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2.
Bull Acad Natl Med ; 190(1): 123-34; discussion 135-7, 2006 Jan.
Article in French | MEDLINE | ID: mdl-16878450

ABSTRACT

Hepatitis C virus (HCV) is the leading cause of chronic liver disease in industrialized countries. HCV also causes a variety of extrahepatic disorders, of which systemic vasculitis, of the cryoglobulin or polyarteritis nodosa type, is the most severe. This article reviews the main diagnostic, pathophysiologic and therapeutic aspects of HCV-induced systemic vasculitis.


Subject(s)
Cryoglobulinemia/virology , Hepatitis C, Chronic/complications , Vasculitis/virology , Cryoglobulinemia/physiopathology , Humans , Vasculitis/diagnosis , Vasculitis/physiopathology
3.
Medicine (Baltimore) ; 83(6): 315-334, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15525844

ABSTRACT

This retrospective study concerned 18 female and 23 male patients with cardiac sarcoidosis (CS). The average age at CS diagnosis was 38 years. CS was observed in white (73% of cases) and in black or Caribbean patients (27% of cases). All patients had extracardiac histologic proof of sarcoid tissue. In 63% of cases, the CS arose during the follow-up of systemic sarcoidosis. Systemic sarcoidosis was not specific except for a high frequency of neurosarcoidosis. Revealing cardiac signs were clinical in 63% of cases and electrical in 22%. In most patients these signs were associated with an abnormal echocardiography (77%) and/or a defect on thallium-201 or sestamibi imaging (75%). Thirty-nine patients received steroid therapy (initial dose mostly equal to 1 mg/kg per day), associated in 13 cases with another immunosuppressive treatment. In 26% of cases the immunosuppressive treatment was associated with a specific cardiac treatment. In the long-term follow-up (average follow-up, 58 mo), 87% of the cases showed an improvement, and 54% were cured from a clinical and laboratory point of view (electrocardiogram, 24-hour monitoring, echocardiography, radionuclide imaging). There was no sudden death. Two patients worsened, which can be explained in 1 case by very late treatment and in the other case by lack of treatment, except for a pacemaker. Our experience leads us to treat CS with corticosteroids as soon as possible and to use another immunosuppressive treatment where there is an insufficient therapeutic response or where there are contraindications to corticosteroids.


Subject(s)
Cardiomyopathies/diagnosis , Cardiomyopathies/drug therapy , Sarcoidosis/diagnosis , Sarcoidosis/drug therapy , Adolescent , Adult , Aged , Alkaline Phosphatase/blood , Biopsy , Black People/statistics & numerical data , Blood Cell Count , Blood Sedimentation , Cardiomyopathies/classification , Cardiovascular Agents/therapeutic use , Echocardiography , Electrocardiography , Female , Humans , Hypercalcemia/etiology , Hypercalcemia/urine , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Peptidyl-Dipeptidase A/blood , Retrospective Studies , Treatment Outcome , White People/statistics & numerical data
4.
Medicine (Baltimore) ; 83(6): 348-359, 2004 Nov.
Article in English | MEDLINE | ID: mdl-15525847

ABSTRACT

Systemic lupus erythematosus (SLE) is uncommon after the age of 50 years, and studies of elderly patients with SLE are scarce. We conducted the current study to analyze characteristics and outcome of patients with late-onset SLE in a French tertiary referral center, and to compare them with those of younger patients with SLE. From 1980 to 2000, 47 patients were identified as having late-onset SLE, defined as SLE diagnosed at or over the age of 50 years. These patients were compared with a group of 114 randomly selected patients aged younger than 50 years at SLE diagnosis. We compared clinical characteristics, laboratory data, therapy, and course. The female to male ratio was smaller in the late-onset SLE group (p = 0.0012). Some manifestations occurred less frequently in late-onset SLE: arthritis (p = 0.009), malar rash (p = 0.013), and nephropathy (p = 0.009). High-dose corticosteroids (p = 0.0016) and immunosuppressive drugs (p = 0.006) were less commonly used in the elderly. Deaths occurred more frequently in late-onset SLE (p = 0.019), with a 10-year survival rate of 71% versus 95% in early-onset SLE (p < 0.01). In patients with late-onset SLE, causes of death were usually unrelated to SLE. Analysis of pooled data from the literature, based on 714 old and 4700 young SLE patients, confirmed that late-onset SLE was characterized by a smaller female to male ratio (4.4:1 vs. 10.6:1; p = 3.10); a higher occurrence of serositis (36.7% vs. 28.6%; p = 7.10) and pulmonary involvement (21.2% vs. 11.3%; p = 6.10); and a lower occurrence of malar rash (31.1% vs. 62.4%; p = 10), photosensitivity (26.2% vs. 38.2%; p = 6.10), purpura/cutaneous vasculitis (13.4% vs. 25.9%; p = 9.10), alopecia/hair loss (24% vs. 44.9%; p = 3.10), Raynaud phenomenon (24.8% vs. 37.2%; p = 3.10), neuropsychiatric manifestations (15.3% vs. 20.2%; p = 0.025), lymphadenopathy (9.1% vs. 19.6%; p = 2.10), nephrotic syndrome (8.1% vs. 24.3%; p = 0.015), and nephritis (28.6% vs. 42.7%; p = 2.10). Regarding laboratory features, rheumatoid factor positivity was more frequent (32.7% vs. 20.1%; p = 3.10), whereas anti-RNP positivity (10.4% vs. 20.9%; p = 9.10), anti-Sm positivity (9.1% vs. 17.1%; p = 0.001), and a low CH50 complement fraction (45% vs. 64.9%; p = 0.002) were less frequent in old compared with young SLE patients. In conclusion, the clinical pattern of late-onset SLE is characterized by a lower disease severity. The reduced survival observed in this group seems to result mainly from the consequences of aging.


Subject(s)
Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/mortality , Adolescent , Adrenal Cortex Hormones/therapeutic use , Adult , Age of Onset , Aged , Antirheumatic Agents/therapeutic use , Child , Child, Preschool , Female , France/epidemiology , Humans , Hydroxychloroquine/therapeutic use , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/drug therapy , Male , Middle Aged , Sex Distribution , Survival Rate
5.
J Rheumatol ; 29(9): 1897-906, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12233884

ABSTRACT

OBJECTIVE: To develop diagnostic imaging criteria for polymyositis (PM) and sporadic inclusion body myositis (sIBM). METHODS: We investigated 220 patients with suspected inflammatory myopathies by magnetic resonance imaging (MRI). Findings were compared with the results of clinical and biological examinations and muscle biopsy. PM and IBM were diagnosed in 25 patients each. Quantitative and qualitative MRI analysis of the 3 muscle groups of the 2 thighs included fatty infiltration, atrophy, inflammation, and the type and distribution of the lesions. RESULTS: MRI was abnormal in all patients. Fatty infiltration and atrophy were more frequent in patients with sIBM (p < 0.05). Inflammation as the sole abnormality was preferentially encountered in PM (p = 0.05). Widespread abnormalities were more frequent in sIBM (p < 0.01). Abnormalities in PM tended to be distributed along the fascia. Involvement of the anterior group, an asymmetrical distribution, and a distal predominance were all more frequent in sIBM (p < 0.001). CONCLUSION: Despite some overlap in MRI findings between the 2 diseases, MRI was useful for distinguishing PM from sIBM.


Subject(s)
Magnetic Resonance Imaging , Myositis, Inclusion Body/pathology , Polymyositis/pathology , Adult , Aged , Biopsy, Needle , Chi-Square Distribution , Cohort Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Myositis, Inclusion Body/diagnosis , Polymyositis/diagnosis , Probability , Prospective Studies , Sensitivity and Specificity , Severity of Illness Index , Statistics, Nonparametric
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