P Cathébras

Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, Rhône-Alpes, France

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Publications (254)263.29 Total impact

  • La Revue de Médecine Interne. 01/2014; 35:A38–A39.
  • P Cathébras
    La Revue de Médecine Interne 12/2013; · 0.90 Impact Factor
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    ABSTRACT: Relapsing polychondritis (RP) is a rare inflammatory disease characterized by diffuse cartilage involvement, especially those of the respiratory tract, leading to potentially life threatening complications. Corticosteroids remain the first-line empirical therapy. Immunosuppressive drugs such as azathioprine, cyclophosphamide and tumor necrosis factor blockers (anti-TNFα) are commonly used as second-line therapy with varying degrees of success. We report a 40-year-old man with severe RP for whom conventional therapy and immunosuppressive treatments were ineffective. Prolonged clinical remission was obtained after introduction of the anti-interleukin-6 receptor antibody (tocilizumab), which was perfectly tolerated and allowed to taper steroids and methotrexate to a very low dosage. Our patient is the fifth published one documenting the efficacy of tocilizumab in severe refractory RP, which strengthens the use of anti-IL-6 in that indication.
    La Revue de Médecine Interne 09/2013; · 0.90 Impact Factor
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    ABSTRACT: Mastocytosis is a heterogeneous disease characterized by mast cell accumulation in 1 or more organs. Gastrointestinal manifestations of systemic mastocytosis have been previously studied in small cohorts of patients, and no specific histologic description is available. We sought to assess the clinical and pathologic features of gastrointestinal manifestations in patients with mastocytosis. Medical history and gastrointestinal symptoms of patients with mastocytosis (n = 83) were compared with those of matched healthy subjects (n = 83) by means of patient questionnaire. Data were analyzed for epidemiologic, clinical, biological, and genetic factors associated with gastrointestinal symptoms for patients with mastocytosis. A comparative analysis of gastrointestinal histology from patients with mastocytosis (n = 23), control subjects with inflammatory bowel disease (n = 17), and healthy subjects (n = 19) was performed. The following gastrointestinal symptoms occurred more frequently and were more severe in patients with mastocytosis than in healthy subjects: bloating (33% vs 7.2%, P < .0001), abdominal pain (27.3% vs 4.8%, P < .0001), nausea (23% vs 8.4%, P = .02), and diarrhea (33.85% vs 1.2%, P < .0001). Patients with mastocytosis had a significantly higher incidence of personal history of duodenal ulcer (P = .02). Wild-type (WT) c-Kit was associated with diarrhea (P = .03). Specific histologic lesions were present in patients with mastocytosis but were not correlated with clinical symptoms. Gastrointestinal manifestations in patients with mastocytosis are highly prevalent and often severe. Clinical symptoms do not correspond to histologic findings, are nonspecific, and can simulate irritable bowel syndrome.
    The Journal of allergy and clinical immunology 07/2013; · 12.05 Impact Factor
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    ABSTRACT: Type I cryoglobulinemia vasculitis (CryoVas) is considered a life-threatening condition; however, data on the characteristics and outcome are scarce. To analyze the presentation, prognosis, and efficacy and safety of treatments of type I CryoVas, we conducted a French nationwide survey that included 64 patients with type I CryoVas between January 1995 and July 2010: 28 patients with monoclonal gammopathy of unknown significance (MGUS) and 36 with hematologic malignancy.Type I monoclonal CryoVas was characterized by severe cutaneous involvement (necrosis and ulcers) in almost half the patients and high serum cryoglobulin levels, contrasting with a lower frequency of glomerulonephritis than expected. The 1-, 3-, 5-, and 10-year survival rates were 97%, 94%, 94%, and 87%, respectively. Compared to MGUS, type I CryoVas related to hematologic malignancy tended to be associated with a poorer prognosis. Therapeutic regimens based on alkylating agents, rituximab, thalidomide or lenalinomide, and bortezomib showed similar efficacy on vasculitis manifestations, with clinical response rates from 80% to 86%.Data from the CryoVas survey show that the prognosis of type I CryoVas does not seem to be as poor as previously suggested. Besides alkylating agents, the use of regimens based on rituximab, thalidomide or lenalinomide, and bortezomib are interesting alternative options, although the exact role of each strategy remains to be defined.
    Medicine 03/2013; 92(2):61-68. · 4.35 Impact Factor
  • Pascal Cathébras, Henri Laurent, Isabelle Guichard
    British Journal of Haematology 02/2013; · 4.94 Impact Factor
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    ABSTRACT: Introduction Relapsing polychondritis (RP) is a rare inflammatory disease characterized by diffuse cartilage involvement, especially those of the respiratory tract, leading to potentially life threatening complications. Corticosteroids remain the first-line empirical therapy. Immunosuppressive drugs such as azathioprine, cyclophosphamide and tumor necrosis factor blockers (anti-TNFα) are commonly used as second-line therapy with varying degrees of success. Case report We report a 40-year-old man with severe RP for whom conventional therapy and immunosuppressive treatments were ineffective. Prolonged clinical remission was obtained after introduction of the anti-interleukin-6 receptor antibody (tocilizumab), which was perfectly tolerated and allowed to taper steroids and methotrexate to a very low dosage. Conclusion Our patient is the fifth published one documenting the efficacy of tocilizumab in severe refractory RP, which strengthens the use of anti-IL-6 in that indication.
    La Revue de Médecine Interne. 01/2013;
  • P. Cathébras
    La Revue de Médecine Interne. 01/2013;
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    ABSTRACT: TNFRSF1A is involved in an autosomal dominant autoinflammatory disorder called TNFR-associated periodic syndrome (TRAPS). Most TNFRSF1A mutations are missense changes and, apart from those affecting conserved cysteines, their deleterious effect remains often questionable. This is especially true for the frequent R92Q mutation, which might not be responsible for TRAPS per se but represents a susceptibility factor to multifactorial inflammatory disorders. This study investigates TRAPS pathophysiology in a family exceptional by its size (13 members) and compares the consequences of several mutations affecting arginine 92. TNFRSF1A screening was performed by PCR-sequencing. Comparison of the 3-dimensional structure and electrostatic properties of wild-type and mutated TNFR1 proteins was performed by in silico homology modeling. TNFR1 expression was assessed by FACS analysis, western blotting and ELISA in lysates and supernatants of HEK293T cells transiently expressing wild-type and mutated TNFR1. A TNFRSF1A heterozygous missense mutation, R92W (c.361C>T), was shown to perfectly segregate with typical TRAPS manifestations within the family investigated (p<5.10(-4)). It was associated with very high disease penetrance (0.9). Prediction of its impact on the protein structure revealed local conformational changes and alterations of the receptor electrostatic properties. R92W also impairs the TNFR1 expression at the cell surface and the levels of soluble receptor. Similar results were obtained with R92P, another mutation previously identified in a very small familial form with incomplete penetrance and variable expressivity. In contrast, TNFR1-R92Q behaves like the wild-type receptor. These data demonstrate the pathogenicity of a mutation affecting arginine 92, a residue whose involvement in inflammatory disorders is deeply debated. Combined with previous reports on arginine 92 mutations, this study discloses an unusual situation in which different amino acid substitutions at the same position in the protein are associated with a clinical spectrum bridging Mendelian to multifactorial conditions.
    PLoS ONE 01/2013; 8(7):e69757. · 3.73 Impact Factor
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    ABSTRACT: INTRODUCTION: Granulomatosis with polyangeitis (Wegener's granulomatosis) (GPA) is a granulomatous vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA). Affected organs usually include upper and lower respiratory tracts, and kidneys. Limited forms of GPA may affect the central nervous system (vasculitis, hypertrophic pachymeningitis, encephalitis), a location in which diagnosis is often uneasy. CASE REPORT: We report a 74-year-old woman who presented with a limited form of GPA affecting the cavernous sinus. Diagnosis was considered in view of a retrospectively suggestive clinical presentation, compatible cerebral MRI and temporal artery biopsy, despite the absence of ANCA. It was supported by a favourable outcome with cyclophosphamide administration. CONCLUSION: GPA presenting as a cavernous sinus syndrome is rare. Three co-existing pathogenic mechanisms may be involved in GPA affecting the central nervous system: contiguous invasion from nasal or orbitary granulomatous sites, vasculitis, or primary intra-cerebral granulomatous inflammation. Lack of biopsy evidence of affected tissues and ANCA negativity should not delay diagnosis and appropriate therapeutic management in central nervous system GPA.
    La Revue de Médecine Interne 12/2012; · 0.90 Impact Factor
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    ABSTRACT: The incidence of venous thromboembolism in multiple myeloma depends on the disease characteristics that include recent diagnosis, persistent or recurrent multiple myeloma, patient characteristics, and the type of treatment received such as thalidomide or lenalidomide especially in combination with high-dose dexamethasone, or combined chemotherapy. Currently, recommendations could be challenged by the results of the first randomized study evaluating aspirin, low molecular weight heparins and vitamin K antagonists in the antithrombotic prophylaxis. The recent data from the literature show that it is not possible to propose a therapeutic management for venous thromboembolism prophylaxis in multiple myeloma and that the use of antithrombotic prophylaxis may not be mandatory.
    La Revue de Médecine Interne. 12/2012; 33(12):693–696.
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    ABSTRACT: The incidence of venous thromboembolism in multiple myeloma depends on the disease characteristics that include recent diagnosis, persistent or recurrent multiple myeloma, patient characteristics, and the type of treatment received such as thalidomide or lenalidomide especially in combination with high-dose dexamethasone, or combined chemotherapy. Currently, recommendations could be challenged by the results of the first randomized study evaluating aspirin, low molecular weight heparins and vitamin K antagonists in the antithrombotic prophylaxis. The recent data from the literature show that it is not possible to propose a therapeutic management for venous thromboembolism prophylaxis in multiple myeloma and that the use of antithrombotic prophylaxis may not be mandatory.
    La Revue de Médecine Interne 10/2012; · 0.90 Impact Factor
  • Pascal Cathébras, Pauline Régny
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    ABSTRACT: "Hysterical" conversion hasn't vanished, and remains a diagnostic, therapeutic and relational challenge for the clinician. Conversion may be associated with organic disease. From the clinical point of view, two subtypes of conversion symptoms, namely psychogenic nonepileptic seizures and functional movement disorders, have been individualized. Physical signs of neurological inconsistency, and classical arguments in favor of a psychological etiology have been recently reevaluated, which allows, along with the progress of neurological investigations, to minimize the rate of misdiagnosis. Functional neuroimaging has shed light on the brain mechanisms involved in conversion phenomena. From a nosological point of view, there is a tension between the whish to "banalize" the conversion symptoms as mere "functional neurological symptoms", which makes easier to communicate the diagnosis to the patient and may remove the stigma from the diagnosis; and the wish of certain authors to "revive" hysteria, emphasizing the core phenomenon of dissociation and its close relationship with trauma. Proposed treatment of conversion disorder are numerous, although poorly evaluated and often insatisfactory, but recent publications insist on the importance of communicating the diagnosis to the patient in a honest, nonjudmental and understandable way, at the earliest phase of the disorder.
    La Revue du praticien 10/2012; 62(8):1119-25, 1127-30.
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    ABSTRACT: To assess clinical features, treatment and outcome of Hypothalamo-pituitary (HP) sarcoidosis and to determine whether HP is associated with a particular clinical phenotype of sarcoidosis. Multicentric retrospective study. Retrospective chart review. Each patient was matched with two controls. Twenty-four patients were identified (10 women, 14 men). Their median age at the sarcoidosis diagnosis was 31.5 years (range: 8-69 years). HP involvement occurred in the course of a previously known sarcoidosis in 11 cases (46%), whereas it preceded the diagnosis in 13 patients (54%). All but two patients had anterior pituitary dysfunction, 12 patients presented with diabetes insipidus. The most common hormonal features were gonadotropin deficiency (n = 21), TSH deficiency (n = 15) and hyperprolactinemia (n = 12). Magnetic Resonance Imaging (MRI) revealed infundibulum involvement (n = 8), pituitary stalk thickness (n = 12) and involvement of the pituitary gland (n = 14). All but two patients received prednisone. After a mean follow-up of 4 years, only two patients recovered from hormonal deficiencies. MRI abnormalities improved or disappeared in 12 cases under corticosteroid. There was no correlation between the hormonal dysfunctions and the radiologic outcomes. Patients with HP sarcoidosis had significantly more frequent sinonasal localizations and neurosarcoidosis and required a systemic treatment more frequently than controls. Although HP sarcoidosis is unusual, physicians should be aware that such specific localization could be the first manifestation of sarcoidosis. HP involvement is associated with general severity of sarcoidosis. MRI abnormalities can improve or disappear under corticosteroid treatment, but most endocrine defects are irreversible.
    QJM: monthly journal of the Association of Physicians 06/2012; 105(10):981-95. · 2.36 Impact Factor
  • P. Cathébras
    Revue De Medecine Interne - REV MED INTERNE. 02/2012;
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    ABSTRACT: Hypertrophic osteoarthropathy (HOA) located to lower extremities may be the initial manifestation of an infected aortic graft. We report two patients with HOA secondary to aortobifemoral vascular prosthesis infection and aortoenteric fistula. As reported in the literature, initial manifestations included fever, painful swelling of limbs, joint pain, clubbing and in one case intestinal bleeding. These symptoms preceded frank episodes of septicaemia due to a wide variety of bacteria (microbial enteric flora). Bone scan was an appropriate tool for confirming the diagnosis of HOA. Abdominal computed tomography, and PET-scan were useful for detecting vascular infection. Aortoenteric fistula remained difficult to identify. Mechanisms involved in the pathogenesis of HOA associated with infected graft are poorly understood, but vascular endothelial growth factor (VEGF) could play a major role. The mortality of infected aortic grafts remains high, but knowledge of this association could lead to early diagnosis and accurate treatment.
    La Revue de Médecine Interne 07/2011; 32(7):432-5. · 0.90 Impact Factor
  • The Journal of Rheumatology 04/2011; 38(4):775-6. · 3.26 Impact Factor
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    ABSTRACT: PurposeThe aim of the medical autopsy is to define the causes of a patient's death. Although its rate has dramatically decreased, the post-mortem examination remains one of the basic tools for the assessment of medical care. The objective of this study was to identify the factors influencing the acceptance of medical autopsies.
    Revue De Medecine Interne - REV MED INTERNE. 01/2011; 32(4):205-211.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2011; 32.
  • Revue De Medecine Interne - REV MED INTERNE. 01/2011; 32.

Publication Stats

518 Citations
263.29 Total Impact Points

Institutions

  • 1991–2013
    • Centre Hospitalier Universitaire de Saint-Étienne
      • Department of Internal Medicine
      Saint-Étienne, Rhône-Alpes, France
    • Jewish General Hospital
      Montréal, Quebec, Canada
  • 2009
    • Université Jean Monnet
      Saint-Étienne, Rhône-Alpes, France
    • University Joseph Fourier - Grenoble 1
      Grenoble, Rhône-Alpes, France
  • 2008
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2003
    • Centre Hospitalier Universitaire de Lyon
      Lyons, Rhône-Alpes, France
  • 1990–1992
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France