ObjectiveTo assess the effect of a weather index on in-hospital COVID-19-linked deaths.DesignEcol... more ObjectiveTo assess the effect of a weather index on in-hospital COVID-19-linked deaths.DesignEcological study.SettingContinental France administrative areas (départements; henceforth counties). The study period, from 18 March to 30 May 2020, corresponds to the main first outbreak period in France.PopulationCOVID-19-linked in-hospital deaths.Main outcome measuresIn-hospital deaths and demographics (population, human density, male sex and population percentage >59 years old) were obtained from national and centralised public databases. County weather indexes were calculated by the French National Meteorological Agency.MethodsIn this observational ecological study, the relationship between in-hospital COVID-19-related mortality and climate zones in continental French counties were analysed, by comparing the cumulative in-hospital death tolls in France by county to other factors (population density, climate, age and sex). The study period lasted from 18 March to 30 May 2020. A multiv...
BackgroundSchnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticari... more BackgroundSchnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticarial exanthema, bone and joint alterations, fever and monoclonal IgM gammopathy. Overactivation of the interleukin(IL)-1 system is reported, even though the exact pathophysiological pathways remain unknown.ObjectiveTo determine ex vivo cytokine profiles of Peripheral Blood Mononuclear Cells (PBMCs) from SchS patients prior to treatment and after initiation of anti-IL-1 therapy (anakinra). The sera cytokine profile was studied in parallel.MethodsWe collected blood samples from thirty-six untreated or treated SchS. PBMCs were cultured with and without LPS or anti-CD3/CD28. Cytokine levels were evaluated in serum and cell culture supernatants using Luminex technology.ResultsSpontaneous TNFα, IL-6, IL-1β, IL-1α, and IL-1RA release by PBMCs of SchS patients were higher than in controls. LPS-stimulation further induced the secretion of these cytokines. In contrast, after T-cell stimulation, TNFα...
OBJECTIVE To study the effect of weather on severity indicators of coronavirus disease 2019 (covi... more OBJECTIVE To study the effect of weather on severity indicators of coronavirus disease 2019 (covid-19). DESIGN Ecological study. SETTING Paris region. POPULATION Severely ill patients with covid-19. MAIN OUTCOME MEASURES Daily covid-19-related intensive care unit (ICU) admission and in-hospital deaths in the Paris region, and the daily weather characteristics of Paris midtown. RESULTS Daily ICU admissions and in-hospital deaths were strongly and negatively correlated to ambient temperatures, with a time lag. The highest Pearson correlation coefficients and statistically significant P values were found 8 days before occurrence of ICU admissions and 15 days before deaths. CONCLUSIONS The study findings show a strong effect of previously observed ambient temperature that has an effect on severity indicators of covid-19.
Les vascularites systémiques associées aux ANCA (Antibodies to Neutrophil Cytoplasmic Antigens) c... more Les vascularites systémiques associées aux ANCA (Antibodies to Neutrophil Cytoplasmic Antigens) comprennent la maladie de Wegener (WG), la polyangéite microscopique (PAM), la forme limitée au rein (RLV ou Renal-Limited Vasculitis) et l’angéite de Churg et Strauss (CSS). Histologiquement, ces affections ont en commun une atteinte vasculaire nécrosante et focale des petits vaisseaux, artérioles, veinules et capillaires. L’atteinte rénale se présente habituellement sous la forme d’une glomérulonéphrite nécrosante pauci-immune. Concernant plus de 70 p. 100 des patients, cette atteinte rénale est un élément essentiel dans la décision et la stratégie thérapeutiques des vascularites associées aux ANCA (AAV). Avant l’ère des traitements immunosuppresseurs, la mortalité à 2 ans des vascularites atteignait 80 p. 100. Si l’introduction des corticoïdes a permis d’améliorer le pronostic, la mortalité sous ce seul traitement reste néanmoins élevée, de 50 p. 100 à 5 ans, et l’évolution est émaillée de nombreuses rechutes. L’association depuis plus de 30 ans aux corticoïdes du cyclophosphamide a complètement transformé le pronostic des AAV, dont la survie à 5 ans est actuellement proche de 80 p. 100 [1, 2]. Au cours de ces dernières années, la publication des résultats d’essais cliniques établis par des groupes internationaux d’experts (EUVAS, GFEV) a contribué à
Introduction Les resultats de l’etude randomisee controlee WEGENT ont demontre, a 28 mois, que le... more Introduction Les resultats de l’etude randomisee controlee WEGENT ont demontre, a 28 mois, que le methotrexate (MTX) est aussi efficace que l’azathioprine (AZA) pour maintenir la remission au cours de la granulomatose avec polyangeite (Wegener) (GPA) et de la polyangeite microscopique (PAM) severe [1] . Cette nouvelle etude propose d’analyser le suivi a long terme des patients inclus dans l’etude WEGENT. Patients et methodes Le suivi a long terme des 126 patients inclus dans l’essai WEGENT entre 1999 et 2004 a ete analyse. Les donnees de survie, d’utilisation d’immunosuppresseurs, de rechutes, cancers, infections et la morbidite cardiovasculaire ont ete recueillies. Les patients ont ete analyses selon leur groupe de randomisation. Les parametres demographiques, cliniques, et biologiques a l’inclusion ont ete evalues afin de determiner s’ils etaient des facteurs pronostiques de deces ou de rechute en analyse multivariee. Resultats Le suivi median est de 11,8 ans. La survie globale a 10 ans est de 74,8 % [IC 95 %, 64,5–86,9] pour le bras AZA et 79,9 % [IC 95 %, 70,3–90,7] pour le bras MTX, sans difference significative (HR MTX vs AZA = 0,79 [IC 95 %, 0,37–1,70] ; p = 0,55). Il n’y a pas de difference a long terme entre les deux bras pour la frequence des effets indesirables, des effets indesirables severes, des infections, des cancers, le taux de rechute et le taux de rechute severe. La survie sans rechute a 10 ans est de 26,3 % [IC 95 %, 17,3–40,1] sous AZA et 35,1 % [IC 95 %, 24,9-49,4] sous MTX, sans difference significative entre les deux (HR MTX vs AZA = 0,78 [IC 95 %, 0,51–1,20] ; p = 0,26). De meme, la survie a 10 ans sans effet indesirable severe est comparable entre les deux groupes (HR MTX vs AZA = 1,02 [IC 95 %, 0,64–1,63] ; p = 0,93), comme la survie sans rechute ni effet indesirable severe (HR MTX vs AZA = 1,04 [IC 95 %, 0,66–1,63] ; p = 0,87). En restreignant l’analyse aux 97 patients atteints de GPA, aucune difference n’est constatee pour les parametres de survie entre les deux bras. La survie sans rechute est moindre dans le groupe des patients atteints de GPA par rapport a ceux atteints de PAM (HR 2,16 [IC 95 %, 1,22–3,83] ; p = 0,009). Les analyses multivariees ont retenu la dose de prednisone a la fin du traitement d’entretien de 1 an (HR 1,18 [IC 95 %, 1,09–1,29] ; p Conclusion Cette analyse a long terme confirme que l’AZA et le MTX representent deux alternatives therapeutiques comparables pour maintenir la remission au cours de la GPA et de la PAM. Si la survie globale est acceptable, les rechutes et les effets indesirables restent frequents. Des alternatives therapeutiques sont necessaires pour reduire le taux de rechute a long terme des vascularites associees aux ANCA.
Presse médicale (Paris, France : 1983), Jan 16, 1999
Side-effects, including autoimmune disorders, are frequent with D-penicillamine therapy. Proteinu... more Side-effects, including autoimmune disorders, are frequent with D-penicillamine therapy. Proteinuria is observed in 10% of the patients, often secondary to extramembranous glomerulopathy. Necrotizing extracapillary glomerulonephritis is however exceptional. Two patients with systemic sclerodermia were treated with D-penicillamine for 7 and 14 years. Both developed necrotizing extracapillary glomerulonephritis with anti-myeloperoxidase antibodies (anti-MPO), associated with hemorrhagic alveolitis in one case. Partial regression of the renal failure was obtained after withdrawal of D-penicillamine and combination treatment with prednisone and cyclophosphamide. Extracapillary glomerulonephritis or a lung-kidney syndrome are frequently associated with anti-MPO antineutrophil cytoplasm antibodies (ANCA). In systemic sclerodermia, the presence of anti-MPO appears to define a group of patients at risk of pauci-immune extracapillary glomerulonephritis or a lung-kidney syndrome. In addition,...
Background: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, ... more Background: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophilmediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. Methods: This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenstr€ om disease, and 10 with chronic spontaneous urticaria. Results: All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. Conclusion: Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations. Schnitzler syndrome was first described in 1972 by a French dermatologist, Liliane Schnitzler (1). Its main features include urticarial rash, recurrent fever, bone or joint pain, monoclonal IgM or rarely IgG gammopathy, and elevated acute-phase reactants such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). The first cases were described in Europe, but now, Schnitzler syndrome has been reported all over the world including Japan (2) and Australia
Introduction. -Myalgies et rhabdomyolyse sont des effets secondaires rares, dose-dépendants des t... more Introduction. -Myalgies et rhabdomyolyse sont des effets secondaires rares, dose-dépendants des traitements par statines et fibrates dont l'évolution est généralement favorable après l'arrêt du traitement en cause. Récemment, la survenue de maladies auto-immunes sous statines et fibrates a été rapportée. Au sein de ce groupe hétérogène, moins de dix cas de dermatomyosites ou polymyosites ont été décrits. Nous en rapportons cinq autres.
Arthritis & rheumatology (Hoboken, N.J.), Jan 16, 2015
The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could e... more The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm difference...
Arthritis & rheumatology (Hoboken, N.J.), Jan 16, 2015
The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could e... more The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm difference...
Communications orales / La Revue de médecine interne 30 (2009) S36-S76 tance, le viol, la toxicom... more Communications orales / La Revue de médecine interne 30 (2009) S36-S76 tance, le viol, la toxicomanie, la tentative de suicide, l'IVG, n'influençaient pas le portage. Quatre-vingt-quatre pour cent des BU− étaient corrélées à une PCR C.T−. Dix-neuf pour cent des BU+ à une PCR C.T+. En RL : plaintes somatiques (OR : 4,35), > 1 partenaire sexuel (OR : 2,27), temps entre PR et premier RS > 5 ans (OR : 1,33). Le sur-risque d'être porteur de C.T avec RS protégés et symptômes était 5,6. Celui d'être porteur avec RS protégés sans symptôme était 0,36. Après traitement, 47 % étaient PCR−, 11 % PCR+ et 42 % perdues de vue. Tous les partenaires masculins ont été dépistés porteurs de C.T et ont été traités. Discussion.-La prévalence du portage à C.T situe notre population dans une tranche dite « à risque » avec peu d'hommes dépistés. Les signes cliniques et le nombre de partenaires dès le début de la vie sexuelle sont les indices les plus performants pour dépister le portage. Après traitement 11 % des patientes étaient PCR+ (recontamination ou échec thérapeutique) comparable à celui de la littérature. Conclusion.-Dans notre population, la prévalence du portage à C.T est élevée. Un dépistage efficace chez les filles doit commencer par rechercher le nombre de partenaires dès le début de la vie sexuelle et l'existence de douleurs abdominales chroniques et/ou de pertes inhabituelles. Après un premier dépistage positif, nous recommandons de répéter l'examen 2 fois par an y compris chez les patientes devenues PCR−.
ObjectiveTo assess the effect of a weather index on in-hospital COVID-19-linked deaths.DesignEcol... more ObjectiveTo assess the effect of a weather index on in-hospital COVID-19-linked deaths.DesignEcological study.SettingContinental France administrative areas (départements; henceforth counties). The study period, from 18 March to 30 May 2020, corresponds to the main first outbreak period in France.PopulationCOVID-19-linked in-hospital deaths.Main outcome measuresIn-hospital deaths and demographics (population, human density, male sex and population percentage >59 years old) were obtained from national and centralised public databases. County weather indexes were calculated by the French National Meteorological Agency.MethodsIn this observational ecological study, the relationship between in-hospital COVID-19-related mortality and climate zones in continental French counties were analysed, by comparing the cumulative in-hospital death tolls in France by county to other factors (population density, climate, age and sex). The study period lasted from 18 March to 30 May 2020. A multiv...
BackgroundSchnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticari... more BackgroundSchnitzler syndrome (SchS) is a rare autoinflammatory disease characterized by urticarial exanthema, bone and joint alterations, fever and monoclonal IgM gammopathy. Overactivation of the interleukin(IL)-1 system is reported, even though the exact pathophysiological pathways remain unknown.ObjectiveTo determine ex vivo cytokine profiles of Peripheral Blood Mononuclear Cells (PBMCs) from SchS patients prior to treatment and after initiation of anti-IL-1 therapy (anakinra). The sera cytokine profile was studied in parallel.MethodsWe collected blood samples from thirty-six untreated or treated SchS. PBMCs were cultured with and without LPS or anti-CD3/CD28. Cytokine levels were evaluated in serum and cell culture supernatants using Luminex technology.ResultsSpontaneous TNFα, IL-6, IL-1β, IL-1α, and IL-1RA release by PBMCs of SchS patients were higher than in controls. LPS-stimulation further induced the secretion of these cytokines. In contrast, after T-cell stimulation, TNFα...
OBJECTIVE To study the effect of weather on severity indicators of coronavirus disease 2019 (covi... more OBJECTIVE To study the effect of weather on severity indicators of coronavirus disease 2019 (covid-19). DESIGN Ecological study. SETTING Paris region. POPULATION Severely ill patients with covid-19. MAIN OUTCOME MEASURES Daily covid-19-related intensive care unit (ICU) admission and in-hospital deaths in the Paris region, and the daily weather characteristics of Paris midtown. RESULTS Daily ICU admissions and in-hospital deaths were strongly and negatively correlated to ambient temperatures, with a time lag. The highest Pearson correlation coefficients and statistically significant P values were found 8 days before occurrence of ICU admissions and 15 days before deaths. CONCLUSIONS The study findings show a strong effect of previously observed ambient temperature that has an effect on severity indicators of covid-19.
Les vascularites systémiques associées aux ANCA (Antibodies to Neutrophil Cytoplasmic Antigens) c... more Les vascularites systémiques associées aux ANCA (Antibodies to Neutrophil Cytoplasmic Antigens) comprennent la maladie de Wegener (WG), la polyangéite microscopique (PAM), la forme limitée au rein (RLV ou Renal-Limited Vasculitis) et l’angéite de Churg et Strauss (CSS). Histologiquement, ces affections ont en commun une atteinte vasculaire nécrosante et focale des petits vaisseaux, artérioles, veinules et capillaires. L’atteinte rénale se présente habituellement sous la forme d’une glomérulonéphrite nécrosante pauci-immune. Concernant plus de 70 p. 100 des patients, cette atteinte rénale est un élément essentiel dans la décision et la stratégie thérapeutiques des vascularites associées aux ANCA (AAV). Avant l’ère des traitements immunosuppresseurs, la mortalité à 2 ans des vascularites atteignait 80 p. 100. Si l’introduction des corticoïdes a permis d’améliorer le pronostic, la mortalité sous ce seul traitement reste néanmoins élevée, de 50 p. 100 à 5 ans, et l’évolution est émaillée de nombreuses rechutes. L’association depuis plus de 30 ans aux corticoïdes du cyclophosphamide a complètement transformé le pronostic des AAV, dont la survie à 5 ans est actuellement proche de 80 p. 100 [1, 2]. Au cours de ces dernières années, la publication des résultats d’essais cliniques établis par des groupes internationaux d’experts (EUVAS, GFEV) a contribué à
Introduction Les resultats de l’etude randomisee controlee WEGENT ont demontre, a 28 mois, que le... more Introduction Les resultats de l’etude randomisee controlee WEGENT ont demontre, a 28 mois, que le methotrexate (MTX) est aussi efficace que l’azathioprine (AZA) pour maintenir la remission au cours de la granulomatose avec polyangeite (Wegener) (GPA) et de la polyangeite microscopique (PAM) severe [1] . Cette nouvelle etude propose d’analyser le suivi a long terme des patients inclus dans l’etude WEGENT. Patients et methodes Le suivi a long terme des 126 patients inclus dans l’essai WEGENT entre 1999 et 2004 a ete analyse. Les donnees de survie, d’utilisation d’immunosuppresseurs, de rechutes, cancers, infections et la morbidite cardiovasculaire ont ete recueillies. Les patients ont ete analyses selon leur groupe de randomisation. Les parametres demographiques, cliniques, et biologiques a l’inclusion ont ete evalues afin de determiner s’ils etaient des facteurs pronostiques de deces ou de rechute en analyse multivariee. Resultats Le suivi median est de 11,8 ans. La survie globale a 10 ans est de 74,8 % [IC 95 %, 64,5–86,9] pour le bras AZA et 79,9 % [IC 95 %, 70,3–90,7] pour le bras MTX, sans difference significative (HR MTX vs AZA = 0,79 [IC 95 %, 0,37–1,70] ; p = 0,55). Il n’y a pas de difference a long terme entre les deux bras pour la frequence des effets indesirables, des effets indesirables severes, des infections, des cancers, le taux de rechute et le taux de rechute severe. La survie sans rechute a 10 ans est de 26,3 % [IC 95 %, 17,3–40,1] sous AZA et 35,1 % [IC 95 %, 24,9-49,4] sous MTX, sans difference significative entre les deux (HR MTX vs AZA = 0,78 [IC 95 %, 0,51–1,20] ; p = 0,26). De meme, la survie a 10 ans sans effet indesirable severe est comparable entre les deux groupes (HR MTX vs AZA = 1,02 [IC 95 %, 0,64–1,63] ; p = 0,93), comme la survie sans rechute ni effet indesirable severe (HR MTX vs AZA = 1,04 [IC 95 %, 0,66–1,63] ; p = 0,87). En restreignant l’analyse aux 97 patients atteints de GPA, aucune difference n’est constatee pour les parametres de survie entre les deux bras. La survie sans rechute est moindre dans le groupe des patients atteints de GPA par rapport a ceux atteints de PAM (HR 2,16 [IC 95 %, 1,22–3,83] ; p = 0,009). Les analyses multivariees ont retenu la dose de prednisone a la fin du traitement d’entretien de 1 an (HR 1,18 [IC 95 %, 1,09–1,29] ; p Conclusion Cette analyse a long terme confirme que l’AZA et le MTX representent deux alternatives therapeutiques comparables pour maintenir la remission au cours de la GPA et de la PAM. Si la survie globale est acceptable, les rechutes et les effets indesirables restent frequents. Des alternatives therapeutiques sont necessaires pour reduire le taux de rechute a long terme des vascularites associees aux ANCA.
Presse médicale (Paris, France : 1983), Jan 16, 1999
Side-effects, including autoimmune disorders, are frequent with D-penicillamine therapy. Proteinu... more Side-effects, including autoimmune disorders, are frequent with D-penicillamine therapy. Proteinuria is observed in 10% of the patients, often secondary to extramembranous glomerulopathy. Necrotizing extracapillary glomerulonephritis is however exceptional. Two patients with systemic sclerodermia were treated with D-penicillamine for 7 and 14 years. Both developed necrotizing extracapillary glomerulonephritis with anti-myeloperoxidase antibodies (anti-MPO), associated with hemorrhagic alveolitis in one case. Partial regression of the renal failure was obtained after withdrawal of D-penicillamine and combination treatment with prednisone and cyclophosphamide. Extracapillary glomerulonephritis or a lung-kidney syndrome are frequently associated with anti-MPO antineutrophil cytoplasm antibodies (ANCA). In systemic sclerodermia, the presence of anti-MPO appears to define a group of patients at risk of pauci-immune extracapillary glomerulonephritis or a lung-kidney syndrome. In addition,...
Background: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, ... more Background: Schnitzler syndrome is characterized by an urticarial rash, a monoclonal gammopathy, and clinical, histological, and biological signs of neutrophilmediated inflammation. The aim of this study was to assess the applicability and validity of the existing diagnostic criteria in real-life patients. Methods: This multicentric study was conducted between 2009 and 2014 in 14 hospitals in which patients with Schnitzler syndrome or controls with related disorders were followed up. We compared the sensitivities and specificities and calculated the positive and negative predictive values of the Lipsker and of the Strasbourg criteria for the patients with Schnitzler syndrome and for the controls. We included 42 patients with Schnitzler syndrome, 12 with adult-onset Still's disease, 7 with cryopyrin-associated periodic disease, 9 with Waldenstr€ om disease, and 10 with chronic spontaneous urticaria. Results: All patients with Schnitzler syndrome met the Lipsker criteria. According to the Strasbourg criteria, 34 patients had definite Schnitzler syndrome, five had probable Schnitzler syndrome, and three did not meet the criteria. One control met the Lipsker criteria and had probable Schnitzler syndrome according to the Strasbourg criteria. Sensitivity and specificity of the Lipsker criteria were 100% and 97%, respectively. For the Strasbourg criteria, sensitivity for definite and probable diagnosis was 81% and 93%, respectively, with a corresponding specificity of 100% and 97%. Conclusion: Diagnostic criteria currently in use to diagnose Schnitzler syndrome are reliable. More investigations must be done to attest their efficiency in patients with recent-onset manifestations. Schnitzler syndrome was first described in 1972 by a French dermatologist, Liliane Schnitzler (1). Its main features include urticarial rash, recurrent fever, bone or joint pain, monoclonal IgM or rarely IgG gammopathy, and elevated acute-phase reactants such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). The first cases were described in Europe, but now, Schnitzler syndrome has been reported all over the world including Japan (2) and Australia
Introduction. -Myalgies et rhabdomyolyse sont des effets secondaires rares, dose-dépendants des t... more Introduction. -Myalgies et rhabdomyolyse sont des effets secondaires rares, dose-dépendants des traitements par statines et fibrates dont l'évolution est généralement favorable après l'arrêt du traitement en cause. Récemment, la survenue de maladies auto-immunes sous statines et fibrates a été rapportée. Au sein de ce groupe hétérogène, moins de dix cas de dermatomyosites ou polymyosites ont été décrits. Nous en rapportons cinq autres.
Arthritis & rheumatology (Hoboken, N.J.), Jan 16, 2015
The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could e... more The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm difference...
Arthritis & rheumatology (Hoboken, N.J.), Jan 16, 2015
The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could e... more The WEGENT trial and other short-term studies suggested that azathioprine or methotrexate could effectively maintain granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) remission. Whether differences in relapse or adverse event rates would appear after discontinuation of those 2 maintenance regimens and longer follow-up remains unknown. Long-term outcomes for the patients enrolled in the WEGENT trial were analyzed according to their randomization group. Parameters at trial entry were evaluated as potential prognostic factors for death, relapse or damage in multivariate models. Data were returned for 88.8% of the 126 original participants. Median [95% confidence interval] followup was 11.9 [11.3-12.5] years. For the azathioprine and methotrexate arms, respectively, the 10-year overall survival rates were 75.1% [64.8-86.9] and 79.9% [70.3-90.8] (P = 0.56), and relapse-free survival rates 26.3% [17.3-40.1] and 33.5% [23.5-47.7] (P = 0.29). No between-arm difference...
Communications orales / La Revue de médecine interne 30 (2009) S36-S76 tance, le viol, la toxicom... more Communications orales / La Revue de médecine interne 30 (2009) S36-S76 tance, le viol, la toxicomanie, la tentative de suicide, l'IVG, n'influençaient pas le portage. Quatre-vingt-quatre pour cent des BU− étaient corrélées à une PCR C.T−. Dix-neuf pour cent des BU+ à une PCR C.T+. En RL : plaintes somatiques (OR : 4,35), > 1 partenaire sexuel (OR : 2,27), temps entre PR et premier RS > 5 ans (OR : 1,33). Le sur-risque d'être porteur de C.T avec RS protégés et symptômes était 5,6. Celui d'être porteur avec RS protégés sans symptôme était 0,36. Après traitement, 47 % étaient PCR−, 11 % PCR+ et 42 % perdues de vue. Tous les partenaires masculins ont été dépistés porteurs de C.T et ont été traités. Discussion.-La prévalence du portage à C.T situe notre population dans une tranche dite « à risque » avec peu d'hommes dépistés. Les signes cliniques et le nombre de partenaires dès le début de la vie sexuelle sont les indices les plus performants pour dépister le portage. Après traitement 11 % des patientes étaient PCR+ (recontamination ou échec thérapeutique) comparable à celui de la littérature. Conclusion.-Dans notre population, la prévalence du portage à C.T est élevée. Un dépistage efficace chez les filles doit commencer par rechercher le nombre de partenaires dès le début de la vie sexuelle et l'existence de douleurs abdominales chroniques et/ou de pertes inhabituelles. Après un premier dépistage positif, nous recommandons de répéter l'examen 2 fois par an y compris chez les patientes devenues PCR−.
Uploads
Papers by Xavier Kyndt