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Jallouli M, Galicier L, Zahr N, Aumaître O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Kahn JE, Pourrat J, Sailler L, Ackermann F, Papo T, Sacré K, Fain O, Stirnemann J, Cacoub P, Leroux G, Cohen-Bittan J, Sellam J, Mariette X, Blanchet B, Hulot JS, Amoura Z, Piette JC, Costedoat-Chalumeau N. Determinants of hydroxychloroquine blood concentration variations in systemic lupus erythematosus. Arthritis Rheumatol 2015; 67:2176-84. [PMID: 25989906 DOI: 10.1002/art.39194] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/05/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Blood concentrations of hydroxychloroquine (HCQ) vary widely among patients with systemic lupus erythematosus (SLE). A pharmacokinetic/pharmacodynamic relationship has been found in different situations, and a very low blood concentration of HCQ is a simple marker of nonadherence to treatment. Therefore, interest in blood HCQ concentration measurement has increased, but little is known about factors that influence blood HCQ concentration variability. This study was undertaken to analyze determinants of blood HCQ concentrations. METHODS We conducted a retrospective analysis of patient data, including data from the Plaquenil Lupus Systemic (PLUS) study, to determine the association of epidemiologic, clinical, and biologic factors with blood HCQ concentrations. Data for nonadherent patients (blood HCQ concentration <200 ng/ml) were excluded. RESULTS To examine homogeneous pharmacologic data, we restricted the analyses of the PLUS data to the 509 SLE patients receiving 400 mg/day. We found no association of ethnicity or smoking with blood HCQ concentrations and no pharmacokinetic drug-drug interaction with antacids or with inhibitors or inducers of cytochrome P450 enzymes. On multivariate analysis, high body mass index (P = 0.008), no treatment with corticosteroids (P = 0.04), increased time between the last tablet intake and measurement of blood HCQ concentrations (P = 0.017), low platelet count (P < 0.001), low neutrophil count (P < 0.001), and high estimated creatinine clearance (P < 0.001) were associated with low blood HCQ concentrations. In 22 SLE patients with chronic renal insufficiency (median serum creatinine clearance 52 ml/minute [range 23-58 ml/minute]) who received 400 mg/day HCQ, the median blood HCQ concentration was significantly higher than that in the 509 patients from the PLUS study (1,338 ng/ml [range 504-2,229 ng/ml] versus 917 ng/ml [range 208-3316 ng/ml]) (P < 0.001). CONCLUSION We provide a comprehensive analysis of determinants of blood HCQ concentrations. Because this measurement is increasingly being used, these data might be useful for clinicians.
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Affiliation(s)
- M Jallouli
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - L Galicier
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - N Zahr
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - O Aumaître
- Université de Clermont-Ferrand and Centre Hospitalier Universitaire (CHU) Clermont-Ferrand, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - C Francès
- Université Pierre et Marie Curie and AP-HP, Hôpital Tenon, Paris, France
| | - V Le Guern
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
| | - F Lioté
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Lariboisière, Paris, France
| | - A Smail
- CHU Amiens, Hôpital Nord, Amiens, France
| | - N Limal
- AP-HP, Hôpital Henri Mondor, Créteil, France
| | - L Perard
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - H Desmurs-Clavel
- Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Lyon, France
| | - D Le Thi Huong
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - B Asli
- Université Paris Diderot, Sorbonne Paris Cité, and AP-HP, Hôpital Saint Louis, Paris, France
| | - J-E Kahn
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - J Pourrat
- Université Paul Sabatier and CHU Toulouse, Hôpital Rangueil, Toulouse, France
| | - L Sailler
- Université Paul Sabatier and CHU Toulouse, Hôpital Purpan, Toulouse, France
| | - F Ackermann
- Université Versailles St. Quentin en Yvelines and Hôpital Foch, Suresnes, France, and Université Paris-Sud and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin Bicêtre, France
| | - T Papo
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - K Sacré
- Université Paris Diderot, Sorbonne Paris-Cité, and AP-HP, Hôpital Bichat Claude-Bernard, Paris, France
| | - O Fain
- Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and AP-HP, Hôpital St. Antoine, Paris, France
| | | | - P Cacoub
- Sorbonne Universités, Université Pierre et Marie Curie, UMR 7211, and Inflammation Immunopathology Biotherapy Department, AP-HP, Hôpital Pitié-Salpêtrière, Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, INSERM UMRS 959, and CNRS, FRE3632, Paris, France
| | - G Leroux
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | | | - J Sellam
- AP-HP, Université Pierre et Marie Curie, Inflammation Immunopathology Biotherapy Department, and INSERM UMRS 938, Paris, France
| | - X Mariette
- Université Paris-Sud, INSERM U1012, and AP-HP, Hôpitaux Universitaires Paris-Sud, Le Kremlin-Bicêtre, France
| | | | - J S Hulot
- Université Pierre et Marie Curie and AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Z Amoura
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - J C Piette
- Université Pierre et Marie Curie, AP-HP, Hôpital Pitié-Salpêtrière, and Centre de Référence pour le Lupus Systémique et le Syndrome des Antiphospholipides, Paris, France
| | - N Costedoat-Chalumeau
- Université Paris-Descartes, AP-HP, Hôpital Cochin, and Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Paris, France
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Hanouna G, Morel N, Le Thi Huong D, Josselin L, Vauthier-Brouzes D, Saadoun D, Kettaneh A, Levesque K, Le Guern V, Goffinet F, Carbonne B, Amoura Z, Piette JC, Nizard J, Costedoat-Chalumeau N. Catastrophic antiphospholipid syndrome and pregnancy: an experience of 13 cases. Rheumatology (Oxford) 2013; 52:1635-41. [DOI: 10.1093/rheumatology/ket167] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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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Desbois AC, Wechsler B, Resche-Rigon M, Piette JC, Huong DLT, Amoura Z, Koskas F, Desseaux K, Cacoub P, Saadoun D. Immunosuppressants reduce venous thrombosis relapse in Behçet's disease. ACTA ACUST UNITED AC 2012; 64:2753-60. [DOI: 10.1002/art.34450] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Costedoat-Chalumeau N, Guettrot-Imbert G, Leguern V, Leroux G, Le Thi Huong D, Wechsler B, Morel N, Vauthier-Brouzes D, Dommergues M, Cornet A, Aumaître O, Pourrat O, Piette JC, Nizard J. Grossesse et syndrome des antiphospholipides. Rev Med Interne 2012; 33:209-16. [DOI: 10.1016/j.revmed.2012.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 01/04/2012] [Indexed: 10/14/2022]
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Arnaud L, Mathian A, Le Thi Huong D, Costedoat-Chalumeau N, Amoura Z. Syndrome des antiphospholipides et grossesse. Rev Med Interne 2011; 32 Suppl 1:S26-30. [DOI: 10.1016/j.revmed.2011.02.012] [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: 10/28/2022]
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Hanouna G, Le Thi Huong D, Morel N, Mathian A, Vauthier-Brouzes D, Nizard J, Amoura Z, Piette J, Costedoat-Chalumeau N. Syndrome catastrophique des antiphospholipides (CAPS) et grossesse : série monocentrique rétrospective de neuf patientes. Rev Med Interne 2011. [DOI: 10.1016/j.revmed.2011.03.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Abstract
OBJECTIVE To report the long-term mortality in patients with Behçet's disease (BD). METHODS A cohort of 817 patients fulfilling the international criteria for BD from a single center in France were analyzed for causes of death, the standardized mortality ratio (SMR), and the factors associated with mortality. RESULTS Among the 817 patients with BD, 41 (5%) died after a median followup of 7.7 years, of whom 95.1% were male. The mean ± SD age at death was 34.8 ± 11.9 years. Main causes of death included major vessel disease (mainly, arterial aneurysm and Budd-Chiari syndrome) (43.9%), cancer and malignant hemopathy (14.6%), central nervous system involvement (12.2%), and sepsis (12.2%). The mortality rate at 1 year and 5 years was 1.2% and 3.3%, respectively. There was an increased mortality among patients ages 15-24 years (SMR 2.99, 95% confidence interval [95% CI] 1.54-5.39) and those ages 25-34 years (SMR 2.90, 95% CI 1.80-4.49) as compared with age-and sex-matched healthy controls. The mortality decreased in patients older than age 35 years (SMR 1.23, 95% CI 0.75-1.92). In multivariate analyses, male sex (hazard ratio [HR] 4.94, 95% CI 1.53-16.43), arterial involvement (HR 2.51, 95% CI 1.07-5.90), and a high number of BD flares (HR 2.37, 95% CI 1.09-5.14) were independently associated with the risk of mortality. CONCLUSION The overall mortality in our BD cohort was 5% after a median followup of 7.7 years. Male sex, arterial involvement, and the number of flares were associated with mortality in BD.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie-Paris 6, Paris, France.
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Saadoun D, Wechsler B, Terrada C, Hajage D, Le Thi Huong D, Resche-Rigon M, Cassoux N, Le Hoang P, Amoura Z, Bodaghi B, Cacoub P. Azathioprine in severe uveitis of Behçet's disease. Arthritis Care Res (Hoboken) 2010; 62:1733-8. [PMID: 20665749 DOI: 10.1002/acr.20308] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/20/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the efficacy and tolerance of azathioprine in severe uveitis related to Behçet's disease (BD). METHODS We reported 157 consecutive patients with severe uveitis (active posterior uveitis or panuveitis) fulfilling the international criteria for BD and treated with corticosteroids (0.5-1 mg/kg/day) and azathioprine (2.5 mg/kg/day). Long-term outcome and factors associated with complete remission were assessed. RESULTS Mean±SD age at diagnosis was 29.9±10.1 years, with 71.3% men. At baseline, 59 patients (37.6%) had loss of useful vision, 54 (34.4%) had retinal vasculitis, 66 (42.0%) had panuveitis, and 132 (84.1%) had bilateral uveitis. Following azathioprine therapy, 81 patients (51.6%) were complete responders, 65 (41.4%) were partial responders, and 11 (7%) were nonresponders. The visual acuity significantly improved (P<0.001), and a significant decrease in the mean oral prednisone dosage (55.3 to 10.5 mg/day; P<0.001) was observed after therapy. Patients with retinal vasculitis (odds ratio [OR] 0.45 [95% confidence interval (95% CI) 0.2-0.9], P=0.02) and severe visual loss (OR 0.28 [95% CI 0.2-0.7], P<0.0001) at diagnosis were less likely to be complete responders. Azathioprine was well tolerated, with only 3 withdrawals due to hepatotoxic effects (n=2) and bacterial septicemia (n=1). CONCLUSION Azathioprine represents an effective and safe therapy in patients with severe uveitis of BD.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière and Pierre et Marie Curie-Paris VI University, Paris, France.
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Costedoat-Chalumeaum N, Galicier L, Aumaitre O, Francès C, Le Guern V, Lioté F, Smail A, Limal N, Perard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Jallouli M, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Données épidémiologiques d’une cohorte française multicentrique de 569 patients lupiques. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mania A, Guettrot-Imbert G, Dubois-Morell S, Bienvenu B, Le Thi Huong D, Amoura Z, Delèvaux I, Hachulla E, Andre M, Guillevin L, Frances C, Aumaitre O. Nécrose digitale : une manifestation dermatologique rare de la granulomatose de Wegener. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Costedoat-Chalumeau N, Jallouli M, Galicier L, Aumaître O, Francès C, Le Guern V, Liote F, Smail A, Limal N, Pérard L, Desmurs-Clavel H, Le Thi Huong D, Asli B, Grandpeix C, Pourrat J, Ackermann F, Papo T, Brihaye B, Fain O, Stirnemann J, Cohen J, Tanguy ML, Hulot JS, Lechat P, Musset L, Piette JC, Amoura Z. Description des patients lupiques inclus dans l’étude PLUS (Plaquénil Lupus Systémique, étude française multicentrique) en fonction de leur origine ethnique. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Delluc C, Costedoat-Chalumeau N, Leroux G, Imbert G, Le Thi Huong D, Vauthier-Brouzes D, Piette JC, Chazouilleres O, Cacoub P. Pathologies hépatiques et grossesse. Rev Med Interne 2009; 30:508-15. [DOI: 10.1016/j.revmed.2008.09.012] [Citation(s) in RCA: 7] [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: 05/19/2008] [Revised: 09/12/2008] [Accepted: 09/24/2008] [Indexed: 12/27/2022]
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Saadoun D, Wechsler B, Resche-Rigon M, Trad S, Le Thi Huong D, Sbai A, Dormont D, Amoura Z, Cacoub P, Piette JC. Cerebral venous thrombosis in Behçet's disease. ACTA ACUST UNITED AC 2009; 61:518-26. [PMID: 19333987 DOI: 10.1002/art.24393] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the clinical findings, treatment, outcome, and prevalence of cerebral venous thrombosis (CVT) in a large cohort of patients with Behçet's disease (BD) from a single center. METHODS We reported a series of 64 consecutive patients with CVT who fulfilled the international criteria for BD. Multivariate analysis was performed to define factors that affect prognosis. RESULTS Among a cohort of 820 patients with BD, CVT was present in 64 (7.8%). Compared with BD patients without CVT, those with CVT had lower parenchymal central nervous system involvement (4.7% versus 28.7%; P = 0.0001) and higher extraneurologic vascular lesions (62.5% versus 38.8%; P = 0.03). Up to 90% of patients responded to anticoagulation therapy without severe hemorrhagic complications. Neither steroid nor immunosuppressant use provided better outcome. Severe visual loss due to optic atrophy was the main complication of CVT, being found in 15% of patients. In multivariate analysis, papilledema (odds ratio [OR] 7.1, 95% confidence interval [95% CI] 1.6-31.9) and concurrent prothrombotic risk factors (OR 4.6, 95% CI 1.1-20.2) were independently associated with the occurrence of sequelae. Factors associated with relapse of thrombosis were concurrent prothrombotic risk factors (hazard ratio [HR] 4.9, 95% CI 1.5-15.4) and a peripheral venous thrombosis (HR 2.8, 95% CI 0.7-10.5). After a mean +/- SD followup of 8.2 +/- 6.9 years, 4 deaths unrelated to CVT were noted. CONCLUSION CVT in patients with BD may result in serious neurologic outcomes. Anticoagulation represents a safe and effective therapy. Extensive investigation of prothrombotic disorders should be considered.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière and Pierre et Marie Curie-Paris VI University, Paris, France.
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Saadoun D, Wechsler B, Resche-Rigon M, Trad S, Le Thi Huong D, Amoura Z, Piette JC, Cacoub P. Thrombophlébites cérébrales et maladie de Behçet. Rev Med Interne 2008. [DOI: 10.1016/j.revmed.2008.10.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leroux G, Sellam J, Costedoat-Chalumeau N, Le Thi Huong D, Combes A, Tieulié N, Haroche J, Amoura Z, Nieszkowska A, Chastre J, Dormont D, Piette JC. Posterior reversible encephalopathy syndrome during systemic lupus erythematosus: four new cases and review of the literature. Lupus 2008; 17:139-47. [PMID: 18250139 DOI: 10.1177/0961203307085405] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Posterior reversible encephalopathy syndrome (PRES) associates various neurological manifestations (headaches, seizures, altered mental status, cortical blindness, focal neurological deficits, vomiting) and transient changes on neuroimaging consistent with cerebral edema. Posterior reversible encephalopathy syndrome mainly occurs in the setting of hypertension, eclampsia, renal failure and/or use of immunosuppressive drugs. We report four cases of PRES complicating systemic lupus erythematosus (SLE). In all our cases, renal involvement and hypertension were present. Neurological symptoms were typical. Magnetic resonance imaging showed posterior cerebral edema and in one case hemorrhagic complication. With symptomatic treatment and immunosuppressor withdrawal when they were previously used, symptoms fully resolved within 15 days in all cases, but one who had only partial regression related to cerebral hemorrhage. Including our cases, we reviewed a total of 46 patients with SLE and PRES. Their clinical and radiological presentation was not specific. The peculiar role of SLE itself in the occurrence of PRES was not clear, since hypertension (95%), renal involvement (91%), recent onset of immunosuppressive drugs (54%) and/or recent treatment with high intravenous dose of steroids (43%) were often present. The hypertension and other worsening factors should be treated. Finally, the evolution of this clinical and radiological spectacular syndrome is generally rapidly favorable.
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Affiliation(s)
- G Leroux
- Department of Internal Medicine, Centre Hospitalier Universitaire Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France
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De Preobrajensky N, Fardeau C, Gineys R, Leparmentier A, Le Thi Huong D, Bodaghi B, Lehoang P. 040 Interféron alpha 2a au cours des uvéites granulomateuses postérieures chroniques. J Fr Ophtalmol 2008. [DOI: 10.1016/s0181-5512(08)70635-1] [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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Medkour K, Ducos de Lahitte G, Terrada C, Cassoux N, Fardeau C, Le Thi Huong D, Bodaghi B, Lehoang P. 437 Prise en charge diagnostique et thérapeutique des vasculites rétiniennes occlusives sévères. J Fr Ophtalmol 2008. [DOI: 10.1016/s0181-5512(08)71035-0] [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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Garrigues P, Duc P, Coquery ML, Le Thi Huong D, Champetier de Ribes D, de Zuttere D. Fibroélastome papillaire à propos de 2 observations. Rev Med Interne 2006. [DOI: 10.1016/j.revmed.2006.10.170] [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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Le Thi Huong D, Cassoux N, Lebrun-Vignes B, Wechsler B, Bodaghi B, Lehoang P, Piette JC. [Therapy of chronic non infectious uveitis]. Rev Med Interne 2006; 28:232-41. [PMID: 17275966 DOI: 10.1016/j.revmed.2006.10.326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Revised: 10/07/2006] [Accepted: 10/09/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE Chronic non infectious uveitis represents two-thirds of the causes of chronic uveitis referred in tertiary referral ophthalmology centre. One case out of 5 may evolve towards blindness. Therapy should be discussed on the basis of the uveitis severity and the diagnosis; it uses topics or systemic drugs, mainly corticosteroids and immunosuppressors. CURRENT KNOWLEDGE AND KEY POINTS Besides corticosteroids and ciclosporin, use of immunosuppressors and biotherapy in chronic non infectious uveitis is not an indication of the Autorisation de Mise sur le Marché. However, immunosuppressors and biotherapy were the subjects of several studies, although controlled studies are scarce. Controlled studies concerned cyclosporine, azathioprine and intravenous cyclophosphamide in Behçet's disease, ciclosporine and tacrolimus in uveitis of various causes. Therapy of chronic non infectious uveitis was recently enriched by new drugs: mycophenolate mofetil, initially used in transplantation, has its indications extended to systemic diseases; TNF inhibitors initially used in therapy of systemic diseases; interferon efficacy revealed in Behçet's disease is now used in uveitis due to other causes. FUTURE PROSPECTS AND PROJECTS Controlled studies are suitable in order to determinate the respective part of immunosuppressors and biotherapies in the treatment of chronic non infectious uveitis.
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Affiliation(s)
- D Le Thi Huong
- Service de médecine interne, groupe hospitalier de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Tazi N, Le Thi Huong D, Bodaghi B, Rixe O, Lehoang P, Piette JC. Métastase choroïdienne révélatrice d'un adénocarcinome bronchique. Rev Med Interne 2006; 27:699-701. [PMID: 16872723 DOI: 10.1016/j.revmed.2006.06.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 06/07/2006] [Indexed: 11/30/2022]
Abstract
Lung cancer is the first cause of choroidal metastasis in man. Generally, its discovery is made at end-stage of the disease. It can be uncommonly the presenting sign as in our case. We report a case of a 28-year-old patient with no prior medical history. He presented with visual decrease and metamorphopsia that lead to the diagnosis of a metastatic adenocarcinoma of the lung (bone, liver, choroid, nodles). Chemotherapy permitted to improve visual acuity, in parallel with disappearance of choroidal metatasis. Discovery of choroidal tumor should evoke in first line metastasis. Chemotherapy can improve visual acuity and the quality of life.
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Affiliation(s)
- N Tazi
- Service de Médecine Interne, Groupe Hospitalier Pitié-Salpétrière, 47-83, Boulevard de l'Hôpital, 75651 Paris Cedex 13, France
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Costedoat-Chalumeau N, Amoura Z, Villain E, Cohen L, Fermont L, Le Thi Huong D, Vauthier D, Georgin-Lavialle S, Wechsler B, Dommergues M, Piette JC. Prise en charge obstétricale des patientes à risque de « lupus néonatal ». ACTA ACUST UNITED AC 2006; 35:146-56. [PMID: 16575360 DOI: 10.1016/s0368-2315(06)76388-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Fetuses and infants of women with anti-SSA/Ro and anti-SSB/La antibodies are at risk of neonatal lupus syndrome, featuring skin lesions, hematological and hepatic disorders, and congenital heart block (CHB) in the absence of severe cardiac malformation. The prevalence of CHB in newborns of anti-SSA/Ro positive women with known connective tissue disease is 1 to 2% and the risk of recurrence ranges from 10 to 17%. CHB is definitive and is associated with significant morbidity (pacemaker must be implanted in 2/3 of cases) and mortality (16 to 19%). Myocardial involvement may either be associated or appear subsequently. Other manifestations are discussed. For anti-SSA/Ro positive pregnant women, echocardiograms should be performed every 2 weeks from 16 to 24 weeks of gestation, and every week in case of past history of CHB. Electrocardiogram should be performed in the first days of life for all children to detect incomplete CHB. Therapy for CHB detected in utero is based on fluorinated steroids, especially betamethasone. Its efficiency is variable.
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MESH Headings
- Antibodies, Antinuclear/blood
- Antibodies, Antinuclear/immunology
- Autoimmune Diseases/complications
- Female
- Heart Defects, Congenital/immunology
- Hematologic Diseases/immunology
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/immunology
- Infant, Newborn, Diseases/mortality
- Infant, Newborn, Diseases/prevention & control
- Liver Diseases/immunology
- Lupus Erythematosus, Systemic/immunology
- Lupus Erythematosus, Systemic/mortality
- Lupus Erythematosus, Systemic/prevention & control
- Male
- Pregnancy
- Pregnancy Complications/immunology
- Skin Diseases/immunology
- Syndrome
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Affiliation(s)
- N Costedoat-Chalumeau
- Service de Médecine Interne, CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris Cedex 13.
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Auzary C, Le Thi Huong D, Delarbre X, Sbai A, Lhote F, Papo T, Wechsler B, Cacoub P, Martin-Hunyadi C, Piette JC. Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis. Clin Exp Rheumatol 2006; 24:S38-40. [PMID: 16859595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To report on several patients with subacute bacterial endocarditis who were initially presumed, incorrectly, to have polymyalgia rheumatica or giant cell arteritis. METHODS We report 3 cases of subacute streptococcal endocarditis mimicking giant cell arteritis in 2 cases and polymyalgia rheumatica in one. We reviewed the literature through Medline search of French and English-language articles published between 1966 and 2005 and found 5 similar cases. RESULTS Shoulder and/or pelvic girdle pain was associated with neck or back pain in all patients. Scalp tenderness, bilateral jaw pain, amaurosis fugax were present in 2 patients. One patient had no fever. Two patients were treated with corticosteroids with initial good clinical response in one. Appropriate antibiotic therapy resulted in the rapid disappearance of rheumatic complaints in 2 patients and achieved a definitive cure of endocarditis in all cases. CONCLUSION Rheumatologic symptoms may hinder the correct diagnosis of infective endocarditis in patients who present with a clinical picture suggesting polymyalgia rheumatica or giant cell arteritis. In such cases, blood cultures should be systematically drawn.
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Affiliation(s)
- C Auzary
- Department of Internal Medicine, Centre Hospitalier Moulins-Yzeure, Moulins, France.
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24
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Le Thi Huong D, Wechsler B, Vauthier-Brouzes D, Duhaut P, Costedoat N, Andreu MR, Lefebvre G, Piette JC. The second trimester Doppler ultrasound examination is the best predictor of late pregnancy outcome in systemic lupus erythematosus and/or the antiphospholipid syndrome. Rheumatology (Oxford) 2005; 45:332-8. [PMID: 16249242 DOI: 10.1093/rheumatology/kei159] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the predictive value of clinical examination, laboratory tests and Doppler ultrasound examination in systemic lupus erythematosus (SLE) and/or antiphospholipid syndrome (APS) pregnancies. METHODS A prospective study of 116 pregnancies followed in a single tertiary referral centre. Outcomes analysed were fetal/neonatal death and adverse pregnancy outcome. Univariate analysis was performed for: (i) medical and obstetric history; (ii) medical and obstetric clinical examination; (iii) biological data; (iv) Doppler ultrasound examination. Variables significantly associated with the outcomes in the univariate analysis were entered into a logistic regression model. RESULTS Sixteen out of 116 pregnancies ended in 12 fetal deaths and 4 embryonic losses. Hence, data for 100 pregnancies were analysed. Seven fetal deaths and one neonatal death occurred, associated with abnormal end-diastolic umbilical artery Doppler flow at the second trimester (P < 0.006), a history of thrombophlebitis (P < 0.001) or notched uterine artery and growth restriction at the second trimester (P < 0.002). Multivariate analysis retained abnormal end-diastolic umbilical artery Doppler flow (P = 0.047) and history of thrombophlebitis (P = 0.018) as significant predictors. Thirty-one adverse pregnancy outcomes occurred, associated with notched uterine artery (P < 0.00003), abnormal end-diastolic umbilical artery Doppler flow (P < 0.0006) and fetal growth restriction at the second trimester (P < 0.008), growth restriction (P < 0.00001) and notched uterine artery at the third trimester (P < 0.0008), use of heparin (P < 0.05) and history of thrombophlebitis (P < 0.04). Notched uterine artery at the second trimester remained the only predictor in multivariate analysis (P = 0.001). CONCLUSIONS Results of the second trimester Doppler ultrasound examination are the best predictors for late pregnancy outcome in SLE and/or APS.
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Affiliation(s)
- D Le Thi Huong
- Department of Internal Medicine, Groupe Hospitalier Pitié-Salpêtrière, 83 bd de l'Hôpital, 75013 Paris, France.
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25
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Bodaghi B, Bui Quoc E, Wechsler B, Tran THC, Cassoux N, Le Thi Huong D, Chosidow O, Herson S, Piette JC, LeHoang P. Therapeutic use of infliximab in sight threatening uveitis: retrospective analysis of efficacy, safety, and limiting factors. Ann Rheum Dis 2005; 64:962-4. [PMID: 15897316 PMCID: PMC1755514 DOI: 10.1136/ard.2004.025882] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [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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Le Thi Huong D, Guilpain P, Naccache JM, Fain O, Lhote F, Koskas F, Piette JC. Une cause rare d'embolies systémiques. Rev Med Interne 2005; 26:343-4. [PMID: 15820573 DOI: 10.1016/j.revmed.2004.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2004] [Accepted: 09/11/2004] [Indexed: 11/17/2022]
Affiliation(s)
- D Le Thi Huong
- Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Costedoat-Chalumeau N, Amoura Z, Le Thi Huong D, Wechsler B, Piette JC. [Pleading to maintain hydroxychloroquine throughout Lupus pregnancies]. Rev Med Interne 2005; 26:467-9. [PMID: 15936475 DOI: 10.1016/j.revmed.2005.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2005] [Accepted: 02/21/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The use of Hydroxychloroquine (HCQ) during pregnancy has remained controversial for a long time. However, it is generally agreed that pregnancy per se increases disease activity in patients with systemic lupus erythematosus (SLE) and that withdrawal of HCQ at the onset of pregnancy may result in exacerbation of SLE. Therefore, stopping HCQ at the onset of pregnancy may result in exacerbation of SLE which could be detrimental to both mother and fetus. CURRENT KNOWLEDGE AND KEY POINTS The available data suggest that HCQ can be continued safely throughout pregnancy. After the first report by Parke of successful continuation of HCQ throughout gestation, more than 250 pregnancies resulting in live births have been reported and no increase in the rate of birth defects have been demonstrated. When studied, no retinal toxicity and ototoxicity have been found in the children. Data concerning lactation and HCQ treatment are rare. However, the amount of HCQ received by children through lactation seems very low. FUTURE PROSPECTS AND PROJECTS For patients with SLE already taking HCQ, the benefits of continuing treatment with this medication throughout pregnancy seem to outweigh the hypothetical risks associated with its use. HCQ should probably be maintained throughout pregnancy in these patients with SLE and it does not seem necessary to advise against breastfeeding. Further studies with prospective follow-up of children exposed in utero to HCQ remain however needed to provide a definitive answer.
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Affiliation(s)
- N Costedoat-Chalumeau
- Service de médecine interne, CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Deligny C, Le Thi Huong D, Grivois JP, Clero D, Bodaghi B, Piette JC. [Optic neuropathy revealing invasive aspergillosis of ethmoid and sphenoid sinuses]. Rev Med Interne 2004; 26:425-6. [PMID: 15893035 DOI: 10.1016/j.revmed.2004.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 09/17/2004] [Indexed: 11/29/2022]
Affiliation(s)
- C Deligny
- Service de médecine interne, groupe hospitalier Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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29
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Wechsler B, Sablé-Fourtassou R, Bodaghi B, Huong DLT, Cassoux N, Badelon I, Fain O, LeHoang P, Piette JC. Infliximab in refractory uveitis due to Behçet's disease. Clin Exp Rheumatol 2004; 22:S14-6. [PMID: 15515776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To report 4 cases of refractory panuveitis due to Behçet's disease treated with a novel therapy: infliximab. METHODS Retrospective study of 3 women and 1 man of Causasian origin with Behçet's disease complicated with panuveitis. Their uveitis was relapsing from 48 to 96 months and was resistant to the combination of colchicine (n = 4), high-dose prednisone (n = 4), pentoxyphilline (n = 2) and various immunossuppressors and/or immunomodulators given successively: intravenous cyclophosphamide (n = 4), azathioprine (n = 3), interferon alpha (n = 3), cyclosporine A (n = 2), oral cyclophosphamide (n = 1), mycophenolate mofetil (n = 1), methotrexate (n = 1), high-dose immunoglobulin (n = 1). Combination with respectively 1, 3, 4 and 5 immunossuppressors and/or immunomodulators failed before institution of infliximab. After informed consent was obtained, infliximab was administered as a single infusion of 5 mg/kg (maximum dose: 400 mg) at day 1, at week 2, 6 and then every 8 weeks. RESULTS With a follow-up ranging from 7 to 22 months, infliximab was efficient in all cases. The mean prednisone dose decreased from 45 mg to 13 mg daily. Total recovery of visual acuity was observed in half of the cases. Infliximab was well tolerated without fever, severe sepsis or autoimmune manifestation. CONCLUSION Infliximab may be efficient in refractory uveitis due to Behçet's disease. The optimal dose, rhythm and duration of infliximab infusions need to be standardized.
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Affiliation(s)
- B Wechsler
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
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Le Thi Huong D, Gompel A, Wechsler B, Piette JC. Spontaneous pregnancy in a woman with lupus and thyroiditis despite imminent premature ovarian failure. Ann Rheum Dis 2003; 63:108-9. [PMID: 14672906 PMCID: PMC1754705 DOI: 10.1136/ard.2002.003012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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31
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Le Thi Huong D, Boddaert J, Andreu M, Wechsler B, Amoura Z, Godeau P, Piette J. Ménopause et lupus systémique. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80114-5] [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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Le Page L, Amoura Z, Le Thi Huong D, Haroche J, Francès C, Piette J. Un nouveau syndrome sclérodermiforme associé à une myopathie vacuolaire : Trois observations. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80117-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wechsler B, Le Thi Huong D. [Menopause and systemic disease]. Rev Med Interne 2000; 21 Suppl 4:478s-481s. [PMID: 11347487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- B Wechsler
- Service de médecine interne, CHU Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, Paris, France
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Le Thi Huong D, Amoura Z, Costedoat N, Wechsler B, Sibai A, Piette J. Ménopause et fertilité après traitement par cyclophosphamide intraveineux. Étude rétrospective de 83 cas. Rev Med Interne 2000. [DOI: 10.1016/s0248-8663(00)90109-7] [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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Le Thi Huong D, Wechsler B, Piette JC. [Effect of pregnancy, menopause and hormone substitution therapy on disseminated systemic lupus erythematosus]. Presse Med 2000; 29:55-60. [PMID: 10682060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
UNLABELLED EXACERBATIONS DURING PREGNANCY: Clinical and experimental data have clearly evidenced the influence of hormones on the course of systemic lupus erythematosus. In prospective studies of pregnant women, an exacerbation is observed in 57% to 60% of the cases. It can be severe in 10% of the cases and occur in the post partum in 7%. For most patients, the exacerbation is moderate and has no unfavorable effect on the outcome of pregnancy. In case of renal involvement, it is difficult to differentiate an intricated HELPP syndrome. MARKERS AND RISK FACTORS Low complement and elevated anti-DNA levels are distinctive markers. Earlier renal involvement and hypertension are important prognostic factors, particularly when the lupus begins during pregnancy. However, when serum creatinine is lower than 100 mumol/l at pregnancy onset in patients in remission, pregnancy does not alter renal function. An association with antiphospholipid antibodies increases the risk for the fetus and the kidney function. TREATMENT Optimal treatment remains to be defined. Commonly, patients are given aspirin, heparin in case of a history of thromboembolism, or both. The rate of success currently exceeds 70%. The risk of thromboembolism in the peri or post partum period requires anticoagulant treatment. Outside pregnancy: Ovulation induction raises two risks: triggering a lupus flare-up and thrombosis, particularly for patients with antiphospholipid antibodies. The influence of menopause and hormone replacement therapy remains poorly understood.
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Affiliation(s)
- D Le Thi Huong
- Service de Médecine interne, Groupe Hospitalier Pitié-Salpêtrière, Paris
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Crétel E, Cacoub P, Le Thi Huong D, Wechsler B, Amoura Z, Piette J. Hémorragie ovarienne massive compliquant un traitement antivitamine K au cours du syndrome des antiphospholipides. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(99)80204-5] [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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39
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Papo T, Le Thi Huong D, Wiederkehr JL, Woehl-Kremer B, Bletry O, Wechsler B, Godeau P, Piette JC. Etoposide in Wegener's granulomatosis. Rheumatology (Oxford) 1999; 38:473-5. [PMID: 10371290 DOI: 10.1093/rheumatology/38.5.473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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40
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Le Thi Huong D, Wechsler B, Vauthier-Brouzes D, De Gennes C, Lefèbvre G, Piette J. L’induction d’ovulation au cours du lupus systémique et du syndrome des antiphospholipides. Rev Med Interne 1999. [DOI: 10.1016/s0248-8663(00)87622-5] [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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Abstract
The prognosis of systemic lupus erythematosus (SLE) has greatly improved during the last two decades, now allowing most patients to have a very long survival including a satisfactory quality of life. Initially considered contraindicated in SLE due to its overwhelming risks, pregnancy is nowadays allowed in a majority of patients, and fair results are usually obtained under appropriate management (1-3). Consequently, patients thought to have infertility ask the question of a possible therapy, i.e. ovulation induction (OI) associated or not with in vitro fertilization (IVF). Considering the importance of estrogens in the pathogenesis of the disease, the use of such procedures raise several questions in SLE. Though data remain to date extremely scarce, the theoretical and practical aspects of OI in SLE will be briefly reviewed here.
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Affiliation(s)
- B Wechsler
- Service de Médecine Interne, Hôpital Pitié-Salpêtrière, Paris, France
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Le Thi Huong D, Cassoux N, Kemali Z, Wechsler B, Blétry O, Le Hoang P, Piette JC. [Endogenous infectious endophthalmitis]. Rev Med Interne 1998; 19:658-60. [PMID: 9793153 DOI: 10.1016/s0248-8663(99)80045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Endogenous endophthtalmitis is an intraocular infection of hematogenous origin. EXEGESIS It is generally a panuveitis that may be mixed-up with a non-infectious inflammatory disease, promoting delayed treatment and compromising the visual prognosis, as the visual loss rate reaches up to 37.5%. Antibiotherapy should be started immediately after bacteriological examinations and without waiting for vitrectomy. Identification of the causative microorganism is absolutely necessary. It may require aqueous or vitreous culture if cultures from other body fluids are negative and infection progresses. The most common infections are endocarditis and digestive and renal diseases. Virectomy is indicated for first line treatment of ocular abcess and improvement of antibiotic absorption. However, it may lead to retinal detachment. Vitrectomy is also indicated in case of unsuccessful therapy. To decrease the inflammatory reaction and risks of vitreous organization, local or systemic corticotherapy is prescribed after control of the infection. CONCLUSION Although rare, endogenous endophthalmitis should be diagnosed as it may be mixed-up with inflammatory uveitis, leading to inappropriate corticotherapy. Furthermore, antibiotherapy with good intraocular penetration should be started immediately, but it should be kept in mind that the functional prognosis is poor.
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Affiliation(s)
- D Le Thi Huong
- Service de médecine interne, hôpital de la Pitié-Salpêtrière, Paris, France
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Papo T, Le Thi Huong D, Godeau P, Piette JC. [Pancreatitis and systemic diseases]. Gastroenterol Clin Biol 1998; 21:768-75. [PMID: 9587519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- T Papo
- Service de Médecine Interne, Groupe Hospitalier Pitié-Salpêtrière, Paris
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44
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Le Thi Huong D, Wechsler B, Blétry O, Vauthier-Brouzes D, Lefebvre G, Seebacher J, Godeau P, Piette JC. La grossesse au cours du syndrome des antiphospholipides. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)90104-7] [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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45
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Lévy-Soussan M, Le Thi Huong D, Laraki R, Koskas F, Godeau P, Piette JC. Anévrisme de l'aorte thoracique révélateur d'une brucellose subaiguë. Rev Med Interne 1997. [DOI: 10.1016/s0248-8663(97)80516-4] [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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46
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Le Thi Huong D, Valla D, Franco D, Wechsler B, De Gramont A, Auperin A, Godeau P. Cholangitis associated with paroxysmal nocturnal hemoglobinuria: another instance of ischemic cholangiopathy? Gastroenterology 1995; 109:1338-43. [PMID: 7557105 DOI: 10.1016/0016-5085(95)90598-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Ischemia is increasingly recognized as a cause of cholangiopathy. The aim of this study was to report a case of association of paroxysmal nocturnal hemoglobinuria with abrupt-onset cholangiopathy. Anomalies resembling sclerosing cholangitis were documented in a patient suffering from recurrent biliary pain. None of the conditions that have been associated with primary sclerosing cholangitis or other forms of cholangiopathy was present, but shortly thereafter, paroxysmal nocturnal hemoglobinuria occurred. Hepatic vein thrombosis later complicated the course of the disease. Because the fortuitous coincidence of these uncommon conditions is unlikely, this case indicates that paroxysmal nocturnal hemoglobinuria is a cause of ischemic cholangiopathy. Other thrombogenic conditions may also be implicated in some instances of apparently idiopathic cholangiopathy.
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Affiliation(s)
- D Le Thi Huong
- Service de Médecine Interne I, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Abstract
In a multi-centre prospective study of systemic lupus erythematosus and pregnancy in France, 117 cases were identified from 1987 to 1992. We report significant morbidity and mortality for mother and fetus from an analysis of 103 cases. Pregnancy outcome was as follows: 28 full-term births, 48 premature births, 18 fetal losses (13 early and two late spontaneous abortions, three stillbirths), five therapeutic abortions and four elective abortions (for unwanted pregnancy). Four preterm neonates died. Lupus was active at pregnancy onset in 28 patients. Of 75 patients with inactive lupus at conception, 27 relapsed during pregnancy, and seven postpartum. Two patients with nephrotic syndrome treated with high-dose corticosteroids died from opportunistic infections. Fetal loss correlated with a history of proteinuria and absence of anti-SSA antibodies. Prematurity was related to a history of fetal loss, active lupus at pregnancy onset, hypertension and > or = 20 mg/day prednisone during pregnancy. Intrauterine growth retardation correlated with pregnancy of short duration, low serum C3 or C4, hypertension, and absence of SSA antibodies. Three of 22 newborns whose mothers had anti-SSA antibodies developed neonatal lupus: two with cutaneous involvement and one with complete atrioventricular block.
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Affiliation(s)
- D Le Thi Huong
- Department of Internal Medicine, Groupe Hospitalier Pitié Salpêtrière, Paris, France
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Affiliation(s)
- D Le Thi Huong
- Department of Internal Medicine, Groupe hospitalier Pitié-Salpêtrière, Paris, France
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50
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Godeau B, Coutant-Perronne V, Le Thi Huong D, Guillevin L, Magadur G, De Bandt M, Dellion S, Rossert J, Rostoker G, Piette JC. Pneumocystis carinii pneumonia in the course of connective tissue disease: report of 34 cases. J Rheumatol 1994; 21:246-51. [PMID: 8182632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the circumstances, the clinical features and the outcome of Pneumocystis carinii pneumonia (PCP) in human immunodeficiency virus (HIV)-free patients with connective tissue diseases (CTD). METHODS Retrospective analysis of all cases referred 10 medical units in the last 10 years. RESULTS A total of 34 cases of PCP in patients with CTD were studied (Wegener's granulomatosis, n = 12; systemic lupus erythematosus, n = 6; polyarteritis nodosa, n = 4; poly/dermatomyositis, n = 5; others, n = 7). The majority of patients (25/34 patients; 74%) presented PCP during the first 8 months following the diagnosis of CTD. At the time of diagnosis of PCP, most patients (32/34; 94%) were receiving corticosteroids (mean prednisone equivalent dose: 1.2 mg/kg/day) associated in 24 cases with cytotoxic agents (cyclophosphamide, n = 19; methotrexate, n = 5). Most patients were lymphocytopenic at the onset of PCP: 91% (31/34) of patients had fewer than 1.5 x 10(9)/l circulating lymphocytes and 76% (26/34) had fewer than 0.8 x 10(9)/l. The mean duration of prodromal symptoms was 6 days: this is much shorter than for AIDS associated PCP. Half the patients required intensive care for respiratory failure. Mortality was high (11/34 patients; 32%) although deaths were partly due to infections acquired in intensive care units. Among the 23 survivors, 10 (43%) received secondary prophylaxis for PCP and 13 (57%), received the usual therapeutic regimen. No relapse has been observed in either group with a mean followup of 22 months. CONCLUSION Although rare, PCP must be considered in patients with any type of CTD and receiving cytotoxic agents and corticosteroids, particularly if they are lymphocytopenic. Thus, bronchoalveolar lavage must be rapidly performed in patients with CTD presenting with fever, pulmonary infiltrates, hypoxemia and lymphopenia.
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Affiliation(s)
- B Godeau
- Hôpital Henri Mondor, Service de Médecine Interne, Créteil, France
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