175 results on '"S. Carette"'
Search Results
2. A 21-Year-Old Man with Systemic-Onset Juvenile Rheumatoid Arthritis, Cough and Progressive Dyspnea
- Author
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A Leber, S Carette, KR Chapman, DM Hwang, LG Singer, and TK Marras
- Subjects
Diseases of the respiratory system ,RC705-779 - Abstract
Primary or nonobstructive, endogenous lipoid pneumonia is a rare clinical entity usually associated with an underlying systemic disease. The present report describes a case involving a 21-year-old man with systemic-onset juvenile rheumatoid arthritis who developed primary endogenous lipoid pneumonia. Multiple treatment regimens were attempted; however, definitive management was only achieved through double-lung transplantation.
- Published
- 2010
- Full Text
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3. Des abcès froids chez une enfant
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S. Racoussot, E. Desmedt, S. Carette, S. Benarab, S. Faiz, B. Catteau, and N. Wizla
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Dermatology - Abstract
Introduction Une infection d’origine cutanee a Staphylococcus aureus lors de la periode neo-natale peut se presenter sous diverses manifestations qui sont, pour la majorite d’entre elles, associees a des signes clinico-biologiques d’inflammation. Observations Un nourrisson âge de 10 jours, ne a terme, etait recu aux urgences neonatalogiques devant l’apparition depuis 48 h de quatre lesions nodulaires sous cutanees : une centimetrique axillaire gauche, deux millimetriques inguinales droites, et une millimetrique retro-auriculaire. Il n’existait pas d’autres lesions cutanees mais on notait une conjonctivite gauche non purulente. Le reste de l’examen physique etait normal, et l’enfant etait apyretique. Biologiquement, il n’y avait pas de syndrome inflammatoire. Le bilan immunitaire etait sans particularites. Une echographie des parties molles decrivait des collections sous cutanees, sans adenopathies satellites. Le prelevement vaginal maternel etait positif a Staphylococcus aureus multisensible. Devant une evolution defavorable apres 48 h, l’abces axillaire gauche a ete draine. Le prelevement trouvait un Staphylococcus aureus d’antibiogramme identique a celui du prelevement vaginal maternel, en faveur d’une transmission bacterienne materno-fœtale durant l’accouchement. Apres drainage et antibiotherapie par amoxicilline et acide clavulanique per os, l’evolution etait rapidement favorable avec guerison complete de l’ensemble des localisations. Juste au decours, nous apprenions que le test de Guthrie etait en faveur d’une mucoviscidose, confirmee par le test de la sueur et le test genetique. Discussion L’abces froid des grands plis du nourrisson est une entite de description recente par l’equipe de dermato-pediatrie du CHU de Bordeaux. Elle correspond a une infection neonatale a Staphylococcus aureus. Elle se presente chez un nourrisson en bon etat general par l’existence d’abces peu inflammatoires des grands plis. Ces abces sont decrits comme « froids » devant l’absence de symptomes generaux et de syndrome inflammatoire biologique. Il parait licite de chercher une immunodepression face a cette pathologie en raison de sa survenue precoce dans la vie, bien qu’aucun cas de deficit immunitaire n’ait ete mis en evidence a ce jour dans cette pathologie. Dans cette observation, notre patiente est atteinte de mucoviscidose, ce qui pourrait etre un facteur favorisant. Conclusion Nous rapportons un cas d’abces froids des grands plis du nouveau-ne en contexte de mucoviscidose. Cette entite, bien que debattue, doit pouvoir etre evoquee par le dermatologue. Face a celle-ci, la recherche d’une contamination par transmission materno-fœtale et d’une immunodepression du nouveau-ne s’avere interessante, bien que d’autres observations soient necessaires pour mieux caracteriser la pathologie.
- Published
- 2020
4. Sauvetage d'une avulsion cutanée de jambe grâce à la thérapie par pression négative (VAC®) : à propos d'un cas
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N. Zwillinger, S. Carette, and B. Lorenceau
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Surgery - Abstract
Resume Nous presentons le cas d'une patiente de 51 ans ayant subi un degantage de jambe droite apres un accident de voiture. Le premier geste de repose simple avec parage minimal des lambeaux se solde par un echec et une necrose quasi totale. Apres une avulsion complete des tissus devitalises, il est pose un VAC® circulaire de jambe. Quatre cycles de VAC® et 12 jours plus tard, une greffe de peau mince en filet est realisee. Celle-ci prend parfaitement et permet a la patiente une verticalisation en un mois apres l'accident initial. Cet exemple souligne le role de detersion et probourgeonnant de la therapie negative lors du sauvetage d'un degantage de jambe mal conduit.
- Published
- 2008
5. Le lambeau musculaire pur de Latissimus dorsi dans les séquelles de traitement conservateur du cancer du sein: à propos d'un cas
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N. Zwillinger, S. Carette, and B. Lorenceau
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Difficult problem ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Scars ,law.invention ,Surgery ,body regions ,Breast conservative surgery ,medicine.anatomical_structure ,Z-plasty ,law ,Breast implant ,Medicine ,Latissimus dorsi flap ,medicine.symptom ,business ,Areola - Abstract
The correction of type II sequelae of breast conservative surgery is a difficult problem to solve. The authors present the case of a 39 years old woman, in which the repair has been carried out in two steps. A latissimus dorsi muscular flap is first realised, then a breast implant and a double-opposing Z plasty on the areola finish the reconstruction. The final result is very satisfactory in a cosmetic point of view, with a little cost in terms of scars. This difficult case presents the muscular variant of the latissimus dorsi flap, as a technique of choice in the post-quadrantectomy sequelae.
- Published
- 2007
6. Évaluation du recours aux médecines non conventionnelles par les enfants atteints de maladie inflammatoire chronique de l’intestin
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F. Couttenier, L. Michaud, P. S. Ganga-Zandzou, Dominique Guimber, Dominique Turck, C. Legrand, S. Coopman, Claire Spyckerelle, Frédéric Gottrand, S. Carette-Lherbier, E. Devouge, Corinne Gower-Rousseau, and H. Sarter
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Pediatrics, Perinatology and Child Health - Abstract
Introduction Le recours aux medecines non conventionnelles (MNC) semble augmenter, surtout chez les patients ayant une maladie chronique. L’objectif de notre etude etait d’estimer la frequence du recours aux MNC au cours des maladies inflammatoires du tube digestif (MICI) pediatriques. Les objectifs secondaires etaient de preciser les MNC les plus utilisees, etudier les facteurs favorisants et les raisons de leur utilisation ainsi que les benefices ressentis par les enfants et leurs parents. Methodes Notre etude etait une enquete, par auto-questionnaire nominatif, multicentrique menee dans les centres hospitaliers du Nord-Pas-de-Calais. Les enfants, âges de moins de 18 ans revolus, suivis pour une MICI etaient inclus de maniere prospective, de septembre a decembre 2013. Une etude dans les dossiers medicaux permettait de completer le recueil de donnees. Resultats Cent dix questionnaires ont ete distribues. Le taux de reponse etait de 74 % ; 69 % des patients avaient une maladie de Crohn, 27 % une rectocolite hemorragique et 4 % une colite inclassee ; 32 % (IC : 22 %–42 %) des patients avaient eu recours aux MNC pour leur MICI et 39 % (IC : 29–50 %) pour une autre maladie. Au total, 53 % (IC : 41–63 %) des enfants avaient deja eu recours a une MNC. Les MNC les plus utilisees etaient l’homeopathie (58 %), l’osteopathie (27 %), la naturopathie et la kinesiologie (15 % chacun) ; 42 % des parents avaient discute des MNC avec le pediatre gastro-enterologue referent (56 % avant leur utilisation) ; 53 % des parents auraient aime que le pediatre leur parle de lui-meme des MNC. Les principales raisons d’utilisation d’une MNC etaient : la volonte que l’enfant se sente mieux (88 %) ; la peur des effets secondaires des traitements (42 %) ; et l’impression que les MNC sont plus naturelles et moins dangereuses (42 %). En analyse multivariee, les facteurs favorisant l’utilisation des MNC etaient : âge du patient plus eleve ( p = 0,03) ; categorie socioprofessionnelle de la mere elevee ( p = 0,04) ; utilisation des MNC par les parents ( p = 0,0002) ; traitement actuel par immunomodulateur ( p = 0,03) ; insatisfaction de la medecine conventionnelle ( p = 0,02). Parmi les patients ayant utilise une MNC, 63 % ont ressenti un effet benefique et aucun un effet deletere. Conclusion Le recours aux MNC est frequent chez les enfants suivis pour une MICI. Les pediatres gastro-enterologues doivent s’informer sur ces pratiques et ouvrir le dialogue avec les familles, afin de pouvoir les guider dans leur choix, prevenir les effets potentiellement deleteres des MNC et determiner les sources d’insatisfaction motivant les familles a se tourner vers d’autres alternatives therapeutiques.
- Published
- 2016
7. Estimation of observer reliability and sample size calculation parameters for outcome measures in fibromyalgia clinical trials
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S. Carette, B. Haraoui, Mary J. Bell, George A. Wells, Glenn A. McCain, N. Bellamy, W. J. Reynolds, Adel G. Fam, and J. Campbell
- Subjects
Pharmacology ,medicine.medical_specialty ,Observer (quantum physics) ,Immunology ,Pharmacology toxicology ,Outcome measures ,medicine.disease ,Clinical trial ,Sample size determination ,Fibromyalgia ,Physical therapy ,medicine ,Pharmacology (medical) ,Reliability (statistics) ,Mathematics - Abstract
Bellamy N, Bell MJ, Carette S, Fam AG, Haraoui BW, McCain GA, Reynolds WJ, Wells GA, Campbell J. Estimation of observer reliability and sample size calculation parameters for outcome measures in fibromyalgia clinical trials. Inflammopharmacology. 1994;2:345-360.
- Published
- 1994
8. An approach to the patient with fibromyalgia
- Author
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S, Carette
- Subjects
Features - Abstract
Fibromyalgia (fibrositis) is one of the most common rheumatologic conditions. This paper reviews the clinical presentation and pathophysiology of the syndrome and presents a global approach to the management of the disease.
- Published
- 2011
9. A 21-Year-Old Man with Systemic-Onset Juvenile Rheumatoid Arthritis, Cough and Progressive Dyspnea
- Author
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Kenneth R. Chapman, S Carette, David M. Hwang, A Leber, LG Singer, and Theodore K. Marras
- Subjects
Male ,Pulmonary and Respiratory Medicine ,Systemic disease ,Pediatrics ,medicine.medical_specialty ,Pathology ,Article Subject ,RC705-779 ,Treatment regimen ,business.industry ,Case Report ,Pneumonia ,medicine.disease ,Arthritis, Juvenile ,Transplantation ,Young Adult ,Diseases of the respiratory system ,Dyspnea ,Endogenous lipoid pneumonia ,Cough ,medicine ,Humans ,business ,Juvenile rheumatoid arthritis ,Lung Transplantation - Abstract
Primary or nonobstructive, endogenous lipoid pneumonia is a rare clinical entity usually associated with an underlying systemic disease. The present report describes a case involving a 21-year-old man with systemic-onset juvenile rheumatoid arthritis who developed primary endogenous lipoid pneumonia. Multiple treatment regimens were attempted; however, definitive management was only achieved through double-lung transplantation.
- Published
- 2010
10. Low-dose cyclosporin versus placebo in patients with rheumatoid arthritis
- Author
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P. Tugwell, C. Bombardier, M. Gent, K.J. Bennett, R.S. Roberts, D. Ludwin, W.G. Bensen, S. Carette, A. Chalmers, A.V. Klinkhoff, J.M. Esdaile, and G.R. Kraag
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Urology ,Administration, Oral ,Arthritis ,Blood Pressure ,Cyclosporins ,Placebo ,Severity of Illness Index ,Drug Administration Schedule ,Arthritis, Rheumatoid ,Placebos ,chemistry.chemical_compound ,Activities of Daily Living ,medicine ,Humans ,Multicenter Studies as Topic ,In patient ,Randomized Controlled Trials as Topic ,Chemotherapy ,Creatinine ,business.industry ,Low dose ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Blood pressure ,chemistry ,Rheumatoid arthritis ,Drug Evaluation ,Female ,business ,Follow-Up Studies - Abstract
144 patients with severe rheumatoid arthritis from six centres were randomised to receive oral cyclosporin or placebo for 6 months. The initial daily dose of cyclosporin was 2·5 mg/kg, which was increased cautiously with monitoring of serum cyclosporin levels and creatinine; the mean stabilisation dose was 3·8 mg/kg. There were significant improvements in the cyclosporin-treated patients compared with the controls in the major outcomes of reduction of active joints (23% improvement), pain (24%), and functional status (16%); global improvement was 27%. In the cyclosporin group serum creatinine increased by a mean of 15·6 μmol/l and mean arterial blood pressure by 6·27 mm Hg; these increases were controlled in all but 2 patients by dose adjustment without withdrawal from the study.
- Published
- 1990
11. [Salvage of a leg avulsion injury by vacuum negative pressure therapy: a case report]
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N, Zwillinger, S, Carette, and B, Lorenceau
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Reoperation ,Treatment Outcome ,Accidents, Traffic ,Humans ,Female ,Skin Transplantation ,Middle Aged ,Limb Salvage ,Negative-Pressure Wound Therapy ,Leg Injuries - Abstract
We present the case of a 51-year-old woman who suffered an avulsion injury of the right leg in a car accident. In a first time, the simple suture with tiny debridement of the flaps is a failure and lead to a nearly complete necrosis. In a second time, a total avulsion of the devitalized skin is realised and a circumferential VAC system is placed on the wound. Four cycles of vacuum therapy and twelve days later, a split-thickness skin mesh-graft is applied on the leg. This one has a very good take and allows the patient to stand up one month after the initial accident. This example underlines the role of cleaning and pro-budding of the negative therapy after the salvage of a leg avulsion.
- Published
- 2006
12. P-118: Use of complementary and alternative medicines among children with inflammatory bowel disease
- Author
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D. Guimber, Hélène Sarter, C. Spyckerelle, Frédéric Gottrand, Dominique Turck, Laurent Michaud, Corinne Gower-Rousseau, S. Carette-Lherbier, Stéphanie Coopman, and M. Bridenne
- Subjects
Pediatrics ,medicine.medical_specialty ,business.industry ,Gastroenterology ,Azathioprine ,Retrospective cohort study ,General Medicine ,Disease ,medicine.disease ,Inflammatory bowel disease ,Remission duration ,medicine ,Effective treatment ,Methotrexate ,business ,Survival analysis ,medicine.drug - Abstract
Introduction: Methotrexate is one of treatment options for Crohns disease (CD) in children. However, actual evidence of its efficacy in scientific literature is scarce. Aim: The aim of this study was to evaluate the efficacy of methotrexate in maintaining remission in pediatric CD resistant to azathioprine. Methods: This retrospective study included children with CD who were treated in our hospital since January 2004 and who received methotrexate for at least 12 months. Results: During the observed period 25 children were treated with methotrexate for at least 12 months [8 girls (32%); median age at diagnosis 13.4 years (range 1 17.3 years)]. Methotrexate was started in average of 1.8 years after the diagnosis (median: 1.3 years; range 0.6 6.9 years). The mean duration of follow-up was 4.6 years (median 4.7 years; range 1.7 9.6 years). During the treatment with methotrexate 6 (24%) children had a relapse during the first year, 8 (32%) children after the first year and 11 (44%) children remained in remission till the end of follow-up period. The mean duration of remission was 1.7 years (median 1.1 years; range 1 3.5 years). The overall remission duration was longer after methotrexate was introduced comparing to remission duration on previous therapy (azathioprine) (0.9 vs 1.7 years; p = 0.022). Survival analysis (Cox proportional hazard regression model) failed to reveal the relapse risk factors (disease location, treatment for remission induction, age at diagnosis, duration of disease and disease location). Conclusion: Methotrexate is an effective treatment option for children with CD who did not respond to azathioprine.
- Published
- 2014
13. A randomized, controlled trial of methotrexate versus placebo in early diffuse scleroderma
- Author
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J E, Pope, N, Bellamy, J R, Seibold, M, Baron, M, Ellman, S, Carette, C D, Smith, I M, Chalmers, P, Hong, D, O'Hanlon, E, Kaminska, J, Markland, J, Sibley, L, Catoggio, and D E, Furst
- Subjects
Male ,Scleroderma, Systemic ,Dose-Response Relationship, Drug ,Health Status ,Middle Aged ,Severity of Illness Index ,Disability Evaluation ,Methotrexate ,Treatment Outcome ,Double-Blind Method ,Surveys and Questionnaires ,Humans ,Female ,Immunosuppressive Agents ,Skin - Abstract
Early diffuse scleroderma (systemic sclerosis; SSc) has no proven treatment. This study was undertaken to examine the efficacy of methotrexate (MTX) in improving the skin and other disease parameters in early diffuse SSc.Seventy-one patients with diffuse SSc of3 years' duration were enrolled in a multicenter, randomized, placebo-controlled, double-blind trial. Thirty-five patients were treated with MTX and 36 with placebo. Treatment was administered for 12 months. The primary outcome measures were skin score (as determined with 2 different indices) and physician global assessment.At baseline, there were no statistically significant differences in skin scores, carbon monoxide diffusing capacity (DLco), physician global assessment, or other secondary outcome measurements between the 2 treatment groups. At study completion, results slightly favored the MTX group (mean +/- SEM modified Rodnan skin score 21.4+/-2.8 in the MTX group versus 26.3+/-2.1 in the placebo group [P0.17]; UCLA skin score 8.8+/-1.2 in the MTX group versus 11.0+/-0.9 in the placebo group [P0.15]; DLco in the MTX group 75.7+/-4.6 versus 61.8+/-3.4 in the placebo group [P0.2]). In addition, physician global assessment results favored MTX (P0.035), whereas patient global assessment did not differ significantly between groups. When between-group differences for changes in scores from baseline to 12 months were examined using intent-to-treat methodology, MTX appeared to have a favorable effect on skin scores (modified Rodnan score -4.3 in the MTX group versus 1.8 in the placebo group [P0.009]; UCLA score -1.2 in the MTX group versus 1.2 in the placebo group [P0.02]), but differences in the degree of change in the DLco and physician global assessment were not significant. For the UCLA skin score, these differences in results were not statistically significant after adjustment for baseline differences in sex distribution and steroid use. Dropout rates were similar in the 2 groups.Although results of this trial demonstrated a trend in favor of MTX versus placebo in the treatment of early diffuse SSc, the between-group differences were small and the power to rule out false-negative results was only 50%. Our findings do not provide evidence that MTX is significantly effective in the treatment of early diffuse SSc.
- Published
- 2001
14. The role of life events and childhood experiences in the development of rheumatoid arthritis
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S, Carette, P G, Surtees, N W, Wainwright, K T, Khaw, D P, Symmons, and A J, Silman
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Arthritis, Rheumatoid ,Life Change Events ,Male ,Stress, Physiological ,Case-Control Studies ,Surveys and Questionnaires ,Adaptation, Psychological ,Humans ,Female ,Middle Aged ,Parent-Child Relations ,Demography ,Retrospective Studies - Abstract
To evaluate the role of stressful life events, including negative childhood experiences on the development of rheumatoid arthritis (RA).Retrospective, community based, case-control study founded upon 116 cases, aged 45 to 74 years, registered with the Norfolk Arthritis Register (NOAR), who were also participants in the Norfolk European Prospective Investigation of Cancer study (EPIC). Three controls, matched for age and sex, were selected for each of the cases from among EPIC participants not suffering from arthritis. Data on adverse experiences during childhood and adulthood were available from a self-report questionnaire. The 1987 American Rheumatism Association (ARA) criteria for RA were met by 55 NOAR cases and this subset provided the primary focus for analysis.The number and timing of occurrence of stressful life events, as well as their subjective immediate impact, did not differ between participants who developed RA and their matched controls. Termination of pregnancy was the only specific event individually associated with a higher risk of developing RA (OR 3.74; 95% CI 1.4-9.9). Negative childhood experiences were not associated with the risk of RA. However, RA cases reported significantly slower adaptation to the effects of adverse events than controls.The results of this study do not support the hypothesis that the rate of exposure or reported impact of stressful life events and of adverse childhood experiences play an etiologic role in the development of RA.
- Published
- 2000
15. Risk factors for adult Still's disease
- Author
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J S, Sampalis, T A, Medsger, J F, Fries, C, Yeadon, J L, Senécal, D, Myhal, M, Harth, A, Gutkowski, S, Carette, F, Beaudet, A J, Partridge, and J M, Esdaile
- Subjects
Adult ,Male ,Dust ,Environmental Exposure ,Cohort Studies ,Coal ,Risk Factors ,Stress, Physiological ,Case-Control Studies ,Surveys and Questionnaires ,Odds Ratio ,Humans ,Female ,Still's Disease, Adult-Onset ,Contraceptives, Oral - Abstract
To assess risk factors for adult Still's disease (ASD).A matched case-control study of 60 patients with ASD and 60 same sex siblings closest in age was conducted. Subjects were recruited from cohorts in Eastern Canada, Pittsburgh, and the Arthritis, Rheumatism, and Aging, Medical Information Systems (ARAMIS). A questionnaire was used to obtain data on demographic characteristics, education, income, occupation, exposure to toxic substances, stress, and medical history.116 patients with ASD were identified, of which 104 participated. 86 identified same sex siblings, of which 60 replied. When compared to same sex siblings, ASD patients were similar with respect to education and occupation but had a trend to higher median income. There were no significant associations of ASD with smoking, alcohol consumption, individual toxic substances, vaccination, blood transfusion, minor or major surgery, pregnancy, or diet in the year preceding disease onset. There were no significant associations with tonsillectomy or adenoidectomy, appendectomy, asthma, hay fever, allergy shots, or pregnancy at any time preceding the onset of disease. There was a statistically nonsignificant increase in a history of exposure to coal dust [odds ratio (OR) 3.0; 95% confidence interval (CI) 0.30 to 28.84], in allergy preceding the onset of disease (OR 2.67; 95% CI 0.71 to 10.05), and in oral contraceptive use in the year preceding onset (OR 2.00; 95% CI 0.18 to 22.06). Stressful life events (OR 2.56; 95% CI 1.18 to 5.52) in the year preceding onset was significantly associated with increased risk for ASD. This positive association should be treated with caution unless confirmed by a separate study.This exploratory study of risk factors for ASD draws attention to stress as a potentially important risk factor, while likely excluding a considerable number of others.
- Published
- 1996
16. Variability of skin scores and clinical measurements in scleroderma
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J E, Pope, M, Baron, N, Bellamy, J, Campbell, S, Carette, I, Chalmers, P, Dales, J, Hanly, E A, Kaminska, and P, Lee
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Male ,Observer Variation ,Methotrexate ,Scleroderma, Systemic ,Treatment Outcome ,Humans ,Reproducibility of Results ,Female ,Middle Aged ,Skin - Abstract
To determine the variability of several clinical outcome measurements commonly used in scleroderma clinical trials.Ten researchers, members of a multicenter placebo controlled trial of methotrexate in early diffuse scleroderma, studied the intraobserver and interobserver variability of variables used to assess efficacy in scleroderma trials.For most measures, the variability within an observer was less than that found between observers, and therefore the intraobserver reliability was better than the interobserver reliability. The reliability of the modified Rodnan skin score exceeded the Rodnan skin score. Measures with inherent interpretation such as global assessments and skin scores had more variability than easily performed measurements such as grip strength and oral opening.Some of our variability was higher than variability previously reported; this could be due to the large number of examiners and patients in our study.
- Published
- 1995
17. Fibromyalgia 20 years later: what have we really accomplished?
- Author
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S, Carette
- Subjects
Hypothalamo-Hypophyseal System ,Neurotransmitter Agents ,Fibromyalgia ,Rheumatology ,Mental Disorders ,Muscles ,Humans ,Disabled Persons ,Electroencephalography ,Sleep ,Spine - Published
- 1995
18. Comparison of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia. A randomized, double-blind clinical trial
- Author
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S, Carette, M J, Bell, W J, Reynolds, B, Haraoui, G A, McCain, V P, Bykerk, S M, Edworthy, M, Baron, B E, Koehler, and A G, Fam
- Subjects
Placebos ,Fibromyalgia ,Double-Blind Method ,Amitriptyline ,Humans ,Patient Compliance ,Antidepressive Agents, Tricyclic ,Pain Measurement - Abstract
To compare the relative efficacy and tolerability of amitriptyline, cyclobenzaprine, and placebo in the treatment of fibromyalgia, and to identify predictors of response to amitriptyline and cyclobenzaprine.Two hundred eight patients who fulfilled the American College of Rheumatology criteria for the classification of fibromyalgia were entered into a 6-month prospective, double-blind, multicenter trial and were randomized to 1 of 3 treatment groups: amitriptyline, cyclobenzaprine, or placebo.After 1 month, 21%, 12%, and 0% of the amitriptyline, cyclobenzaprine, and placebo patients, respectively, had significant clinical improvement (amitriptyline versus placebo P = 0.002, cyclobenzaprine versus placebo P = 0.02, amitriptyline versus cyclobenzaprine P not significant). These percentages increased to 36%, 33%, and 19%, respectively, at the 6-month assessment (P not significant). The nature and frequency of side effects reported by patients treated with amitriptyline and those reported by patients treated with cyclobenzaprine were similar. A normal Minnesota Multiphasic Personality Inventory (MMPI) profile at baseline was predictive of clinical improvement at the 1-month evaluation (odds ratio 3.3, 95% confidence interval 1.2-9.0). However, neither the MMPI profile nor any of the demographic, clinical, or functional parameters evaluated at baseline predicted long-term response.Our data confirm the short-term efficacy of amitriptyline and cyclobenzaprine in a small percentage of patients with fibromyalgia. Long-term efficacy could not be demonstrated because of a higher-than-expected placebo response. Predictors of response to these drugs could not be determined.
- Published
- 1994
19. Fibromyalgia and sex hormones
- Author
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S, Carette, M, Dessureault, and A, Bélanger
- Subjects
Adult ,Fibromyalgia ,Sex Hormone-Binding Globulin ,Humans ,Female ,Follicle Stimulating Hormone ,Luteinizing Hormone ,Gonadal Steroid Hormones - Published
- 1992
20. Osteoarthritis antirheumatic drug trials. II. Tables for calculating sample size for clinical trials
- Author
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N, Bellamy, S, Carette, P M, Ford, W F, Kean, N G, le Riche, A, Lussier, G A, Wells, and J, Campbell
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Clinical Trials as Topic ,Research Design ,Osteoarthritis ,Humans - Abstract
The calculation of sample size for clinical trials requires knowledge of the standard deviation (SD) of index variables. There are no published lists of SD and it is difficult to locate variance estimates based on relevant populations. In this study we used standardized procedures to determine in 60 patients with osteoarthritis (OA) of the knee the standard deviation of key outcome measures recommended in current Food and Drug Administration and European League Against Rheumatism guidelines for OA clinical trials. These tables will be useful to clinical researchers in selecting outcome measures as well as for calculating sample size requirements for future clinical studies in OA.
- Published
- 1992
21. Osteoarthritis antirheumatic drug trials. III. Setting the delta for clinical trials--results of a consensus development (Delphi) exercise
- Author
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N, Bellamy, S, Carette, P M, Ford, W F, Kean, N G, le Riche, A, Lussier, G A, Wells, and J, Campbell
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Clinical Trials as Topic ,Delphi Technique ,Osteoarthritis ,Humans - Abstract
Defining the minimum clinically important difference or delta to be detected in a clinical trial depends on a number of factors including the research hypothesis, patient characteristics, the nature of the intervention and the trial design. In 2 studies, we have developed standardized procedures for conducting outcome measurement based on current Food and Drug Administration and European League Against Rheumatism guidelines for osteoarthritis clinical trials, and determined the standard deviation for these outcome measures. In the final component of this series of studies, we have used a Delphi technique to establish estimates for delta, and calculated the sample size requirements under 2 different conditions of Type I and Type II error probabilities.
- Published
- 1992
22. Osteoarthritis antirheumatic drug trials. I. Effects of standardization procedures on observer dependent outcome measures
- Author
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N, Bellamy, S, Carette, P M, Ford, W F, Kean, N G, le Riche, A, Lussier, G A, Wells, and J, Campbell
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Adult ,Observer Variation ,Analysis of Variance ,Clinical Trials as Topic ,Statistics as Topic ,Anti-Inflammatory Agents ,Reproducibility of Results ,Middle Aged ,Research Design ,Osteoarthritis ,Outcome Assessment, Health Care ,Humans ,Female ,Aged - Abstract
We designed a study to assess the effects of standardization procedures on reducing interobserver variability for outcome measures given in the current Food and Drug Administration and European League Against Rheumatism guidelines and others selected from the rheumatology literature. Over 2 days, 6 rheumatologists independently examined 6 patients with osteoarthritis (OA) in predetermined order before and after standardizing their examination techniques. An important and beneficial effect of the standardization procedure was observed on the majority of outcome variables. Such reductions in observer variability have the potential to diminish sample size requirements for OA antirheumatic drug studies.
- Published
- 1992
23. [Disseminated lupus erythematosus. The continued efficacy of hydroxychloroquine scientifically proven by default]
- Author
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S, Carette
- Subjects
Humans ,Lupus Erythematosus, Systemic ,Hydroxychloroquine - Published
- 1991
24. Rheumatoid iliopsoas bursitis presenting as unilateral femoral nerve palsy
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L, Létourneau, M, Dessureault, and S, Carette
- Subjects
Arthritis, Rheumatoid ,Bursitis ,Nerve Compression Syndromes ,Humans ,Female ,Hip Joint ,Tomography, X-Ray Computed ,Femoral Nerve ,Aged - Abstract
A 65-year-old woman with rheumatoid arthritis (RA) developed symptomatic compression of the femoral nerve secondary to an iliopsoas bursitis. Her adjacent hip joint was not severely affected by arthritis. This entity should be included among the entrapment neuropathies complicating RA.
- Published
- 1991
25. Adult Still's disease: manifestations, disease course, and outcome in 62 patients
- Author
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J, Pouchot, J S, Sampalis, F, Beaudet, S, Carette, F, Décary, M, Salusinsky-Sternbach, R O, Hill, A, Gutkowski, M, Harth, and D, Myhal
- Subjects
Adult ,Male ,Outcome and Process Assessment, Health Care ,Adolescent ,Age Factors ,Humans ,Female ,Prognosis ,Arthritis, Juvenile ,Follow-Up Studies ,Retrospective Studies - Abstract
Clinical and laboratory manifestations, disease course, outcome, and HLA associations were studied in an inception cohort of 62 subjects with adult Still's disease (ASD) from 5 Canadian universities. Twenty-eight patients (45%) were female and the median age at disease onset was 24 years. In general, the clinical features observed in our patients were identical to those in other published series. However, significantly higher frequencies of sore throat (92%), weight loss (76%), lymphadenopathy (74%), pleuritis (53%), pneumonitis (27%), and abdominal pain (48%) were noted in our patients compared to those in a recent literature review. Liver involvement with hepatomegaly (44%) or abnormal liver function tests (LFTs) (76%) was common and was responsible for the 2 deaths attributed to Still's disease in our series. Severe liver failure always occurred in conjunction with aspirin or NSAID therapy. Therefore, whether or not aspirin or other NSAIDs are used, we recommend close monitoring of LFTs in patients with ASD, especially early in the disease course. Laboratory manifestations were similar to those already reported. Leukocytosis (greater than or equal to 15,000/mm3) was present in 50 patients (81%), a normochromic, normocytic anemia (hemoglobin less than or equal to 10 g/dl) in 42 (68%), and an elevated ESR in all. The mean follow-up of the 62 patients was 70 months (range, 2-163). Twenty-one patients (34%) had a self-limited disease course, 15 (24%) an intermittent course, and 22 (36%) a chronic disease course. Four patients (6%) died, and 2 of these deaths were attributed to Still's disease. For those patients who experienced a recurrence of ASD, the flares were usually of shorter duration and milder in severity than the initial episode. No initiating factor for disease exacerbation was identified in our patients. Although 22 of 62 patients (36%) had a chronic disease course, 52 (90%) were in ARA Functional Class I, and only 4 and 2 patients were in ARA Functional Class II and III, respectively. Patients with Still's disease had higher scores than the controls on the Pain (P less than 0.01) and Physical Disability (P less than 0.05) subscales of Arthritis Impact Measurement Scales health status questionnaire. Joint radiographs performed at the follow-up evaluation disclosed typical carpometacarpal and intercarpal involvement in 16 of 39 patients. In our series, HLA-B17, B18, B35, and DR2 were significantly associated with ASD. Three significant predictors of an unfavorable outcome, either a chronic disease course or a longer time to clinical remission, were identified.(ABSTRACT TRUNCATED AT 400 WORDS)
- Published
- 1991
26. Arthritis impact measurement scales: reliability of a French version and validity in adult Still's disease
- Author
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J S, Sampalis, J, Pouchot, F, Beaudet, S, Carette, A, Gutkowski, M, Harth, D, Myhal, J L, Senécal, C, Yeadon, and J I, Williams
- Subjects
Adult ,Male ,Adolescent ,Movement ,Surveys and Questionnaires ,Statistics as Topic ,Humans ,Female ,France ,Middle Aged ,Arthritis, Juvenile ,Aged - Abstract
The Arthritis Impact Measurement Scales (AIMS) questionnaire was administered to 57 patients with adult Still's disease (ASD) and 104 controls. Six of the 9 scales were consistent for both groups (Cronbach's alpha greater than or equal to 0.70). Two scales, Mobility and Dexterity, were consistent for ASD only (alpha greater than or equal to 0.70). The reliability of a French version of the AIMS was similar to the standard AIMS. Of the 13 associations evaluating criterion related validity of the AIMS in ASD, 11 were statistically significant. We conclude that the French and standard AIMS are comparable and that this questionnaire is reliable and valid for assessing outcome in ASD.
- Published
- 1990
27. Postmenopausal hormones and the incidence of rheumatoid arthritis
- Author
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S. Marcoux, S. Gingras, and S. Carette
- Subjects
medicine.medical_specialty ,Primary osteoarthritis ,business.industry ,Incidence (epidemiology) ,Obstetrics and Gynecology ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Confidence interval ,Telephone interview ,Relative risk ,Rheumatoid arthritis ,Internal medicine ,Soft tissue rheumatism ,Medicine ,business ,Hormone - Abstract
This case-control study assessed whether postmenopausal use of hormones reduces the incidence of rheumatoid arthritis (RA). Cases had classical or definite RA. Controls were patients with primary osteoarthritis or soft tissue rheumatism. Information on exposure was obtained by telephone interview. Compared to women who had never used postmenopausal hormones before onset of rheumatologic symptoms, adjusted relative risk (95% confidence limits) for past and current users were 0.95 (0.56-1.60) and 0.89 (0.49-1.63), respectively. Among current users, the association was not related to the duration of use. Our results provide little support for the hypothesis that use of postmenopausal hormones has a protective effect on the development of RA.
- Published
- 1990
28. Clinical evaluation of a new controlled-release formulation of naproxen in osteoarthritis and rheumatoid arthritis
- Author
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M. Willans, Nicholas Bellamy, G. R. Kraag, Boulos Haraoui, P. Ryan, S. Carette, N. J. Ryley, W. W. Buchanan, Denis Choquette, P. Corey, V. N. Khanna, Ménard Ha, A. Fitzgerald, Jean-Pierre Pelletier, J. S. Percy, and Anthony S. Russell
- Subjects
medicine.medical_specialty ,Naproxen ,business.industry ,Arthritis ,General Medicine ,Osteoarthritis ,medicine.disease ,Dose level ,Controlled release ,Surgery ,Tolerability ,Rheumatoid arthritis ,Internal medicine ,medicine ,business ,Clinical evaluation ,medicine.drug - Abstract
SummaryA two-part multi-centre study was carried out to assess the efficacy and tolerability of a new controlled-release (CR) naproxen tablet in the treatment of osteoarthritis and rheumatoid arthritis. Patients already receiving naproxen on a regular basis were first enrolled in a 6-week randomized double-blind trial comparing the controlled-release tablet (750 mg or 1000 mg once-a-day) to the standard marketed tablet (375 mg or 500 mg twice-a-day). At the end of this phase, patients in both treatment groups were eligible to enter the long-term phase involving 28 weeks of open-label treatment with controlled-release naproxen at the previously established dose level (750 mg or 1000 mg once-a-day). A total of 404 patients entered the initial double-blind phase, 320 of whom continued into the open-label phase. Twenty-nine (14%) naproxen patients and 23 (11%) naproxen CR patients were withdrawn prematurely from the double-blind phase, 87 (27%) patients from the open-label phase. Parameters of efficacy and to...
- Published
- 1988
29. Neonatal Behcet's syndrome in an infant of a mother with the disease
- Author
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Katherine A. Siminovitch, S Carette, L From, and A G Fam
- Subjects
Adult ,Male ,medicine.medical_specialty ,Immunology ,Arthritis ,Scars ,Antigen-Antibody Complex ,Disease ,Thrombophlebitis ,General Biochemistry, Genetics and Molecular Biology ,Immune system ,Rheumatology ,Pregnancy ,medicine ,Humans ,Immunology and Allergy ,Colonic Ulcer ,Maternal-Fetal Exchange ,biology ,business.industry ,Behcet Syndrome ,Infant, Newborn ,Transplacental ,medicine.disease ,Dermatology ,digestive system diseases ,Pregnancy Complications ,biology.protein ,Female ,medicine.symptom ,Antibody ,business ,Research Article - Abstract
Behçet's disease is reported in a newborn infant of a mother with the disease. The mother had recurrent orogenital ulcers, pustulonecrotic skin lesions, arthritis, thrombophlebitis, and colonic ulcers. Shortly after birth the infant presented with transient orogenital ulcerations and pustular cutaneous lesions. On healing, depressed scars developed which were very similar to those of the mother. The finding of circulating immune complexes in the mother's serum gives some support to the hypothesis that the infant's transient illness was caused by transplacental passage of maternal antibodies.
- Published
- 1981
30. Fibrositis and primary hypothyroidism
- Author
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S, Carette and L, Lefrançois
- Subjects
Adult ,Aged, 80 and over ,Male ,Thyroxine ,Fibromyalgia ,Adolescent ,Hypothyroidism ,Humans ,Pain ,Thyrotropin ,Female ,Middle Aged ,Aged - Abstract
The prevalence of fibrositis was determined in 100 patients with subclinical or biochemical primary hypothyroidism. Nineteen patients reported symptoms of joint and/or muscle pain with stiffness. Five of these patients presented 7 or more tender points on examination, thus allowing a diagnosis of fibrositis to be made in only 5% of the total group. Symptomatic improvement after thyroid hormone replacement occurred in 10 of the 19 patients, including 3 of those with fibrositis. There were no significant changes in tender points. Our data indicate that fibrositis is uncommon in patients with primary hypothyroidism despite the frequent occurrence of symptoms suggestive of this syndrome.
- Published
- 1988
31. Severe myositis and myocarditis in progressive systemic sclerosis
- Author
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S, Carette, J, Turcotte, and G, Mathon
- Subjects
Adult ,Myocarditis ,Scleroderma, Systemic ,Myositis ,Echocardiography ,Humans ,Female ,Methylprednisolone - Abstract
A 22-year-old woman with progressive systemic sclerosis developed severe myositis and life threatening myocarditis. Her myocarditis responded to intravenous pulse methylprednisolone therapy. We stress the usefulness of echocardiography in establishing the diagnosis and following the course of myocarditis.
- Published
- 1985
32. Cranial computerized tomography in systemic lupus erythematosus
- Author
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S, Carette, M B, Urowitz, H, Grosman, and E L, St Louis
- Subjects
Adult ,Brain Diseases ,Adolescent ,Adrenal Cortex Hormones ,Brain ,Humans ,Lupus Erythematosus, Systemic ,Female ,Middle Aged ,Tomography, X-Ray Computed ,Aged - Abstract
Twelve patients with active central nervous system systemic lupus erythematosus (CNS SLE) and 11 patients without CNS involvement, all taking corticosteroids, were studied by computerized tomography (CT). Thirty CT scans on 23 individuals were performed and read blindly and independently by 2 neuroradiologists with an 86% correlation. Minimal to moderate atrophy was the most frequent finding, both in CNS SLE and controls, severe atrophy seen in 1 patient only, and no atrophy in 3 patients and a single control. Of the 6 patients who had repeated scans, 4 showed no change in the degree of atrophy, 1 had more and 1 less atrophy. Three patients had evidence of multiple brain infarcts on scan with or without associated cerebral atrophy. Sequential scans in 1 of these patients showed total resolution of the infarcts after 30 months. Thus, there was no correlation between the presence of cerebral atrophy on CT scan and CNS SLE. Rather our findings suggest that steroids may be the cause of atrophy.
- Published
- 1982
33. Radionuclide esophageal transit in progressive systemic sclerosis
- Author
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S, Carette, Y, Lacourciere, S, Lavoie, and P, Hallé
- Subjects
Adult ,Male ,Esophagus ,Scleroderma, Systemic ,Adolescent ,Evaluation Studies as Topic ,Manometry ,Humans ,Female ,Diagnostic Errors ,Middle Aged ,Radionuclide Imaging ,Aged - Abstract
Twenty-three patients with progressive systemic sclerosis (PSS) were studied by radionuclide esophageal transit (RT) and esophageal manometry. Twenty-two patients had abnormal manometry ranging from lower esophageal sphincter incompetence to aperistaltism. Of these 22 patients, twenty (91%) had abnormal RT with prolongation of transit time. A characteristic RT pattern showing stagnation of the radionuclide in the distal and middle segments of the esophagus was demonstrated in 82% of the patients with advanced sclerodermatous involvement of the esophagus. Fifteen of the 19 controls (79%) studied had a normal RT. Four showed prolongation of transit time without stagnation. We conclude that RT is a safe, noninvasive, highly sensitive method which might be used as an alternative to esophageal manometry. However, it may lack specificity.
- Published
- 1985
34. An experiment in reducing interobserver variability of the examination for joint tenderness
- Author
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A V, Klinkhoff, N, Bellamy, C, Bombardier, S, Carette, A, Chalmers, J M, Esdaile, C, Goldsmith, P, Tugwell, H A, Smythe, and W W, Buchanan
- Subjects
Arthritis, Rheumatoid ,Analysis of Variance ,Humans ,Joints ,Pain Measurement - Abstract
This experiment was designed to test the feasibility of reducing interobserver variability of the joint examination by agreement on a standard examination. Six rheumatologists independently examined 6 patients with rheumatoid arthritis (RA) in predetermined order, before and after a standardization of examination techniques. Results of an analysis of variance showed a reduction of the percent of variability due to observers from 13.8%, before standardization, to 3.2% after standardization, and an improvement in the percent variability related to patient differences from 70.7%, before standardization, to 86.3% after standardization. Such a reduction in observer variability has a potential for allowing a reduction in sample sizes required for RA clinical trials.
- Published
- 1988
35. Postmenopausal hormones and the incidence of rheumatoid arthritis
- Author
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S, Carette, S, Marcoux, and S, Gingras
- Subjects
Arthritis, Rheumatoid ,Risk Factors ,Humans ,Female ,Menopause ,Middle Aged ,Gonadal Steroid Hormones - Abstract
This case-control study assessed whether postmenopausal use of hormones reduces the incidence of rheumatoid arthritis (RA). Cases had classical or definite RA. Controls were patients with primary osteoarthritis or soft tissue rheumatism. Information on exposure was obtained by telephone interview. Compared to women who had never used postmenopausal hormones before onset of rheumatologic symptoms, adjusted relative risk (95% confidence limits) for past and current users were 0.95 (0.56-1.60) and 0.89 (0.49-1.63), respectively. Among current users, the association was not related to the duration of use. Our results provide little support for the hypothesis that use of postmenopausal hormones has a protective effect on the development of RA.
- Published
- 1989
36. Cardiopulmonary manifestations of systemic lupus erythematous
- Author
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S, Carette
- Subjects
Lung Diseases ,Heart Diseases ,Muscular Diseases ,Hypertension, Pulmonary ,Diaphragm ,Humans ,Lupus Erythematosus, Systemic ,Pulmonary Embolism - Abstract
The cardiac and pulmonary manifestations of SLE are numerous. While the pleura and pericardium are most commonly affected, the myocardium and lung parenchyma can be the targets of life-threatening complications. Secondary processes (in particular, infection) must always be ruled out before attributing a cardiopulmonary manifestation to lupus.
- Published
- 1988
37. Multiple tendon rupture at unusual sites in rheumatoid arthritis
- Author
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C, Lauzon, S, Carette, and G, Mathon
- Subjects
Arthritis, Rheumatoid ,Male ,Rupture ,Rupture, Spontaneous ,Adrenal Cortex Hormones ,Tendon Injuries ,Ligaments, Articular ,Humans ,Patella ,Middle Aged ,Achilles Tendon - Abstract
A patient with seropositive nodular rheumatoid arthritis taking large doses of corticosteroids developed multiple tendon ruptures around weight bearing joints. The mechanisms underlying this rare complication are discussed.
- Published
- 1987
38. Serum alpha interferon and lymphocyte inclusions in systemic lupus erythematosus
- Author
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O T Preble, R M Friedman, J H Klippel, P M Grimley, and S Carette
- Subjects
Inclusion Bodies ,Systemic lupus erythematosus ,Lupus erythematosus ,business.industry ,Lymphocyte ,Immunology ,Alpha interferon ,medicine.disease ,General Biochemistry, Genetics and Molecular Biology ,Inclusion bodies ,medicine.anatomical_structure ,Rheumatology ,Cytoplasm ,Interferon ,Interferon Type I ,medicine ,Immunology and Allergy ,Humans ,Lupus Erythematosus, Systemic ,Lymphocytes ,business ,Interferon type I ,medicine.drug ,Research Article - Abstract
The relationship between serum acid-labile alpha interferon and tubuloreticular inclusions within the cytoplasm of circulating lymphocytes was studied in 46 patients with systemic lupus erythematosus. Elevated levels of interferon (greater than or equal to 8 IU/ml) were found in 17 patients and lymphocyte inclusions in 35. The mean serum interferon concentration in patients with lymphocyte inclusions was significantly higher than in patients without inclusions (17.2 versus 2.4 IU/ml, p less than 0.01). Inclusions were found in 16 of 17 patients with elevated interferon and also in 19 of 29 patients without interferon (p = 0.026). In lupus, serum interferon appears to be a sufficient though not an essential marker for the presence of lymphocyte inclusions.
- Published
- 1985
39. SUR LA GYRENCEPHALIE RELATIVE DE CERTAINS RONGEURS
- Author
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S. Carette
- Subjects
Animal Science and Zoology ,Ecology, Evolution, Behavior and Systematics - Published
- 1950
40. Acute adrenal insufficiency as a manifestation of the anticardiolipin syndrome?
- Author
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F Jobin and S Carette
- Subjects
medicine.medical_specialty ,Systemic disease ,Deep vein ,Immunology ,Gastroenterology ,General Biochemistry, Genetics and Molecular Biology ,Serology ,Rheumatology ,immune system diseases ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Adrenal insufficiency ,Immunology and Allergy ,cardiovascular diseases ,skin and connective tissue diseases ,Systemic lupus erythematosus ,Lupus erythematosus ,business.industry ,medicine.disease ,Thrombosis ,medicine.anatomical_structure ,lipids (amino acids, peptides, and proteins) ,Complication ,business ,Research Article - Abstract
A 34 year old man with a past history of deep vein thrombosis, positive lupus serology, and high titres of anticardiolipin antibodies developed acute adrenal insufficiency. Association of anticardiolipin antibodies with adrenal insufficiency has not been previously reported.
- Published
- 1989
41. CRANIAL COMPUTERIZED TOMOGRAPHY IN SYSTEMIC LUPUS ERYTHEMATOSUS
- Author
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H Grosman, E. L. St. Louis, M. D. Urowitz, and S. Carette
- Subjects
medicine.medical_specialty ,business.industry ,medicine ,Radiology, Nuclear Medicine and imaging ,Radiology ,Tomography ,business - Published
- 1984
42. A study of implementation factors for a novel approach to clinical trials: constructs for consideration in the coordination of direct-to-patient online-based medical research.
- Author
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Cronholm PF, Applequist J, Krischer J, Fontenot E, Davis T, Burroughs C, McAlear CA, Borchin R, Kullman J, Carette S, Khalidi N, Koening C, Langford CA, Monach P, Moreland L, Pagnoux C, Specks U, Sreih AG, Ytterberg SR, and Merkel PA
- Subjects
- Humans, Male, Female, Qualitative Research, Middle Aged, Patient Selection, Adult, Internet, Randomized Controlled Trials as Topic methods, Research Design, Communication, Biomedical Research methods
- Abstract
Background: Traditional medical research infrastructures relying on the Centers of Excellence (CoE) model (an infrastructure or shared facility providing high standards of research excellence and resources to advance scientific knowledge) are often limited by geographic reach regarding patient accessibility, presenting challenges for study recruitment and accrual. Thus, the development of novel, patient-centered (PC) strategies (e.g., the use of online technologies) to support recruitment and streamline study procedures are necessary. This research focused on an implementation evaluation of a design innovation with implementation outcomes as communicated by study staff and patients for CoE and PC approaches for a randomized controlled trial (RCT) for patients with vasculitis., Methods: In-depth qualitative interviews were conducted with 32 individuals (17 study team members, 15 patients). Transcripts were coded using the Consolidated Framework for Implementation Research (CFIR)., Results: The following CFIR elements emerged: characteristics of the intervention, inner setting, characteristics of individuals, and process. From the staff perspective, the communication of the PC approach was a major challenge, but should have been used as an opportunity to identify one "point person" in charge of all communicative elements among the study team. Study staff from both arms were highly supportive of the PC approach and saw its promise, particularly regarding online consent procedures. Patients reported high self-efficacy in reference to the PC approach and utilization of online technologies. Local physicians were integral for making patients feel comfortable about participation in research studies., Conclusions: The complexity of replicating the interpersonal nature of the CoE model in the virtual setting is substantial, meaning the PC approach should be viewed as a hybrid strategy that integrates online and face-to-face practices., Trial Registrations: 1) Name: The Assessment of Prednisone In Remission Trial - Centers of Excellence Approach (TAPIR)., Trial Registration Number: ClinicalTrials.gov NCT01940094 . Date of registration: September 10, 2013. 2) Name: The Assessment of Prednisone In Remission Trial - Patient Centric Approach (TAPIR)., Trial Registration Number: Clinical Trials.gov NCT01933724 . Date of registration: September 2, 2013., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
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43. Vitamin D status in ANCA-associated vasculitis.
- Author
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Doubelt I, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach P, Seo P, Specks U, Warrington KJ, Merkel PA, and Pagnoux C
- Abstract
Objective: Vitamin D might participate in the pathogenesis of several immune-mediated diseases, but few related data are available for ANCA-associated vasculitis (AAV). In this study, we analysed the association between vitamin D status and disease in patients with AAV., Methods: Serum levels of 25(OH)D
2/ 3 were measured in 125 randomly selected patients with AAV [granulomatosis with polyangiitis ( n = 50), eosinophilic granulomatosis with polyangiitis ( n = 50) or microscopic polyangiitis ( n = 25)] enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies at the time of enrolment and a subsequent relapse visit. Sufficient, insufficient and deficient vitamin D status were defined as 25(OH)D3 levels >30, 20-30 and ˂20 ng/ml, respectively., Results: Seventy of 125 patients (56%) were female, with a mean age of 51.5 (16) years at diagnosis; 84 (67%) were ANCA positive. Mean 25(OH)D was 37.6 (16) ng/ml, with vitamin D deficiency in 13 (10.4%) and insufficiency in 26 (20.8%). In univariate analysis, lower vitamin D status was associated with male sex ( P = 0.027) and disease activity ( P = 0.047). In univariate and multivariate analyses, deficient vitamin D status was associated with disease activity ( P = 0.015). Mean 25(OH)D status in the 21 patients with a subsequent relapse did not differ between baseline and relapse visit [37.8 (16) vs 38.0 (10) ng/ml, respectively; P = 0.92]., Conclusion: Most patients with AAV have sufficient 25(OH)D levels, although those with lower vitamin D status were more likely to be male and to have active disease. Whether optimization of vitamin D status alters disease manifestations or activity in AAV remains to be determined., Trial Registration: Vasculitis Clinical Research Consortium (VCRC) Longitudinal Study (LS), NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)- Published
- 2023
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- View/download PDF
44. Oncohistone interactome profiling uncovers contrasting oncogenic mechanisms and identifies potential therapeutic targets in high grade glioma.
- Author
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Siddaway R, Canty L, Pajovic S, Milos S, Coyaud E, Sbergio SG, Vadivel Anguraj AK, Lubanszky E, Yun HY, Portante A, Carette S, Zhang C, Moran MF, Raught B, Campos EI, and Hawkins C
- Subjects
- Amino Acids genetics, Child, DNA, Humans, Mutation genetics, Nucleosomes, Transcription Factors genetics, Glioma genetics, Glioma metabolism, Histones genetics
- Abstract
Histone H3 mutations at amino acids 27 (H3K27M) and 34 (H3G34R) are recurrent drivers of pediatric-type high-grade glioma (pHGG). H3K27M mutations lead to global disruption of H3K27me3 through dominant negative PRC2 inhibition, while H3G34R mutations lead to local losses of H3K36me3 through inhibition of SETD2. However, their broader oncogenic mechanisms remain unclear. We characterized the H3.1K27M, H3.3K27M and H3.3G34R interactomes, finding that H3K27M is associated with epigenetic and transcription factor changes; in contrast H3G34R removes a break on cryptic transcription, limits DNA methyltransferase access, and alters mitochondrial metabolism. All 3 mutants had altered interactions with DNA repair proteins and H3K9 methyltransferases. H3K9me3 was reduced in H3K27M-containing nucleosomes, and cis-H3K9 methylation was required for H3K27M to exert its effect on global H3K27me3. H3K9 methyltransferase inhibition was lethal to H3.1K27M, H3.3K27M and H3.3G34R pHGG cells, underscoring the importance of H3K9 methylation for oncohistone-mutant gliomas and suggesting it as an attractive therapeutic target., (© 2022. The Author(s).)
- Published
- 2022
- Full Text
- View/download PDF
45. Hypothyroidism in vasculitis.
- Author
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Kermani TA, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford CA, McAlear CA, Monach PA, Moreland L, Pagnoux C, Seo P, Specks U, Sreih A, Warrington KJ, and Merkel PA
- Subjects
- Antibodies, Antineutrophil Cytoplasmic, Female, Humans, Longitudinal Studies, Male, Middle Aged, Prospective Studies, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis diagnosis, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis epidemiology, Churg-Strauss Syndrome epidemiology, Granulomatosis with Polyangiitis, Hypothyroidism epidemiology, Microscopic Polyangiitis complications, Microscopic Polyangiitis epidemiology
- Abstract
Objective: To study the prevalence, risk and clinical associations of hypothyroidism among several forms of vasculitis., Methods: Patients with GCA, Takayasu's arteritis (TAK), PAN and the three forms of ANCA-associated vasculitis [AAV; granulomatosis with polyangiitis (GPA), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (EGPA)] enrolled in a prospective, multicentre, longitudinal study were included., Results: The study included data on 2085 patients [63% female, 90% White] with a mean age of 54.6 years (s.d. 17.2). Diagnoses were GCA (20%), TAK (11%), PAN (5%), GPA (42%), microscopic polyangiitis (8%) and EGPA (14%). Hypothyroidism was present in 217 patients (10%) (83% female), with a mean age 59.8 years (s.d. 14.5). Age- and sex-adjusted risk of hypothyroidism was GCA, odds ratio (OR) 0.61 (95% CI 0.41, 0.90); TAK, OR 0.57 (95% CI 0.31, 1.03); PAN, OR 0.59 (95% CI 0.25, 1.38); GPA, OR 1.51 (95% CI 1.12, 2.05); microscopic polyangiitis, OR 1.81 (95% CI 1.18, 2.80) and EGPA, OR 0.82 (95% CI 0.52, 1.30). Among patients with AAV, age- and sex-adjusted risk of hypothyroidism was higher with positive MPO-ANCA [OR 1.89 (95% CI 1.39, 2.76)]. The clinical manifestations of vasculitis were similar in patients with and without hypothyroidism, except transient ischaemic attacks, which were more frequently observed in patients with GCA and hypothyroidism (12% vs 2%; P = 0.001)., Conclusions: Differences in the risk of hypothyroidism among vasculitides may be due to genetic susceptibilities or immune responses. This study confirms an association of hypothyroidism with MPO-ANCA., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
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46. Vasculitis: What Have We Learned in the Last 50 Years?
- Author
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Carette S
- Subjects
- Humans, Vasculitis
- Abstract
Realizing in the fall of 2021 that I had started medical school exactly 50 years ago, on September 7, 1971, I thought that it would be interesting for the 2022 Dunlop-Dottridge Lecture to briefly review what we knew about vasculitis prior to 1971 and then reflect on what we have learned since., (Copyright © 2022 by the Journal of Rheumatology.)
- Published
- 2022
- Full Text
- View/download PDF
47. Self-Reported Data and Physician-Reported Data in Patients With Eosinophilic Granulomatosis With Polyangiitis: Comparative Analysis.
- Author
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Doubelt I, Springer JM, Kermani TA, Sreih AG, Burroughs C, Cuthbertson D, Carette S, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Shaw DG, Seo P, Specks U, Warrington KJ, Young K, Merkel PA, and Pagnoux C
- Abstract
Background: Patient-based registries can help advance research on rare diseases such as eosinophilic granulomatosis with polyangiitis (EGPA), a complex multiorgan form of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis., Objective: The aim of this study is to compare patient-reported and physician-reported data on manifestations, treatments, and outcomes for patients with EGPA., Methods: We completed a comparative analysis of patients ≥18 years with EGPA in Canada and the United States from the following 2 cohorts: (1) The Vasculitis Patient-Powered Research Network (VPPRN), a self-enrolled secure portal with patient-entered data updated quarterly (2014-2019) and (2) the Vasculitis Clinical Research Consortium (VCRC) observational studies, a physician-entered database (2003-2019) of patients who fulfilled the 1990 American College of Rheumatology classification criteria for EGPA. The studied parameters included demographic characteristics, clinical manifestations, ANCA status, treatments, and relapses., Results: Data from 195 patients with a validated diagnosis of EGPA in the VPPRN and 354 patients enrolled in the VCRC were analyzed. Compared to the VCRC cohort, the patients in the VPPRN cohort were more likely to be female (135/195, 69.2% compared to 209/354, 59%; P=.02) and younger at diagnosis (47.3 compared to 50.0 years; P=.03); both cohorts reported similar frequencies of asthma (177/184, 96.2% in the VPPRN cohort compared to 329/354, 92.9% in the VCRC cohort; P=.13) and cardiac manifestations (44/153, 28.8% compared to 75/354, 21.2%; P=.06), but the VPPRN cohort reported less frequent lung manifestations other than asthma and more frequent disease manifestations in all other organ systems. The ANCA positivity was 48.9% (64/131) in the VPPRN patients compared to 38.9% (123/316; P=.05) in the VCRC cohort. Relapsing disease after study enrollment was reported in 32.3% (63/195) of patients in the VPPRN compared to 35.7% (99/277) of patients in the VCRC. Most therapies (GC, cyclophosphamide, mepolizumab) were used at similar frequencies in both groups, except for rituximab with VPPRN patients reporting more use than the VCRC cohort (47/195, 24.1% compared to 29/277, 10.5%; P<.001)., Conclusions: Overall, patients and physicians report manifestations of EGPA at similar frequencies. However, observed differences between patient and physician reports imply the potential occurrence of selection biases. These results support the use of patient-reported data in EGPA but also the need for careful consideration of disease-specific definitions for the study of EGPA and how patient- and physician-reported data are collected., Trial Registration: ClinicalTrials.gov NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380; ClinicalTrials.gov NCT01241305, https://clinicaltrials.gov/ct2/show/NCT01241305., (©Irena Doubelt, Jason M Springer, Tanaz A Kermani, Antoine G Sreih, Cristina Burroughs, David Cuthbertson, Simon Carette, Nader A Khalidi, Curry L Koening, Carol Langford, Carol A McAlear, Larry W Moreland, Paul A Monach, Dianne G Shaw, Philip Seo, Ulrich Specks, Kenneth J Warrington, Kalen Young, Peter A Merkel, Christian Pagnoux. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/), 25.05.2022.)
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- 2022
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48. An Initiative to Improve Timely Glucocorticoid Tapering in Vasculitis.
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Mendel A, Ennis D, Lake S, Carette S, and Pagnoux C
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- Glucocorticoids, Humans, Prednisone, Treatment Outcome, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis drug therapy, Arteritis
- Abstract
Background/objective: High-dose glucocorticoids (GCs) are required in the initial treatment of systemic vasculitis. However, slow or delayed tapering can lead to unnecessary GC exposure and toxicity. In this quality improvement initiative, we aimed to increase appropriate GC tapering among newly referred patients awaiting specialty consultation at a tertiary vasculitis clinic., Methods: For each patient referred for anti-neutrophil cytoplasm antibody-associated vasculitis (AAV) or large vessel vasculitis (LVV), recommendation-based GC tapering suggestions were faxed to referring physicians. To maximize uptake, the intervention format was modified according to feedback from referring physicians' offices. The proportion of new patients presenting to their first appointment who (1) had started to taper GCs, (2) were taking their target GC dose according to recommendations, (3) experienced a vasculitis flare during tapering were compared before (July 2017-January 2019) and after (February-October 2019) the intervention., Results: Among 169 consecutive patients referred for AAV or LVV, the proportion who had started to taper GCs by their first visit increased from 84 of 117 (72%) preintervention to 49 of 52 (94%) postintervention (p < 0.01). Mean daily prednisone dose at first visit decreased from 29.9 (SD, 18) mg to 21.7 (SD, 14) mg (p < 0.01). However, the proportion who were ultimately taking "target" GC doses at their first visit did not significantly increase (72% vs. 77%). Disease flares during tapering were similar before and after the intervention (9% vs. 12%)., Conclusions: Patients with AAV and LVV had increased GC tapering and lower GC doses at first visit following a preappointment intervention. Further strategies are needed to improve timely GC tapering in vasculitis., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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49. ANCA status and renal parameters at month 12 post-diagnosis can help predict subsequent relapses in patients with granulomatosis with polyangiitis.
- Author
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Cho LK, Carette S, and Pagnoux C
- Subjects
- Antibodies, Antineutrophil Cytoplasmic, Canada, Humans, Myeloblastin, Recurrence, Retrospective Studies, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis complications, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis diagnosis, Granulomatosis with Polyangiitis
- Abstract
Objective: To determine the predictive value of disease characteristics at 12-month follow-up after the diagnosis of GPA for subsequent relapses in a cohort of patients followed at a tertiary vasculitis clinic., Methods: Demographic, clinical, and biological data at diagnosis and during follow-up from patients with GPA followed for at least 24 months at the Mount Sinai Hospital Vasculitis Clinic in Toronto, Canada were extracted from the Canadian Vasculitis Research Network (CanVasc) database and analyzed. The association between ANCA status and type (PR3- or MPO-ANCA), presence of microscopic hematuria, or serum creatinine level at follow-up month 12 ± 3 (M12) and relapses after M12 were assessed using Cox proportional hazard models., Results: A total of 113 GPA patients were included in this study (50 ANCA positive, 63 ANCA negative at M12). Patient demographics and disease characteristics were similar at diagnosis, including the treatments used for induction and at M12. The global 5-year relapse rate was 55.8%, without any difference in the relapse rates after M12 between those ANCA-positive or negative at M12. However, in multivariate analyses, MPO-ANCA positivity at M12 was predictive of increased relapses after M12 (hazard ratio [HR] 3.54, P=0.01), as was the presence of microhematuria at M12 (HR 1.91, P=0.04). In contrast, higher serum creatinine levels at M12 were associated with a decreased risk of subsequent relapse (HR 0.99, P=0.04)., Conclusion: In this cohort of patients with GPA, MPO-ANCA positivity and persistent microscopic hematuria at M12 were associated with increased risk of subsequent relapse, and could thus have value to predict disease outcome during follow-up., Competing Interests: Declaration of Competing Interest LKC and SC have declared no conflicts of interest. CP has declared grants and personal fees (Roche, ChemoCentryx, GSK, InflaRx, AstraZeneca, Pfizer, TEVA, Sanofi <$10,000)., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)
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- 2021
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50. Clinical Manifestations and Long-Term Outcomes of Eosinophilic Granulomatosis With Polyangiitis in North America.
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Doubelt I, Cuthbertson D, Carette S, Chung SA, Forbess LJ, Khalidi NA, Koening CL, Langford C, McAlear CA, Moreland LW, Monach PA, Seo P, Specks U, Spiera RF, Springer JM, Sreih AG, Warrington KJ, Merkel PA, and Pagnoux C
- Abstract
Objective: To describe clinical manifestations and outcomes in patients with eosinophilic granulomatosis with polyangiitis (EGPA) in North America., Methods: Analysis of patients aged 18 years or older who fulfilled the 1990 American College of Rheumatology Classification Criteria for EGPA enrolled in the Vasculitis Clinical Research Consortium from 2003 to 2019. Main clinical characteristics, treatments, outcomes, and accumulated damage were studied., Results: The cohort included 354 patients; 59% female; age at diagnosis of 50.0 (±14) years; 39% were antineutrophil cytoplasm antibody (ANCA) positive. Time from diagnosis to last follow-up was 7.0 (±6.2) years; 49.4% had one or more relapse. Patients positive for ANCA more commonly had neurological and kidney involvement when compared with patients negative for ANCA, who had more cardiac and lung manifestations. At last study visit, only 35 (12.6%) patients had been off all therapy for more than 2 years during their follow-up. The overall mortality rate was 4.0% and did not differ by ANCA status or cyclophosphamide use. Scores on the Vasculitis Damage Index (VDI) for 134 patients with two or more visits and more than 1 year of follow-up increased from 1.7 (±1.8) at enrollment (3.7 [±5.1] years after diagnosis) to 3.35 (±2.1) at last follow-up (7.5 [±5.8] years after diagnosis), mainly represented by chronic asthma (67.5%), peripheral neuropathy (49.6%), and chronic sinusitis (31.3%). Longer duration of glucocorticoid use and relapse were associated with higher VDI scores., Conclusion: This analysis describes the many clinical manifestations and varied outcomes of EGPA and highlights the ongoing need to attain more sustained, long-term remission to limit the accrual of disease-related damage., (© 2021 The Authors. ACR Open Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)
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- 2021
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