Giant cell arteritis (GCA) is the most common vasculitis in people ≥50 years and can be associated with stroke. We aimed to evaluate the epidemiology and characteristics of stroke in patients with ...GCA.
All patients with a biopsy-proven diagnosis of GCA were identified among residents of the city of Dijon, France (152 000 inhabitants), between 2001 and 2012 using a prospective database. Among these, patients who suffered from stroke were retrieved by crossing data from the population-based Dijon Stroke Registry. Demographics and clinical features were recorded. We considered that the stroke was GCA-related if the stroke revealed GCA or occurred between the onset of symptoms and 4 weeks after the start of treatment.
Among the 57 biopsy-proven patients with GCA (incidence rate 10.9/100 000/year in individuals ≥50 years), 4 (7.0%) experienced a GCA-related stroke. Three were men and all had ≥2 vascular risk factors and were ≥80 years. The stroke was vertebrobasilar for 3/4 patients and undetermined for the remaining one. The incidence rate of GCA-related stroke in patients ≥50 years was 0.76/100 000/year (95% CI 0 to 2.47), 1.36/100 000/year in men (95% CI 0 to 3.63) and 0.33/100 000/year (95% CI 0 to 1.45) in women.
This population-based study demonstrated that GCA-related stroke essentially affects the vertebrobasilar territory and mainly occurs in old men with associated vascular risk factors. Although rare, GCA symptoms must be searched for in elderly patients with stroke, and optimal vascular prevention must be conducted carefully in patients with GCA with a high vascular risk before initiating GCA treatment.
Objective. To obtain an overview of rheumatic disorders occurring after hepatitis B vaccination. Methods. A questionnaire was sent to rheumatology departments in nine French hospitals. Criteria for ...entry were rheumatic complaints of 1 week's duration or more, occurrence during the 2 months following hepatitis B vaccination, no previously diagnosed rheumatic disease and no other explanation for the complaints. Results. Twenty-two patients were included. The observed disorders were as follows: rheumatoid arthritis for six patients; exacerbation of a previously non-diagnosed systemic lupus erythematosus for two; post-vaccinal arthritis for five; polyarthralgia–myalgia for four; suspected or biopsy-proved vasculitis for three; miscellaneous for two. Conclusions. Hepatitis B vaccine might be followed by various rheumatic conditions and might trigger the onset of underlying inflammatory or autoimmune rheumatic diseases. However, a causal relationship between hepatitis B vaccination and the observed rheumatic manifestations cannot be easily established. Further epidemiological studies are needed to establish whether hepatitis B vaccination is associated or not with an incidence of rheumatic disorders higher than normal.
Le purpura thrombopénique immunologique (PTI) est une maladie auto-immune plurifactorielle caractérisée par une destruction périphérique accélérée des plaquettes et une production médullaire ...inadaptée. Le traitement du PTI à ce jour n’est pas parfaitement codifié.
Étude rétrospective descriptive des réponses aux traitements d’une série de 40 patients atteints de PTI chronique.
Il s’agit d’une population d’un âge moyen de 54 ans, dont la maladie est révélée par des saignements dans 2/3 des cas. Malgré un chiffre moyen de plaquettes très bas, aucune manifestation hémorragique engageant le pronostic vital n’a été observée. Les anticorps antiplaquettes sont retrouvés dans 2/3 des cas, la GPIIb/IIIa est l’antigène cible le plus fréquent. La corticothérapie reste la thérapeutique de première ligne permettant d’obtenir un taux de réponse de 54 %, une rechute survenant néanmoins dans 86 % des cas. La dapsone permet d’obtenir une réponse chez 42,1 % des patients, sans effets indésirables importants, avec un taux de rechute de 37,5 % à l’arrêt. Le rituximab (RTX) est efficace dans 42,1 % des cas, avec un maintien de la réponse dans 40 % des cas environ. La splénectomie permet quant à elle une réponse dans 42,9 % des cas sans que nous n’ayons observé de rechute. Nous n’avons pas identifié de facteur prédictif de réponse aux différentes thérapeutiques.
Le PTI est une maladie rare, qui touche une population d’âge moyen. Les taux de rechute ou de non réponse (NR) restent importants et imposent le recours à plusieurs lignes thérapeutiques. La dapsone, médicament peu onéreux avec un taux de réponse satisfaisant nous paraît indiqué avant le recours à des thérapeutiques plus chères. La place de nouveaux traitements comme les agonistes du récepteur de la thrombopoïétine (TPO) ou les nouvelles thérapeutiques antilymphocytaires B restent à définir.
Immune thrombocytopenia (ITP) is an auto-immune disease associating a peripheral platelet destruction without increased central production.
Forty patients with chronic ITP were retrospectively analyzed for clinical and biological presentation and response to treatment.
Mean age at diagnosis was 54 years. ITP was revealed by hemorrhage in 65 % of the patients. Despite very low platelet count, no life threatening hemorrhage was observed. Platelet associated antibodies were found in 66 %, usually directed against GPIIb/IIIa. Corticosteroids were used as first line treatment, with response in 54 %, and relapse in 86 %. A response was observed in 42.1 % with dapsone, which was well tolerated, a relapse occurring in 37.5 % of the patients. Rituximab (RTX) allowed a response rate of 42.1 %, prolonged in 40 % of the patients. A response was achieved in 42.9 % cases after splenectomy, without any relapse. No factor was identified to predict the response to treatment.
ITP is a rare disorder occurring most frequently in middle aged patients. Because of high relapse or no response rates, many treatments should be used. Dapsone offers a good efficacy without major side effects. RTX is well tolerated and allows a good response rate. The use of new agents like thrombopoietin receptor agonist or new therapeutics against B lymphocytes should be defined.
Le cancer est une des causes de maladie thromboembolique veineuse. Le mécanisme physiopathologique est mal connu. Une hyperhomocystéinémie pourrait être un facteur favorisant.
Nous avons colligé, ...dans une cohorte cas témoins de 65 patients sur une période de deux ans, les valeurs d'homocystéinémie chez des patients atteints d'un cancer en comparaison aux témoins.
Parmi les patients cancéreux, un patient sur deux présente une élévation significative de l'homocystéinémie par rapport au groupe témoin (
p
=
0,006). Dans cette étude, le taux élevé ne semble pas corrélé à un déficit vitaminique en folates ou en vitamine B12.
L'hyperhomocystéinémie pourrait être corrélé à la prolifération tumorale et provenir de la cellule tumorale elle-même.
Cancer is a cause of venous thromboembolism. However, the physiopathology remains unknown. Hyperhomocysteinemia could be a promoting factor.
We built a case-control study of 65 patients followed for 2 years to compare levels of homocystéinémie in cancer bearing patients with that in matched cancer free control patients.
Fifty per cent of cancer bearing patients had significantly increased blood serum levels of homocystéine (
P
=
0.006). This increase did not correlate with any deficiency in blood serum levels of folate or vitamin B12.
High levels of homocystéinémie could be linked to tumor proliferation.
PDF
