Rheumatoid Arthritis: Godeau B

Bussone G, Hachulla E, Sibilia J, Michel M, Godeau B, Guillevin L, Mouthon L. · Université Paris Descartes, Pôle de médecine interne, Centre de référence pour les vascularites nécrosantes et la sclérodermie systémique, Hôpital Cochin, Assistance publique-Hôpitaux de Paris, F-75679 Paris Cedex 14, France. · Presse Med. · Pubmed #19297127 No free full text.

Abstract: Rituximab is a chimeric monoclonal antibody that targets CD20 antigen at the surface of B lymphocytes. The efficacy of rituximab in patients with rheumatoid arthritis has been demonstrated in 3 randomized controlled trials. Rituximab is now used in a wide range of systemic autoimmune and inflammatory diseases, as it is well tolerated and efficient. Adverse events are scarce, consisting mainly in reactions during infusion and infectious complications that are favoured by the association of rituximab therapy with other immunosuppressants. Relapses of the disease are common around six months after rituximab infusion. The response to retreatment with rituximab is usually the same that was obtained after the first course of treatment.

Khellaf M, Godeau B. · Service de Médecine Interne, Assistance Publique-Hôpitaux de Paris, CHU Henri Mondor, Université Paris XII, Créteil Cedex, France. · Presse Med. · Pubmed #19062243 No free full text.

Abstract: The termPneumocystis carinii is now reserved for the animal form of the disease, for humans Pneumocystis jiroveci is appropriated. Incidence of pneumocystis pneumonia (PCP) among patients with systemic rheumatic diseases varies from 0.2% for rheumatoid arthritis to up 12% for Wegener's granulomatosis. Clinical and radiological presentation of pneumocystis pneumonia among non-VIH patients is often difficult to diagnose and the installation can be abrupt. Most of cases of PCP occur during the first 3 months following the beginning of immunosuppressant agents. Mortality during PCP is high with an average of 40% of death, rising 60% in case of mechanical ventilation. Prophylaxis of PCP is needed (without support by randomised studies) for patients with Wegener's granulomatosis, in case of cyclophosphamide or high-dose of methotrexate use except for rheumatoid patients, if a simultaneous treatment by corticosteroids and immunosuppressant agent is required, if a prolonged corticosteroid treatment (> 2 months) is used with dose of prednisone-equivalent > 16mg per day or > 20mg per day > 1month associated with one or more risk factors of PCP among advanced age, denutrition or deep lymphopenia. The best prophylaxis of PCP is cotrimoxazole.

Michel M, Habibi A, Godeau B, Bachir D, Lahary A, Galacteros F, Fifi-Mah A, Arfi S. · Department of Internal Medicine, Henri-Mondor University Hospital, Créteil, France. · Semin Arthritis Rheum. · Pubmed #18177923 No free full text.

Abstract: OBJECTIVES: To analyze the main characteristics of adults with sickle cell disease (SCD) and concurrent connective tissue disease (CTD). METHODS: A retrospective investigational study was performed. CTD was diagnosed according to standard international criteria. Severity of SCD was assessed by a clinical severity score. RESULTS: Thirty patients, 23 women (76%) and 7 men, with hemoglobin S/S (n = 25) or S/C (n = 5) SCD were included. The subtypes of CTD were rheumatoid arthritis (RA) (n = 15), definite systemic lupus erythematosus or "incomplete lupus" requiring treatment (n = 13), primary Sjögren's syndrome with central nervous system involvement (n = 1), and systemic sclerosis (n = 1). Twenty-five of the 30 patients (83%) received steroid treatment, and 15 (50%) received at least 1 immunosuppressive agent (methotrexate in 14 cases) to control CTD. Four RA patients were given antitumor necrosis factor (TNF)alpha and 1 was treated with rituximab without SCD exacerbation. After a median follow-up of 4.5 years [range: 6 months to 30 years] from CTD diagnosis, 11 of the 25 (44%) patients receiving steroids had at least 1 episode of severe infection (mostly due to Staphylococcus aureus or Escherichia coli). SCD exacerbated in 13 of the 30 (43%) patients after CTD onset; 12 of these patients were receiving prednisone and/or methotrexate. Six patients (20%) had died from sepsis (n = 2), stroke (n = 2), or acute chest syndrome (n = 2). CONCLUSIONS: CTD-related clinical manifestations and outcome were not particularly severe in patients with SCD. However, those with active CTD and undergoing steroid +/- methotrexate treatment had more serious SCD-related manifestations, a higher rate of severe infections, and an overall patient mortality rate of 20%. Thus, the management of patients with CTD and underlying SCD should consider the risk/benefit ratio of each treatment and steroid-sparing strategies should be implemented.

Mahévas M, Audia S, De Lastours V, Michel M, Bonotte B, Godeau B. · 1Department of Internal Medicine, Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France. · Haematologica. · Pubmed #17726769 links to  free full text

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