Center Viggo Petersen

Paris, France

Center Viggo Petersen

Paris, France
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Nuki G.,University of Edinburgh | Doherty M.,University of Nottingham | Richette P.,Center Viggo Petersen
Polskie Archiwum Medycyny Wewnetrznej | Year: 2017

The European League Against Rheumatism published updated recommendations for the management of gout in 2016, comprising 3 overarching principles and 11 key recommendations for clinical practice. Patient education about the pathophysiology of gout and its comorbidities, as well as the existence of effective treatments are important, and understanding the principles of managing acute attacks and eliminating urate crystals by lifelong lowering of the serum urate (SU) below a target level are essential. Advice about lifestyle, diet, weight, and other risk factors, as well as the need to screen for and manage comorbidities are emphasized. For the treatment of flares, colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and oral or intraarticular steroids, or a combination thereof, are recommended. In patients with frequent flares and contraindications to colchicine, NSAIDs, and corticosteroids, an interleukin-1 blocker should be considered. Urate-lowering therapy (ULT) should be discussed from the first presentation of the disease, and SU levels should be maintained at less than 6 mg/dl (360 μmol/l), or less than 5 mg/dl (300 μmol/l) in patients with severe gout. Allopurinol is recommended as first-line ULT with dose adjust-ment according to renal function. If the SU target cannot be achieved with allopurinol, then febuxostat, a uricosuric, or combining a xanthine oxidase inhibitor with a uricosuric should be considered. All ULTs should be started at low dose and titrated upwards until the SU target is achieved. Unless contraindicated, flare prophylaxis with low-dose colchicine or with NSAIDs at low dosage is recommended during the first 6 months of ULT. In patients with refractory gout, pegloticase can be considered. Copyright by Medycyna Praktyczna, Kraków 2017.

Piat C.,Center Viggo Petersen | Piat C.,University of Paris Descartes
Revue du Podologue | Year: 2016

A patient, aged 18 and a half, consults an orthopedic surgeon for plantar heel pain felt when walking and running. The clinical examination reveals a projection on the side of the foot which is deforming the heel. The X-rays show a bone tumour with plantar and lateral development. The radioclinical and magnetic aspect is evocative of benign osteochondroma, which enables an excisional biopsy to be performed. The post-operative recovery is straightforward with immediate weight-bearing. In children, adolescents and young adults, any exostosis which becomes uncomfortable will be surgically removed due to the theoretical risk of it becoming malignant. © 2016 Publie par Elsevier Masson SAS.

Piat C.,Center Viggo Petersen | Piat C.,University of Paris Descartes
Revue du Podologue | Year: 2015

Supra tendinous bursitis of the big toe is a rare infection which occurs mainly in women who wear high heels. This pathology is manifested by pain, swelling and frequent infection. Surgical treatment is used, after antibiotic therapy, in order to remove the infected areas and prevent recurrences. © 2015 Elsevier Masson SAS.

Briole V.,Institute Of Lappareil Locomoteur Nollet | Genty C.,French National Center for Scientific Research | Chevalier X.,Service de rhumatologie | Richette P.,Center Viggo Petersen
Joint Bone Spine | Year: 2011

Objective: To determine the prevalence of generalized osteoarthritis in patients with knee osteoarthritis. Methods: Patients with knee osteoarthritis were recruited for a therapeutic trial via press announcement and selected based on American College of Rheumatology radioclinical criteria for femorotibial arthritis. Patients were asked to bring all their radiographs to the study visits, which included a physical examination. Each patient had an inclusion visit and a second visit 1 month later. The study physicians used a standardized chart to indicate clinical and radiographic evidence of osteoarthritis in each patient. At the hands and feet, the presence of clinical criteria was sufficient for the diagnosis of osteoarthritis. The shoulders and elbows were not assessed. Three criteria sets for generalized osteoarthritis were evaluated: Kellgren and Moore criteria (Heberden's nodes or interphalangeal osteoarthritis), ACR criteria (osteoarthritis of the spine and at least two other joints), and Dougados criteria (bilateral finger osteoarthritis or osteoarthritis of the spine and both knees). Results: We included 302 patients for whom the side affected with knee osteoarthritis was known. Mean symptom duration was 5.9±5.7 years, mean number of painful flares was 10.1±9.4, mean number of joints with osteoarthritis was 2.6±1.8, and mean body mass index was 29.5±5.3kg/m2. A family history of osteoarthritis was noted in 154 (51%) patients and spinal osteoarthritis in 148 (49%) patients. Kellgren-Moore criteria for interphalangeal osteoarthritis were met in 42 (13.9%) patients, ACR criteria by 124 (41%) patients, and Dougados criteria by 127 (42%) patients. In all, 156 (52%) patients met at least one of the three definitions of generalized osteoarthritis. Conclusion: More than half the patients included in a therapeutic trial in knee osteoarthritis had generalized osteoarthritis with maximum symptoms at the knee at baseline. Some patients with osteoarthritis in multiple joints met none of the three criteria sets for generalized osteoarthritis. Further studies are needed to assess the sensitivity and specificity of current criteria sets and, if needed, to identify new criteria. © 2009 Société française de rhumatologie.

Liote F.,Center Viggo Petersen | Liote F.,University Paris Diderot | Seroussi B.,Hopital Tenon | Seroussi B.,University Pierre and Marie Curie | And 3 more authors.
European Respiratory Journal | Year: 2010

The anti-CD20 antibody rituximab has been reported to induce a heterogeneous spectrum of lung disorders. The aim of the present study was to critically review data on the clinical presentations, causality assessments and management strategies of lung diseases possibly related to rituximab. A systematic literature review was performed on English-language reports in PubMed until September 2008. Cases of lung diseases ascribed to rituximab (n=45) were identified, with three time-to-onset patterns. The most common presentation was acute/subacute hypoxaemic organising pneumonia (n=37), starting 2 weeks after the last infusion (often around the fourth cycle) and resolving, in most cases, provided glucocorticoid therapy was given early. Acute respiratory distress syndrome occurred in five patients, within a few hours and usually after the first infusion. In the remaining three patients, macronodular organising pneumonia developed insidiously long after rituximab therapy and responded to steroids. Eight patients died. Based on time to onset, symptoms, and responses to discontinuation and rechallenge with rituximab and other drugs, 13 cases were highly compatible and 32 compatible with rituximab-induced lung disease. Knowledge of these presentations of rituximab-induced lung disease should prove helpful for diagnosis and causality assessment purposes. Time-to-onset data, suggesting different pathogenic mechanisms, support closer clinical and perhaps radiological monitoring between infusions, particularly in patients with a history of reversible respiratory symptoms. Copyright © ERS Journals Ltd 2010.

Doherty M.,City Hospital | Jansen T.L.,Radboud University Nijmegen | Nuki G.,University of Edinburgh | Pascual E.,University Miguel Hernández | And 4 more authors.
Annals of the Rheumatic Diseases | Year: 2012

Gout is the most common inflammatory arthritis and one in which pathogenesis and risk factors are best understood. One of the treatment objectives in current guidelines is 'cure'. However, audits show that only a minority of patients with gout receive adequate advice and treatment. Suboptimal care and outcomes reflect inappropriately negative perceptions of the disease, both in patients and providers. Historically, gout has been portrayed as a benign and even comical condition that is self-in flicted through overeating and alcohol excess. Doctors often focus on managing acute attacks rather than viewing gout as a chronic progressive crystal deposition disease. Urate-lowering treatment is underprescribed and often underdosed. Appropriate education of patients and doctors, catalysed by recent introduction of new urate-lowering treatments after many years with no drug development in the field, may help to overcome these barriers and improve management of this easily diagnosed and curable form of potentially severe arthritis.

PubMed | Clinique du Landy, Center Viggo Petersen and University Paris Diderot
Type: Case Reports | Journal: Joint, bone, spine : revue du rhumatisme | Year: 2016

Calcific uremic arteriolopathy (CUA) or calciphylaxis is a severe complication of advanced chronic kidney disease (CKD) and dialysis. Few effective treatments are available and the mortality rate is high. We report 4 cases in which sodium thiosulfate therapy was rapidly effective.Sodium thiosulfate therapy was given to 4 Caucasian patients (3 females and 1 male aged 49 to 91 years) with CUA. The causes of end-stage CKD were nephroangiosclerosis (n=2) and diabetic nephropathy (n=2). The lesions developed 1 to 6.5 years after the initiation of hemodialysis and involved the lower limbs in 2 patients, the fingers in 1 patient, and a breast in the remaining patient. They were responsible for pain and skin necrosis in all 4 patients. Local superinfection occurred in 3 patients. Intravenous sodium thiosulfate was given in a dosage of 12.5 to 25g after each hemodialysis session, for 12 to 24 weeks. The pain and trophic disorders resolved fully in all 4 patients. The side effects consisted of nausea and vomiting (n=2) and a moderate blood pressure decrease (n=1). No recurrences were noted during the follow-up of 5 to 17 months after treatment discontinuation.The findings from this small case-series suggest that sodium thiosulfate may hold promise for the treatment of CUA.

Maravic M.,Center Viggo Petersen | Ea H.-K.,Center Viggo Petersen | Ea H.-K.,University Paris Diderot | Ea H.-K.,French Institute of Health and Medical Research
Joint Bone Spine | Year: 2015

Objective: To describe the hospital burden of microcrystal arthropathies in France. Methods: Data were extracted from the 2009-2011 French hospital national databases. We selected all hospital stays for microcrystal arthropathies (gout, chondrocalcinosis, other) encoded as primary or secondary diagnoses in patients older than 18. A descriptive analysis focused on number of patients and hospital stays, age, gender, comorbidities related to metabolic syndrome, and hospital costs based on 2012 public-sector costs. Results: 132,275 hospitalizations involving 109,734 patients were related to microcrystal arthropathies encoded as primary or secondary diagnosis (61% related to gout, 34% to chondrocalcinosis, and 5% to other microcrystal arthropathies). 23,362 hospitalizations involving 25,105 patients were due to microcrystal diseases, encoded as primary diagnosis, (48% related to gout, 43% to chondrocalcinosis, and 9% to other microcrystal arthropathies). In this population, patients with chondrocalcinosis were older (mean 75.6 ± 13.5 versus 71 ± 16 years for other microcrystal arthropathies and 69.7 ± 14.7 for gout). Men represented 70% of the patients with gout, 39% of those with chondrocalcinosis and 52% of the patients with other microcrystal arthropathies. Hypertension, diabetes, dyslipidemia, cardiac ischemia, and renal failure were more frequent in patients with gout than other patients. The hospital costs for microcrystal arthropathies encoded as primary diagnosis were 82.3 million Euros, 45% related to gout, 45% to chondrocalcinosis and 11% to other microcrystals. Conclusion: In terms of hospital costs, gout and chondrocalcinosis represented the main part of the economic burden of crystal arthropathies and a high level of diseases belonging to the metabolic syndrome. Specific education programs favouring accurate microcrystal diagnosis and adherence to treatment could diminish this hospital economic burden. © 2015 Société française de rhumatologie.

Tomi A.-L.,Center Viggo Petersen | Liote F.,Center Viggo Petersen | Liote F.,University Paris Diderot | Ea H.-K.,Center Viggo Petersen | Ea H.-K.,University Paris Diderot
Joint Bone Spine | Year: 2012

Felty's syndrome (FS) is a rare association of rheumatoid arthritis (RA), neutropenia and splenomegaly. Mechanisms of neutropenia in FS are unclear but involve both innate and humoral immunity, impaired granulopoiesis and decreased granulocyte half-life. Several treatments have been used without clear efficiency. We report a patient with FS efficiently treated with rituximab (RTX), the monoclonal anti-CD20 antibody. A literature review of FS treated with RTX was performed. © 2012.

Liote F.,University Paris Diderot | Liote F.,French Institute of Health and Medical Research | Liote F.,Center Viggo Petersen | Ea H.-K.,University Paris Diderot | And 2 more authors.
Current Opinion in Rheumatology | Year: 2014

PURPOSE OF REVIEW: The role of intraarticular calcifications has been challenged over the past years, with respect to cartilage destruction, especially in osteoarthritis. RECENT FINDINGS: Main themes reviewed in this article will discuss prevalence of articular cartilage calcifications, mechanisms of cartilage calcifications, and mostly the pathogenic role of both calcium pyrophosphate and basic calcium phosphate crystals. SUMMARY: A direct pathogenic role of both calcium crystals has been depicted, in cartilage as a crystal-induced stress, or via acute or chronic crystal-induced synovitis. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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