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Article: Unilateral metastatic pulmonary calcification in context of ipsilateral central pulmonary embolism.

Semionov, Alexandre / Azuelos, Ilan / Mendel, Arielle

2023 Volume 18, Issue 12, Page(s) 4239–4242

Abstract: We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main pulmonary artery pulmonary embolism. Unilateral MPC is rare and is mostly seen in the ... ...

Abstract	We report a case of unilateral left metastatic pulmonary calcification (MPC) in a 30-year-old woman with systemic lupus erythematosus, acute nephritis, and left main pulmonary artery pulmonary embolism. Unilateral MPC is rare and is mostly seen in the context of ipsilateral pulmonary embolism. The proposed mechanism is the promotion of calcium salts precipitation by focal alkalosis resulting from reduced blood flow to the lung affected by the pulmonary arterial obstruction.
Language	English
Publishing date	2023-09-22
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	2406300-9
ISSN	1930-0433
ISSN	1930-0433
DOI	10.1016/j.radcr.2023.08.102
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Article: Use of Rituximab for the Treatment of Antineutrophil Cytoplasm Antibody-associated Vasculitis in Canada, 2010-2020.

Mendel, Arielle / Pagnoux, Christian

The Journal of rheumatology

2021 Volume 48, Issue 11, Page(s) 1755–1756

MeSH term(s)	Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy ; Canada ; Humans ; Rituximab/therapeutic use
Chemical Substances	Rituximab (4F4X42SYQ6)
Language	English
Publishing date	2021-09-01
Publishing country	Canada
Document type	Letter
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.210537
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Article ; Online: Treatment of systemic necrotizing vasculitides: recent advances and important clinical considerations.

Pagnoux, Christian / Mendel, Arielle

Expert review of clinical immunology

2019 Volume 15, Issue 9, Page(s) 939–949

Abstract: ... ...

Abstract	Introduction
MeSH term(s)	Cyclophosphamide/therapeutic use ; Drug Therapy, Combination ; Glucocorticoids/therapeutic use ; Humans ; Immunosuppressive Agents/therapeutic use ; Polyarteritis Nodosa/diagnosis ; Polyarteritis Nodosa/drug therapy ; Severity of Illness Index ; Treatment Outcome ; Vasculitis/diagnosis ; Vasculitis/drug therapy
Chemical Substances	Glucocorticoids ; Immunosuppressive Agents ; Cyclophosphamide (8N3DW7272P)
Language	English
Publishing date	2019-08-26
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2274260-8
ISSN	1744-8409 ; 1744-666X
ISSN (online)	1744-8409
ISSN	1744-666X
DOI	10.1080/1744666X.2019.1656527
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Zs.A 6661: Show issues

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Article ; Online: Outcomes associated with antiphospholipid antibodies in COVID-19: A prospective cohort study.

Mendel, Arielle / Fritzler, Marvin J / St-Pierre, Yvan / Rauch, Joyce / Bernatsky, Sasha / Vinet, Évelyne

Research and practice in thrombosis and haemostasis

2023 Volume 7, Issue 1, Page(s) 100041

Abstract: Background: The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain.: Objectives: We determined whether aPL are associated with COVID-19 and/or thrombosis or adverse outcomes during hospitalization for COVID-19.: Methods! ...

Abstract	Background: The significance of antiphospholipid antibodies (aPL) in COVID-19 remains uncertain. Objectives: We determined whether aPL are associated with COVID-19 and/or thrombosis or adverse outcomes during hospitalization for COVID-19. Methods: Symptomatic adults tested for SARS-CoV-2 for clinical reasons (March-July 2020) with either ≥1 positive polymerase chain reaction (COVID-19+) or all negative (non-COVID-19) results were recruited to a biobank collecting plasma, clinical data, and outcomes. We tested baseline plasma samples (days 0-7) of all subjects (and day-30 samples in the COVID-19+ subjects, when available) for aPL (anticardiolipin immunoglobulin [Ig]M/IgG, anti-β2-glycoprotein I IgM/IgG, antiphosphatidylserine/prothrombin IgM/IgG, and lupus anticoagulant). We compared the baseline prevalence of aPL between the COVID-19+ and non-COVID-19 subjects. Among hospitalized COVID-19+ subjects, multivariable logistic regression was used to evaluate the association of aPL (and their subtypes) with arterial or venous thromboembolic events, acute kidney injury, intensive care unit admission, mechanical ventilation, and death after adjusting for potential confounders. Results: At baseline, 123 of 289 (43%) COVID+ subjects had ≥1 aPL versus 116 of 261 (32%) non-COVID-19 subjects (difference, 10%; 95% CI, 3%-18%). Among 89 COVID+ subjects with repeated samples, aPL persisted on day 30 in 15 of 34 (44%) subjects with baseline aPL positivity, and half of those without aPL at baseline developed one or more new aPL. In hospitalized COVID-19 subjects ( Conclusion: In patients with COVID-19, aPL may help identify an increased risk of thrombosis and other adverse outcomes.
Language	English
Publishing date	2023-01-07
Publishing country	United States
Document type	Journal Article
ISSN	2475-0379
ISSN (online)	2475-0379
DOI	10.1016/j.rpth.2023.100041
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Article ; Online: Trimethoprim-sulfamethoxazole prophylaxis during treatment of granulomatosis with polyangiitis with rituximab in the United States of America: a retrospective cohort study.

Mendel, Arielle / Behlouli, Hassan / de Moura, Cristiano Soares / Vinet, Évelyne / Curtis, Jeffrey R / Bernatsky, Sasha

Arthritis research & therapy

2023 Volume 25, Issue 1, Page(s) 133

Abstract: Background: Antibiotic prophylaxis is recommended during ANCA-associated vasculitis (AAV) induction. We aimed to describe the frequency, persistence, and factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in an adult population sample ... ...

Abstract	Background: Antibiotic prophylaxis is recommended during ANCA-associated vasculitis (AAV) induction. We aimed to describe the frequency, persistence, and factors associated with trimethoprim-sulfamethoxazole (TMP-SMX) use in an adult population sample with granulomatosis with polyangiitis (GPA) treated with rituximab (RTX). Methods: We identified adults with GPA treated with RTX within the Merative™ Marketscan® Research Databases (2011-2020). TMP-SMX prophylaxis was defined as a [Formula: see text] 28-day prescription dispensed within a month of starting RTX. We estimated TMP-SMX persistence, allowing prescription refill gaps of 30 days. Multivariable logistic regression and Cox proportional hazards regression assessed the factors associated with baseline TMP-SMX use and persistence, respectively. Covariates included age, sex, calendar year, insurance type, immunosuppressant use, hospitalization, and co-morbidities. Results: Among 1877 RTX-treated GPA patients, the mean age was 50.9, and 54% were female. A minority (n = 426, 23%) received TMP-SMX with a median persistence of 141 (IQR 83-248) days. In multivariable analyses, prophylaxis was associated with prednisone use in the month prior to RTX ([Formula: see text] 20 mg/day vs none, OR 3.96; 95% CI 3.0-5.2; 1-19 mg/day vs none, OR 2.63; 95% CI 1.8-3.8), and methotrexate use (OR 1.48, 95% CI 1.04-2.1), intensive care (OR 1.95; 95% CI 1.4-2.7), and non-intensive care hospitalization (OR 1.56; 95% CI 1.2-2.1) in the 6 months prior to RTX. Female sex (OR 0.63; 95% CI 0.5-0.8) was negatively associated with TMP-SMX use. Conclusions: TMP-SMX was dispensed to a minority of RTX-treated GPA patients, more often to those on glucocorticoids and with recent hospitalization. Further research is needed to determine the optimal use and duration of TMP-SMX prophylaxis following RTX in AAV.
MeSH term(s)	Adult ; Humans ; United States ; Female ; Middle Aged ; Male ; Rituximab/therapeutic use ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Granulomatosis with Polyangiitis/drug therapy ; Retrospective Studies ; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Chemical Substances	Rituximab (4F4X42SYQ6) ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2023-07-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2107602-9
ISSN	1478-6362 ; 1478-6354
ISSN (online)	1478-6362
ISSN	1478-6354
DOI	10.1186/s13075-023-03114-7
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Zs.A 5490: Show issues

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Article ; Online: An Initiative to Improve Timely Glucocorticoid Tapering in Vasculitis.

Mendel, Arielle / Ennis, Daniel / Lake, Shirley / Carette, Simon / Pagnoux, Christian

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2021 Volume 27, Issue 8, Page(s) e612–e615

Abstract: Background/objective: High-dose glucocorticoids (GCs) are required in the initial treatment of systemic vasculitis. However, slow or delayed tapering can lead to unnecessary GC exposure and toxicity. In this quality improvement initiative, we aimed to ... ...

Abstract	Background/objective: High-dose glucocorticoids (GCs) are required in the initial treatment of systemic vasculitis. However, slow or delayed tapering can lead to unnecessary GC exposure and toxicity. In this quality improvement initiative, we aimed to increase appropriate GC tapering among newly referred patients awaiting specialty consultation at a tertiary vasculitis clinic. Methods: For each patient referred for anti-neutrophil cytoplasm antibody-associated vasculitis (AAV) or large vessel vasculitis (LVV), recommendation-based GC tapering suggestions were faxed to referring physicians. To maximize uptake, the intervention format was modified according to feedback from referring physicians' offices. The proportion of new patients presenting to their first appointment who (1) had started to taper GCs, (2) were taking their target GC dose according to recommendations, (3) experienced a vasculitis flare during tapering were compared before (July 2017-January 2019) and after (February-October 2019) the intervention. Results: Among 169 consecutive patients referred for AAV or LVV, the proportion who had started to taper GCs by their first visit increased from 84 of 117 (72%) preintervention to 49 of 52 (94%) postintervention (p < 0.01). Mean daily prednisone dose at first visit decreased from 29.9 (SD, 18) mg to 21.7 (SD, 14) mg (p < 0.01). However, the proportion who were ultimately taking "target" GC doses at their first visit did not significantly increase (72% vs. 77%). Disease flares during tapering were similar before and after the intervention (9% vs. 12%). Conclusions: Patients with AAV and LVV had increased GC tapering and lower GC doses at first visit following a preappointment intervention. Further strategies are needed to improve timely GC tapering in vasculitis.
MeSH term(s)	Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy ; Arteritis ; Glucocorticoids ; Humans ; Prednisone ; Treatment Outcome
Chemical Substances	Glucocorticoids ; Prednisone (VB0R961HZT)
Language	English
Publishing date	2021-04-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000001744
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Article: Assessment of glucocorticoid tapering in large vessel and anti-neutrophil cytoplasmic antibody-associated vasculitides.

Mendel, Arielle / Ennis, Daniel / Carette, Simon / Pagnoux, Christian

Clinical and experimental rheumatology

2020 Volume 39 Suppl 129, Issue 2, Page(s) 119–124

Abstract: Objectives: Glucocorticoids (GC) remain integral to large vessel vasculitis (LVV) and ANCA-associated vasculitis (AAV) treatment. We aimed to assess real-world GC tapering trajectories among patients referred for LVV or AAV and identify factors ... ...

Abstract	Objectives: Glucocorticoids (GC) remain integral to large vessel vasculitis (LVV) and ANCA-associated vasculitis (AAV) treatment. We aimed to assess real-world GC tapering trajectories among patients referred for LVV or AAV and identify factors associated with 'delayed' tapering. Methods: Patients first assessed at a vasculitis clinic July 2017-August 2019 for LVV or AAV and taking GC were included. Delayed tapering was defined as prednisone >10 mg above target based on tapering recommendations (2010 British Society of Rheumatology Guidelines for Giant Cell Arteritis, 2015 CanVasc AAV Recommendations). We compared characteristics of patients with delayed and appropriate tapering and assessed barriers to timely tapering though chart reviews and referring physician surveys. Results: 160 patients (65 LVV, 95 AAV) were taking GC at their first visit. Among the 42 (26%) patients with delayed tapering, mean daily prednisone dose was 39.2 mg (SD 14) compared to a target of 15.2 mg (SD 15). Pulse GC were administered to 19/42 (45%) patients with delayed tapering compared to 26/118 (22%) with appropriate tapering (p<0.05). Mean Birmingham Vasculitis Activity Score at treatment onset and GC duration were not significantly different between the two groups. Vision loss and/or stroke was more frequent in LVV referrals who experienced delayed (9/21, 43%) vs. appropriate (6/44, 14%) tapering (p<0.05). Managing risk of vasculitis flare was the most common challenge to tapering GC among surveyed referring physicians. Conclusions: In one quarter of patients referred for LVV or AAV taking GC, tapering was slower than recommended. Promoting timely tapering may reduce GC toxicity.
MeSH term(s)	Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy ; Antibodies, Antineutrophil Cytoplasmic ; Arteritis ; Giant Cell Arteritis/diagnosis ; Giant Cell Arteritis/drug therapy ; Glucocorticoids ; Humans
Chemical Substances	Antibodies, Antineutrophil Cytoplasmic ; Glucocorticoids
Language	English
Publishing date	2020-12-04
Publishing country	Italy
Document type	Journal Article
ZDB-ID	605886-3
ISSN	1593-098X ; 0392-856X
ISSN (online)	1593-098X
ISSN	0392-856X
DOI	10.55563/clinexprheumatol/6spy2c
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Article ; Online: N-Terminal pro-Brain Natriuretic Peptide is a biomarker for cardiovascular damage in systemic lupus erythematous: a cross-sectional study.

Sacre, Karim / Vinet, Evelyne / Pineau, Christian A / Mendel, Arielle / Kalache, Fares / Grenier, Louis-Pierre / Huynh, Thao / Bernatsky, Sasha

Rheumatology (Oxford, England)

2023

Abstract: Objectives: Prediction models based on traditional risk factors underestimate cardiovascular (CV) risk in systemic lupus erythematosus (SLE). In a large sample of unselected SLE patients, we investigated cross-sectional associations of NT-proBNP with ... ...

Abstract	Objectives: Prediction models based on traditional risk factors underestimate cardiovascular (CV) risk in systemic lupus erythematosus (SLE). In a large sample of unselected SLE patients, we investigated cross-sectional associations of NT-proBNP with cardiovascular damage (CVD). Methods: Serum NT-proBNP was measured in SLE patients enrolled in the MUHC Lupus Clinic registry. Serum were collected between March 2022 and April 2023 at annual research visits. The primary outcome was CVD identified on the SLICC Damage Index. Factors associated with CVD and NT-proBNP levels were determined. Results: Overall, 270 SLE patients (female 91%, median age 50.7 [1st quartile- 3rd quartile : 39.6-62.1] years) were analyzed for the primary outcome. Among them, 33 (12%) had CVD. The ROC curve for NT-proBNP demonstrated strong associations with CVD (AUC 0.78, 95% CI 0.69-0.87) with a threshold of 133 pg/ml providing the best discrimination for those with/without CVD. Hypertension (OR 3.3, 95% CI 1.2-9.0), dyslipidaemia (OR 3.6, 95% CI 1.3-9.6) and NT-proBNP > 133 pg/ml (OR 7.0, 95% CI, 2.6-19.1) were associated with CVD in the multivariable logistic regression model. Increased NT-proBNP levels were associated with age (OR 4.2, 95% CI 2.2-8.3), ever smoking (OR 1.9, 95% CI 1.0-3.5), reduced eGFR (4.1, 95% CI 1.3-13.1), prior pericarditis/pleuritis (OR 2.5, 95% CI 1.4-4.5) and aPL antibodies (OR 2.6, 95% CI 1.4-4.9). Conclusion: NT-proBNP is a biomarker for CV damage in SLE. The novel associations of NT-proBNP levels with prior pericarditis/pleuritis and aPL antibodies suggest new avenues for research to better understand what drives CV risk in SLE.
Language	English
Publishing date	2023-10-06
Publishing country	England
Document type	Journal Article
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/kead522
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Article ; Online: Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza: A Systematic Review and Meta-Analysis.

Hanula, Ryan / Bortolussi-Courval, Émilie / Mendel, Arielle / Ward, Brian J / Lee, Todd C / McDonald, Emily G

JAMA internal medicine

2023 Volume 184, Issue 1, Page(s) 18–27

Abstract: Importance: Despite widespread use, summary evidence from prior meta-analyses has contradictory conclusions regarding whether oseltamivir decreases the risk of hospitalization when given to outpatients. Several large investigator-initiated randomized ... ...

Abstract	Importance: Despite widespread use, summary evidence from prior meta-analyses has contradictory conclusions regarding whether oseltamivir decreases the risk of hospitalization when given to outpatients. Several large investigator-initiated randomized clinical trials have not yet been meta-analyzed. Objective: To assess the efficacy and safety of oseltamivir in preventing hospitalization among influenza-infected adult and adolescent outpatients. Data sources: PubMed, Ovid MEDLINE, Embase, Europe PubMed Central, Web of Science, Cochrane Central, ClinicalTrials.gov, and WHO International Clinical Trials Registry were searched from inception to January 4, 2022. Study selection: Included studies were randomized clinical trials comparing oseltamivir vs placebo or nonactive controls in outpatients with confirmed influenza infection. Data extraction and synthesis: In this systematic review and meta-analysis, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines were followed. Two independent reviewers (R.H. and É.B.C.) extracted data and assessed risk of bias using the Cochrane Risk of Bias Tool 2.0. Each effect size was pooled using a restricted maximum likelihood random effects model. The quality of evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Main outcomes and measures: Hospitalization was pooled as risk ratio (RR) and risk difference (RD) estimates with 95% CIs. Results: Of 2352 studies identified, 15 were included. The intention-to-treat infected (ITTi) population was comprised of 6166 individuals with 54.7% prescribed oseltamivir. Across study populations, 53.9% (5610 of 10 471) were female and the mean age was 45.3 (14.5) years. Overall, oseltamivir was not associated with reduced risk of hospitalization within the ITTi population (RR, 0.79; 95% CI, 0.48 to 1.29; RD, -0.17%; 95% CI, -0.23% to 0.48%). Oseltamivir was also not associated with reduced hospitalization in older populations (mean age ≥65 years: RR, 1.01; 95% CI, 0.21 to 4.90) or in patients considered at greater risk of hospitalization (RR, 0.65; 0.33 to 1.28). Within the safety population, oseltamivir was associated with increased nausea (RR, 1.43; 95% CI, 1.13 to 1.82) and vomiting (RR, 1.83; 95% CI, 1.28 to 2.63) but not serious adverse events (RR, 0.71; 95% CI, 0.46 to1.08). Conclusions and relevance: In this systematic review and meta-analysis among influenza-infected outpatients, oseltamivir was not associated with a reduced risk of hospitalization but was associated with increased gastrointestinal adverse events. To justify continued use for this purpose, an adequately powered trial in a suitably high-risk population is justified.
MeSH term(s)	Adult ; Adolescent ; Humans ; Female ; Aged ; Middle Aged ; Male ; Oseltamivir/adverse effects ; Influenza, Human/drug therapy ; Influenza, Human/prevention & control ; Outpatients ; Hospitalization ; Europe
Chemical Substances	Oseltamivir (20O93L6F9H)
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Meta-Analysis ; Systematic Review ; Journal Article
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2023.0699
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Article: Impact of health portal enrolment with email reminders at an academic rheumatology clinic.

Mendel, Arielle / Chow, Shirley

BMJ quality improvement reports

2017 Volume 6, Issue 1

Abstract: Missed appointments reduce the quality, safety and efficiency of healthcare delivery. 'No-Shows' (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a ... ...

Abstract	Missed appointments reduce the quality, safety and efficiency of healthcare delivery. 'No-Shows' (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario. NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%). Patients were encouraged to enroll in the hospital's electronic patient portal, MyChart, and email reminders were implemented at one clinic for portal users. A detailed follow-up card was also given to patients. Process measures included portal enrolment, email reminder receipt, and call volumes. Outcome measures were NS and patient and staff satisfaction. During the intervention, 120/274 (44%) surveyed patients had MyChart accounts. Of these, 73 (61%) received the e-mail reminder and 72 (99%) found the e-mail helpful. Twenty-two patients knew about their appointment from the e-mail reminder alone. Improvement in attendance was seen after 3.5 months, but it was not sustained thereafter. Prior to this intervention there was no appointment reminder system at this clinic, and the email reminder demonstrated high patient satisfaction. Low portal enrolment, technical difficulties, and the inability of the intervention to reach new patients were possible reasons why the intervention was unsuccessful at reducing NS.
Language	English
Publishing date	2017-03-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2677829-4
ISSN	2050-1315
ISSN	2050-1315
DOI	10.1136/bmjquality.u214811.w5926
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