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Biomedical subjects

M Soubrier

Publications and source records attributed to M Soubrier.

At least 37 records · Page 2Linked to original sources
PubMed1999

HLA and self-limiting, unclassified rheumatism. A role for HLA-B35?

OBJECTIVE: To test the hypothesis of increased frequency of HLA-B35 in self-limiting, unclassified rheumatism (SUR). METHODS: Patients (n = 50) were included if they had swelling of one or more joints for more than 24 h and/or pain without trauma of 2 or more joints for one month or longer, and at least one of (1) history of joint swelling, (2) morning stiffness, (3) elevated erythrocyte sedimentation rate and/or C-reactive protein. Patients fulfilling diagnostic criteria sets of any rheumatic disease and patients with other identified diseases were excluded. Controls were 50 patients with rheumatoid arthritis (RA) and 199 healthy blood donors. RESULTS: HLA-B35 frequency (0.32) was significantly greater in SUR than in RA (0.14) and controls (0.17). HLA-DR4 frequency was significantly increased in HLA-B35 positive SUR, while that of HLA-DR1 was decreased (NS). Clinical characteristics of SUR were: history of atopy; transient, mono or oligoarticular synovitis and widespread, longlasting pain. HLA-B35 positive patients with SUR more often had hip, knee, or back pain than HLA-B35 negative patients. CONCLUSION: HLA-B35 frequency is increased in SUR, while HLA-DR1 frequency is not. A likely hypothesis of attenuated immune inflammation in SUR is further supported by results in juvenile RA, adult Still's disease, and a series of mild inflammatory arthritides, and by indirect evidence of decreased Th1 response and increased Th2 response in HLA-B35 positive patients with various conditions.

Adult↗
PubMed1998

Pulmonary hypertension in POEMS syndrome: a new feature mediated by cytokines.

POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare variant of plasma cell dyscrasia with multiple systemic manifestations. We followed the progress of 20 patients with POEMS syndrome in our institution over a 10-yr period. Pulmonary hypertension (PH) was observed in five patients. All patients suffered dyspnea on exertion, which always appeared during an exacerbation of POEMS syndrome. The typical echocardiographic signs of PH were observed in all of these patients, and the median pulmonary-artery systolic pressure was 57 mm Hg (range, 50 to 65 mm Hg). Mean pulmonary-artery pressure during right side heart catheterization in two patients was 32 mm Hg. No other explanation for the PH could be found. Overproduction of cytokines was found in all cases, with high serum concentrations of interleukin-1beta, interleukin-6, tumor necrosis factor-alpha, and vascular endothelial growth factor. We suggest that PH should be added to the list of symptoms of POEMS syndrome. Cytokines may mediate POEMS syndrome-associated PH, as proposed for the other systemic manifestations of this disorder.

Adult↗
PubMed1998

Arterial obliteration in POEMS syndrome: possible role of vascular endothelial growth factor.

Acute arterial obliteration is a newly acknowledged manifestation of the POEMS syndrome (plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes), in which overproduction of proinflammatory cytokines has been implicated. We describe a case in which serum levels of proinflammatory cytokines were normal or slightly raised. In contrast, vascular endothelial growth factor (VEGF) was greatly increased. This angiogenic and vascular permeability factor is involved in the development of atheromatous and thrombotic lesions and may be responsible for the arterial complications of the disorder.

Aortography↗
PubMed1997

[Does reactive arthritis caused by Brucella exist? Apropos of 4 cases].

OBJECTIVES: Arthritis observed in patients with Brucella infection is usually considered to result from live micro-organisms invading the synovia. We observed four cases of brucellosis in which the clinical and laboratory findings suggested a different mechanism: reactive arthritis. CLINICAL OBSERVATIONS: The diagnosis of brucellosis was made on the basis of serology tests in 3 patients and blood cultures in 1. All 4 patients presented oligoarthritis. The synovial fluid was sterile in 3. Antibiotics were ineffective in reducing joint pain and inflammation whereas local and systemic anti-inflammatory drugs were effective. Three patients also had other manifestations (sausage-shaped toes, talalgia, sacroiliitis) and fulfilled the diagnostic criteria for spondylarthropathy. All patients were positive for antigen HLA-B27. DISCUSSION: These observations suggest that Brucella should be added to the list of intracellular infectious agents capable of inducing reactive arthritis, despite the lack of all the diagnostic criteria. For some, such as the uretritis or diarrhea observed before joint involvement, it would be difficult to implicate the germ. Brucella serology should be part of the etiology work-up for reactive arthritis in endemic areas.

Adult↗
PubMed1997

Response to minocycline of arthritis associated with agammaglobulinemia. A case-report.

Seven to 22% of patients with agammaglobulinemia develop joint manifestations consisting of septic arthritis or aseptic arthritis of unclear pathogenesis. Intravenous gammaglobulin therapy seems effective on the latter condition but is burdensome and expensive. We report the case of a patient with common variable immunodeficiency and aseptic oligoarthritis in which minocycline therapy was effective in relieving the joint symptoms.

Agammaglobulinemia↗
PubMed1997

[Epiphyseal pain from cyclosporine in renal transplants].

In patients with renal transplant, cyclosporin has been implicated in the occurrence of osteoarticular pain. This syndrome, which we illustrate by two of our observations, is fairly stereo-typed. Osteoarticular pain begins around the second month post-transplant and in a symmetrical pattern involves, knees, ankles, tarsi, less frequently hips, and almost never upper limbs. Pain arises on standing and walking, which is severely impeded. Clinical examination is usually normal. Radiographs show patchy, subchondral osteopenia. Bone scintiscan documents numerous foci of increased uptake and MRI multiple areas of T1-weighted low signal intensity and T2-weighted high signal intensity. Pain disappears in three to six months. Ethiopathogeny is still a matter of discussion with frequent reference to reflex sympathetic dystrophy. The syndrome could also be related to a cyclosporin-induced increase in bone remodelling. Steroids could contribute, as could the healing of pre-transplant, renal osteodystrophy. Microfractures are common but it is not known whether they are causative through an ensuing reflex sympathetic dystrophy or whether they are simply but a consequence of increased bone remodelling.

Arthralgia↗
PubMed1997

An open study of the anti-TNF alpha agent pentoxifylline in the treatment of rheumatoid arthritis.

OBJECTIVE: Monoclonal antibodies to TNF alpha have a rapid therapeutic effect in rheumatoid arthritis. Pentoxifylline is an anti-TNF alpha agent that is easier to handle than antibodies. METHODS: An open prospective trial was conducted in 21 patients with active rheumatoid arthritis. Pentoxifylline was given in a daily dosage of 1,200 mg for at least one month. Five patients received the drug as a continuous intravenous infusion during the first seven days. RESULTS: After one month, a significant decrease in the pain severity score was noted, but all other clinical and laboratory efficacy parameters were unchanged. A limited response was seen in four patients. TNF alpha levels did not decrease under therapy. CONCLUSION: Under the conditions of our trial, the therapeutic benefits provided by pentoxifylline were too small to warrant use of this drug in severe refractory rheumatoid arthritis.

Antirheumatic Agents↗
PubMed1997

Vasculitis confined to the calves. Report of a case.

Polyarteritis nodosa is a systemic disease of which limited forms have been reported, with the most common involving the skin. Only 13 cases with lesions confined to the calves have been reported to date. We report a new case.

Female↗
PubMed1996

Overproduction of proinflammatory cytokines imbalanced by their antagonists in POEMS syndrome.

The polyneuropathy, organomegaly, endocrinopathy, M protein, skin changes (POEMS) syndrome is a rare multisystem disorder of obscure pathogenesis associated with osteosclerotic myeloma. Circulating levels of proinflammatory cytokines (tumor necrosis factor-alpha (TNF-alpha) interleukin-1 beta [IL-1 beta], IL-2, IL-6, and interferon-gamma [IFN-gamma]), anti-inflammatory cytokines (transforming growth factor beta 1 [TGF beta 1], IL-4, IL-10, and IL-13), the cytokine carrier protein alpha 2 macroglobulin, IL-1 receptor antagonist (IL-1ra), soluble TNF receptors (sTNFr) p55 and p75, and soluble IL-6 receptor (sIL-6r) were determined in 15 patients with POEMS syndrome and 15 with multiple myeloma. Patients with POEMS syndrome had higher serum levels of IL-1 beta, TNF-alpha, and IL-6 and lower serum levels of TGF beta 1 than did patients with multiple myeloma. Serum levels of IL-2, IL-4, IL-10, IL-13, IFN-gamma, alpha 2 macroglobulin, and sIL-6r were similar in both groups. IL-1ra and sTNFrs were increased in POEMS syndrome, but out of proportion to the increase of IL-1 beta and TNF-alpha. Serial evaluations in 1 patient showed that proinflammatory cytokine serum levels paralleled disease activity assessed by platelet count and neurologic involvement. Our results suggest that the manifestations of POEMS syndrome might be regarded as the result of a marked activation of the proinflammatory cytokine network (IL-1 beta, IL-6, and TNF-alpha) associated with a weak or even decreased (TGF beta 1) antagonistic reaction insufficient to counteract the noxious effects of cytokines.

Adult↗
PubMed1996

[Prognosis of multiple myeloma treated with conventional chemotherapy has not improved in 20 years].

The treatment of multiple myeloma has changed over the last 20 years. We investigated the effects of theses changes on patient survival in the current practice of a rheumatology ward. Two hundred and seventy-nine patients were hospitalised between 1972 and 1993: 30 from 1972 to 1976, 70 from 1977 to 1981, 86 from 1982 to 1986, 75 from 1987 to 1991 and 18 from 1992 to 1993. Staging according to Durie and Salmon was I in 8%, II in 29% and III in 65%. In principle, the initial therapy was monochemotherapy in 65% of the cases and polychemotherapy in 35%. At the time of the present study, 197 patients have died. The actuarial curves of survival were similar in all historical classes defined by the date of first admission. Curves of median of follow-up and of floating means were level between 1972 and 1990. No correlation was found between the date of first admission and survival in the 174 patients who died between 1972 and 1987. The following parameters were associated with longer survival: achievement of an objective response on chemotherapy, lower patient's age, high haemoglobin, low creatinine, low stage according to Durie and Salmon, low number of plasma cells in bone marrow, low calcemia and low levels of IgA, monoclonal component. The comparison of prognosis factors in historical classes showed a difference only for haemoglobin which was lower in the earlier class. The type of the first chemotherapy regimen varied widely between historical classes. The number of responders was significantly greater after polychemotherapy than after monochemotherapy but no correlation was observed between the type of chemotherapy and survival. The frequencies of early death, and the causes of death in general, were not different in the historical classes. The lack of improvement of survival over the last 20 years shows that the efficacy of current chemotherapies is limited, a conclusion which warrants the exploration of other therapeutic avenues.

Aged↗
PubMed1996

Subchondral insufficiency fracture of the femoral head.

We report two cases of subchondral insufficiency fractures of the femoral head. Clinical manifestations of this lesion are nonspecific. Radionuclide bone scanning demonstrates early hyperactivity. Initial roentgenograms are usually normal. Magnetic resonance imaging establishes the diagnosis and rules out other conditions.

Aged↗