Publications by authors named "Nathalie Klemmer"

6 Publications

  • Page 1 of 1

Smoking and inflammatory diseases.

Best Pract Res Clin Rheumatol 2008 Oct;22(5):923-35

Department of Rheumatology, Rouen University Hospital & Inserm U905, Rouen, France.

Smoking has an impact on the development and outcome of rheumatoid arthritis (RA) and lupus. In RA, smoking is associated with the development of the anti-cyclic citrullinated peptide (CCP2)-positive subset. This risk is increased in heavy smokers carrying at least one copy of the HLA DRB1 shared epitope (SE) alleles. Whereas this interaction between smoking and SE relevant in northern Europe, discrepant results have been observed in other geographic locations, suggesting the involvement of other environmental stimuli and/or gene polymorphisms. There is no interaction between tobacco exposure and PTPN22 1858T for the development of anti-CCP-positive or anti-CCP-negative RA. A strong association exists between smoking and the occurrence of extra-articular manifestations (subcutaneous nodules and cardiovascular events), but smoking has no influence on radiographic outcome. In lupus, tobacco exposure has an impact on the production of anti-double-stranded Desoxyribonuclic (dsDNA) and possibly on the development of the disease, as well as on disease activity/severity. In both diseases, smoking might interfere with drug efficacy.
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http://dx.doi.org/10.1016/j.berh.2008.09.011DOI Listing
October 2008

Effectiveness of anti-IL1 in Schnitzler's syndrome.

Joint Bone Spine 2007 Oct 4;74(5):509-10. Epub 2007 Jun 4.

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http://dx.doi.org/10.1016/j.jbspin.2006.11.018DOI Listing
October 2007

Management of infusion reactions to infliximab in patients with rheumatoid arthritis or spondyloarthritis: experience from an immunotherapy unit of rheumatology.

J Rheumatol 2006 Jul 1;33(7):1307-14. Epub 2006 Jun 1.

Department of Rheumatology, Rouen University Hospital, Rouen, France.

Objective: To suggest recommendations for management of acute infusion reactions induced by infliximab in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Methods: In total, 203 patients were treated with infliximab (120 ml/h). Prevalence of acute infusion reaction was evaluated. To manage these conditions, recommendations were devised according to the type and the severity of clinical manifestations, which were classified beforehand in 2 groups: A (hypertension, pruritus, sudden flush, vomiting, tachycardia or bradycardia, shivers, fever) and B (urticaria, tickling throat, Quincke's edema, dyspnea, and hypotension). Recommendations were based mainly on adjustment of the infusion rate.

Results: It was observed that 23/203 patients (11.3%) had acute infusion reactions. Among them and prior to our recommendations, infliximab was completely discontinued in 8/23 patients. After our recommendations were implemented, 15/23 patients presented an acute infusion reaction: 8 and 7 patients with symptoms of Group A and B, respectively. In Group A (8 patients), reducing the infusion rate to 60-80 ml/h led to disappearance of symptoms; the modified treatment was then maintained. In Group B (7 patients), the infusion was immediately stopped and appropriate drugs were administered. Once clinical manifestations were alleviated, the infusion was resumed (60 ml/h). Prior to subsequent infusions (60 ml/h), a premedication was administered.

Conclusion: Based on these recommendations, infliximab could be maintained with great efficacy on disease activity in every patient with an acute infusion reaction. Our recommendations permit sustained administration of infliximab and allow every patient to benefit from this therapy.
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July 2006

[Diagnosis of early arthritis].

Rev Prat 2005 Dec;55(19):2106-14

Service de rhumatologie et Inserm U 519, IFR 23, CHU de Rouen.

The diagnosis of early arthritis is often difficult even though it is an important issue. A step-by-step clinical examination is necessary to make the diagnosis of "joint emergency": an infection must be suspected when fever is associated with arthritis. Then, classification of early arthritis will be carried on with a special attention to rheumatoid arthritis when the rheumatism is persistent and erosive. However, arthritis might be undifferentiated for several months to years; such an explanation should be given to the patient. A tight follow-up is necessary.
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December 2005