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Perray L, Nguyen Y, Clavel Refregiers G, Chazal T, Héron E, Pouchelon C, Dunogué B, Costedoat-Chalumeau N, Murarasu A, Régent A, Puéchal X, Thoreau B, Lifermann F, Graveleau J, Hié M, Froissart A, Baudet A, Deroux A, Lavigne C, Puigrenier S, Mesbah R, Moulinet T, Vasco C, Revuz S, Pugnet G, Rieu V, Combes A, Brézin A, Terrier B. ANCA-associated scleritis: impact of ANCA on presentation, response to therapy and outcome. Rheumatology (Oxford) 2024; 63:329-337. [PMID: 37233203 DOI: 10.1093/rheumatology/kead252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES To describe the characteristics, treatment and outcome of isolated ANCA-associated scleritis at diagnosis compared with idiopathic scleritis with negative ANCA tests. METHODS This retrospective multicentre case-control study was performed within the French Vasculitis Study Group (FVSG) network and in three French tertiary ophthalmologic centres. Data from patients with scleritis without any systemic manifestation and with positive ANCA results were compared with those of a control group of patients with idiopathic scleritis with negative ANCA tests. RESULTS A total of 120 patients, including 38 patients with ANCA-associated scleritis and 82 control patients, diagnosed between January 2007 and April 2022 were included. The median follow-up was 28 months (IQR 10-60). The median age at diagnosis was 48 years (IQR 33-60) and 75% were females. Scleromalacia was more frequent in ANCA-positive patients (P = 0.027) and 54% had associated ophthalmologic manifestations, without significant differences. ANCA-associated scleritis more frequently required systemic medications, including glucocorticoids (76% vs 34%; P < 0.001), and rituximab (P = 0.03) and had a lower remission rate after the first- and second-line treatment. Systemic ANCA-associated vasculitis (AAV) occurred in 30.7% of patients with PR3- or MPO-ANCA, after a median interval of 30 months (IQR 16.3-44). Increased CRP >5 mg/l at diagnosis was the only significant risk factor of progression to systemic AAV [adjusted hazard ratio 5.85 (95% CI 1.10, 31.01), P = 0.038]. CONCLUSION Isolated ANCA-associated scleritis is mostly anterior scleritis with a higher risk of scleromalacia than ANCA-negative idiopathic scleritis and is more often difficult to treat. One-third of patients with PR3- or MPO-ANCA scleritis progressed to systemic AAV.
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Affiliation(s)
- Laura Perray
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Yann Nguyen
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Thibaud Chazal
- Department of Internal Medicine, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France
| | - Clara Pouchelon
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Anne Murarasu
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Thoreau
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
| | | | - Julie Graveleau
- Department of Internal Medicine, Centre Hospitalier de Saint Nazaire, Saint Nazaire, France
| | - Miguel Hié
- Department of Internal Medicine, Hôpital Pitié Salpêtrière, AP-HP, Paris, France
| | - Antoine Froissart
- Department of Internal Medicine, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Antoine Baudet
- Department of Internal Medicine, Centre Hospitalier d'Annecy, Annecy, France
| | - Alban Deroux
- Department of Internal Medicine, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Christian Lavigne
- Department of Internal Medicine, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Sébastien Puigrenier
- Department of Internal Medicine, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Rafik Mesbah
- Department of Nephrology, Centre Hospitalier de Boulogne-sur-Mer, Boulogne-sur-Mer, France
| | - Thomas Moulinet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Claire Vasco
- Department of Internal Medicine, Centre Hospitalier de Libourne, Libourne, France
| | - Sabine Revuz
- Department of Internal Medicine, Centre Hospitalier Universitaire Saint Pierre, La Réunion, Saint Pierre, France
| | - Grégory Pugnet
- Department of Internal Medicine, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Virginie Rieu
- Department of Internal Medicine, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Anaïs Combes
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Antoine Brézin
- Department of Ophthalmology, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, AP-HP, Paris, France
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Le Gall A, Hoang-Thi TN, Porcher R, Dunogué B, Berezné A, Guillevin L, Le Guern V, Cohen P, Chaigne B, London J, Groh M, Paule R, Chassagnon G, Vakalopoulou M, Dinh-Xuan AT, Revel MP, Mouthon L, Régent A. Prognostic value of automated assessment of interstitial lung disease on CT in systemic sclerosis. Rheumatology (Oxford) 2024; 63:103-110. [PMID: 37074923 DOI: 10.1093/rheumatology/kead164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023] Open
Abstract
OBJECTIVE Stratifying the risk of death in SSc-related interstitial lung disease (SSc-ILD) is a challenging issue. The extent of lung fibrosis on high-resolution CT (HRCT) is often assessed by a visual semiquantitative method that lacks reliability. We aimed to assess the potential prognostic value of a deep-learning-based algorithm enabling automated quantification of ILD on HRCT in patients with SSc. METHODS We correlated the extent of ILD with the occurrence of death during follow-up, and evaluated the additional value of ILD extent in predicting death based on a prognostic model including well-known risk factors in SSc. RESULTS We included 318 patients with SSc, among whom 196 had ILD; the median follow-up was 94 months (interquartile range 73-111). The mortality rate was 1.6% at 2 years and 26.3% at 10 years. For each 1% increase in the baseline ILD extent (up to 30% of the lung), the risk of death at 10 years was increased by 4% (hazard ratio 1.04, 95% CI 1.01, 1.07, P = 0.004). We constructed a risk prediction model that showed good discrimination for 10-year mortality (c index 0.789). Adding the automated quantification of ILD significantly improved the model for 10-year survival prediction (P = 0.007). Its discrimination was only marginally improved, but it improved prediction of 2-year mortality (difference in time-dependent area under the curve 0.043, 95% CI 0.002, 0.084, P = 0.040). CONCLUSION The deep-learning-based, computer-aided quantification of ILD extent on HRCT provides an effective tool for risk stratification in SSc. It might help identify patients at short-term risk of death.
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Affiliation(s)
- Aëlle Le Gall
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | | | - Raphaël Porcher
- Université de Paris, Paris, France
- Service d'Epidémiologie Clinique, Hôpital Hôtel Dieu, AP-HP, Paris, France
| | - Bertrand Dunogué
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Alice Berezné
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Véronique Le Guern
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Benjamin Chaigne
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Jonathan London
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Matthieu Groh
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Romain Paule
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
| | - Guillaume Chassagnon
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Maria Vakalopoulou
- Centre de Vision Numérique, École Centrale Supelec, Gif-sur-Yvette, France
| | - Anh-Tuan Dinh-Xuan
- Service de Physiologie et Explorations Fonctionnelles, Hôpital Cochin, AP-HP, Paris, France
| | - Marie Pierre Revel
- Service de Radiologie, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'ile de France, APHP-CUP, Hôpital Cochin, Paris, France
- Université de Paris, Paris, France
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Foré R, Liozon E, Dumonteil S, Sené T, Héron E, Lacombe V, Leclercq M, Magnant J, Beuvon C, Régent A, de Mornac D, Samson M, Smets P, Alexandra JF, Granel B, Robert PY, Curumthaullee MF, Parreau S, Palat S, Bezanahary H, Ly KH, Fauchais AL, Gondran G. BOB-ACG study: Pulse methylprednisolone to prevent bilateral ophthalmologic damage in giant cell arteritis. A multicentre retrospective study with propensity score analysis. Joint Bone Spine 2024; 91:105641. [PMID: 37734440 DOI: 10.1016/j.jbspin.2023.105641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/25/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Giant cell arteritis (GCA) is complicated in 10 to 20% of cases by permanent visual ischemia (PVI). International guidelines advocate the use of intravenous pulse of methylprednisolone from 250 to 1000mg per day, for three days, followed by oral prednisone at 1mg/kg per day. The aim of this study is to assess whether this strategy significantly reduces the risk of early PVI of the second eye, compared with direct prednisone at 1mg/kg per day. METHODS We conducted a multicentre retrospective observational study over the past 15 years in 13 French hospital centres. Inclusion criteria included: new case of GCA; strictly unilateral PVI, prednisone at dose greater than or equal to 0.9mg/kg per day; for the intravenous methylprednisolone (IV-MP) group, total dose between 900 and 5000mg, close follow-up and knowledge of visual status at 1 month of treatment, or earlier, in case of contralateral PVI. The groups were compared on demographic, clinical, biological, iconographic, and therapeutic parameters. Statistical analysis was optimised using propensity scores. RESULTS One hundred and sixteen patients were included, 86 in the IV-MP group and 30 in the direct prednisone group. One patient in the direct prednisone group and 13 in the IV-MP group bilateralised, without significant difference between the two strategies (3.3% vs 15.1%). Investigation of the association between IV-MP patients and contralateral PVI through classical logistic regression, matching or stratification on propensity score did not show a significant association. Weighting on propensity score shows a significant association between IV-MP patients and contralateral PVI (OR=12.9 [3.4; 94.3]; P<0.001). Improvement in visual acuity of the initially affected eye was not significantly associated with IV-MP (visual acuity difference 0.02 vs -0.28 LogMar), even in the case of early management, i.e., within the first 48hours after the onset of PVI (n=61; visual acuity difference -0.11 vs 0.25 LogMar). Complications attributable to corticosteroid therapy in the first month were significantly more frequent in the IV-MP group (31.8 vs 10.7%; P<0.05). DISCUSSION Our data do not support the routine use of pulse IV-MP for GCA complicated by unilateral PVI to avoid bilateral ophthalmologic damage. It might be safer to not give pulse IV-MP to selected patients with high risks of glucocorticoids pulse side effects. A prospective randomised multicentre study comparing pulse IV-MP and prednisone at 1mg/kg per day is desirable.
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Affiliation(s)
- Romain Foré
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France.
| | - Eric Liozon
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | | | - Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Emmanuel Héron
- Department of Internal Medicine, CH National d'Ophtalmologie des Quinze-Vingt, Paris, France
| | - Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, CHU d'Angers, Angers, France
| | | | - Julie Magnant
- Department of Internal Medicine, CHU de Tours, Tours, France
| | - Clément Beuvon
- Department of Internal Medicine, CHU La Milétrie, Poitiers, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | | | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, CHU de Dijon, Dijon, France
| | - Perrine Smets
- Department of Internal Medicine, CHU de Clermont-Ferrand, site Gabriel-Montpied, Clermont-Ferrand, France
| | | | - Brigitte Granel
- Department of Internal Medicine, Hôpital Nord, Marseille, France
| | | | | | - Simon Parreau
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Sylvain Palat
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Holy Bezanahary
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
| | - Kim Heang Ly
- Department of Internal Medicine, CHU Dupuytren 2, Limoges, France
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Sorin B, Iudici M, Guerry MJ, Samson M, Bielefeld P, Maillet T, Nouvier M, Karras A, Meyer L, Lavigne C, Régent A, Durel CA, Fabre M, Charles P, Raimbourg Q, Lanteri A, Pugnet G, Rivière F, Pineton de Chambrun M, Cacoub P, Le Guenno G, Jourdain P, Mekinian A, Paule R, Dion J, Legendre P, Cohen P, Guillevin L, Puéchal X, Terrier B. Induction failure in granulomatosis with polyangiitis: a nationwide case-control study of risk factors and outcomes. Rheumatology (Oxford) 2023; 62:3662-3671. [PMID: 36847447 DOI: 10.1093/rheumatology/kead098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/08/2023] [Accepted: 02/20/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE To identify characteristics of granulomatosis with polyangiitis (GPA) associated with induction failure, describe salvage therapies and their efficacy. METHODS We conducted a nationwide retrospective case-control study of GPA with induction failure between 2006 and 2021. Each patient with induction failure was randomly paired to three controls matched for age, sex and induction treatment. RESULTS We included 51 patients with GPA and induction failure (29 men and 22 women). At induction therapy, median age was 49 years. Twenty-seven patients received intravenous cyclophosphamide (ivCYC) and 24 rituximab (RTX) as induction therapy. Patients with ivCYC induction failure more frequently had PR3-ANCA (93% vs 70%, P = 0.02), relapsing disease (41% vs 7%, P < 0.001) and orbital mass (15% vs 0%, P < 0.01) compared with controls. Patients with disease progression despite RTX induction therapy more frequently had renal involvement (67% vs 25%, P = 0.02) with renal failure (serum creatinine >100 µmol/l in 42% vs 8%, P = 0.02) compared with controls. After salvage therapy, remission was achieved at 6 months in 35 (69%) patients. The most frequent salvage therapy was switching from ivCYC to RTX (or vice versa), showing an efficacy in 21/29 (72%). Remission was achieved in nine (50%) patients with inappropriate response to ivCYC, while in patients with progression after RTX induction, remission was achieved in four (100%) who received ivCYC (with or without immunomodulatory therapy), but only in three (50%) after adding immunomodulatory therapy alone. CONCLUSION In patients with induction failure, characteristics of GPA, salvage therapies and their efficacy vary according to induction therapy and failure modality.
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Affiliation(s)
- Boris Sorin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Michele Iudici
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Division of Rheumatology, Department of Internal Medicine and Department of Medicine, Faculty of Medicine, Geneva University Hospitals, Geneve, Switzerland
| | - Mary-Jane Guerry
- Department of Nephrology, Centre Hospitalier de Valenciennes, Valenciennes, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Hôpital François Mitterrand, Dijon, France
| | - Philip Bielefeld
- Department of Nephrology and Systemic Diseases, Hôpital François Mitterrand, Dijon, France
| | - Thibault Maillet
- Department of Internal Medicine and Clinical Immunology, Hôpital François Mitterrand, Dijon, France
| | - Mathilde Nouvier
- Department of Nephrology, Centre Hospitalier Lyon Sud, Lyon, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Lara Meyer
- Department of Nephrology, Hôpital Européen Georges Pompidou, Paris, France
| | - Christian Lavigne
- Department of Internal Medicine-Clinical Immunology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marc Fabre
- Department of Internal Medicine, Centre Hospitalier Pierre Oudot, Bourgouin, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Quentin Raimbourg
- Department of Nephrology, Hôpital Bichat Claude Bernard, Paris, France
| | - Aurélia Lanteri
- Department of Internal Medicine-Infectious Diseases, Centre Hospitalier d'Antibes, Antibes, France
| | - Grégory Pugnet
- Department of Internal Medicine and Clinical Immunology, Hôpital Rangueil, Toulouse, France
| | - Frédéric Rivière
- Department of Pneumology, Hôpital d'Instruction des Armées Percy, Clamart, France
| | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Hôpital Pitié Salpêtrière, Paris, France
| | - Guillaume Le Guenno
- Department of Internal Medicine, Hôpital d'Estaing, Clermont-Ferrand, France
| | - Pierre Jourdain
- Department of Nephrology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Arsène Mekinian
- Department of Internal Medicine, Hôpital Saint-Antoine, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Jérémie Dion
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
- Department of Clinical Immunology, Centre Hospitalier du Mans, Le Mans, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Paris, France
- National Reference Center for Rare Systemic and Autoimmune Diseases, Hôpital Cochin, Paris, France
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Nehme A, Arquizan C, Régent A, Isabel C, Dequatre N, Guillon B, Capron J, Detante O, Lanthier S, Poppe AY, Boulouis G, Godard S, Terrier B, Pagnoux C, Aouba A, Touzé E, de Boysson H. Comparison of patients with biopsy positive and negative primary angiitis of the central nervous system. Rheumatology (Oxford) 2023:kead542. [PMID: 37802919 DOI: 10.1093/rheumatology/kead542] [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: 06/22/2023] [Revised: 09/08/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE There is limited evidence on when to obtain a central nervous system (CNS) biopsy in suspected primary angiitis of the central nervous system (PACNS). Our objective was to identify which clinical and radiological characteristics were associated with a positive biopsy in PACNS. METHODS From the multicenter retrospective Cohort of Patients with Primary Vasculitis of the CNS (COVAC), we included adults with PACNS based on a positive CNS biopsy or otherwise unexplained intracranial stenoses with additional findings supportive of vasculitis. Baseline findings were compared between patients with a positive and negative biopsy using logistic regression models. RESULTS 200 patients with PACNS were included, among which a biopsy was obtained in 100 (50%) and was positive in 61 (31%). Patients with a positive biopsy were more frequently female (OR 2.90, 95% CI 1.25-7.10, p = 0.01) and more often presented with seizures (OR 8.31, 95% CI 2.77-33.04, p < 0.001) or cognitive impairment (OR 2.58, 95% CI 1.11-6.10, p = 0.03). On imaging, biopsy positive patients more often had non-ischemic parenchymal or leptomeningeal gadolinium enhancement (OR 52.80, 95% CI 15.72-233.06, p < 0.001) or ≥ 1 cerebral microbleed (OR 8.08, 95% CI 3.03-25.13, p < 0.001), and less often had ≥ 1 acute brain infarct (OR 0.02, 95% CI 0.004-0.08, p < 0.001). In the multivariable model, non-ischemic parenchymal or leptomeningeal gadolinium enhancement (aOR 8.27, 95% CI 1.78-38.46), p < 0.01) and absence of ≥ 1 acute brain infarct (aOR 0.13, 95% CI 0.03-0.65, p = 0.01) were significantly associated with a positive biopsy. CONCLUSIONS Baseline clinical and radiological characteristics differed between biopsy positive and negative PACNS. These results may help physicians individualize the decision to obtain a CNS biopsy in suspected PACNS.
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Affiliation(s)
- Ahmad Nehme
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | | | - Alexis Régent
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | | | | | | | - Jean Capron
- Neurology, Hôpital Saint-Antoine, AP-HP, Paris, France
| | - Olivier Detante
- Université Grenoble Alpes, INSERM, U1216, Neurology, CHU Grenoble Alpes, Grenoble Institute Neurosciences, Grenoble, France
| | | | - Alexandre Y Poppe
- Neurology, Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | | | - Benjamin Terrier
- Internal Medicine, Université Paris-Cité, Hôpital Cochin, AP-HP, Paris, France
| | - Christian Pagnoux
- Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Ontario, Canada
| | - Achille Aouba
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
| | - Emmanuel Touzé
- Neurology, Université Caen-Normandie, CHU Caen-Normandie, Caen, France
| | - Hubert de Boysson
- Université Caen-Normandie, Internal Medicine, CHU Caen-Normandie, Caen, France
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6
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Régent A, Thampy H, Singh M. Assessing clinical reasoning in the OSCE: pilot-testing a novel oral debrief exercise. BMC Med Educ 2023; 23:718. [PMID: 37789308 PMCID: PMC10548592 DOI: 10.1186/s12909-023-04668-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/11/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Clinical reasoning (CR) is a complex skill enabling transition from clinical novice to expert decision maker. The Objective Structured Clinical Examination (OSCE) is widely used to evaluate clinical competency, though there is limited literature exploring how this assessment is best used to assess CR skills. This proof-of-concept study explored the creation and pilot testing of a post-station CR assessment, named Oral Debrief (OD), in the context of undergraduate medical education. METHODS A modified-Delphi technique was used to create a standardised domain-based OD marking rubric encapsulating the key skills of CR that drew upon existing literature and our existing placement-based CR tool. 16 OSCE examiners were recruited to score three simulated OD recordings that were scripted to portray differing levels of competency. Adopting a think-aloud approach, examiners vocalised their thought processes while utilising the rubric to assess each video. Thereafter, semi-structured interviews explored examiners' views on the OD approach. Recordings were transcribed, anonymised and analysed deductively and inductively for recurring themes. Additionally, inter-rater agreement of examiners' scoring was determined using the Fleiss Kappa statistic both within group and in comparison to a reference examiner group. RESULTS The rubric achieved fair to good levels of inter-rater reliability metrics across its constituent domains and overall global judgement scales. Think-aloud scoring revealed that participating examiners considered several factors when scoring students' CR abilities. This included the adoption of a confident structured approach, discriminating between relevant and less-relevant information, and the ability to prioritise and justify decision making. Furthermore, students' CR skills were judged in light of potential risks to patient safety and examiners' own illness scripts. Feedback from examiners indicated that whilst additional training in rubric usage would be beneficial, OD offered a positive approach for examining CR ability. CONCLUSION This pilot study has demonstrated promising results for the use of a novel post-station OD task to evaluate medical students' CR ability in the OSCE setting. Further work is now planned to evaluate how the OD approach can most effectively be implemented into routine assessment practice.
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Affiliation(s)
- Alexis Régent
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, APHP-CUP, Hôpital Cochin, F-75014, Paris, France.
- Université de Paris, 15 rue de l'école de médecine, F-75006, Paris, France.
| | - Harish Thampy
- Division of Medical Education, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Mini Singh
- Division of Medical Education, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
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Parreau S, Dentel A, Mhenni R, Dumonteil S, Régent A, Gondran G, Monnet D, Brézin AP, Ly KH, Liozon É, Sené T, Terrier B. Clinical, biological, and ophthalmological characteristics differentiating arteritic from non-arteritic anterior ischaemic optic neuropathy. Eye (Lond) 2023; 37:2095-2100. [PMID: 36273039 PMCID: PMC10333225 DOI: 10.1038/s41433-022-02295-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 09/27/2022] [Accepted: 10/13/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/AIMS To identify characteristics that can distinguish AAION from NAAION in emergency practice. METHODS This is a multicentre retrospective case-control study. Ninety-four patients with AAION were compared to ninety-four consecutive patients with NAAION. We compared the clinical, biological, and ophthalmological characteristics at baseline of patients with AAION and those with NAAION. RESULTS Patients with AAION were older and more likely to have arterial hypertension. Cephalic symptoms and acute-phase reactants were more frequent in AAION. Profound vision loss and bilateral involvement were more frequent in AAION at baseline. Central retinal and cilioretinal artery occlusions was only observed in AAION, and delayed choroidal perfusion was more frequently observed in AAION than in NAAION. Using logistic regression, an age >70 years (OR = 3.4, IC95% = 0.8-16.1, p = 0.105), absence of splinter haemorrhage (OR = 4.9, IC95% = 1.4-20.5, p = 0.019), delayed choroidal perfusion (OR = 7.2, IC95% = 2.0-28.0, p = 0.003), CRP > 7 mg/L (OR = 43.6, IC95% = 11.6-229.1, p < 0.001) and platelets >400 × G/L (OR = 27.5, IC95% = 4.6-270.9, p = 0.001) were independently associated with a diagnosis of AAION. An easy-to-use score based on these variables accurately distinguished AAION from NAAION with a sensitivity of 93.3% and specificity of 92.4%. CONCLUSION In patients presenting with AION, a set of ophthalmological and laboratory criteria can efficiently discriminate patients with AAION and NAAION and can identify which patients would benefit from high-dose glucocorticoids. External validation of our results is required.
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Affiliation(s)
- Simon Parreau
- Department of Internal Medicine, Paris Descartes University, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Paris, France.
- Department of Internal Medicine, Hôpital Dupuytren, Limoges, France.
| | - Alexandre Dentel
- Department of Ophthalmology, Fondation Adolphe-de-Rothschild hospital, Paris, France
| | - Rania Mhenni
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
| | | | - Alexis Régent
- Department of Internal Medicine, Paris Descartes University, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Paris, France
| | | | - Dominique Monnet
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
| | - Antoine P Brézin
- Université de Paris, Department of Ophthalmology, Hôpital Cochin, Paris, France
| | - Kim-Heang Ly
- Department of Internal Medicine, Hôpital Dupuytren, Limoges, France
| | - Éric Liozon
- Department of Internal Medicine, Hôpital Dupuytren, Limoges, France
| | - Thomas Sené
- Department of Internal Medicine, Fondation Adolphe-de-Rothschild hospital, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Paris Descartes University, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Paris, France
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London J, Chassagnon G, Puéchal X, Régent A, Legendre P, Cohen P, Revel M, Lefevre E, Borie R, Jilet L, Abdoul H, Terrier B. Évaluation de la pirfénidone chez les patients présentant une fibrose pulmonaire associée aux anticorps anti-myéloperoxydase (MPO) ou à une vascularite associée aux anti-MPO : résultats de l’essai prospectif PIRFENIVAS. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Perray L, Nguyen Y, Clavel-Refregiers G, Chazal T, Héron E, Puéchal X, Pouchelon C, Thoreau B, Régent A, Murarasu A, Dunogué B, Costedoat-Chalumeau N, Lifermann F, Deroux A, Graveleau J, Vasco C, Hié M, Froissart A, Brézin A, Terrier B. Sclérites et épisclérites associées aux anticorps anti-cytoplasme des polynucléaires neutrophiles : présentation initiale et pronostic. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Culerrier J, Nguyen Y, Karadag O, Yasar Bilge S, Kronbichler A, Jayne D, Régent A, Teixeira V, Marchand-Adam S, Duffau P, Oro S, Droumaguet C, Andre B, Luca L, Lechtman S, Aouba A, Lebas C, Servettaz A, Puéchal X, Terrier B. Caractéristiques et évolution des vascularites associées aux ANCA induites par les antithyroïdiens de synthèse comparativement aux formes primitives : étude rétrospective multicentrique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.10.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Régent A, Arlet JB, Cheminet G, Pouchot J, Mouthon L, Le Jeunne C. [Contribution and limits of "OSCE", "long-case" and "global end-of-placement marking" as end-of-rotation assessment methods. Experience from two internal medicine wards]. Rev Med Interne 2022; 43:581-588. [PMID: 36089428 DOI: 10.1016/j.revmed.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 07/11/2022] [Accepted: 07/27/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION During placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment. MATERIAL AND METHODS Internal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire. RESULTS In 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement. CONCLUSION Despite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.
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Affiliation(s)
- A Régent
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France.
| | - J-B Arlet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - G Cheminet
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - J Pouchot
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France
| | - L Mouthon
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
| | - C Le Jeunne
- Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France
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Eshagh D, Quéméneur T, Karras A, Queyrel V, Augusto J, Agard C, Audard V, Couderc M, Duffau P, Durel C, Faguer S, Jourde-Chiche N, Lavergne A, Christian L, Limal N, Servettaz A, Smets P, Régent A, Mouthon L, Terrier B. Particularités phénotypiques et thérapeutiques des vascularites à ANCA au cours de la sclérodermie systémique. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.03.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Puéchal X, Iudici M, Calich AL, Vivot A, Terrier B, Régent A, Cohen P, Jeunne CL, Mouthon L, Ravaud P, Guillevin L. Corrigendum to: Rituximab for induction and maintenance therapy of granulomatosis with polyangiitis: a single-centre cohort study on 114 patients. Rheumatology (Oxford) 2022; 61:3505. [PMID: 35237803 DOI: 10.1093/rheumatology/keac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Ana Luisa Calich
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Alexandre Vivot
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, APHP.,UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Claire Le Jeunne
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes.,Institut Cochin, INSERM U1016, CNRS UMR 8104
| | - Philippe Ravaud
- Clinical Epidemiology Unit, Hôtel-Dieu Hospital, APHP.,UMR 1153 Epidemiology and Statistics Sorbonne Paris Cité Research Center (CRESS), INSERM, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Université Paris Descartes
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14
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Nezam D, Porcher R, Grolleau F, Morel P, Titeca-Beauport D, Faguer S, Karras A, Solignac J, Jourde-Chiche N, Maurier F, Sakhi H, El Karoui K, Mesbah R, Carron PL, Audard V, Ducloux D, Paule R, Augusto JF, Aniort J, Tiple A, Rafat C, Beaudreuil S, Puéchal X, Gobert P, Massy Z, Hanrotel C, Bally S, Martis N, Durel CA, Desbuissons G, Godmer P, Hummel A, Perrin F, Néel A, De Moreuil C, Goulenok T, Guerrot D, Grange S, Foucher A, Deroux A, Cordonnier C, Guilbeau-Frugier C, Modesto-Segonds A, Nochy D, Daniel L, Moktefi A, Rabant M, Guillevin L, Régent A, Terrier B. Kidney Histopathology Can Predict Kidney Function in ANCA-Associated Vasculitides with Acute Kidney Injury Treated with Plasma Exchanges. J Am Soc Nephrol 2022; 33:628-637. [PMID: 35074934 PMCID: PMC8975074 DOI: 10.1681/asn.2021060771] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 10/24/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Data from the PEXIVAS trial challenged the role of plasma exchange (PLEX) in ANCA-associated vasculitides (AAV). We aimed to describe kidney biopsy from patients with AAV treated with PLEX, evaluate whether histopathologic findings could predict kidney function, and identify which patients would most benefit from PLEX. METHODS We performed a multicenter, retrospective study on 188 patients with AAV and AKI treated with PLEX and 237 not treated with PLEX. The primary outcome was mortality or KRT at 12 months (M12). RESULTS No significant benefit of PLEX for the primary outcome was found. To identify patients benefitting from PLEX, we developed a model predicting the average treatment effect of PLEX for an individual depending on covariables. Using the prediction model, 223 patients had a better predicted outcome with PLEX than without PLEX, and 177 of them had >5% increased predicted probability with PLEX compared with without PLEX of being alive and free from KRT at M12, which defined the PLEX-recommended group. Risk difference for death or KRT at M12 was significantly lower with PLEX in the PLEX-recommended group (-15.9%; 95% CI, -29.4 to -2.5) compared with the PLEX not recommended group (-4.8%; 95% CI, 14.9 to 5.3). Microscopic polyangiitis, MPO-ANCA, higher serum creatinine, crescentic and sclerotic classes, and higher Brix score were more frequent in the PLEX-recommended group. An easy to use score identified patients who would benefit from PLEX. The average treatment effect of PLEX for those with recommended treatment corresponded to an absolute risk reduction for death or KRT at M12 of 24.6%. CONCLUSIONS PLEX was not associated with a better primary outcome in the whole study population, but we identified a subset of patients who could benefit from PLEX. However, these findings must be validated before utilized in clinical decision making.
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Affiliation(s)
- Dorian Nezam
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Raphaël Porcher
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - François Grolleau
- Centre de Recherche Épidémiologie et Statistiques, Université de Paris, Paris, France
| | - Pauline Morel
- Service de dialyse et aphérèse, AURA Paris Plaisance, Paris, France
| | | | - Stanislas Faguer
- Département de Néphrologie et Transplantation d’organes, Hôpital Rangueil, Toulouse, France
| | - Alexandre Karras
- Service de Néphrologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Justine Solignac
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - Noémie Jourde-Chiche
- Centre de Néphrologie et Transplantation Rénale, Hôpital de la Conception (APHM), Marseille, France
| | - François Maurier
- Hôpital Belle-Isle, Groupe Hospitalier Associatif UNEOS, Metz, France
| | - Hamza Sakhi
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Khalil El Karoui
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Rafik Mesbah
- Service de Néphrologie, Centre Hospitalier, Boulogne-sur-mer, France
| | | | - Vincent Audard
- Service de Néphrologie et Transplantation, Hôpital Henri Mondor, Creteil, France,Institut National de la Santé et de la Recherche Médicale U955, Institut Mondor de Recherche Biomédicale, Creteil, France
| | - Didier Ducloux
- Service de Néphrologie, Dialyse et Transplantation, CHU Besançon, France
| | - Romain Paule
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | | | - Julien Aniort
- Service de Néphrologie, Dialyse et Transplantation rénale, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Aurélien Tiple
- Service de Néphrologie, CHU Jacques Lacarin, Vichy, France
| | - Cédric Rafat
- Unité de Néphrologie, Transplantation Rénale, Hôpital Tenon (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Séverine Beaudreuil
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital Bicêtre, Le Kremlin Bicêtre, France
| | - Xavier Puéchal
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Pierre Gobert
- Service de Médecine Interne et Immunologie clinique, Clinique Rhône Durance, Avignon, France
| | - Ziad Massy
- Département de Néphrologie, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Catherine Hanrotel
- Service de Néphrologie, Dialyse et Transplantation rénale, Hôpital La Cavale Blanche, Brest, France
| | - Stéphane Bally
- Service de Néphrologie Dialyse, Centre Hospitalier Métropole Savoie, Chambery, France
| | | | - Cécile-Audrey Durel
- Service de Médecine, Interne Hôpital Edouard Herriot, Hospices civils de Lyon, France
| | | | - Pascal Godmer
- Service de Médecine Interne, CHBA site de Vannes, Vannes, France
| | - Aurélie Hummel
- Service de Néphrologie et Transplantation Rénale, Hôpital Necker-Enfants Malades (Assistance Publique des Hôpitaux de Paris), Paris, France
| | | | - Antoine Néel
- Service de Médecine Interne, CHU de Nantes, France
| | | | - Tiphaine Goulenok
- Service de Médecine Interne, Hôpital Bichat (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Dominique Guerrot
- Service de Néphrologie, Dialyse et Transplantation, CHU de Rouen, France
| | - Steven Grange
- Service de Réanimation médicale, CHU Charles Nicolle, Rouen, France
| | - Aurélie Foucher
- Service de Médecine Interne, CHU site Sud Saint-Pierre, Saint-Pierre, France
| | - Alban Deroux
- Service de Médecine Interne, CHU de Grenoble, France
| | - Carole Cordonnier
- Service d’anatomie et de cytologie pathologiques, Hôpital Nord, CHU d’Amiens, France
| | - Céline Guilbeau-Frugier
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Anne Modesto-Segonds
- Service d’anatomie pathologique et histologie-cytologie, Hôpital de Rangueil-Larrey, CHU Toulouse, Toulouse, France
| | - Dominique Nochy
- Service d’Anatomie et Cytologie Pathologiques, Hôpital Européen Georges Pompidou (Assistance Publique des Hôpitaux de Paris), Paris, France
| | - Laurent Daniel
- Service d’Anatomie et cytologie pathologiques, Hôpital La Timone (APHM), Marseille, France
| | - Anissa Moktefi
- Assistance Publique des Hôpitaux de Paris, Department of Pathology, Groupe Hospitalier Henri-Mondor 94010 Creteil, France
| | - Marion Rabant
- Department of Pathology, Necker Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Loïc Guillevin
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Université de Paris, Paris, France
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Parreau S, Nocturne G, Mariette X, Burroni B, Lazure T, Besson FL, Régent A, Mouthon L, Terrier B, Seror R, Le Guern V. Features of non-Hodgkin’s lymphoma diagnosed in minor salivary gland biopsies from primary Sjögren’s syndrome patients. Rheumatology (Oxford) 2021; 61:3818-3823. [DOI: 10.1093/rheumatology/keab949] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
To evaluate the contribution of minor salivary gland biopsy (mSGB) histology to diagnosing primary Sjögren’s syndrome (pSS)-associated non-Hodgkin B cell lymphoma (NHL).
Methods
pSS patients with mSGB at NHL diagnosis were included.
Results
Among the 24 patients (92.3% female; mean age: 61.3 years) with an mSGB at NHL diagnosis, 13 (54.2%) had mSGB-histology–revealed NHL (mSGB+); it was the only site enabling NHL diagnosis in 10/13 (76.9%) patients. Mucosa-associated lymphoid tissue (MALT) lymphoma was found in 23/24 (95.8%) patients; 100% of mSGB+ identified MALT lymphomas. pSS and lymphoma characteristics were comparable for mSGB+ and mSGB– patients. Eight (61.5%) of the 13 mSGB+ patients and all 11 mSGB– patients were treated for lymphoma. Between diagnosis and 1 year of follow-up, ESSDAI without the NHL item remained stable (7.4 vs 5.0; p = 0.33) for the five untreated patients, while it decreased significantly for the 19 treated patients (15.8 vs 5.1; p = 0.004).
Conclusion
For pSS patients with suspected NHL, mSGB histology enabled NHL diagnosis in half of them, MALT was found in 95.8% and all mSGBs+ were MALT lymphomas, thereby avoiding more invasive biopsy. Our results suggest that mSGB should be obtained at pSS diagnosis and repeated during follow-up, when NHL is suspected.
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Affiliation(s)
- Simon Parreau
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (APHP), Paris
| | - Gaétane Nocturne
- Department of Rheumatology, Université Paris-Saclay, FHU CARE (Cancer and Autoimmunity RElationship), INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | - Xavier Mariette
- Department of Rheumatology, Université Paris-Saclay, FHU CARE (Cancer and Autoimmunity RElationship), INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | - Barbara Burroni
- Department of Pathology, Université Paris Descartes, Hôpital Cochin, APHP, Paris
| | - Thierry Lazure
- Department of Pathology, Université Paris-Saclay, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | - Florent L Besson
- Department of Biophysics, Nuclear Medicine-Molecular Imaging, Université Paris-Saclay, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Université Paris-Saclay, CEA, CNRS, Inserm, BioMaps, France, Orsay
| | - Alexis Régent
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (APHP), Paris
| | - Luc Mouthon
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (APHP), Paris
| | - Benjamin Terrier
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (APHP), Paris
| | - Raphaele Seror
- Department of Rheumatology, Université Paris-Saclay, FHU CARE (Cancer and Autoimmunity RElationship), INSERM UMR1184: Centre for Immunology of Viral Infections and Autoimmune Diseases, APHP, Hôpital Bicêtre, Le Kremlin-Bicêtre
| | - Véronique Le Guern
- Department of Internal Medicine, Université Paris Descartes, Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris (APHP), Paris
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London J, Régent A, Dion J, Jilet L, Jachiet M, Lidove O, Cohen-Aubart F, Aractingi S, Guégan S, Pennaforte JL, Abdoul H, Puéchal X, Terrier B. Efficacy and safety of ustekinumab in Behçet disease: Results from the prospective phase 2 STELABEC trial. J Am Acad Dermatol 2021; 87:681-684. [PMID: 34864108 DOI: 10.1016/j.jaad.2021.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Jonathan London
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Jérémie Dion
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France
| | - Léa Jilet
- Unité de Recherche Clinique Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, France
| | - Marie Jachiet
- Department of Dermatology, Hôpital-Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Lidove
- Department of Internal Medicine, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Fleur Cohen-Aubart
- Sorbonne Université, Service de Médecine Interne 2, Centre de Référence National Lupus Systémique et Syndromes des anti-phospholipides et Autres Maladies Auto-immunes et Systémiques Rares, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, France
| | - Selim Aractingi
- Université de Paris, France; Department of Dermatology, Hôpital Cochin, AP-HP, Paris, France
| | - Sarah Guégan
- Université de Paris, France; Department of Dermatology, Hôpital Cochin, AP-HP, Paris, France
| | - Jean-Loup Pennaforte
- Department of Internal Medicine, Centre Hospitalier Universitaire de Reims, Hôpital Robert Debré, Reims, France
| | - Hendy Abdoul
- Unité de Recherche Clinique Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, France.
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Vergneault H, Chauvin A, Savale L, Galicier L, Costedoat-Chalumeau N, Le Guern V, Saadoun D, Hummel A, Mouthon L, Sitbon O, Régent A. Effet du traitement immunosuppresseur et du traitement spécifique dans l’HTAP associée au lupus érythémateux systémique. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.225] [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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18
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Legendre P, Chapuis N, Régent A, Ribeiro E, Fouquet G, Deau-Fischer B, Retornaz F, Terrier B. Spectre des maladies auto-immunes ou inflammatoires associées à une prolifération T clonale de signification indéterminée. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.254] [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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Sorin B, Samson M, Durel CA, Diot E, Guichard I, Grados A, Limal N, Régent A, Cohen P, Dion J, Legendre P, Le Guern V, Mouthon L, Guillevin L, Terrier B. Rituximab plus methotrexate combination as a salvage therapy in persistently active granulomatosis with polyangiitis. Rheumatology (Oxford) 2021; 61:2619-2624. [PMID: 34698818 DOI: 10.1093/rheumatology/keab791] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/20/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe the efficacy and safety of rituximab and methotrexate (RTX/MTX) combination therapy in ANCA-associated vasculitides (AAV). METHODS A retrospective French nationwide study was conducted in patients with AAV who received RTX/MTX combination therapy for persistently active disease. RESULTS Seventeen patients were included. All patients had granulomatosis with polyangiitis (GPA), with positive ANCA in 76% mainly with PR3-ANCA specificity. Sixteen (94%) were still active after rituximab and 11 (65%) after cyclophosphamide (oral and/or intravenous). Patients had experienced a median of 3 (2-4) flares. Manifestations requiring RTX/MTX combination therapy were subglottic or bronchial stenosis in 6 patients (35%), orbital mass in 6 (35%), disabling ENT involvement in 2 (12%), and epiduritis and pachymeningitis in 1 case each (6%). Median follow-up with combination was 11 months (11-26 months). At 6 months, global response was achieved in 15 patients (88%), including partial response in 11 (65%) and complete response in 4 (24%). At last evaluation, global response was achieved in 16 patients (94%). Seven patients (41%) experienced severe adverse events (grade 3 or 4), including infections in 4 (24%) and hepatitis in 2 (12%). Combination therapy was withdrawn in 4 patients (24%) but never for safety concerns. In contrast, MTX dose was decreased in 2 patients (12%) because of adverse events. One patient died of an unknown cause. CONCLUSION RTX/MTX combination therapy could be an effective salvage therapy to treat persistently active GPA with granulomatous manifestations, with an acceptable safety profile.
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Affiliation(s)
- Boris Sorin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and clinical immunology, Dijon University Hospital, Dijon, France
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, France
| | - Elisabeth Diot
- Department of Internal Medicine, Hôpital Bretonneau, Tours, France
| | - Isabelle Guichard
- Department of Internal Medicine, Centre Hospitalier Universitaire de Saint-Etienne, France
| | - Aurélie Grados
- Department of Internal Medicine, Centre Hospitalier de Niort, France
| | - Nicolas Limal
- Department of Internal Medicine, Hôpital Henri Mondor, Créteil, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Jérémie Dion
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Paul Legendre
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | | | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Hôpital Cochin, Paris, France
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Iudici M, Pagnoux C, Courvoisier DS, Cohen P, Néel A, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Le Gallou T, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard JF, Blanchard-Delaunay C, Godmer P, Le Quellec A, Quéméneur T, de Moreuil C, Régent A, Terrier B, Mouthon L, Guillevin L, Puéchal X. Localised Versus Systemic Granulomatosis with Polyangiitis: Data from the French Vasculitis Study Group Registry. Rheumatology (Oxford) 2021; 61:2464-2471. [PMID: 34542599 DOI: 10.1093/rheumatology/keab719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/08/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the main features at diagnosis and evolution over time of patients with localised granulomatosis with polyangiitis (L-GPA) compared to those of systemic GPA (S-GPA). METHODS EULAR definitions of L-GPA, i.e., upper and/or lower respiratory tract involvement, and S-GPA were applied to patients from the French Vasculitis Study Group Registry. L-GPA and S-GPA patients' characteristics at diagnosis and long-term outcomes were analyzed and compared. RESULTS Among the 795 Registry patients, 79 (10%) had L-GPA. Their main clinical manifestations were rhinitis, lung nodules, sinusitis and otitis. L-GPA versus S-GPA patients at diagnosis, respectively, were younger, more frequently had saddle nose deformity or subglottic stenosis and were less often PR3-ANCA-positive. L-GPA versus S-GPA induction therapy less frequently included cyclophosphamide but more often a combination of methotrexate and glucocorticoids; 64% of methotrexate-treated patients experienced disease progression within 18 months post-diagnosis. L- and S-GPA patients' estimated relapse-free-survival probabilities, relapse rates and refractory disease rates at each time point were comparable, but L-GPA patients had more frequent ENT and lung relapses, and higher overall survival rates (P <0.02). Over a median follow-up of 3.5 years, 18 (22.8%) L-GPA progressed to S-GPA, either as a relapse after a period in remission or more frequently in the context of refractory disease. L-GPA patients experienced more ENT-related damage. CONCLUSIONS The relapse risks of L-GPA and S-GPA were similar, but relapse patterns differed and L-GPA overall survival rate was higher. About one-quarter of L-GPA patients developed S-GPA over time, but without end-stage organ involvement.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.,Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Delphine S Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Antoine Néel
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Côte-de-Nacre, Caen, France
| | | | - Marc Ruivard
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | - Olivier Aumaître
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | - Bernard Bonnotte
- Department of Internal Medicine, CHU François Mitterrand, Dijon, France
| | - François Maurier
- Service of Internal Medicine, Groupe Hospitalier UNEOS, Metz-Vantoux, France
| | - Thomas Le Gallou
- Department of Internal Medicine and Immunology, CHU, Rennes, France
| | - Eric Hachulla
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine and Clinical Immunology, CHU Claude Huriez, Lille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Chahéra Khouatra
- Department of Respiratory Medicine, CHU Louis-Pradel and UMR754, Université Claude-Bernard Lyon 1, Lyon, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRAE 1260, APHM, Department of Nephrology, CHU de la Conception, Marseille, France
| | | | | | - Pascal Godmer
- Department of Internal Medicine, CH Bretagne-Atlantique, Vannes, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, CH, Valenciennes, France
| | - Claire de Moreuil
- Department of Internal Medicine, CHU La Cavale Blanche, Brest, France
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Université de Paris, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Vuitton L, Maurier F, Laharie D, Fuméry M, Agard C, Collins M, Nancey S, Rafat C, Kervegant AG, Queyrel-Moranne V, Moulis G, Pigneur B, Régent A, Gay C, Morbieu C, Durel CA, Ducloux D, Aubin F, Voicu M, Joher N, Szwebel T, Martinez-Vinson C, Koch S, Guillevin L, Peyrin-Biroulet L, Terrier B. IgA Vasculitis in Patients with Inflammatory Bowel Disease: new insights into the role of TNF-α blockers. Rheumatology (Oxford) 2021; 61:1957-1965. [PMID: 34427590 DOI: 10.1093/rheumatology/keab662] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/10/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Association of IgA vasculitis (IgAV) and inflammatory bowel diseases (IBD) is rarely described, mainly during anti-TNF-α therapy. We aimed to describe the association of IgAV and IBD. METHODS We retrospectively analyzed the association of IgAV and IBD through the implication of the GETAID and FVSG networks. Characteristics of IBD and IgAV were collected using a standardized case report form. RESULTS Forty-three cases were included. IBD (mainly Crohn's disease (CD) in 58%) preceded IgAV in 38 (88%), with median interval of 9.2 (IQR 5.4-15.4) years. In these 38 patients, at IgAV diagnosis, 5 (13%) had active IBD and 28 (74%) were treated with anti-TNF-α for a median duration of 31.5 (IQR 19-56) months. Main IgAV manifestations were purpura all patients (100%), joints in 20/35 (57%), renal in 15/35 (43%) and gastrointestinal in 11/35 (31%) involvement. IgAV was treated with glucocorticoids in 25 (66%), colchicine in 6 (16%), cyclophosphamide in 6 (16%), and anti-TNF-α were discontinued in 15/28 (54%). No IgAV relapse occurred when TNF-α blockers were stopped, vs 23% in patients pursuing it. Conversely, 5 (33%) had IBD flare or complication after anti-TNF-α cessation vs 1 (8%) in those continuing biologics. Anti-TNF-α were resumed in 6 (40%), with subsequent IgAV relapse in 4 (67%). CONCLUSIONS This large cohort suggests that TNF-α blockers may promote the onset of IgAV in IBD. Discontinuation of anti-TNF-α was associated with vasculitis remission but increased risk of IBD relapses, whereas continuation of anti-TNF-α was associated with IBD remission but vasculitis relapse.
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Affiliation(s)
- Camille Rasmussen
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | - Vered Abitbol
- Department of Gastroenterology, Hopital Cochin, APHP-CUP, Paris
| | | | - Anne Bourrier
- Department of Gastroenterology, Hôpital Saint-Antoine, AP-HP, Paris
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes
| | | | | | | | | | | | - Michael Collins
- Department of Gastroenterology, Hopital Bicêtre, AP-HP, Le Kremlin-Bicêtre
| | | | - Cédric Rafat
- Department of Nephrology, Hôpital Tenon, AP-HP, Paris
| | | | | | | | - Bénédicte Pigneur
- Pediatric Gastroenterology, Hepatology and Nutrition, Hôpital Necker, AP-HP
- Université de Paris, Paris
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Claire Gay
- Department of Gastroenterology, CHRU, Besançon
| | - Caroline Morbieu
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | - Cécile Audrey Durel
- Department of Internal Medicine, Hopital Edouard Herriot, Hospices Civils de Lyon, Lyon
| | | | | | - Mickaela Voicu
- Department of Internal Medicine, CHRU Besançon, Besançon
| | - Nizar Joher
- Department of Nephrology, Hôpital Henri Mondor, AP-HP, Créteil
| | - Tali Szwebel
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
| | | | | | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
| | | | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, APHP-Centre Université de Paris (CUP)
- Université de Paris, Paris
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22
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Catano J, Uzunhan Y, Paule R, Dion J, Régent A, Legendre P, Gonin F, Martinod E, Cohen P, Puéchal X, Le Guern V, Mouthon L, Coste A, Lorut C, Lacroix C, Périé S, Terrier B. Presentation, Diagnosis, and Management of Subglottic and Tracheal Stenosis During Systemic Inflammatory Diseases. Chest 2021; 161:257-265. [PMID: 34324839 DOI: 10.1016/j.chest.2021.07.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Subglottic stenosis (SGS) and tracheal stenosis (TS) are characterized by a narrowing of the airways. The goal of this study was to describe the characteristics and prognosis of nontraumatic and nontumoral SGS or TS. RESEARCH QUESTION What are the inflammatory etiologies of SGS and TS, and what are their characteristics and prognosis? STUDY DESIGN AND METHODS This multicenter, observational retrospective study was performed in patients with SGS or TS that was neither traumatic nor tumoral. RESULTS Eighty-one patients were included, 33 (41%) with granulomatosis with polyangiitis (GPA) and 21 (26%) with relapsing polychondritis (RP). GPA-related stenoses exhibited circumferential subglottic narrowing in 85% of cases, without calcifications. In contrast, RP-related stenoses displayed anterior involvement in 76%, in a longer distance from vocal cords (4 cm), with calcifications in 62%, and extension to bronchi in 86%. Other diagnoses included bullous dermatoses (n = 3), amyloidosis (n = 3), sarcoidosis (n = 2), and Crohn's disease (n = 2); the remaining stenoses (n = 15) were idiopathic. SGS/TS was the initial manifestation of the disease in 66% of cases, with a median interval from stenosis to disease diagnosis of 12 months (interquartile range, 0-48 months). Despite the use of glucocorticoids in 80%, combined with methotrexate in 49%, endoscopic procedures were required in 68% of patients. Relapses of stenoses occurred in 76% without any difference between causes (82% in GPA, 67% in RP, and 75% in idiopathic SGS/TS). Three patients died due to the stenosis, two of RP and one of GPA. INTERPRETATION These data show that GPA and RP are the two main inflammatory diseases presenting with SGS/TS. GPA-related stenoses are mostly subglottic and circumferential, whereas RP-related stenoses are mostly tracheal, anterior, and calcified with a frequent extension to bronchi. Relapses of stenoses are common, and relapse rates do not differ between causes. Diagnosis and management of SGS/TS require a multidisciplinary approach.
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Affiliation(s)
- Jennifer Catano
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Yurdagul Uzunhan
- Department of Pneumology, Reference Center for Rare Pulmonary Diseases, Hôpital Avicenne, AP-HP, INSERM U1272, Université Paris Nord, Bobigny, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Jérémie Dion
- Department of Clinical Immunology, Oncopôle, Toulouse, France
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Paul Legendre
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - François Gonin
- Department of Thoracic Surgery, Hôpital Foch, Suresnes, France
| | - Emmanuel Martinod
- Department of Thoracic Surgery, Hôpital Avicenne, AP-HP, Bobigny, France
| | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Véronique Le Guern
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France
| | - André Coste
- Department of Otolaryngology, Hôpital Intercommunal, Créteil, France
| | | | | | - Sophie Périé
- Department of Otolaryngology (S. Périé), Clinique Hartmann, Neuilly-Sur-Seine, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Autoimmune and Systemic Diseases, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP)-Centre Université Paris (CUP), Paris, France.
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Régent A, Terrier B, Legendre P, Wartski M, Cohen P, Mouthon L, Le Jeunne C. Efficacy of baricitinib for refractory large vessel vasculitis. Rheumatology (Oxford) 2021; 60:e389-e391. [PMID: 34247230 DOI: 10.1093/rheumatology/keab541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/11/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alexis Régent
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
| | - Benjamin Terrier
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
| | - Paul Legendre
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
| | - Myriam Wartski
- Service de biophysique et de médecine nucléaire, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Cohen
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
| | - Luc Mouthon
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
| | - Claire Le Jeunne
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France.,APHP-CUP, Hôpital Cochin, F-75014 Paris, Université de Paris, 15 rue de l'école de médecine, 75006, Paris
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Sartorelli S, Chassagnon G, Cohen P, Dunogué B, Puéchal X, Régent A, Mouthon L, Guillevin L, Terrier B. Revisiting characteristics, treatment and outcome of cardiomyopathy in eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Rheumatology (Oxford) 2021; 61:1175-1184. [PMID: 34156464 DOI: 10.1093/rheumatology/keab514] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Eosinophilic granulomatosis with polyangiitis (EGPA) is a necrotizing eosinophil-rich vasculitis. Specific cardiomyopathy (CM) was described in old studies as the most important predictor of mortality. We aimed to revisit EGPA-related CM and its outcome in recent decades. METHODS We reviewed all EGPA patients managed from 2000 to 2019 in our vasculitis clinic. Baseline characteristics and outcomes were analyzed. EGPA-related CM was defined as clinical or extra-clinical manifestations of patent myocardial involvement, after exclusion of other causes. RESULTS We included 176 patients. Median age was 47 years (IQR 36-58 years). Specific CM was observed in 70 patients (40%). Cardiac symptoms were observed in 81% of CM+ patients, including mainly typical or atypical chest pain and peripheral edema. Abnormal EKG, TTE and cardiac magnetic resonance imaging (CMRI) were found in 72%, 72% and 99% in CM+ patients, respectively, contrasting with abnormalities in 32%, 38% and 60% in CM-negative patients. Late gadolinium enhancement (LGE) was the most frequent abnormality on CMRI (70%). CM+ patients were less frequently ANCA-positive, had less frequent peripheral neuropathy and had higher eosinophil count. Major adverse cardiovascular events (MACE) occurred in 13%, both in CM+ and CM- patients. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE. Four patients died, but none from cardiac causes. CONCLUSIONS Specific cardiomyopathy is frequent in EGPA, especially in ANCA-negative patients with high eosinophil counts. Long-term outcome was better than previously reported. Abnormal EKG and LGE on CMRI were associated with the occurrence of MACE.
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Affiliation(s)
- Silvia Sartorelli
- Unit of Immunology, Rheumatology, Allergy and Rare disease, IRCCS San Raffaele Hospital, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Guillaume Chassagnon
- Department of Radiology, Cochin Hospital, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Bertrand Dunogué
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Luc Mouthon
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department of Internal Medicine, Cochin Hospital, Paris, France.,National Referral Centre for Rare Systemic and Autoimmune Diseases of Ile de France, Hôpital Cochin, Paris, France
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25
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Sorin B, Samson M, Durel C, Diot E, Guichard I, Grados A, Limal N, Régent A, Cohen P, Dion J, Legendre P, Le Guern V, Mouthon L, Guillevin L, Terrier B. Étude de l’association rituximab et methotrexate dans les vascularites associées aux ANCA. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.03.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Bettuzzi T, Jourdes A, Robineau O, Alcaraz I, Manda V, Molina JM, Mehlen M, Cazanave C, Tattevin P, Mensi S, Terrier B, Régent A, Ghosn J, Charlier C, Martin-Blondel G, Dupin N. Ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis in France: a retrospective multicentre study. Lancet Infect Dis 2021; 21:1441-1447. [PMID: 34051142 DOI: 10.1016/s1473-3099(20)30857-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/10/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intravenous benzylpenicillin is the gold-standard treatment for neurosyphilis, but it requires prolonged hospitalisation. Ceftriaxone is a possible alternative treatment, the effectiveness of which remains unclear. We aimed to assess the effectiveness of ceftriaxone compared with benzylpenicillin in the treatment of neurosyphilis. METHODS We did a retrospective multicentre study including patients with neurosyphilis who were treated at one of eight tertiary care centres in France, from Jan 1, 1997, to Dec 31, 2017. We defined neurosyphilis as positive treponemal and non-treponemal tests and at least one of otic syphilis, ocular syphilis, either neurological symptom with a positive result on cerebrospinal fluid (CSF)-VDRL or CSF-PCR tests, or more than five leukocytes in a CSF cell count. Patients with neurosyphilis were identified from the medical information department database of each centre and assigned to one of two groups on the basis of the initial treatment received (ie, benzylpenicillin group or ceftriaxone group). The primary outcome was the overall clinical response (ie, proportion of patients with a complete or partial response) 1 month after treatment initiation. The secondary endpoints were proportions of patients with a complete response at 1 month and serological response at 6 months, and length of hospital stay. FINDINGS Of 365 patients with a coded diagnosis of neurosyphilis in one of the eight care centres during 1997-2017, 208 were included in this study (42 in the ceftriaxone group and 166 in the benzylpenicillin group). The mean age of patients was 44·4 years (SD 13·4), and 193 (93%) were men. We observed 41 instances of overall clinical response (98%) in the ceftriaxone group versus 125 (76%) in the benzylpenicillin group (crude odds ratio [OR] 13·02 [95% CI 1·73-97·66], p=0·017). After propensity score weighting, overall clinical response rates remained different between the groups (OR 1·22 [95% CI 1·12-1·33], p<0·0001). 22 (52%) patients in the ceftriaxone group and 55 (33%) in the benzylpenicillin group had a complete response (crude OR 2·26 [95% CI 1·12-4·41], p=0·031), with no significant difference after propensity score weighting (OR 1·08 [95% CI 0·94-1·24], p=0·269). Serological response at 6 months did not differ between the groups (21 [88%] of 24 in the ceftriaxone group vs 76 [82%] of 93 in the benzylpenicillin group; crude OR 1·56 [95% CI 0·42-5·86], p=0·50), whereas hospital stay was shorter for patients in the ceftriaxone group than for those in the benzylpenicillin group (mean 13·8 days [95% CI 12·8-14·8] vs 8·9 days [5·7-12·0], p<0·0001). No major adverse effects were reported in either group. INTERPRETATION Our results suggest that ceftriaxone is similarly effective to benzylpenicillin for the treatment of neurosyphilis, potentially decreasing the length of hospital stay. Randomised, controlled trials should be done to confirm these results. FUNDING None.
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Affiliation(s)
- Thomas Bettuzzi
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; EpiDermE, University Paris Est Créteil, Créteil, France
| | - Aurélie Jourdes
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Robineau
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Isabelle Alcaraz
- Service Universitaire des Maladies Infectieuses et du Voyageur, Hôpital Dron, Tourcoing, France
| | - Victoria Manda
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Jean Michel Molina
- Département des Maladies Infectieuses, Hôpital Saint Louis et Lariboisière, AP-HP, Paris, France; Université de Paris, Paris, France
| | - Maxime Mehlen
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Charles Cazanave
- Service de Maladies Infectieuses, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Pierre Tattevin
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Sami Mensi
- Service de Maladies Infectieuses, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Benjamin Terrier
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexis Régent
- Service de Médecine Interne, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jade Ghosn
- Service de Maladies Infectieuses, Hôpital Bichat, AP-HP, Paris, France
| | - Caroline Charlier
- Université de Paris, Paris, France; Service de Maladies Infectieuses, Hôpital Necker, AP-HP, Paris, France
| | - Guillaume Martin-Blondel
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; INSERM UMR 1291 - CNRS UMR 5051, Toulouse Institute for Infectious and Inflammatory Diseases, Université Toulouse III, Toulouse, France
| | - Nicolas Dupin
- Service de Dermatologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Centre National de Référence de la Syphilis, Institut Cochin, Unité Inserm U1016, Université de Paris, Paris, France.
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Papo M, Friedrich C, Delaval L, de Boysson H, Viallard JF, Bachmeyer C, Sené T, Humbert S, Duffau P, Contis A, Agard C, Gombert B, Puyade M, Foucher A, Alary AS, Danlos FX, Régent A, Mouthon L, Guillevin L, Samson M, Kosmider O, Terrier B. Myeloproliferative neoplasms and clonal hematopoiesis in patients with giant cell arteritis: a case-control and exploratory study. Rheumatology (Oxford) 2021; 61:775-780. [PMID: 33836046 DOI: 10.1093/rheumatology/keab337] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/02/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Giant cell arteritis (GCA) is a large vessel vasculitis for which triggering factors remain unknown. Clonal hematopoiesis (CH) was associated with atherosclerosis through the induction of inflammation in myeloid cells, and data suggest that CH expansion and inflammation may support each other to induce a proinflammatory loop. Our objective was to describe the impact of JAK2p.V617F-mutated myeloproliferative neoplasms (MPN) on GCA and to screen MPN-free patients for CH mutations. METHODS We performed a retrospective case-control study comparing characteristics of 21 GCA patients with MPN and 42 age and gender-matched GCA patients without MPN. Also, 18 GCA patients were screened for CH through Next Generation Sequencing. RESULTS The most frequent associated MPN was essential thrombocythemia (ET) (n = 11). Compared to controls, GCA patients with MPN had less frequent cephalic symptoms (71.4 vs. 97.6%, p = 0.004) and higher platelets count at baseline [485 (346-586) vs. 346 [IQR 296-418] x 109/L, p = 0.02). There was no difference between groups for other clinical features. Overall survival was significantly shorter in patients with MPN compared to controls [HR 8.2 (95% CI 1.2-56.6), p = 0.03]. Finally, screening for CH using NGS in 15 GCA patients without MPN revealed CH in 33%. CONCLUSION GCA patients with MPN display higher platelets count and shorter overall survival than controls. This association could not be fortuitous given the possible pathophysiological relationship between the two diseases. CH was found in one third of GCA patients, which may be higher than the expected prevalence for similar age, what should be confirmed in a larger cohort.
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Affiliation(s)
- Matthias Papo
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Chloé Friedrich
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - Laure Delaval
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Hubert de Boysson
- Department of Internal Medicine, UNICAEN, EA4650 SEILIRM, Caen Normandie University Hospital, Caen, France
| | - Jean-François Viallard
- Department of Internal Medicine and Infectious Diseases, Haut Lévêque University Hospital, Bordeaux University, Pessac, France
| | - Claude Bachmeyer
- Department of Internal Medicine, AP-HP, Tenon Hospital, Sorbonne University, Paris, France
| | - Thomas Sené
- Department of Internal Medicine, Rothschild Foundation Hospital, Paris, France
| | - Sébastien Humbert
- Internal Medicine Department, University Hospital Besancon, Besançon, France
| | - Pierre Duffau
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, 33000 Bordeaux, France; CNRS UMR 5164, Immuno ConcEpT, Bordeaux University, 33076 Bordeaux, France
| | - Anne Contis
- Department of Internal Medicine and Clinical Immunology, Saint Andre Hospital, University Hospital Centre of Bordeaux, 33000 Bordeaux, France; CNRS UMR 5164, Immuno ConcEpT, Bordeaux University, 33076 Bordeaux, France
| | | | - Bruno Gombert
- Department of Rheumatology, La Rochelle Hospital, La Rochelle, France
| | - Mathieu Puyade
- Department of Internal Medicine and Infectious Diseases, Poitiers Universitary Hospital, Poitiers, France
| | - Aurélie Foucher
- Department of Internal Medicine, CHU de La Réunion, Saint Pierre, France
| | - Anne-Sophie Alary
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - François-Xavier Danlos
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François-Mitterrand Teaching Hospital, University of Bourgogne-Franche-Comté, Dijon, France
| | - Olivier Kosmider
- Laboratory of Hematology, Cochin Institute, Paris University, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Cochin Hospital, National Referral Center for Rare Systemic Autoimmune Diseases, Paris University, Paris, France
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Guillet H, Saraux A, Mouthon L, Régent A. [Management of patients with a suspicion of giant cell arteritis: Survey among general practitioners and specialists]. Rev Med Interne 2021; 42:600-607. [PMID: 33726918 DOI: 10.1016/j.revmed.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Headache, visual disturbances and shoulder and hip girdle pain are frequent symptoms of consultation and the diagnosis of giant cell arteritis (GCA) can be evoked in these situations. However, GCA is a rare disease, and the management modalities of a clinical suspicion of GCA are poorly described, which warranted this study. METHODS This is a survey evaluating the management of a suspected case of GCA. The questionnaires were sent to general practitioners (GPs), members of the French Rheumatology Society (SFR) and the French National Society of Internal Medicine (SNFMI) RESULTS: One thousand four hundred and fifty two physicians responded to the survey, including 967 GPs (66.6 %) and 485 other specialists (33.4 %). GPs immediately referred the patient to the emergency room in 42 % of cases, and to a specialist colleague in 72 % of cases in the presence of visual symptoms. GPs and other specialists reported performing temporal artery biopsy (TAB) respectively in 46.7 % and 69.7 % of cases (P<0.05). GPs and other specialists reported using diagnostic imaging in 7.4 % and 16.2 % of cases, respectively (P<0.05). Temporal artery ultrasound was the most used diagnostic imaging. The average prednisone equivalent dose prescribed as initial treatment was 1mg/kg/day for GPs and 0.7mg/kg/day for other specialists (P<0.05). CONCLUSION Some suspected GCA patients would be managed by their GPs. Imaging was little used for the diagnosis of GCA and TAB remained the preferred diagnostic examination. The initial prednisone equivalent dose varied between GP and other specialists.
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Affiliation(s)
- H Guillet
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, Paris, France
| | - A Saraux
- Service de rhumatologie, Hôpital de la Cavale Blanche, CHRU, Brest, France; Université de Bretagne Occidentale, 22, rue Camille-Desmoulins, 29238 Brest, France
| | - L Mouthon
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, Paris, France; Université de Paris, 75006 Paris, France
| | - A Régent
- Service de médecine interne, Centre de référence maladies auto-immunes et systémiques rares d'Ile de France, Hôpital Cochin, Assistance Publique Hôpitaux de Paris (AP-HP), 27, rue du Faubourg Saint Jacques, Paris, France; Université de Paris, 75006 Paris, France.
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Perrineau S, Ghesquière T, Charles P, Paule R, Samson M, Gayraud M, Chauvin A, Terrier B, Guillevin L, Bonnotte B, Mouthon L, Régent A. A French cohort of patients with giant cell arteritis: glucocorticoid treatment and its associated side effects. Clin Exp Rheumatol 2021; 39 Suppl 129:155-160. [PMID: 33938796 DOI: 10.55563/clinexprheumatol/0nd4kk] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Giant cell arteritis (GCA) is the most common primary large-vessel vasculitis. Glucocorticoids (GC) therapy remains the standard of care for GCA despite frequent side effects (SEs). However, treatment modality changes, prophylactic treatment of osteoporosis, or vaccinations might have decreased the frequency of GC-related SEs. This study aims to describe GCA treatment and GC-related SEs in a recent cohort. METHODS Patients with a diagnosis of GCA between May 2009 and March 2018 were included in this multicentric retrospective study. Characteristics of patients, treatment modalities and GC-related SEs were collected and analysed. Risk factors associated with the occurrence of SE were studied. RESULTS We analysed the files from 206 patients (153 women, 53 men; median age 74 years). Median follow-up was 34 months. Patients received GC for a median of 25 months, starting at 0.7 mg/kg/day, with tapering to 5 mg/day after 11 months follow-up. Flares occurred in 83/201 (41%) patients. Among the 132 patients who stopped GC, 29 (22%) experienced a relapse. SEs occurred in 129 (64%) patients: bone fractures and infections in 13% each and hypertension onset in 9%. Age >75 years, treatment duration >2 years, past medical history of diabetes were risk factors associated with GC-related SEs. CONCLUSIONS Flares occur in 41% of patients during GC withdrawal. As much as 64% of patients had treatment related SEs. An age> 75 year and a past medical history of diabetes were predictive of SEs during follow-up.
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Affiliation(s)
- Ségolène Perrineau
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France
| | - Thibault Ghesquière
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Pierre Charles
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Romain Paule
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Martine Gayraud
- Department of Internal Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Anthony Chauvin
- METHODS Team, Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité (CRESS UMR 1153), INSERM, Paris, Île-de-France, and Emergency Department, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France; Faculté de Médecine, Université Diderot, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France
| | - Loic Guillevin
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, François Mitterrand Hospital, Dijon University Hospital, Dijon, France
| | - Luc Mouthon
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, Hôpital Cochin, Université de Paris, Sorbonne Paris Cité, INSERM Unité 1016, Centre de Référence pour les Maladies Auto-immunes Rares, Paris, and Institut Cochin, INSERM U1016, CNRS UMR 8104, Paris, France.
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Iudici M, Pagnoux C, Courvoisier DS, Cohen P, Hamidou M, Aouba A, Lifermann F, Ruivard M, Aumaître O, Bonnotte B, Maurier F, Decaux O, Hachulla E, Karras A, Khouatra C, Jourde-Chiche N, Viallard JF, Blanchard-Delaunay C, Godmer P, Quellec AL, Quéméneur T, de Moreuil C, Régent A, Terrier B, Mouthon L, Guillevin L, Puéchal X. Granulomatosis with polyangiitis: Study of 795 patients from the French Vasculitis Study Group registry. Semin Arthritis Rheum 2021; 51:339-346. [PMID: 33601189 DOI: 10.1016/j.semarthrit.2021.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/19/2021] [Accepted: 02/06/2021] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe the characteristics and long-term outcomes of patients with granulomatosis with polyangiitis (GPA) from the French Vasculitis Study Group database. METHODS Patients' clinical and laboratory characteristics, Birmingham Vasculitis Activity Score (BVAS)-assessed disease activity, malignancies, opportunistic infections, and vital status were collected at diagnosis and each visit. Estimated probabilities and predictors of overall (OS) and relapse-free survival (RFS) were analyzed by Cox regression. RESULTS We enrolled 795 newly diagnosed patients, followed for a median of 3.5 years. Initial clinical manifestations involved ear, nose & throat (ENT; 80%), lungs (68%) and kidneys (56%). Among the 728 available ELISA results, 75.0% were PR3-ANCA-positive, 16.5% MPO-ANCA-positive and 62 (8.5%) ANCA-negative. Relapses occurred in 394 (50%) patients, involving ≥1 organ(s) affected at onset in 179 (46%), mainly ENT, lungs and kidneys, with mean BVAS 10.2 points below that at diagnosis (p<0.001). Five- and 10-year RFS rates were 37% and 17%, respectively. PR3-ANCA-positivity independently predicted relapse (p = 0.05) and prolonged survival (p = 0.038). OS-but not RFS-improved significantly over time (p<0.001); 10-year OS reached 88.2% (95% CI 83.9 to 92.7) for the 660 patients diagnosed after 2000. Infections were the main causes of death. Malignancy or opportunistic infection each occurred in ≤5% of the patients. CONCLUSION Survival has improved dramatically over the last decades but the high relapse rate remains a major concern for GPA patients, once again stressing the need for therapeutic strategy optimization to lower it. PR3-ANCA-positivity was associated with increased probability of relapse and survival.
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Affiliation(s)
- Michele Iudici
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France; Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Christian Pagnoux
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France; Present address: Vasculitis Clinic, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Delphine S Courvoisier
- Division of Rheumatology, Department of Internal Medicine Specialties, Geneva University Hospitals, Switzerland
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Mohamed Hamidou
- Department of Internal Medicine, Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Nantes, France
| | - Achille Aouba
- Department of Internal Medicine, CHU Côte-de-Nacre, Caen, France
| | | | - Marc Ruivard
- Department of Internal Medicine, CHU, Clermont-Ferrand, France
| | | | | | | | - Olivier Decaux
- Department of Internal Medicine, CHU Sud, Rennes, France
| | - Eric Hachulla
- National Referral Center for Rare Systemic Autoimmune Diseases, Department of Internal Medicine and Clinical Immunology, Claude-Huriez Hospital, University of Lille, Lille, France
| | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges-Pompidou, APHP, Paris, France
| | - Chahéra Khouatra
- Department of Respiratory Medicine, CHU Louis-Pradel and UMR754, Université Claude-Bernard Lyon 1, Lyon, France
| | - Noémie Jourde-Chiche
- Aix-Marseille Univ, C2VN, INSERM 1263, INRAE 1260, AP-HM, Department of Nephrology, CHU de la Conception, Marseille, France
| | | | | | - Pascal Godmer
- Department of Internal Medicine, Centre Hospitalier Bretagne Atlantique, Vannes, France
| | - Alain Le Quellec
- Department of Internal Medicine, CHU Saint-Eloi, Montpellier, France
| | - Thomas Quéméneur
- Department of Nephrology and Internal Medicine, Centre Hospitalier, Valenciennes, France
| | - Claire de Moreuil
- Department of Internal Medicine, CHU La Cavale Blanche, Brest, France
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France
| | - Xavier Puéchal
- National Referral Center for Rare Systemic Autoimmune Diseases, Université Paris Descartes, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (APHP), 27, rue du faubourg Saint-Jacques, Paris, Cedex 14 75679, France.
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Lenfant T, Salah S, Leroux G, Bousquet E, Le Guern V, Chasset F, Francès C, Morel N, Chezel J, Papo T, Cacoub P, Mouthon L, Guettrot-Imbert G, Cohen P, Régent A, Mauget-Faÿsse M, Piette JC, Jallouli M, Costedoat-Chalumeau N. Risk factors for hydroxychloroquine retinopathy in systemic lupus erythematosus: a case-control study with hydroxychloroquine blood-level analysis. Rheumatology (Oxford) 2021; 59:3807-3816. [PMID: 32442312 PMCID: PMC8186841 DOI: 10.1093/rheumatology/keaa157] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/05/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE HCQ is an essential medication in SLE, proven to lengthen survival and reduce flares. Its use, however, is limited by its rare but severe ophthalmological complications. Here, we aimed to analyse factors associated with HCQ retinopathy including HCQ blood levels. METHODS This case-control study compared SLE patients with and without HCQ retinopathy, defined by abnormal results for at least two of the following ophthalmological tests: automated visual fields, spectral-domain optical coherence tomography (SD-OCT), multifocal electroretinogram (mfERG) and fundus autofluorescence. We compared clinical and laboratory findings to assess risk factors for HCQ retinopathy. RESULTS The study included 23 patients with confirmed retinopathy (cases) and 547 controls. In the univariate analysis, age (P < 0.001), height (P = 0.045), creatinine clearance (P < 0.001), haemoglobin concentration (P = 0.01), duration of HCQ intake, (P < 0.001), higher cumulative HCQ dose (P < 0.001) and geographical origin (West Indies and sub-Saharan Africa) (P = 0.007) were associated with the risk of retinopathy, while HCQ blood levels were not. In the multivariate analysis, only cumulative dose (P = 0.016), duration of intake (P = 0.039), creatinine clearance (P = 0.002) and geographical origin (P < 0.0001, odds ratio 8.7) remained significantly associated with retinopathy. CONCLUSION SLE patients on HCQ should be closely monitored for retinopathy, especially those from the West Indies or sub-Saharan Africa, or with renal insufficiency, longer HCQ intake or a high cumulative dose. Although reducing the daily dose of HCQ in patients with persistently high HCQ blood levels seems logical, these concentrations were not associated with retinopathy in this study with controls adherent to treatment.
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Affiliation(s)
- Tiphaine Lenfant
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Sawsen Salah
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Elodie Bousquet
- Department of Ophthalmology, Ophtalmopôle, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Véronique Le Guern
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - François Chasset
- Department of Dermatology and Allergology, Tenon Hospital, APHP.,Faculty of Medicine, Sorbonne University
| | - Camille Francès
- Department of Dermatology and Allergology, Tenon Hospital, APHP
| | - Nathalie Morel
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Julie Chezel
- Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Thomas Papo
- Faculty of Medicine, Université de Paris.,Department of Internal Medicine, Bichat-Claude Bernard Hospital, APHP
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP.,Faculty of Medicine, Sorbonne University.,INSERM, UMR_S 959.,Paris CNRS, FRE3632
| | - Luc Mouthon
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,INSERM U1016, Équipe Neutrophiles et Vascularites, Institut Cochin
| | - Gaëlle Guettrot-Imbert
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Pascal Cohen
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP
| | - Alexis Régent
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris
| | - Martine Mauget-Faÿsse
- Clinical Investigative Platform, Rothschild Ophthalmologic Foundation Hospital, Paris, France
| | - Jean-Charles Piette
- Department of Internal Medicine and Clinical Immunology, Centre de Référence Maladies Auto-Immunes et Systémiques Rares de l'île de France, Pitié-Salpêtrière University Hospital, APHP
| | - Moez Jallouli
- Department of Internal Medicine, Hédi Chaker Sfax Hospital, Sfax, Tunisia
| | - Nathalie Costedoat-Chalumeau
- Department of Internal Medicine, Centre de Référence Maladies Auto-Immunes et Systémiques Rares d'Ile de France, Cochin Hospital, APHP.,Faculty of Medicine, Université de Paris.,Center for Epidemiology and Statistics, Sorbonne Paris Cité (CRESS), INSERM U1153, Paris, France
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Henriquez S, Dunogué B, Porcher R, Régent A, Cohen P, Berezne A, Kolta S, Le Jeunne C, Mouthon L, Roux C, Guillevin L, Briot K, Terrier B. Handgrip strength is a comorbidity marker in systemic necrotizing vasculitides and predicts the risk of fracture and serious adverse events. Rheumatology (Oxford) 2021; 59:2581-2590. [PMID: 32449923 DOI: 10.1093/rheumatology/kez680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/30/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Sarcopenia has been associated with poor outcomes in various medical and surgical conditions. However, its impact in systemic necrotizing vasculitides (SNV) had never been characterized. We aimed to assess the prevalence, associated factors and prognostic impact of sarcopenia in SNV. METHODS Patients with SNV were successively included in a prospective longitudinal study assessing comorbidities. At inclusion, we evaluated sarcopenia by assessing skeletal muscle mass index using DXA and muscle strength using handgrip strength. Vasculitis and treatments-related events were recorded and analysed using Cox models. RESULTS One hundred and twenty patients were included. At inclusion, low handgrip strength (<30 kg for men and 20 kg for women) was identified in 28 (23%) patients, while no patient exhibited low skeletal muscle mass index (<7.23 kg/m2 for men and 5.67 kg/m2 for women). Low handgrip strength was associated with age (P <0.0001), type of vasculitis (P =0.01), vasculitis damage index (P =0.01), history of falls (P =0.0002), osteoporosis (P =0.04), low serum albumin (P =0.003) and prealbumin (P =0.0007), high CRP (P =0.001), high FRAX® tool (P =0.002) and low bone mineral density at femoral neck (P =0.0002). After median follow-up of 42 months, low handgrip strength was associated with higher risk of bone fracture [HR 4.25 (1.37-13.2), P =0.01] and serious adverse events [HR 2.80 (1.35-5.81), P =0.006]. CONCLUSION Handgrip strength is associated in SNV with nutritional status and comorbidities such as bone disease, and seems to predict, as in other medical conditions, the risk of fracture and serious adverse events during follow-up. In contrast, assessment of skeletal muscle mass index in this population remains uncertain.
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Affiliation(s)
- Soledad Henriquez
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France
| | - Bertrand Dunogué
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Raphael Porcher
- Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France.,INSERM UMR-1153, Paris, France
| | - Alexis Régent
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Pascal Cohen
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Alice Berezne
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Sami Kolta
- Department of Rheumatology, Hôpital Cochin, Paris, France
| | - Claire Le Jeunne
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Luc Mouthon
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Christian Roux
- Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France.,Department of Rheumatology, Hôpital Cochin, Paris, France
| | - Loïc Guillevin
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
| | - Karine Briot
- Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France.,Department of Rheumatology, Hôpital Cochin, Paris, France
| | - Benjamin Terrier
- Department of Internal MedicineHôpital Cochin, Paris, France.,National Referral Center for Systemic and Autoimmune Diseases, Hôpital CochinParis, France.,Faculté de Médecine Paris Descartes, Université Paris DescartesParis, France
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Matet A, Fournel L, Gaillard F, Amar L, Arlet JB, Baron S, Bats AS, Buffel du Vaure C, Charlier C, De Lastours V, Faye A, Jablon E, Kadlub N, Leguen J, Lebeaux D, Malmartel A, Mirault T, Planquette B, Régent A, Thebault JL, Dinh AT, Nuzzo A, Turc G, Friedlander G, Ruszniewski P, Badoual C, Ranque B, Oualha M, Courbebaisse M. Impact of integrating objective structured clinical examination into academic student assessment: Large-scale experience in a French medical school. PLoS One 2021; 16:e0245439. [PMID: 33444375 PMCID: PMC7808634 DOI: 10.1371/journal.pone.0245439] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 10/01/2020] [Accepted: 01/01/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Objective structured clinical examinations (OSCE) evaluate clinical reasoning, communication skills, and interpersonal behavior during medical education. In France, clinical training has long relied on bedside clinical practice in academic hospitals. The need for a simulated teaching environment has recently emerged, due to the increasing number of students admitted to medical schools, and the necessity of objectively evaluating practical skills. This study aimed at investigating the relationships between OSCE grades and current evaluation modalities. Methods Three-hundred seventy-nine 4th-year students of University-of-Paris Medical School participated to the first large-scale OSCE at this institution, consisting in three OSCE stations (OSCE#1–3). OSCE#1 and #2 focused on cardiovascular clinical skills and competence, whereas OSCE#3 focused on relational skills while providing explanations before planned cholecystectomy. We investigated correlations of OSCE grades with multiple choice (MCQ)-based written examinations and evaluations of clinical skills and behavior (during hospital traineeships); OSCE grade distribution; and the impact of integrating OSCE grades into the current evaluation in terms of student ranking. Results The competence-oriented OSCE#1 and OSCE#2 grades correlated only with MCQ grades (r = 0.19, P<0.001) or traineeship skill grades (r = 0.17, P = 0.001), respectively, and not with traineeship behavior grades (P>0.75). Conversely, the behavior-oriented OSCE#3 grades correlated with traineeship skill and behavior grades (r = 0.19, P<0.001, and r = 0.12, P = 0.032), but not with MCQ grades (P = 0.09). The dispersion of OSCE grades was wider than for MCQ examinations (P<0.001). When OSCE grades were integrated to the final fourth-year grade with an incremental 10%, 20% or 40% coefficient, an increasing proportion of the 379 students had a ranking variation by ±50 ranks (P<0.001). This ranking change mainly affected students among the mid-50% of ranking. Conclusion This large-scale French experience showed that OSCE designed to assess a combination of clinical competence and behavioral skills, increases the discriminatory capacity of current evaluations modalities in French medical schools.
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Affiliation(s)
- Alexandre Matet
- Université de Paris, Faculté de Médecine, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMR1138, Paris, France
- Service d’ophtalmologie, Institut Curie, Paris, France
- * E-mail:
| | - Ludovic Fournel
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR1124, Paris, France
- Service de chirurgie thoracique, AP-HP, Hôpital Cochin, Paris, France
| | - François Gaillard
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Laurence Amar
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Benoit Arlet
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Stéphanie Baron
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Anne-Sophie Bats
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR-S 1147, Paris, France
- Service de gynécologie oncologique et de chirurgie du sein, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Celine Buffel du Vaure
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Caroline Charlier
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Pasteur, INSERM U1117, Paris, France
- Département de maladies infectieuses et tropicales, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Victoire De Lastours
- Université de Paris, Faculté de Médecine, Paris, France
- IAME, UMR1137, INSERM, Paris, France
- Service de Médecine Interne, AP-HP, Hôpital Beaujon, Clichy, France
| | - Albert Faye
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Pédiatrie Générale, Hôpital Robert Debré, Paris, INSERM ECEVE 1123, Paris, France
| | - Eve Jablon
- Service AGIR, Université de Paris, Faculté de Médecine, Paris, France
| | - Natacha Kadlub
- Université de Paris, Faculté de Médecine, Paris, France
- Département de chirurgie maxillo-faciale et de chirurgie plastique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Julien Leguen
- Université de Paris, Faculté de Médecine, Paris, France
- Service de Gériatrie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - David Lebeaux
- Université de Paris, Faculté de Médecine, Paris, France
- Département de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexandre Malmartel
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Tristan Mirault
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Département d’hypertension artérielle, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Benjamin Planquette
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM UMR S1140, Paris, France
- Service de Pneumologie et de soins intensifs, AH-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Alexis Régent
- Université de Paris, Faculté de Médecine, Paris, France
- Institut Cochin, INSERM U1016, CNRS UMR 8104, LabEx INFLAMEX, Paris, France
- Service de Médecine Interne, Centre de Référence pour les Maladies Systémiques Auto immunes Rares d’Ile-de-France, AP-HP, Hôpital Cochin, Paris, France
| | - Jean-Laurent Thebault
- Département de médecine générale, Université de Paris, Faculté de Médecine, Paris, France
| | - Alexy Tran Dinh
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1148 LVTS, Villetanneuse, France
- Département d'Anesthésie-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Alexandre Nuzzo
- Université de Paris, Faculté de Médecine, Paris, France
- Service de gastro-entérologie et pancréatologie, AP-HP, Hôpital Beaujon, Paris, France
| | - Guillaume Turc
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- Service de neurologie, Hôpital Sainte Anne, AH-HP, Paris, France
| | - Gérard Friedlander
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
| | - Philippe Ruszniewski
- Université de Paris, Faculté de Médecine, Paris, France
- INSERM U1266, Paris, France
- INSERM UMR1149, Paris, France
| | - Cécile Badoual
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service d’anatomopathologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Brigitte Ranque
- Université de Paris, Faculté de Médecine, Paris, France
- PARCC INSERM U970, Paris, France
- Service de Médecine interne, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Mehdi Oualha
- Université de Paris, Faculté de Médecine, Paris, France
- Unité EA7323, Université de Paris, Faculté de Médecine, Paris, France
- Service de réanimation et de surveillance continue médico-chirurgicale pédiatrique, AP-HP, Hôpital Universitaire Necker, Paris, France
| | - Marie Courbebaisse
- Université de Paris, Faculté de Médecine, Paris, France
- Département de physiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Institut Necker-Enfants Malades, INSERM U1151-CNRS UMR8253, Paris, France
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Rasmussen C, Abitbol V, El Karoui K, Bourrier A, Paule R, Koch S, Maurier F, Laharie D, Aubin F, Fumery M, Peyrin-Biroulet L, Rafat C, Queyrel V, Moulis G, Pigneur B, Régent A, Morbieu C, Guillevin L, Terrier B. Vascularites à IgA associées aux maladies inflammatoires chroniques de l’intestin : étude observationnelle multicentrique rétrospective de 43 patients. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Catano J, Uzunhan Y, Paule R, Dion J, Régent A, Legendre P, Cohen P, Puéchal X, Le Guern V, Mouthon L, Lorut C, Lacroix C, Périé S, Terrier B. Spectre étiologique des sténoses sous-glottiques dans les maladies dysimmunitaires. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.032] [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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Parreau S, Régent A, Dumonteil S, Fauchais A, Liozon E, Mouthon L, Monnet D, Brézin A, Ly K, Terrier B. Neuropathies optiques ischémiques antérieures : étude des caractéristiques des formes artéritiques et non artéritiques. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.140] [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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Bettuzzi T, Jachiet M, Sbidian E, Chasset F, Frumholtz L, Cordoliani F, Bouaziz J, Aractingi S, Mouthon L, Guillevin L, Paule R, Terrier B, Dupin N, Régent A. Efficacité et effets indésirables des traitements de la périartérite noueuse cutanée : une étude observationnelle rétrospective. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chassagnon G, Vakalopoulou M, Régent A, Sahasrabudhe M, Marini R, Hoang-Thi TN, Dinh-Xuan AT, Dunogué B, Mouthon L, Paragios N, Revel MP. Elastic Registration-driven Deep Learning for Longitudinal Assessment of Systemic Sclerosis Interstitial Lung Disease at CT. Radiology 2020; 298:189-198. [PMID: 33078999 DOI: 10.1148/radiol.2020200319] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Longitudinal follow-up of interstitial lung diseases (ILDs) at CT mainly relies on the evaluation of the extent of ILD, without accounting for lung shrinkage. Purpose To develop a deep learning-based method to depict worsening of ILD based on lung shrinkage detection from elastic registration of chest CT scans in patients with systemic sclerosis (SSc). Materials and Methods Patients with SSc evaluated between January 2009 and October 2017 who had undergone at least two unenhanced supine CT scans of the chest and pulmonary function tests (PFTs) performed within 3 months were retrospectively included. Morphologic changes on CT scans were visually assessed by two observers and categorized as showing improvement, stability, or worsening of ILD. Elastic registration between baseline and follow-up CT images was performed to obtain deformation maps of the whole lung. Jacobian determinants calculated from the deformation maps were given as input to a deep learning-based classifier to depict morphologic and functional worsening. For this purpose, the set was randomly split into training, validation, and test sets. Correlations between mean Jacobian values and changes in PFT measurements were evaluated with the Spearman correlation. Results A total of 212 patients (median age, 53 years; interquartile range, 45-62 years; 177 women) were included as follows: 138 for the training set (65%), 34 for the validation set (16%), and 40 for the test set (21%). Jacobian maps demonstrated lung parenchyma shrinkage of the posterior lung bases in patients found to have worsened ILD at visual assessment. The classifier detected morphologic and functional worsening with an accuracy of 80% (32 of 40 patients; 95% confidence interval [CI]: 64%, 91%) and 83% (33 of 40 patients; 95% CI: 67%, 93%), respectively. Jacobian values correlated with changes in forced vital capacity (R = -0.38; 95% CI: -0.25, -0.49; P < .001) and diffusing capacity for carbon monoxide (R = -0.42; 95% CI: -0.27, -0.54; P < .001). Conclusion Elastic registration of CT scans combined with a deep learning classifier aided in the diagnosis of morphologic and functional worsening of interstitial lung disease in patients with systemic sclerosis. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Verschakelen in this issue.
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Affiliation(s)
- Guillaume Chassagnon
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Maria Vakalopoulou
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Alexis Régent
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Mihir Sahasrabudhe
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Rafael Marini
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Trieu-Nghi Hoang-Thi
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Anh-Tuan Dinh-Xuan
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Bertrand Dunogué
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Luc Mouthon
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Nikos Paragios
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
| | - Marie-Pierre Revel
- From the Department of Radiology (G.C., T.N.H.T., M.P.R.), Department of Internal Medicine, Reference Center for Rare Systemic Autoimmune Diseases of Île de France (A.R., B.D., L.M.), and Department of Physiology (A.T.D.X.), Hôpital Cochin, AP-HP Centre, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, École CentraleSupélec, Png-sur-Yvette, France (G.C., M.V., M.S., N.P.); and TheraPanacea, Paris, France (R.M., N.P.)
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Terrier B, Dechartres A, Gouya H, Ben Arfi M, Bérézne A, Régent A, Dunogué B, London J, Cohen P, Guillevin L, Le Jeunne C, Legmann P, Vignaux O, Mouthon L. Cardiac Intravoxel Incoherent Motion Diffusion-Weighted Magnetic Resonance Imaging With T1 Mapping to Assess Myocardial Perfusion and Fibrosis in Systemic Sclerosis: Association With Cardiac Events From a Prospective Cohort Study. Arthritis Rheumatol 2020; 72:1571-1580. [PMID: 32379399 DOI: 10.1002/art.41308] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 04/30/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Myocardial involvement may occur during systemic sclerosis (SSc) and can lead to impaired myocardial contraction and/or arrhythmia. Cardiac magnetic resonance imaging (MRI) is used for noninvasive characterization of the myocardium. The aim of this study was to evaluate the utility of cardiac MRI with intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) and longitudinal relaxation time (T1) sequence mapping for assessment of myocardial microvascular and interstitium impairment in SSc. METHODS In this single-center prospective cohort study, 40 consecutive patients with SSc and 20 healthy controls were assessed by cardiac MRI with IVIM DWI and T1 mapping sequences on a 3T scanning system. Images were analyzed independently by 2 assessors, and Bland-Altman plots were used to assess interreader concordance and reproducibility. Characteristics of the patients were compared according to quartiles of T1 and perfusion fraction (f-coefficient) values, using exact Cochran-Ermitage trend tests for qualitative variables and analysis of variance for quantitative variables. Kaplan-Meier cardiac events-free survival curves were plotted and compared with a log-rank test for trend. RESULTS T1 values were higher in SSc patients than in healthy controls, and were higher in the diffuse cutaneous SSc (dcSSc) subset (P = 0.02). Higher T1 values were associated with the immunologic pattern seen in patients with the dcSSc form (P = 0.0001), a higher modified Rodnan skin thickness score (MRSS) (P = 0.003), and a higher frequency of interstitial lung disease (P = 0.03). Moreover, higher T1 values were correlated with higher MRSS scores (r = +0.32, P = 0.04) and reduced forced vital capacity (r = -0.34, P = 0.048), and tended to be correlated with reduced total lung capacity (r = -0.30, P = 0.07). Lower f-coefficient values, as a measure of decreased tissue perfusion, were associated with less frequent use of vasodilators (P = 0.02 for angiotensin-converting enzyme inhibitors and P = 0.06 for calcium-channel blockers) and more frequent use of glucocorticoids (P = 0.02). The f-coefficients were inversely correlated with the T1 values (r = -0.31, P = 0.02). Furthermore, higher T1 values were associated with higher incidence of cardiac events (log-rank test for trend P = 0.03). CONCLUSION Increased T1 values, potentially suggesting microscopic fibrosis, were observed more frequently in patients with dcSSc, and higher T1 values were associated with interstitial lung disease and more frequent cardiac events during follow-up. The results of this study show that cardiac MRI with T1 mapping sequences and IVIM DWI may be useful in assessing myocardial involvement in patients with SSc.
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Affiliation(s)
- Benjamin Terrier
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, AP-HP, Paris, France
| | | | - Moncef Ben Arfi
- Hôpital Cochin, AP-HP, Paris, France, and American Hospital of Paris, Neuilly-sur-Seine, France
| | - Alice Bérézne
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Paris, France
| | - Alexis Régent
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Bertrand Dunogué
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jonathan London
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pascal Cohen
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Claire Le Jeunne
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Olivier Vignaux
- Hôpital Cochin, AP-HP, Paris, France, and American Hospital of Paris, Neuilly-sur-Seine, France
| | - Luc Mouthon
- National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, AP-HP, and Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Chassagnon G, Vakalopoulou M, Régent A, Zacharaki EI, Aviram G, Martin C, Marini R, Bus N, Jerjir N, Mekinian A, Hua-Huy T, Monnier-Cholley L, Benmostefa N, Mouthon L, Dinh-Xuan AT, Paragios N, Revel MP. Deep Learning-based Approach for Automated Assessment of Interstitial Lung Disease in Systemic Sclerosis on CT Images. Radiol Artif Intell 2020; 2:e190006. [PMID: 33937829 DOI: 10.1148/ryai.2020190006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/19/2020] [Accepted: 03/31/2020] [Indexed: 12/23/2022]
Abstract
Purpose To develop a deep learning algorithm for the automatic assessment of the extent of systemic sclerosis (SSc)-related interstitial lung disease (ILD) on chest CT images. Materials and Methods This retrospective study included 208 patients with SSc (median age, 57 years; 167 women) evaluated between January 2009 and October 2017. A multicomponent deep neural network (AtlasNet) was trained on 6888 fully annotated CT images (80% for training and 20% for validation) from 17 patients with no, mild, or severe lung disease. The model was tested on a dataset of 400 images from another 20 patients, independently partially annotated by three radiologist readers. The ILD contours from the three readers and the deep learning neural network were compared by using the Dice similarity coefficient (DSC). The correlation between disease extent obtained from the deep learning algorithm and that obtained by using pulmonary function tests (PFTs) was then evaluated in the remaining 171 patients and in an external validation dataset of 31 patients based on the analysis of all slices of the chest CT scan. The Spearman rank correlation coefficient (ρ) was calculated to evaluate the correlation between disease extent and PFT results. Results The median DSCs between the readers and the deep learning ILD contours ranged from 0.74 to 0.75, whereas the median DSCs between contours from radiologists ranged from 0.68 to 0.71. The disease extent obtained from the algorithm, by analyzing the whole CT scan, correlated with the diffusion lung capacity for carbon monoxide, total lung capacity, and forced vital capacity (ρ = -0.76, -0.70, and -0.62, respectively; P < .001 for all) in the dataset for the correlation with PFT results. The disease extents correlated with diffusion lung capacity for carbon monoxide, total lung capacity, and forced vital capacity were ρ = -0.65, -0.70, and -0.57, respectively, in the external validation dataset (P < .001 for all). Conclusion The developed algorithm performed similarly to radiologists for disease-extent contouring, which correlated with pulmonary function to assess CT images from patients with SSc-related ILD.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Guillaume Chassagnon
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Maria Vakalopoulou
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Alexis Régent
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Evangelia I Zacharaki
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Galit Aviram
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Charlotte Martin
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rafael Marini
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Norbert Bus
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Naïm Jerjir
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Arsène Mekinian
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Thông Hua-Huy
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Laurence Monnier-Cholley
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Nouria Benmostefa
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Luc Mouthon
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Anh-Tuan Dinh-Xuan
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Nikos Paragios
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Marie-Pierre Revel
- Departments of Radiology (G.C., N.J., M.P.R.) and Physiology (T.H.H., A.T.D.X.), Hôpital Cochin, and Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin (A.R., N. Benmostefa, L.M.), Assistance Publique-Hôpitaux de Paris, Université de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France; Center for Visual Computing, Ecole CentraleSupelec, Gif-sur-Yvette, France (G.C., M.V., E.I.Z., C.M., N.P.); Department of Radiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (G.A.); TheraPanacea, Paris, France (R.M., N. Bus, N.P.); and Departments of Internal Medicine and Inflammatory Disorders (A.M.) and Radiology (L.M.C.), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
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Paule R, Vignon M, Régent A, London J, Cohen P, Le Jeunne C, Mouthon L, Bouscary D, Tamburini J, Terrier B. IgA monoclonal gammopathy associated with refractory IgA vasculitis successfully treated with clone-targeted therapy. Autoimmun Rev 2020; 19:102611. [PMID: 32659477 DOI: 10.1016/j.autrev.2020.102611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 02/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Romain Paule
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France
| | - Marguerite Vignon
- Paris Descartes University, Paris University, Paris, France; Department of Hematology, Hôpital Cochin, AP-HP, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France
| | - Jonathan London
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France
| | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Claire Le Jeunne
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France
| | - Didier Bouscary
- Paris Descartes University, Paris University, Paris, France; Department of Hematology, Hôpital Cochin, AP-HP, Paris, France
| | - Jérôme Tamburini
- Paris Descartes University, Paris University, Paris, France; Department of Hematology, Hôpital Cochin, AP-HP, Paris, France
| | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Descartes University, Paris University, Paris, France.
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Parreau S, Seror R, Terrier B, Burroni B, Jamart C, Régent A, Nocturne G, Mouthon L, Mariette X, Le Guern V. SAT0226 MINOR SALIVARY GLAND BIOPSY TO DIAGNOSE LYMPHOMA IN PATIENTS WITH PRIMARY SJÖGREN’S SYNDROME. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Non-Hodgkin B-cell lymphoma (NHL), especially mucosa-associated lymphoid tissue (MALT) lymphoma, is one of the main complications of primary Sjögren’s syndrome (pSS). Frequent extranodal lymphoproliferation makes its diagnosis challenging and obtaining a biopsy difficult. Since pSS-associated lymphomas are very frequently MALT lymphomas with salivary gland involvement, we hypothesized that minor salivary gland biopsy (MSGB) could be useful for NHL diagnosis in this context.Objectives:To evaluate the potential contribution of MSGB for the diagnosis of pSS-associated MALT lymphoma by comparing patients diagnosed with NHL based on MSGB or another tissue.Methods:All pSS patients (ACR/EULAR 2016 classification criteria), from the Paris National Referral Centers for Rare Systemic Autoimmune Diseases, diagnosed with NHL between January 2010 and October 2019, were included. Each patient’s clinical, biological, radiological and therapeutic information was collected retrospectively at NHL diagnosis and 1-year later. Only patients with MSGB available were analyzed; they were divided into 2 groups according to MSGB results for NHL: MSGB+and MSGB–.Results:Among 36 pSS patients diagnosed with NHL during the study period, 25 had an MSGB available at the time of NHL diagnosis. Among them, 13 MSGBs contained NHL (MSGB+). MSGB was the only site enabling NHL diagnosis for 10/13 (77%); pSS and NHL were diagnosed simultaneously in 4/13 (31%). MSBGs were NHL–for lymphomas diagnosed based on other tissue samples for 12 (48%) patients (MSGB–). The clinical, biological, histological and radiological characteristics of both groups are reported in Table 1. No major differences were found between groups for median ESSDAI at NHL diagnosis and the frequency of salivary gland hypermetabolism on PET-CT. MALT-type NHL was found in 24/25 (96%) patients including 13/13 (100%) of those MSGB+and 11/12 (92%) of those MSGB–. Six of the 13 (46%) MSGB+patients received no treatment, while all MSGB–patients were treated. Between diagnosis and 1 year of follow-up, ESSDAI scores without the NHL item did not differ (6.5 [3.5–9.5]) for the 6 untreated patients, but had significantly decreased for the 19 treated patients (3.5 [2.0–5.8]) (p=0.02).Table 1.Comparison of the pSS patients’ characteristics according to MSGB+vs. MSGB–for NHLCharacteristicMSGB+, n=13MSGB–, n=12Female/male (ratio)12/1 (12)11/1 (11)Age at NHL diagnosis, yr60 (52–72)58 (49.5–69.8)pSS duration at NHL diagnosis, yr2.(0–9)3.5 (0.8–11)ESSDAI score without NHL item9 (6–16)10.(3.5–19.8)Cryoglobulinemia+9 (69)3/9 (33)Rheumatoid factor+9/11 (82)8/8 (100)Anti-SSA antibody+10 (77)7 (58)Anemia (Hb<12g/dL)2 (15)6/11 (55)Gammaglobulins, g/L12.4 (10.8–16.9)16.1 (12.3–20.0)Histology MALT-type lymphoma13 (100)11 (92) Diffuse-large B-cell lymphoma0 (0)1 (8)[18F]FDG-PET–CT, SUV max >4.7 Parotid or submandibular gland6/12 (50)3/10 (30) Lymph nodes1/12 (8)3/10 (30)Results are presented as number (%) or median (IQR).Conclusion:Our results showed that, when MALT lymphoma is suspected, MSGB contributed to diagnosing NHL, either at initial assessment or during pSS evolution, enabling MALT lymphoma diagnosis in at least a third of NHL patients and >50% when MSGB was obtained systematically. Thus, MSGB might avoid the need for a more invasive procedure. Moreover, our findings suggest MSGB should be obtained at pSS diagnosis, and repeatedly during follow-up, when NHL, especially MALT, is suspected.Disclosure of Interests:Simon Parreau: None declared, Raphaèle Seror Consultant of: BMS UCB Pfizer Roche, Benjamin Terrier: None declared, Barbara Burroni: None declared, Céline Jamart: None declared, Alexis Régent: None declared, Gaetane Nocturne: None declared, Luc Mouthon: None declared, Xavier Mariette Consultant of: BMS, Gilead, Medimmune, Novartis, Pfizer, Servier, UCB, Véronique LE GUERN Grant/research support from: UCB for GR2 study (to our institution)
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Bertolino J, Jouve E, Skopinski S, Agard C, Achille A, Thoreau B, Diot E, Sanges S, Berthier S, Chaigne B, Régent A, Martin T, Pugnet G, Benyamine A, Rossi P, Launay D, Mouthon L, Granel B. Characteristics of patients with systemic sclerosis suffering from a lower limb amputation: Results of a French collaborative study. J Scleroderma Relat Disord 2020; 5:224-230. [PMID: 35382523 DOI: 10.1177/2397198320913689] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 02/16/2020] [Indexed: 11/15/2022]
Abstract
Objective Systemic sclerosis mainly affects the microvascular network. However, macrovascular manifestations have been reported. We aimed to investigate the characteristics of systemic sclerosis patients with an amputation of a lower limb segment. Methods We designed a retrospective, case-control, multicentric study on systemic sclerosis patients with amputation of a lower limb segment secondary to critical ischemia via the French Research Group on Systemic Sclerosis. For each case, a control (systemic sclerosis patient without lower limb symptom) was matched with sex, age (±5 years), and cutaneous subset of systemic sclerosis. Results In total, 26 systemic sclerosis patients (mean age of 67.2 ± 10.9 years, 20 females, 21 limited cutaneous forms) with a lower limb amputation and 26 matched controls (mean age of 67.3 ± 11.2 years, 20 females, 22 limited cutaneous forms) were included. At the time of amputation, the mean disease duration was 12.8 (±8.6) years. In comparison to controls, systemic sclerosis patients with amputation had more digital ulcers (p = 0.048), history of digital ulcers (p = 0.026), and a higher prevalence of pulmonary arterial hypertension (p = 0.024). Systemic sclerosis patients with amputation were more often smokers (p = 0.008) and under corticosteroids (p = 0.015). In the multivariate model, pulmonary arterial hypertension, smoking status, and corticosteroids were independent markers associated with lower limb amputation in systemic sclerosis. In the follow-up, 10 patients (38.5%) had recurrent ischemia requiring a new limb amputation, and five patients (19.2%) had an amputation of the contralateral limb. Conclusion This study identifies some markers associated with lower limb amputation in systemic sclerosis such as digital ulcers and pulmonary arterial hypertension and points out the high risk associated with tobacco consumption and corticosteroid use.
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Affiliation(s)
- Julien Bertolino
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - Elisabeth Jouve
- Medical Evaluation Service, AP-HM, CIC-CPCET, Marseille, France
| | - Sophie Skopinski
- Vascular Medicine Department, Hôpital St André, Bordeaux, France
| | | | | | | | | | - Sebastien Sanges
- University of Lille, U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, CHU Lille, Internal Medicine and Clinical Immunology Department, Lille, France, Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | - Sabine Berthier
- Internal Medicine and Clinical Immunology Department, CHU Dijon, Dijon, France
| | - Benjamin Chaigne
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Alexis Régent
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Thierry Martin
- Clinical Immunology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Gregory Pugnet
- Internal Medicine Department, Hôpital Purpan, CHU Toulouse, Toulouse, France
| | - Audrey Benyamine
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - Pascal Rossi
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
| | - David Launay
- University of Lille, U995-LIRIC-Lille Inflammation Research International Center, INSERM, U995, CHU Lille, Internal Medicine and Clinical Immunology Department, Lille, France, Referral Center for Rare Systemic Autoimmune Diseases North and North-West of France, Lille, France
| | - Luc Mouthon
- Internal Medicine Department, Reference Center for Rare Systemic Autoimmune Diseases of Ile de France, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Brigitte Granel
- Internal Medicine Department, Hôpital Nord, AP-HM, Marseille, France
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Nguyen Y, Pagnoux C, Karras A, Quéméneur T, Maurier F, Hamidou M, Le Quellec A, Chiche NJ, Cohen P, Régent A, Lifermann F, Mékinian A, Khouatra C, Hachulla E, Pourrat J, Ruivard M, Godmer P, Viallard JF, Terrier B, Mouthon L, Guillevin L, Puéchal X. Microscopic polyangiitis: Clinical characteristics and long-term outcomes of 378 patients from the French Vasculitis Study Group Registry. J Autoimmun 2020; 112:102467. [PMID: 32340774 DOI: 10.1016/j.jaut.2020.102467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To describe characteristics and long-term outcomes of patients with microscopic polyangiitis (MPA), an antineutrophil cytoplasm antibody (ANCA)-associated small-vessel necrotizing vasculitis. METHODS MPA patients from the French Vasculitis Study Group Registry satisfying the European Medicines Agency algorithm were analyzed retrospectively. Characteristics at diagnosis, treatments, relapses and deaths were analyzed to identify factors predictive of death or relapse. RESULTS Between 1966 and 2017, 378 MPA patients (median age 63.7 years) were diagnosed and followed for a mean of 5.5 years. At diagnosis, the main clinical manifestations included renal involvement (74%), arthralgias (45%), skin (41%), lung (40%) and mononeuritis multiplex (32%), with less frequent alveolar hemorrhage (16%), cardiomyopathy (5%) and severe gastrointestinal signs (4%); mean serum creatinine was 217 μmol/L. ANCA were detected in 298/347 (86%) patients by immunofluorescence and/or enzyme-linked immunosorbent assay (ELISA). Among the 293 patients with available ELISA specificities, 272 (92.8%) recognized myeloperoxidase and 13 (4.4%) proteinase-3. During follow-up, 131 (34.7%) patients relapsed and 78 (20.6%) died, mainly from infections. Respective 5-year overall and relapse-free survival rates were 84.2% and 60.4%. Multivariable analyses retained age >65 years, creatinine >130 μmol/L, severe gastrointestinal involvement and mononeuritis multiplex as independent risk factors for death. Renal impairment was associated with a lower risk of relapse. CONCLUSION Non-renal manifestations and several risk factors for death or relapse were frequent in this nationwide cohort. While mortality was low, and mainly due to treatment-related complications, relapses remained frequent, suggesting that MPA management can be further improved.
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Affiliation(s)
- Yann Nguyen
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | | | - Alexandre Karras
- Department of Nephrology, Hôpital Européen Georges Pompidou, APHP, Paris, France
| | | | | | | | - Alain Le Quellec
- Department of Internal Medicine, Hôpital Saint-Eloi, CHU, Montpellier, France
| | | | - Pascal Cohen
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Alexis Régent
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | | | - Arsène Mékinian
- Department of Internal Medicine, Hôpital Saint-Antoine, APHP, Paris, France
| | - Chahéra Khouatra
- Department of Respiratory Medicine, National Referral Center for Rare Pulmonary Diseases, Hôpital Louis-Pradel, CHU Lyon, France
| | - Eric Hachulla
- Department of Internal Medicine, National Referral Center for Systemic Sclerosis, CHRU Claude Huriez, Lille, France
| | | | - Marc Ruivard
- Department of Internal Medicine, CHU Estaing, Clermont-Ferrand, France
| | | | | | - Benjamin Terrier
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Luc Mouthon
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France
| | - Xavier Puéchal
- Department of Internal Medicine, National Referral Center for Rare Systemic Autoimmune Diseases, Hôpital Cochin, APHP, Université Paris Descartes, Paris, France.
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Rodriguez-Régent C, Ben Hassen W, Seners P, Oppenheim C, Régent A. 3D T1-weighted black-blood magnetic resonance imaging for the diagnosis of giant cell arteritis. Clin Exp Rheumatol 2020; 38 Suppl 124:95-98. [PMID: 32301421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Imaging techniques have an increasing place in the diagnosis of giant cell arteritis (GCA). Achieving a confident diagnosis of GCA is often challenging and temporal artery biopsy is still considered as the gold standard despite the delayed results. 3T-MRI with 2D sequences has been evaluated for the detection of mural inflammation in extracranial arteries to support the diagnosis of GCA. METHODS We evaluated the diagnostic performance of fat-suppressed 3D T1-weighted black-blood MRI (CUBE T1) with 3D TOF coregistration. RESULTS Thirty-two patients with clinically suspected GCA were included and 10 had a diagnosis of GCA. Sensitivity and specificity of CUBE T1 were 80% and 100% respectively. Therefore, the positive predictive value of post-contrast CUBE T1 was 100% and the negative predictive value was 92%. Intra- and inter-observer agreement for mural enhancement on CUBE T1 was 1 and 0.83, respectively. CONCLUSIONS We demonstrate that CUBE T1 is accurate for the diagnosis of GCA. The reproducibility and short scan duration of the technique support a wider use of MRI in the diagnosis process.
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Affiliation(s)
- Christine Rodriguez-Régent
- Département d'Imagerie, Pôle Neuro Sainte Anne, GHT Paris, Psychiatrie & Neurosciences, Paris, and INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, France
| | - Wagih Ben Hassen
- Département d'Imagerie, Pôle Neuro Sainte Anne, GHT Paris, Psychiatrie & Neurosciences, Paris, and INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris, France
| | - Pierre Seners
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris; Service de Neurologie, Pôle Neuro Sainte Anne, GHT Paris, Psychiatrie & Neurosciences; and Université Paris Descartes, Paris, France
| | - Catherine Oppenheim
- Département d'Imagerie, Pôle Neuro Sainte Anne, GHT Paris, Psychiatrie & Neurosciences, Paris; INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris; and Université Paris Descartes, Paris, France
| | - Alexis Régent
- Université Paris Descartes, and Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Systémiques Rares, Hôpital Cochin, AP-HP, Paris, France.
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Nezam D, Morel P, Faguer S, Karras A, Aniort J, Titeca-Beauport D, Solignac J, Ducloux D, Rafik M, Carron P, Rafat C, Gobert P, Nochy D, Audard V, Maurier F, Martis N, Jourde-Chiche N, Régent A, Guillevin L, Terrier B. Impact de la biopsie rénale pour prédire la réponse aux échanges plasmatiques au cours des vascularites associées aux ANCA. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rodriguez-Regent C, Ben Hassen W, Seners P, Oppenhein C, Régent A. Apport de la séquence 3D T1 haute résolution dans le diagnostic d’artérite à cellules géantes. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Parreau S, Seror R, Terrier B, Burroni B, Jamart C, Régent A, Nocturne G, Mouthon L, Mariette X, Le Guern V. Particularités initiales et évolutives des lymphomes diagnostiqués sur glandes salivaires accessoires au cours du syndrome de Sjögren primitif. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.088] [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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Delaval L, Daumas A, Samson M, Ebbo M, De Boysson H, Liozon E, Dupuy H, Puyade M, Blockmans D, Benhamou Y, Sacré K, Berezne A, Devilliers H, Pugnet G, Maurier F, Zénone T, de Moreuil C, Lifermann F, Arnaud L, Espitia O, Deroux A, Grobost V, Lazaro E, Agard C, Balageas A, Bouiller K, Durel CA, Humbert S, Rieu V, Roriz M, Souchaud-Debouverie O, Vinzio S, Nguyen Y, Régent A, Guillevin L, Terrier B. Large-vessel vasculitis diagnosed between 50 and 60 years: Case-control study based on 183 cases and 183 controls aged over 60 years. Autoimmun Rev 2019; 18:714-720. [PMID: 31059846 DOI: 10.1016/j.autrev.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/11/2019] [Accepted: 02/16/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Age at onset of large-vessel vasculitis (LVV) is commonly used to distinguish giant cell arteritis (GCA) and Takayasu arteritis (TA). However, LVV between age 50 and 60 years may be difficult to classify. METHODS We conducted a retrospective study including LVV aged between 50 and 60 years at onset (LVV50-60, cases) and compared them to LVV aged over 60 years (LVV>60, controls). LVV was defined histologically and/or morphologically. Controls fulfilled ACR 1990 criteria for GCA or presented isolated aortitis. RESULTS We included 183 LVV50-60 and 183 gender-matched LVV>60. LVV50-60 had more frequent peripheral limb manifestations (23 vs. 5%), and less frequent cephalic (73 vs. 90%) and ocular signs (17 vs. 27%) than LVV>60. Compared to LVV>60, CT angiography and PET/CT scan were more frequently abnormal in LVV50-60 (74 vs. 38%, and 90 vs. 72%, respectively), with aorta being more frequently involved (78 vs. 47%). By multivariate analysis, absence of cephalic symptoms, presence of peripheral limb ischemia and aorta involvement, and increased CRP level were significantly associated with LVV50-60 presentation compared to LVV>60. At last follow-up, compared to LVV>60, LVV50-60 received significantly more lines of treatment (2 vs. 1), more frequent biologics (12 vs. 3%), had more surgery (10 vs. 0%), and had higher prednisone dose (8.8 vs. 6.5 mg/d) at last follow-up, CONCLUSION: LVV onset between 50 and 60 years identifies a subset of patients with more frequent aorta and peripheral vascular involvement and more refractory disease compared to patients with LVV onset after 60.
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Affiliation(s)
- Laure Delaval
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Aurélie Daumas
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Mikael Ebbo
- Department of Internal Medecine, La Timone University Hospital, Marseille, France
| | - Hubert De Boysson
- Department of Internal Medecine, Caen University Hospital, University of Caen-Basse Normandie, France
| | - Eric Liozon
- Department of Internal Medecine, Limoges University Hospital, France
| | - Henry Dupuy
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Mathieu Puyade
- Department of Internal Medicine, University Hospital of Poitiers, Poitiers, France
| | - Daniel Blockmans
- Clinical department of general internal medicine department, University Hospitals Leuven, Belgium
| | - Ygal Benhamou
- Department of Internal Medecine, 1 rue de Germont, Rouen, France
| | - Karim Sacré
- Department of Internal Medecine, Bichat Hospital, Paris, France
| | - Alice Berezne
- Department of Internal Medecine, CHR Annecy-Genevois, Annecy, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Diseases, CHU Dijon Bourgogne, Inserm CIC 1432, Clinical Epidemiology Unit, Dijon, France
| | - Grégory Pugnet
- Department of Internal Medecine, CHU de Toulouse, UMR 1027 Inserm-Université de Toulouse, France
| | - François Maurier
- Department of Internal Medicine, Hôpital Belle Isle, Metz, France
| | - Thierry Zénone
- Internal Medicine Department, Valence Hospital, Valence, France
| | - Claire de Moreuil
- Department of Internal Medecine and pneumology, CHU Brest, La Cavale Blanche Hospital, Brest Cedex, France
| | | | - Laurent Arnaud
- Department of Rheumatology, CHU Strasbourg, INSERM UMR-S1109, RESO, Strasbourg University, F-67000 Strasbourg, France
| | - Olivier Espitia
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | - Alban Deroux
- Grenoble University Hospital, Division of Internal Medicine, Grenoble F-38043, France
| | - Vincent Grobost
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Christian Agard
- Department of Internal Medicine, Nantes University Hospital, Nantes, France
| | | | - Kevin Bouiller
- Department of internal medicine, CHU Jean Minjoz, Besancon, France
| | | | | | - Virginie Rieu
- Internal Medicine Department, University Hospital, Clermont-Ferrand, France
| | - Mélanie Roriz
- Department of Internal Medicine, Hôpital Lariboisière, Paris, France
| | | | - Stéphane Vinzio
- Department of Internal Medicine Groupe Hospitalier Mutualiste of Grenoble, Grenoble, France
| | - Yann Nguyen
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Alexis Régent
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Loïc Guillevin
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France
| | - Benjamin Terrier
- National Referral Center for Rare Autoimmune and Systemic Diseases, Hopital Cochin, AP-HP, Université Paris Descartes, Paris, France.
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