[Pre-capillary pulmonary hypertension in elderly patients: a descriptive study]. / Hypertension pulmonaire pré-capillaire du sujet âgé : étude descriptive.

INTRODUCTION: Pulmonary hypertension (PH) is a serious medical condition subsequently complicating many other common diseases. PH seems to be increasing in the elderly; however, it has been poorly studied in this group. The aim of this study was to determine the diagnostic and prognosis features as well as management of pre-capillary PH in the elderly compared to young subjects. METHODS: We performed a single center retrospective study in the Regional Hospital of Reims, France. Patients with precapillary PH diagnosed by right cardiac catheterization between January 2008 and December 2016 were included. Elderly patients (aged ≥65 years at diagnosis) were compared to younger patients (18-64 years). Patients with post-capillary PH were excluded. RESULTS: A total of 146 patients were included, 82 patients were aged 65 years or more (median age 74 years (68-78), 56% women) and 64 non-elderly (median age 54 years (48-61, 5), 52% women). In the elderly group, 31.7% had pulmonary arterial hypertension (PAH): 15% idiopathic PAH, 36.6% WHO group 3 PH and 28% WHO group 4 PH, with no significant differences with younger patients. In the group of 56 patients with PAH, 26 were elderly (46%). Frequency of comorbidities was similar in both groups, except for arterial hypertension more prevalent in the elderly (52% vs. 34%, p = 0.029). Older patients often had lower extremities oedema (53.3% vs 36.2%, p = 0.045) and reduced 6-minutes walking distance (189 m vs 289, p = 0.004). Younger patients had lower FEV1 (58% vs 75%, p = 0.003) and higher right atrial pressure (12 vs 9, p = 0.023). Oxygenotherapy and diurectis were more often used in elderly subjects (58.5% vs. 34.4%, p = 0.004) and (82.9% vs. 67.2%, p = 0.027) respectively. Three-year and five-year survival were lower in elderly patients (53% and 24%, vs 86% and 63%, p = 0.003 and p=0.004 respectively). CONCLUSION: PH mainly affects individuals aged 65 years and more. Post-capillary PH is more prevalent but precapillary PH could be encountered. Clinical and paraclinical features seem to be similar in both groups. This entity has a worse impact on general health in elderly patient and the prognosis is poor.

[Late-onset lupus in the elderly after 65 years: retrospective study of 18 cases]. / Le lupus érythémateux systémique survenant après 65 ans : étude rétrospective de 18 cas.

OBJECTIVE: The aim of our study was to investigate characteristics of late-onset lupus after 65 years compared to younger ones. METHOD: Patients with lupus revealed after 65 years were investigated in four French hospitals between 1985 and 2013. Patients with 4 ACR criteria or more were included. Clinical and biological characteristics, prognosis, treatment, comorbidities were described retrospectively and compared to the cohort of 1000 lupus patients of Cervera et al. RESULTS: Eighteen patients were included (14 women and 4 men). The most frequent features were arthritis (13/18), skin involvement (9/18). Hemolytic anemia and thrombosis were more frequently found in elderly lupus (p<0.05). During evolution, only cutaneous involvement were less frequent than in young subjects (p <0.05). Corticosteroids were often used (16/18), but iatrogenic complications were frequent (10/16). CONCLUSION: Diagnosis is difficult because of non-specific clinical features. Treatment needed a rigourous follow-up because of iatrogenic complications.