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Dumoulin N, Cormier G, Varin S, Coiffier G, Albert JD, Le Goff B, Darrieutort-Laffite C. Factors Associated With Clinical Improvement and the Disappearance of Calcifications After Ultrasound-Guided Percutaneous Lavage of Rotator Cuff Calcific Tendinopathy: A Post Hoc Analysis of a Randomized Controlled Trial. Am J Sports Med 2021; 49:883-891. [PMID: 33719606 DOI: 10.1177/0363546521992359] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Calcific tendinitis of the rotator cuff is a frequent cause of shoulder pain. Ultrasound-guided percutaneous lavage (UGPL) is an effective treatment, but factors associated with good clinical and radiological outcomes still need to be identified. PURPOSE To study the clinical, procedural, and radiological characteristics associated with improved shoulder function and the disappearance of calcification on radiograph after UGPL. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS This is a post hoc analysis of the CALCECHO trial, a double-blinded randomized controlled trial conducted on 132 patients. The trial assessed the effect of corticosteroid injections after UGPL, and patients were randomly assigned to receive either corticosteroid or saline solution in the subacromial bursa. We analyzed all patients included in the randomized controlled trial as 1 cohort. We collected the patients' clinical, procedural, and radiological characteristics at baseline and during follow-up (3, 6, and 12 months). Univariable analysis, followed by multivariable stepwise regression through forward elimination, was performed to identify the factors associated with clinical success (Disabilities of the Arm, Shoulder and Hand [DASH] score <15) or the disappearance of calcification. RESULTS Good clinical outcomes at 3 months were associated with steroid injections after the procedure (odd ratio [OR], 3.143; 95% CI, 1.105-8.94). At 6 months, good clinical evolution was associated with a lower DASH score at 3 months (OR, 0.92; 95% CI, 0.890-0.956) and calcium extraction (OR, 10.7; 95% CI, 1.791-63.927). A lower DASH at 6 months was also associated with a long-term favorable outcome at 12 months (OR, 0.939; 95% CI, 0.912-0.966). Disappearance of calcification at 3 and 12 months occurred more frequently in patients in whom communication was created between the calcification and the subacromial bursa during the procedure (OR, 2.728 [95% CI, 1.194-6.234] at 3 months; OR, 9.835 [95% CI, 1.977-48.931] at 12 months). Importantly, an association between calcification resorption and good clinical outcome was found at each time point. CONCLUSION Assessing patients at 3 months seems to be an essential part of their management strategy. Calcium extraction and creating a communication between the calcific deposits and subacromial bursa are procedural characteristics associated with good clinical and radiological evolution.
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Abstract
The ageing of the population leads health professionals to question the tolerance and the effectiveness of the different biotherapies used in autoimmune diseases. Due to the exponential increase of biotherapies and their indications, several studies have been carried out to evaluate their impact on elderly patients suffering from autoimmune disease. However, these studies are still too few to take into account all the different specificities of elderly patients and their comorbidities; prescribers are therefore hesitant with their introduction after 75 years or even 65. More than the age of patients, it is necessary to evaluate the comorbidities before introducing this kind of treatments. Every biotherapy has different indications and contraindications, which must be known to adapt each treatment to each patient. This focus aims to remind of the adaptations and contraindications of the different biological disease-modifying anti-rheumatic drugs for geriatric population, and improve their uses since the treatments for these patients are sometimes not enough. Here we resume the methods allowing supervisors to identify errors of clinical reasoning in medical students and interns and we explain remediation techniques adapted to the types of error identified. Access to short illustrative videos of a MOOC (Massive Open On line Course) devoted to the supervision of clinical reasoning constitutes practical help for supervisors who are not expert in the complexity of medical pedagogy at the bedside.
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Affiliation(s)
- A Michaut
- Service de Rhumatologie, Centre Hospitalier Départemental de Vendée, Boulevard Stéphane Moreau, 85000 La Roche-sur-Yon, France.
| | - S Varin
- Service de Rhumatologie, Centre Hospitalier Départemental de Vendée, Boulevard Stéphane Moreau, 85000 La Roche-sur-Yon, France
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Letarouilly JG, Pariente B, Staumont-Sallé D, Goupille P, Claudepierre P, Varin S, Lanot S, Dernis E, Pascart T, Banneville B, Baudart P, Gombert B, Bauer E, Plastaras L, Barbarot S, Felten R, Le Dantec L, Sultan-Bichat N, Girard C, Constantin A, Wendling D, Gaudin P, Jullien D, Pham T, Flipo RM. THU0393 INFLAMMATORY BOWEL DISEASES AMONG SECUKINUMAB-TREATED PATIENTS: 24 CASES FROM THE MISSIL REGISTRY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2516] [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:An alert regarding about the tolerance of Interleukin 17 (IL-17) inhibitors has been issued from data of randomized controlled trials showing cases of de novo inflammatory bowel diseases (IBD). In a recent analysis of pooled data from 21 clinical trials, cases of IBD events (including Crohn’s disease (CD), ulcerative colitis (UC) and inflammatory bowel disease unclassified (IBDU)) were uncommon (1). Yet, real-world data are lacking.Objectives:To describe real-world data about patients treated by IL-17 inhibitors developing new onset IBD (CD or UC).Methods:A French national registry called MISSIL was started in February 2018 to collect the cases of patients treated by IL-17 inhibitors developing new onset IBD. This registry is conducted by rheumatologist, dermatologist and gastroenterologist learned societies specialized on immune-mediated inflammatory diseases. In France, secukinumab (SEK) has been granted market authorization since June 2016 and ixekizumab since April 2018.Results:24 cases under SEK were reported between February 2018 and January 2020: 3 patients with psoriasis and 21 patients with spondylwoarthritis. There were 20 patients with new onset CD and 4 with UC. Mean age was 51.7 ± 15.7 years old and 12/24 were female; 10 presented an axial spondyloarthritis, 5 a peripheral spondyloarthritis and 6 both,13/17 were HLA-B27 positive,7/19 had a radiographic sacroiliitis and 11/17 a MRI sacroiliitis. Only 2 were biological Disease-modifying antirheumatic drug (bDMARD)-naïve. Crohn’s disease was mainly located at the ileum, colon and rectum. The median time to onset of symptoms was 2 (1-6) months. The main symptoms were diarrhea, nausea and vomiting and loss of weight. Median CRP at the onset of symptoms was 68 mg/L (41-140.5); 21 patients underwent biopsies, 12 were in favor of CD. IL-17 inhibitors were consistently stopped. Patients were treated by corticosteroids (16/24), mesalazine (7/24), methotrexate (3/24), thiopurines (2/24), infliximab (9/243), adalimumab (3/24), golimumab (2/24), ustekinumab (5/24). The evolution was favorable under treatment with complete resolution (4/24), improvement (11/24) or stabilization (5/24). 3 patients worsened under treatment and 1 died (massive myocardial infarction).Conclusion:IBD flare in patients treated with IL-17 inhibitors are rare and lead to discuss the potential iatrogenic role of IL-17 inhibitor drugs. Further cases are needed to better characterize this complication. A case-control study will be conducted to identify patients at risk to develop IBD under IL-17 inhibitor.References:[1]Reich et al. Incidence rates of inflammatory bowel disease in patients with psoriasis, psoriatic arthritis and ankylosing spondylitis treated with secukinumab: a retrospective analysis of pooled data from 21 clinical trials. Ann Rheum Dis. 2019;78:473-479Disclosure of Interests:Jean-Guillaume Letarouilly Grant/research support from: Research grant from Pfizer, Benjamin Pariente: None declared, Delphine Staumont-Sallé Speakers bureau: Lilly, Novartis, Philippe Goupille Grant/research support from: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Consultant of: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Speakers bureau: AbbVie, Amgen, Biogen, BMS, Celgene, Chugai, Lilly, Janssen, Medac, MSD France, Nordic Pharma, Novartis, Pfizer, Sanofi and UCB, Pascal Claudepierre Speakers bureau: Janssen, Novartis, Lilly, Stephane Varin: None declared, Sylvain Lanot: None declared, Emmanuelle Dernis Speakers bureau: Lilly, Novartis, Tristan Pascart Speakers bureau: Novartis, Lilly, Beatrice Banneville Speakers bureau: Lilly, Novartis, Pauline Baudart: None declared, Bruno Gombert: None declared, Elodie BAUER: None declared, Laurianne Plastaras: None declared, Sébastien Barbarot: None declared, Renaud FELTEN: None declared, Loïc Le Dantec: None declared, Nathalie Sultan-Bichat: None declared, Céline Girard: None declared, Arnaud Constantin Grant/research support from: Study was sponsored by Sanofi Genzyme, Consultant of: Consulting fees from Abbvie, BMS, Celgene, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, Daniel Wendling: None declared, Philippe Gaudin Speakers bureau: Lilly, Denis Jullien Speakers bureau: Lilly, Novartis, Thao Pham Speakers bureau: Novartis, Janssen, Lilly, Rene-Marc Flipo Speakers bureau: Novartis, Janssen, Lilly
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Cormier G, Le Goff B, Denis A, Varin S, Auzanneau L, Dimet J, Le Thuaut A. Corticosteroids injections versus corticosteroids with hyaluronic acid injections in rhizarthrosis: the randomised multicentre RHIZ'ART trial study protocol. BMJ Open 2019; 9:e022553. [PMID: 30782680 PMCID: PMC6340006 DOI: 10.1136/bmjopen-2018-022553] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Osteoarthritis of the trapeziometacarpal joint affects approximately 10%-25% of women, especially those who are postmenopausal. It may result in thumb dysfunction. Among the treatments, intra-articular injections of corticosteroid (CS) and hyaluronic acid (HA) are both effective and recommended. However, clinical trials have shown that HA improves functional capacity, whereas CS only produces a decrease in pain. The synergy of these two drugs has not been evaluated. The primary goal of this study was to determine whether the association between HA and CS produce an additional decrease of more pain during thumb movement at three months postinjection, compared to the level of pain relief from CS alone. METHODS AND ANALYSIS RHIZ'ART is a prospective, multicentre, comparative, randomised, controlled, double-blind trial. Patients referred to the rheumatology department for thumb rhizarthrosis will receive an injection of betamethasone with HA or placebo (serum saline) based on central randomisation and stratification by centre. Injections will be given under ultrasound guidance. The primary outcome will compare the pain Visual Analogue Scale with motion at three months for both groups using a mixed model. The expected decrease in pain intensity in the CS group is 25% and 35% in the CS with HA group. In order to achieve a 80% power for detecting this difference with α set at 5%, 73 patients are needed in each group (146 total). The main secondary outcomes are the Cochin score (hand function) and grip strength. Follow-up visits are at 1, 3, 6 and 12 months. ETHICS AND DISSEMINATION The study project has been approved by the appropriate ethics committee (CPP île de France III, 2017-002298-20). In agreement with current French regulations, a signed informed written consent will be obtained from each patient. Results of the main trial and of the secondary endpoints will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03431584.
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Affiliation(s)
| | | | - Amélie Denis
- Service de Rhumatologie, CH Le Mans, Le Mans, Pays de la Loire, France
| | - Stéphane Varin
- Service de Rhumatologie, CHD Vendée, La Roche-sur-Yon, France
| | - Lucie Auzanneau
- Methodologist, centre de Recherche Clinique, CHD Vendée, La Roche-sur-Yon, Pays de la Loire, France
| | - Jérôme Dimet
- Methodologist, centre de Recherche Clinique, CHD Vendée, La Roche-sur-Yon, Pays de la Loire, France
| | - Aurélie Le Thuaut
- Methodologist, centre de Recherche Clinique, CHD Vendée, La Roche-sur-Yon, Pays de la Loire, France
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Lhuillier M, Cormier G, André V, Varin S, Caulier M, Tanguy G, Cozic C. Hip disease complicating myelitis. Joint Bone Spine 2018; 86:383. [PMID: 30201479 DOI: 10.1016/j.jbspin.2018.09.001] [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] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Marine Lhuillier
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Grégoire Cormier
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Vincent André
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Stéphane Varin
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Michel Caulier
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Gilles Tanguy
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France
| | - Céline Cozic
- Service de rhumatologie, CHD Vendée, boulevard Stéphane-Moreau, 85000 La Roche-sur-Yon, France.
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Couture P, Brillet PY, Varin S, Le Goff B, Meyer A, Sibilia J, Jouneau S, Valeyre D, Hervier B, Uzunhan Y. Sarcoidosis in Patients with Antisynthetase Syndrome: Presentation and Outcome. J Rheumatol 2018; 45:1296-1300. [DOI: 10.3899/jrheum.171098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the uncommon co-occurrence of antisynthetase syndrome (AS) and sarcoidosis.Methods.From 2000 to 2015, patients with sarcoidosis were extracted from a retrospective multicentric cohort of 352 patients with AS.Results.Ten patients (2.8%; 6 men, 8 whites, 5 smokers, median age 50 yrs) had both AS and sarcoidosis. Most of the time, sarcoidosis and AS occurred simultaneously (n = 7). Antibody testing revealed anti-Jo1 (n = 5), anti-PL12 (n = 4), or anti-PL7 (n = 1). Finally, no patient had a worsening of muscular condition, 5 patients presented respiratory deterioration, 3 remained stable, and 2 showed improvement.Conclusion.Sarcoidosis may be underdiagnosed in patients with AS.
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Glémarec J, Varin S, Cozic C, Tanguy G, Volteau C, Montigny P, Le Goff B, Darrieutort Laffite C, Maugars Y, Cormier G. Efficacy of local glucocorticoid after local anesthetic in low back pain with lumbosacral transitional vertebra: A randomized placebo-controlled double-blind trial. Joint Bone Spine 2018; 85:359-363. [DOI: 10.1016/j.jbspin.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/26/2022]
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André V, Pot-Vaucel M, Cozic C, Visée E, Morrier M, Varin S, Cormier G. Septic arthritis of the facet joint. Med Mal Infect 2015; 45:215-21. [PMID: 25958100 DOI: 10.1016/j.medmal.2015.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 01/06/2015] [Revised: 02/26/2015] [Accepted: 04/02/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Septic arthritis of the facet joint is a rare clinical entity. We report 11 cases of facet joint infections diagnosed in our institution. PATIENTS AND METHOD Patients were identified via the computerized patients record (PMSI). Their features were collected and compared with published data. RESULTS The clinical symptoms are similar to those of infectious spondylodiscitis: back pain with stiffness (11/11), fever (9/11), radicular pain (5/11), and asthenia. Ten patients presented with lumbar infection and 1 with dorsal infection. An inflammatory syndrome was observed in every case. A rapid access to spine MRI allowed making the diagnosis in every case, and assessing a potential extension of infection (epidural extension 5/11, paraspinal extension 5/11). Blood culture (8/11) or culture of spinal samples allowed identifying the causative bacterium in every case and adapting the antibiotic treatment. The bacteria identified in our series were different from previously reported ones, with less staphylococci. The origin of the infection was found in 4 cases. Another localization of infection was observed in 4 cases. The outcome was favorable with medical treatment in 10 cases. An abscess was surgically drained in 1 case. None of our patients presented with neurological complications, probably because of the rapid diagnosis. CONCLUSION Assessing the facet joint is essential in case of inflammatory back pain, and the radiologist must be asked to perform this examination.
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Affiliation(s)
- V André
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France.
| | - M Pot-Vaucel
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - C Cozic
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - E Visée
- Service d'imagerie médicale, centre hospitalier départemental, site de La-Roche-sur-Yon, Les Oudairies 85925, La-Roche-sur-Yon, France
| | - M Morrier
- Services d'infectiologie, centre hospitalier départemental, site de La-Roche-sur-Yon, Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - S Varin
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
| | - G Cormier
- Service de rhumatologie, centre hospitalier départemental, site de La-Roche-sur-Yon-Les Oudairies, 85925 La-Roche-sur-Yon, France
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Boureau AS, Cozic C, Poiraud C, Varin S, Chaillous B, Cormier G. Does immunodepression induced by TNF antagonists promote atypical scabies? Joint Bone Spine 2013; 81:186-7. [PMID: 23953222 DOI: 10.1016/j.jbspin.2013.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anne Sophie Boureau
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Céline Cozic
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Carole Poiraud
- Dermatologist, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | - Stéphane Varin
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
| | | | - Grégoire Cormier
- Service de Rhumatologie, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France.
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Paquin A, Varin S, Bemer P, Corvec S, Chambreuil G. Polyarthrite à Streptobacillus moniliformis. Med Mal Infect 2011; 41:213-4. [DOI: 10.1016/j.medmal.2010.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/28/2010] [Accepted: 07/20/2010] [Indexed: 10/18/2022]
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Soltner E, Neel A, Tiab M, Varin S, Cormier G, Maisonneuve H, Maugars Y, Tanguy G, Hamidou M, Berthelot JM. Maladie de Kawasaki de l’adulte : un cas d’évolution chronique et d’issue fatale avec une spondylarthropathie sensible au traitement par immunoglobulines intraveineuses. Revue du Rhumatisme 2009; 76:908-911. [PMID: 32288504 PMCID: PMC7110466 DOI: 10.1016/j.rhum.2009.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2009] [Indexed: 11/16/2022]
Abstract
Nous rapportons l’observation inhabituelle d’un homme âgé de 40 ans, d’origine caucasienne, qui présentait une atteinte clinique sévère évocatrice de maladie de Kawasaki. La maladie évoluait depuis sept années avant que n’apparaissent des anévrismes coronariens multiples qui ont entraîné le décès malgré un traitement par immunoglobulines intraveineuses polyvalentes (IgIV). Le patient souffrait aussi d’une atteinte invalidante du rachis qui avait débuté en même temps que la maladie de Kawasaki. Alors que ni les anti-inflammatoires non stéroïdiens, ni la corticothérapie à forte dose, ni les agents anti-TNF n’avaient eu d’efficacité probante, les signes cliniques d’inflammation rachidienne ont été très sensibles au traitement par IgIV et ont été attribués de manière certaine à une spondylarthrite axiale HLA B27 négative sur les données de la scintigraphie osseuse et de l’imagerie par résonance magnétique qui avaient mis en évidence des enthésites des deux talons et une sacro-iliite bilatérale.
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Affiliation(s)
- Elise Soltner
- Service de rhumatologie, Hôtel-Dieu-CHU de Nantes, 1, place Alexis-Ricordeau, 44093, Nantes cedex 01, France
| | - Antoine Neel
- Service de médecine interne, CHU Nantes, 44093, Nantes cedex 01, France
| | - Mourad Tiab
- Service de médecine interne, centre hospitalier de La Roche-sur-Yon, Les Oudairies, 85000, La Roche-sur-Yon, France
| | - Stéphane Varin
- Service de rhumatologie, centre hospitalier de La Roche-sur-Yon, Les Oudairies, 85000, La Roche-sur-Yon, France
| | - Grégoire Cormier
- Service de rhumatologie, centre hospitalier de La Roche-sur-Yon, Les Oudairies, 85000, La Roche-sur-Yon, France
| | - Hervé Maisonneuve
- Service de médecine interne, centre hospitalier de La Roche-sur-Yon, Les Oudairies, 85000, La Roche-sur-Yon, France
| | - Yves Maugars
- Service de rhumatologie, Hôtel-Dieu-CHU de Nantes, 1, place Alexis-Ricordeau, 44093, Nantes cedex 01, France
| | - Gilles Tanguy
- Service de rhumatologie, centre hospitalier de La Roche-sur-Yon, Les Oudairies, 85000, La Roche-sur-Yon, France
| | - Mohamed Hamidou
- Service de rhumatologie, Hôtel-Dieu-CHU de Nantes, 1, place Alexis-Ricordeau, 44093, Nantes cedex 01, France
| | - Jean-Marie Berthelot
- Service de rhumatologie, Hôtel-Dieu-CHU de Nantes, 1, place Alexis-Ricordeau, 44093, Nantes cedex 01, France
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Maugars Y, Varin S, Gouin F, Huguet D, Rodet D, Nizard J, N'Guyen JM, Guillot P, Glémarec J, Passutti N, Berthelot JM. Treatment of shoulder calcifications of the cuff: A controlled study. Joint Bone Spine 2009; 76:369-77. [DOI: 10.1016/j.jbspin.2008.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2008] [Indexed: 10/20/2022]
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Soltner E, Neel A, Tiab M, Varin S, Cormier G, Maisonneuve H, Maugars Y, Tanguy G, Hamidou M, Berthelot JM. Chronic, eventually fatal, Kawasaki-like disease in an adult with spondylarthropathy responding to IVIG therapy. Joint Bone Spine 2009; 76:559-61. [PMID: 19464220 PMCID: PMC7172168 DOI: 10.1016/j.jbspin.2009.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 07/28/2008] [Accepted: 01/19/2009] [Indexed: 11/30/2022]
Abstract
We report on an unusual case of a 40-year-old Caucasian male displaying severe Kawasaki-like symptoms. The disease lasted for seven years before diffuse coronary aneurysms occurred, leading to the patient's death, despite ongoing treatment by intravenous immunoglobulins (IVIGs). The patient had also been suffering from a disabling inflammation of the spine, which was reported to have started at the onset of the disorder. Whereas neither NSAIDS, nor high doses corticosteroids, or anti-TNF drugs had a clear effect, the clinical features of spinal inflammation were highly sensitive to IVIGs, and were attributed definitively to HLA-B27-negative axial spondylarthropathy after bone scan and magnetic resonance imaging disclosed typical enthesitis of both heels and bilateral sacroiliitis.
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Affiliation(s)
- Elise Soltner
- Rheumatology Unit, CHU de Nantes, 44093 Nantes cedex 01, France
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Wendling D, Flipo RM, Breban M, Bouquillard E, Varin S, Dernis E, Frocrain L, Gaborit P, Lioté F, Martin A, Sichère P. Coexistence of spondyloarthropathy and multiple sclerosis: a series of 21 cases. Ann Rheum Dis 2008; 67:901-3. [PMID: 18474665 DOI: 10.1136/ard.2007.082909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Berthelot JM, Varin S, Cormier G, Tortellier L, Guillot P, Glemarec J, Maugars Y. 25mg etanercept once weekly in rheumatoid arthritis and spondylarthropathy. Joint Bone Spine 2007; 74:144-7. [DOI: 10.1016/j.jbspin.2006.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2005] [Accepted: 03/22/2006] [Indexed: 11/26/2022]
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Cormier G, Lucas V, Varin S, Hamelin JP, Tanguy G. Yersinia pseudotuberculosis infection of a lumbar facet joint. Joint Bone Spine 2007; 74:110-1. [PMID: 17197222 DOI: 10.1016/j.jbspin.2006.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 04/25/2006] [Indexed: 11/20/2022]
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17
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Varin S, Faure A, Bouc P, Maugars Y, Berthelot JM. Endoneural metastasis of the sciatic nerve disclosing the relapse of a renal carcinoma, four years after its surgical treatment. Joint Bone Spine 2006; 73:760-2. [PMID: 17126055 DOI: 10.1016/j.jbspin.2006.01.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 01/31/2006] [Indexed: 10/24/2022]
Abstract
METHODS To report on an exceptional case of renal metastasis. Indeed, endoneural metastases of peripheral nerves are thought to be exceptional, and such an event has not yet been ascribed to a renal carcinoma. RESULTS We report on a sciatica leading to the discovery of a tumour of the right thigh which proved to be an endoneural metastasis of the sciatic nerve from a renal carcinoma surgically removed 4 years before. CONCLUSION A thorough palpation of peripheral nerve can help recognise such metastases in patients previously diagnosed with renal carcinoma.
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Affiliation(s)
- Stéphane Varin
- Rheumatology Unit, Hotel-Dieu, CHU of Nantes, 44093 Nantes cedex 01, France
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Gillard J, Boutoille D, Varin S, Asseray N, Berthelot JM, Maugars Y. Suspected disk space infection with negative microbiological tests—report of eight cases and comparison with documented pyogenic discitis. Joint Bone Spine 2005; 72:156-62. [PMID: 15797497 DOI: 10.1016/j.jbspin.2004.01.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2003] [Accepted: 01/30/2004] [Indexed: 11/30/2022]
Abstract
UNLABELLED Few data are available on patients with suspected noniatrogenic pyogenic discitis but negative microbiological tests. OBJECTIVES To compare the features, treatment, and outcomes in patients with suspected versus microbiologically documented noniatrogenic pyogenic discitis. PATIENTS A retrospective chart review identified eight patients with suspected noniatrogenic pyogenic discitis managed at our institution over a 15-year period. Eighteen age- and sex-matched patients with microbiologically documented noniatrogenic pyogenic discitis managed at our institution during the same period served as controls. RESULTS The eight cases had a longer time to diagnosis, a greater risk of abscess formation or epidural infection, and a smaller number of cutaneous portals of entry, as compared to the controls. None of the cases had evidence of endocarditis or diabetes mellitus. Infection at another site preceded the discitis in half the cases. Empirical treatment with two antimicrobials (usually a fluoroquinolone with a beta-lactam or fosfomycin) ensured a full recovery in all eight cases, with no relapses or long-term recurrences, whereas relapses occurred in three of the 18 controls treated with antibiotics selected by antibiotic susceptibility testing. CONCLUSION Noniatrogenic pyogenic discitis with negative microbiological studies is associated with distinctive clinical features consistent with smoldering infection. The outcome is favorable under empirical two-drug antimicrobial therapy, usually including a fluoroquinolone given by the intravenous route.
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Affiliation(s)
- Jérôme Gillard
- Rheumatology Department, Service de Rhumatologie, Hôtel-Dieu, Nantes Teaching Hospital, 1 place Alexis Ricordeau, 44093 Nantes cedex 1, France
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Berthelot JM, Varin S. Is dosage reduction appropriate in patients who respond well to anti-TNF-alpha agents? Joint Bone Spine 2004; 71:257-60. [PMID: 15288847 DOI: 10.1016/j.jbspin.2004.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2003] [Accepted: 01/08/2004] [Indexed: 10/26/2022]
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Abstract
OBJECTIVES To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. Hyperparathyroidism was ruled out in our patient. Adrenal insufficiency should be considered in some patients with hypercalcemia.
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Berthelot JM, Glemarec J, Laborie Y, Varin S, Maugars Y. Reasons for rheumatology department admission in 125 patients with disk-related sciatica. Rev Rhum Engl Ed 1999; 66:267-70. [PMID: 10380258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVES To identify medical and nonmedical reasons for admission of disk-related sciatica patients. PATIENTS AND METHODS 125 patients were evaluated prospectively using a 25-items questionnaire, including seven items on medical reasons, four on psychological reasons, four on work-related reasons, six on social and family reasons, and four on miscellaneous reasons. RESULTS Severe nerve root pain (34%), motor loss (17%), atypical clinical manifestations (13%), severe low back pain (8%), and/or sphincter dysfunction (4%) were recorded in only 55% of patients, and only 16% had at least two of these reasons. A minority of patients were admitted to avoid premature surgery (13%) or to try one more conservative approach prior to surgery (15%). Seventy-five per cent of patients reported at least one of the psychological reasons listed in the questionnaire (irritability/fatigue, 66%; anxiety, 42%; depression, 26%; panic disorder, 21%), 50% reported at least one work-related reason (workaholism, 21%; job offer, 16%; self-employed, 14%; fear of losing their job, 11%), 66% reported at least one social or family reason (living alone, 34%; one or more dependents younger than seven years of age, 32%; too many demands from household members, 22%; one or more dependents older than seven years of age, 8%; need to care for another person, 9%; important upcoming family or personal event, 6%), and 26% reported at least one miscellaneous reason (firm belief that sciatica can be cured only by inhospital treatment, 10%; desire to put pressure on the employer or on an expert, 7% and 6%, respectively; admission via the emergency room without prior medical advice, 6%). CONCLUSION In France, the reason for admission of patients with disk-related sciatica is frequently a mixture of physical, psychological, and social problems, with only 55% of patients having a symptom requiring inhospital management.
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Affiliation(s)
- J M Berthelot
- Rheumatology Department, Nantes Teaching Hospital, France
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22
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Roubin P, Varin S, Crépin C, Gauthier-Roy B, Flank AM, Delaunay R, Pompa M, Tremblay B. Probing molecular site structure in low-temperature matrices: An EXAFS study of carbonyl sulfide in solid argon. J Chem Phys 1998. [DOI: 10.1063/1.477442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Roubin P, Varin S, Verlaque P, Coussan S, Berset JM, Ortéga JM, Peremans A, Zheng WQ. Infrared induced isomerization efficiency for CH2D–CH2D isolated in rare gas matrices: Influence of the vibrational excitation and of the medium. J Chem Phys 1997. [DOI: 10.1063/1.475093] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P. Roubin
- P21M, Université de Provence, Centre Saint-Jérôme, 13 397 Marseille Cedex 20, France
| | - S. Varin
- P21M, Université de Provence, Centre Saint-Jérôme, 13 397 Marseille Cedex 20, France
| | - P. Verlaque
- P21M, Université de Provence, Centre Saint-Jérôme, 13 397 Marseille Cedex 20, France
| | - S. Coussan
- LSCM, Université P. et M. Curie, 4 Place Jussieu, 75 252 Paris Cedex 05, France
| | - J.-M. Berset
- Lure, Bât 209D, Université Paris-Sud, 91 405 Orsay Cedex, France
| | - J.-M. Ortéga
- Lure, Bât 209D, Université Paris-Sud, 91 405 Orsay Cedex, France
| | - A. Peremans
- Lure, Bât 209D, Université Paris-Sud, 91 405 Orsay Cedex, France
| | - W.-Q. Zheng
- Lure, Bât 209D, Université Paris-Sud, 91 405 Orsay Cedex, France
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Weiss K, Poirier L, Varin S, Beliveau C, Laverdière M. Hepatitis E: A newcomer to the hepatitis alphabet - Case report and review of the literature. Can J Infect Dis 1995; 6:34-7. [PMID: 22514379 PMCID: PMC3327903 DOI: 10.1155/1995/370423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/1994] [Accepted: 04/28/1994] [Indexed: 11/17/2022] Open
Abstract
The first Canadian case of hepatitis E is described in a patient who travelled to Asia for a six-month period and spent most of his time in India. Hepatitis E shares some similarities with hepatitis A, notably the mode of transmission and the absence of chronic course. However, a few important differences have been noted, including a higher mortality rate and a high fatality rate in pregnant women. Hepatitis E is very common in developing countries and should be suspected more often in individuals with gastrointestinal complaints returning from endemic areas.
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Affiliation(s)
- K Weiss
- Département de Microbiologie-Infectiologie, Hôpital Maisonneuve-Rosemont, Montréal, Québec
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