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Pattarabanjird T, Srikakulapu P, Ransegnola B, Marshall MA, Ghosheh Y, Gulati R, Durant C, Drago F, Taylor AM, Ley K, McNamara CA. Single-cell profiling of CD11c+ B cells in atherosclerosis. Front Immunol 2024; 14:1296668. [PMID: 38259450 PMCID: PMC10800418 DOI: 10.3389/fimmu.2023.1296668] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/06/2023] [Indexed: 01/24/2024] Open
Abstract
Circulating CD11c+ B cells, a novel subset of activated B cells, have been linked to autoimmunity and shown to expand with age. Atherosclerosis is an age-associated disease that involves innate and adaptive immune responses to modified self-antigens. Yet, the expression of CD11c on specific B-cell subtypes and its link to atherosclerosis are poorly understood. In this study, we characterized the frequency of CD11c+ B cells in tissues in mice with aging. We observed an age-associated increase in CD11c+ B cells in the spleen and bone marrow of ApoE-/- mice, and this was associated with an increase in aortic plaque. In addition, we also utilized single-cell multi-omics profiling of 60 human subjects undergoing advanced imaging for coronary artery disease (CAD) to subtype CD11c+ B cells and determine their frequency in subjects with high and low severity of CAD. Using unsupervised clustering, we identified four distinct clusters of CD11c+ B cells, which include CD27 and IgD double negative 2 (DN2), age-associated (ABC), CD11c+ unswitched memory (USWM), and activated Naïve (aNav) B cells. We observed an increase in the frequency of both ABC B cells and DN2 B cells in patients with high CAD severity. Pathway analysis further demonstrated augmentation of autophagy, IFNg signaling, and TLR signaling in DN2 cells in high-severity CAD patients. On the other hand, an increase in the negative regulator of BCR signaling through CD72 was found in ABC cells in low-severity CAD patients. Through investigating scRNAseq of atheroma, these DN2 cells were also found to infiltrate human coronary atheroma.
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Affiliation(s)
- Tanyaporn Pattarabanjird
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
- Division of Cardiovascular Medicine/Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Prasad Srikakulapu
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Brett Ransegnola
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
- Division of Cardiovascular Medicine/Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Melissa A. Marshall
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Yanal Ghosheh
- La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Rishab Gulati
- La Jolla Institute for Immunology, La Jolla, CA, United States
| | | | - Fabrizio Drago
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
| | - Angela M. Taylor
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
- Division of Cardiovascular Medicine/Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Klaus Ley
- Immunology Center of Georgia, Augusta University, Augusta, GA, United States
| | - Coleen A. McNamara
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States
- Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States
- Division of Cardiovascular Medicine/Department of Medicine, University of Virginia, Charlottesville, VA, United States
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2
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Renaud A, Jirka A, Durant C, Connault J, Espitia O, Takoudju C, Agard C. [Gastrointestinal tract involvement in systemic sclerosis]. Rev Med Interne 2023; 44:410-422. [PMID: 37270380 DOI: 10.1016/j.revmed.2023.05.003] [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: 09/08/2022] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Gastrointestinal tract involvement in systemic sclerosis concerns more than 90% of patients but is of heterogeneous clinical expression. It can involve the entire intestinal tract and be responsible for multifactorial malnutrition, which is frequent in this disease. It is a major source of deterioration in the quality of life and can even be life-threatening. Management is complex and multidisciplinary, ranging from simple hygienic and dietary measures, to specialized endoscopic or surgical interventional procedures, also including medical treatments, particularly proton pump inhibitors and prokinetics, with potential side effects. Ongoing research for new diagnostic and therapeutic tools promises to improve the management and prognosis of these patients.
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Affiliation(s)
- A Renaud
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - A Jirka
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Durant
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Connault
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Espitia
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Takoudju
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Agard
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Isotalus H, Wearn A, Selwood J, Bartsch U, Durant C, Jones M, Kauppinen R, Coulthard E. Sleep architecture and hippocampal subfields in healthy older adults. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pattarabanjird T, Wilson JM, Erickson LD, Workman LJ, Qiao H, Ghosheh Y, Gulati R, Durant C, Vallejo J, Saigusa R, Platts-Mills TAE, Taylor AM, Ley K, McNamara CA. Chemokine Receptor Activation Enhances Memory B Cell Class Switching Linked to IgE Sensitization to Alpha Gal and Cardiovascular Disease. Front Cardiovasc Med 2022; 8:791028. [PMID: 35097011 PMCID: PMC8793803 DOI: 10.3389/fcvm.2021.791028] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background: Recent studies have suggested that IgE sensitization to α-gal is associated with coronary artery disease (CAD). However, the B cell subtype(s) responsible for production of IgE to α-gal and mechanisms mediating this production remain elusive. Methods: Single cell multi-omics sequencing, was utilized to phenotype B cells obtained from 60 subjects that had undergone coronary angiography in whom serum IgE was evaluated by ImmunoCAP. Bioinformatics approaches were used to identify B cell subtype(s) and transcriptomic signatures associated with α-gal sensitization. In vitro characterization of chemokine/chemokine receptor pairs on switched memory B cells associated with IgE to α-gal was performed. Results: Of the 60 patients, 17 (28%) were positive for IgE to α-gal. CITESeq identified CCR6+ class-switched memory (SWM) B cells and CXCR4 expresssion on these CCR6+ SWM B cells as significantly associated with IgE sensitization to α-gal but not to other common allergens (peanut or inhalants). In vitro studies of enriched human B cells revealed significantly greater IgE on SWM B cells with high CCR6 and CXCR4 expression 10 days after cells were treated with IL-4 and CD40 to stimulate class switch recombination. Both CCL20 (CCR6 ligand) and CXCL12 (ligand for CXCR4) increased the expression of IgE on SWM B cells expressing their receptors. However, they appeared to have unique pathways mediating this effect as only CCL20 increased activation-induced cytidine deaminase (AID), while CXCL12 drove proliferation of CXCR4+ SWM B cells. Lastly, correlation analysis indicated an association between CAD severity and the frequency of both CCR6+ SWM and CXCR4+ SWM B cells. Conclusions: CCR6+ SWM B cells were identified as potential producers of IgE to α-gal in CAD patients. Additionally, our findings highlighted non-chemotaxis roles of CCL20/CCR6 and CXCL12/CXCR4 signaling in mediating IgE class switching and cell proliferation of SWM B cells respectively. Results may have important implications for a better understanding and better therapeutic approaches for subjects with IgE sensitization to α-gal.
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Affiliation(s)
- Tanyaporn Pattarabanjird
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States,Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States,Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jeffrey M. Wilson
- Division of Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Loren D. Erickson
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States,Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA, United States
| | - Lisa J. Workman
- Division of Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Hui Qiao
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States,Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA, United States
| | - Yanal Ghosheh
- La Jolla Institute of Immunology, La Jolla, CA, United States
| | - Rishab Gulati
- La Jolla Institute of Immunology, La Jolla, CA, United States
| | | | - Jenifer Vallejo
- La Jolla Institute of Immunology, La Jolla, CA, United States
| | - Ryosuke Saigusa
- La Jolla Institute of Immunology, La Jolla, CA, United States
| | - Thomas A. E. Platts-Mills
- Division of Allergy and Immunology, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Angela M. Taylor
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Klaus Ley
- La Jolla Institute of Immunology, La Jolla, CA, United States
| | - Coleen A. McNamara
- Carter Immunology Center, University of Virginia, Charlottesville, VA, United States,Cardiovascular Research Center, University of Virginia, Charlottesville, VA, United States,Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, Charlottesville, VA, United States,*Correspondence: Coleen A. McNamara
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Genin V, Horeau-Langlard D, Diot E, Gagnadoux F, Lavigne C, Fournet M, Durant C, Agard C. [Characteristics of patients with connective tissue disease-associated pulmonary arterial hypertension treated with prostanoids: A multicenter retrospective study]. Rev Med Interne 2021; 42:825-831. [PMID: 34462153 DOI: 10.1016/j.revmed.2021.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/18/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue disease (CTD). Data on use of prostanoids in this particular subset of patients are lacking. We aimed to describe the characteristics of patients with PAH-CTD treated with prostanoids and the outcomes under treatment. METHODS In this multicenter retrospective study, all patients treated with prostanoids since 2006 were included. Data on PAH and CTD were collected at the time of prostanoid introduction and under treatment. RESULTS Twenty-one patients were included, of whom 20 (95%) had limited cutaneous systemic sclerosis. Nineteen patients were treated with oral monotherapy or combination before addition of prostanoid. Treprostinil was the most used molecule (57% of patients). At the time of prostanoid introduction, 90% of patients were considered at high risk for death. Among patients who had right heart catheterization during follow-up, there was no significant difference in haemodynamics. No extrarespiratory worsening of the CTD was reported. The 1-year survival under prostanoid was 62%. In univariate analysis, NYHA functional class was associated with survival under treatment. CONCLUSION This study provides original data on use of prostanoids in a cohort consisting mainly of systemic sclerosis. It underlines the difficulty to achieve a standardized assessment in this subset of patients. Safety profile was comparable with data reported in idiopathic PAH.
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Affiliation(s)
- V Genin
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, centre de compétence HTAP de l'adulte, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - D Horeau-Langlard
- Service de pneumologie, hôpital Laennec, CHU de Nantes, centre de compétence HTAP de l'adulte, boulevard Jacques-Monod, Saint-Herblain, France
| | - E Diot
- Service de médecine interne, hôpital Bretonneau, CHRU de Tours, centre de compétence HTAP de l'adulte, 2, boulevard Tonnellé, Tours, France
| | - F Gagnadoux
- Service de pneumologie, CHU d'Angers, centre de compétence HTAP de l'adulte, 4, rue Larrey, Angers, France
| | - C Lavigne
- Service de médecine interne-immunologie clinique, CHU d'Angers, centre de compétence HTAP de l'adulte, 4, rue Larrey, Angers, France
| | - M Fournet
- Service de cardiologie, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri le Guilloux, 35000 Rennes, France
| | - C Durant
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, centre de compétence HTAP de l'adulte, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Agard
- Service de médecine interne, Hôtel-Dieu, CHU de Nantes, centre de compétence HTAP de l'adulte, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Briane A, Jamet B, Espitia O, Jaafar P, Durant C, Mugniot A, Néel A, Hamidou M, Agard C. Rechute valvulaire cardiaque d’une granulomatose avec polyangéite. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.180] [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: 12/01/2022]
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7
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Pattarabanjird T, Nguyen AT, McSkimming C, Dinh H, Marshall MA, Ghosheh Y, Gulati R, Durant C, Vallejo J, Saigusa R, Drago F, Taylor AM, Tsimikas S, Miller Y, Ley K, Hedrick CC, McNamara CA. Single cell profiling identifies IgMMDA-LDL-producing human B cells and a novel role for CD24. The Journal of Immunology 2021. [DOI: 10.4049/jimmunol.206.supp.52.23] [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] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Abstract
Objectives:
IgMs that inactivate oxidation specific epitopes (IgMOSE) on phospholipids such as low density lipoprotein (LDL) were shown to confer athero-protection. We developed a 24 antibodies mass cytometry panel (CyTOF) to identify the human B cell subtype producing IgM to malondialdehyde modified LDL (IgMMDA-LDL), a predominant IgMOSE in humans. We also utilized humanized mice model to characterize a role of CD24 mediated IgM production.
Methods:
Peripheral blood mononuclear cells from healthy donors and subjects with coronary artery disease (CAD) undergoing quantitative coronary angiography were used to perform high dimensional analysis using CyTOF, RNAseq and Abseq as well as adoptive transfer into humanized mice model.
Results:
CD20+CD27+IgM+ cells (B27+IgM+) spontaneously produced IgM and produced IgMMDA-LDL in response to MDA stimulation when injected into humanized mice; an effect significantly augmented in B27+IgM+ cells with high expression of CD24 (B27+IgM+CD24hi). CD24 expression also enhanced splenic and bone marrow trafficking of B27+IgM+ cells. Blocking CD24 with a mAb reduced CCR6 expression, increased CCL20-induced CCR6 internalization and impaired migration to the spleen leading to lower IgM production. Lastly, single cell protein and transcriptome sequencing of PBMCs from 60 CAD subjects revealed enhanced CCR6 and IgM signaling in B27+IgM+CD24hi cells in subjects with low compared to high CAD severity.
Conclusions:
Identification of IgMMDA-LDL-producing cells in humans has the potential to allow for the development of therapeutics aimed at cellular targeting that may allow for enhancing production of IgM to the many OSE produced during inflammatory states such as atherosclerosis.
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Affiliation(s)
| | - Anh Tram Nguyen
- 2The Robert M. Berne Cardiovascular Research Center (CVRC), University of Virginia
| | | | - Huy Dinh
- 3La Jolla Institute for Immunology
| | | | | | | | | | | | | | | | - Angela M Taylor
- 2The Robert M. Berne Cardiovascular Research Center (CVRC), University of Virginia
| | | | - Yury Miller
- 5Department of Medicine, University of California San Diego (UCSD)
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8
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Guittet M, Lamirault G, Connault J, Durant C, Hamidou M, Wargny M, Le Bras M, Winer N, Artifoni M. [Evaluation of a woman's care program after pre-eclampsia]. Rev Med Interne 2021; 42:154-161. [PMID: 33485699 DOI: 10.1016/j.revmed.2020.12.004] [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: 01/04/2020] [Revised: 11/30/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The medical treatment of preeclampsia is well structured in its acute phase but the required follow-up with patients in post-partum is discussed. However, preeclampsia is associated with an increased risk of cardiovascular morbi-mortality in the long term. In order to optimize the post-partum treatment, a care program has been developed for these patients in the city of Nantes, France. This includes a check-up of the cardiovascular risks at a day hospital. Our study presents the first results of this program. METHODS The study included 134 patients who were diagnosed with preeclampsia between October 2016 and January 2019 in the Nantes area, France, and took part in the program within the year following their childbirth. A descriptive analysis was first carried out and then a multivariate logistic regression model was used to investigate the risk factors for persistent high blood pressure after preeclampsia. RESULTS The study detected 28 cases of persistent hypertension (20.9%), 34 cases of obesity (25.3%) and 1 case of diabetes. Hypertension was predominantly diastolic, mild and sometimes masked (35.7%). In a third of the cases (32.1%), the hypertension was secondary. High blood pressure was found to be more frequent in older patients (OR: 2.26; 95% CI: 1.25-4.11, p=0.072), patients from sub-Saharan Africa (OR: 11.52; 95% CI: 2.67-49.86, p=0.01) and multiparous patients (OR: 7.82; 95% CI: 1.15-53.21, p=0.035). CONCLUSION The study confirmed that this care program enables an earlier detection and therefore treatment of the cardiovascular risk factors of these young women.
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Affiliation(s)
- M Guittet
- CHU Nantes, Médecine interne Nantes, France.
| | - G Lamirault
- Université de Nantes, CHU Nantes, CNRS, Inserm, l'institut du thorax, 44000 Nantes, France.
| | - J Connault
- CHU Nantes, Médecine interne Nantes, France.
| | - C Durant
- CHU Nantes, Médecine interne Nantes, France.
| | - M Hamidou
- CHU Nantes, Médecine interne Nantes, France.
| | - M Wargny
- CHU Nantes, Santé publique Nantes, France.
| | - M Le Bras
- CHU Nantes, Endocrinologie Nantes, France
| | - N Winer
- CHU Nantes, Gynéco-obstetricologie Nantes, France.
| | - M Artifoni
- CHU Nantes, Médecine interne Nantes, France.
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9
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Renaud A, Durant C, Achille A, Artifoni M, Espitia O, Agard C. [Monocentric study on pharmaceuticals taken by patients to treat systemic sclerosis]. Rev Med Interne 2020; 42:86-92. [PMID: 33129579 DOI: 10.1016/j.revmed.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/14/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pharmaceutical prescription in systemic sclerosis is guided by national and international recommendations. This study's primary objective was to describe and analyze these prescriptions among patients of our cohort. We also aimed to assess drug compliance among our patients. METHODS This is a monocentric observational study on two cohorts of patients with systemic sclerosis; a primary cohort comprising ambulatory patients, who were prospectively included, with exhaustive prescription's data collection; and a secondary cohort included patients asked to fill in a self-questionnaire on treatment compliance. RESULTS The main cohort included 157 patients, including 31 cases of diffuse systemic sclerosis. A vasodilator drug for Raynaud's phenomenon was prescribed in 75 patients (47.9%) and a specific treatment for pulmonary arterial hypertension in 10 patients (6.4%). Immuno-modulators/immunosuppressants was prescribed in 62 patients (39.5%), who received prednisone (n=37, 23.6%), mycophenolate mofetil (n=14, 8.9%), hydroxychloroquine (n=12, 7.6%) and colchicine (n=22, 14%). Treatment for "gastro-intestinal tract involvement" was prescribed for 106 patients (67.5%) and treatment of a scleroderma renal crisis with an angiotensin-converting enzyme inhibitor for 6 patients (3.8%). Among the 42 patients in the secondary cohort, 21.4% reported a good compliance, mostly older patients (P=0.045) or those who had not experienced adverse events (P=0.009). CONCLUSION This study provides original real-life data illustrating the heterogeneity of prescription habits in systemic sclerosis. As previously reported, treatment compliance was insufficient.
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Affiliation(s)
- A Renaud
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - C Durant
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - A Achille
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - M Artifoni
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Espitia
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Agard
- Service de médecine interne, centre hospitalo-universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44000 Nantes, France
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10
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Rafii H, Frère C, Benzidia I, Crichi B, Andre T, Assenat E, Bournet B, Carpentier A, Connault J, Doucet L, Durant C, Emmerich J, Gris JC, Hij A, Le Hello C, Madelaine I, Messas E, Ndour A, Villiers S, Marjanovic Z, Ait Abdallah N, Yannoutsos A, Farge D. Management of cancer-related thrombosis in the era of direct oral anticoagulants: A comprehensive review of the 2019 ITAC-CME clinical practice guidelines. On behalf of the Groupe Francophone Thrombose et Cancer (GFTC). J Med Vasc 2020; 45:28-40. [PMID: 32057323 DOI: 10.1016/j.jdmv.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Venous thromboembolism (VTE) is a common disease complication in cancer patients and the second cause of death after cancer progression. VTE management and prophylaxis are critical in cancer patients, but effective therapy can be challenging because these patients are at higher risk of VTE recurrence and bleeding under anticoagulant treatment. Numerous published studies report inconsistent implementation of existing evidence-based clinical practice guidelines (CPG), including underutilization of thromboprophylaxis, and wide variability in clinical practice patterns across different countries and various practitioners. This review aims to summarize the 2019 ITAC-CME evidence-based CPGs for treatment and prophylaxis of cancer-related VTE, which include recommendations on the use of direct oral anticoagulants specifically in cancer patients. The guidelines underscore the gravity of developing VTE in cancer and recommend the best approaches for treating and preventing cancer-associated VTE, while minimizing unnecessary or over-treatment. Greater adherence to the 2019 ITAC guidelines could substantially decrease the burden of VTE and improve survival of cancer patients.
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Affiliation(s)
- H Rafii
- Eurocord, Équipe 3 EA3518, hôpital Saint-Louis, Université de Paris, AP-HP, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - C Frère
- Inserm UMRS_1166, Department of Haematology, hôpital Pitié-Salpêtrière, Université de Paris, Sorbonne Paris-Cité, AP-HP, Paris, France
| | - I Benzidia
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - B Crichi
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - T Andre
- Hôpital Saint-Antoine, AP-HP, Paris, France
| | - E Assenat
- Montpellier school of Medicine, Saint-Eloi University Hospital, Montpellier, France
| | - B Bournet
- Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | | | | | - L Doucet
- Hôpital Saint-Louis, AP-HP, Paris, France
| | | | | | | | - A Hij
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | - C Le Hello
- CHU Saint-Étienne, Saint-Étienne, France
| | | | - E Messas
- Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - A Ndour
- Hôpital Saint-Louis, AP-HP, Paris, France
| | - S Villiers
- Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - N Ait Abdallah
- Autoimmune and vascular disease unit, hôpital Saint-Louis, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, EA3518, AP-HP, Sorbonne Paris-Cité, Paris, France
| | | | - D Farge
- Internal Medicine (UF04), Équipe 3 EA 3518, Autoimmune and Vascular Disease Unit, Saint-Louis Hospital, Center of reference for rare systemic autoimmune diseases (FAI2R), Université de Paris, AP-HP, Sorbonne Paris-Cité, Paris, France; Department of Medicine, McGill University, Montreal, QC, Canada
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Mesnard C, Le Lan M, Hamidou M, Durant C. Une hypophosphorémie profonde après injection de carboxymaltose ferrique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.189] [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: 11/16/2022]
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12
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Hocqueloux M, Achille A, Durant C, Agard C. Sclérodermie localisée et sclérodermie systémique : 5 observations. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.039] [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: 11/25/2022]
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13
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Espitia O, Raimbeau A, Connault J, Gautier G, Goueffic Y, Plissonneau P, Artifoni M, Durant C, Didier Q, Maurel B, Pistorius M, Agard C. Ischémies digitales : présentation clinique, étiologies et suivi à long terme. Une cohorte de 323 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.325] [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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14
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Affiliation(s)
- C Crosnier
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - A Achille
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - M Lecouffe-Desprets
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - A Néel
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - C Durant
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
| | - C Agard
- From the Internal Medicine Department, Hôtel-Dieu, Centre Hospitalier Universitaire de Nantes, 44093 Nantes, France
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Achille A, Journeau L, Espitia O, Connault J, Espitia-Thibault A, Durant C, Perrin F, Pistorius MA, Néel A, Hamidou M, Agard C. Sclérodermie systémique de révélation tardive : étude rétrospective de 27 patients diagnostiqués après l’âge de 70 ans. Ann Dermatol Venereol 2018; 145:166-172. [DOI: 10.1016/j.annder.2017.10.016] [Citation(s) in RCA: 2] [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] [Received: 04/06/2017] [Revised: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 11/30/2022]
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16
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Génin V, Caristan A, Ledamany A, Horeau-Langlard D, Connault J, Durant C, Agard C. Treprostinil dans l’hypertension artérielle pulmonaire associée à la sclérodermie systémique : expérience monocentrique chez 11 patients. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.409] [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: 10/18/2022]
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17
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Soenen A, Durant C, Aubert H, Guitteny M, Bougouin EK, Penhoat MG, Kassam D, Bailly C, Barbarot S. Œdème cyanique chronique douloureux des doigts. Ann Dermatol Venereol 2017. [DOI: 10.1016/j.annder.2017.09.307] [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: 11/26/2022]
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18
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Masson C, Lecouffe-Desprets M, Néel A, Achille A, Durant C, Hamidou M, Agard C. Sclérodermie systémique révélée par une crise rénale chez le sujet âgé et survenue d’un cancer à 1 an de suivi : 2 observations. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.232] [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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Hassoun D, Lecouffe-Desprets M, Néel A, Durant C, Dirou S, Arrigoni P, Sagan C, Hamidou M, Agard C. Atteinte pulmonaire exceptionnelle au cours d’une sclérodermie systémique cutanée limitée : la fibroélastose pleuro-parenchymateuse. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.234] [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: 11/26/2022]
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20
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De Bataille S, Durant C, Bossard C, Barbarot S. Dermatose annulaire granulomateuse révélant une artérite de Takayasu asymptomatique sur le plan vasculaire. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.394] [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: 11/27/2022]
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21
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Achille A, Journeau L, Najm A, Espitia-Thibault A, Durant C, Le Goff B, Agard C. Association hypertension artérielle pulmonaire–rhumatisme de Jaccoud au cours d’une connectivite : trois observations. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.024] [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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Castillo JM, Agard C, Artifoni M, Brisseau JM, Connault J, Durant C, Espitia O, Masseau A, Neel A, Perrin F, Pistorius MA, Planchon B, Ponge T, Hamidou M, Pottier P. Évaluation qualitative et quantitative d’un service d’assistance téléphonique de médecine interne dédié à l’aide diagnostique et thérapeutique de pathologies relevant du champ de la médecine générale. Rev Med Interne 2016; 37:321-6. [DOI: 10.1016/j.revmed.2015.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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Najm A, Le Goff B, Achille A, Espitia O, Durant C, Perrin F, Agard C. [Three cases of Jaccoud's arthropathy during systemic sclerosis]. Rev Med Interne 2016; 37:708-713. [PMID: 26869295 DOI: 10.1016/j.revmed.2016.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/06/2016] [Accepted: 01/11/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Jaccoud's arthropathy (JA) is a chronic and non-erosive deforming arthropathy, usually affecting the hands. JA pathophysiology is poorly known but involves periarticular structures such as tendons and the joint capsule. JA is associated with various conditions including the connective tissue disease, especially systemic lupus erythematosis. JA has been rarely described and studied in systemic sclerosis. CASE REPORTS We report the clinical histories of 3 patients with systemic sclerosis (ScS) who developed JA. One patient had a systemic limited disease and the 2 others a cutaneous limited disease ; mean age of the patients was 79.3 years. Systemic sclerosis was diagnosed respectively 19, 1 and 21 years prior to the development of JA. One of the 3 patients had a past clinical history of discoid lupus. For 1 out of the 3 patients, JA appeared whereas the ScS was completely stable. The disease was still active in the 2 remaining patients, with concurrent pulmonary hypertension diagnosis. Deformities increased during years (Z thumbs, ulnar deviation), leading to mild to severe disability. No benefit from either prednisone (n=2) or a combination of prednisone and methotrexate (n=1) was obtained. CONCLUSION We described 3 cases of Jaccoud's arthropathy among our scleroderma cohort of 296 patients (1%). This arthropathy worsens hand functional disability. Its pathophysiology is unknown and optimal therapeutic approach remains to establish.
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Affiliation(s)
- A Najm
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - B Le Goff
- Service de rhumatologie, pôle hospitalo-universitaire 4, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - A Achille
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - O Espitia
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Durant
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - F Perrin
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - C Agard
- Service de médecine interne, pôle hospitalo-universitaire 3, centre de compétences maladies systémiques et auto-immunes rares, hôpital Hôtel-Dieu, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Inserm UMR1087, CNRS UMR6291, unité de recherche de l'Institut du thorax, équipe 2 « Signalisation et hypertension artérielle », IRS université de Nantes, 8, quai Moncousu, BP 70721, 44007 Nantes cedex 1, France.
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Journeau L, Perrin F, Espitia O, Durant C, Lecomte R, Horeau-Langlard D, Néel A, Hamidou M, Agard C. Caractéristique des connectivites au moment où elles se compliquent d’hypertension pulmonaire précapillaire : étude monocentrique rétrospective de 42 patients diagnostiqués depuis 2003. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.265] [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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25
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Muguet Guenot L, Aubert H, Isidor B, Durant C, Guemas I, Barbarot S. Acanthosis nigricans et hypochondroplasie : mutation du gène FGFR3. À propos de deux cas. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.317] [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: 10/24/2022]
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26
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Sevestre MA, Belizna C, Durant C, Bosson JL, Vedrine L, Cajfinger F, Debourdeau P, Farge D. Compliance with recommendations of clinical practice in the management of venous thromboembolism in cancer: the CARMEN study. ACTA ACUST UNITED AC 2014; 39:161-8. [PMID: 24746736 DOI: 10.1016/j.jmv.2014.03.001] [Citation(s) in RCA: 45] [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: 01/09/2014] [Accepted: 02/28/2014] [Indexed: 11/30/2022]
Abstract
UNLABELLED Cancer is associated with venous thromboembolism in 20% of patients. In such patients, thrombosis is difficult to treat, associated with bleeding, recurrence, and death. Specific treatments for venous thromboembolism in cancer are recommended. Guidelines have been implemented in many countries and international guidelines have been recently developed. We evaluated the adhesion to national French guidelines via a survey of cancer patients treated for venous thromboembolism. METHODS A national cross-sectional observational study evaluated the adhesion to guidelines in hospitalized patients. Good clinical practice was defined as initial 10-day treatment with injectable molecules followed by long-term treatment with low molecular weight heparin for at least 3 months. Demographic data, cancer type, stage, treatment, risk factors and type of thrombosis, were recorded. RESULTS Five patients were included in 47 centers. Overall adhesion to guidelines was present in 59% (55-63%) of patients (295/500). During initial treatment, adhesion was high (487/496; 98%) but dropped (296/486; 62%) during the long-term maintenance. In patients with renal insufficiency, only a fourth of them received the adequate treatment. A majority of patients had metastatic disease (64%). Cancer sites were gastro-intestinal (25%), gynecologic (23%), pulmonary (21%), hematological (14%), urologic (10%), or other (8%). Lung and hematological malignancies were significantly associated with the highest and lowest rates of adhesion. CONCLUSION Adhesion to national guidelines for treatment of venous thromboembolism in cancer is not optimal. Good compliance is observed during initial treatment, but drops after 10 days, underlying the need for further education to achieve a better implementation on a national level.
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Affiliation(s)
- M-A Sevestre
- Service de médecine vasculaire, CHU d'Amiens, 80054 Amiens cedex, France.
| | | | - C Durant
- CHU de Nantes, 44093 Nantes cedex 01, France
| | - J-L Bosson
- CHU de Grenoble, 38043 Grenoble cedex 09, France
| | - L Vedrine
- Hôpital du Val-de-Grace, 75005 Paris, France
| | - F Cajfinger
- GH Pitié-Salpêtrière, 75651 Paris cedex 13, France
| | - P Debourdeau
- Centre hospitalier d'Avignon, 84000 Avignon, France
| | - D Farge
- Hôpital Saint-Louis, 75010 Paris, France
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Achille A, Espitia O, Perrin F, Durant C, Masseau A, Ponge T, Connault J, Néel A, Hamidou M, Agard C. Sclérodermie systémique du sujet âgé : étude rétrospective de 27 patients diagnostiqués après 70ans. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.035] [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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28
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Daguze J, Aubert H, Durant C, Soltner E, Barbarot S, Stalder JF. Maladie de Whipple et purpura vasculaire. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.542] [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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29
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Kogge A, Durant C, Aubert H, Barbarot S, Bernier C. Purpura isolé des grands plis révélant une primo-infection à parvovirus B19. Ann Dermatol Venereol 2013. [DOI: 10.1016/j.annder.2013.09.497] [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: 11/15/2022]
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30
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Katchakourian L, Durant C, Graveleau J, Lestang E, Penhoat M, Masseau A, Néel A, Toquet C, Agard C, Morineau N, Hamidou M. Artérite temporale avec aortite malgré traitement par anti-CD52 (alemtuzumab) pour une leucémie lymphoïde chronique. Intérêt du TEP scan. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.252] [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: 10/26/2022]
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31
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Artifoni M, Ternisien C, Durant C, Pistorius M, Hamidou M, Connault J. Évaluation qualitative des recherches d’antiphospholipides et devenir des patients suspects de SAPL au CHU de Nantes. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.048] [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: 10/26/2022]
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32
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Artifoni M, Chemel M, Connault J, Loussouarn D, Graveleau J, Hamidou M, Durant C. Nécroses digitales inaugurales d’une maladie de Horton : une présentation atypique d’une maladie fréquente. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.109] [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: 10/26/2022]
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Leloup P, Le Bras M, Mirallie E, Barbarot S, Durant C. [Cushing's syndrome revealed by a chronic sore]. Ann Dermatol Venereol 2013; 140:407-9. [PMID: 23663721 DOI: 10.1016/j.annder.2013.01.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 01/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- P Leloup
- Service de dermatologie, clinique dermatologique, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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Dary M, Durant C, Brunet A, Lintz F, Mary M. Lymphome osseux primitif multifocal. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.275] [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: 11/16/2022]
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35
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Georgin-Lavialle S, Roux X, Ackermann F, Durant C, Ranque B, Arlet JB. Intérêt de la PET en médecine interne : étude multicentrique prospective de 161 cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.034] [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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Prey S, Ezzedine K, Doussau A, Grandoulier AS, Barcat D, Chatelus E, Diot E, Durant C, Hachulla E, de Korwin-Krokowski JD, Kostrzewa E, Quemeneur T, Paul C, Schaeverbeke T, Seneschal J, Solanilla A, Sparsa A, Bouchet S, Lepreux S, Mahon FX, Chene G, Taïeb A. Imatinib mesylate in scleroderma-associated diffuse skin fibrosis: a phase II multicentre randomized double-blinded controlled trial. Br J Dermatol 2012; 167:1138-44. [PMID: 23039171 DOI: 10.1111/j.1365-2133.2012.11186.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Imatinib mesylate is a potent inhibitor of platelet-derived growth factor and transforming growth factor-β signalling pathways which may play a role in systemic sclerosis (SSc)-associated skin changes. OBJECTIVES We aimed primarily at assessing the efficacy of imatinib mesylate in scleroderma skin fibrosis. METHODS We performed a phase II double-blinded trial on patients with scleroderma with either morphoea involving > 20% of body surface area or SSc with extensive skin involvement: modified Rodnan Skin Score (mRSS) ≥ 20/51. Each patient was randomized to receive either imatinib mesylate 400 mg or placebo daily for a total of 6 months, and then was followed up 6 months after therapy discontinuation. Skin fibrosis was assessed by mRSS and measurement of the dermal thickness using skin biopsies performed at inclusion and at 6 months of treatment. In addition, quality of life (Dermatology Life Quality Index and modified Health Assessment Questionnaire for Scleroderma) was recorded at each visit, and pulmonary function before and after intervention. RESULTS Twenty-eight patients were included in the study with a mean age of 48·9 years (range 30-71): 25 had a diagnosis of a SSc and three of diffuse cutaneous scleroderma. Demographic data, frequency of organ involvement of SSc and mRSS were comparable between groups. At 6 months, the proportion of variation of mRSS from inclusion was not statistically significantly different between the two groups (median +0·10 in imatinib group vs. -0·16 in placebo group, P = 0·098). Similarly, changes in dermal thickness, quality of life and diffusion capacity for carbon monoxide were not significantly different between groups. CONCLUSIONS This study failed to demonstrate the efficacy of imatinib 400 mg daily to improve skin fibrosis of diffuse scleroderma after 6 months of treatment based on validated outcome measurements.
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Affiliation(s)
- S Prey
- Department of Dermatology, Hôpital Saint André, CHU de Bordeaux, 1 rue Jean Burguet, 33075 Bordeaux, France.
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Durant C, Hadj-Khelifa S, Lei J, Badaoui A, Moreau AS, Traineau R, Farge D, Decaux O. La Schtroumpfette en Australie. Rev Med Interne 2012; 33:536-8. [DOI: 10.1016/j.revmed.2012.06.011] [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: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 10/28/2022]
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Hervier B, Morell-Dubois S, Durant C, Uzunhan Y, Devilliers H, Mathian A, Hatron PY, Masseau A, Hamidou M, Hachulla E, Amoura Z, Benveniste O. Intérêt de la 18F-FDG tomographie par émission de positron au cours du syndrome des antisynthétases. Analyse rétrospective de 26 cas. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.03.012] [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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Bould H, Panicker V, Kessler D, Durant C, Lewis G, Dayan C, Evans J. Investigation of thyroid dysfunction is more likely in patients with high psychological morbidity. Fam Pract 2012; 29:163-7. [PMID: 21890841 DOI: 10.1093/fampra/cmr059] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mild or subclinical hypothyroidism [raised thyroid-stimulating hormone (TSH) but normal free thyroxine (T4)] affects 5-10% of adults. Symptoms are non-specific and TSH levels are needed for diagnosis. OBJECTIVES We explore the relationship between thyroid function and psychological distress and investigate the usefulness of an expert-designed Thyroid Symptom Questionnaire (TSQ) in identifying hypothyroidism. METHODS DEPTH (DEPression and THyroid) is a cross-sectional study of 325 patients recruited from general practices in Bristol, for whom thyroid function tests were requested by the GP. Subjects completed the TSQ, General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ) and had blood tests for TSH and free T4. RESULTS The mean age was 45.7 years; 252 subjects (78%) were female; median TSH was 1.6. Psychological morbidity in this population is high: 54.2% have a GHQ-12 score >3, indicating psychological distress. We found no relationship between TSH and psychological distress [adjusted odds ratio 1.02 (95% confidence interval 0.91-1.13), P = 0.78]. The prevalence of hypothyroidism was 6.2% (95% confidence interval 3.8-9.5%). We found no evidence of an unadjusted association between TSQ score and subclinical hypothyroidism [adjusted odds ratio of 1.09 (95% confidence interval 0.95-1.24), P = 0.23]. CONCLUSIONS Those referred for thyroid function tests, although no more likely than others to have hypothyroidism, have high rates of psychological distress. When mild (subclinical) hypothyroidism is detected in patients with psychological distress, it is important that GPs are aware that this is likely to be coincidental rather than causal and offer appropriate treatment.
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Affiliation(s)
- H Bould
- Academic Unit of Psychiatry, School of Social and Community Medicine, University of Bristol, Oakfield Grove, Bristol, UK.
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Baraut J, Farge D, Jean-Louis F, Kesmandt H, Durant C, Verrecchia F, Michel L. Les cytokines dans la sclérodermie systémique. ACTA ACUST UNITED AC 2012; 60:127-39. [DOI: 10.1016/j.patbio.2009.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/17/2009] [Indexed: 12/20/2022]
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De Masson A, Bouaziz JD, Rybojad M, Peffault de Latour R, Robin M, Rodriguez-Otero P, Durant C, Socie G, Bagot M. EF/SSc overlap syndrome and aplastic anaemia resistant to immunosuppressive therapy. Rheumatology (Oxford) 2012; 51:762-4. [DOI: 10.1093/rheumatology/ker406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Connault J, Masseau A, Audrain M, Durant C, Agard C, Néel A, Pottier P, Planchon B, Hamidou M. Étude monocentrique rétrospective de 59 patients porteurs du syndrome des antiphospholipides (SAPL) : dépistage et correction des facteurs de risque cardiovasculaire lors des SAPL primaires et secondaires. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.10.340] [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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43
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Farge-Bancel D, Lefort A, Mahé I, Algayres JP, Durant C, Roux X, Rapp C. Bienvenue au 64e congrès de la Société nationale française de médecine interne. Rev Med Interne 2011; 32 Suppl 2:S201-2. [DOI: 10.1016/j.revmed.2011.09.017] [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: 10/15/2022]
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Cajfinger F, Debourdeau P, Drouet L, Durant C, Elalamy I, Farge-Bancel D. Risque thromboembolique et prise en charge du cancer du sein. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2089-6] [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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Hervier B, Hamidou M, Haroche J, Durant C, Mathian A, Amoura Z. Systemic lupus erythematosus associated with ANCA-associated vasculitis: an overlapping syndrome? Rheumatol Int 2011; 32:3285-90. [PMID: 21805174 DOI: 10.1007/s00296-011-2055-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 07/10/2011] [Indexed: 01/12/2023]
Abstract
Systemic lupus erythematosus (SLE) and small-sized vessel vasculitis are usually two distinguishable autoimmune diseases. However, a vasculitis may be found in the course SLE but rarely corresponds to an ANCA-associated vasculitis (AAV). We report four cases of de novo SLE associated with AAV, our aim being to discuss the clinical significance of this association. We included four patients fulfilling the criteria for both SLE and AAV and followed in two different university hospitals between 1996 and 2009. In light of a 20-year literature review (25 described clinical cases), we discussed the etiopathogeny of such an association. All patients presented a severe renal involvement (creatininemia ranging from 120 to 370 μmol/l) and thrombopenia (ranging from 45,000 to 137,000 platelets/mm(3)). The other main clinical symptoms were arthritis (n = 3), serositis (n = 2) and intra-alveolar hemorrhage (n = 2). An inflammatory syndrome was noticed at diagnosis in all cases. ANCAs were MPO-ANCAs in all cases. Two out of these four patients were also diagnosed with antiphospholipid syndrome. The frequency of this association seems not fortuitous. Although the etiopathogenic mechanisms of such an association remain to be more precisely described, several clinical, histological and immunological features support the hypothesis of the existence of a SLE-AAV overlapping syndrome. Moreover, clinicians must be aware of such an overlapping syndrome, notably because its initial presentation can be very severe.
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Affiliation(s)
- B Hervier
- Internal Medicine Department, National Reference Centre for Lupus and Antiphospholipid Syndrome, CHU Pitié-Salpétrière, 83 Boulevard de l'hôpital, 75013 Paris, France.
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Lefebvre M, Capito C, Durant C, Hervier B, Grossi O. Tungiasis: a poorly documented tropical dermatosis. Med Mal Infect 2011; 41:465-8. [PMID: 21703785 DOI: 10.1016/j.medmal.2011.05.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 02/16/2011] [Accepted: 05/17/2011] [Indexed: 11/16/2022]
Abstract
Tungiasis is the parasitic skin disease caused by the sand flea Tunga penetrans, also called the jigger flea, found in most intertropical countries. The contamination occurs when walking barefoot in the sand: adult females actively burrow the foot epidermis leading to self-limited lesions responsible for itching or pain. The diagnosis is made on clinical observation and history of travelling to an endemic country. The simple treatment is surgical extraction of the flea.
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Affiliation(s)
- M Lefebvre
- Service de maladies infectieuses et tropicales, CHU Nantes, 1 place Alexis-Ricordeau, Nantes cedex 1, France.
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Connault J, Durant C, Pottier P, Josnin M, Hello M, Ponge T, Planchon B, Hamidou M. Expression clinique vasculaire sévère et précoce de la mutation homozygote MTHFR chez 3 patientes tabagiques. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.302] [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: 10/28/2022]
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48
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Daikeler T, Durant C, Martin T, Launay D, Gluckman E, Farge D. Incidence et facteurs de risque de développer une maladie auto-immune secondaire après transplantation de cellules souches hématopoïétique pour maladie auto-immune sévère. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.031] [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: 11/12/2022]
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49
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Khelifa SH, Durant C, Sibon D, Keshtmand H, Farge D. Réactivation virale EBV après autogreffe de cellules souches hématopoïétiques pour sclérodermie systémique. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.197] [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: 10/28/2022]
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50
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Martin J, Audrain M, Durant C, Rimbert M, Fromont P, Hamidou M. Neutropénies auto-immunes. Rev Med Interne 2011; 32:26-32. [DOI: 10.1016/j.revmed.2010.04.005] [Citation(s) in RCA: 4] [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] [Received: 10/29/2009] [Revised: 03/05/2010] [Accepted: 04/11/2010] [Indexed: 11/30/2022]
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