogenesis by inducing PA-SMC proliferation.Acknowledgments:NoneDisclosure of Interests:Sebastien SANGES: None declared, Lisa Rice: None declared, Ly Tu: None declared, Jean-Luc Cracowski Grant/research support from: JL Cracowski received grants from United Therapeutic, Bioprojet and Topadur, David Montani Grant/research support from: Dr. MONTANI reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, personal fees from MSD, personal fees from Chiesi, outside the submitted work, Julio Mantero: None declared, Camille Ternynck: None declared, Guillemette Marot: None declared, Eric Hachlla: None declared, David Launay Grant/research support from: Dr. Launay reports personal fees from Actelion, grants and personal fees from Takeda, grants and personal fees from CSL Behring, outside the submitted work., Marc Humbert Grant/research support from: Dr. Humbert reports personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from GSK, personal fees from Merck, from United Therapeutics, personal fees from Acceleron, outside the submitted work., Christophe Guignabert: None declared, Robert Lafyatis Grant/research support from: RL holds research grants from Formation, Elpidera and Kiniksa., Consultant of: R.L. has served as a consultant for Bristol Myers Squibb, Boehringer-Mannheim, Merck, Magenta and Genentech/Roche,
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Davion JB, Sanges S, Ghulam A, Lambert M, Morell-Dubois S, Yelnik C, Sobanski V, Hachulla E, Launay D, Douillard C. Low hormone levels during an attack of systemic capillary leak syndrome normalizing after treatment. Horm Mol Biol Clin Investig 2020; 41:hmbci-2020-0004. [PMID: 32432565 DOI: 10.1515/hmbci-2020-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022]
Abstract
We report herein the case of a patient with low blood levels of different hormones during a systemic capillary leak syndrome (Clarkson's disease) attack.
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Affiliation(s)
- Jean-Baptiste Davion
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
| | - Sébastien Sanges
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Amjad Ghulam
- Laboratoire de Biochimie et Hormonologie, Centre de Biologie Pathologie, Centre Hospitalier Régional Universitaire, 59037 Lille, France
| | - Marc Lambert
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Sandrine Morell-Dubois
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Cécile Yelnik
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Vincent Sobanski
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Eric Hachulla
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - David Launay
- Université de Lille, UFR Médecine, F-59000 Lille, France
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
- INSERM, U995, LIRIC - Lille Inflammation Research International Center, F-59000 Lille, France
- Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Claire Douillard
- Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude Huriez, Service D'Endocrinologie-Diabétologie-Métabolisme, 59037, Lille, France
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Galland J, Jaffrelot M, Sanges S, Fournier JP, Jouquan J, Chiniara G, Rivière É. [Introduction to debriefing for internists: how to transform real or simulated clinical situations into learning moments]. Rev Med Interne 2020; 41:536-544. [PMID: 32359818 DOI: 10.1016/j.revmed.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/18/2020] [Accepted: 03/06/2020] [Indexed: 01/09/2023]
Abstract
Debriefing is a phase of synthesis and reflection that immediately follows a real-life or simulated situation. It is an essential educational step that forces the learners to reflect upon the thought processes that underlie their actions. Debriefing encourages a personal and collective reflection in order to remodel erroneous mental schemas and rectify actions done in context. Debriefing cannot be improvised; it requires a sound structure and regular practice in order to be truly effective. The debriefer must be considerate, choose appropriate learning objectives and dedicate ample time to the learners. Debriefing is focused on learning acquired in context-in other words, on the actions that were performed within a real-life or simulated clinical practice situation-and immediately follows the situation. After an initial phase of emotional release, the debriefer will help learners analyse their actions to identify their underlying rationale (contextualization), extract the overarching principles related to the lived situation in order to modify the rationale if needed (decontextualization) and assist the transfer of learning to real life (in the case of simulation) and to similar situations (recontextualization). A final summary of learning achieved during the training session concludes the debriefing. Debriefing is useful in any learning situation, including in internal medicine. Even if simulation is still underused in internal medicine, post-event debriefing can be implanted in our clinical services. Indeed, training our students and shaping them into healthcare professionals rest in no small part on hospital rotations where the intern is confronted with real-patient situations that are suitable to learning. Some in-hospital clinical encounters can be actively transformed into learning opportunities thanks to post-event debriefing, but can also passively morph into bad daily practice if no supporting action is implemented. Debriefing can thus provide an opportunity to develop non-technical skills in critical situations, or doctor-patient communication skills, within a team or between colleagues. These competencies are the hallmark of well-trained interns and are indispensable for the proper functioning of a care team. We will not develop the emotional and psychological management of debriefing in this article. We hope we will helpfully introduce as many of our colleagues as possible to the art of debriefing in most circumstances.
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Affiliation(s)
- J Galland
- Service de médecine interne, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, F-75010 Paris, France; Université de Paris, Faculté de médecine Paris Diderot, F-75010 Paris, France.
| | - M Jaffrelot
- Expert-consultant en simulation et santé, Professeur associé au département d'anesthésiologie et de soins intensifs, Université Laval, Québec, Canada
| | - S Sanges
- Centre de Simulation PRESAGE, Université de Lille, UFR Médecine, F-59000 Lille, France; CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000 Lille, France
| | - J P Fournier
- Centre de simulation médicale de Nice, Université de Nice Sofia Antipolis, F-06107 Nice, France
| | - J Jouquan
- Equipe d'accueil EA4686 "Ethique, professionnalisme et santé", Université de Bretagne occidentale, 29609 Brest, France
| | - G Chiniara
- Directeur du département d'anesthésiologie et de soins intensifs (Université Laval, Québec, Canada) et titulaire de la chaire de leadership en enseignement de la simulation des sciences de la santé Université Laval - Université Côte d'Azur, Université Laval, Québec City, Québec, Canada
| | - É Rivière
- Service de médecine interne et maladies infectieuses, CHU de Bordeaux, F-33600 Pessac, France; 1 rue Hoffman Martinot, Université de Bordeaux, et CHU de Bordeaux, F-33000 Bordeaux, France.
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Bertolino J, Jouve E, Skopinski S, Agard C, Achille A, Thoreau B, Diot E, Sanges S, Berthier S, Chaigne B, Regent A, Martin T, Pugnet G, Benyamine A, Rossi P, Launay D, Mouthon L, Granel B. Caractéristiques des patients atteints de sclérodermie systémique souffrant d’une amputation d’un segment d’un membre inférieur. Étude collaborative au sein du GFRS. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Germain N, Sanges S, Vignes S, Seguy D, Etienne N, Terriou L, Launay D, Hachulla E, Huglo D, Labalette M, Lefèvre G. L’entéropathie exsudative, complication et/ou diagnostic différentiel du déficit immunitaire commun variable. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sanges S, Savale L, Lamblin N, Rémy-Jardin M, Humbert M, Sobanski V. Efficacy of immunosuppressants with bridge vasodilator therapy in severe lupus erythematosus-associated pulmonary arterial hypertension. ESC Heart Fail 2019; 6:1322-1325. [PMID: 31536678 PMCID: PMC6989275 DOI: 10.1002/ehf2.12507] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 01/08/2023] Open
Abstract
Optimal management of systemic lupus erythematosus (SLE)‐associated pulmonary arterial hypertension (PAH) remains unclear. Our observation describes the case of a 31‐year‐old SLE patient presenting with cardiogenic shock revealing severe PAH, in which a therapeutic scheme combining immunosuppressants (pulse cyclophosphamide and corticosteroids) and PAH‐specific drugs (bosentan, tadalafil, and epoprostenol) led to a complete normalization of pulmonary haemodynamics and allowed a progressive weaning of PAH vasodilators. This case report supports the efficacy of immunosuppressants and use of PAH‐specific therapy as a bridge therapy in severe SLE‐PAH. Further studies on larger population are required to confirm these findings.
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Affiliation(s)
- Sébastien Sanges
- UFR Médecine, Univ. Lille, F-59000, Lille, France.,INSERM, U995, LIRIC - Lille Inflammation Research International Center, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
| | - Laurent Savale
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France.,AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France.,INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - Nicolas Lamblin
- Univ. Lille, CHU Lille, Service de Cardiologie, Institut Pasteur, Lille, France
| | | | - Marc Humbert
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France.,AP-HP, Service de Pneumologie, DHU Thorax Innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, Paris, France.,INSERM U999, Centre Chirurgical Marie-Lannelongue, LabEx LERMIT, Le Plessis-Robinson, France
| | - Vincent Sobanski
- UFR Médecine, Univ. Lille, F-59000, Lille, France.,INSERM, U995, LIRIC - Lille Inflammation Research International Center, Lille, France.,Département de Médecine Interne et Immunologie Clinique, CHU Lille, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), Lille, France
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Sanges S, Morell-Dubois S, Farhat M, Assaraf M, Lambert M, Sobanski V, Launay D, Hachulla E. Enseignement des maladies rares par le jeu de rôle en santé : résultats d’une expérimentation pilote autour du phénomène de Raynaud. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sanges S, Jeanpierre E, Lopez B, Russick J, Delignat S, Dubois R, Hachulla E, Paris C, Susen S, Launay D, Lacroix-Desmazes S, Terriou L. Association hémophilie acquise et maladie associée aux IgG4 : présentation d’un cas et étude physiopathologique. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.03.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sanges S, Giovannelli J, Sobanski V, Morell-Dubois S, Maillard H, Lambert M, Podevin C, Lamblin N, De Groote P, Bervar JF, Perez T, Matran R, Rémy-Jardin M, Hatron PY, Hachulla É, Launay D. Factors associated with the 6-minute walk distance in patients with systemic sclerosis. Arthritis Res Ther 2017; 19:279. [PMID: 29246248 PMCID: PMC5732461 DOI: 10.1186/s13075-017-1489-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background There is an ongoing debate regarding the relevance of the 6-minute walking distance (6MWD) in systemic sclerosis (SSc) assessment, widely used as a usual test in these patients as well as an outcome measure in clinical trials. In this work, we aimed to assess the associations between the 6MWD and various disease parameters in patients with SSc. Methods Consecutive patients followed in our SSc National Reference Centre were included in this cross-sectional study if they fulfilled the 2013 American College of Rheumatology/European League Against Rheumatism criteria for SSc. Data were systematically collected during a comprehensive standardized evaluation that included a 6-minute walk test, clinical assessment, biological results, pulmonary function tests, transthoracic echocardiography, composite scores (European Scleroderma Study Group Activity Index, Medsger severity score, Health Assessment Questionnaire–Disability Index (HAQ-DI)) and treatments. Associations of the 6MWD with various disease parameters were assessed by linear regression in univariate and multivariate analyses. Results The study population comprised 298 patients (females 81%; mean age 58.2 ± 13.3 years; limited cutaneous SSc 82%; interstitial lung disease (ILD) 42%; pulmonary arterial hypertension (PAH) 6%). The 6MWD was significantly and independently associated with gender, age, body mass index, baseline heart rate (HR), HR variation during the test, PAH, history of arterial thrombosis and C-reactive protein levels, as well as with the HAQ-DI score in a sensitivity analysis. Muscle involvement, joint involvement and ILD were not independently associated with the 6MWD. Conclusions During SSc, the 6MWD is independently associated with initial HR and HR variation; with PAH but not ILD, suggesting that pulmonary vasculopathy may have a greater impact than parenchymal involvement on functional limitation; and with global markers of disease activity and patient disability. These results give clinicians further insight into how to interpret the 6MWD in the context of SSc. Electronic supplementary material The online version of this article (doi:10.1186/s13075-017-1489-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sébastien Sanges
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Jonathan Giovannelli
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Vincent Sobanski
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Sandrine Morell-Dubois
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Hélène Maillard
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Marc Lambert
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Céline Podevin
- CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France
| | | | | | | | - Thierry Perez
- CHU Lille, Service d'Explorations Fonctionnelles Respiratoires, F-59000, Lille, France
| | - Régis Matran
- CHU Lille, Service d'Explorations Fonctionnelles Respiratoires, F-59000, Lille, France
| | | | - Pierre-Yves Hatron
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - Éric Hachulla
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France.,INSERM U995, F-59000, Lille, France.,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France.,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France.,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France
| | - David Launay
- University of Lille, INSERM U995, LIRIC-Lille Inflammation Research International Center, F-59000, Lille, France. .,INSERM U995, F-59000, Lille, France. .,CHU Lille, Département de Médecine Interne et Immunologie Clinique, F-59000, Lille, France. .,Centre National de Référence Maladies Systémiques et Auto-immunes Rares (Sclérodermie Systémique), F-59000, Lille, France. .,Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000, Lille, France.
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Audemard-Verger A, Terrier B, Dechartres A, Chanal J, Amoura Z, Le Gouellec N, Cacoub P, Jourde-Chiche N, Urbanski G, Augusto JF, Moulis G, Raffray L, Deroux A, Hummel A, Lioger B, Catroux M, Faguer S, Goutte J, Martis N, Maurier F, Rivière E, Sanges S, Baldolli A, Costedoat-Chalumeau N, Roriz M, Puéchal X, André M, Lavigne C, Bienvenu B, Mekinian A, Zagdoun E, Girard C, Bérezné A, Guillevin L, Thervet E, Pillebout E. Characteristics and Management of IgA Vasculitis (Henoch-Schönlein) in Adults: Data From 260 Patients Included in a French Multicenter Retrospective Survey. Arthritis Rheumatol 2017; 69:1862-1870. [DOI: 10.1002/art.40178] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/08/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Alexandra Audemard-Verger
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Agnès Dechartres
- Center for Clinical Epidemiology, Hôtel Dieu, AP-HP; Paris France
| | - Johan Chanal
- Department of Dermatology, Hôpital Tarnier, AP-HP; Paris France
| | - Zahir Amoura
- Department of Internal Medicine, Hôpital Pitié-Salpétrière, AP-HP; Paris France
| | - Noémie Le Gouellec
- Department of Internal Medicine and Nephrology, Centre Hospitalier de Valenciennes; Valenciennes France
| | - Patrice Cacoub
- Department of Internal Medicine, Hôpital Pitié-Salpétrière, AP-HP; Paris France
| | | | - Geoffrey Urbanski
- Department of Internal Medicine and Vascular Disease, Centre Hospitalier Universitaire d'Angers; Angers France
| | | | - Guillaume Moulis
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Loic Raffray
- Department of Internal Medicine, Centre Hospitalier Universitaire de la Réunion; Réunion France
| | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble; Grenoble France
| | - Aurélie Hummel
- Department of Nephrology, Hôpital Necker, AP-HP; Paris France
| | - Bertrand Lioger
- Department of Internal Medicine, Centre Hospitalier Universitaire de Tours; Tours France
| | - Mélanie Catroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Poitiers; Poitiers France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Centre Hospitalier Universitaire de Toulouse; Toulouse France
| | - Julie Goutte
- Department of Internal Medicine, Centre Hospitalier Universitaire de St. Etienne; St. Etienne France
| | - Nihal Martis
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nice; Nice France
| | - François Maurier
- Department of Internal Medicine, Hôpitaux Privés de Metz; Metz France
| | - Etienne Rivière
- Department of Internal Medicine, Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Sébastien Sanges
- Centre Hospitalier Universitaire Lille, Département de Médecine Interne et Immunologie Clinique; Lille France
| | - Aurélie Baldolli
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen; Caen France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Mélanie Roriz
- Department of Internal Medicine, Centre Hospitalier Universitaire de Tours; Tours France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Marc André
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand; Clermont-Ferrand France
| | - Christian Lavigne
- Department of Internal Medicine and Vascular Disease, Centre Hospitalier Universitaire d'Angers; Angers France
| | - Boris Bienvenu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Caen; Caen France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital de Bondy, AP-HP; Paris France
| | - Elie Zagdoun
- Department of Nephrology, Centre Hospitalier de St. Lo; St. Lo France
| | - Charlotte Girard
- Department of Internal Medicine, Centre Hospitalier Universitaire de Lyon; Lyon France
| | - Alice Bérezné
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes; Paris France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes; Paris France
| | - Evangéline Pillebout
- Department of Nephrology, Hôpital Saint Louis, AP-HP, Université Paris Descartes; Paris France
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Sanges S, Wallet F, Blondiaux N, Theis D, Vérin I, Vachée A, Dessein R, Faure K, Viget N, Senneville E, Leroy O, Maury F, Just N, Poissy J, Mathieu D, Prévotat A, Chenivesse C, Scherpereel A, Smith G, Lopez B, Rosain J, Frémeaux-Bacchi V, Hachulla E, Hatron PY, Bahuaud M, Batteux F, Launay D, Labalette M, Lefèvre G. Diagnosis of primary antibody and complement deficiencies in young adults after a first invasive bacterial infection. Clin Microbiol Infect 2017; 23:576.e1-576.e5. [DOI: 10.1016/j.cmi.2017.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/28/2017] [Accepted: 02/04/2017] [Indexed: 01/29/2023]
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Sanges S, Riviere S, Mekinian A, Martin T, Le Quellec A, Chatelus E, Lescoat A, Quéméneur T, Deroux A, Hatron P, Hachulla E, Launay D. Utilisation des immunoglobulines intraveineuses au cours de la sclérodermie systémique : étude rétrospective multicentrique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Audemard A, Baldolli A, Amoura Z, Cacoub P, Sanges S, Maurier F, Lioger B, Martis N, Riviere E, Urbanski G, Pillebout E, Terrier B. Description et pronostic des atteintes digestives au cours de la vascularite à IgA de l’adulte. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Audemard A, Baldolli A, Le Gouellec N, Raffray L, Deroux A, Goutte J, Lioger B, Amoura Z, Cacoub P, Sanges S, Pillebout E, Terrier B. Impact de l’âge sur la présentation clinique et le pronostic au cours de la vascularite à IgA de l’adulte. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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