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3.
Diagn Interv Imaging ; 93(9): 711-22, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22925594

RESUMO

Spinal injections must be carried out adhering to very strict conditions. However, these procedures have almost come to be seen as everyday and may be practised under quite questionable conditions. The recent reports of new and extremely serious neurological complications have changed the attitudes of those making referrals as well as the attitudes of the interventional radiologists carrying out these procedures. The range of indications for transforaminal injections has shrunk in favour of epidural injections. Where the transforaminal approach is still used, the needle must be positioned extremely accurately. A prior radioopaque contrast medium injection is essential from a safety perspective. The transforaminal epidural injection via the transfacet approach looks to be a promising alternative that is strictly avascular.


Assuntos
Injeções Espinhais/métodos , Dor/tratamento farmacológico , Raízes Nervosas Espinhais , Humanos
4.
Rheumatology (Oxford) ; 46(4): 695-8, 2007 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-17158212

RESUMO

OBJECTIVES: Anti-tumour necrosis factor (TNF)-alpha therapies are considered category B drugs for pregnancy. Although sometimes prescribed to women of reproductive age, data in humans are limited with regard to safety for a developing fetus. The objectives of the present article are to report experience of anti-TNF-alpha use in pregnancy, and review the international literature. METHODS: Since 1999 the present authors have used anti-TNF-alpha (infliximab, etanercept, adalimumab) to treat patients with various chronic rheumatic conditions. All patients were prospectively followed during their treatment time and data were systematically collected. RESULTS: In a group of 442 patients treated with anti-TNF, three women with RA unexpectedly became pregnant One treated with etanercept chose a therapeutic termination at two and a half months, despite of any ultrasound anomaly, and satisfactory fetal growth. The other two patients (one with adalimumab exposure and one with etanercept exposure) delivered healthy infants. The following perinatal complications were observed: prematurity, neonatal jaundice, neonatal urinary Escherichia coli infection and adrenal congenital hyperplasia of probable hereditary origin. CONCLUSIONS: To date, there is no evidence that TNF-alpha antagonists are associated with embryo toxicity, teratogenicity or increased pregnancy loss. However, caution should be taken when anti-TNF agents are used during pregnancy, as human experience is still extremely limited, particularly in patients with rheumatic diseases among whom there are several alarming reports. The potential risk should be balanced against the known risks associated with DMARDs and steroid therapy. Large registries will be necessary before firm conclusions can be drawn.


Assuntos
Antirreumáticos/efeitos adversos , Artrite Reumatoide/tratamento farmacológico , Complicações na Gravidez/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Artrite Juvenil/tratamento farmacológico , Artrite Psoriásica/tratamento farmacológico , Etanercepte , Feminino , Humanos , Imunoglobulina G/efeitos adversos , Infliximab , Troca Materno-Fetal , Gravidez , Resultado da Gravidez , Estudos Prospectivos , Receptores do Fator de Necrose Tumoral
5.
Clin Infect Dis ; 43(10): e95-100, 2006 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-17051484

RESUMO

BACKGROUND: Patients treated with tumor necrosis factor-alpha (TNF-alpha) antagonists have an increased risk of infection, but infection due to Legionella pneumophila has rarely been described in patients receiving such therapy. METHODS: A registry involving 486 clinical departments in France was designed by a multidisciplinary group (Recherche Axée sur la Tolérance des Biothérapies [RATIO]) to collect data on opportunistic and severe infections occurring in patients treated with TNF-alpha antagonists. All cases are reported to RATIO in accordance with national health authorities and validated by infectious disease experts. The legionellosis rate among patients treated with TNF-alpha antagonists was compared with the rate in France overall. RESULTS: We report a 1-year consecutive series of 10 cases of L. pneumophila pneumonia in France in 2004, including 6 cases treated with adalimumab, 2 treated with etanercept, and 2 treated with infliximab. The median patient age was 51 years (range, 40-69 years). Eight patients were treated for rheumatoid arthritis, 1 was treated for cutaneous psoriasis, and 1 was treated for pyoderma gangrenosum. The median duration of TNF-alpha antagonist treatment at onset of infection was 38.5 weeks (range, 3-73 weeks). Eight patients were receiving concomitant treatment with corticosteroids, and 6 were receiving treatment with methotrexate. The relative risk of legionellosis when receiving treatment with a TNF-alpha antagonist, compared with the relative risk in France overall, was estimated to be between 16.5 and 21.0. We also report a second episode of confirmed legionellosis following the reintroduction of infliximab therapy. CONCLUSIONS: L. pneumophila pneumonia is a potentially severe but curable infection that might complicate anti-TNF-alpha therapy. In patients receiving anti-TNF-alpha who develop pneumonia, legionellosis should be systematically investigated, and first-line antibiotic therapy should be efficient against L. pneumophila.


Assuntos
Legionella pneumophila , Doença dos Legionários/tratamento farmacológico , Pneumonia/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Adulto , Idoso , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Doenças Transmissíveis Emergentes/tratamento farmacológico , Etanercepte , Feminino , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêutico
6.
Rheumatology (Oxford) ; 45(10): 1294-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16603583

RESUMO

OBJECTIVE: To assess the safety of anti-tumour necrosis factor (TNF)-alpha therapy in patients with rheumatoid arthritis (RA) or spondylarthropathies (SA) and concurrent chronic hepatitis B or C. METHODS: Records concerning 480 outpatients attending the Rheumatology Department of the University Hospital of Nice (France) for RA or SA were retrospectively reviewed for the duration of disease, treatment, serological status and biological data. RESULTS: Six relevant cases were identified: two of RA with chronic hepatitis B; one of SA with chronic hepatitis B and three of RA with chronic hepatitis C. Five patients had received etanercept and one infliximab; two had been given adalimumab after an unsuccessful trial of etanercept. Patients with concurrent chronic hepatitis B were also given lamivudine. In none of the cases had changes in serum aminotransferases or viral load been reported. CONCLUSION: The use of anti-TNF-alpha therapy (plus lamivudine in the presence of concurrent underlying hepatitis B viral infection) appeared to be safe in that it had no effect on serum aminotransferases and/or viral load. However, repeated monitoring is necessary throughout the treatment period.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/virologia , Hepatite Crônica/complicações , Hepatite Crônica/tratamento farmacológico , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Antivirais/uso terapêutico , Quimioterapia Combinada , Etanercepte , Feminino , Hepatite B Crônica/complicações , Hepatite B Crônica/tratamento farmacológico , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/uso terapêutico , Estudos Retrospectivos , Espondiloartropatias/tratamento farmacológico , Espondiloartropatias/virologia , Transaminases/sangue , Resultado do Tratamento , Carga Viral
7.
Clin Rheumatol ; 24(3): 294-5, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15940563

RESUMO

We describe a case of IgD myeloma with amyloid and plasmocytic pleural localisations. At the onset of the disease it mimicked rheumatoid arthritis, which can be the first presentation of both AL amyloidosis and multiple myeloma. Pleural effusion can happen first in IgD myeloma, but our observation is of interest in that it confirms the very rare possibility of pleural amyloid and plasmocytic localisations devoid of pleural effusion.


Assuntos
Amiloidose/complicações , Imunoglobulina D/sangue , Mieloma Múltiplo/complicações , Doenças Pleurais/complicações , Amiloidose/sangue , Amiloidose/diagnóstico , Biópsia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Imunoeletroforese , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mieloma Múltiplo/sangue , Mieloma Múltiplo/diagnóstico , Pleura/diagnóstico por imagem , Pleura/patologia , Doenças Pleurais/sangue , Doenças Pleurais/diagnóstico , Tomografia Computadorizada por Raios X
11.
Presse Med ; 31(39 Pt 1): 1836-9, 2002 Nov 23.
Artigo em Francês | MEDLINE | ID: mdl-12496713

RESUMO

OBJECTIVE: Patients with severe rheumatoid arthritis and resistant to at least three DMARDS can benefit from anti-TNFalpha (tumor necrosis factor) therapy. In some patients, because of inefficacy or adverse events, treatment with one of the two available TNFalpha drugs (etanercept and infliximab) must be stopped. In this study, we explored the results in efficacy and tolerance of switching from one anti-TNFalpha to the other. PATIENTS: Between August 1999 and January 2002, we administered one of the two anti TNFalpha drugs to 131 patients: 67 patients received infiximab and 64 etanercept. RESULTS: Among the 67 patients treated with infliximab, 17 patients had to stop treatment. In 8 of them (4 allergies, 2 infections and 2 non responders) the switch from infliximab to etanercept was beneficial for 5 patients, 2 patients did not respond and 1 patient withdrew for personal reasons. Among the 64 patients treated with etanercept, 13 had to stop treatment. In 6 of them (2 adverse events, 4 failures) the switch from etanercept to infliximab was beneficial for 3 patients, 2 did not respond and 1 withdrew because of adverse events. CONCLUSION: In all, 14 patients with severe rheumatoid arthritis and treated by one of the two TNFalpha drugs (and in whom treatment was stopped because of adverse events or inefficacy) benefited from the switch to the other anti- TNFalpha, with excellent response in 8 out of 14 patients.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Imunoglobulina G/uso terapêutico , Receptores do Fator de Necrose Tumoral/uso terapêutico , Idoso , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/administração & dosagem , Antirreumáticos/efeitos adversos , Quimioterapia Combinada , Etanercepte , Feminino , Humanos , Imunoglobulina G/administração & dosagem , Imunoglobulina G/efeitos adversos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Infliximab , Masculino , Metotrexato/administração & dosagem , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/administração & dosagem , Fatores de Tempo
14.
Gastroenterol Clin Biol ; 25(3): 310-2, 2001 Mar.
Artigo em Francês | MEDLINE | ID: mdl-11395677

RESUMO

We report the case of a 46-year-old patient in whom ulcerative colitis had been diagnosed three years ago. He was admitted to the hospital for swelling of the nose. Clinical course and complementary exams led us to diagnose atrophic polychondritis. Twelve cases of such an association have been published so far.


Assuntos
Colite Ulcerativa/complicações , Policondrite Recidivante/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Nariz , Policondrite Recidivante/complicações , Policondrite Recidivante/tratamento farmacológico , Prednisolona/uso terapêutico , Tecnécio
15.
Presse Med ; 28(22): 1165-6, 1999 Jun 19.
Artigo em Francês | MEDLINE | ID: mdl-10414240

RESUMO

BACKGROUND: Sympathetic reflex dystrophy is an uncommon cause of pelvic pain not to be overlooked in pregnant women. CASE REPORT: At 8 months pregnancy, a 27-year-old woman complained of invalidating pain of the left hip. Magnetic resonance imaging of the pelvis performed the day after delivery evidenced a non-displaced fracture of the femoral neck and a typical aspect of sympathetic reflex dystrophy. DISCUSSION: The true frequency of sympathetic reflex dystrophy during pregnancy is probably underestimated. Approximately one hundred cases have been reported. The hip joint is involved in 9 out of 10 cases. Such localizations are uncommon outside pregnancy, accounting for 14 to 17% of all cases.


Assuntos
Fraturas do Colo Femoral/etiologia , Complicações na Gravidez/diagnóstico , Distrofia Simpática Reflexa/complicações , Adulto , Feminino , Fraturas do Colo Femoral/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Gravidez , Terceiro Trimestre da Gravidez , Distrofia Simpática Reflexa/diagnóstico
17.
J Radiol ; 78(7): 511-2, 1997 Jul.
Artigo em Francês | MEDLINE | ID: mdl-9296032

RESUMO

Sacral insufficiency fractures are not rare. They are well known in female patients over age 50 with osteopenia. One case occurring in a young pregnant woman is described. We did not find another case in the literature.


Assuntos
Doenças Ósseas Metabólicas/complicações , Fraturas Espontâneas/etiologia , Complicações na Gravidez , Sacro , Adulto , Feminino , Humanos , Dor Lombar/etiologia , Gravidez , Ciática/etiologia
20.
Rev Rhum Engl Ed ; 63(3): 217-9, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8731241

RESUMO

Reactive arthritis induced by Strongyloides is exceedingly rare. A case in a 53-year-old man from the Guadeloupe (French Antilles) is reported. The outcome was rapidly favorable under thiabendazole therapy. The cycle of Strongyloides is reviewed, and the contribution of parasites to reactive arthritis in patients with genetic risk factors is discussed. Establishing the correct diagnosis is sometimes difficult but is essential in order to avoid inappropriate administration of corticosteroids that can lead to fatal, multivisceral dissemination of the parasite, particularly in patients with strongyloidiasis.


Assuntos
Artrite Reativa/parasitologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/complicações , Animais , Antinematódeos/administração & dosagem , Antinematódeos/uso terapêutico , Artrite Reativa/diagnóstico , Artrite Reativa/tratamento farmacológico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Tiabendazol/administração & dosagem , Tiabendazol/uso terapêutico
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