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Chevalier K, Thoreau B, Michel M, Godeau B, Agard C, Papo T, Sacre K, Seror R, Mariette X, Cacoub P, Benhamou Y, Levesque H, Goujard C, Lambotte O, Bonnotte B, Samson M, Ackermann F, Schmidt J, Duhaut P, Kahn JE, Hanslik T, Costedoat-Chalumeau N, Terrier B, Regent A, Dunogue B, Cohen P, Guern VL, Hachulla E, Chaigne B, Mouthon L. Clinical presentation, course, and prognosis of patients with mixed connective tissue disease: A multicenter retrospective cohort. J Intern Med 2024; 295:532-543. [PMID: 38013625 DOI: 10.1111/joim.13752] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Indexed: 11/29/2023]
Abstract
OBJECTIVES The objective of this study is to better characterize the features and outcomes of a large population of patients with mixed connective tissue disease (MCTD). METHODS We performed an observational retrospective multicenter cohort study in France. Patients who fulfilled at least one diagnostic criterion set for MCTD and none of the criteria for other differentiated CTD (dCTD) were included. RESULTS Three hundred and thirty patients (88% females, median [interquartile range] age of 35 years [26-45]) were included. The diagnostic criteria of Sharp or Kasukawa were met by 97.3% and 93.3% of patients, respectively. None met other classification criteria without fulfilling Sharp or Kasukawa criteria. After a median follow-up of 8 (3-14) years, 149 (45.2%) patients achieved remission, 92 (27.9%) had interstitial lung disease, 25 (7.6%) had pulmonary hypertension, and 18 (5.6%) died. Eighty-five (25.8%) patients progressed to a dCTD, mainly systemic sclerosis (15.8%) or systemic lupus erythematosus (10.6%). Median duration between diagnosis and progression to a dCTD was 5 (2-11) years. The presence at MCTD diagnosis of an abnormal pattern on nailfold capillaroscopy (odds ratio [OR] = 2.44, 95% confidence interval [95%CI] [1.11-5.58]) and parotid swelling (OR = 3.86, 95%CI [1.31-11.4]) were statistically associated with progression to a dCTD. Patients who did not progress to a dCTD were more likely to achieve remission at the last follow-up (51.8% vs. 25.9%). CONCLUSIONS This study shows that MCTD is a distinct entity that can be classified using either Kasukawa or Sharp criteria, and that only 25.8% of patients progress to a dCTD during follow-up.
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Affiliation(s)
- Kevin Chevalier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Marc Michel
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Bertrand Godeau
- Department of Internal Medicine, Henri-Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil (UPEC), Créteil, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, University of Nantes, Nantes, France
| | - Thomas Papo
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Karim Sacre
- Department of Internal Medicine, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Raphaèle Seror
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Xavier Mariette
- Department of Rheumatology, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, Université Paris Sorbonne, Paris, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU de Rouen, UniRouen, Rouen, France
| | - Cécile Goujard
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Olivier Lambotte
- Department of Internal Medicine and Clinical Immunology, Université Paris Saclay, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, UMR1184 Inserm, CEA, Le Kremlin Bicêtre, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Félix Ackermann
- Department of Internal Medicine, Foch Hospital, Suresnes, France
| | - Jean Schmidt
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Pierre Duhaut
- Department of Internal Medicine and RECIF, Amiens University Hospital, Université Picardie Jules Verne, Amiens, France
| | - Jean-Emmanuel Kahn
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Thomas Hanslik
- Department of Internal Medicine, Ambroise Paré Hospital, Assistance Publique - Hôpitaux de Paris, Université de Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Alexis Regent
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Bertrand Dunogue
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Eric Hachulla
- Department of Internal Medicine and Clinical Immunology, North-West National Reference Center for Rare Systemic Autoimmune Diseases iques et Auto-Immunes Rares du Nord-Ouest, Hôpital Claude Huriez, Université de Lille, Lille, France
| | - Benjamin Chaigne
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Reference Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Lebel N, Marie I, Grosjean J, Brevet P, Leclercq M, Dumont A, Levesque H, Benhamou Y, Marcelli C, Lequerre T, Vittecoq O. Potential efficacy of T and B lymphocyte-targeted therapies on articular involvement of patients with rheumatoid arthritis and systemic sclerosis overlap syndrome. Results from a 2-centre series of 22 cases. Clin Exp Rheumatol 2024:19981. [PMID: 38489323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/28/2023] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To analyse in routine practice the efficacy of targeted therapies on joint involvement of patients with rheumatoid arthritis/systemic sclerosis (RA/SSc) overlap syndrome. METHODS This was a retrospective analysis of medical records of two academic centres over a 10-year period. Joint response to targeted therapies was measured according to EULAR criteria based on Disease Activity Score (DAS)-28. In addition, changes in CRP level and glucocorticoid consumption were recorded. RESULTS Nineteen patients were included. Methotrexate (n=11) and hydroxychloroquine (n=4) were the most used first-line treatments. Targeted therapies were frequently used (n=14). Tocilizumab was the most selected therapy (n=8), then rituximab (n=5), abatacept and anti-tumour necrosis factor (n=4). Twenty-one treatment sequences were assessed, including 18 with EULAR response criteria. Responses were "good" or "moderate" in 100% (4/4) of patients treated with abatacept, 80% (4/5) with rituximab, 40% (2/5) with tocilizumab, and 25% (1/4) with anti-TNF. T and B lymphocyte-targeted therapies (abatacept, rituximab) resulted more frequently in a "good" or "moderate" response compared to cytokine inhibitors (tocilizumab, etanercept, infliximab) with a significant decrease in DAS-28 at 6 months (-1.75; p=0.016) and a trend to a lower consumption of glucocorticoids. CCONCLUSIONS In patients with RA/SSc overlap syndrome refractory to conventional synthetic-DMARDs, T and B lymphocyte-targeted therapies seem to be a promising therapeutic option to control joint activity.
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Affiliation(s)
- Nans Lebel
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Isabelle Marie
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Julien Grosjean
- Department of Biomedical Informatics, Rouen University, CHU de Rouen, and LIMICS U1142, Sorbonne University, Paris, France
| | - Pauline Brevet
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Mathilde Leclercq
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Anaël Dumont
- Department of Internal Medicine, Normandie Univ, UNICAEN, CHU de Caen, France
| | - Hervé Levesque
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University, CHU de Rouen, and Inserm 1234, Rouen, France
| | - Christian Marcelli
- Department of Rheumatology, Normandie Univ, UNICAEN, CHU de Caen, France
| | - Thierry Lequerre
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University, CHU de Rouen, and CIC-CRB 1404, Inserm 1234, Rouen, France.
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de Frémont GM, Costedoat-Chalumeau N, Lazaro E, Belkhir R, Guettrot-Imbert G, Morel N, Nocturne G, Molto A, Goulenok T, Diot E, Perard L, Ferreira-Maldent N, Le Besnerais M, Limal N, Martis N, Abisror N, Debouverie O, Richez C, Sobanski V, Maurier F, Sauvetre G, Levesque H, Timsit MA, Tieulié N, Orquevaux P, Bienvenu B, Mahevas M, Papo T, Lartigau-Roussin C, Chauvet E, Berthoux E, Sarrot-Reynauld F, Raffray L, Couderc M, Silva NM, Jourde-Chiche N, Belhomme N, Thomas T, Poindron V, Queyrel-Moranne V, Delforge J, Le Ray C, Pannier E, Mariette X, Le Guern V, Seror R. Pregnancy outcomes in women with primary Sjögren's syndrome: an analysis of data from the multicentre, prospective, GR2 study. Lancet Rheumatol 2023; 5:e330-e340. [PMID: 38251600 DOI: 10.1016/s2665-9913(23)00099-1] [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: 02/17/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Adverse pregnancy outcomes in women with primary Sjögren's syndrome have only been evaluated retrospectively using heterogeneous methods and with contradictory results. We aimed to describe adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren's syndrome compared with those of a matched general population in France, and to identify factors predictive of disease flares or adverse pregnancy outcomes. METHODS We conducted a multicentre, prospective, cohort study in France using the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) registry. Women from the GR2 study were eligible if they had conceived before March, 2021, had primary Sjögren's syndrome according to the American College of Rheumatology and European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria, and had an ongoing pregnancy at 12 weeks of gestation. In women who entered in the registry with pregnancies before 18 weeks of gestation, we sought to identify factors associated with primary Sjögren's syndrome flare (≥3-point increase in EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI] score) or adverse pregnancy outcomes (fetal or neonatal death, placental insufficiency leading to a preterm delivery [<37 weeks of gestation], or small-for-gestational-age birthweight). A matched controlled study compared adverse pregnancy, delivery, and birth outcome rates between pregnant women with primary Sjögren's syndrome from the GR2 registry and matched controls from the general population included in the last French perinatal survey (Enquête Nationale Périnatale 2016). FINDINGS 1944 pregnancies were identified in the GR2 cohort, of which 106 pregnancies in 96 women with primary Sjögren's syndrome were included in this analysis. The median age at pregnancy onset was 33 years (IQR 31-36). 87 (83%) of 105 pregnancies (with ethnicity data) were in White women, 18 (17%) were in Black women; 92 (90%) of 102 had previous systemic activity (ESSDAI score of ≥1; data missing in four pregnancies), and 48 (45%) of 106 had systemic activity at inclusion. Of 93 pregnancies included at week 18 of gestation or earlier, primary Sjögren's syndrome flares occurred in 12 (13%). No baseline parameters were associated with primary Sjögren's syndrome flare. Four twin pregnancies and one medical termination were excluded from the adverse pregnancy outcome analysis; of the remaining 88, adverse pregnancy outcomes occurred in six (7%). Among pregnancies in women with data for antiphospholipid antibodies (n=55), antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (two [50%] of four pregnancies) compared with those without adverse outcomes (two [4%] of 51 pregnancies; p=0·023). Anti-RNP antibody positivity was also more frequent among pregnancies with adverse outcomes than those without, although this was not statistically significant. In the matched controlled study, adverse pregnancy outcomes occurred in nine (9%) of 105 pregnancies in women with primary Sjögren's syndrome and 28 (7%) of the 420 matched control pregnancies; adverse pregnancy outcomes were not significantly associated with primary Sjögren's syndrome (odds ratio 1·31, 95% CI 0·53-2·98; p=0·52). INTERPRETATION Pregnancies in women with primary Sjögren's syndrome had very good prognoses for mothers and fetuses, with no overall increase in adverse pregnancy outcome risk compared with the general population. Women with antiphospholipid antibodies or anti-RNP antibodies require close monitoring, because these factors might be associated with a higher risk of adverse pregnancy outcomes. FUNDING Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.
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Affiliation(s)
- Grégoire Martin de Frémont
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Nathalie Costedoat-Chalumeau
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France; Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Estibaliz Lazaro
- CHU de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Bordeaux, France
| | - Rakiba Belkhir
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gaëlle Guettrot-Imbert
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Nathalie Morel
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Gaétane Nocturne
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Anna Molto
- Centre de Recherche Epidémiologie et Biostatistiques de Sorbonne Paris Cité, Université de Paris, Paris, France; APHP, Hôpital Cochin, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | | | - Elisabeth Diot
- CHU de Tours, Service de Médecine Interne, Tours, France
| | - Laurent Perard
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | | | - Nicolas Limal
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Nihal Martis
- CHU de Nice, Hôpital Archet, Service de Médecine Interne, Nice, France
| | - Noémie Abisror
- APHP, Hôpital Saint-Antoine, Service de Médecine Interne, Paris, France
| | | | | | - Vincent Sobanski
- CHU de Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Inserm U1286, Université de Lille, Lille, France
| | - François Maurier
- Hôpitaux Privés de Metz, Service de Médecine Interne, Metz, France
| | | | - Hervé Levesque
- CHU de Rouen, Service de Médecine Interne, Rouen, France
| | | | | | | | - Boris Bienvenu
- Hôpital Saint-Joseph, Service de Médecine Interne, Marseille, France
| | - Matthieu Mahevas
- APHP, Hôpital Henri-Mondor, Service de Médecine Interne, Créteil, France
| | - Thomas Papo
- APHP, Hôpital Bichat, Service de Médecine Interne, Paris, France
| | | | - Elodie Chauvet
- Polyclinique Médipôle Saint-Roch, Service de Médecine Interne, Cabestany, France
| | - Emilie Berthoux
- Hôpital Saint-Joseph, Service de Médecine Interne, Lyon, France
| | | | - Loïc Raffray
- CHU Félix-Guyon, Service de Médecine Interne, Saint-Denis de la Réunion, France
| | - Marion Couderc
- CHU de Clermont-Ferrand, Service de Rhumatologie, Clermont-Ferrand, France
| | | | - Noémie Jourde-Chiche
- APHM, CHU de la Conception, Centre de Néphrologie et Transplantation Rénale, C2VN, Inserm 1263, Institut National de la Recherche Agronomique (INRA) 1260, Faculté de Pharmacie, Marseille, France
| | | | - Thierry Thomas
- CHU de Saint-Etienne, Service de Médecine Interne, Saint-Etienne, France
| | - Vincent Poindron
- CHU de Strasbourg, Service de Médecine Interne, Strasbourg, France
| | | | - Juliette Delforge
- APHP, Hôpital Jean-Verdier, Service de Médecine Interne, Bobigny, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université Paris Cité, Paris, France
| | - Emmanuelle Pannier
- APHP, Hôpital Cochin Port Royal, Maternité Port Royal, Service d'Obstétrique, Université de Paris, Paris, France
| | - Xavier Mariette
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Le Guern
- APHP, Hôpital Cochin, Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Paris, France
| | - Raphaèle Seror
- APHP, Hôpital Bicêtre, Service de Rhumatologie, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Île-de-France, Inserm UMR 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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4
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Dupré A, Morel N, Yelnik C, Moguelet P, Le Guern V, Stammler R, Nguyen Y, Paule R, Dufrost V, Ackermann F, Benhamou Y, Godeau B, Lambert M, Duffau P, Mekinian A, Saadoun D, Mouthon L, Hachulla E, Maillard H, Levesque H, Morell-Dubois S, Leroux G, Piette JC, Chasset F, Costedoat-Chalumeau N. Cutaneous Involvement in Catastrophic Antiphospholipid Syndrome in a Multicenter Cohort of 65 Patients. JAMA Dermatol 2022; 159:62-67. [PMID: 36477813 PMCID: PMC9856595 DOI: 10.1001/jamadermatol.2022.5221] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Catastrophic antiphospholipid syndrome (CAPS) is a severe, rare complication of antiphospholipid syndrome (APS), but cutaneous involvement has not yet been adequately described. Objective To describe cutaneous involvement during CAPS, its clinical and pathological features, and outcomes. Design, Setting, and Participants This cohort study was a retrospective analysis of patients included in the French multicenter APS/systemic lupus erythematosus register (ClinicalTrials.gov: NCT02782039) by December 2020. All patients meeting the revised international classification criteria for CAPS were included, and patients with cutaneous manifestations were analyzed more specifically. Main Outcomes and Measures Clinical and pathological data as well as course and outcome in patients with cutaneous involvement during CAPS were collected and compared with those in the register without cutaneous involvement. Results Among 120 patients with at least 1 CAPS episode, the 65 (54%) with skin involvement (43 [66%] women; median [range] age, 31 [12-69] years) were analyzed. Catastrophic antiphospholipid syndrome was the first APS manifestation for 21 of 60 (35%) patients with available data. The main lesions were recent-onset or newly worsened livedo racemosa (n = 29, 45%), necrotic and/or ulcerated lesions (n = 27, 42%), subungual splinter hemorrhages (n = 19, 29%), apparent distal inflammatory edema (reddened and warm hands, feet, or face) (n = 15, 23%), and/or vascular purpura (n = 9, 14%). Sixteen biopsies performed during CAPS episodes were reviewed and showed microthrombi of dermal capillaries in 15 patients (94%). These lesions healed without sequelae in slightly more than 90% (58 of 64) of patients. Patients with cutaneous involvement showed a trend toward more frequent histologically proven CAPS (37% vs 24%, P = .16) than those without such involvement, while mortality did not differ significantly between the groups (respectively, 5% vs 9%, P = .47). Conclusions and Relevance In this cohort study, half the patients with CAPS showed cutaneous involvement, with a wide spectrum of clinical presentations, including distal inflammatory edema. Skin biopsies confirmed the diagnosis in all but 1 biopsied patient.
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Affiliation(s)
- Anastasia Dupré
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Nathalie Morel
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Cécile Yelnik
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Philippe Moguelet
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Tenon, Service d’Anatomopathologie, Paris, France
| | - Véronique Le Guern
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Romain Stammler
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Yann Nguyen
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Romain Paule
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | - Virginie Dufrost
- Centre Hospitalier Régional et Universitaire de Nancy, Service de Médecine Vasculaire, Nancy, France
| | | | - Ygal Benhamou
- Normandie Université, UNIROUEN, U 1096, Centre Hospitalo-Universitaire, Service de Médecine Interne, Rouen, France
| | - Bertrand Godeau
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Mondor, Service de Médecine Interne, Créteil, France
| | - Marc Lambert
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Pierre Duffau
- Centre Hospitalo-Universitaire de Bordeaux, Service de Médecine Interne et Immunologie Clinique, Bordeaux, France
| | - Arsène Mekinian
- Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Centre Hospitalo-Universitaire Saint Antoine, service de médecine interne et Inflammation-Immunopathology-Biotherapy Department (DMU i3), Paris, France
| | - David Saadoun
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Luc Mouthon
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France
| | - Eric Hachulla
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Hélène Maillard
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Hervé Levesque
- Normandie Université, UNIROUEN, U 1096, Centre Hospitalo-Universitaire, Service de Médecine Interne, Rouen, France
| | - Sandrine Morell-Dubois
- Centre Hospitalo-Universitaire Claude Huriez, Service de Médecine Interne et Immunologie Clinique, Lille, France
| | - Gaëlle Leroux
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - Jean-Charles Piette
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire La Pitié, Département de Médecine Interne et Immunologie Clinique, Paris, France
| | - François Chasset
- Sorbonne Université, Faculté de Médecine, Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Tenon, Service de Dermatologie, Paris, France
| | - Nathalie Costedoat-Chalumeau
- Assistance Publique–Hôpitaux de Paris, Centre Hospitalo-Universitaire Cochin, Service de Médecine Interne, Paris, France,Université de Paris, Centre de Recherche Épidémiologie et Biostatistiques de Sorbonne Paris Cité, Paris, France
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5
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Moyon Q, Pineton de Chambrun M, Gousseff M, Mathian A, Hie M, Urbanski G, Verlicchi F, Faguer S, Dossier A, Lega JC, Riviere S, Saadoun D, Graveleau J, Lucchini-Lecomte MJ, Christides C, Le Moal S, Bibes B, Malizia G, Ruivard M, Blaison G, Alric L, Agard C, Soubrier M, Viallard JF, Levesque H, Rivard GE, Tieulie N, Hot A, Lovey PY, Hanslik T, Lhote F, Eble V, Álvarez Troncoso J, Aujayeb A, Quentric P, Taieb D, Cohen-Aubart F, Lambert M, Amoura Z. Intravenous Immunoglobulins Tapering and Withdrawal in Systemic Capillary Leak Syndrome (Clarkson Disease). J Allergy Clin Immunol Pract 2022; 10:2889-2895. [PMID: 35870726 DOI: 10.1016/j.jaip.2022.07.006] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/05/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The systemic capillary leak syndrome (SCLS), also known as Clarkson disease, is a very rare condition characterized by recurrent life-threatening episodes of vascular hyperpermeability in the presence of a monoclonal gammopathy. Extended intravenous immunoglobulin (IVIG) treatment is associated with fewer recurrences and improved survival, but the optimal treatment dosage and duration remain unknown. OBJECTIVE We aim to evaluate the safety of IVIG tapering and withdrawal in patients with SCLS. METHODS We conducted a retrospective multicenter study including all adult patients with monoclonal gammopathy-associated SCLS from the EurêClark registry who received at least 1 course of IVIG. The primary end point was overall survival according to IVIG withdrawal. RESULTS Fifty-nine patients of mean ± SD age 51 ± 13 years were included. Overall cumulative probabilities of 2-, 5-, 10- and 15-year survival were 100%, 85%, 72%, 44%, respectively. The IVIG was withdrawn at least once in 18 patients (31%; W+ group) and never in 41 patients (69%; W- group). Cumulative probabilities of 10-year survival in W+ versus W- groups were 50% and 83% (log rank test, P = .02), respectively. Relapse rate and the median number of relapses in the W+ versus the W- groups were 72% versus 58% (P = 0.3) and 2.5 (0.3-4) versus 1 (0-2) (P = .03), respectively. The IVIG tapering was not statistically associated with increased person-year incidence of attacks using a mixed linear model. CONCLUSIONS The IVIG withdrawal was associated with increased mortality and higher rate of recurrence in SCLS patients. The IVIG tapering might be cautiously considered in stable SCLS patients.
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Affiliation(s)
- Quentin Moyon
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Marc Pineton de Chambrun
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institut de Cardiométabolisme et Nutrition (ICAN), Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France.
| | - Marie Gousseff
- Service de médecine interne, Centre Hospitalier (CH) Bretagne Atlantique, Vannes, France
| | - Alexis Mathian
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Miguel Hie
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d'Immunologie Clinique, Centre Hospitalier Universitaire (CHU) d'Angers, Angers, France
| | | | - Stanislas Faguer
- Département de Néphrologie Et Transplantation D'organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, équipe 12), CHU de Toulouse, Toulouse, France
| | - Antoine Dossier
- Service de médecine interne, CHU Bichat, APHP, Paris, France
| | - Jean-Christophe Lega
- Service de médecine interne et pathologies vasculaires, CHU Lyon Sud, Pierre-Bénite, Lyon; Univ Lyon 1, UMR CNRS 5558 Laboratoire de Biologie et Biométrie Evolutive
| | - Sophie Riviere
- Service de médecine interne, Hôpital S(t)-Eloi, CHRU, Montpellier, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology- Immunopathology-Immunotherapy (I3), Paris, France
| | | | | | | | | | | | | | - Marc Ruivard
- Service de médecine interne, Hôpital d'Estaing, CHU de Clermont-Ferrand, France
| | - Gilles Blaison
- Service de médecine interne, Hôpital Pasteur, Colmar, France
| | - Laurent Alric
- Service de médecine interne, Pôle digestif, CHU Rangueil, Toulouse 3 University, Toulouse, France
| | - Christian Agard
- Nantes Université, CHU Nantes, service de médecine interne, F-44000 Nantes, France
| | - Martin Soubrier
- Service de rhumatologie, Hôpital Gabriel-Montpied, CHU Clermont-Ferrand, France
| | | | - Hervé Levesque
- Service de médecine interne, Normandie Université, UNIROUEN, 76031 Rouen, France
| | | | | | - Arnaud Hot
- Service de médecine interne, CHU Edouard Herriot, Lyon, France
| | | | - Thomas Hanslik
- Université Versailles Saint Quentin, APHP, CHU Ambroise Paré, Service de médecine interne, Boulogne-Billancourt, France
| | - François Lhote
- Service de médecine interne, Hôpital Delafontaine, Saint-Denis, France
| | | | - Jorge Álvarez Troncoso
- Servicio de Medicina Interna, Unidad de Enfermedades Autoinmunes Sistémicas, Hospital Universitario La Paz, Madrid, Spain
| | - Avinash Aujayeb
- Northumbria Specialist Emergency Care Hospital, Newcastle, UK
| | - Paul Quentric
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Inserm, Centre d'Immunologie et des Maladies Infectieuses (CIMI-Paris), and AP-HP, Hôpital La Pitié-Salpêtrière, Département d'Immunologie, Paris, France
| | - Dov Taieb
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France; Sorbonne Université, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Service de Médecine Intensive-Réanimation, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Marc Lambert
- Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France; Univ. Lille, CHU Lille, Département de Médecine Interne et d'Immunologie Clinique, Centre National de Référence Maladies Systémiques et Auto-immunes Rares Nord et Nord-Ouest de France (CeRAINO), European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNECT), INSERM, UMR 1167, RID-AGE, F-59000 Lille, France
| | - Zahir Amoura
- Sorbonne Université, APHP, Hôpital La Pitié-Salpêtrière, Institut E3M, Service de Médecine Interne 2; Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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Nguyen Y, Yelnik CM, Morel N, Paule R, Stammler R, Plaçais L, Sacré K, Godeau B, Maillard H, Launay D, Morell-Dubois S, Dupré A, Lefèvre G, Devloo C, Dufrost V, Benhamou Y, Levesque H, Leroux G, Piette JC, Mouthon L, Hachulla É, Lambert M, Guern VL, Costedoat-Chalumeau N. Determination of four homogeneous subgroups of patients with antiphospholipid syndrome: a cluster analysis based on 509 cases. Rheumatology (Oxford) 2022:6747168. [PMID: 36190346 DOI: 10.1093/rheumatology/keac548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 08/11/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Antiphospholipid syndrome (APS) is a heterogeneous disease with different phenotypes. Using an unsupervised hierarchical cluster analysis, we aimed to determine distinct homogeneous phenotypes among APS patients. METHODS We performed an observational, retrospective study of APS patients enrolled in the French multicentre 'APS and SLE' registry who meet the Sydney classification criteria. The clustering process involved an unsupervised multiple correspondence analysis followed by a hierarchical ascendant clustering analysis; it used 27 variables selected to cover a broad range of APS clinical and laboratory manifestations. RESULTS These analyses included 509 patients, mainly women (77.8%). Mean (± SD) age at APS diagnosis was 36.2 ± 14.6 years, and mean follow-up since diagnosis 10.3 ± 8.5 years. This hierarchical classification cluster analysis yielded four homogeneous groups of patients: cluster 1, mostly with venous thromboembolism without any associated autoimmune disease; cluster 2, older, lowest proportion of women, history of arterial events, and/or with migraines, arterial hypertension, diabetes mellitus, or dyslipidaemia; cluster 3, younger, highest proportion of women, associated SLE or other autoimmune diseases, and a history of venous thromboembolism or pregnancy morbidity; and cluster 4, mainly with a history of catastrophic antiphospholipid syndrome, aPL-associated nephropathy, and pregnancy morbidity, with frequent triple positivity and more deaths (16.7%). CONCLUSIONS Our study applied an unsupervised clustering method to distinguish four homogeneous APS patient subgroups that were predominantly venous; arterial; associated with SLE or another autoimmune disease; and arterial microthrombotic. Heterogeneous pathophysiological mechanisms may explain these findings.
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Affiliation(s)
- Yann Nguyen
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
| | - Cécile M Yelnik
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Nathalie Morel
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Romain Stammler
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Léo Plaçais
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Karim Sacré
- Department of Internal Medicine, Hôpital Bichat, AP-HP Nord, Université de Paris, Paris, France
| | - Bertrand Godeau
- Department of Internal Medicine, Hôpital Mondor, AP-HP, Université de Paris-Est Créteil, Créteil, France
| | - Hélène Maillard
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - David Launay
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Sandrine Morell-Dubois
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Anastasia Dupré
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Guillaume Lefèvre
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Cécile Devloo
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Virginie Dufrost
- Department of Internal Medicine, CHU de Rouen, UniRouen, Inserm, U1096, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Hervé Levesque
- Department of Internal Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Luc Mouthon
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Éric Hachulla
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Marc Lambert
- Department of Internal Medicine and Clinical Immunology, Referral Centre for Centre for rare systemic autoimmune diseases North and North-West of France (CeRAINO, ), CHU Lille, Univ. Lille, Inserm, U1286, - INFINITE-Institute for Translational Research in Inflammation, F-59000, Lille, France
| | - Véronique Le Guern
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France
| | - Nathalie Costedoat-Chalumeau
- National Referral Centre for Rare Autoimmune and Systemic Diseases, Department of Internal Medicine, Hôpital Cochin, AP-HP Centre; Université de Paris, Paris, France.,Centre de Recherche en Epidémiologie et Statistiques (CRESS), Unité Inserm 1153, Université de Paris, Paris, France
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7
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Jamart C, Levesque H, Thietart S, Fain O, Rivière S, Benhamou Y, Mekinian A. Iloprost Duration for Digital Ulcers in Systemic Sclerosis: French Retrospective Study at Two Centers and Literature Review. Front Med (Lausanne) 2022; 9:878970. [PMID: 35872796 PMCID: PMC9298754 DOI: 10.3389/fmed.2022.878970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Ischemic digital ulcers (DUs) are frequent and severe complications of systemic sclerosis (SSc). Treatment options for SSc-related digital vasculopathy are based on aggressive vasodilation, with the objective to improve blood flow in ischemic areas. Intravenous prostanoids are recommended to treat active DUs. However, the level of evidence for the duration of 5 days is low. Therefore, the aim of this study was to determine whether prolonging the infusion beyond 5 days increases the rate of healing of active DUs in SSc. Methods This is an observational longitudinal retrospective bicenter study from 2000 to 2017. The objective was to compare the healing rate and time (defined by a healing of at least 50% of DUs) between two durations of iloprost administration: 5 days or less, or more than 5 days. Results Forty-one patients, with a mean age of 47 ± 15 years at diagnosis and 32 (78%) females have been included. Systemic sclerosis was diffuse in 10 (24%) cases and 13 (32%) had an interstitial lung disease. A total of 243 iloprost infusions for DUs were performed: 140 infusions for 5 days or less, and 103 infusions for more than 5 days (prolonged duration). Patients with active DUs which received >5 days of iloprost had higher modified Rodnan skin scale at the time of iloprost infusion (median 33 vs. 15; p < 0.05), more interstitial lung disease (44 vs. 27%; p < 0.05), more anti-topoisomerase I antibody positivity (59 vs. 44%; p < 0.05), and received more previous cyclophosphamide therapy (48 vs. 19%; p < 0.05). While the number of active DUs before iloprost infusion was not significantly different among those who received ≤5 days and >5 days of iloprost, the time to healing after iloprost infusion significantly decreased in SSc patients who received >5 days iloprost infusion: 48 [7–392] vs. 91 [9–365] days (p < 0.05). The proportion of SSc patients with healed DUs tended to increase in patients with >5 days iloprost infusion (log rank = 0.06). The number of patients with complete DU healing at day 90 was significantly increased in SSc who received >5 days of iloprost: 53 (51%) vs. 52 (37%) (p < 0.05). In addition, the time to healing was not significantly associated with the use of calcium channel blockers, endothelin receptor antagonists or a combination of PDE-5 inhibitors. Conclusion Prolonging duration of iloprost >5 days could improve the healing rate and the time to healing of SSc-related DUs. Prospective randomized studies are needed to confirm these data and define the optimal duration of iloprost therapy.
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Affiliation(s)
- Céline Jamart
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Hervé Levesque
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Sara Thietart
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Olivier Fain
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Sébastien Rivière
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
| | - Ygal Benhamou
- Service de Médecine Interne, Hôpital Rouen, Université de Rouen, Rouen, France
| | - Arsène Mekinian
- Sorbonne Université, APHP, Service de Médecine Interne-DMU i3, Hôpital Saint-Antoine, Paris, France
- INSERM U938, Centre de Recherche Saint-Antoine, Paris, France
- *Correspondence: Arsène Mekinian,
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Lebel N, Marcelli C, Marie I, Levesque H, Lequerre T, Vittecoq O. AB0663 Bicentric observational study on the therapeutic management of patients with rheumatoid arthritis and systemic sclerosis overlap syndrome. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe rheumatoid arthritis (RA)/systemic sclerosis (SSc) overlap syndrome is a rare and understudied association. It affects 5% of patients with SSc. Only open studies evaluating biological drugs (bDMARDs) have reported encouraging results, particularly on joint involvement. The management of these patients is therefore not codified.ObjectivesThe objective was to analyze in real conditions the therapeutic strategy and the response to bDMARDs, with a focus on joint involvement.MethodsWe retrospectively analyzed over a 10-year period the clinical, biological, radiographic characteristics and therapeutic management of patients meeting the ACR/EULAR diagnostic criteria for RA and SSc in two academic centers. Response to bDMARDs was assessed according to EULAR and if unavailable according to therapeutic maintenance. The evolution of lung function test was also evaluated.ResultsTwenty-two patients were identified. Interstitial lung involvement was common (n=11). Only 7 patients were treated with csDMARD alone. The most commonly used drug was methotrexate. The use of bDMARDs was frequent (15/22), significantly greater in patients with rheumatoid factors (OR 26.7; p=0.004) and with a trend in patients with higher levels of anti-CCP (160 vs 15 IU; p=0.11) or diffuse interstitial lung disease (OR 10.6; p=0.063). Tocilizumab was the most selected therapy (n = 8) followed by rituximab (n = 5), abatacept, and anti-TNFs (n = 4 respectively). We evaluated 21 treatment sequences, 19 of which were evaluated according to EULAR response criteria. bDMARDS that inhibits the activation of lymphocytes (abatacept, rituximab) generally resulted in a good or moderate response (n = 9/10) with a significant decrease in DAS28 at 6 months (-1.75; p = 0.016). Cytokine inhibitors (tocilizumab, etanercept, infliximab) were less likely to achieve good or moderate control of joint involvement (n = 3/9) with a smaller decrease in DAS28 at 6 months (-0.79; p = 0.36). Two tocilizumab sequences were stopped early due to intolerance and could not be evaluated. One patient received tofacitinib with a good clinical response but was discontinued at 9 months for intolerance. Lung function test data did not change significantly on bDMARD.ConclusionIn patients with rheumatoid arthritis (RA)/systemic sclerosis (SSc) overlap syndrome, bDMARDS that inhibits the activation of lymphocytes (abatacept, rituximab) resulted in more frequent and greater improvement in joint involvement than cytokine inhibitors (tocilizumab, etanercept, infliximab).Disclosure of InterestsNone declared
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9
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Leclercq M, Vannier M, Benhamou Y, Liard A, Gilard V, Auquit-Auckbur I, Levesque H, Sibert L, Schneider P. Identification des facteurs associés à la réussite aux examens cliniques objectifs et structurés dans la faculté de médecine de Rouen. Rev Med Interne 2022; 43:278-285. [DOI: 10.1016/j.revmed.2022.02.007] [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: 11/01/2021] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
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10
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Pineton de Chambrun M, Moyon Q, Faguer S, Urbanski G, Mathian A, Zucman N, Werner M, Luyt CE, Verlicchi F, Amoura Z, Gousseff M, Mauhin W, Hot A, Lega JC, Lambert M, Riviere S, Dossier A, Ruivard M, Lhote F, Blaison G, Merceron S, Zapella N, Alric L, Agard C, Lacout M, Saadoun D, Graveleau J, Soubrier M, Haroche J, Boileau J, Lucchini-Lecomte MJ, Hanslik T, Christides C, Levesque H, Talasczka A, Bulte C, Hachulla E, Decaux O, Sonneville R, Ibouanga F, Arnulf B, Benedit M, Viallard JF, Tieulie N, Haddad F, Moulin B, Cohen-Aubert F, Lovey PY, le Moal S, Bibes B, Rivard GE, Rondeau E, Malizia G, Debourdeau P, Abgueguen P, Bosseray A, Devaquet J, Presne C, Liferman F, Limal N, Argaud L, Hernu R, de la Salle S, Faguer S, Urbanski G, Zucman N, Werner M, Luyt CE, Moyon Q, Verlicchi F, Troncoso JÁ, Harty J, Godmer P, Hie M, Papo T, Hatron PY, Mathian A, Amoura Z. The consequences of COVID-19 pandemic on patients with monoclonal gammopathy-associated systemic capillary leak syndrome (Clarkson disease). J Allergy Clin Immunol Pract 2022; 10:626-629. [PMID: 34890829 PMCID: PMC8648572 DOI: 10.1016/j.jaip.2021.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Marc Pineton de Chambrun
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France,Corresponding author: Marc Pineton de Chambrun, MD, MSc, Service de Médecine Intensive-Réanimation, Hôpital La Pitié-Salpêtrière, 47-83, boulevard de l’Hôpital, 75651 Paris Cedex 13, France
| | - Quentin Moyon
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Stanislas Faguer
- Département de Néphrologie et Transplantation d'Organes, Centre de Référence Des Maladies Rénales Rares, INSERM U1297 (I2MC, Équipe 12), Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Geoffrey Urbanski
- Service de Médecine Interne et d’Immunologie Clinique, Centre Hospitalier Universitaire, Angers, France
| | - Alexis Mathian
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Hôpital Louis Mourier, APHP, DMU ESPRIT, Université de Paris, Colombes, France
| | - Marie Werner
- Service de Réanimation Chirurgicale Adulte, AP-HP, Hôpital Bicêtre, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Charles-Edouard Luyt
- Service de Médecine Intensive-Réanimation, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital La Pitié-Salpêtrière, Sorbonne Université, Paris, France,Institut de Cardiométabolisme et Nutrition (ICAN), INSERM, UMRS_1166-ICAN, Sorbonne Université, Paris, France
| | | | - Zahir Amoura
- Service de Médecine Interne 2, Institut E3M, APHP, Hôpital La Pitié-Salpêtrière, Sorbonne Université Centre de Référence National Lupus Systémique, Syndrome des Anticorps Anti-Phospholipides et Autres Maladies Auto-Immunes Systémiques Rares, Paris, France
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Deghmani I, Miranda S, Guerrot D, Nouhaud F, Benhamou Y, Levesque H, Armengol G. Fibrose rétropéritonéale: analyse descriptive retrospective d’une cohorte de 56 patients. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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De gail S, Levesque H, Jardin F, Manuel E, Tamion F, Benhamou Y, Grall M. Caractéristiques et profil évolutif des lymphohistiocytoses hémophagogytaires : étude rétrospective monocentrique au CHU de Rouen entre 2010 et 2020. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Worbe N, Damian L, Le Cam-Duchez V, Levesque H, Michel P, Quak E. Hemorrhagic disseminated intravascular coagulation after 177Lu-Dotatate in metastatic midgut neuroendocrine tumor: A case report. Medicine (Baltimore) 2021; 100:e27455. [PMID: 34622868 PMCID: PMC8500554 DOI: 10.1097/md.0000000000027455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Peptide receptor radionuclide therapy with 177Lu-Dotatate represents a major breakthrough in the treatment of metastatic well differentiated neuroendocrine tumors. This treatment is generally well tolerated. Reported severe long-term hematological side effects are rare and include hematopoietic neoplasms and bone marrow failure. PATIENTS CONCERNS We describe the case of a patient presenting spontaneous bleeding and bruising occurring 6 weeks after the first administration of 177Lu-Dotatate. Blood tests showed anemia, thrombocytopenia, prolonged clotting times, profound fibrinolysis and low levels of coagulation factors II and V. There were no signs of tumor lysis syndrome. DIAGNOSES We made the diagnosis of acute disseminated intravascular coagulation. INTERVENTION Treatment consisted of multiple transfusions of fresh frozen plasma, fibrinogen and platelets, and corticosteroids. Acute disseminated intravascular coagulation (DIC) persisted for 10 days and then resolved. OUTCOMES Metabolic imaging 5 months after the 177Lu-Dotatate administration showed disease progression. Treatment with 177Lu-Dotatate was not rechallenged due to the occurrence of DIC. LESSONS Our case suggests that acute hemorrhagic disseminated intravascular coagulation can be a rare and life-threatening subacute side effect of 177Lu-Dotatate peptide receptor radionuclide therapy.
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Affiliation(s)
- Noémie Worbe
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Louise Damian
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Véronique Le Cam-Duchez
- Normandie Univ, UNIROUEN, Inserm U1096, Rouen University Hospital, Hemostasis Unit, Rouen, France
| | - Hervé Levesque
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
| | - Pierre Michel
- Rouen University Hospital, Department of Hepato-gastroenterology, Rouen, France
| | - Elske Quak
- UNICANCER, Comprehensive Cancer Centre F. Baclesse, Department of Nuclear Medicine, Caen, France
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14
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Adham S, Armengol G, Cailleux-Talbot N, Levesque H, Benhamou Y, Miranda S. Bilateral deep vein thrombosis: Time to screen for occult cancer? Vasc Med 2021; 26:660-661. [PMID: 34533078 DOI: 10.1177/1358863x211034919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Salma Adham
- Département de génétique, Centre de référence des maladies vasculaires rares, Hôpital européen George Pompidou, AP-HP, Paris, France.,Faculté de médecine Paris Descartes, Université Paris Centre, Paris, France
| | - Guillaume Armengol
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | | | - Hervé Levesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
| | - Sébastien Miranda
- Department of Internal Medicine, Rouen University Hospital, Rouen, France.,Normandie Univ, UNIROUEN, Inserm U1096 EnVI, Rouen, France
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15
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Daumas A, Magalon J, Jouve E, Casanova D, Philandrianos C, Abellan Lopez M, Mallet S, Veran J, Auquit-Auckbur I, Farge D, Levesque H, Benhamou Y, Arnaud L, Giraudo L, Dumoulin C, Giverne C, Boyer O, Giuliani A, Bourgarel V, Harlé JR, Schleinitz N, Brunet J, Pers YM, Ferreira R, Cras A, Bocara D, Larghero J, Château J, Hot A, Dignat-George F, Magalon G, Sabatier F, Granel B. Adipose tissue-derived stromal vascular fraction for treating hands of patients with systemic sclerosis: a multicentre randomized trial. Rheumatology (Oxford) 2021; 61:1936-1947. [PMID: 34297066 DOI: 10.1093/rheumatology/keab584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/25/2021] [Accepted: 07/13/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To assess the superiority of adipose tissue-derived stromal vascular fraction (AD-SVF) injection into the fingers vs placebo in reducing hand disability in systemic sclerosis (SSc) patients. METHODS We performed a double-blind, multicentre, phase II trial from October 2015 to January 2018 in France. SSc patients with a Cochin Hand Function Scale (CHFS) ≥20/90 were randomized 1:1 to receive injection of AD-SVF or placebo. AD-SVF was obtained using the automated processing Celution®800/CRS system. The placebo was lactated Ringer's solution. The primary efficacy end point was the change of the CHFS score from baseline to 3 months. Secondary efficacy endpoints included the CHFS score at 6 months, hands function, vasculopathy, hands pain, skin fibrosis, sensitivity of the finger' pulps, Scleroderma Health Assessment Questionnaire, patients and physician satisfaction and the safety. RESULTS 40 patients were randomized. The AD-SVF and placebo groups were comparable for age, sex ratio, disease duration, skin fibrosis of the hands and main cause of hand disability. After 3 month-follow-up, hand function significantly improved in both groups with no between-group difference of CHFS (mean change of -9.2 ± 12.2 in the AD-SVF group vs -7.6 ± 13.2 in the placebo group). At 6 months, hand function improved in both groups. CONCLUSION This study showed an improvement of hand function in both groups other time, with no superiority of the AD-SVF. Considering the limits of this trial, studies on a larger population of patients with homogeneous phenotype and hand handicap, should be encouraged to accurately assess the benefit of AD-SVF therapy. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02558543. Registered on September 24, 2015.
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Affiliation(s)
- Aurélie Daumas
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE
| | - Jérémy Magalon
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Elisabeth Jouve
- Pharmacometry CIC- CPCET, Clinical Pharmacology and Pharmacovigilance Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Dominique Casanova
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Cécile Philandrianos
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Maxime Abellan Lopez
- Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Stéphanie Mallet
- Department of Dermatology, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Julie Veran
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Isabelle Auquit-Auckbur
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Plastic, reconstructive and hand surgery, ROUEN, FRANCE
| | - Dominique Farge
- Assistance Publique-Hôpitaux de Paris, Saint-Louis Hospital, Autoimmune and Vascular Disease Unit, Internal Medicine (UF04), Center of reference for rare systemic autoimmune diseases (FAI2R); Université de Paris, PARIS, EA, 3518, FRANCE.,Department of Medicine, McGill University, Montreal, QC, CANADA
| | - Hervé Levesque
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen University Hospital, ROUEN, FRANCE
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen University Hospital, ROUEN, FRANCE
| | - Laurent Arnaud
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Laurent Giraudo
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Chloé Dumoulin
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Camille Giverne
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology and Biotherapy, ROUEN, FRANCE
| | - Olivier Boyer
- Normandie Univ, UNIROUEN, INSERM, U1234, Rouen University Hospital, Department of Immunology and Biotherapy, ROUEN, FRANCE
| | - Alexandra Giuliani
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Véronique Bourgarel
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Cancer Research Center of Marseille (CRCM), INSERM UMR1068, CNRS UMR7258, Aix-Marseille University, MARSEILLE, France
| | - Jean-Robert Harlé
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Nicolas Schleinitz
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Julie Brunet
- Health research department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Yves-Marie Pers
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, MONTPELLIER, France.,IRMB, University of Montpellier, INSERM U1183, CHU Montpellier, MONTPELLIER, France
| | - Rosanna Ferreira
- Clinical Immunology and Osteoarticular Diseases Therapeutic Unit, Department of Rheumatology, Lapeyronie University Hospital, MONTPELLIER, France
| | - Audrey Cras
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, PARIS, France.,INSERM U976 et CIC de Biothérapies CBT501, Université de Paris, PARIS, France
| | - David Bocara
- Department of Plastic, Reconstructive, and Esthetic Surgery, Saint Louis Hospital, Paris; Paris Diderot University, Sorbonne, Paris, France
| | - Jérome Larghero
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Unité de Thérapie Cellulaire, PARIS, France.,INSERM UMR1140 et CIC de Biothérapies CBT501, Université de Paris, PARIS, France
| | - Joseph Château
- Department of Hand Surgery ICMMS, Medipole Hospital Lyon Villeurbanne; Department of plastic, reconstructive and aesthetic surgery, Hospital Jean Mermoz Lyon; CRIOac Lyon, Regional Reference center for the management of complex bone and joint infection, Hospices Civils de Lyon, LYON, France
| | - Arnaud Hot
- Service de Médecine Interne, Hôpital Edouard Herriot, LYON, F-69003, France
| | - Françoise Dignat-George
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Hematology and Vascular Biology Laboratory, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, FRANCE
| | - Guy Magalon
- Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE.,Plastic Surgery Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE
| | - Florence Sabatier
- Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE.,Culture and Cell Therapy Laboratory, INSERM CIC BT 1409, Assistance Publique Hôpitaux de Marseille (AP-HM), Aix-Marseille University, MARSEILLE, FRANCE
| | - Brigitte Granel
- Internal Medicine Department, Assistance Publique Hôpitaux de Marseille (AP-HM), MARSEILLE, FRANCE.,Vascular Research Center Marseille, INSERM, INRA, Aix-Marseille University, MARSEILLE, FRANCE
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Fares Y, Sinzogan-Eyoum YC, Billoir P, Bogaert A, Armengol G, Alexandre K, Lammens J, Grall M, Levesque H, Benhamou Y, Miranda S. Systematic screening for a proximal DVT in COVID-19 hospitalized patients: Results of a comparative study. J Med Vasc 2021; 46:163-170. [PMID: 34238510 PMCID: PMC8118667 DOI: 10.1016/j.jdmv.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The COVID-19 pandemic is associated with a high incidence of venous thromboembolism questioning the utility of a systematic screening for deep venous thrombosis (DVT) in hospitalised patients. METHODS In this prospective bicentric controlled study, 4-point ultrasound using a pocket device was used to screen for DVT, in patients with SARS-CoV-2 infection and controls admitted for acute medical illness not related to COVID-19 hospitalised in general ward, in order to assess the utility of a routine screening and to estimate the prevalence of VTE among those patients. RESULTS Between April and May 2020, 135 patients were screened, 69 in the COVID+ group and 66 in the control one. There was no significant difference in the rate of proximal DVT between the two groups (2.2% vs. 1.5%; P=0.52), despite the high rate of PE diagnosed among COVID-19 infected patients (10.1% vs. 1.5%, P=0.063). No isolated DVT was detected, 37.5% of PE was associated with DVT. Mortality (7.2% vs. 1.5%) was not different (P=0.21) between COVID-19 patients and controls. CONCLUSION The systematic screening for proximal DVT was not found to be relevant among COVID-19 patients hospitalized in general ward despite the increase of VTE among this population. Further studies are needed to confirm the hypothesis of a local pulmonary thrombosis which may lead to new therapeutic targets.
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Affiliation(s)
- Y Fares
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - Y C Sinzogan-Eyoum
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - P Billoir
- Department of vascular haemostasis, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - A Bogaert
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - G Armengol
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - K Alexandre
- Department of infectious diseases, Rouen university hospital, 76000 Rouen, France
| | - J Lammens
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France
| | - M Grall
- Department of internal medicine, Rouen university hospital, 76000 Rouen, France; Department of medical intensive care unit, Rouen university hospital, 76000 Rouen, France
| | - H Levesque
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - Y Benhamou
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France
| | - S Miranda
- UNIROUEN, Inserm U1096 EnVI, department of internal medicine, Rouen university hospital, Normandie university, 76000 Rouen, France.
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Cordel N, Derambure C, Coutant S, Mariette X, Jullien D, Debarbieux S, Chosidow O, Meyer A, Bessis D, Joly P, Mathian A, Levesque H, Sabourin JC, Tournier I, Boyer O. TRIM33 gene somatic mutations identified by next generation sequencing in neoplasms of patients with anti-TIF1γ positive cancer-associated dermatomyositis. Rheumatology (Oxford) 2021; 60:5863-5867. [PMID: 33764396 DOI: 10.1093/rheumatology/keab260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/28/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To deep sequence the TRIM33 gene in tumours from patients with cancer-associated anti-TIF1γ autoantibody-positive dermatomyositis (DM) since TRIM33 somatic mutations in tumours may trigger this auto-immune disease. METHODS Next generation sequencing of tumour DNA samples from patients with cancer-associated anti-TIF1γ autoantibody-positive DM. Fourteen tumours from 13 anti-TIF1γ autoantibody-positive DM individuals were sequenced along with 2 control tumours from non-DM individuals. RESULTS Fourteen probable somatic variants from 4 tumours were identified in the TRIM33 gene. CONCLUSION These results are in accordance with the previous report of Pinal-Fernandez et al. and support the hypothesis of a role of TRIM33 gene mutations in the pathophysiology of anti-TIF1γ autoantibody-positive DM.
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Affiliation(s)
- Nadège Cordel
- Department of Dermatology and Clinical Immunology, Guadeloupe University Hospital, Pointe-à-Pitre, Guadeloupe.,Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France
| | - Céline Derambure
- Normandie University, UNIROUEN, IRIB, Inserm U1245, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Sophie Coutant
- Normandie University, UNIROUEN, IRIB, Inserm U1245, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Xavier Mariette
- Department of Rheumatology, Hôpitaux Universitaires Paris-Sud, Le Kremlin- Bicêtre, France
| | - Denis Jullien
- Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sébastien Debarbieux
- Department of Dermatology, Lyon sud Hospital, Hospices Civils de Lyon, Lyon, France
| | - Olivier Chosidow
- Henri Mondor Hospital, Creteil University Hospital, AP-HP, Department of Dermatology, Creteil, France and research Group Dynamic, EA7380, Faculté de Santé de Créteil, Ecole Nationale Vétérinaire d'Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
| | - Alain Meyer
- National Centre for Rare Systemic Autoimmune Diseases, University Hospitals of Strasbourg, Department of Rheumatology, Strasbourg, France
| | - Didier Bessis
- St Eloi Hospital, Montpellier University Hospital, Department of Dermatology, Montpellier, France
| | - Pascal Joly
- Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France.,Department of Dermatology, Rouen University Hospital, Rouen, France
| | - Alexis Mathian
- Groupement Hospitalier Pitié-Salpêtrière, AP-HP, Department of Internal Medicine 2, E3M Institute, Paris, France
| | - Hervé Levesque
- Department of Internal Medicine, Rouen University Hospital, Rouen, France
| | - Jean-Christophe Sabourin
- Normandie University, UNIROUEN, IRIB, Inserm U1245, Normandy Center for Genomic and Personalized Medicine, Rouen, France.,Department of Pathology, Rouen University Hospital, Rouen, France
| | - Isabelle Tournier
- Normandie University, UNIROUEN, IRIB, Inserm U1245, Normandy Center for Genomic and Personalized Medicine, Rouen, France
| | - Olivier Boyer
- Normandie University, UNIROUEN, IRIB, Inserm, U1234, Rouen, France.,Department of Immunology and biotherapies, Rouen University Hospital, Rouen, France
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Levesque H, Benhamou Y. Rituximab versus cyclophosphamide au cours de l’hémophilie acquise. Résultats à 6 mois d’une étude prospective randomisée (étude CREHA). Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bodard Q, Langlois V, Guilpain P, Le Quellec A, Vittecoq O, Noel D, Eble V, Josse S, Schmidt J, Aouba A, Levesque H, Le Besnerais M, Benhamou Y. Cardiac involvement in adult-onset Still's disease: Manifestations, treatments and outcomes in a retrospective study of 28 patients. J Autoimmun 2020; 116:102541. [PMID: 32943282 DOI: 10.1016/j.jaut.2020.102541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 08/30/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Adult-onset Still's disease (AOSD) is a rare inflammatory disease that may be life-threatening if complicated by cardiac problems. We performed a retrospective multicenter study to describe the manifestations, treatments and outcomes of cardiac involvement in AOSD. METHODS We reviewed the medical databases of eight centers. All AOSD patients identified as fulfilling Yamagushi's or Fautrel's criteria were included in the study. Cardiac involvement, clinical manifestations, laboratory features, the course of the disease and treatments were evaluated. RESULTS We included 96 AOSD patients in this study: 28 (29%) had documented cardiac involvement (AOSD + C group) and 68 (71%) had no cardiac involvement (control group). Cardiac complications were observed at diagnosis in 89% of cases. It were pericarditis (n = 17), tamponade (n = 5), myocarditis (n = 5) and non-infectious endocarditis (n = 1). Levels of leukocytes, neutrophils and C-reactive protein were significantly higher (p = 0.02, p = 0.02 and p = 0.002, respectively in the AOSD + C group than in the control group. Admission to intensive care, and the use of biotherapy were more frequent during follow-up in the AOSD + C group than the control group (p = 0.0001 and p = 0.03 respectively). Cardiac involvement was associated with refractory form in multivariate analyzed (p = 0.01). Corticosteroids were effective with or without methotrexate in 71% of patients but not in severe involvement as myocarditis or tamponade. CONCLUSION Cardiac complications are frequent, inaugural, can be life-threatening and predictive of a refractory course in patients with AOSD. Systematic cardiac screening should be proposed at diagnosis and biotherapy early use should be considered especially in myocarditis.
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Affiliation(s)
- Quentin Bodard
- Department of Internal Medicine, Infectious Diseases, Rheumatology and Endocrinology, Angoulême Hospital, 16959, Angoulême, France
| | - Vincent Langlois
- Department of Infectious Diseases and Internal Medicine, Le Havre Hospital, 76083, Le Havre, France.
| | - Philippe Guilpain
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, IRMB, Univ Montpellier, INSERM, Montpellier University Hospital, 34295, Montpellier, France
| | - Alain Le Quellec
- Department of Internal Medicine-Multiorganic Diseases, Saint-Eloi Hospital, IRMB, Univ Montpellier, INSERM, Montpellier University Hospital, 34295, Montpellier, France
| | - Olivier Vittecoq
- Department of Rheumatology, Rouen University Hospital, 76000, Rouen, France
| | - David Noel
- Department of Infectious Diseases and Internal Medicine, Elbeuf-Louviers Hospital, 76410, Elbeuf, France
| | - Vincent Eble
- Department of Internal Medicine, Eure et Seine Hospital, 27015, Evreux, France
| | - Séverine Josse
- Department of Internal Medicine, Dieppe Hospital, 76200, Dieppe, France
| | - Jean Schmidt
- Department of Internal Medicine, Amiens University Hospital, 80054, Amiens, France
| | - Achille Aouba
- Department of Internal Medicine, Caen University Hospital, 14003, Caen, France
| | - Hervé Levesque
- Department of Internal Medicine, Rouen University Hospital, 76000, Rouen, France; INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, 76000, Rouen, France
| | - Maelle Le Besnerais
- Department of Internal Medicine, Rouen University Hospital, 76000, Rouen, France; INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, 76000, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, Rouen University Hospital, 76000, Rouen, France; INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen University Hospital, 76000, Rouen, France
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Leclercq M, Langlois V, Girszyn N, Le Besnerais M, Benhamou Y, Levesque H, Muraine M, Gueudry J. Comparison of conventional immunosuppressive drugs versus anti-TNF-α agents in non-infectious non-anterior uveitis. J Autoimmun 2020; 113:102481. [PMID: 32586650 DOI: 10.1016/j.jaut.2020.102481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of Disease-modifying antirheumatic drugs (DMARDs) and anti-TNF-α agents in patients with non-infectious non-anterior uveitis. METHODS Single center retrospective study including adult patients with non-infectious intermediate, posterior or pan-uveitis. Outcomes were compared between patients treated with DMARDs or anti-TNF-α agents. The primary outcome was treatment failure or occurrence of serious adverse events. Treatment failure was determined by ophthalmologic criteria. RESULTS Seventy-three patients were included, mostly female (52%). Among them, 39 were treated with DMARDs and 34 with anti-TNF-α agents. The main uveitis causes were idiopathic (30%), birdshot chorio-retinopathy (25%), sarcoidosis (16%) and Behçet's disease (14%). The primary outcome was observed in 56% of patients treated with anti-TNF-α agents versus 59% of patients treated with DMARDs (p = 0.82). Median time to observe the primary outcome was 16 months (anti-TNF-α group) versus 21 months (p = 0.52). There was no significant difference between the two groups in terms of treatment failure, corticosteroid sparing effect, visual acuity improvement or adverse events. Earlier control of ocular inflammation was achieved with anti-TNF-α agents than with DMARDs (p = 0.006). In relapsing patients, anti-TNF-α agents allowed better corticosteroid sparing (p = 0.06). CONCLUSION DMARDs could still be used as first-line therapy for non-infectious non-anterior uveitis after corticosteroid therapy. However, anti-TNF-α agents could be proposed as an alternative in cases of severe inflammation or initial high level of steroid dependency.
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Affiliation(s)
- Mathilde Leclercq
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France.
| | - Vincent Langlois
- Internal Medicine Department, Hospital Jacques Monod, Le Havre, France
| | - Nicolas Girszyn
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France
| | - Maëlle Le Besnerais
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Ygal Benhamou
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Hervé Levesque
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Marc Muraine
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France; EA7510, UFR Santé, Rouen University, Rouen, France
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Daher A, Sauvetre G, Girszyn N, Verspyck E, Levesque H, Le Besnerais M. Granulomatosis with polyangiitis and pregnancy: A case report and review of the literature. Obstet Med 2020; 13:76-82. [PMID: 32714439 PMCID: PMC7359661 DOI: 10.1177/1753495x18822581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/10/2018] [Indexed: 12/24/2022] Open
Abstract
The association of granulomatosis with polyangiitis and pregnancy is rare and therapeutic options are limited by the risk of teratogenicity and fetotoxicity. There is a paucity of published literature to guide clinical decision-making in these cases. We report the case of a 26-year-old woman with no medical history who presented at 21 weeks of gestation with a bilateral sudden loss of hearing and erosive rhinitis. The diagnosis of granulomatosis with polyangiitis was confirmed radiologically and biologically. Corticosteroids were not enough to stabilize the disease and she received intravenous immunoglobulins with remission. A successful delivery of a healthy male newborn was done at 36 weeks. A review of all published literature on granulomatosis with polyangiitis in pregnancy between 1970 and 2017 is presented. Trial registration: Not applicable.
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Affiliation(s)
- A Daher
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - G Sauvetre
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - N Girszyn
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - E Verspyck
- Obstetric and Gynecology Department, CHU de Rouen, Rouen, France
| | - H Levesque
- Internal Medicine Department, CHU de Rouen, Rouen, France
| | - M Le Besnerais
- Internal Medicine Department, CHU de Rouen, Rouen, France
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Cordel N, Aussy A, Derambure C, Coutant S, Mariette X, Jullien D, Debarbieux S, Chosidow O, Beneveniste O, Meyer A, Bessis D, Joly P, Levesque H, Tournier I, Boyer O. Étude des mutations somatiques tumorales du gène codant pour la protéine TIF1 gamma chez les patients présentant une dermatomyosite TIF1 gamma positive avec cancer associé. Ann Dermatol Venereol 2019. [DOI: 10.1016/j.annder.2019.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cohen Aubart F, Lhote R, Steichen O, Roeser A, Otriv N, Levesque H, Morlat P, Amoura Z, Mouthon L. Workload, well-being and career satisfaction among French internal medicine physicians and residents in 2018. Postgrad Med J 2019; 96:21-27. [DOI: 10.1136/postgradmedj-2019-136657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/06/2019] [Accepted: 07/24/2019] [Indexed: 11/03/2022]
Abstract
ObjectivesThis work aimed to study the prevalence and risk factors associated with well-being and career satisfaction among French internal medicine physicians and residents.MethodsA total of 1689 French internal medicine physicians or trainees were surveyed to evaluate their workload, well-being and career satisfaction during February 2018.ResultsThe response rate was 620/1689 (37%). The mean age of the participants was 37 years (±12); 49% of the participants were female, 27% worked in the Paris area, 74% worked in a university hospital and 49% were residents. Sixty-six per cent of the responders were satisfied with their work, and 66% would choose the internal medicine specialty again. However, 71% of the responders worked more than 50 hours a week, 21% worked more than 60 hours a week and 70% believed that they did not have enough time for personal/family activities. Twenty-five per cent of the responders had at least one sign of burnout (19% of the physicians in practice and 32% of the residents). Compared with the graduate physicians in practice, the residents worked more hours a week, had more activities at night, spent more time on administrative tasks, had a worse global appreciation of their work and felt that their work was less meaningful. In multivariate analysis, the factors associated with global satisfaction at work were autonomy and meaningful work.ConclusionsFrench internal medicine physicians have a high rate of career satisfaction. However, residents have a higher workload, less time for personal/family activities and feel that their work is less meaningful.
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Abstract
INTRODUCTION Chylothorax is a rare cause of pleural effusion. The most common causes are iatrogenic or medical. We report an unusual and rare cause of bilateral chylothorax. CASE REPORT A 73-year-old woman with no past history was admitted to the emergency department for sudden onset of dyspnoea. Chest X-ray and thoracic CT scan revealed large bilateral pleural effusions. Analysis of the fluid revealed a chylothorax. The patient was treated by chest tube drainage and a fat free (medium chain triglyceride) diet. This led to drying up of the effusions and rapid discharge. Complementary imaging examinations with chest-abdomen-pelvis CT, PET CT and pelvic MRI did not reveal any underlying cause. The final diagnosis was bilateral traumatic chylothorax caused by tearing of the thoracic duct during stretching exercises. CONCLUSION Following a literature review, similar cases with the same clinical presentation were found. Combined treatment with thoracic drainage and medium chain triglyceride diet was effective in drying up the effusions. Our diagnosis was a diagnosis of exclusion. It is important to exclude a medical cause by thorough investigation.
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Affiliation(s)
- B Bottet
- Service de chirurgie generale et thoracique, CHU de Rouen, 76000 Rouen, France.
| | - J Melki
- Service de chirurgie generale et thoracique, CHU de Rouen, 76000 Rouen, France
| | - H Levesque
- Service de medecine interne, CHU de Rouen, 76000 Rouen, France
| | - J-M Baste
- Service de chirurgie generale et thoracique, CHU de Rouen, 76000 Rouen, France
| | - E Roussel
- Service de chirurgie digestive, CHU de Rouen, 76000 Rouen, France
| | - C Peillon
- Service de chirurgie generale et thoracique, CHU de Rouen, 76000 Rouen, France
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Billoir P, Miranda S, Abboud J, Armengol G, Levesque H, Benhamou Y, Le Cam Duchez V. [Which place of antiphosphatidylethanolamine antibodies research in seronegative antiphospholipid syndrome suspicion?]. Rev Med Interne 2019; 40:351-354. [PMID: 30905593 DOI: 10.1016/j.revmed.2018.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 08/03/2018] [Revised: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Antiphospholipid syndrome (APS) is a clinico-biological syndrome, which associates vascular injury and persisting antiphospholipid antibodies (aPL). Patients with clinical symptoms of APS but without aPL are defined as "seronegative APS" (SNAPS). The aim of this study was to evaluate antiphosphatidylethanolamine antibody (aPE) investigation in patients with SNAPS suspicion. METHODS This retrospective study was conducted in patients with SNAPS suspicion. A homemade enzyme-linked immunosorbent assay (ELISA) was used to search for aPE. The results of this homemade method were compared with those from a global screening ELISA. RESULTS Two hundred twenty-eight patients with SNAPS suspicion were included. Among them, 58.3% had a thrombotic event. The homemade ELISA found positive persisting aPE in 23 patients (10%): 15 with a thrombotic event, 6 with obstetrical morbidity and 2 with a combined event. The global screening ELISA was positive in only 11 of these 23 patients (47.8%). CONCLUSION These results suggest the implication of aPE in SNAPS.
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Affiliation(s)
- P Billoir
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, vascular hemostasis unit, 76000 Rouen, France.
| | - S Miranda
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, department of internal medicine, vascular and thrombosis unit, 76000 Rouen, France
| | - J Abboud
- Rouen university hospital, vascular hemostasis unit, 76000 Rouen, France
| | - G Armengol
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, department of internal medicine, vascular and thrombosis unit, 76000 Rouen, France
| | - H Levesque
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, department of internal medicine, vascular and thrombosis unit, 76000 Rouen, France
| | - Y Benhamou
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, department of internal medicine, vascular and thrombosis unit, 76000 Rouen, France
| | - V Le Cam Duchez
- Normandie université, UNIROUEN, Inserm U1096, Rouen university hospital, vascular hemostasis unit, 76000 Rouen, France
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Miranda S, Billoir P, Damian L, Thiebaut PA, Schapman D, Le Besnerais M, Jouen F, Galas L, Levesque H, Le Cam-Duchez V, Joannides R, Richard V, Benhamou Y. Hydroxychloroquine reverses the prothrombotic state in a mouse model of antiphospholipid syndrome: Role of reduced inflammation and endothelial dysfunction. PLoS One 2019; 14:e0212614. [PMID: 30870459 PMCID: PMC6417644 DOI: 10.1371/journal.pone.0212614] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 04/10/2018] [Accepted: 02/06/2019] [Indexed: 01/01/2023] Open
Abstract
Antiphospholipid antibodies (aPL) promote endothelial dysfunction, inflammation and procoagulant state. We investigated the effect of hydroxychloroquine (HCQ) on prothrombotic state and endothelial function in mice and in human aortic endothelial cells (HAEC). Human aPL were injected to C57BL/6 mice treated or not with HCQ. Vascular endothelial function and eNOS were assessed in isolated mesenteric arteries. Thrombosis was assessed both in vitro by measuring thrombin generation time (TGT) and tissue factor (TF) expression and in vivo by the measurement of the time to occlusion in carotid and the total thrombosis area in mesenteric arteries. TGT, TF, and VCAM1 expression were evaluated in HAEC. aPL increased VCAM-1 expression and reduced endothelium dependent relaxation to acetylcholine. In parallel, aPL shortened the time to occlusion and extended thrombus area in mice. This was associated with an overexpression of TF and an increased TGT in mice and in HAEC. HCQ reduced clot formation as well as TGT, and improved endothelial-dependent relaxations. Finally, HCQ increased the p-eNOS/eNOS ratio. This study provides new evidence that HCQ improves procoagulant status and vascular function in APS by modulating eNOS, leading to an improvement in the production of NO.
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Affiliation(s)
- Sébastien Miranda
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- Rouen University Hospital, Department of Vascular Haemostasis, Rouen France
| | - Louise Damian
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Pierre Alain Thiebaut
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Damien Schapman
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
- Univ, Inserm, UNIROUEN, PRIMACEN, Cell Imaging Platform of Normandy, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Maelle Le Besnerais
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Fabienne Jouen
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
- Inserm U1234, Rouen, France
| | - Ludovic Galas
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
- Univ, Inserm, UNIROUEN, PRIMACEN, Cell Imaging Platform of Normandy, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Hervé Levesque
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Véronique Le Cam-Duchez
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- Rouen University Hospital, Department of Vascular Haemostasis, Rouen France
| | - Robinson Joannides
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Vincent Richard
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
| | - Ygal Benhamou
- Rouen University Hospital, Department of Internal Medicine, Rouen, France
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, Rouen, France
- University of Rouen, Institute for Research and Innovation in Biomedicine, Rouen, France
- * E-mail:
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Marie, Dominique S, Joly P, Aouba A, Vittecoq O, Marcelli C, Delahaye F, Kerleau J, Noel D, Bonnet B, Levesque H, Benichou J. Prévalence des myopathies inflammatoires idiopathiques en NormandieI. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Damian L, Jardin F, Langlois V, Kerleau J, Benhamou Y, Levesque H, Sauvetre G. Thrombopénie immunologique primaire de l’adulte : facteurs prédictifs d’évolution vers la chronicité. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.10.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hellouin De Menibus Demas L, Miranda S, Cailleux N, Armengol G, Levesque H, Benhamou Y, Le Besnerais M. Ischémies digitales : élaboration d’un algorithme diagnostique à partir d’une étude rétrospective de 203 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bodard Q, Guilpain P, Lequerré T, Quatresous I, Eble V, Josse S, Schmidt J, Aouba A, Le Quellec A, Levesque H, Benhamou Y, Langlois V. Maladie de Still de l’adulte avec atteinte cardiaque : étude rétrospective multicentrique de 38 cas. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Marie I, Gehanno J, Duval-Modeste A, Joly P, Dominique S, Noel D, Cailleux A, Benichou J, Levesque H, Bubenheim M, Goulle J. Influence de l’exposition professionnelle au palladium sur les caractéristiques de la sclérodermie systémique. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Leclercq M, Le Besnerais M, Langlois V, Girszyn N, Benhamou Y, Ngo C, Levesque H, Muraine M, Gueudry J. Tocilizumab for the treatment of birdshot uveitis that failed interferon alpha and anti-tumor necrosis factor-alpha therapy: two cases report and literature review. Clin Rheumatol 2018; 37:849-853. [PMID: 29397459 DOI: 10.1007/s10067-018-4007-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/14/2022]
Abstract
Biotherapies appear as potential drugs for the treatment of inflammatory noninfectious uveitis. In this report, we show that tocilizumab, an anti-IL-6 agent, greatly improved two patients with birdshot chorioretinopathy refractory to conventional immunosuppressive drugs, interferon α2a, and anti-TNFα agents. After a follow-up of 22 months, patients exhibited an improvement of both visual acuity and macular edema. A corticosteroid-sparing effect was achieved in both cases.
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Affiliation(s)
- Mathilde Leclercq
- Normandie Université UNI Rouen, Service de Médecine Interne, CHU Charles Nicolle, 76000, Rouen, France.
| | - M Le Besnerais
- Normandie Université UNI Rouen U1096, Service de Médecine Interne, CHU Charles Nicolle, 76000, Rouen, France
| | - V Langlois
- Service de Médecine Interne et Maladies Infectieuses, CH Le Havre, 76290, Montivilliers, France
| | - N Girszyn
- Normandie Université UNI Rouen, Service de Médecine Interne, CHU Charles Nicolle, 76000, Rouen, France
| | - Y Benhamou
- Normandie Université UNI Rouen U1096, Service de Médecine Interne, CHU Charles Nicolle, 76000, Rouen, France
| | - C Ngo
- Normandie Université UNI Rouen, Service d'Ophtalmologie, CHU Charles Nicolle, 76000, Rouen, France
| | - H Levesque
- Normandie Université UNI Rouen U1096, Service de Médecine Interne, CHU Charles Nicolle, 76000, Rouen, France
| | - M Muraine
- Normandie Université UNI Rouen, Service d'Ophtalmologie, CHU Charles Nicolle, 76000, Rouen, France
| | - J Gueudry
- Normandie Université UNI Rouen, Service d'Ophtalmologie, CHU Charles Nicolle, 76000, Rouen, France
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Marie I, Gehanno J, Duval-Modeste A, Joly P, Dominique S, Bravard P, Noel D, Cailleux A, Benichou J, Levesque H, Bubenheim M, Goulle J. Influence de l’exposition professionnelle au cadmium sur les caractéristiques de la sclérodermie systémique. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cadiou G, Varin R, Levesque H, Grassi V, Benichou J, Tiret I, Dieu B, Lecam-Duchez V, Borg JY, Muller JM, Benhamou Y, Marie I. Risk factors of vitamin K antagonist overcoagulation. Thromb Haemost 2017. [DOI: 10.1160/th08-04-0265] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThe aims of this case-control study were to identify in vitamin K antagonist (VKA)-treated unselected patients, factors associated with international normalised ratio (INR) values: (i) greater than 6.0.;and (ii) ranging from 4.0 to 6.0 complicated with bleeding. We also assessed VKA-related morbidity in these patients. During a two-month period, 4,188 consecutive and unselected patients were referred to our Emergency Department. At admission, the medical records of each patient and two age- and sex-matched controls were reviewed for: both duration and indication of VKA therapy, previous medical history of VKA-related haemorrhage, underlying co-morbidities, concomitant medications other than VKA, duration of hospitalization and deaths’ causes. Of these 4,188 subjects,50 case-patients (1.19%) were identified; both case-patients and controls did not differ as regards indications and patterns of VKA therapy. Interestingly, two-thirds of case-patients were women, suggesting that female gender may be a risk factor of VKA over-coagulation onset. We identified the following risk factors of VKA over-coagulation: previous medical history of INR levels over therapeutic range, therapy with antibiotics, amiodarone and proton pump inhibitors, as well as fever. A total of 88% of case-patients were hospitalized; mean duration of patients’ hospitalization was seven days [range:1–56 days];no patient died from major bleeding. Our study underscores that it is of utmost importance to consider the strength of indication before starting VKA therapy, as this therapy has been responsible for as high as 1.19% of admissions in unselected subjects referred to an Emergency Department. Our data therefore suggest that internists should be aware of VKA-related high morbidity, particularly in situations at risk of VKA over-coagulation.
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Deschamps A, Samain A, Carvalho P, Courville P, Levesque H, Musette P, Joly P. A familial mediterranean fever flare induced by a drug reaction with eosinophilia and systemic symptoms. J Eur Acad Dermatol Venereol 2017; 32:e16-e17. [PMID: 28653374 DOI: 10.1111/jdv.14432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Deschamps
- Dermatology Department, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Inserm, U905, University of Normandy, 1 Rue de Germont, 76031, Rouen, France
| | - A Samain
- Dermatology Department, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Inserm, U905, University of Normandy, 1 Rue de Germont, 76031, Rouen, France
| | - P Carvalho
- Dermatology Department, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Inserm, U905, University of Normandy, 1 Rue de Germont, 76031, Rouen, France
| | - P Courville
- Pathology Department, Rouen University Hospital, University of Normandy, 76031, Rouen, France
| | - H Levesque
- Department of Internal Medicine, Rouen France, University of Rouen, Institute for Research and Innovation in Biomedicine, 76031, Rouen, France
| | - P Musette
- Dermatology Department, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Inserm, U905, University of Normandy, 1 Rue de Germont, 76031, Rouen, France
| | - P Joly
- Dermatology Department, Institute for Research and Innovation in Biomedicine, Rouen University Hospital, Inserm, U905, University of Normandy, 1 Rue de Germont, 76031, Rouen, France
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Marie I, Gremain V, Nassermadji K, Richard L, Joly P, Menard JF, Levesque H. Nail involvement in systemic sclerosis. J Am Acad Dermatol 2017; 76:1115-1123. [DOI: 10.1016/j.jaad.2016.11.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/10/2016] [Accepted: 11/10/2016] [Indexed: 12/31/2022]
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Miranda S, Dhamy A, Le Cam Duchez V, Barbay V, Cailleux N, Armengol G, Levesque H, Benhamou Y. Évaluation du risque de récidive de la maladie thromboembolique veineuse par les dosages de D-dimères et du fragment F1 + 2 de la prothrombine : analyse d’une cohorte de 125 patients. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ngo S, Chamouni P, Lenain P, Lamoureux F, Levesque H. Polyglobulie secondaire : devrait-on penser au cannabis ? Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lesourd A, Langlois V, Miranda S, Le Besnerais M, Grange S, Noel D, Levesque H, Benhamou Y, Armengol G. Enquête étiologique des syndromes d’activation lymphohistiocytaires secondaires : intérêt du dosage de la procalcitonine. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pineton De Chambrun M, Gousseff M, Levesque H, Lega J, Le Moal S, Haddad F, Merceron S, Lifermann F, Christides C, Argaud L, Hatron P, Amoura Z. Dysfonction myocardique au cours des crises graves de syndrome de fuite capillaire idiopathique. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Aouba A, Villette B, Borg J, Guillet B, Borel-Derlon A, Schved J, Schneid H, Levesque H. Utilisation quotidienne du facteur VII activé recombinant dans les saignements aigus de l’hémophile acquise A : résultats d’ACQUI-7, une étude française prospective. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Armengol G, Miranda S, Le Cam-Duchez V, Benichou J, Barbay V, Donnadieu N, Le Besnerais M, Cuvelier A, Delmas F, Levesque H, Benhamou Y. Intérêt d’une thromboprophylaxie adaptée au poids chez le patient obèse hospitalisé : étude comparative de 2 schémas posologiques d’énoxaparine (étude Itohenox). Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Marie I, Leroi AM, Gourcerol G, Levesque H, Menard JF, Ducrotte P. Lactose malabsorption in systemic sclerosis. Aliment Pharmacol Ther 2016; 44:1123-1133. [PMID: 27677253 DOI: 10.1111/apt.13810] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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] [Received: 07/17/2016] [Revised: 08/01/2016] [Accepted: 09/05/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are no studies on systemic sclerosis (SSc) assessing the relationship between food intake, especially lactose, and gastrointestinal dysfunction. AIM To determine the prevalence of lactose malabsorption, using lactose breath test, in patients with SSc. To evaluate the correlation between lactose malabsorption and gastrointestinal involvement. To predict which SSc patients exhibit lactose malabsorption. METHODS Seventy-seven consecutive Caucasian patients with SSc and 20 control subjects underwent lactose breath test. All patients also completed a questionnaire on digestive symptoms, and a global symptom score (GSS) was calculated. RESULTS The prevalence of lactose malabsorption was higher in SSc patients than in controls (44.3% vs. 10%; P = 0.004). We observed a marked correlation between the presence of lactose malabsorption and: higher values of GSS (P < 0.0001); severe oesophageal (P = 0.018) and small intestinal (P = 0.04) motor disorders; and joint involvement (P = 0.019). Furthermore, in SSc patients with symptomatic lactose malabsorption, the median value of GSS of digestive symptoms was lower after initiation of lactose-free diet (P < 0.0001). CONCLUSIONS Our study underscores the fact that lactose malabsorption often occurs in patients with systemic sclerosis. Furthermore, our findings highlight the fact that lactose breath test is a helpful, noninvasive method, by identifying the group of patients with systemic sclerosis with symptomatic lactose malabsorption that may benefit from a reduction in lactose intake.
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Affiliation(s)
- I Marie
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
| | - A-M Leroi
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - G Gourcerol
- Department of Digestive Physiology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - H Levesque
- Department of Internal Medicine, Rouen University Hospital, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, Rouen University Hospital, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, Rouen University Hospital, and INSERM UMR 1073, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
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Le Besnerais M, Favre J, Denis CV, Mulder P, Martinet J, Nicol L, Levesque H, Veyradier A, Kopić A, Motto DG, Coppo P, Richard V, Benhamou Y. Assessment of endothelial damage and cardiac injury in a mouse model mimicking thrombotic thrombocytopenic purpura. J Thromb Haemost 2016; 14:1917-1930. [PMID: 27501520 DOI: 10.1111/jth.13439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/18/2016] [Indexed: 01/01/2023]
Abstract
Essentials Endothelial injury is thought to be a key event in thrombotic thrombocytopenic purpura (TTP). Endothelial and cardiac damages were assessed in a model of TTP using ADAMTS-13 knockout mice. Damages of cardiac perfusion and function were associated with nitric oxide pathway alteration. Endothelial dysfunction constitutes a critical event in TTP development and cardiac injury. SUMMARY Background Cardiac alterations represent a major cause of mortality in patients with thrombotic thrombocytopenic purpura (TTP). Endothelial injury remains poorly defined, but seems to be a key initiating event leading to the formation of platelet-rich thrombi in TTP patients. Objectives To assess the changes in endothelial function and the induced cardiac damage in a mouse model of TTP. Patients/methods We used an animal model in which TTP-like symptoms are triggered by injection of 2000 units kg-1 of recombinant von Willebrand factor in ADAMTS-13 knockout mice. Results These mice developed TTP-like symptoms, i.e. severe thrombocytopenia, schistocytosis, and anemia. On day 2, magnetic resonance imaging demonstrated a decrease in left ventricular perfusion associated with alteration of left ventricular ejection fraction, fractional shortening, and cardiac output, suggesting early systolic dysfunction. This was associated with decrease in endothelium-mediated relaxation responses to acetylcholine in mesenteric and coronary arteries, demonstrating severe early endothelial dysfunction. In parallel, we showed decreased cardiac expression of endothelial nitric oxide (NO) synthase and increased expression of antioxidant enzymes, suggesting alteration of the NO pathway. At this time, cardiac immunohistochemistry revealed an increase in the expression of VCAM-1 and E-selectin. Conclusion This study provides evidence that the heart is a sensitive target organ in TTP, and shows, for the first time, strong mesenteric and coronary endothelial dysfunction in an induced-TTP model. The mechanisms incriminated are the occurrence of a pro-oxidant state, and proadhesive and proinflammatory phenotypes. This previously largely unrecognized vascular dysfunction may represent an important contributor to the systemic organ failure occurring in TTP.
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Affiliation(s)
- M Le Besnerais
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - J Favre
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - C V Denis
- INSERM UMR S 1176, Université Paris-Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - P Mulder
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - J Martinet
- INSERM U905, UFR médecine pharmacie Rouen, Rouen, France
| | - L Nicol
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - H Levesque
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - A Veyradier
- Service d'hématologie biologique, Hôpital Lariboisière, AP-HP, Paris, France
- EA3518, IUH Saint Louis, Université Paris-Diderot, Paris, France
| | - A Kopić
- Baxalta Innovations GmbH, Vienna, Austria
| | - D G Motto
- Bloodworks Northwest Research Institute, Seattle, WA, USA
| | - P Coppo
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France
- Service d'Hématologie, Hôpital Saint-Antoine, AP-HP, Paris, France
- Institut Gustave Roussy, INSERM U1170, Villejuif, France
| | - V Richard
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France
| | - Y Benhamou
- Service de Médecine Interne, CHU Charles Nicolle, Rouen, France.
- INSERM U1096, UFR médecine pharmacie Rouen, Rouen, France.
- Centre de Référence des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, AP-HP, Paris, France.
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Allenbach Y, Leroux G, Suárez-Calvet X, Preusse C, Gallardo E, Hervier B, Rigolet A, Hie M, Pehl D, Limal N, Hufnagl P, Zerbe N, Meyer A, Aouizerate J, Uzunhan Y, Maisonobe T, Goebel HH, Benveniste O, Stenzel W, Hot A, Grados A, Schleinitz N, Gallet L, Streichenberger N, Petiot P, Hachulla E, Launay D, Devilliers H, Hamidou M, Cornec D, Bienvenu B, Langlois V, Levesque H, Delluc A, Drouot L, Charuel JL, Jouen F, Romero N, Dubourg O, Leonard-Louis S, Behin A, Laforet P, Stojkovic T, Eymard B, Costedoat-Chalumeau N, Campana-Salort E, Tournadre A, Musset L, Bader-Meunier B, Kone-Paut I, Sibilia J, Servais L, Fain O, Larroche C, Diot E, Terrier B, De Paz R, Dossier A, Menard D, Morati C, Roux M, Ferrer X, Martinet J, Besnard S, Bellance R, Cacoub P, Saadoun D, Arnaud L, Grosbois B, Herson S, Boyer O. Dermatomyositis With or Without Anti-Melanoma Differentiation-Associated Gene 5 Antibodies. The American Journal of Pathology 2016; 186:691-700. [DOI: 10.1016/j.ajpath.2015.11.010] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 10/19/2015] [Accepted: 11/16/2015] [Indexed: 12/18/2022]
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Eble V, Legallicier B, Joly P, Vittecoq O, Caron F, Tamion F, Ducrotte P, Levesque H, Menard JF, Jouen F, Guerrot D, Marie I. Long term outcome of patients with low level of cryoglobulin (<0.05g/L). Autoimmun Rev 2016; 15:440-6. [PMID: 26827906 DOI: 10.1016/j.autrev.2016.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/20/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To date, no studies have yet assessed the characteristics of non-HCV patients with low level of cryoglobulin (≤0.05 g/L). The aims of the current study were thus to: 1) determine the prevalence of cryoglobulin ≤0.05 g/L in patients with non-HCV cryoglobulin; and 2) compare clinical features and long term outcome, including organ complications and mortality rate, between non-HCV patients with cryoglobulin level ≤0.05 g/L and those exhibiting cryoglobulin level >0.05 g/L. METHODS Among 6379 cryoglobulin testing, cryoglobulin was detected in 618 patients (9.69% of cases); of these 618 patients, 453 non-HCV patients were included in the study. The medical records of these patients were reviewed. RESULTS Of the 453 non-HCV cryoglobulin-positive patients, 265 (58.6%) exhibited cryoglobulin level ≤0.05 g/L. We showed that patients with cryoglobulin level ≤0.05 g/L had: 1) less commonly: palpable purpura (p<0.001), digital ulcers (p=0.006), peripheral neurologic involvement (p=0.03) and renal impairment (p=0.03); and 2) lower median values of ESR (p<0.001) and C-reactive protein (p=0.001). The patients with cryoglobulin level ≤0.05 g/L less often experienced infections (p=0.04) and hematological malignancies (p=0.01); both groups did not differ regarding prevalence of connective tissue diseases and solid tumors. Mortality rate was as high as 13.6% in patients with cryoglobulin level ≤0.05 g/L; death was mainly due to: solid tumors (16.6%), cardiovascular complications (13.8%), hematological malignancies (11.1%), infections (8.3%), pulmonary/renal complications of cryoglobulin (8.3%) and connective tissue diseases (8.3%). CONCLUSION Our study shows a high prevalence of cryoglobulin level ≤0.05 g/L in clinical practice. Our findings further underscore that non-HCV cryoglobulin level ≤0.05 g/L may be responsible for severe renal and neurological complications, leading to high morbidity and mortality in these patients. Thus, our data suggest that both appropriate therapy and close follow-up may be required to improve such patients' outcome.
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Affiliation(s)
- V Eble
- Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | | | - P Joly
- Department of Dermatology and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, CHU Rouen, Rouen, France
| | - O Vittecoq
- Department of Rheumatology and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, CHU Rouen, Rouen, France
| | - F Caron
- Department of Infectious Diseases, CHU Rouen, Rouen, France
| | - F Tamion
- Intensive Care Unit, CHU Rouen, Rouen, France
| | - P Ducrotte
- Department of Gastroenterology, CHU Rouen, Rouen, France
| | - H Levesque
- Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - J-F Menard
- Department of Biostatistics, CHU Rouen, Rouen, France
| | - F Jouen
- Laboratory of Immunology and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France
| | - D Guerrot
- Department of Nephrology, CHU Rouen, Rouen, France
| | - I Marie
- Department of Internal Medicine, CHU Rouen, and INSERM U 905, University of Rouen IFRMP, Institute for Biochemical Research, Rouen, France.
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Langlois V, Lesourd A, Girszyn N, Ménard JF, Levesque H, Caron F, Marie I. Antineutrophil Cytoplasmic Antibodies Associated With Infective Endocarditis. Medicine (Baltimore) 2016; 95:e2564. [PMID: 26817911 PMCID: PMC4998285 DOI: 10.1097/md.0000000000002564] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 12/17/2015] [Accepted: 12/28/2015] [Indexed: 12/23/2022] Open
Abstract
To determine the prevalence of antineutrophil cytoplasmic antibodies (ANCA) in patients with infective endocarditis (IE) in internal medicine; and to compare clinical and biochemical features and outcome between patients exhibiting IE with and without ANCA.Fifty consecutive patients with IE underwent ANCA testing. The medical records of these patients were reviewed.Of the 50 patients with IE, 12 exhibited ANCA (24%). ANCA-positive patients with IE exhibited: longer duration between the onset of first symptoms and IE diagnosis (P = 0.02); and more frequently: weight loss (P = 0.017) and renal impairment (P = 0.08), lower levels of C-reactive protein (P = 0.0009) and serum albumin (P = 0.0032), involvement of both aortic and mitral valves (P = 0.009), and longer hospital stay (P = 0.016). Under multivariate analysis, significant factors for ANCA-associated IE were: longer hospital stay (P = 0.004), lower level of serum albumin (P = 0.02), and multiple valve involvement (P = 0.04). Mortality rate was 25% in ANCA patients; death was because of IE complications in all these patients.Our study identifies a high prevalence of ANCA in unselected patients with IE in internal medicine (24%). Our findings further underscore that ANCA may be associated with a subacute form of IE leading to multiple valve involvement and more frequent renal impairment. Because death was due to IE complications in all patients, our data suggest that aggressive therapy may be required to improve such patients' outcome.
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Affiliation(s)
- Vincent Langlois
- From the Department of Internal Medicine, Institute for Biochemical Research, IFRMP, University of Rouen (VL, AL, NG, HL, IM); Department of Infectious diseases (FC); and Department of Biostatistics (J-F M), CHU Rouen, France
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Van Elslande H, Ngo S, Lahary A, Kerleau J, Levesque H. Connaissance des drépanocytaires de Haute-Normandie de leur maladie, contexte sociodémographique et caractéristiques sanitaires : intérêt de la mise en place d’une éducation thérapeutique. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marie I, Goulle J, Duval-Modeste A, Dominique S, Joly P, Noel D, Bravard P, Cailleux A, Benichou J, Levesque H. Sclérodermie systémique et exposition aux métaux lourds : enquête prospective cas-témoins. Rev Med Interne 2015. [DOI: 10.1016/j.revmed.2015.10.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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