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Ratti N, Ly KH, Dumonteil S, François M, Sailler L, Lambert M, Hot A, Gondran G, Palat S, Bezanahary H, Desvaux E, Aslanbekova N, Parreau S, Fauchais AL, Sève P, Liozon E. Recurrent (or episodic) fever of unknown origin (FUO) as a variant subgroup of classical FUO: a French Multicenter Retrospective study of 170 patients. Clin Med (Lond) 2024:100202. [PMID: 38642612 DOI: 10.1016/j.clinme.2024.100202] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/23/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Recurrent-FUO (fever of unknown origin) is a rare subtype of FUO for which diagnostic procedures are ill-defined and outcome data are lacking. METHODS We performed a retrospective multicentre study of patients with recurrent-FUO between 1995 and 2018. By multivariate analysis, we identified epidemiological, clinical, and prognostic variables independently associated with final diagnosis and mortality. RESULTS Of 170 patients, 74 (44%) had a final diagnosis. Being ≥ 65 years of age (OR=5.2; p<0.001), contributory history (OR=10.4; p < 0.001), and abnormal clinical examination (OR=4.0; p=0.015) independently increased the likelihood of reaching a diagnosis, whereas lymph node and/or spleen enlargement decreased it (OR = 0.2; p=0.004). The overall prognosis was good; 58% of patients recovered (70% of those with a diagnosis). Twelve (7%) patients died; patients without a diagnosis had a fatality rate of 2%. Being ≥ 65 years of age (OR = 41.3; p < 0.001) and presence of skin signs (OR = 9.5; p = 0.005) significantly increased the risk of death. CONCLUSION This study extends the known yield of recurrent-FUO and highlights the importance of repeated complete clinical examinations to discover potential diagnostic clues during follow- up. Moreover, their overall prognosis is excellent.
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Affiliation(s)
- N Ratti
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - K H Ly
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Dumonteil
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren).
| | - M François
- Departments of Internal Medicine, University Hospitals of Lyon Sud (Pierre-Bénite)
| | - L Sailler
- Departments of Internal Medicine, University Hospitals of Toulouse (Purpan)
| | - M Lambert
- Departments of Internal Medicine, University Hospitals of Lille (Claude Huriez)
| | - A Hot
- Departments of Internal Medicine, University Hospitals of Lyon (Édouard Herriot)
| | - G Gondran
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Palat
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - H Bezanahary
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - E Desvaux
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - N Aslanbekova
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Parreau
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - A L Fauchais
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - P Sève
- Departments of Internal Medicine, University Hospitals of Lyon (La Croix-Rousse)
| | - E Liozon
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
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Nguyen Y, Nocturne G, Henry J, Ng WF, Belkhir R, Desmoulins F, Bergé E, Morel J, Perdriger A, Dernis E, Devauchelle-Pensec V, Sène D, Dieudé P, Couderc M, Fauchais AL, Larroche C, Vittecoq O, Salliot C, Hachulla E, Le Guern V, Gottenberg JE, Mariette X, Seror R. Identification of distinct subgroups of Sjögren's disease by cluster analysis based on clinical and biological manifestations: data from the cross-sectional Paris-Saclay and the prospective ASSESS cohorts. Lancet Rheumatol 2024; 6:e216-e225. [PMID: 38437852 PMCID: PMC10949202 DOI: 10.1016/s2665-9913(23)00340-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 03/06/2024]
Abstract
BACKGROUND Sjögren's disease is a heterogenous autoimmune disease with a wide range of symptoms-including dryness, fatigue, and pain-in addition to systemic manifestations and an increased risk of lymphoma. We aimed to identify distinct subgroups of the disease, using cluster analysis based on subjective symptoms and clinical and biological manifestations, and to compare the prognoses of patients in these subgroups. METHODS This study included patients with Sjögren's disease from two independent cohorts in France: the cross-sectional Paris-Saclay cohort and the prospective Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. We first used an unsupervised multiple correspondence analysis to identify clusters within the Paris-Saclay cohort using 26 variables comprising patient-reported symptoms and clinical and biological manifestations. Next, we validated these clusters using patients from the ASSESS cohort. Changes in disease activity (measured by the European Alliance of Associations for Rheumatology [EULAR] Sjögren's Syndrome Disease Activity Index [ESSDAI]), patient-acceptable symptom state (measured by the EULAR Sjögren's Syndrome Patient Reported Index [ESSPRI]), and lymphoma incidence during follow-up were compared between clusters. Finally, we compared our clusters with the symptom-based subgroups previously described by Tarn and colleagues. FINDINGS 534 patients from the Paris-Saclay cohort (502 [94%] women, 32 [6%] men, median age 54 years [IQR 43-64]), recruited between 1999 and 2022, and 395 patients from the ASSESS cohort (370 [94%] women, 25 [6%] men, median age 53 years [43-63]), recruited between 2006 and 2009, were included in this study. In both cohorts, hierarchical cluster analysis revealed three distinct subgroups of patients: those with B-cell active disease and low symptom burden (BALS), those with high systemic disease activity (HSA), and those with low systemic disease activity and high symptom burden (LSAHS). During follow-up in the ASSESS cohort, disease activity and symptom states worsened for patients in the BALS cluster (67 [36%] of 186 patients with ESSPRI score <5 at month 60 vs 92 [49%] of 186 at inclusion; p<0·0001). Lymphomas occurred in patients in the BALS cluster (five [3%] of 186 patients; diagnosed a median of 70 months [IQR 42-104] after inclusion) and the HSA cluster (six [4%] of 158 patients; diagnosed 23 months [13-83] after inclusion). All patients from the Paris-Saclay cohort with a history of lymphoma were in the BALS and HSA clusters. This unsupervised clustering classification based on symptoms and clinical and biological manifestations did not correlate with a previous classification based on symptoms only. INTERPRETATION On the basis of symptoms and clinical and biological manifestations, we identified three distinct subgroups of patients with Sjögren's disease with different prognoses. Our results suggest that these subgroups represent different heterogeneous pathophysiological disease mechanisms, stages of disease, or both. These findings could be of interest when stratifying patients in future therapeutic trials. FUNDING Fondation pour la Recherche Médicale, French Ministry of Health, French Society of Rheumatology, Innovative Medicines Initiative 2 Joint Undertaking, Medical Research Council UK, and Foundation for Research in Rheumatology.
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Affiliation(s)
- Yann Nguyen
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Gaëtane Nocturne
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Julien Henry
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Wan-Fai Ng
- Faculty of Medical Sciences, Clinical and Translational Research Institute, Newcastle University, NIHR Newcastle Biomedical Research Centre and NIHR Newcastle Clinical Research Facility, Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Rakiba Belkhir
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Frédéric Desmoulins
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Elisabeth Bergé
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France
| | - Jacques Morel
- Rheumatology Department, CHU de Montpellier, PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France
| | - Aleth Perdriger
- Rheumatology Department, CHU Rennes, Université Rennes, Rennes, France
| | - Emmanuelle Dernis
- Department of Rheumatology and Clinical Immunology, General Hospital, Le Mans, France
| | - Valérie Devauchelle-Pensec
- Department of Rheumatology, CHU de Brest, INSERM 1227, LBAI, Université de Bretagne Occidentale, Centre de Référence des Maladies Auto-Immunes Rares de l'Adulte, Brest, France
| | - Damien Sène
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Philippe Dieudé
- Department of Rheumatology, Hôpital Bichat-Claude Bernard, Assistance Publique - Hôpitaux de Paris, INSERM UMR1152, Paris-Cité University, Paris, France
| | - Marion Couderc
- Department of Rheumatology, CHU de Clermont-Ferrand, INSERM UMR 1240, Clermont Auvergne University, Clermont-Ferrand, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, University Hospital of Limoges, Limoges, France
| | - Claire Larroche
- Department of Internal Medicine, Assistance Publique - Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University Hospital, Rouen, France
| | - Carine Salliot
- Department of Rheumatology, Centre Hospitalier Universitaire d'Orléans, Orléans, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Hôpital Claude Huriez, University of Lille, Lille, France
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique - Hôpitaux de Paris Centre, Université Paris Cité, Paris, France
| | - Jacques-Eric Gottenberg
- Rheumatology Department, EA 3432, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Paris, France; Center for Immunology of Viral Infections and Auto-immune Diseases (IMVA), Institut pour la Santé et la Recherche Médicale (INSERM) UMR 1184, Université Paris-Saclay, Paris, France.
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Fourmond S, Parreau S, Dumonteil S, Verdie-Kessler C, Ly KH, Lacroix P, Fauchais AL, Bernard P, Palat S. The functional disabilities of the dominant and opposite hands in patients with systemic sclerosis. Clin Exp Rheumatol 2024:20461. [PMID: 38526006 DOI: 10.55563/clinexprheumatol/db7upl] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/28/2023] [Indexed: 03/26/2024]
Abstract
OBJECTIVES Hand involvement in patients with systemic sclerosis (SSc) is responsible for 75% of the overall disability but varies greatly among individuals. No study has yet compared the functionalities between the two hands of SSc patients. We thus evaluated the joint limitations and extent of skin involvement in the dominant and contralateral hands. METHODS This prospective, descriptive, comparative single-centre study enrolled SSc patients diagnosed using the ACR/EULAR criteria. We assessed limitations in the joint range of motion during active and passive mobilisation; the first commissure opening angles; the Kapandji scale and Rodnan hand scores; the digital pressures; the finger brachial pressure indices; and the number of telangiectasias, calcinosis, digital ulcerations, and painful joints on each hand. RESULTS Thirty patients were included. Spontaneous flexion joint limitations were significantly greater in the dominant hand (p<0.0001). The Kapandji score was lower (p<0.001) and the Rodnan hand score significantly higher, for the dominant hand (p<0.001). The digital pressure was similar between the hands. CONCLUSIONS The dominant hand exhibited significantly more skin sclerosis and mean flexion deterioration, a lower Kapandji score, and a tendency toward reduced mean extension, compared with the other hand. No vascular pathology was noted in either hand. Larger studies are needed to confirm these results and to draw therapeutic conclusions.
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Affiliation(s)
- Salomé Fourmond
- Division of Dermatology, Dupuytren University Hospital, Limoges, France.
| | - Simon Parreau
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Stéphanie Dumonteil
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Charlotte Verdie-Kessler
- Division of Physical Medicine and Rehabilitation, Dupuytren University Hospital, Limoges, France
| | - Kim-Heang Ly
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Philippe Lacroix
- Division of Vascular Medicine, Dupuytren University Hospital, Limoges, France
| | - Anne-Laure Fauchais
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Philippe Bernard
- Division of Dermatology, Dupuytren University Hospital, Limoges, France
| | - Sylvain Palat
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
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4
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Foré R, Liozon E, Dumonteil S, Sené T, Héron E, Lacombe V, Leclercq M, Magnant J, Beuvon C, Régent A, de Mornac D, Samson M, Smets P, Alexandra JF, Granel B, Robert PY, Curumthaullee MF, Parreau S, Palat S, Bezanahary H, Ly KH, Fauchais AL, Gondran G. BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis. Joint Bone Spine 2024; 91:105641. [PMID: 37734440 DOI: 10.1016/j.jbspin.2023.105641] [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: 03/29/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Giant cell arteritis (GCA) is complicated in 10 to 20% of cases by permanent visual ischemia (PVI). International guidelines advocate the use of intravenous pulse of methylprednisolone from 250 to 1000mg per day, for three days, followed by oral prednisone at 1mg/kg per day. The aim of this study is to assess whether this strategy significantly reduces the risk of early PVI of the second eye, compared with direct prednisone at 1mg/kg per day. METHODS We conducted a multicentre retrospective observational study over the past 15 years in 13 French hospital centres. Inclusion criteria included: new case of GCA; strictly unilateral PVI, prednisone at dose greater than or equal to 0.9mg/kg per day; for the intravenous methylprednisolone (IV-MP) group, total dose between 900 and 5000mg, close follow-up and knowledge of visual status at 1 month of treatment, or earlier, in case of contralateral PVI. The groups were compared on demographic, clinical, biological, iconographic, and therapeutic parameters. Statistical analysis was optimised using propensity scores. RESULTS One hundred and sixteen patients were included, 86 in the IV-MP group and 30 in the direct prednisone group. One patient in the direct prednisone group and 13 in the IV-MP group bilateralised, without significant difference between the two strategies (3.3% vs 15.1%). Investigation of the association between IV-MP patients and contralateral PVI through classical logistic regression, matching or stratification on propensity score did not show a significant association. Weighting on propensity score shows a significant association between IV-MP patients and contralateral PVI (OR=12.9 [3.4; 94.3]; P<0.001). Improvement in visual acuity of the initially affected eye was not significantly associated with IV-MP (visual acuity difference 0.02 vs -0.28 LogMar), even in the case of early management, i.e., within the first 48hours after the onset of PVI (n=61; visual acuity difference -0.11 vs 0.25 LogMar). Complications attributable to corticosteroid therapy in the first month were significantly more frequent in the IV-MP group (31.8 vs 10.7%; P<0.05). DISCUSSION Our data do not support the routine use of pulse IV-MP for GCA complicated by unilateral PVI to avoid bilateral ophthalmologic damage. It might be safer to not give pulse IV-MP to selected patients with high risks of glucocorticoids pulse side effects. A prospective randomised multicentre study comparing pulse IV-MP and prednisone at 1mg/kg per day is desirable.
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Affiliation(s)
- Romain Foré
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France.
| | - Eric Liozon
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | | | - Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, CH National d'Ophtalmologie des Quinze-Vingt, Paris, France
| | - Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, CHU d'Angers, Angers, France
| | | | - Julie Magnant
- Department of Internal Medicine, CHU de Tours, Tours, France
| | - Clément Beuvon
- Department of Internal Medicine, CHU La Milétrie, Poitiers, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | | | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, CHU de Dijon, Dijon, France
| | - Perrine Smets
- Department of Internal Medicine, CHU de Clermont-Ferrand, site Gabriel-Montpied, Clermont-Ferrand, France
| | | | - Brigitte Granel
- Department of Internal Medicine, Hôpital Nord, Marseille, France
| | | | | | - Simon Parreau
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Sylvain Palat
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Holy Bezanahary
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Kim Heang Ly
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
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Guédon AF, Carrat F, Mouthon L, Launay D, Chaigne B, Pugnet G, Lega JC, Hot A, Cottin V, Agard C, Allanore Y, Fauchais AL, Jego P, Dhote R, Papo T, Chatelus E, Bonnotte B, Khan JE, Diot E, Bienvenu B, Magy-Bertrand N, Queyrel V, Le Quellec A, Kieffer P, Amoura Z, Harlé JR, Gaultier JB, Balquet MH, Wahl D, Lidove O, Fain O, Mékinian A, Hachulla E, Rivière S. Heart and systemic sclerosis-findings from a national cohort study. Rheumatology (Oxford) 2023:kead599. [PMID: 37944039 DOI: 10.1093/rheumatology/kead599] [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: 04/03/2023] [Revised: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES Heart involvement is one of the leading causes of death in systemic sclerosis (SSc). The prevalence of SSc-related cardiac involvement is poorly known. Our objective was to investigate the prevalence and prognosis burden of different heart diseases in a nationwide cohort of patients with SSc. METHODS We used data from a multicentric prospective study using the French SSc national database. Focusing on SSc-related cardiac involvement, we aimed to determine its incidence and risk factors. RESULTS Over the 3528 patients with SSc 312 (10.9%) had SSc-related cardiac involvement at baseline. They tended to have a diffuse SSc subtype more frequently, more severe clinical features, and presented more cardiovascular risk factors. From the 1646 patients available for follow-up analysis, SSc-related cardiac involvement was associated with an increased risk of death. There was no significant difference in overall survival between SSc-related cardiac involvement, ischaemic heart disease or pulmonary arterial hypertension. Regarding survival analysis, 98 patients developed SSc-related cardiac involvement at five years (5-year event rate: 11.15%). Regarding reduced LVEF < 50% and left ventricular diastolic dysfunction, the 5-year event rate was 2.49% and 5.84% respectively. Pericarditis cumulative incidence at five years was 3%. Diffuse SSc subtype was a risk factor for SSc-related cardiac involvement and pericarditis. Female sex was associated with less left ventricular diastolic dysfunction incidence. CONCLUSIONS Our results describe the incidence and prognostic burden of SSc-related cardiac involvement at a large scale, with gender and diffuse SSc subtype as risk factors. Further analyses should assess the potential impact of treatment on these various cardiac outcomes.
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Affiliation(s)
- Alexis F Guédon
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Center de Référence des maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, University of Lille, Lille, France, University of Lille, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille F-59000, France; INSERM, Lille, France
| | - Benjamin Chaigne
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, Centre for Clinical Investigation (CIC BT 1436), University Hospital of Toulouse, Toulouse, France
| | - Jean-Christophe Lega
- Service de médecine interne et vasculaire, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France; Lyon immunopathology FEderation (LIFE), Hospices Civils de Lyon, Lyon, France
| | - Arnaud Hot
- Department of Internal Medicine, Edouard Herriot University Hospital, Hospices Civils de Lyon, Université Claude, Bernard-Lyon 1, Lyon, France
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, UMR 754, INRAE, Claude Bernard University, Lyon 1, Lyon, France
| | - Christian Agard
- Internal Medicine Department, Nantes Université, CHU Nantes, 1 place Alexis Ricordeau, Nantes, France
| | - Yannick Allanore
- Department of Rheumatology, Université de Paris, Cochin Hospital, Paris, France, INSERM U1016, Institut Cochin, CNRS UMR8104, Paris, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, CEDEX, Limoges, France
| | - Patrick Jego
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France, Univ Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
| | - Robin Dhote
- Sorbonne Paris Nord University, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France
| | - Thomas Papo
- Department of Internal Medicine, Université de Paris, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Emmanuel Chatelus
- Rheumatology Department, Strasbourg University Hospital, East and South-West national reference center for auto-immune diseases, Strasbourg, France
| | - Bernard Bonnotte
- Department of Internal Medicine, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Jean-Emmanuel Khan
- Department of Internal Medicine, Hôpital Ambroise Paré, Université Versailles-Saint Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Systemic and Autoimmune Rare Diseases, Bretonneau Hospital, Tours, Tours, France
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, Caen, France
| | | | - Viviane Queyrel
- Pasteur 2 Hospital, Department of Rheumatology, Cote d'Azur University, Nice University Hospital, Nice, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | | | - Zahir Amoura
- Département d'Immunologie, Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), Assistance Publique-Hôpitaux de Paris, Groupement Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jean-Robert Harlé
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Jean-Baptiste Gaultier
- Service de Médecine Interne, Hôpital Nord, Centre Hospitalier universitaire de St Etienne, saint Etienne, France
| | | | - Denis Wahl
- Department of Vascular Medicine, Referral Center for Rare Vascular Diseases, Centre Hospitalier Régional Universitaire de Nancy, Vandoeuvre-lès-Nancy, France
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
| | - Arsène Mékinian
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, Center de Référence des maladies Autoimmunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), CHU Lille, University of Lille, Lille, France; University of Lille, U1286 - INFINITE-Institute for Translational Research in Inflammation, Lille F-59000, France; INSERM, Lille, France
| | - Sebastien Rivière
- Sorbonne Université, APHP, Service de Médecine Interne, Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DMU i3), Paris, France
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Parreau S, Molina E, Dumonteil S, Goulabchand R, Naves T, Bois MC, Akil H, Terro F, Fauchais AL, Liozon E, Jauberteau MO, Weyand CM, Ly KH. Use of high-plex data provides novel insights into the temporal artery processes of giant cell arteritis. Front Immunol 2023; 14:1237986. [PMID: 37744332 PMCID: PMC10512077 DOI: 10.3389/fimmu.2023.1237986] [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: 06/10/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To identify the key coding genes underlying the biomarkers and pathways associated with giant cell arteritis (GCA), we performed an in situ spatial profiling of molecules involved in the temporal arteries of GCA patients and controls. Furthermore, we performed pharmacogenomic network analysis to identify potential treatment targets. Methods Using human formalin-fixed paraffin-embedded temporal artery biopsy samples (GCA, n = 9; controls, n = 7), we performed a whole transcriptome analysis using the NanoString GeoMx Digital Spatial Profiler. In total, 59 regions of interest were selected in the intima, media, adventitia, and perivascular adipose tissue (PVAT). Differentially expressed genes (DEGs) (fold-change > 2 or < -2, p-adjusted < 0.01) were compared across each layer to build a spatial and pharmacogenomic network and to explore the pathophysiological mechanisms of GCA. Results Most of the transcriptome (12,076 genes) was upregulated in GCA arteries, compared to control arteries. Among the screened genes, 282, 227, 40, and 5 DEGs were identified in the intima, media, adventitia, and PVAT, respectively. Genes involved in the immune process and vascular remodeling were upregulated within GCA temporal arteries but differed across the arterial layers. The immune-related functions and vascular remodeling were limited to the intima and media. Conclusion This study is the first to perform an in situ spatial profiling characterization of the molecules involved in GCA. The pharmacogenomic network analysis identified potential target genes for approved and novel immunotherapies.
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Affiliation(s)
- Simon Parreau
- Division of Rheumatology, Mayo Clinic, Rochester, MN, United States
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Elsa Molina
- Stem Cell Genomics Core, Stem Cell Program, University of California, San Diego, La Jolla, CA, United States
- Next Generation Sequencing Core, Salk Institute for Biological Studies, La Jolla, CA, United States
| | - Stéphanie Dumonteil
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Radjiv Goulabchand
- Division of Internal Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, San Diego, CA, United States
| | - Thomas Naves
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Melanie C. Bois
- Division of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Hussein Akil
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Faraj Terro
- Cell Biology, Dupuytren University Hospital, Limoges, France
| | - Anne-Laure Fauchais
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
| | - Eric Liozon
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | | | | | - Kim-Heang Ly
- Division of Internal Medicine, Dupuytren University Hospital, Limoges, France
- INSERM U1308, Faculty of Medicine, University of Limoges, Limoges, France
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7
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Chaigne B, Bense A, Agard C, Allanore Y, Pugnet G, Hachulla E, Avouac J, Bienvenu B, Palat S, Grange C, Berthier S, Chatelus E, Rivière S, Truchetet ME, Kahn JE, Maurier F, Diot E, Berezne A, Mouthon L, Amoura Z, Aouba A, Smets P, Balquet MH, Baudet A, Bonnotte B, de Boysson H, Cazalets C, Cottin V, Couderc LJ, Dhote R, Fauchais AL, Goulenok T, Harle JR, Hot A, Imbert B, Lega JC, Lequellec A, Lidove O, Liozon E, Bertrand NM, Mékinian A, Pennaforte JL, Queyrel V, Wahl D. Mouth opening in systemic sclerosis: A longitudinal analysis from the French National Cohort Study. J Intern Med 2023. [PMID: 37376708 DOI: 10.1111/joim.13689] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Few studies have evaluated mouth opening (MO) in systemic sclerosis (SSc). None have studied MO trajectories. OBJECTIVE To study MO trajectories in SSc. METHODS This multicentre study included patients enrolled in the French national SSc cohort with at least one MO assessment, described patients based on MO baseline measure, modeled MO trajectories, and associated MO measures with SSc prognosis. RESULTS We included 1101 patients. Baseline MO was associated with disease severity. On Kaplan-Meier analysis, MO < 30 mm was associated with worse 30-year-survival (p<0.01) and risk of pulmonary arterial hypertension (p<0.05). Individual MO trajectories were heterogenous among patients. The best model of MO trajectories according to latent-process mixed modeling showed that 88.8% patients had a stable MO trajectory and clustered patients into 3 groups that predicted SSc survival (p<0.05) and interstitial lung disease (ILD) occurrence (p<0.05). The model highlighted a cluster of 9.5% patients with diffuse cutaneous SSc (dcSSc) (p<0.05) and high but decreasing MO over 1 year (p<0.0001) who were at increased risk of poor survival and ILD. CONCLUSION MO, which is a simple and reliable measure, could be used to predict disease severity and survival in SSc. Although MO remained stable in most SSc patients, dcSSc patients with high but decreasing MO were at risk of poor survival and ILD. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Alexandre Bense
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Christian Agard
- CHU Nantes, Service de Médecine interne, Nantes Université, Nantes, France
| | - Yannick Allanore
- Rheumatology Department, Cochin hospital, Paris Cité University, Paris, France
| | - Grégory Pugnet
- Centre Hospitalier Universitaire, Medecine Interne, Toulouse, France
| | - Eric Hachulla
- Université de Lille, INSERM, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Nord et Nord-Ouest de France, France
| | - Jérôme Avouac
- Rheumatology Department, Cochin hospital, Paris Cité University, Paris, France
| | - Boris Bienvenu
- Service de Médecine Interne, Centre Hospitalier National Ophtalmologique des 15-20, Paris
| | | | - Claire Grange
- Department of Internal Medicine, Lyon Sud University Hospital, Lyon, France
| | - Sabine Berthier
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Emmanuel Chatelus
- Rheumatology, Hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - Sébastien Rivière
- Service de Médecine Interne and Inflammation-Immunopathology, Biotherapy Department (DMU 3iD), Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, 75012, France
| | - Marie-Elise Truchetet
- Rheumatology Department, University Hospital of Bordeaux, Centre de Référence des Maladies Autoimmunes Systémiques Rares Du Sud-Ouest, Bordeaux, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Hôpital Ambroise-Paré, Boulogne-Billancourt, France
| | - Francois Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, 57070, France
| | - Elisabeth Diot
- Department of Internal Medicine and Clinical Immunology, University Hospital of Tours, Tours, France
| | - Alice Berezne
- Department of Internal Medicine and Infectious Diseases, CHR Annecy-Genevois Annecy France, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Autoimmunes Systémiques Rares d'Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Ile de France, France
- APHP-CUP, Hôpital Cochin, F-75014 Paris, Université Paris Cité, France
| | - Zahir Amoura
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Service de Médecine Interne 2, Maladies Auto-Imunes et Systémiques, Centre National de Référence des Histiocytoses, Hôpital Pitié-Salpêtrière, Paris, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Perrine Smets
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | | | - Antoine Baudet
- Department of Internal Medicine and Infectious Diseases, CHR Annecy-Genevois Annecy France, France
| | - Bernard Bonnotte
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Claire Cazalets
- Department of Internal Medicine, CHU Rennes, University of Rennes 1, Rennes, France
| | - Vincent Cottin
- Unité Mixte de Recherche 754: Infections Virales et Pathologie Comparée, Hospices Civils de Lyon, Université Lyon 1-Institut National de la Recherche Agronomique-Centre National de Référence des Maladies Pulmonaires Rares, Lyon, France
| | - Louis-Jean Couderc
- Respiratory Diseases Department, Foch Hospital, Suresnes, France; VIM Suresnes, UMR 0892 Paris-Saclay University, France
| | - Robin Dhote
- Service de Médecine Interne, AP-HP, Hôpital Avicenne, Bobigny, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Jean-Robert Harle
- Assistance Publique des Hôpitaux de Marseille, Hôpital de la Timone, Service de Médecine Interne, Marseille, France
| | - Arnaud Hot
- Service de Médecine interne et Immunologie Clinique, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Bernard Imbert
- Département de médecine vasculaire, centre hospitalier universitaire Grenoble-Alpes, Grenoble, F-38000, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, Groupe d'Etude Multidisciplinaires des Maladies Thrombotiques (GEMMAT), Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Alain Lequellec
- Department of Internal Medicine and Multi-Organic Diseases, Montpelier University Hospital, France
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, Paris, France
| | | | - Nadine Magy Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Arsène Mékinian
- Service de Médecine Interne and Inflammation-Immunopathology, Biotherapy Department (DMU 3iD), Sorbonne Université, Hôpital Saint-Antoine, AP-HP, Paris, 75012, France
| | - Jean-Loup Pennaforte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | | | - Denis Wahl
- Inserm UMR_S 1116, CHRU de Nancy, Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, University of Lorraine, Nancy, F-54000, France
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8
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Parreau S, Liozon E, Chen JJ, Curumthaullee MF, Fauchais AL, Warrington KJ, Ly KH, Weyand CM. Temporal artery biopsy: A technical guide and review of its importance and indications. Surv Ophthalmol 2023; 68:104-112. [PMID: 35995251 PMCID: PMC10044509 DOI: 10.1016/j.survophthal.2022.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 02/01/2023]
Abstract
Temporal artery biopsy (TAB) is a surgical procedure that enables the histological diagnosis of giant cell arteritis (GCA). Performing a TAB requires expertise and a precise approach. Nevertheless, available data supports the value of tissue diagnosis in managing GCA. The current therapeutic recommendation for GCA is long-term glucocorticoid therapy, with an increasing emphasis on the addition of immunosuppressants/biotherapies. Though effective, immunosuppressants and other such biotherapies may put the patient at more risk. Optimizing the diagnosis through tissue evaluation is therefore important in weighing the risks and benefits of initiating therapeutic intervention. We evaluate the evidence supporting the importance of TAB and its indications. We also describe what technical approaches should be used to maximize sensitivity and to avoid possible complications during the procedure.
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Affiliation(s)
- Simon Parreau
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France; Department of Rheumatology, Mayo Clinic, Rochester, MN, USA.
| | - Eric Liozon
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Kim-Heang Ly
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France
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9
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Durieux MF, Lopez JG, Banjari M, Passebosc-Faure K, Brenier-Pinchart MP, Paris L, Gargala G, Berthier S, Bonhomme J, Chemla C, Villena I, Flori P, Fréalle E, L’Ollivier C, Lussac-Sorton F, Montoya JG, Cateau E, Pomares C, Simon L, Quinio D, Robert-Gangneux F, Yera H, Labriffe M, Fauchais AL, Dardé ML. Toxoplasmosis in patients with an autoimmune disease and immunosuppressive agents: A multicenter study and literature review. PLoS Negl Trop Dis 2022; 16:e0010691. [PMID: 35939518 PMCID: PMC9387931 DOI: 10.1371/journal.pntd.0010691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/18/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Cases of Toxoplasma reactivation or more severe primary infection have been reported in patients receiving immunosuppressive (IS) treatment for autoimmune diseases (AID). The purpose of this study was to describe features of toxoplasmosis occurring in patients with AID treated by IS therapy, excluded HIV-positive and transplant patients.
Methods
A multicenter descriptive study was conducted using data from the French National Reference Center for Toxoplasmosis (NRCT) that received DNA extracts or strains isolated from patients, associated with clinical data. Other cases were retrieved through a questionnaire sent to all French parasitology and internal medicine departments. Furthermore, a systematic literature review was conducted.
Results
61 cases were collected: 25 retrieved by the NRCT and by a call for observations and 36 from a literature review. Half of the cases were attributed to reactivation (50.9%), and most of cases (49.2%) were cerebral toxoplasmosis. The most common associated AID were rheumatoid arthritis (28%) and most frequent treatments were antimetabolites (44.3%). Corticosteroids were involved in 60.7% of cases. Patients had a favorable outcome (50.8%) but nine did not survive. For 12 cases, a successful Toxoplasma strain characterization suggested the possible role of this parasitic factor in ocular cases.
Conclusion
Although this remains a rare condition, clinicians should be aware for the management of patients and for the choice of IS treatment.
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Affiliation(s)
- Marie-Fleur Durieux
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
- * E-mail:
| | - Jean-Guillaume Lopez
- Department of internal medicine, Dupuytren University Hospital, Limoges Cedex, France
| | - Maher Banjari
- Department of internal medicine faculty of medicine -Rabigh Campus- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Karine Passebosc-Faure
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
| | | | - Luc Paris
- Parasitology laboratory, AP-HP Pitié-Salpêtrière, Paris, France
| | - Gilles Gargala
- Parasitology laboratory, University hospital of Rouen, Rouen, France
| | - Sabine Berthier
- Department of internal medicine, University hospital of Dijon, Dijon, France
| | - Julie Bonhomme
- Microbiology laboratory, University hospital of Caen, Caen, France
| | - Cathy Chemla
- Parasitology Laboratory, EA 7510, Reims Champagne Ardenne University, National Reference Centre on Toxoplasmosis CHU Reims, Reims, France
| | - Isabelle Villena
- Parasitology Laboratory, EA 7510, Reims Champagne Ardenne University, National Reference Centre on Toxoplasmosis CHU Reims, Reims, France
| | - Pierre Flori
- Parasitology laboratory, Hospital of Saint-Étienne, Saint-Étienne, France
| | - Emilie Fréalle
- Parasitology laboratory, University hospital of Lille, Lille, France
| | | | | | - José Gilberto Montoya
- Dr. Jack S. Remington Laboratory for Specialty Diagnostics, Palo Alto, California, United States of America
| | - Estelle Cateau
- Parasitology laboratory, University hospital of Poitiers, Poitiers, France
| | - Christelle Pomares
- Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, University hospital of Nice, Nice, France
| | - Loïc Simon
- Parasitology-Mycology laboratory, Côte d’Azur University, INSERM 1065, University hospital of Nice, Nice, France
| | - Dorothée Quinio
- Parasitology laboratory, University hospital of Brest, Brest, France
| | | | - Hélène Yera
- Parasitology laboratory, AP-HP Cochin, Paris, France
| | - Marc Labriffe
- Pharmacology & Transplantation, INSERM U1248, Université de Limoges, Limoges, France
| | - Anne-Laure Fauchais
- Department of internal medicine, Dupuytren University Hospital, Limoges Cedex, France
| | - Marie-Laure Dardé
- Department of parasitology and mycology, Dupuytren University Hospital, National Reference Center of Toxoplasmosis, Limoges Cedex, France
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10
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Curumthaullee MF, Liozon E, Dumonteil S, Gondran G, Fauchais AL, Ly KH, Robert PY, Parreau S. Features and risk factors for new (secondary) permanent visual involvement in giant cell arteritis. Clin Exp Rheumatol 2022; 40:734-740. [DOI: 10.55563/clinexprheumatol/btj1ia] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022]
Affiliation(s)
| | - Eric Liozon
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France.
| | - Stéphanie Dumonteil
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Guillaume Gondran
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Kim-Heang Ly
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Pierre-Yves Robert
- Department of Ophthalmology, Dupuytren University Hospital, Limoges, France
| | - Simon Parreau
- Department of Internal Medicine, Dupuytren University Hospital, Limoges, France
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11
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Parreau S, Dumonteil S, Montoro FM, Gondran G, Bezanahary H, Palat S, Ly KH, Fauchais AL, Liozon E. Giant cell arteritis-related stroke in a large inception cohort: A comparative study. Semin Arthritis Rheum 2022; 55:152020. [PMID: 35512621 DOI: 10.1016/j.semarthrit.2022.152020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Stroke caused by giant cell arteritis (GCA) is a rare but devastating condition and early recognition is of critical importance. The features of GCA-related stroke were compared with those of GCA without stroke and atherosclerosis-related or embolic stroke with the aim of more readily diagnosing GCA. METHODS The study group consisted of 19 patients who experienced GCA-related strokes within an inception cohort (1982-2021) of GCA from the internal medicine department, and the control groups each consisted of 541 GCA patients without a stroke and 40 consecutive patients > 50 years of age with usual first ever stroke from the neurology department of a French university hospital. Clinical, laboratory, and imaging findings associated with GCA related-stroke were determined using logistic regression analyses. Early survival curves were estimated using the Kaplan-Meier method and compared using the log rank test. RESULTS Amongst 560 patients included in the inception cohort, 19 (3.4%) developed GCA-related stroke. GCA-related stroke patients had more comorbid conditions (p = 0.03) and aortitis on imaging (p = 0.02), but less headache (p < 0.01) and scalp tenderness (p = 0.01). Multivariate logistic regression analysis showed that absence of involvement of the anterior circulation (OR = 0.1 - CI: 0.01-0.5), external carotid ultrasound (ECU) abnormalities (OR = 8.1 - CI: 1.3-73.9), and C-reactive protein (CRP) levels > 3 mg/dL (OR = 15.4 - CI: 1.9-197.1) were independently associated with GCA-related stroke. Early survival of GCA-related stroke patients was significantly decreased compared with control stroke patients (p = 0.02) and GCA patients without stroke (p < 0.001). CONCLUSIONS The location of stroke and assessment of ECU results and CRP level could help improve the prognosis of GCA-related stroke by bringing this condition to the clinician's attention more quickly, thus shortening diagnostic delay.
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Affiliation(s)
- Simon Parreau
- Internal Medicine Department, University Hospital of Limoges, France
| | | | | | - Guillaume Gondran
- Internal Medicine Department, University Hospital of Limoges, France
| | - Holy Bezanahary
- Internal Medicine Department, University Hospital of Limoges, France
| | - Sylvain Palat
- Internal Medicine Department, University Hospital of Limoges, France
| | - Kim-Heang Ly
- Internal Medicine Department, University Hospital of Limoges, France
| | | | - Eric Liozon
- Internal Medicine Department, University Hospital of Limoges, France.
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12
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Ly KH, Costedoat-Chalumeau N, Liozon E, Dumonteil S, Ducroix JP, Sailler L, Lidove O, Bienvenu B, Decaux O, Hatron PY, Smail A, Astudillo L, Morel N, Boutemy J, Perlat A, Denes E, Lambert M, Papo T, Cypierre A, Vidal E, Preux PM, Monteil J, Fauchais AL. Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study. J Clin Med 2022; 11:jcm11020386. [PMID: 35054081 PMCID: PMC8779072 DOI: 10.3390/jcm11020386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 12/24/2022] Open
Abstract
Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.
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Affiliation(s)
- Kim-Heang Ly
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
- Correspondence: ; Tel.: +33-55-5055-8076
| | - Nathalie Costedoat-Chalumeau
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Stéphanie Dumonteil
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Jean-Pierre Ducroix
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Laurent Sailler
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses-Croix Saint-Simon, 75020 Paris, France;
| | - Boris Bienvenu
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Olivier Decaux
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Pierre-Yves Hatron
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Amar Smail
- Department of Internal Medicine, Amiens University Hospital, 80054 Amiens, France; (J.-P.D.); (A.S.)
| | - Léonardo Astudillo
- Department of Internal Medicine, CHU Toulouse-Purpan, CEDEX, 31059 Toulouse, France; (L.S.); (L.A.)
| | - Nathalie Morel
- AP-HP, Cochin University Hospital, Internal Medicine Department, Referral Centre for Rare Autoimmune and Systemic Diseases, 75014 Paris, France; (N.C.-C.); (N.M.)
| | - Jonathan Boutemy
- Department of Internal Medicine, Caen University Hospital, CEDEX 9, 14033 Caen, France; (B.B.); (J.B.)
| | - Antoinette Perlat
- Department of Internal Medicine CHU de Rennes, 35000 Rennes, France; (O.D.); (A.P.)
| | - Eric Denes
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Marc Lambert
- Department of Internal Medicine, CHU Claude Huriez, 59000 Lille, France; (P.-Y.H.); (M.L.)
| | - Thomas Papo
- Department of Internal Medicine, Paris Diderot University, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, 75018 Paris, France;
| | - Anne Cypierre
- Department of Infectious Diseases, CHU Limoges, CEDEX, 87042 Limoges, France; (E.D.); (A.C.)
| | - Elisabeth Vidal
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
| | - Pierre-Marie Preux
- Centre d’Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Jacques Monteil
- Department of Nuclear Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France;
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, CEDEX, 87042 Limoges, France; (E.L.); (S.D.); (E.V.); (A.-L.F.)
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Baisse A, Lafon T, Caumes S, Dumonteil S, Fauchais AL, Parreau S. Acute hypereosinophilia in emergency department: variables associated with a 3-month mortality. Intern Emerg Med 2022; 17:279-283. [PMID: 34302275 DOI: 10.1007/s11739-021-02808-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Arthur Baisse
- Emergency Department, Centre Hospitalier Universitaire Dupuytren, Limoges University Hospital Center, 2, avenue Martin Luther King, 87042, Limoges cedex, France.
| | - Thomas Lafon
- Emergency Department, Centre Hospitalier Universitaire Dupuytren, Limoges University Hospital Center, 2, avenue Martin Luther King, 87042, Limoges cedex, France
- Inserm CIC 1435, Limoges University Hospital Center, 87042, Limoges, France
| | - Samuel Caumes
- Emergency Department, Centre Hospitalier Universitaire Dupuytren, Limoges University Hospital Center, 2, avenue Martin Luther King, 87042, Limoges cedex, France
| | - Stéphanie Dumonteil
- IDepartment of Internal Medicine, Limoges University Hospital Center, 87042, Limoges, France
| | - Anne-Laure Fauchais
- IDepartment of Internal Medicine, Limoges University Hospital Center, 87042, Limoges, France
| | - Simon Parreau
- IDepartment of Internal Medicine, Limoges University Hospital Center, 87042, Limoges, France
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14
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Lecuit M, Aucouturier P, Abbas A, Cadranel J, Silvain C, Berthelot JM, Fauchais AL, Loubet P, Bachmeyer C, Montravers F, Dossier A, Nunes H, Cervera P, Coppo P. Overexpression of IgG2 in patients resembling IgG4-related disease with normal IgG4. Scand J Immunol 2021; 95:e13126. [PMID: 34877676 DOI: 10.1111/sji.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/22/2021] [Accepted: 12/06/2021] [Indexed: 11/29/2022]
Abstract
IgG4-Related Disease (IgG4-RD) results from tissue infiltration by IgG4-expressing plasma cells and lymphocytes, leading to fibrosis and organomegaly. Clinical presentation is remarkably variable according to organ involvement, and high IgG4 serum concentration, initially considered a diagnostic hallmark of IgG4-RD, tends to be forgone as an indispensable criterion for its diagnosis; it can indeed be absent in some patients, highlighting the diversity of presentation of this dysimmune condition. Nevertheless, elevation of IgG4 serum concentration in suggestive settings remains an argument in favour of IgG4-RD, and while other IgG subclasses can be elevated, this biological feature lacks any diagnostic value. We retrospectively studied 9 patients (5 females, 4 males, 31-81 years old) for whom a diagnosis of IgG4-RD had been considered, based on clinical, imaging or histological criteria, but appeared to display abnormally high serum IgG2 while IgG4 levels were normal. Increased serum IgG1 in one case and increased IgG3 in another one were also noticed. Immunohistochemical analyses of intracellular immunoglobulins could be performed on tissue lymph node biopsies from 2 patients, which demonstrated strong infiltration with IgG2-expressing plasma cells. Thus, overexpression of IgG2 subclass may highlight cases of dysimmune disorders resembling IgG4-RD, although the disease trigger might be different, notably infectious. We suggest measuring all serum IgG subclass levels in patients with features consistent with IgG4-RD.
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Affiliation(s)
| | - Pierre Aucouturier
- Département d'Immunologie Biologique, AP-HP.6, Paris, France.,Sorbonne Université, Paris, France.,Inserm, Centre de Recherche Saint-Antoine, CRSA, Paris, France
| | - Aicha Abbas
- Département d'Immunologie Biologique, AP-HP.6, Paris, France
| | - Jacques Cadranel
- Sorbonne Université, Paris, France.,Service de Pneumologie, AP-HP.6 and Constitutive Referent Center for Rare Pulmonary Diseases, Paris, France
| | - Christine Silvain
- Service d'Hépato-gastro-entérologie, CHU de Poitiers, Poitiers, France
| | | | | | - Paul Loubet
- Service de Maladies Infectieuses et Tropicales, AP-HP.7, Paris, France.,IAME, UMR 1137, Inserm, Paris Diderot University, Sorbonne Paris Cité, Paris, France
| | | | - Françoise Montravers
- Sorbonne Université, Paris, France.,Service de Médecine Nucléaire, AP-HP.6, Paris, France
| | - Antoine Dossier
- Service de Médecine Interne, AP-HP, Hôpital Bichat, Paris, France
| | - Hilario Nunes
- Service de Pneumologie, AP-HP, Hôpital Avicenne, Paris, France
| | | | - Paul Coppo
- Service d'Hématologie, AP-HP.6, Paris, France.,Sorbonne Université, Paris, France.,Centre de référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France.,INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France
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15
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Parreau S, Curumthaullee MF, Dumonteil S, Robert PY, Fauchais AL, Ly KH, Liozon É. Intraoperative findings during temporal artery biopsy: keys to optimise the diagnosis of giant cell arteritis. Br J Oral Maxillofac Surg 2021; 60:791-794. [DOI: 10.1016/j.bjoms.2021.11.015] [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: 10/06/2021] [Accepted: 11/19/2021] [Indexed: 10/19/2022]
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16
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Parreau S, Liozon E, Ly KH, Fauchais AL, Hantz S. High incidence of giant cell arteritis during the COVID-19 pandemic: no causal relationship but possible involvement of stress. Clin Exp Rheumatol 2021; 39 Suppl 129:199-200. [DOI: 10.55563/clinexprheumatol/qsx4mt] [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: 02/22/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022]
Affiliation(s)
- Simon Parreau
- Internal Medicine, Dupuytren University Hospital, Limoges, France.
| | - Eric Liozon
- Internal Medicine, Dupuytren University Hospital, Limoges, France
| | - Kim-Heang Ly
- Internal Medicine, Dupuytren University Hospital, Limoges, France
| | | | - Sébastien Hantz
- Bacteriology-Virology-Hygiene Department, Dupuytren University Hospital, Limoges, and UMR INSERM 1092 RESINFIT, University of Limoges, France
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17
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Parreau S, Vedrenne N, Regent A, Richard L, Sindou P, Mouthon L, Fauchais AL, Jauberteau MO, Ly KH. An immunohistochemical analysis of fibroblasts in giant cell arteritis. Ann Diagn Pathol 2021; 52:151728. [PMID: 33798926 DOI: 10.1016/j.anndiagpath.2021.151728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a systemic vasculitis of large and medium vessels characterized by an inflammatory arterial infiltrate. GCA begins in the adventitia and leads to vascular remodeling by promoting proliferation of myofibroblasts in the intima. The morphology of the fibroblasts in the adventitia in GCA is unclear. Access to temporal artery biopsies allows morphological studies and evaluation of the microenvironment of the arterial wall. We evaluated the distribution of vascular fibroblasts and of markers of their activation in GCA. METHODS Formalin-fixed paraffin-embedded tissue sections from 29 patients with GCA and 36 controls were examined. Immunohistochemistry was performed for CD90, vimentin, desmin, alpha-smooth muscle actin (ASMA), prolyl-4-hydroxylase (P4H), and myosin to evaluate the distribution of fibroblasts within the intima, media, and adventitia. RESULTS Temporal arteries from patients with GCA showed increased levels of CD90, vimentin, and ASMA in the adventitia and intima compared to the controls. Desmin was expressed only in the media in both groups. P4H was expressed similarly in the adventitia and intima in the two groups. Adventitial and intimal CD90+ cells co-expressed P4H, ASMA, and myosin at a high level in GCA. CONCLUSION The results suggest a role for adventitial fibroblasts in GCA. Inhibiting the differentiation of adventitial fibroblasts to myofibroblasts has therapeutic potential for GCA.
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Affiliation(s)
- Simon Parreau
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France; EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France.
| | - Nicolas Vedrenne
- EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France
| | - Alexis Regent
- Department of Internal Medicine, Cochin Hospital, Paris, France
| | | | - Philippe Sindou
- EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, Paris, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France; EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France
| | - Marie-Odile Jauberteau
- EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France
| | - Kim-Heang Ly
- Department of Internal Medicine, Dupuytren Hospital, Limoges, France; EA3842-CaPTuR, Contrôle de l'Activation Cellulaire, Progression Tumorale et Résistance thérapeutique, Faculty of Medicine, Limoges, France
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18
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Parreau S, Jacques J, Dumonteil S, Palat S, Geyl S, Gondran G, Bezanahary H, Liozon E, Azaïs J, Colombie S, Jauberteau MO, Loustaud-Ratti V, Ly KH, Fauchais AL. Abdominal symptoms during Sjogren's syndrome: a pilot study. Adv Rheumatol 2021; 61:5. [PMID: 33468262 DOI: 10.1186/s42358-021-00164-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 01/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abdominal symptoms in patients with primary Sjögren syndrome (pSS) are poorly documented. The objective of the study was to describe the abdominal symptoms of patients with pSS and to assess their association with characteristics of the disease. METHODS One hundred and fifty patients with pSS were evaluated using a composite global symptom score for abdominal symptoms and their severity. Data concerning the clinical and biological characteristics of pSS and abdominal disorders were also collected. RESULTS Of the patients with pSS, 95% suffered from abdominal symptoms (median global symptom score 7.5 ± 5.5 points out of 30). More than half of the patients experienced abdominal tension (68%), upper abdominal pain (54%), abdominal discomfort (58%) and/or constipation (54%). Regarding the pSS activity, in relation to European League Against Rheumatism (EULAR) Sjögren syndrome disease activity index score items, general and central nervous system involvement wereassociated with a high global symptom score. The EULAR Sjogren Syndrome Patient Reported Index (ESSPRI) symptom score was positively correlated with the global symptom score (p < 0.01). Multivariate analysis showed a significant association between a high global symptom score and SSA seronegativity, gastroparesis, and ESSPRI score (p < 0.01 for each). CONCLUSIONS The majority of patients with pSS suffered abdominal symptoms. There is currently no therapeutic recommendation because of the lack of information on the underlying pathophysiological mechanisms. TRIAL REGISTRATION NCT03157011 . Date of registration: July 17, 2017.
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Affiliation(s)
- Simon Parreau
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France. .,EA 3842 - Cellular Homeostasis and Diseases, Faculty of Medicine, University of Limoges, 2 rue du Docteur Marcland, 87025, Limoges, France.
| | - Jérémie Jacques
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France.,BioEM, UMR 7252, CNRS, Limoges, France
| | - Stéphanie Dumonteil
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Sylvain Palat
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Sophie Geyl
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Guillaume Gondran
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Holy Bezanahary
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Eric Liozon
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Julie Azaïs
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Stéphanie Colombie
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France
| | - Marie-Odile Jauberteau
- EA 3842 - Cellular Homeostasis and Diseases, Faculty of Medicine, University of Limoges, 2 rue du Docteur Marcland, 87025, Limoges, France
| | - Véronique Loustaud-Ratti
- Gastroenterology Department, Limoges University Hospital, 2 Avenue Martin Luther King, 87042, Limoges, France
| | - Kim-Heang Ly
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France.,EA 3842 - Cellular Homeostasis and Diseases, Faculty of Medicine, University of Limoges, 2 rue du Docteur Marcland, 87025, Limoges, France
| | - Anne-Laure Fauchais
- Internal Medicine Department, Limoges University Hospital, 16 rue du Professeur Bernard Descottes, 87042, Limoges, France.,EA 3842 - Cellular Homeostasis and Diseases, Faculty of Medicine, University of Limoges, 2 rue du Docteur Marcland, 87025, Limoges, France
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19
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Liozon E, Dumonteil S, Parreau S, Gondran G, Bezanahary H, Palat S, Ly KH, Fauchais AL. Risk profiling for a refractory course of giant cell arteritis: The importance of age and body weight: "Risk profiling for GC resistance in GCA". Semin Arthritis Rheum 2020; 50:1252-1261. [PMID: 33065420 DOI: 10.1016/j.semarthrit.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Giant cell arteritis (GCA) is a disease that relapses often, and some patients run a refractory course. Although prompt recognition of resistant GCA is a major issue, there is no well-recognized, baseline risk factor for poor response to glucocorticoid (GC) treatment. METHODS We included all patients consecutively diagnosed with GCA and homogeneously treated since 1976 in a single department and regularly followed-up for at least 18 months. Using a set of customized criteria defining response to GCs, we separated patients into highly responsive, usually responsive, dependent on GCs, and resistant to GCs. We determined which of the baseline variables were associated with GC-resistance and conducted factor analyses of mixed data and decision tree analyses. We also determined whether being GC-resistant was associated with poorer tolerance to GCs and higher death rates. RESULTS In all, 455 patients were followed for 93.4 ± 67.6 (standard deviation) months; 41 (9%) and 21 (4.6%) patients developed GC-dependent and GC-resistant disease, respectively. Factor analyses suggested an association between clinical pattern and degree of responsiveness to GCs; The decision tree analyses, built on an age at GCA onset 〈 66 years and body weight 〉 71 kg, delineated a high risk profile (44% of the patients who featured both characteristics were GC-resistant vs. less than 3% who featured neither, p < 0.001). Infections were more prevalent in the GC-resistant or GC-dependent patients, but without decreasing their survival. CONCLUSION Extra-cranial, large-vessel GCA may be associated with prolonged GC requirements. A simple combination of age and body weight defined a subgroup of patients at high risk for developing GC resistance. Our findings need confirmation in prospective controlled studies.
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Affiliation(s)
- Eric Liozon
- Departments of 1Internal Medicine, University Hospital of Limoges, France.
| | - Stéphanie Dumonteil
- Departments of 1Internal Medicine, University Hospital of Limoges, France; Functional Unit of Clinical Research and Biostatistics, Limoges School of Medicine, Limoges Cedex, France
| | - Simon Parreau
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Guillaume Gondran
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Holy Bezanahary
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Sylvain Palat
- Departments of 1Internal Medicine, University Hospital of Limoges, France
| | - Kim-Heang Ly
- Departments of 1Internal Medicine, University Hospital of Limoges, France
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Talbot H, Saada S, Barthout E, Gallet PF, Gachard N, Abraham J, Jaccard A, Troutaud D, Lalloué F, Naves T, Fauchais AL, Jauberteau MO. BDNF belongs to the nurse-like cell secretome and supports survival of B chronic lymphocytic leukemia cells. Sci Rep 2020; 10:12572. [PMID: 32724091 PMCID: PMC7387561 DOI: 10.1038/s41598-020-69307-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 06/22/2020] [Indexed: 02/02/2023] Open
Abstract
Evading apoptosis and sustained survival signaling pathways are two central hallmarks of B-cell chronic lymphocytic leukemia (B-CLL) cells. In this regard, nurse-like cells (NLC), the monocyte-derived type 2 macrophages, deliver stimulatory signals via B-cell activating factor (BAFF), a proliferation-inducing ligand (APRIL), and the C-X-C Motif Chemokine Ligand 12 (CXCL12). Previously, we demonstrated that brain-derived neurotrophic factor (BDNF) protects B-CLL cells from spontaneous apoptosis by activating the oncogenic complex NTSR2-TrkB (neurotensin receptor 2-tropomyosin-related kinase receptor B), only overexpressed in B-CLL cells, inducing anti-apoptotic protein Bcl-2 (B-cell lymphoma 2) expression and Src kinase survival signaling pathways. Herein, we demonstrate that BDNF belongs to the NLC secretome and promotes B-CLL survival. This was demonstrated in primary B-CLL co-cultured with their autologous NLC, compared to B-CLL cells cultured alone. Inhibition of BDNF in co-cultures, enhances B-CLL apoptosis, whereas its exogenous recombinant activates pro-survival pathways in B-CLL cultured alone (i.e. Src activation and Bcl-2 expression), at a higher level than those obtained by the exogenous recombinant cytokines BAFF, APRIL and CXCL12, the known pro-survival cytokines secreted by NLC. Together, these results showed that BDNF release from NLC trigger B-CLL survival. Blocking BDNF would support research strategies against pro-survival cytokines to limit sustained B-CLL cell survival.
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Affiliation(s)
- Hugo Talbot
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Sofiane Saada
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Elodie Barthout
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Paul-François Gallet
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Nathalie Gachard
- Hematology Laboratory, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France.,CNRS-UMR 7276, Limoges University, Limoges Cedex, France
| | - Julie Abraham
- CNRS-UMR 7276, Limoges University, Limoges Cedex, France.,Department of Hematology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - Arnaud Jaccard
- CNRS-UMR 7276, Limoges University, Limoges Cedex, France.,Department of Hematology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - Danielle Troutaud
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Fabrice Lalloué
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Thomas Naves
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France
| | - Anne-Laure Fauchais
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France.,Department of Internal Medicine, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - Marie-Odile Jauberteau
- Equipe Accueil 3842 CAPTuR, Faculty of Medicine, Limoges University, 2, Rue du Docteur Marcland, 87025, Limoges Cedex, France. .,Department of Immunology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France.
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21
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Liozon E, Fauchais AL. [Low-dose methotrexate]. Rev Prat 2020; 70:239-245. [PMID: 32877051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Eric Liozon
- Service de médecine interne A, hôpital universitaire Dupuytren, Limoges, France
| | - Anne-Laure Fauchais
- Service de médecine interne A, hôpital universitaire Dupuytren, Limoges, France
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22
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Ledoult E, Launay D, Béhal H, Mouthon L, Pugnet G, Lega JC, Agard C, Allanore Y, Jego P, Fauchais AL, Harlé JR, Berthier S, Aouba A, Mekinian A, Diot E, Truchetet ME, Boulon C, Duhamel A, Hachulla E, Sobanski V. Early trajectories of skin thickening are associated with severity and mortality in systemic sclerosis. Arthritis Res Ther 2020; 22:30. [PMID: 32070422 PMCID: PMC7029583 DOI: 10.1186/s13075-020-2113-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 10/08/2019] [Accepted: 01/31/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Systemic sclerosis (SSc) is a severe and highly heterogeneous disease. The modified Rodnan skin score (mRSS) is a widely used tool for the assessment of the extent and degree of skin thickness. This study aimed to identify the classes of patients with early similar skin thickening trajectories without any a priori assumptions and study their associations with organ involvement and survival. METHODS From the French SSc national cohort, patients with a disease duration of less than 2 years at inclusion and with at least 2 mRSS available within the first 4 years of follow-up were enrolled. Classes of patients with similar mRSS trajectories were identified based on a latent class mixed model. The clinical characteristics and survival rate were compared between the obtained classes. RESULTS A total of 198 patients fulfilled the inclusion criteria, with a total of 641 mRSS available. The median disease duration and follow-up were 0.8 (interquartile range 0.4; 1.2) and 6.3 (3.8; 8.9) years, respectively. Individual trajectories of mRSS were highly heterogeneous between patients. Models with 1-6 latent classes of trajectories were sequentially assessed, and the 5-class model represented the best fit to data. Each class was characterized by a unique global trajectory of mRSS. The median disease duration did not differ significantly between classes. Baseline organ involvement was more frequent in classes with significant change over time (classes 2-5) than in class 1 (low baseline mRSS without significant change over time). Using Cox regression, we observed a progressively increasing risk of death from classes 1 to 5. CONCLUSIONS Early identification of clinical phenotype based on skin thickening trajectories could predict morbi-mortality in SSc. This study suggested that mRSS trajectories characterization might be pivotal for clinical practice and future trial designs.
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Affiliation(s)
- Emmanuel Ledoult
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - David Launay
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Hélène Béhal
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Luc Mouthon
- Hôpital Cochin-APHP, Service de Médecine Interne, Paris, France
| | - Grégory Pugnet
- CHU Toulouse, Service de Médecine Interne, Toulouse, France
| | | | | | | | - Patrick Jego
- CHU Rennes, Service de Médecine Interne, Rennes, France
| | | | - Jean-Robert Harlé
- Hôpital de la Timone, Service de Médecine Interne, Marseille, France
| | - Sabine Berthier
- CHU Dijon, Service de Médecine Interne et Immunologie Clinique, Dijon, France
| | | | - Arsène Mekinian
- Hôpital Saint-Antoine-APHP, Service de Médecine Interne, Paris, France
| | | | | | - Carine Boulon
- CHU Bordeaux, Service de Médecine vasculaire, Bordeaux, France
| | - Alain Duhamel
- Univ. Lille, CHU Lille, EA 2694-Santé publique, épidémiologie et qualité des soins, Unité de Biostatistiques, F-59000, Lille, France
| | - Eric Hachulla
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France.,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France.,INSERM, U1286, F-59000, Lille, France
| | - Vincent Sobanski
- Univ. Lille, Institute for Translational Research in Inflammation (INFINITE), F-59000, Lille, France. .,CHU Lille, Service de Médecine Interne, Centre de Référence des Maladies Auto-immunes et Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000, Lille, France. .,INSERM, U1286, F-59000, Lille, France.
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Bezanahary H, Gutierrez B, Dumonteil S, Coste Mazeau P, Eyraud JL, Preux PM, Fauchais AL, Ly K, Aubard Y. Risk factors of pregnancy morbidity in migrant women from Subsaharan Africa. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.173] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Reduction of maternal mortality remains a major public health issue worldwide. In France, the latest national confidential enquiry regarding maternal mortality (2010-2012) stated a ratio of 10 /100 000 livebirths whereas the goal was 5/100 000. The risk of death among pregnant women from Subsaharan Africa (SSA) was 3 times higher.
We performed a monocentric observational retrospective study from 01/01/2009 to 01/09/2016 in order to better understand the factors of maternal morbidity among SSA pregnant women. Demographic characteristics as well as pregnancy outcomes were collected. Antenatal clinics attendance was scored (+1 if positive, +1 if done following the recommended schedule). A total 1 489 (7%) out of 20 755 pregnancies were registred among SSA women. Mean age was 29 years (14-48), mean gestity/parity were respectively 3.5 and 1.8. About 38% of pregnancies occured in overweight or obese women. Obstetrical complications were seen in 542 (36%) pregnancies: gestational diabetes (n = 206, 36,4%), hypertensive disorders (n = 122, 8,2%), 19 had both. Pre-eclampsia represented 4%, sepsis 5%, premature rupture of membrane 5% and post partum haemorrhage 3%. Livebirths was high (97%) with a mean gestational age of 37(22-41), a mean birth weight of 3150g (500-5000). The unique maternal death in this cohort was due to amniotic fluid embolism. Complication risk factors were age (30 versus 28 years; p < 0.0001), BMI (26 versus 25 kg/m2; p < 0.0001), past history of chronic hypertension and pregestational diabetes (p < 0,001). Furthermore, the score of antenatal care attendance was low in those who presented pregnancy morbidities (p = 0.0006) (adjusted with age, BMI> 25 and chronic hypertension).
Higher risk of maternal morbidity among SSA women is not only explained by individual risk factors but also by a lack of compliance to the recommended antenatal care even if they live in France. Further investigations including sociological studies are therefore needed.
Key messages
Maternal mortality and morbidity are higher among migrant women from Subsaharan Africa. Our study highlights a non compliance to the recommended antenatal care surveillance among risk factors.
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Affiliation(s)
- H Bezanahary
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - B Gutierrez
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - S Dumonteil
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | | | - J L Eyraud
- Obstetric Department, CHU, Limoges, France
| | - P M Preux
- UMR 1094 NET, INSERM, Limoges, France
| | - A L Fauchais
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - K Ly
- Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Y Aubard
- Obstetric Department, CHU, Limoges, France
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24
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Liozon E, Delmas C, Dumonteil S, Dumont A, Gondran G, Bezanahary H, Aouba A, Fauchais AL, Ly KH, de Boysson H. Features and prognosis of giant cell arteritis in patients over 85 years of age: A case-control study. Semin Arthritis Rheum 2019; 49:288-295. [PMID: 30910217 DOI: 10.1016/j.semarthrit.2019.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/20/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND We examined the initial features, course, and prognosis of giant cell arteritis (GCA) in patients ≥ 85 years of age (≥85 year) and compared them to those of younger patients. METHODS The present retrospective study included all patients who were newly diagnosed with GCA in the Internal Departments of two French University Hospitals from 1976 or 1998 to 2017 and who were followed up for at least 6 months. Logistic regression analyses were conducted to identify baseline and prognostic characteristics associated with being ≥85 year. RESULTS Of the 865 patients assessed in this study, 87 were ≥85 year. Compared to younger patients, patients ≥ 85 year had more comorbid conditions (odds ratio [OR] = 1.11-1.74, p < 0.01), less often exhibited polymyalgia rheumatica (PMR; OR = 0.33-0.96, p = 0.04), and more often developed permanent visual loss (OR = 1.29-3.81, p < 0.01). The older patients also showed less dependence on glucocorticoid (GC) medications (OR = 0.23-0.94, p = 0.04), had fewer relapses (OR = 0.31-0.87, p = 0.015), less often recovered from GCA (OR = 0.22-0.69, p < 0.01), and more often died during treatment (OR = 1.45-4.65, p = 0.001) compared to younger patients. Being ≥85 year was the only factor associated with an increased 1-year mortality (hazard ratio = 1.77-5.81, p = 0.0001) for the whole cohort. CONCLUSIONS GCA in very elderly patients was characterized by a higher rate of severe ischemic complications and an increased risk for early death compared to younger patients. Thus, there is a need for the early diagnosis of GCA and close clinical monitoring in this unique population.
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Affiliation(s)
- Eric Liozon
- Departments of Internal Medicine, University Hospital of Limoges, France.
| | - Claire Delmas
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Stéphanie Dumonteil
- Departments of Functional Unit of Clinical Research and Biostatistics, Limoges School of Medicine, Limoges, France
| | - Anael Dumont
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | - Guillaume Gondran
- Departments of Internal Medicine, University Hospital of Limoges, France
| | - Holy Bezanahary
- Departments of Internal Medicine, University Hospital of Limoges, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, Caen, France
| | | | - Kim-Heang Ly
- Departments of Internal Medicine, University Hospital of Limoges, France
| | - Hubert de Boysson
- Department of Internal Medicine, Caen University Hospital, Caen, France
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25
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Talbot H, Saada S, Naves T, Gallet PF, Fauchais AL, Jauberteau MO. Regulatory Roles of Sortilin and SorLA in Immune-Related Processes. Front Pharmacol 2019; 9:1507. [PMID: 30666202 PMCID: PMC6330335 DOI: 10.3389/fphar.2018.01507] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/10/2018] [Indexed: 12/25/2022] Open
Abstract
Sortilin, also known as Neurotensin Receptor-3, and the sorting-related receptor with type-A repeats (SorLA) are both members of the Vps10p domain receptor family. Initially identified in CNS cells, they are expressed in various other cell types where they exert multiple functions. Although mostly studied for its involvement in Alzheimer’s disease, SorLA has recently been shown to be implicated in immune response by regulating IL-6-mediated signaling, as well as driving monocyte migration. Sortilin has been shown to act as a receptor, as a co-receptor and as an intra- and extracellular trafficking regulator. In the last two decades, deregulation of sortilin has been demonstrated to be involved in many human pathophysiologies, including neurodegenerative disorders (Alzheimer and Parkinson diseases), type 2 diabetes and obesity, cancer, and cardiovascular pathologies such as atherosclerosis. Several studies highlighted different functions of sortilin in the immune system, notably in microglia, pro-inflammatory cytokine regulation, phagosome fusion and pathogen clearance. In this review, we will analyze the multiple roles of sortilin and SorLA in the human immune system and how their deregulation may be involved in disease development.
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Affiliation(s)
- Hugo Talbot
- Faculty of Medicine, University of Limoges, Limoges, France
| | - Sofiane Saada
- Faculty of Medicine, University of Limoges, Limoges, France
| | - Thomas Naves
- Faculty of Medicine, University of Limoges, Limoges, France
| | | | - Anne-Laure Fauchais
- Faculty of Medicine, University of Limoges, Limoges, France.,Department of Internal Medicine, University Hospital Limoges Dupuytren Hospital, Limoges, France
| | - Marie-Odile Jauberteau
- Faculty of Medicine, University of Limoges, Limoges, France.,Department of Immunology, University Hospital Limoges Dupuytren Hospital, Limoges, France
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26
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Mirouse A, Seror R, Vicaut E, Mariette X, Dougados M, Fauchais AL, Deroux A, Dellal A, Costedoat-Chalumeau N, Denis G, Sellam J, Arlet JB, Lavigne C, Urbanski G, Fischer-Dumont D, Diallo A, Fain O, Mékinian A. Arthritis in primary Sjögren's syndrome: Characteristics, outcome and treatment from French multicenter retrospective study. Autoimmun Rev 2019; 18:9-14. [PMID: 30408585 DOI: 10.1016/j.autrev.2018.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/23/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the characteristics and the outcome of primary Sjögren Syndrome (pSS) associated arthritis and to compare the efficacy of different therapeutic regimen. METHODS We conducted a retrospective study using Club Rhumatisme and Inflammation (CRI) and French Internal Medicine Society (SNFMI) networks. All patients with a diagnosis of pSS and at least one episode of clinical and/or echographic synovitis were included. Patients with synovitis (cases) were compared to pSS patients without synovitis (controls). RESULTS 57 patients (93% women) were included with a median age of 54 years [45-63]. Patients with synovitis had more frequently lymph node enlargement (12.3% vs. 1.8%, p = .007) and a higher ESSDAI score (8 [6-12] vs. 2 [1-4], p < .0001). There was no difference concerning CRP levels, rheumatoid factor and cyclic citrullinated peptide (CCP)-antibodies positivity. Among 57 patients with synovitis, 101 various treatment courses have been used during the follow-up of 40 [22.5-77] months. First treatment course consisted in steroids alone (3.5%), steroids in association (79%) with hydroxychloroquine (HCQ) (49%), methotrexate (MTX) (35%), rituximab (RTX) (5.3%) or other immunosuppressive drugs (7%). HCQ, MTX, and RTX were associated with a significant reduction of tender and swollen joint count, and a significant steroids-sparing effect. No difference could be shown for the joint response between these treatment regimens. CONCLUSION pSS articular manifestations may include synovitis which could mimic rheumatoid arthritis but differ by the absence of structural damage. Even if the use of HCQ, MTX, and RTX seem to be effective for joint involvement, the best regimen remains to be determined.
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Affiliation(s)
- Adrien Mirouse
- Service de médecine interne, Hôpital Saint-Antoine, APHP, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Raphaèle Seror
- Service de rhumatologie, Hôpital du Kremlin-Bicêtre, APHP, Bicêtre, France
| | - Eric Vicaut
- Service de biostatistiques médicales, Hôpital Lariboisière, APHP, France
| | - Xavier Mariette
- Service de rhumatologie, Hôpital du Kremlin-Bicêtre, APHP, Bicêtre, France
| | | | | | - Alban Deroux
- Service de médecine interne, CHU Grenoble, La Tronche, France
| | - Azeddine Dellal
- Service de rhumatologie, Hôpital Montfermeil, Montfermeil, France
| | - Nathalie Costedoat-Chalumeau
- Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares, Hôpital Cochin, APHP, Paris, France; Université Paris Descartes-Sorbonne Paris Cité, Paris, France; INSERM U 1153, Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | | | - Jérémie Sellam
- Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France; Service de rhumatologie, Hôpital Saint-Antoine, APHP, Paris, France
| | - Jean-Benoît Arlet
- Service de médecine interne, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | | | | | - Abdou Diallo
- Service de biostatistiques médicales, Hôpital Lariboisière, APHP, France
| | - Olivier Fain
- Service de médecine interne, Hôpital Saint-Antoine, APHP, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France
| | - Arsène Mékinian
- Service de médecine interne, Hôpital Saint-Antoine, APHP, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), F-75012 Paris, France.
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27
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Jacques J, Pagnon L, Hure F, Legros R, Crepin S, Fauchais AL, Palat S, Ducrotté P, Marin B, Fontaine S, Boubaddi NE, Clement MP, Sautereau D, Loustaud-Ratti V, Gourcerol G, Monteil J. Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy 2019; 51:40-49. [PMID: 29895073 DOI: 10.1055/a-0628-6639] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [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: 02/08/2023]
Abstract
BACKGROUND Gastroparesis is a functional disorder with a variety of symptoms that is characterized by delayed gastric emptying in the absence of mechanical obstruction. A recent series of retrospective studies has demonstrated that peroral endoscopic pyloromyotomy (G-POEM) is a promising endoscopic procedure for treating patients with refractory gastroparesis. The aim of this prospective study was to evaluate the feasibility, safety, and efficacy of G-POEM. METHODS 20 patients with refractory gastroparesis (10 diabetic and 10 nondiabetic) were prospectively included in the trial. Patients were treated by G-POEM after evaluation of pyloric function using an endoscopic functional luminal imaging probe. Clinical responses were evaluated using the Gastroparesis Cardinal Symptom Index (GCSI), and quality of life was assessed using the Patient Assessment of Upper Gastrointestinal Disorders - Quality of Life scale and the Gastrointestinal Quality of Life Index scores. Gastric emptying was measured using 4-hour scintigraphy before G-POEM and at 3 months. RESULTS Feasibility of the procedure was 100 %. Compared with baseline values, G-POEM significantly improved symptoms (GCSI: 1.3 vs. 3.5; P < 0.001), quality of life, and gastric emptying (T½: 100 vs. 345 minutes, P < 0.001; %H2: 56.0 % vs. 81.5 %, P < 0.001; %H4: 15.0 % vs. 57.5 %, P = 0.003) at 3 months. The clinical success of G-POEM using the functional imaging probe inflated to 50 mL had specificity of 100 % and sensitivity of 72.2 % (P = 0.04; 95 % confidence interval 0.51 - 0.94; area under the curve 0.72) at a distensibility threshold of 9.2 mm2/mmHg. CONCLUSION G-POEM was efficacious and safe for treating refractory gastroparesis, especially in patients with low pyloric distensibility.
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Affiliation(s)
- Jérémie Jacques
- Service de Gastroentérologie, CHU Limoges, Limoges, France.,CNRS, XLIM, UMR 7252, Limoges, France
| | | | - Florent Hure
- Service de Biostatistiques, CHU Limoges, Limoges, France
| | - Romain Legros
- Service de Gastroentérologie, CHU Limoges, Limoges, France
| | - Sabrina Crepin
- Unité de Vigilance des Essais Cliniques, CHU Limoges, Limoges, France
| | | | - Sylvain Palat
- Service de Médecine Interne, CHU Limoges, Limoges, France
| | - Philippe Ducrotté
- Service de Gastroentérologie et Physiologie Digestive, CHU Charles Nicolle, Rouen, France
| | - Benoit Marin
- Service de Biostatistiques, CHU Limoges, Limoges, France
| | | | - Nour Edine Boubaddi
- Service de Gastroentérologie, CH Brive-la-Gaillarde, Brive-la-Gaillarde, France
| | | | | | | | - Guillaume Gourcerol
- Service de Gastroentérologie et Physiologie Digestive, CHU Charles Nicolle, Rouen, France
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Anquetil C, Hachulla E, Machuron F, Mariette X, Le Guern V, Vittecoq O, Dernis E, Larroche C, Dubost JJ, Perdriger A, Devauchelle-Pensec V, Fauchais AL, Morel J, Dieudé P, Rist S, Sene D, Gottenberg JE, Hatron PY. Is early-onset primary Sjögren’s syndrome a worse prognosis form of the disease? Rheumatology (Oxford) 2018; 58:1163-1167. [DOI: 10.1093/rheumatology/key392] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/05/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Céline Anquetil
- Service de médecine interne, CHU Claude Huriez, Lille Cedex, France
| | - Eric Hachulla
- Service de médecine interne, CHU Claude Huriez, Lille Cedex, France
| | - François Machuron
- Department of Biostatistics, Univ. Lille, CHU Lille, EA 2694 - Santé Publique : Épidémiologie et Qualité des Soins, Lille, France
| | - Xavier Mariette
- Service de rhumatologie, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris-Sud, Le Kremlin-Bicêtre, France
| | - Véronique Le Guern
- Centre de référence des maladies auto-immunes rares, CHU Cochin APHP, Paris, France
| | | | - Emmanuelle Dernis
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans Cedex, France
| | - Claire Larroche
- Service de médecine interne, Hôpital Avicenne APHP, Bobigny Cedex, France
| | - Jean-Jacques Dubost
- Service de rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand Cedex, France
| | | | | | | | - Jacques Morel
- Département de rhumatologie, CHU de Montpellier, Université de Montpellier, Montpellier, France
| | - Philippe Dieudé
- Service de rhumatologie, Hôpital Bichat AP-HP, Paris, France
| | | | - Damien Sene
- Département de médecine interne, Hôpital Lariboisière APHP, Paris, France
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29
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Liozon E, de Boysson H, Dalmay F, Gondran G, Bezanahary H, Fauchais AL, Ly KH. Development of Giant Cell Arteritis after Treating Polymyalgia or Peripheral Arthritis: A Retrospective Case-control Study. J Rheumatol 2018; 45:678-685. [DOI: 10.3899/jrheum.170455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 11/22/2022]
Abstract
Objective.We investigated the development of giant cell arteritis (GCA) in patients with prior diagnoses of isolated polymyalgia rheumatica and/or peripheral arthritis (PMR/PA), and the potentially relevant characteristics of both illnesses in such patients.Methods.We retrospectively compared the features of 67 patients at the onset of PMR/PA, and their outcomes, to those of a random group of 65 patients with PMR/PA who did not develop late GCA. We also compared the features and outcomes of patients with late GCA to those of a random sample of patients with more usual GCA (65 with concurrent PMR/PA and 65 without).Results.Patients with late GCA represented 7.4% of all patients with GCA included in a large hospital-based inception cohort. PMR/PA preceded overt GCA by 27 months on average. Permanent visual loss developed in 10 patients, including 8 of 48 (17%) patients featuring cranial arteritis. A questionable female predominance was the only distinguishing feature of PMR/PA evolving into GCA; late GCA more often featured subclinical aortitis (OR 6.42, 95% CI 2.39–17.23; p < 0.001), headache (OR 0.44, 95% CI 0.19–1.03; p = 0.06), and fever (OR 0.29, 95% CI 0.13–0.64; p = 0.002) less often compared to the more usual form of GCA. Patients with either form of GCA experienced similar outcomes.Conclusion.A cranial arteritis pattern of late GCA is associated with a significant risk for ischemic blindness. However, compared to the usual form of GCA, late GCA is often less typical, with a higher frequency of silent aortitis. Patients with relapsing/refractory PMR may not be at increased risk for late GCA.
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30
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Abbaci A, Talbot H, Saada S, Gachard N, Abraham J, Jaccard A, Bordessoule D, Fauchais AL, Naves T, Jauberteau MO. Neurotensin receptor type 2 protects B-cell chronic lymphocytic leukemia cells from apoptosis. Oncogene 2017; 37:756-767. [PMID: 29059151 PMCID: PMC5808079 DOI: 10.1038/onc.2017.365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/29/2017] [Accepted: 08/25/2017] [Indexed: 02/06/2023]
Abstract
B-cell chronic lymphocytic leukemia (B-CLL) cells are resistant to apoptosis, and consequently accumulate to the detriment of normal B cells and patient immunity. Because current therapies fail to eradicate these apoptosis-resistant cells, it is essential to identify alternative survival pathways as novel targets for anticancer therapies. Overexpression of cell-surface G protein-coupled receptors drives cell transformation, and thus plays a critical role in malignancies. In this study, we identified neurotensin receptor 2 (NTSR2) as an essential driver of apoptosis resistance in B-CLL. NTSR2 was highly expressed in B-CLL cells, whereas expression of its natural ligand, neurotensin (NTS), was minimal in both B-CLL cells and patient plasma. Surprisingly, NTSR2 remained in a constitutively active phosphorylated state, caused not by a mutation-induced gain-of-function but rather by an interaction with the oncogenic tyrosine kinase receptor TrkB. Functional and biochemical characterization revealed that the NTSR2-TrkB interaction acts as a conditional oncogenic driver requiring the TrkB ligand brain-derived neurotrophic factor (BDNF), which unlike NTS is highly expressed in B-CLL cells. Together, NTSR2, TrkB and BDNF induce autocrine and/or paracrine survival pathways that are independent of mutation status and indolent or progressive disease course. The NTSR2-TrkB interaction activates survival signaling pathways, including the Src and AKT kinase pathways, as well as expression of the anti-apoptotic proteins Bcl-2 and Bcl-xL. When NTSR2 was downregulated, TrkB failed to protect B-CLL cells from a drastic decrease in viability via typical apoptotic cell death, reflected by DNA fragmentation and Annexin V presentation. Together, our findings demonstrate that the NTSR2-TrkB interaction plays a crucial role in B-CLL cell survival, suggesting that inhibition of NTSR2 represents a promising targeted strategy for treating B-CLL malignancy.
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Affiliation(s)
- A Abbaci
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France
| | - H Talbot
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France
| | - S Saada
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France
| | - N Gachard
- Hematology Laboratory, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France.,CNRS-UMR 7276, Limoges University, Limoges Cedex, France
| | - J Abraham
- Department of Hematology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - A Jaccard
- CNRS-UMR 7276, Limoges University, Limoges Cedex, France.,Department of Hematology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - D Bordessoule
- CNRS-UMR 7276, Limoges University, Limoges Cedex, France.,Department of Hematology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - A L Fauchais
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France.,Department of Internal Medicine, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
| | - T Naves
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France
| | - M O Jauberteau
- Limoges University, Equipe Accueil 3842, Cellular Homeostasis and Diseases, Faculty of Medicine, Limoges Cedex, France.,Department of Immunology, Dupuytren Hospital University Center of Limoges, Limoges Cedex, France
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Jasiek M, Karras A, Le Guern V, Krastinova E, Mesbah R, Faguer S, Jourde-Chiche N, Fauchais AL, Chiche L, Dernis E, Moulis G, Fraison JB, Lazaro E, Jullien P, Hachulla E, Le Quellec A, Rémy P, Hummel A, Costedoat-Chalumeau N, Ronco P, Vanhille P, Meas-Yedid V, Cordonnier C, Ferlicot S, Daniel L, Seror R, Mariette X, Thervet E, François H, Terrier B. A multicentre study of 95 biopsy-proven cases of renal disease in primary Sjögren's syndrome. Rheumatology (Oxford) 2017; 56:362-370. [PMID: 27940588 DOI: 10.1093/rheumatology/kew376] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Indexed: 12/24/2022] Open
Abstract
Objective. Renal involvement is a rare event during primary SS (pSS). We aimed to describe the clinico-biological and histopathological characteristics of pSS-related nephropathy and its response to treatment. Methods. We conducted a French nationwide, retrospective, multicentre study including pSS patients fulfilling American-European Consensus Group criteria or enlarged American-European Consensus Group criteria, and with biopsy-proven renal involvement. Results. A total of 95 patients were included (median age 49 years). An estimated glomerular filtration rate (eGFR) of <60 ml/min was found in 82/95 patients (86.3%). Renal biopsy demonstrated tubulointerstitial nephritis (TIN) in 93 patients (97.9%), and frequent (75%) plasma cell infiltrates. Glomerular lesions were found in 22 patients (23.2%), mainly related to cryoglobulin. The presence of anti-SSA (76.8%) and anti-SSB (53.8%) antibodies was particularly frequent among patients with TIN and was associated with a worse renal prognosis. Eighty-one patients (85.3%) were treated, with CSs in 80 (98.8%) and immunosuppressive agents (mostly rituximab) in 21 cases (25.9%). Despite marked interstitial fibrosis at initial biopsy, kidney function improved significantly during the 12-month period following diagnosis (final eGFR 49.9 vs 39.8 ml/min/1.73 m 2 at baseline, P < 0.001). No proven benefit of immunosuppressive agents over steroid therapy alone was found in this study. Conclusion. Renal involvement of pSS is mostly due to TIN with marked T, B and especially plasma cell infiltration. Renal dysfunction is usually isolated but can be severe. Use of CSs can improve the eGFR, but further studies are needed to define the best therapeutic strategy in this disease.
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Affiliation(s)
- Magali Jasiek
- Department of Nephrology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Le Kremlin-Bicêtre
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP
| | - Véronique Le Guern
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | - Evguenia Krastinova
- Department of Epidemiology and Statistics, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier, Boulogne-Sur-Mer
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, Hôpital Rangueil, Toulouse
| | | | | | - Laurent Chiche
- Department of Internal Medicine, Hôpital Européen, Marseille
| | | | | | | | | | - Perrine Jullien
- Department of Internal Medicine, CHU Saint-Étienne, Saint-Étienne
| | - Eric Hachulla
- Department of Internal Medicine, Hôpital Claude Huriez, Université Lille 2, Lille
| | - Alain Le Quellec
- Department of Internal Medicine, Hôpital Saint-Eloi, Montpellier
| | - Philippe Rémy
- Department of Nephrology, Hôpital Henri Mondor, Créteil
| | | | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
| | | | | | | | | | - Sophie Ferlicot
- Department of Pathology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre
| | | | - Raphaele Seror
- Department of Rheumatology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre.,Center of Immunology of Viral and Autoimmune Diseases (IMVA), INSRM U1184, Le Kremlin-Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpital Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicêtre.,Center of Immunology of Viral and Autoimmune Diseases (IMVA), INSRM U1184, Le Kremlin-Bicêtre, France
| | - Eric Thervet
- Department of Nephrology, Hôpital Européen Georges Pompidou, AP-HP
| | - Hélène François
- Department of Nephrology, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Le Kremlin-Bicêtre
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris
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Ly KH, Dalmay F, Gondran G, Palat S, Bezanahary H, Cypierre A, Fauchais AL, Liozon E. Steroid-sparing effect and toxicity of dapsone treatment in giant cell arteritis: A single-center, retrospective study of 70 patients. Medicine (Baltimore) 2016; 95:e4974. [PMID: 27759628 PMCID: PMC5079312 DOI: 10.1097/md.0000000000004974] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although a glucocorticoid (GC)-sparing strategy is needed for patients with giant cell arteritis (GCA) suffering from refractory disease or serious treatment-related complications, evidence of efficacy in this setting of immunosuppressive drugs and biotherapies is lacking. Herein, we evaluated the GC-sparing effects and tolerability of addition of dapsone (DDS) to prednisone therapy in patients with GCA. We retrospectively assessed data on 18 GCA patients who received DDS as a first-line treatment (DDS-1 group) and 52 patients who received it as a second- or third-line treatment for refractory GCA, with or without excessive GC-related toxicity (DDS-2 group). Of these 70 patients, 63 belonged to an inception cohort of 478 patients, whereas the remaining 7 were referred to our department for resistant GCA. In all, 52 patients were assessable for DDS efficacy. The baseline characteristics of the DDS-1 patients were similar to those of 395 GCA patients (control group) who received prednisone alone. DDS-1 patients had a more sustained decrease in GC dose with a lower mean prednisone dose at 12 months, and they comprised higher proportions who achieved GC withdrawal within the first year, who stopped prednisone treatment, and who recovered from GCA (P < 0.001 for each variable). Patients in the DDS-2 group achieved a mean rate of prednisone reduction of 65% and a prednisone dose reduction of 16.9 ± 13.3 mg/d. The monthly decreases in the prednisone dose were 2.4 and 1.25 mg in DDS-1 and DDS-2 patients, respectively. DDS-induced side effects were recorded in 44 (64%) assessable patients. These side effects led to lowering of the DDS dose by 25 mg/d in 11 (16%) patients and permanent cessation of DDS in 14 patients (20%), due to allergic skin rash in 7, agranulocytosis in 2, icteric hepatitis in 2, and excessive hemolysis in 2 patients. DDS is a potent GC-sparing agent in GCA that should be evaluated in prospective studies. However, DDS use should be restricted to refractory GCA patients due to its toxicity, and close clinical and laboratory monitoring for 3 months is necessary.
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Affiliation(s)
- Kim Heang Ly
- Department of Internal Medicine, University Hospital of Limoges
- Correspondence: Kim Heang Ly, Department of Internal Medicine, CHU Dupuytren, 2 Avenue Martin Luther King, Limoges Cedex 87042, France (e-mail: )
| | - François Dalmay
- Functional unit of Clinical Research and Biostatistics, Limoges School of Medicine, Limoges Cedex, France
| | | | - Sylvain Palat
- Department of Internal Medicine, University Hospital of Limoges
| | - Holy Bezanahary
- Department of Internal Medicine, University Hospital of Limoges
| | - Anne Cypierre
- Department of Internal Medicine, University Hospital of Limoges
| | | | - Eric Liozon
- Department of Internal Medicine, University Hospital of Limoges
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Fauchais AL, Cypierre A. [Not Available]. Rev Prat 2016; 66:e299-e304. [PMID: 30512314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
| | - Anne Cypierre
- Service de médecine interne A, CHU Dupuytren, 87000 Limoges, France
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Martel C, Vignaud G, Liozon E, Magy L, Gallouedec G, Ly K, Bezanahary H, Cypierre A, Lapébie FX, Palat S, Gondran G, Jauberteau MO, Fauchais AL. Contribution of dot-blot assay to the diagnosis and management of myositis: a three-year practice at a university hospital centre. Clin Exp Rheumatol 2016; 34:918-924. [PMID: 27494325] [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] [Received: 10/29/2015] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Idiopathic inflammatory myopathies (IIM) are heterogeneous autoimmune diseases with wide clinical spectrum that may lead to delayed diagnosis. The aim of this study was to examine the impact of IIM-specific dot-blot assay on diagnostic process of patients presenting with muscular or systemic symptoms evocating of IIM. METHODS We collected all the prescriptions of an IIM specific dot-blot assay (8 autoantigens including Jo-1, PL-7, PL-12, SRP, Mi-2, Ku, PM/Scl and Scl-70) over a 38-month period. RESULTS 316 myositis dot-blot assays (MSD) were performed in 274 patients (156 women, mean age 53±10.6 years) referring for muscular and/or systemic symptoms suggesting IIM. The timing of dot prescription through the diagnostic process was highly variable: without (35%), concomitantly (16%) or after electromyographic studies (35%). Fifty-nine patients (22%) had IIM according to Bohan and Peter's criteria. Among them, 29 (49%) had positive dot (8 Jo-1, 6 PM-Scl, 5 PL-12, 5 SRP, 2 Mi-2, 2 PL-7 and 1 Ku). Various other diagnoses were performed including 35 autoimmune disease or granulomatosis (12%), 19 inflammatory rheumatic disease (7%), 16 non inflammatory muscular disorders (6%), 10 drug-induced myalgia (4%), 11 infectious myositis (4%). Except 11 borderline SRP results and one transient PM-Scl, MSD was positive only in one case of IIM. Dot allowed clinicians to correct diagnosis in 4 cases and improved the diagnosis of IIM subtypes in 4 cases. CONCLUSIONS This study reflects the interest of myositis dot in the rapid diagnosis process of patients with non-specific muscular symptoms leading to various diagnoses including IIM.
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Affiliation(s)
- Clothilde Martel
- Department of Internal Medicine, and Department of Immunology, Limoges University Hospital, France
| | - Guillaume Vignaud
- Department of Internal Medicine, Limoges University Hospital, France
| | - Eric Liozon
- Department of Internal Medicine, Limoges University Hospital, France
| | - Laurent Magy
- Department of Neurology, Centre de Référence "Neuropathies Périphériques Rares", Limoges University Hospital, France
| | - Gael Gallouedec
- Department of Neurology, Centre de Référence "Neuropathies Périphériques Rares", Limoges University Hospital, France
| | - Kim Ly
- Department of Internal Medicine, Limoges University Hospital, France
| | - Holly Bezanahary
- Department of Internal Medicine, Limoges University Hospital, France
| | - Anne Cypierre
- Department of Internal Medicine, Limoges University Hospital, France
| | | | - Sylvain Palat
- Department of Internal Medicine, Limoges University Hospital, France
| | - Guillaume Gondran
- Department of Internal Medicine, Limoges University Hospital, France
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Fauchais AL, Lambert M, Launay D, Michon-Pasturel U, Queyrel V, Nguyen N, Hebbar M, Hachulla E, Devulder B, Hatron PY. Antiphospholipid antibodies in primary Sjögren’s syndrome: prevalence and clinical significance in a series of 74 patients. Lupus 2016; 13:245-8. [PMID: 15176660 DOI: 10.1191/0961203304lu1006oa] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study is to determine prevalence, clinical significance of antiphospholipidantibodies (aPL) including anticardiolipin antibodies (aCL), anti-b2GP1 and lupus anticoagulant (LA) in a cohort of 74 patients with primary Sjögren’s syndrome (pSS) according to revised European criteria. aPL were found in 25 (34%) patients; IgG in 23 (12 had low titres, six moderate titres and five high titres) and IgM in five (three and two had respectively moderate and high titres). Eight (11%) patients were found to have LA; anti-b2GP1 antibodies were detected only in three (4%) patients. Only two patients with LA, aPL and b2GP1 had recurrent venous thrombosis. One patient with moderate titres of aPL exhibited recurrent spontaneous foetal losses. Peripheral neuropathies without cryoglobulinemia were more frequent in the aPL group. Other systemic involvements of pSS were the same in both groups with or without aPL. Patients with aPL have more concurrentimmunological diseases such as thyroiditis and primary biliary cirrhosis and a higher prevalence of hypergammaglobulinemia (P < 0.05). Even if aPL prevalence reached 30% in pSS, titres were usually low, with a close correlation with hypergammaglobulinemia but not with antiphospholipid syndrome, which is related to positivity of both LA and aPL.
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Affiliation(s)
- A L Fauchais
- Department of Internal Medicine, Regional University Hospital of Lille, France.
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36
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Samson M, Ly KH, Tournier B, Janikashvili N, Trad M, Ciudad M, Gautheron A, Devilliers H, Quipourt V, Maurier F, Meaux-Ruault N, Magy-Bertrand N, Manckoundia P, Ornetti P, Maillefert JF, Besancenot JF, Ferrand C, Mesturoux L, Labrousse F, Fauchais AL, Saas P, Martin L, Audia S, Bonnotte B. Involvement and prognosis value of CD8(+) T cells in giant cell arteritis. J Autoimmun 2016; 72:73-83. [PMID: 27236507 DOI: 10.1016/j.jaut.2016.05.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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: 04/14/2016] [Revised: 05/09/2016] [Accepted: 05/11/2016] [Indexed: 11/18/2022]
Abstract
CD8(+) T cells participate in the pathogenesis of some vasculitides. However, little is known about their role in Giant Cell Arteritis (GCA). This study was conducted to investigate CD8(+) T cell involvement in the pathogenesis of GCA. Analyses were performed at diagnosis and after 3 months of glucocorticoid treatment in 34 GCA patients and 26 age-matched healthy volunteers. Percentages of CD8(+) T-cell subsets, spectratype analysis of the TCR Vβ families of CD8(+) T cells, levels of cytokines and chemokines and immunohistochemistry of temporal artery biopsies (TAB) were assessed. Among total CD8(+) T cells, percentages of circulating cytotoxic CD8 T lymphocytes (CTL, CD3(+)CD8(+)perforin(+)granzymeB(+)), Tc17 (CD3(+)CD8(+)IL-17(+)), CD63(+)CD8(+) T cells and levels of soluble granzymes A and B were higher in patients than in controls, whereas the percentage of Tc1 cells (CD3(+)CD8(+)IFN-γ(+)) was similar. Moreover, CD8(+) T cells displayed a restricted TCR repertoire in GCA patients. Percentages of circulating CTL, Tc17 and soluble levels of granzymes A and B decreased after treatment. CXCR3 expression on CD8(+) T cells and its serum ligands (CXCL9, -10, -11) were higher in patients. Analyses of TAB revealed high expression of CXCL9 and -10 associated with infiltration by CXCR3(+)CD8(+) T cells expressing granzyme B and TiA1. The intensity of the CD8 T-cell infiltrate in TAB was predictive of the severity of the disease. This study demonstrates the implication and the prognostic value of CD8(+) T-cells in GCA and suggests that CD8(+) T-cells are recruited within the vascular wall through an interaction between CXCR3 and its ligands.
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Affiliation(s)
- Maxime Samson
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France; Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Kim Heang Ly
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | | | - Nona Janikashvili
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France
| | - Malika Trad
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France
| | - Marion Ciudad
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France
| | | | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Valérie Quipourt
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - François Maurier
- Department of Internal Medicine, HP Metz Belle Isle Hospital, Metz, France
| | - Nadine Meaux-Ruault
- Department of Internal Medicine, Besançon University Hospital, Besançon, France
| | | | - Patrick Manckoundia
- Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France; INSERM 1093, plateforme d'investigation technologique, Dijon University Hospital, 21000 Dijon, France
| | - Jean-Francis Maillefert
- Department of Rheumatology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Jean-François Besancenot
- Department of Internal Medicine and Systemic Diseases, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Christophe Ferrand
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France
| | - Laura Mesturoux
- Department of Pathology, Limoges University Hospital, Limoges, France
| | | | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Philippe Saas
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France
| | - Laurent Martin
- Department of Pathology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Sylvain Audia
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France; Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Bernard Bonnotte
- INSERM, UMR1098, University of Bourgogne Franche-Comté, FHU INCREASE, France; Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France.
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Liozon E, Dalmay F, Lalloue F, Gondran G, Bezanahary H, Fauchais AL, Ly KH. Risk Factors for Permanent Visual Loss in Biopsy-proven Giant Cell Arteritis: A Study of 339 Patients. J Rheumatol 2016; 43:1393-9. [DOI: 10.3899/jrheum.151135] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
Objective.To determine the risk factors for permanent visual loss (PVL) in patients with biopsy-proven giant cell arteritis (GCA) and the usefulness of the factors in clinical practice.Methods.From 1976 through 2015, the clinical charts and laboratory results of 339 patients with biopsy-proven GCA were recorded prospectively at the time of diagnosis. We used multivariable logistic regression analysis to determine which of 24 pretreatment characteristics were associated with PVL.Results.Visual ischemic manifestations occurred in 108 patients, including PVL in 53 (16%), bilaterally in 15 patients (28%). The independent predictors associated with an increased risk of PVL were age (OR 1.06, 95% CI 1.01–1.12, p = 0.01), a history of transient visual ischemic symptoms (OR 2.62, 95% CI 1.29–5.29, p < 0.01), and jaw claudication (OR 2.11, 95% CI 1.09–4.10, p = 0.03). The presence of fever (OR 0.30, 95% CI 0.14–0.64, p < 0.01) and rheumatic symptoms (OR 0.23, 95% CI 0.10–0.57, p = 0.001) were associated with a markedly reduced risk of developing visual loss (3.7% if features were both present). No laboratory variables were independently associated with PVL.Conclusion.The visual ischemic risk of untreated GCA can be readily estimated upon simple clinical findings, but not laboratory variables. However, we did not identify a subgroup of patients carrying no risk of developing visual loss. Glucocorticoid treatment remains, therefore, urgent for any patient with a high clinical suspicion index.
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Dubanet L, Bentayeb H, Petit B, Olivrie A, Saada S, de la Cruz-Morcillo MA, Lalloué F, Gourin MP, Bordessoule D, Faumont N, Delage-Corre M, Fauchais AL, Jauberteau MO, Troutaud D. Anti-apoptotic role and clinical relevance of neurotrophins in diffuse large B-cell lymphomas. Br J Cancer 2015; 113:934-44. [PMID: 26284337 PMCID: PMC4578080 DOI: 10.1038/bjc.2015.274] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 12/22/2022] Open
Abstract
Background: Diffuse large B-cell lymphoma (DLBCL) is a fatal malignancy that needs to identify new targets for additional therapeutic options. This study aimed to clarify the clinical and biological significance of endogenous neurotrophin (nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF)) in DLBCL biopsy samples and cell lines. Methods: We analysed expression of NGF, BDNF, and their receptors (Trk, p75NTR) in 51 biopsies and cell lines by immunohistochemistry, immunofluorescence, and western blotting. To investigate the biological role of BDNF/TrkB/p75NTR axis, effects of neurotrophin signalling inhibition were determined on tumour cell survival and vascular endothelial growth factor (VEGF) secretion. The pharmacological pan-Trk inhibitor K252a was used for in vitro and in vivo studies. Results: A BDNF/TrkB axis was expressed in all biopsies, which was independent of the germinal centre B-cell (GCB)/non-GCB profile. p75NTR, TrkB, and BDNF tumour scores were significantly correlated and high NGF expression was significantly associated with MUM1/IRF4, and the non-GCB subtype. Diffuse large B-cell lymphoma cell lines co-expressed neurotrophins and their receptors. The full-length TrkB receptor was found in all cell lines, which was also phosphorylated at Tyr-817. p75NTR was associated to Trk and not to its cell death co-receptor sortilin. In vitro, inhibition of neurotrophin signalling induced cell apoptosis. K252a caused cell apoptosis, decreased VEGF secretion, and potentiated rituximab effect, notably in less rituximab-sensitive cells. In vivo, K252a significantly reduced tumour growth and potentiated the effects of rituximab in a GCB-DLBCL xenograft model. Conclusions: This work argues for a pro-survival role of endogenous neurotrophins in DLBCLs and inhibition of Trk signalling might be a potential treatment strategy for rituximab resistant subgroups.
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Affiliation(s)
- Lydie Dubanet
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Hafidha Bentayeb
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Barbara Petit
- Laboratoire d'Anatomie-Pathologique, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France
| | - Agnès Olivrie
- Structure Régionale de Référence des Lymphomes du Limousin, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France.,Service d'Hématologie Clinique, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France
| | - Sofiane Saada
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Miguel A de la Cruz-Morcillo
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Fabrice Lalloué
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Marie-Pierre Gourin
- Structure Régionale de Référence des Lymphomes du Limousin, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France.,Service d'Hématologie Clinique, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France
| | - Dominique Bordessoule
- Structure Régionale de Référence des Lymphomes du Limousin, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France.,Service d'Hématologie Clinique, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France.,UMR CNRS 7276, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland 87025, Limoges Cedex, France
| | - Nathalie Faumont
- UMR CNRS 7276, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland 87025, Limoges Cedex, France
| | - Manuela Delage-Corre
- Laboratoire d'Anatomie-Pathologique, CHU de Limoges, 2 Avenue Martin Luther King, 87000 Limoges Cedex, France
| | - Anne-Laure Fauchais
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Marie-Odile Jauberteau
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
| | - Danielle Troutaud
- EA3842, Facultés de Médecine et de Pharmacie, Université de Limoges, 2 rue du Docteur Marcland, 87025 Limoges Cedex, France
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Hachulla E, Hatron PY, Carpentier P, Agard C, Chatelus E, Jego P, Mouthon L, Queyrel V, Fauchais AL, Michon-Pasturel U, Jaussaud R, Mathian A, Granel B, Diot E, Farge-Bancel D, Mekinian A, Avouac J, Desmurs-Clavel H, Clerson P. Efficacy of sildenafil on ischaemic digital ulcer healing in systemic sclerosis: the placebo-controlled SEDUCE study. Ann Rheum Dis 2015; 75:1009-15. [PMID: 25995322 PMCID: PMC4893100 DOI: 10.1136/annrheumdis-2014-207001] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [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: 11/15/2014] [Accepted: 04/23/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the effect of sildenafil, a phosphodiesterase type 5 inhibitor, on digital ulcer (DU) healing in systemic sclerosis (SSc). METHODS Randomised, placebo-controlled study in patients with SSc to assess the effect of sildenafil 20 mg or placebo, three times daily for 12 weeks, on ischaemic DU healing. The primary end point was the time to healing for each DU. Time to healing was compared between groups using Cox models for clustered data (two-sided tests, p=0.05). RESULTS Intention-to-treat analysis involved 83 patients with a total of 192 DUs (89 in the sildenafil group and 103 in the placebo group). The HR for DU healing was 1.33 (0.88 to 2.00) (p=0.18) and 1.27 (0.85 to 1.89) (p=0.25) when adjusted for the number of DUs at entry, in favour of sildenafil. In the per protocol population, the HRs were 1.49 (0.98 to 2.28) (p=0.06) and 1.43 (0.93 to 2.19) p=0.10. The mean number of DUs per patient was lower in the sildenafil group compared with the placebo group at week (W) 8 (1.23±1.61 vs 1.79±2.40 p=0.04) and W12 (0.86±1.62 vs 1.51±2.68, p=0.01) resulting from a greater healing rate (p=0.01 at W8 and p=0.03 at W12). CONCLUSIONS The primary end point was not reached in intention-to-treat, partly because of an unexpectedly high healing rate in the placebo group. We found a significant decrease in the number of DUs in favour of sildenafil compared with placebo at W8 and W12, confirming a sildenafil benefit. TRIAL REGISTRATION NUMBER NCT01295736.
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Affiliation(s)
- Eric Hachulla
- Médecine Interne, Hopital Huriez, Université de Lille, Lille, France
| | | | | | | | | | - Patrick Jego
- Médecine Interne, CHR Rennes Sud, Rennes, France
| | - Luc Mouthon
- Médecine Interne, AP-HP, Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | | | | | | | - Alexis Mathian
- Médecine Interne 2, Hôpital Pitié-Salpêtrière, Paris, France
| | - Brigitte Granel
- Médecine Interne, Hôpital Nord, Aix Marseille Université, Marseille, France
| | | | | | - Arsène Mekinian
- Medicine interne and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), AP-HP, Hôpital Saint Antoine, Paris, France
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Seror R, Bowman SJ, Brito-Zeron P, Theander E, Bootsma H, Tzioufas A, Gottenberg JE, Ramos-Casals M, Dörner T, Ravaud P, Vitali C, Mariette X, Asmussen K, Jacobsen S, Bartoloni E, Gerli R, Bijlsma JW, Kruize AA, Bombardieri S, Bookman A, Kallenberg C, Meiners P, Brun JG, Jonsson R, Caporali R, Carsons S, De Vita S, Del Papa N, Devauchelle V, Saraux A, Fauchais AL, Sibilia J, Hachulla E, Illei G, Isenberg D, Jones A, Manoussakis M, Mandl T, Jacobsson L, Demoulins F, Montecucco C, Ng WF, Nishiyama S, Omdal R, Parke A, Praprotnik S, Tomsic M, Price E, Scofield H, L Sivils K, Smolen J, Laqué RS, Steinfeld S, Sutcliffe N, Sumida T, Valesini G, Valim V, Vivino FB, Vollenweider C. EULAR Sjögren's syndrome disease activity index (ESSDAI): a user guide. RMD Open 2015; 1:e000022. [PMID: 26509054 PMCID: PMC4613159 DOI: 10.1136/rmdopen-2014-000022] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/10/2015] [Accepted: 01/18/2015] [Indexed: 12/22/2022] Open
Abstract
The EULAR Sjögren's syndrome (SS) disease activity index (ESSDAI) is a systemic disease activity index that was designed to measure disease activity in patients with primary SS. With the growing use of the ESSDAI, some domains appear to be more challenging to rate than others. The ESSDAI is now in use as a gold standard to measure disease activity in clinical studies, and as an outcome measure, even a primary outcome measure, in current randomised clinical trials. Therefore, ensuring an accurate and reproducible rating of each domain, by providing a more detailed definition of each domain, has emerged as an urgent need. The purpose of the present article is to provide a user guide for the ESSDAI. This guide provides definitions and precisions on the rating of each domain. It also includes some minor improvement of the score to integrate advance in knowledge of disease manifestations. This user guide may help clinicians to use the ESSDAI, and increase the reliability of rating and consequently of the ability to detect true changes over time. This better appraisal of ESSDAI items, along with the recent definition of disease activity levels and minimal clinically important change, will improve the assessment of patients with primary SS and facilitate the demonstration of effectiveness of treatment for patients with primary SS.
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Affiliation(s)
- Raphaèle Seror
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Simon J Bowman
- Rheumatology Department , University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Pilar Brito-Zeron
- Laboratory of Autoimmune Diseases "Josep Font", CELLEX-IDIBAPS, Department of Autoimmune Diseases , ICMiD, Hospital Clinic , Barcelona , Spain
| | - Elke Theander
- Department of Rheumatology , Skane University Hospital Malmö, Lund University , Malmo , Sweden
| | - Hendrika Bootsma
- Department of Rheumatology and Clinical Immunology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
| | - Athanasios Tzioufas
- Department of Pathophysiology , School of Medicine, University of Athens , Athens , Greece
| | - Jacques-Eric Gottenberg
- Rheumatology , Centre National de Référence des Maladies Auto-Immunes Rares, INSERM UMRS_1109, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg University Hospital, Université de Strasbourg , Strasbourg , France
| | - Manel Ramos-Casals
- Laboratory of Autoimmune Diseases "Josep Font", CELLEX-IDIBAPS, Department of Autoimmune Diseases , ICMiD, Hospital Clinic , Barcelona , Spain
| | - Thomas Dörner
- Rheumatology Department , Charité, University Hospital , Berlin , Germany
| | - Philippe Ravaud
- Center of Clinical Epidemiology , Hôpital Hôtel Dieu , Paris , France ; INSERM U738, Université Paris-René Descartes , Paris , France
| | - Claudio Vitali
- Sections of Rheumatology , Instituto San Giuseppe, Como and Casa di Cura di Lecco , Lecco , Italy
| | - Xavier Mariette
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Karsten Asmussen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Soren Jacobsen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Elena Bartoloni
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roberto Gerli
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Johannes Wj Bijlsma
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Aike A Kruize
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Stefano Bombardieri
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Arthur Bookman
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Cees Kallenberg
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Petra Meiners
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Johan G Brun
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roland Jonsson
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roberto Caporali
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Steven Carsons
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Salvatore De Vita
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Nicoletta Del Papa
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Valerie Devauchelle
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Alain Saraux
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Anne-Laure Fauchais
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Jean Sibilia
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Eric Hachulla
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Gabor Illei
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - David Isenberg
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Adrian Jones
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Menelaos Manoussakis
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Thomas Mandl
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Lennart Jacobsson
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Frederic Demoulins
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Carlomaurizio Montecucco
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Wan-Fai Ng
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Sumusu Nishiyama
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roald Omdal
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Ann Parke
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Sonja Praprotnik
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Matjia Tomsic
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Elizabeth Price
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Hal Scofield
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Kathy L Sivils
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Josef Smolen
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Roser Solans Laqué
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Serge Steinfeld
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Nurhan Sutcliffe
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Takayuki Sumida
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Guido Valesini
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Valeria Valim
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Frederick B Vivino
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
| | - Cristina Vollenweider
- Department of Rheumatology , Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hopitaux de Paris, Université Paris-Sud, INSERM U1012 , Le Kremlin Bicêtre , France
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Seror R, Bootsma H, Saraux A, Bowman SJ, Theander E, Brun JG, Baron G, Le Guern V, Devauchelle-Pensec V, Ramos-Casals M, Valim V, Dörner T, Tzioufas A, Gottenberg JE, Solans Laqué R, Mandl T, Hachulla E, Sivils KL, Ng WF, Fauchais AL, Bombardieri S, Priori R, Bartoloni E, Goeb V, Praprotnik S, Sumida T, Nishiyama S, Caporali R, Kruize AA, Vollenweider C, Ravaud P, Meiners P, Brito-Zerón P, Vitali C, Mariette X. Defining disease activity states and clinically meaningful improvement in primary Sjögren's syndrome with EULAR primary Sjögren's syndrome disease activity (ESSDAI) and patient-reported indexes (ESSPRI). Ann Rheum Dis 2014; 75:382-9. [DOI: 10.1136/annrheumdis-2014-206008] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/14/2014] [Indexed: 12/16/2022]
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Ly KH, Régent A, Molina E, Saada S, Sindou P, Le-Jeunne C, Brézin A, Witko-Sarsat V, Labrousse F, Robert PY, Bertin P, Bourges JL, Fauchais AL, Vidal E, Mouthon L, Jauberteau MO. Neurotrophins are expressed in giant cell arteritis lesions and may contribute to vascular remodeling. Arthritis Res Ther 2014; 16:487. [PMID: 25418464 PMCID: PMC4274683 DOI: 10.1186/s13075-014-0487-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
Introduction Giant cell arteritis (GCA) is characterized by intimal hyperplasia leading to ischaemic manifestations that involve large vessels. Neurotrophins (NTs) and their receptors (NTRs) are protein factors for growth, differentiation and survival of neurons. They are also involved in the migration of vascular smooth muscle cells (VSMCs). Our aim was to investigate whether NTs and NTRs are involved in vascular remodelling of GCA. Methods We included consecutive patients who underwent a temporal artery biopsy for suspected GCA. We developed an enzymatic digestion method to obtain VSMCs from smooth muscle cells in GCA patients and controls. Neurotrophin protein and gene expression and functional assays were studied from these VSMCs. Neurotrophin expression was also analysed by immunohistochemistry in GCA patients and controls. Results Whereas temporal arteries of both GCA patients (n = 22) and controls (n = 21) expressed nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), tropomyosin receptor kinase B (TrkB) and sortilin, immunostaining was more intense in GCA patients, especially in the media and intima, while neurotrophin-3 (NT-3) and P75 receptor (P75NTR) were only detected in TA from GCA patients. Expression of TrkB, a BDNF receptor, was higher in GCA patients with ischaemic complications. Serum NGF was significantly higher in GCA patients (n = 28) vs. controls (n = 48), whereas no significant difference was found for BDNF and NT-3. NGF and BDNF enhanced GCA-derived temporal artery VSMC proliferation and BDNF facilitated migration of temporal artery VSMCs in patients with GCA compared to controls. Conclusions Our results suggest that NTs and NTRs are involved in vascular remodelling of GCA. In GCA-derived temporal artery VSMC, NGF promoted proliferation and BDNF enhanced migration by binding to TrkB and p75NTR receptors. Further experiments are needed on a larger number of VSMC samples to confirm these results. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0487-z) contains supplementary material, which is available to authorized users.
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Picat MQ, Thiébaut R, Lifermann F, Delbrel X, Adoue D, Wittkop L, Fauchais AL, Rispal P, Moreau JF, Viallard JF. T-cell activation discriminates subclasses of symptomatic primary humoral immunodeficiency diseases in adults. BMC Immunol 2014; 15:13. [PMID: 24621280 PMCID: PMC4008268 DOI: 10.1186/1471-2172-15-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 02/28/2014] [Indexed: 12/17/2022] Open
Abstract
Background Symptomatic Primary Humoral Immunodeficiency Diseases (PHID) constitute a highly heterogeneous group of diseases characterized by a shared hypogammaglobulinemia, resulting in increased risk of recurrent or severe infections. Associations have been described with a variety of immunological abnormalities involving B and T-cell differentiation, T-cell activation and innate immunity. However, PHID discrimination remains based on B-lymphocyte abnormalities and other components of the immune system have not been sufficiently taken into account. We carried out unsupervised and supervised methods for classification in a cohort of 81 symptomatic PHID patients to evaluate the relative importance of 23 immunological parameters and to select relevant markers that may be useful for diagnosis and prognosis. Results We identified five groups of patients, among which the percentage of PHID complications varied substantially. Combining the set of markers involved in PHID supported the existence of two distinct mechanisms associated with complications. Switched memory B-cell attrition and CD8+ HLA-DR + activated T-cell increase were the prominent abnormalities observed in PHID complications. Furthermore, in a subgroup of 57 patients with common variable immunodeficiency, the classification that added CD8+ HLA-DR + to the consensual EUROclass classification was better than the EUROclass model in predicting complications. Conclusion These results highlight the importance of T-cell activation that may improve discrimination of PHID patients in specific subgroups and help to identify patients with different clinical outcomes.
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Affiliation(s)
| | - Rodolphe Thiébaut
- INSERM, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux F-33076, France.
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Jamilloux Y, Magy L, Hurtevent JF, Gondran G, de Seze J, Launay D, Ly KH, Lambert M, Hachulla E, Hatron PY, Vidal E, Fauchais AL. Immunological profiles determine neurological involvement in Sjögren's syndrome. Eur J Intern Med 2014; 25:177-81. [PMID: 24176941 DOI: 10.1016/j.ejim.2013.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/06/2013] [Accepted: 10/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Up to 68% of patients with primary Sjögren's syndrome (pSS) undergo neurological complications, and evidence for distinct immunological subgroups is emerging. We sought to determine systemic and immunological profiles associated with neurological manifestations. METHODS 420 patients fulfilling the 2002 American-European pSS criteria were retrospectively analyzed. Neurological manifestations were diagnosed through clinical, biological, electrophysiological, and imaging findings. Biographical, clinical, and laboratory data were compared. RESULTS Within 93 (22%) patients with neurological manifestations, peripheral and central nervous systems were involved in 66% and 44%, respectively. Raynaud's phenomenon, cutaneous vasculitis, renal involvement, and cryoglobulinemia were associated with sensorimotor neuropathy and mononeuritis multiplex (p<0.05). Conversely, pure sensory neuropathy occurred without extraglandular manifestation, and without anti-Ro/SSA antibodies (p<0.05). All neurological manifestations were associated with increased use of corticosteroids and immunosuppressive drugs (p<0.05). CONCLUSIONS In pSS, patients with sensorimotor neuropathies and pure sensory neuropathies have distinct extraglandular and immunological profiles.
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Affiliation(s)
- Yvan Jamilloux
- Department of Internal Medicine, Limoges University Hospital, Limoges F-87042, France; EA 3842 - Department of Immunology, Limoges University, Limoges F-87042, France.
| | - Laurent Magy
- Department of Neurology, Limoges University Hospital, Limoges F-87042, France
| | | | - Guillaume Gondran
- Department of Internal Medicine, Limoges University Hospital, Limoges F-87042, France
| | - Jérôme de Seze
- Department of Neurology, Strasbourg University Hospital, Strasbourg F-67091, France
| | - David Launay
- Department of Internal Medicine, Lille University Hospital, Lille F-59037, France
| | - Kim H Ly
- Department of Internal Medicine, Limoges University Hospital, Limoges F-87042, France
| | - Marc Lambert
- Department of Internal Medicine, Lille University Hospital, Lille F-59037, France
| | - Eric Hachulla
- Department of Internal Medicine, Lille University Hospital, Lille F-59037, France
| | - Pierre-Yves Hatron
- Department of Internal Medicine, Lille University Hospital, Lille F-59037, France
| | - Elisabeth Vidal
- Department of Internal Medicine, Limoges University Hospital, Limoges F-87042, France
| | - Anne-Laure Fauchais
- Department of Internal Medicine, Limoges University Hospital, Limoges F-87042, France; EA 3842 - Department of Immunology, Limoges University, Limoges F-87042, France
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Roland-Gosselin B, Allain-Launay E, Plouvier E, Mouthon L, Fauchais AL, Lega JC, Remeaux H, Cochat P, Desjonquères M, Said-Menthon MH, Bader-Meunier B, Belot A. PReS-FINAL-2284: SLE and complement deficiencies: a French multicentric retrospective study. Pediatr Rheumatol Online J 2013. [PMCID: PMC4045050 DOI: 10.1186/1546-0096-11-s2-p274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Fauchais AL, Lise MC, Marget P, Lapeybie FX, Bezanahary H, Martel C, Dumonteil S, Sparsa A, Lalloué F, Ly K, Essig M, Vidal E, Jauberteau MO. Serum and lymphocytic neurotrophins profiles in systemic lupus erythematosus: a case-control study. PLoS One 2013; 8:e79414. [PMID: 24223945 PMCID: PMC3815153 DOI: 10.1371/journal.pone.0079414] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 09/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Neurotrophins play a central role in the development and maintenance of the nervous system. However, neurotrophins can also modulate B and T cell proliferation and activation, especially via autocrine loops. We hypothesized that both serum and lymphocytic neurotrophin levels may be deregulated in systemic Lupus erythematosus (SLE) and may reflect clinical symptoms of the disease. METHODS Neurotrophins in the serum (ELISA tests) and lymphocytes (flow cytometry) were measured in 26 SLE patients and 26 control subjects. Th1 (interferon-γ) and Th2 (IL-10) profiles and serum concentration of BAFF were assessed by ELISA in the SLE and control subjects. FINDINGS We have demonstrated that both NGF and BDNF serum levels are higher in SLE patients than healthy controls (p=0.003 and p<0.001), independently of Th1 or Th2 profiles. Enhanced serum NT-3 levels (p=0.003) were only found in severe lupus flares (i.e. SLEDAI ≥ 10) and significantly correlated with complement activation (decreased CH 50, Γ=-0.28, p=0.03). Furthermore, there was a negative correlation between serum NGF levels and the number of circulating T regulatory cells (Γ=0.48, p=0.01). In circulating B cells, production of both NGF and BDNF was greater in SLE patients than in healthy controls. In particular, the number of NGF-secreting B cells correlated with decreased complement levels (p=0.05). One month after SLE flare treatment, BDNF levels decreased; in contrast, NGF and NT-3 levels remained unchanged. CONCLUSION This study demonstrates that serum and B cell levels of both NGF and BDNF are increased in SLE, suggesting that the neurotrophin production pathway is deregulated in this disease. These results must be confirmed in a larger study with naive SLE patients, in order to avoid the potential confounding influence of prior immune-modulating treatments on neurotrophin levels.
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Affiliation(s)
- Anne-Laure Fauchais
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
- * E-mail:
| | - Marie-Claude Lise
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
| | - Pierre Marget
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
| | - François-Xavier Lapeybie
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Holy Bezanahary
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Clothilde Martel
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Stéphanie Dumonteil
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Agnès Sparsa
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Dermatology, Limoges University Hospital, Limoges, France
| | - Fabrice Lalloué
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
| | - Kim Ly
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Marie Essig
- Department of Nephrology, Limoges University Hospital, Limoges, France
| | - Elisabeth Vidal
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
| | - Marie-Odile Jauberteau
- Limoges University Hospital, Equipe Accueil 3842-Clinical Immunology Laboratory, Fr GEIST, Limoges, France
- Department of Internal Medicine, Limoges University Hospital, Limoges, France
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Cohen C, Mekinian A, Uzunhan Y, Fauchais AL, Dhote R, Pop G, Eder V, Nunes H, Brillet PY, Valeyre D, Fain O, Soussan M. 18F-fluorodeoxyglucose positron emission tomography/computer tomography as an objective tool for assessing disease activity in Sjögren's syndrome. Autoimmun Rev 2013; 12:1109-14. [DOI: 10.1016/j.autrev.2013.06.012] [Citation(s) in RCA: 20] [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: 06/01/2013] [Accepted: 06/11/2013] [Indexed: 02/03/2023]
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48
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Jamilloux Y, Liozon E, Pugnet G, Nadalon S, Heang Ly K, Dumonteil S, Gondran G, Fauchais AL, Vidal E. Recovery of adrenal function after long-term glucocorticoid therapy for giant cell arteritis: a cohort study. PLoS One 2013; 8:e68713. [PMID: 23894335 PMCID: PMC3722149 DOI: 10.1371/journal.pone.0068713] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/02/2013] [Indexed: 12/14/2022] Open
Abstract
Objectives Giant cell arteritis (GCA) is a chronic systemic vasculitis of large and medium-sized arteries, for which long-term glucocorticoid (GC) treatment is needed. During GC withdrawal patients can suffer adrenal insufficiency. We sought to determine the time until recovery of adrenal function after long-term GC therapy, and to assess the prevalence and predictors for secondary adrenal insufficiency. Subjects and Design 150 patients meeting the ACR criteria for GCA between 1984 and 2012 were analyzed. All received the same GC treatment protocol. The low-dose ACTH stimulation test was repeated annually until adrenal recovery. Biographical, clinical and laboratory data were collected prospectively and compared. Results At the first ACTH test, 74 (49%) patients were non-responders: of these, the mean time until recovery of adrenal function was 14 months (max: 51 months). A normal test response occurred within 36 months in 85% of patients. However, adrenal function never recovered in 5% of patients. GC of >15 mg/day at 6 months, GC of >9.5 mg/day at 12 months, treatment duration of >19 months, a cumulative GC dose of >8.5 g, and a basal cortisol concentration of <386 nmol/L were all statistically associated with a negative response in the first ACTH test (p <0.05). Conclusion Adrenal insufficiency in patients with GCA, treated long-term with GC, was frequent but transitory. Thus, physicians’ vigilance should be increased and an ACTH test should be performed when GC causes the above associated statistical factors.
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Affiliation(s)
- Yvan Jamilloux
- Department of Internal Medicine, Limoges University Hospital, Limoges, France.
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49
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Ly KH, Stirnemann J, Liozon E, Michel M, Fain O, Fauchais AL. Interleukin-1 blockade in refractory giant cell arteritis. Joint Bone Spine 2013; 81:76-8. [PMID: 23890680 DOI: 10.1016/j.jbspin.2013.06.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/05/2013] [Indexed: 02/06/2023]
Abstract
Giant cell arteritis is a primary large-vessel vasculitis characterized by an arterial wall inflammation associated with intimal hyperplasia leading to arterial occlusion. Glucocorticoids remain the mainstay of giant cell arteritis treatment. However, relapses and glucocorticoid-related complications are frequent and therapeutic options for refractory giant cell arteritis are quite limited. Like tumor necrosis factor-α and interleukin-6, interleukin-1β is also highly expressed in inflamed arterial walls of patients with giant cell arteritis and may contribute in the pathogenesis of this disease. We report treatment of three cases of refractory giant cell arteritis successfully treated with anakinra, an interleukin-1 blockade therapy. Anakinra was effective for all patients, yielding improvement in their inflammation biomarkers and/or in their symptoms, as well as a disappearance of arterial inflammation in PET/CT for two of them.
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Affiliation(s)
- Kim-Heang Ly
- Service de médecine interne A, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
| | - Jérôme Stirnemann
- Service de médecine interne, hôpital Jean-Verdier, Assistance Publique-hôpitaux de Paris, Bondy, France
| | - Eric Liozon
- Service de médecine interne A, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
| | - Marc Michel
- Service de médecine interne, hôpital Henri-Mondor, Assistance Publique-hôpitaux de Paris, Créteil, France
| | - Olivier Fain
- Service de médecine interne, hôpital Jean-Verdier, Assistance Publique-hôpitaux de Paris, Bondy, France
| | - Anne-Laure Fauchais
- Service de médecine interne A, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France
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Ricard E, Verdier-Kessler C, Sparsa A, Vergne-Salle P, Doeffoel-Hanzt V, Bonnet C, Dufauret-Lombard C, Bertin P, Fauchais AL. AB0496 Segmental evaluation of joint limitations in scleroderma - prospective monocentric study. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2818] [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: 11/03/2022]
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