Georgina Maalouf

Objective: Large vessel‐vasculitis (LVV) accounts for up to 70% of patients with giant cell arteritis (GCA). Stenotic involvement in GCA‐LVV remains largely unknown. The purpose of this study was to assess the long‐term outcome and prognosis of GCA with stenotic LVV. Methods: This was a retrospective multicenter study of 3,149 patients with GCA, including 198 (6.3%) with stenotic LVV. Hierarchical clustering on principal components was performed on baseline arterial localizations and logistic regression assessed factors associated with vascular complications. Results: Stenotic LVV affected mostly the subclavian artery (63%), the carotid artery (58%), vertebral artery (37%), and axillary artery (33%), followed by the femoral artery (30%) and mesenteric arteries (13%). Stroke (31%) was the main complication, followed by limb ischemia (21%), myocardial infarction (4%), and mesenteric ischemia (2%). Cumulative incidence of vascular complications was 13.1% (95% confidence interval [CI] 8.9–18.3), 17.3% (95% CI 12.3–22.9), and 19.5% (95% CI 14.3–25.4), at 1, 5, and 10 years, respectively. Hierarchical clustering analysis identified three clusters among which cluster 1 (n = 123; 62%) included older patients with more arteritic anterior ischemic optic neuropathy ( P = 0.04), vertebral artery stenosis, and a higher mortality rate ( P < 0.044). In multivariate analysis, age at diagnosis (hazard ratio [HR] 1.06, 95% CI 1.03–1.10; P = 0.0004) and vertebral involvement (HR 1.87, 95% CI 1.03–3.40; P = 0.039) were significantly associated with higher risk of vascular complication. Conclusion: Stenotic LVV accounts for less than 10% of GCA and is associated with poor vascular prognosis. image

Objective: Patients with primary Sjögren Disease (pSD) are prone to develop non‐Hodgkin's lymphoma (NHL‐pSD) but relevant biomarkers are lacking. We aimed to determine new biomarkers predictive of NHL in patients with pSD.Methods: 206 pSD patients fulfilling ACR/EULAR 2016 criteria were included and divided into three groups: pSD, lymphoproliferative pSD (Arl‐pSD), and NHL‐pSD. Deep flow cytometry immunophenotyping of B and T cell compartments as well as serum IFNα quantification were coupled to clinical, biological and histopathological data analysis.Results: We identified CD11c⁺FcRL5⁺ tissue‐like memory B cells and IFNγ⁺TNFα⁺ conventional T cells as significantly associated with NHL in pSD. These clusters showed progressive enrichment in Arl‐pSD and NHL‐pSD as compared to pSD. The combination of these two populations abundances discriminates NHL‐pSD patients with a sensitivity of 78.9% and a specificity of 76.8%, thus overcoming alone the performance of the sum of conventional clinical and biological markers such as cryoglobulinemia vasculitis, parotid enlargement, adapted clinESSDAI, RF antibodies, low C4 and elevated serum IFNα (68.4% and 78.0% respectively). CD11c⁺ FcRL5⁺ tissue‐like memory B cells were associated with occurrence of mucosa‐associated lymphoid tissue marginal‐zone lymphoma (MALT NHL), while IFNγ⁺TNFα⁺ conventional T cells were more indicative of non‐MALT B‐cell NHLs.Conclusion: We unveil novel biomarkers of NHL in pSD based on an integrative analysis coupling deep immunophenotyping and clinical, biological and histopathological data. Furthermore, these markers allow distinguishing B‐cell NHL subtypes in pSD.

Uveitis in Behçet’s disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralization usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10–15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, the prevention of recurrent attacks, the achievement of complete remission, and the preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update to a previous article by our team on pathogenesis, diagnostic approaches, and the therapeutic strategy of BD uveitis.

Non-infectious uveitis (NIU) represents one of the leading causes of blindness in developed countries. The therapeutic strategy aims to rapidly control intra-ocular inflammation, prevent irremediable ocular damage, allow corticosteroid sparing and save the vision, and has evolved over the last few years. Anterior NIU is mostly managed with topical treatment in adults. However, for intermediate, posterior and pan-uveitis, notably when both eyes are involved, systemic treatment is usually warranted. Biotherapies are recommended in case of inefficacy or non-tolerance of conventional immunosuppressive drugs in non-anterior NIU. Anti-tumor necrosis factor alpha (anti-TNF-α) agents are by far the most widely used, especially adalimumab (ADA) and infliximab (IFX). In case of sight-threatening uveitis in Behçet’s disease or in case of risk of severe recurrences, respectively IFX and ADA may be recommended as first-line therapy. Many questions are left unanswered; how long to treat NIU, how to discontinue anti-TNF-α agents, what biologic to use in case of anti-TNF-α failure? The objective of this review is to present an updated overview of knowledge on the use of biological treatments in NIU.

Prognostic factors of coronavirus disease 2019 (COVID-19) patients among European population are lacking. Our objective was to identify early prognostic factors upon admission to optimize the management of COVID-19 patients hospitalized in a medical ward. This French single-center prospective cohort study evaluated 152 patients with positive severe acute respiratory syndrome coronavirus 2 real-time reverse transcriptase–polymerase chain reaction assay, hospitalized in the Internal Medicine and Clinical Immunology Department, at Pitié-Salpêtrière’s Hospital, in Paris, France, a tertiary care university hospital. Predictive factors of intensive care unit (ICU) transfer or death at day 14 (D14), of being discharge alive and severe status at D14 (remaining with ventilation, or death) were evaluated in multivariable logistic regression models; models’ performances, including discrimination and calibration, were assessed (C-index, calibration curve, R², Brier score). A validation was performed on an external sample of 132 patients hospitalized in a French hospital close to Paris, in Aulnay-sous-Bois, Île-de-France. The probability of ICU transfer or death was 32% (47/147) (95% CI 25–40). Older age (OR 2.61, 95% CI 0.96–7.10), poorer respiratory presentation (OR 4.04 per 1-point increment on World Health Organization (WHO) clinical scale, 95% CI 1.76–9.25), higher CRP-level (OR 1.63 per 100mg/L increment, 95% CI 0.98–2.71) and lower lymphocytes count (OR 0.36 per 1000/mm³ increment, 95% CI 0.13–0.99) were associated with an increased risk of ICU requirement or death. A 9-point ordinal scale scoring system defined low (score 0–2), moderate (score 3–5), and high (score 6–8) risk patients, with predicted respectively 2%, 25% and 81% risk of ICU transfer or death at D14. Therefore, in this prospective cohort study of laboratory-confirmed COVID-19 patients hospitalized in a medical ward in France, a simplified scoring system at admission predicted the outcome at D14.

Background: Prognostic factors of coronavirus disease 2019 (COVID-19) patients among European population are lacking. Our objective was to identify early prognostic factors upon admission to optimize the management of COVID-19 patients hospitalized in a medical ward. Methods: French single-center prospective cohort study of 152 patients with positive Severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay, hospitalized in a medical ward. Multivariable models and a simplified scoring system assessed predictive factors of intensive care unit (ICU) transfer or death at day 14 (D14), of being discharge alive and severe status at D14 (remaining with ventilation, or death). A validation was performed on an external sample of 132 patients. Findings: At D14, the probability of ICU transfer or death was 32% (95% CI 25-40). Older age (OR 2·61, 95% CI 0·96-7·10), poorer respiratory presentation (OR 4·04 per 1-point increment on World Health Organization (WHO) clinical scale, 95% CI 1·76-9·25), higher CRP-level (OR 1·63 per 100mg/L increment, 95% CI 0·98-2·71) and lower lymphocytes count (OR 0·36 per 1000/mm ³ increment, 95% CI 0·13-0·99) were associated with an increased risk of ICU requirement or death. A 8-point ordinal scale scoring system defined low (score 0-2), moderate (score 3-5), and high (score 6-8) risk patients, with predicted respectively 2%, 25% and 81% risk of ICU transfer or death at D14. Interpretation: In this prospective cohort study of laboratory-confirmed COVID-19 patients hospitalized in a medical ward in France, 32% were transferred to ICU or died. A simplified scoring system at admission predicted the outcome at D14. Funding: No funding.