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Tamanini JVG, Sabino JV, Cordeiro RA, Mizubuti V, Villarinho LDL, Duarte JÁ, Pereira FV, Appenzeller S, Damasceno A, Reis F. The Role of MRI in Differentiating Demyelinating and Inflammatory (not Infectious) Myelopathies. Semin Ultrasound CT MR 2023; 44:469-488. [PMID: 37555683 DOI: 10.1053/j.sult.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
Demyelinating and inflammatory myelopathies represent a group of diseases with characteristic patterns in neuroimaging and several differential diagnoses. The main imaging patterns of demyelinating myelopathies (multiple sclerosis, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis, and myelin oligodendrocyte glycoprotein antibody-related disorder) and inflammatory myelopathies (systemic lupus erythematosus-myelitis, sarcoidosis-myelitis, Sjögren-myelitis, and Behçet's-myelitis) will be discussed in this article, highlighting key points to the differential diagnosis.
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Affiliation(s)
| | - João Vitor Sabino
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Rafael Alves Cordeiro
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Sao Paulo University, SP, Brazil
| | - Vanessa Mizubuti
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | | | - Juliana Ávila Duarte
- Department of Radiology and Diagnostic Imaging, HCPA, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Veloso Pereira
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Alfredo Damasceno
- Department of Neurology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fabiano Reis
- Department of Anesthesiology, Oncology and Radiology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Saadouli D, Lahmar A, Ben Mansour K, El Afrit N, Yahyaoui S, El Afrit MA. [Ocular manifestations of Behçet's disease]. J Fr Ophtalmol 2020; 44:196-202. [PMID: 33380351 DOI: 10.1016/j.jfo.2020.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 04/09/2020] [Accepted: 04/17/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Behçet's disease is a systemic inflammatory disease. Ocular involvement is an important diagnostic criterion, and this disease may be associated with severe visual loss. PURPOSE The goal of this study was to specify the epidemiological, clinical and therapeutic features of ocular involvement in patients with Behçet's disease and to identify risk factors for poor visual outcomes. METHODS A retrospective study was performed in 93 patients diagnosed with ocular Behçet's disease over a period of 9 years. Epidemiological, clinical, and therapeutic data was obtained from medical records and analyzed retrospectively. Poor visual outcome was defined as visual acuity limited to light perception without projection or no light perception. RESULTS The male:female ratio was 1.9. The mean age was 34.5 years. Ocular involvement was the presenting sign in 4%, bilateral in 61% and active in 68.8%. Uveitis was the most common presentation (57%), dominated by panuveitis, followed by retinal vasculitis (51.6%) and papilledema (10.7%). Maculopathy (26.8%) and cataract (18.2%) were the most common complications. Twenty patients (21.5%) had no light perception or light perception without projection. Treatment was based on corticosteroids in combination with immunosuppressive therapy (Azathioprine) in 55.9% of cases. Our study indicates a significant association of male gender and panuveitis with a poor visual outcome. CONCLUSION Ocular involvement in Behçet's disease is frequent and serious, which may lead to blindness. Male gender and panuveitis were predictors of poor visual prognosis.
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Affiliation(s)
- D Saadouli
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - A Lahmar
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - K Ben Mansour
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - N El Afrit
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis
| | - S Yahyaoui
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
| | - M A El Afrit
- Service d'ophtalmologie, centre hospitalo-universitaire La Rabta, Tunis.
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Nazareth T, Hart EM, Ronnebaum SM, Mehta S, Patel DA, Kötter I. Comparability of European League Against Rheumatology-Recommended Pharmacological Treatments of Oral Ulcers Associated with Behçet's Disease: A Systematic Literature Review of Randomized Controlled Trials. Open Access Rheumatol 2020; 12:323-335. [PMID: 33376418 PMCID: PMC7762439 DOI: 10.2147/oarrr.s277036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/31/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Oral ulcers are the cardinal manifestation in Behçet's disease (BD). The 2018 European League Against Rheumatism (EULAR) recommendations describe treatments for BD-associated oral ulcers with mucocutaneous involvement; however, little comparative effectiveness information for these agents is available. In the absence of head-to-head trials, an indirect treatment comparison (ITC) could provide useful evidence regarding comparative effectiveness of BD treatments. The purpose of this study was to conduct a comparative systematic literature review (SLR) and similarity assessment of randomized controlled trials (RCTs) investigating the oral ulcer-related efficacy outcomes of EULAR-recommended treatments for BD-associated oral ulcers to determine the feasibility of an ITC. Methods An SLR was performed to identify relevant RCTs indexed in MEDLINE/Embase before May 29, 2019. RCT similarities for the ITC were assessed based on a step-wise process recommended by the International Society for Pharmacoeconomics and Outcomes Research. Results In total, 317 articles were identified, of which 14 RCTs, reflecting 11 EULAR-recommended treatments, were evaluated in a similarity assessment. Number of oral ulcers, resolution of oral ulcers, and healing time for oral ulcers were identified as the possible oral ulcer-related outcomes. After completing the similarity assessment of these outcomes, it was determined that a robust ITC was infeasible for the three oral ulcer-related outcomes due to heterogeneity in outcomes reporting, study design, and/or patient characteristics. More broadly, the results underscore the need for and consistent use of standardized measures for oral ulcer outcomes to facilitate comparative research. Conclusion In the absence of head-to-head RCTs and infeasibility of quantitative ITC, comparative assessments for BD-associated oral ulcers are limited, including comparative effectiveness and cost-effectiveness evaluations. Healthcare decision-makers must continue to base treatment decisions on the extent and strength of available evidence (eg, robust RCTs), clinical guidelines, real-world experience, and patient considerations.
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Affiliation(s)
| | - Erin M Hart
- Pharmerit - an OPEN Health Company, New York, NY, USA
| | | | | | - Dipen A Patel
- Pharmerit - an OPEN Health Company, Bethesda, MD, USA
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg Eppendorf and Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany
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Long-Term Outcomes of Behçet's Syndrome-Related Uveitis: A Monocentric Italian Experience. Mediators Inflamm 2020; 2020:6872402. [PMID: 32508524 PMCID: PMC7245671 DOI: 10.1155/2020/6872402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/08/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
Objectives To examine demographic and clinical characteristics and long-term visual outcome in a cohort of Italian patients affected by Behçet's uveitis (BU). Materials and Methods Retrospective chart review of 47 patients with BU attending our unit between January 2018 and December 2019. Ophthalmologic manifestations, best-corrected visual acuity (BCVA), fluoroangiography and optical coherence tomography findings, and ocular complications were recorded. Predictive factors of a poor visual outcome and long-term complications were also investigated. Results Forty-seven patients (23 males and 24 females) for a total of 84 eyes were enrolled. Uveitis was bilateral in 37 (78.7%) patients with panuveitis being the most frequent anatomical pattern (40 out of 84 eyes), whereas 27 eyes presented a posterior uveitis. Isolated anterior uveitis was detected in 16 eyes. A significant improvement of median BCVA between baseline and last follow-up values was detected (p = 0.042). A higher risk of poor visual prognosis was observed in patients with uveitis duration greater than 15 years (p = 0.019). A significant resolution of retinal vasculitis was detected between baseline and last follow-up evaluation (p < 0.0001) whereas the mean ± SD macular thickness did not decrease significantly between baseline (376.00 ± 97.45 μm) and last follow-up evaluation (338.08 ± 55.81 μm). Forty-two eyes developed 57 complications during the disease course. Cataract was the most frequent (n = 12), followed by epiretinal membranes (n = 11) and cystoid macular edema (n = 6). The following variables were identified as predictors of long-term complications: human leukocyte antigen- (HLA-) B51 (p = 0.006), panuveitis (p = 0.037), and a uveitis duration of more than 15 years (p = 0.049). Conclusions In Italian patients, BU typically arises in the third decade and predominantly manifests as a bilateral posterior uveitis or panuveitis. Its duration is associated with a poor visual prognosis. Uveitis duration, the presence of HLA-B51, and panuveitis are predictors of long-term structural complications, thus representing main drivers in the treatment decision-making.
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Shi J, Zhao C, Zhou J, Liu J, Wang L, Gao F, Zeng X, Zhang M, Zheng W. Effectiveness and safety of interferon α2a as an add-on treatment for refractory Behçet's uveitis. Ther Adv Chronic Dis 2019; 10:2040622319847881. [PMID: 31105923 PMCID: PMC6505232 DOI: 10.1177/2040622319847881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 04/10/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: The objective of this study was to investigate the effectiveness and safety
of interferon (IFN) α2a as an add-on treatment for refractory Behçet’s
uveitis (BU). Methods: In this retrospective cohort study, 30 refractory BU patients who received
IFNα2a treatment in Peking Union Medical College Hospital between February
2015 and June 2018 were consecutively included. IFNα2a was used mainly as an
add-on treatment for BU patients who underwent relapse under corticosteroids
and conventional immunosuppressive agents. The primary outcome was treatment
success rate before and after initiation of IFNα2a. Changes in ocular
relapse rates, disease activity, corticosteroid- and
immunosuppressant-sparing effects, as well as side effects were secondary
outcomes. Results: A total of 30 patients (27 males and 3 females) with a mean age of 30.5 ±
8.7 years were included. Twenty-one patients (70%) were treated with at
least 2 immunosuppressive agents before the initiation of IFNα2a. Treatment
success was achieved in 26 patients (86.7%), and the median uveitis relapse
rate decreased from 7.3 (range 2–12) to 0 (range 0–6) per patient-year
(p = 0.000002) during a mean follow-up of 21.7 ±
7.5 months, corticosteroids were lowered in 25 cases (83.3%) and completely
withdrawn in four (13.3%). In addition, immunosuppressive agents were
reduced in number and dosage in 22 (73.3%) and 29 patients (96.7%),
respectively, and were completely withdrawn in 12 cases (40%). No severe
adverse events were observed and serum autoantibodies remained negative
during the treatment of IFNα2a. Conclusion: IFNα2a is effective and relatively safe in refractory BU, with significant
steroid- and immunosuppressant-sparing effects.
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Affiliation(s)
- Jing Shi
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jiaxin Zhou
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Jinjing Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Li Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Fei Gao
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing, China
| | - Meifen Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenjie Zheng
- Key Laboratory of Rheumatology and Clinical Immunology, Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Ministry of Education, Beijing 100730, China
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Figus M, Posarelli C, Albert TG, Talarico R, Nardi M. A Clinical Picture of the Visual Outcome in Adamantiades-Behçet's Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:120519. [PMID: 26558256 PMCID: PMC4628956 DOI: 10.1155/2015/120519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
Adamantiades-Behçet's disease is a multisystemic vasculitis with multiorgan involvement. Ocular disorders occur often in this syndrome typically in the form of a relapsing-remitting panuveitis and vasculitis and can lead to blindness as one of its most disabling complications if left untreated. There are known risk factors related with the worst visual prognosis, which require early and intensive treatment in order to obtain a rapid suppression of inflammation and to prevent future relapses. The management strategy to avoid vision loss and blindness currently involves the use of local and systemic drugs including steroids and immunosuppressive and biologic agents. This review aims to demonstrate how the introduction and the use of biologic agents improves the visual outcome of patients with Adamantiades-Behçet's disease.
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Affiliation(s)
- Michele Figus
- Department of Surgical, Medical, Molecular Pathology and Department of Emergency, University of Pisa, 56100 Pisa, Italy
| | - Chiara Posarelli
- Department of Surgical, Medical, Molecular Pathology and Department of Emergency, University of Pisa, 56100 Pisa, Italy
| | - Timothy G. Albert
- Department of Surgical, Medical, Molecular Pathology and Department of Emergency, University of Pisa, 56100 Pisa, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56100 Pisa, Italy
| | - Marco Nardi
- Department of Surgical, Medical, Molecular Pathology and Department of Emergency, University of Pisa, 56100 Pisa, Italy
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Sen HN, Davis J, Ucar D, Fox A, Chan CC, Goldstein DA. Gender disparities in ocular inflammatory disorders. Curr Eye Res 2014; 40:146-61. [PMID: 24987987 DOI: 10.3109/02713683.2014.932388] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ocular inflammatory disorders disproportionately affect women, and the majority of affected women are of childbearing age. The role of sex or reproductive hormones has been proposed in many other inflammatory or autoimmune disorders, and findings from non-ocular autoimmune diseases suggest a complex interaction between sex hormones, genetic factors and the immune system. However, despite the age and sex bias, factors that influence this disparity are complicated and unclear. This review aims to evaluate the gender disparities in prevalence, incidence and severity of the most common infectious and non-infectious ocular inflammatory disorders.
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Affiliation(s)
- Hatice Nida Sen
- National Eye Institute, National Institutes of Health , Bethesda, MD , USA
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Cingu AK, Onal S, Urgancioglu M, Tugal-Tutkun I. Comparison of presenting features and three-year disease course in Turkish patients with Behçet uveitis who presented in the early 1990s and the early 2000s. Ocul Immunol Inflamm 2012; 20:423-8. [PMID: 23163330 DOI: 10.3109/09273948.2012.713159] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To compare Behçet uveitis patients who presented in the 1990s and 2000s. METHODS Records of 170 patients seen in 1990-1994 and 258 patients seen in 2000-2004 were reviewed. Presenting features were analyzed in the whole cohort. Uveitis attacks, vision, complications, and immunomodulatory treatment (IMT) were compared in patients with 3-year follow-up. RESULTS Posterior segment involvement was less common, visual acuity was better, and more patients received IMT before referral in the 2000s. Follow-up revealed no significant difference in number of uveitis attacks in the first 3 years. Less eyes lost useful vision, no patient became legally blind, and fewer severe ocular complications occurred in the 2000s. IMT was started within 3 months in more patients and interferon alfa-2a was used only in the latter study period. CONCLUSIONS The findings suggest a milder disease at referral, lower rate of severe complications, and a better 3-year visual outcome in patients who presented in the early 2000s.
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Affiliation(s)
- Abdullah Kursat Cingu
- Dicle University, Faculty of Medicine, Department of Ophthalmology, Diyarbakir, Turkey
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Kneifel CE, Köhler AK, Altenburg A, Zouboulis CC, Krause L. [Epidemiology of ocular involvement in Adamantiades-Behçets disease]. Ophthalmologe 2012; 109:542-7. [PMID: 22699944 DOI: 10.1007/s00347-011-2503-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Epidemiological studies demonstrate a prevalence of Adamantiades-Behçets disease (MAB) in the range of 0.12-420 per 100,000 inhabitants with the highest rates in Istanbul, Turkey and the lowest rates in the USA. Ophthalmological data on the prevalence of ocular involvement are limited for MAB in Germany because most epidemiological studies are based on rheumatological or dermatological data. Berlin is the city with the highest number of non-native German inhabitants and its multiethnic character renders it uniquely appropriate for epidemiological studies on MAB. This article summarizes the most important epidemiological data of 140 patients (63 female and 77 male) with a mean follow-up of 6.4 years (range 0.5-22 years) which we have recently published. The mean age was 23 years at the first manifestation and 32 years when the fully developed disease was recorded. The mean age at onset of ocular involvement was 30 years, 56% of patients developed ocular involvement, which was the first manifestation in 8.6% and the second manifestation in 19.3%. More than half the patients developed ocular involvement. The calculated prevalence of ocular involvement in MAB is 1.77/100,000 inhabitants for the population of Berlin.
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Affiliation(s)
- C E Kneifel
- Klinik für Augenheilkunde, Städtisches Klinikum Dessau, Auenweg 38, 06847, Dessau, Deutschland
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Altenburg A, Mahr A, Maldini C, Kneifel C, Krause L, Kötter I, Stache T, Bonitsis N, Zouboulis C. Epidemiologie und Klinik des Morbus Adamantiades-Behçet in Deutschland. Ophthalmologe 2012; 109:531-41. [DOI: 10.1007/s00347-012-2601-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saleh OA, Birnbaum AD, Tessler HH, Goldstein DA. Behçet Uveitis in the American Midwest. Ocul Immunol Inflamm 2012; 20:12-7. [DOI: 10.3109/09273948.2011.630550] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Central retinal artery occlusion and recurrent papillitis in a patient with incomplete Behçet disease. J Neuroophthalmol 2011; 31:244-7. [PMID: 21857189 DOI: 10.1097/wno.0b013e318219fe8f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 40-year-old man presented with painless sudden visual loss due to a central retinal artery occlusion (CRAO) in his right eye. Three months later, he had painless acute visual loss in his left eye with visual acuity of 20/100 and a swollen optic disc. After oral prednisone treatment, the disc swelling resolved and acuity recovered to 20/20. Five months later, the patient experienced another episode of vision loss in the left eye associated with optic disc edema. With steroid therapy, he regained 20/20 acuity once again. With a history of recurrent oral ulcers, fluorescein angiography showing obliterative retinal vasculitis in the right eye, and steroid responsive optic neuropathy in the left eye, we made the diagnosis of incomplete Behçet disease.
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Kötter I, Hamuryudan V, Oztürk ZE, Yazici H. Interferon therapy in rheumatic diseases: state-of-the-art 2010. Curr Opin Rheumatol 2010; 22:278-83. [PMID: 20061957 DOI: 10.1097/bor.0b013e3283368099] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Interferons are natural glycoproteins that have antiviral, antiproliferative and immune regulatory functions. They are not only involved in the pathogenesis of certain autoimmune conditions but are also useful in the treatment of some rheumatologic disorders, notably Behçet's syndrome. RECENT FINDINGS Interferon alpha (IFNalpha) has been recommended for severe eye involvement in Behçet's syndrome, especially when there is a significant drop in visual acuity and/or retinal involvement. It can induce a high rate of complete remission that may also persist after its discontinuation. When given early at the beginning, interferon might be effective in ameliorating the attacks of familial Mediterranean fever resistant to colchicine treatment. The combination of PEGylated IFNalpha with ribavirin and rituximab emerges as a novel and promising treatment providing complete clinical response and viral clearance in hepatitis C virus-associated mixed cryoglobulinemia. Limited data also suggest that interferon may induce remissions in Churg-Strauss patients who fail to respond to conventional immunosuppressive treatment. SUMMARY Among several rheumatologic diseases, IFNalpha has found more widespread use in Behçet's syndrome and hepatitis C virus-associated mixed cryoglobulinemia despite a paucity of formal studies. Patients should be carefully monitored for the frequent and dose-dependent adverse effects.
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Affiliation(s)
- Ina Kötter
- Department of Internal Medicine II, University Hospital, Tübingen, Germany
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