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Jafari Nakhjavani MR, Ghorbanihaghjo A, Malek Mahdavi A, Nemati N, Rashtchizadeh N, Abedi Azar S, Khabbazi A. Association between Serum α-Klotho Levels and Behçet Disease. Lab Med 2023; 54:469-472. [PMID: 36637200 DOI: 10.1093/labmed/lmac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Endothelial dysfunction (ED) has a well-known role in promoting vascular inflammation in Behçet disease (BD). α-klotho is involved in regulation of endothelial function, and its reduction has been reported to be associated with ED. OBJECTIVE To assess serum α-klotho in patients with BD, compared with healthy control individuals. METHODS In a cross-sectional study, 55 patients with BD and 30 age- and sex-matched healthy controls were enrolled, and their serum levels of α-klotho were measured. RESULTS Common clinical symptoms in patients with BD were oral aphthous ulcers, uveitis, and genital ulcers. Median (IQR) serum α-klotho levels in the BD and control groups were 0.30 (0.20-0.70) and 1.00 (0.70-2.52) ng/mL, respectively. The difference was statistically significant (P = .005). No significant correlation was observed between serum α-klotho and age (r = 0.194; P = .14). Serum α-klotho levels in patients with uveitis were significantly lower. CONCLUSION α-klotho may have a role in the pathogenesis of ED and is a potential biomarker for uveitis in BD.
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Affiliation(s)
| | | | - Aida Malek Mahdavi
- Connective Tissue Diseases Research Center
- Tuberculosis and Lung Disease Research Center
- Rahat Breathe and Sleep Research Center
| | | | | | - Sima Abedi Azar
- Department of Internal Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Zhang Z, Driskill E, Chi J, Duensing I, Cui Q. The impact of Behcet syndrome on total knee arthroplasty outcomes: a retrospective matched cohort study. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05850-6. [PMID: 37249630 DOI: 10.1007/s00264-023-05850-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
PURPOSE Articu lar involvement is a common manifestation of Behcet syndrome (BS), which can eventually result in significant arthralgia and necessitate total knee arthroplasty (TKA). However, outcomes of BS patients after TKA are still poorly documented in the literature. The purpose of this study was to evaluate BS as a potential risk factor for complications after TKA. METHODS BS patients undergoing primary TKA were identified from the PearlDiver Mariner database from 2010 to 2021 and compared to 10:1 matched controls. Multivariable logistic regression analyses were done for medical complications up to 90 days and surgical complications up to two years. Ninety-day emergency department (ED) visit and inpatient readmission were also documented. RESULTS A total of 4286 patients undergoing primary TKA were queried, of which 390 had BS. Patients with BS demonstrated significantly higher rates of medical complications, including deep venous thrombosis. The rates of surgical complications were similar between the two groups with the exception of periprosthetic instability, aseptic loosening, and wound complications in BS patients. Additionally, a significantly higher rate of ED visits but markedly lower rates of 90-day readmissions were noted in patients with BS. CONCLUSION Patients with BS undergoing TKA are at higher risks of medical and surgical complications. Special considerations for a unique postoperative course with the higher complications should be made. It is crucial for orthopedic surgeons and patients alike to consider these risks when determining the expected course after TKA for patients with BS.
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Affiliation(s)
- Zhichang Zhang
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Xinxiang Medical University, Weihui, 453100, Henan, China
| | - Elizabeth Driskill
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Jialun Chi
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Ian Duensing
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA
| | - Quanjun Cui
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, 22908, USA.
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Nguyen A, Upadhyay S, Javaid MA, Qureshi AM, Haseeb S, Javed N, Cormier C, Farooq A, Sheikh AB. Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management. Inflamm Intest Dis 2022; 6:175-185. [PMID: 35083283 DOI: 10.1159/000520696] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms. Summary BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease. Key Messages In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.
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Affiliation(s)
- Anthony Nguyen
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Shubhra Upadhyay
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Abdul Moiz Qureshi
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shahan Haseeb
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Christopher Cormier
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, Texas, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Merashli M, Bucci T, Pastori D, Pignatelli P, Arcaro A, Gentile F, Marottoli V, Ames PRJ. Plasma Homocysteine in Behcet's Disease: A Systematic Review and Meta-Analysis. Thromb Haemost 2022; 122:1209-1220. [PMID: 34996122 DOI: 10.1055/s-0041-1740637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the relevance of plasma homocysteine (HC) in Behcet's disease (BD) and its clinical manifestations. METHODS Systematic review of EMBASE and PubMed databases according to PRISMA guidelines from inception to July 2021; random-effects meta-analyses for continuous outcomes. RESULTS The search strategy retrieved 48 case-control (2,669 BD and 2,245 control participants) and 5 cohort studies (708 BD participants). Plasma HC was higher in BD than in controls (p < 0.0001) with wide heterogeneity (I2 = 89.7%) that remained unchanged after sensitivity analysis according to year of article publication, age of BD participants, study size, study quality, method of HC determination, and male/female ratio >1.5; some pooled ethnicities explained a small part of the heterogeneity (I2 = 16.3%). Active BD participants had higher HC than inactive ones (p < 0.0001), with moderate heterogeneity (I2 = 49.2%) that disappeared after removal of an outlier study with very high disease activity. BD participants with any vascular involvement had higher HC than those without (p < 0.0001) with wide heterogeneity (I2 = 89.7%); subgroup analysis on venous thrombosis only changed neither effect size (p < 0.0001) nor heterogeneity (I2 = 72.7%). BD participants with ocular involvement had higher HC than those without (p < 0.0001) with moderate heterogeneity (I2 = 40.3%). CONCLUSION Although causality cannot be inferred, the consistency of the elevation of plasma HC in BD, particularly in patients with active disease, with vascular and ocular involvement suggests an intrinsic involvement of HC in these clinical manifestations.
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Affiliation(s)
- Mira Merashli
- Department of Rheumatology, American University of Beirut, Bliss, Beirut, Lebanon
| | - Tommaso Bucci
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessia Arcaro
- Department of Medicine and Health Sciences 'V. Tiberio', Università del Molise, Campobasso, Italy
| | - Fabrizio Gentile
- Department of Medicine and Health Sciences 'V. Tiberio', Università del Molise, Campobasso, Italy
| | | | - Paul R J Ames
- Immune Response and Vascular Disease Unit, CEDOC, Nova University Lisbon, Rua Camara Pestana, Lisbon Portugal.,Department of Haematology, Dumfries Royal Infirmary, Cargenbridge, Dumfries, United Kingdom
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Erdem Y, Erdem S, Barburoglu M, Karaayvaz EB, Shugaiv E, Kurtuncu M, Salmaslioglu A, Oflaz H, Kose AA, Kadioglu A. The risk of endothelial and erectile dysfunctions in Behçet's disease: a comparative analysis of mucocutaneous and systemic patient groups. Postepy Dermatol Alergol 2021; 38:622-628. [PMID: 34658705 PMCID: PMC8501428 DOI: 10.5114/ada.2021.108931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/16/2020] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Behçet's disease (BD) is a chronic inflammatory disease which can be limited to only mucocutaneous tissues or can affect different systems of the body. AIM To investigate the association of endothelial and erectile dysfunctions with BD, on the basis of comparative analysis between mucocutaneous and systemic BD. MATERIAL AND METHODS Thirty-eight men diagnosed with BD were included in the present study. The patients were stratified into two groups as mucocutaneous BD (n = 20, MBD group), and systemic BD (n = 18, SBD group). Erectile dysfunction (ED) was assessed using the Erectile Function domain of the International Index of Erectile Function (IIEF-EF) questionnaire. The coronary flow reserve (CFR) assessment was done for analysing endothelial dysfunction (EnD), and CFR < 2 was defined as EnD. Penile Doppler ultrasonography (PDU) was performed for ED. The demographic and clinical parameters, IIEF-EF score ED classification, CFR and PDU test findings were compared between two groups. RESULTS The median age was 34 (22-52) years in the overall population, and there was no difference between two groups (p = 0.558). Time from diagnosis was significantly longer (24 vs. 102 months, p = 0.021) and the use of immunosuppressive therapies was higher (0 vs. 70.6%, p < 0.001) in the SBD group. In overall, median CFR was 1.92 (1.1-5.96), and there was no difference between two groups (1.88 vs. 1.97, p = 0.812). The percentage of patients with CFR < 2 was similar in two groups (52.6% vs. 52.9%, p = 0.985). The ED status according to IIEF-EF was similar in two groups (45% vs. 27.8%, p = 0.538) as well as according to PDU analyses (10% vs. 16.7%, p = 0.544). CONCLUSIONS The increased risk of endothelial, and erectile dysfunctions should be considered in men who were diagnosed with mucocutaneous and systemic BD.
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Affiliation(s)
- Yasemin Erdem
- Department of Dermatology, Health Science University, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Erdem
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Barburoglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ekrem Bilal Karaayvaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erkingul Shugaiv
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Murat Kurtuncu
- Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Artur Salmaslioglu
- Department of Radiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Afet Akdag Kose
- Department of Dermatology and Venereology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ates Kadioglu
- Department of Urology, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Association between serum homocysteine and arterial stiffness in patients with Behçet’s disease. EGYPTIAN RHEUMATOLOGIST 2020. [DOI: 10.1016/j.ejr.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yücel Ç, Omma A, Sertoğlu E, Sezer S, Turhan T, Özgürtaş T. Evaluation of atherogenic laboratory markers in Behçet's disease patients with vascular involvement. Arch Med Sci 2020; 16:531-537. [PMID: 32399099 PMCID: PMC7212210 DOI: 10.5114/aoms.2018.79139] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/21/2018] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Behçet's disease is a chronic inflammatory vasculitis presenting with immunological and endothelial changes. The aim of the present study is to evaluate blood levels of diagnostic markers which can be used in Behçet's patients with vascular involvement. MATERIAL AND METHODS Fifty Behçet's patients (22 with vascular involvement) and 30 healthy controls were included in the study. High-sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), tumor necrosis factor-α (TNF-α), apolipoprotein A1 (apoA1), apolipoprotein B (apoB), high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride, total cholesterol, Lp-plA-2, homocysteine and ischemia modified albumin (IMA) levels were analyzed. Statistical analysis was performed with the SPSS program version 11.0. p < 0.05 was accepted as statistically significant. RESULTS hsCRP, TNF-α, homocysteine, IMA, apoA1, apoB, HDL, Lp-pla2 and ESR levels in patient and control groups were significantly different (p < 0.001, p = 0.001, p < 0.001, p < 0.001, p = 0.005, p < 0.001, p < 0.001, p < 0.001 and p = 0.003 respectively). In Behçet's patients with vascular involvement, homocysteine, TNF-α and Lp-pla2 levels were significantly higher than in Behçet's patients without vascular involvement (p = 0.035, p = 0.010 and p < 0.001 respectively). CONCLUSIONS Increased levels of inflammatory and atherogenic markers in Behçet's patients are an expected outcome due to the inflammatory nature of the disease. Especially, elevated levels of homocysteine, TNF-α and Lp-pla2 make them candidate diagnostic tools to be helpful in clinical evaluation of Behçet's disease patients with vascular involvement.
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Affiliation(s)
- Çiğdem Yücel
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Altındağ, Ankara, Turkey
| | - Ahmet Omma
- Department of Rheumatology Ankara Numune Training and Research Hospital, Altındağ, Ankara, Turkey
| | - Erdim Sertoğlu
- Department of Clinical Biochemistry, Ankara Gülhane Training and Research Hospital, Etlik, Ankara, Turkey
| | - Sevilay Sezer
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Altındağ, Ankara, Turkey
| | - Turan Turhan
- Department of Clinical Biochemistry, Ankara Numune Training and Research Hospital, Altındağ, Ankara, Turkey
| | - Taner Özgürtaş
- Department of Clinical Biochemistry, Ankara Gülhane Training and Research Hospital, Etlik, Ankara, Turkey
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Chen Y, Cai JF, Lin CH, Guan JL. Demography of vascular Behcet's disease with different gender and age: an investigation with 166 Chinese patients. Orphanet J Rare Dis 2019; 14:88. [PMID: 31036056 PMCID: PMC6489364 DOI: 10.1186/s13023-019-1061-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Clinical features of vascular Behcet’s disease (BD) are not well understood because there are few studies. Our study aimed to investigate characteristics of vascular BD in both genders in different age groups. Results We enrolled 923 patients with BD who presented to our hospital with adequate medical histories and proper vascular screening exams. The raw incidence rate of vascular BD was 17.98% (166/923). The ratio of vascular BD in male to female patients was 1.868 (p = 0.0004, 95% confidence interval (CI): 1.317 to 2.625). There was a tendency towards higher ESR and CRP in vascular BD patients than in mucocutaneous, but the difference was not significant. The most susceptible affected vessels were cerebral (29.6% in males, 59.4% in females) and lower limb vessels (31.2% in males, and 17.2% in females). The incidence of vascular involvement in younger (< 50 years old) and older (≥ 50 years old) patients were similar, with ratios of 16.58% (122/736) and 23.53% (44/187) respectively. However, in females, younger patients were less likely to have vascular involvement than were older patients (11.43% vs. 20% p = 0.0328, OR: 0.5161, 95% CI: 0.2874 to 0.912). Aneurysm or pseudoaneurysm was diagnosed in 1.84% (17/923) patients, mostly in male patients (p < 0.05, OR: 3.221, 95% CI: 1.097 to 9.112). Twenty vascular BD patients were followed up, and the age at BD diagnosis was 33.23 ± 11.56 year. This did not differ statistically with their age at vascular involvement (36.15 ± 9.52 years). Ages of vascular BD patients did not differ significantly from those of mucocutaneous BD patients (n = 143) in both males and females. Conclusion Vascular BD, including lethal types of aneurysm is more likely to occur in male patients. The female patients has a similar incidence rate with the males in their postmenopausal age. There was no evidence of progression course from mucocutaneous BD to vascular involvement.
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Affiliation(s)
- Yong Chen
- Rheumatology and Immunology Department of Huadong Hospital Affiliated to Fudan University, #221 yan'an west Road, Jingan District, Shanghai, 200040, People's Republic of China.,Present address: Department of Rheumatology and Immunology, Hospital of Integrated Traditional Chinese and Western Medicine, Southern Medical University, Guangzhou, 510330, China
| | - Jian-Fei Cai
- Rheumatology and Immunology Department of Huadong Hospital Affiliated to Fudan University, #221 yan'an west Road, Jingan District, Shanghai, 200040, People's Republic of China
| | - Chen-Hong Lin
- Rheumatology and Immunology Department of Huadong Hospital Affiliated to Fudan University, #221 yan'an west Road, Jingan District, Shanghai, 200040, People's Republic of China
| | - Jian-Long Guan
- Rheumatology and Immunology Department of Huadong Hospital Affiliated to Fudan University, #221 yan'an west Road, Jingan District, Shanghai, 200040, People's Republic of China.
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Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behçet's disease: which and when to use? Clin Rheumatol 2018; 37:2811-2817. [PMID: 29980877 DOI: 10.1007/s10067-018-4194-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/04/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is an uncommon autoimmune/autoinflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were investigated in many diseases as a marker of inflammation. In this study, we investigated NLR and PLR in patients with BD as a marker of disease activity and its association with different clinical manifestations. The study included 23 BD patients; their mean age was (32.5 ± 6.76) and M:F ratio was 16:7. Complete blood picture was done for all patients. NLR and PLR were compared in both active and inactive BD patients and its relation with different clinical manifestations was assessed. NLR was higher in active BD patients than in inactive BD patients (P < 0.01). Although both NLR and PLR were correlated with Behçet's Disease Current Activity Form (BDCAF), the correlation of NLR with BDCAF was much stronger than that of PLR. NLR was associated with some mucocutaneous lesions. Both NLR and PLR were associated with articular and GIT manifestations, but also NLR showed more significant results. In our studied patients, both NLR and PLR were not informative about any ongoing ocular activity (P > 0.05). Both ratios were not affected by the presence of neurologic deficits nor previous vascular events (P > 0.05). NLR was superior to PLR as an indicator of disease activity. NLR was closely related to skin manifestations while PLR was not. In our study, both were not considered reliable in representing ocular activity.
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Affiliation(s)
- Marwa Hammad
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Omaima Zakaria Shehata
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Acikgoz N, Kurtoğlu E, Yagmur J, Kapicioglu Y, Cansel M, Ermis N. Elevated Monocyte to High-Density Lipoprotein Cholesterol Ratio and Endothelial Dysfunction in Behçet Disease. Angiology 2017; 69:65-70. [PMID: 28421814 DOI: 10.1177/0003319717704748] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behçet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.
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Affiliation(s)
- Nusret Acikgoz
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertuğrul Kurtoğlu
- 2 Department of Cardiology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Julide Yagmur
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yelda Kapicioglu
- 3 Department of Dermatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Mehmet Cansel
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Necip Ermis
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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The ischemia modified albumin and mean platelet volume levels in patients with Behçet's disease. Postepy Dermatol Alergol 2016; 33:345-348. [PMID: 27881940 PMCID: PMC5110624 DOI: 10.5114/ada.2016.62840] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/27/2015] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Behçet's disease (BD) is a chronic inflammatory disorder with endothelial dysfunction. Ischemia-modified albumin (IMA) is a marker used in the detection of diseases associated with oxidative stress, vascular endothelial cell dysfunction and ischemia. Mean platelet volume (MPV) signifies the platelet function and activity. AIM To show whether MPV and IMA are useful in revealing the oxidative stress and the risk of thrombosis in patients with BD. MATERIAL AND METHODS Twenty-six patients with BD and 28 healthy volunteers as a control group over 18 years of age were included in the study. Serum IMA and MPV levels were analyzed in both groups. RESULTS The mean MPV values were identified as 0.86 ±0.15 and 0.82 ±0.08 (in the BD and control groups, respectively; p = 0.188) and the mean IMA values were 9.39 ±0.73 and 9.17 ±1.09 (in the BD and control groups, respectively; p = 0.275). There were no statistically significant differences between the groups. The IMA values of BD patients who were in the active phase were significant as compared to inactive BD patients and control groups (p = 0.041). The IMA and MPV values of the thrombotic patients, non-thrombotic patients and control groups were not significant. CONCLUSIONS Ischemia-modified albumin may be a helpful marker of possible complications during an active period of BD.
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Lazzerini P, Capecchi P, Selvi E, Lorenzini S, Bisogno S, Galeazzi M, Laghi Pasini F. Hyperhomocysteinemia: a cardiovascular risk factor in autoimmune diseases? Lupus 2016; 16:852-62. [DOI: 10.1177/0961203307084176] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Epidemiological studies conducted over the past 25 years have provided ample support for the association of mild hyperhomocysteinemia (HHcy) with an elevated risk of atherothrombosis. Since autoimmune disorders (AD) are frequently associated with relevant and early signs of atherothrombotic damage not adequately explained by the traditional risk factors involved in the onset of cardiovascular disease (CVD), a large interest has been shown to the putative role of mild HHcy in this setting. On the basis of such considerations, we focused the attention on the relationship between homocysteine (Hcy) and CVD in patients affected with autoimmune diseases, reviewing the most recent literature data and also providing our original experience. Although the large amount of available studies clearly shows that HHcy represents a common finding in patients affected with several autoimmune diseases, the actual role of Hcy in the development of CVD in the course of AD is not clear yet, perhaps, with the only exception of the systemic lupus erythematosus. In the other conditions, the role of Hcy in the pathogenesis of vascular complications is still a matter of debate, as the result of conflicting reports and/or lack of an adequate body of investigation. Lupus (2007) 16, 852—862.
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Affiliation(s)
- P.E. Lazzerini
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
| | - P.L. Capecchi
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
| | - E. Selvi
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - S. Lorenzini
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - S. Bisogno
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - M. Galeazzi
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - F. Laghi Pasini
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
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Seo J, Ahn Y, Zheng Z, Kim BO, Choi MJ, Bang D, Kim DY. Clinical significance of serum YKL-40 in Behçet disease. Br J Dermatol 2016; 174:1337-44. [PMID: 26708309 DOI: 10.1111/bjd.14376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Serum YKL-40 is an inflammatory biomarker of endothelial dysfunction and may play a role in the inflammatory process of Behçet disease (BD). OBJECTIVES Serum YKL-40 levels were evaluated in patients with BD in order to identify associations with other inflammatory cytokines and establish laboratory parameters. Serum YKL-40 levels were also compared with BD clinical features and disease activity. METHODS In total, 112 patients with BD and 45 age- and sex-matched healthy volunteers were included. Disease activity was assessed with BD Current Activity Form score and Electronic Medical Record-based Activity Index (EMRAI) score. RESULTS Serum YKL-40 levels were significantly higher in patients with BD (median 41·88, range 12·52-171·30 ng mL(-1) ) than in healthy volunteers (median 20·92, range 5·01-64·20 ng mL(-1) ; P < 0·01). The cut-off value for YKL-40 (30·005 ng mL(-1) ) was determined from the receiver operating characteristic curve. EMRAI scores and the proportion of patients in the active phase of BD presenting with two or more major criteria were significantly higher in patients with elevated YKL-40 levels (P = 0·04 and P = 0·04, respectively). A statistically significant elevation in YKL-40 levels was observed in patients with active BD compared with patients with inactive BD (P = 0·05). Serum YKL-40 values were positively correlated with interleukin-6 and EMRAI scores (both P = 0·04), indicating that serum YKL-40 levels are increased in patients with BD and positively correlate with disease activity. CONCLUSIONS YKL-40 may play a role in the pathophysiology of BD and provide a useful marker for monitoring patients with BD.
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Affiliation(s)
- J Seo
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Y Ahn
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Z Zheng
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Dermatology, Yanbian University Hospital, Yanji, China
| | - B O Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
| | - M J Choi
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - D Bang
- Department of Dermatology, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea
| | - D Y Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Merashli M, Ster IC, Ames PRJ. Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis. Semin Arthritis Rheum 2016; 45:502-10. [DOI: 10.1016/j.semarthrit.2015.06.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/23/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022]
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Affiliation(s)
- Nusret Acikgoz
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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Kim SR, Leem DW, Moon IJ, Koh BS, Chang MH, Yoo J, Yang HC, Lee CH. A Case of Azathioprine Induced Warfarin Resistance in Behçet's Disease. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sung Ryeol Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Woo Leem
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Il Joo Moon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Beom Seok Koh
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hee Chang
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jongha Yoo
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hee Chul Yang
- Department of Diagnostic Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chan Hee Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Taşolar H, Taşolar S, Kurtuluş D, Altun B, Bayramoğlu A, Otlu YÖ, Ballı M, Çetin M, Altunışık N, Kapıcıoğlu Y, Pekdemir H. Increased epicardial adipose tissue thickness on transthoracic echocardiography in patients with Behçet disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1393-1400. [PMID: 25063404 DOI: 10.7863/ultra.33.8.1393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Owing to the fact that the potential frequency of endothelial dysfunction and early atherosclerosis might be higher in Behçet disease, characterized by acute and chronic inflammatory attacks, it may lead to impairment in flow-mediated dilatation and an increase in epicardial adipose tissue thickness. Therefore, we aimed to evaluate whether epicardial adipose tissue thickness and brachial artery flow-mediated dilatation as markers of early atherosclerosis and endothelial dysfunction were associated with Behçet disease. METHODS Thirty-five patients with Behçet disease and 35 healthy volunteers were included in this study. Epicardial adipose tissue was identified as an anechoic space between epicardial layers on 2-dimensional images, and its thickness was measured on the free wall of the right ventricle. Right brachial artery flow-mediated dilatation was assessed according to recent guidelines. RESULTS Serum γ-glutamyl transferase (GGT) levels and epicardial adipose tissue thickness were significantly higher (P = .001; P < .001 respectively), whereas flow-mediated, endothelium-dependent dilatation was significantly lower in the Behçet disease group than controls (P < .001). There was a significant negative association between epicardial adipose tissue thickness and flow-mediated dilatation (P < .001). Epicardial adipose tissue thickness was also positively correlated with Behçet disease activity (P< .001), Behçet disease duration (P< .001), and waist circumference (P< .001). Flow-mediated dilatation was negatively correlated with GGT (P< .001), Behçet disease activity (P< .001), and age (P< .001). There was also a significant association between GGT and Behçet disease activity (P < .001). CONCLUSIONS We found that epicardial adipose tissue thickness was significantly higher and flow-mediated dilatation was significantly lower in patients with Behçet disease than in controls. We suggest that identification of increased epicardial adipose tissue might aid in the diagnosis and treatment of possible coronary artery disease in patients with Behçet disease.
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Affiliation(s)
- Hakan Taşolar
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey.
| | - Sevgi Taşolar
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Duygu Kurtuluş
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Burak Altun
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Adil Bayramoğlu
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yılmaz Ömür Otlu
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Ballı
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mustafa Çetin
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Nihal Altunışık
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yelda Kapıcıoğlu
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Hasan Pekdemir
- Departments of Cardiology (H.T., M.B., M.Ç.) and Radiology (S.T.), Adiyaman University Training and Research Hospital, Adiyaman, Turkey; Department of Physical Medicine and Rehabilitation, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey (D.K.); Department of Cardiology, Faculty of Medicine, Çanakkale 18 Mart University, Çanakkale, Turkey (B.A.); and Departments of Cardiology (A.B., Y.Ö.O., H.P.) and Dermatology (N.A., Y.K.), Faculty of Medicine, Inonu University, Malatya, Turkey
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18
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Desbois AC, Wechsler B, Cluzel P, Helft G, Boutin D, Piette JC, Cacoub P, Saadoun D. [Cardiovascular involvement in Behçet's disease]. Rev Med Interne 2014; 35:103-11. [PMID: 24434015 DOI: 10.1016/j.revmed.2013.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 12/02/2013] [Indexed: 12/15/2022]
Abstract
Vascular involvement is a common complication of Behçet's disease (BD) and affects up to 40% of BD patients. These complications worsen the prognosis of BD. The concept of vasculo-Behçet has been adopted for cases in which vascular complications dominate the clinical features. Vascular manifestations affect particularly young men, during the first years following onset of the disease. Venous complications are the most frequent vascular complications, affecting 14 to 40% of BD patients. Superficial and deep lower limb thrombosis is the most frequent venous complications but one third of venous thrombosis concern large vessels (such as cerebral venous thrombosis, pulmonary embolism, and inferior or superior vena cava, etc.). Budd-Chiari syndrome is the worst prognostic factor increasing mortality by 9 times. Arterial complications (2 to 17% of BD patients) include aneurysms and occlusions/stenosis. Main locations of arterial lesions are aortic (abdominal and thoracic), femoral, pulmonary and iliac arteries. Aneurysms are the most severe arterial complications, particularly pulmonary aneurysms associated with a high risk of massive bleeding. Cardiac complications (up to 6% of BD patients) include pericarditis, endocardial lesions (aortic regurgitation and less often mitral insufficiency), myocardial lesions (myocardial infarction, myocarditis and endomyocardial fibrosis) and intracardiac thrombosis (right ventricle and atrium). Coronary lesions complicated to myocardial infarction are the most severe cardiac complications. Treatment is based on corticosteroids and immunosuppressive drugs. The use of anticoagulation in venous thrombosis is still controversial.
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Affiliation(s)
- A-C Desbois
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France
| | - B Wechsler
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - P Cluzel
- Service de radiologie, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - G Helft
- Service de cardiologie, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - D Boutin
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - J-C Piette
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France
| | - P Cacoub
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France
| | - D Saadoun
- Service de médecine interne, centre de référence des maladies autoimmunes rares, groupe hospitalier Pitié-Salpêtrière, 75013 Paris, France; DHU i2B, immunopathologie, inflammation, biothérapie, université Pierre-et-Marie-Curie, Paris 6, AP-HP, 75013 Paris, France.
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19
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Allam A, Ammar H, Radwan A. Serum homocysteine level and eye involvement in Egyptian patients with Behçet’s disease. EGYPTIAN RHEUMATOLOGIST 2014. [DOI: 10.1016/j.ejr.2013.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Balta S, Balta I, Demirkol S, Ozturk C, Demir M. Endothelial Function and Behçet Disease. Angiology 2013; 65:657-9. [DOI: 10.1177/0003319713513146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Sevket Balta
- Department of Cardiology, Eskisehir Military Hospital, Eskişehir, Turkey
| | - Ilknur Balta
- Department of Dermatology, Kecioren Training and Research Hospital Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy Ankara, Turkey
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy Ankara, Turkey
| | - Mustafa Demir
- Department of Cardiology, Gulhane Medical Academy Ankara, Turkey
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21
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Ozuguz P, Karabulut AA, Tulmac M, Kisa U, Kocak M, Gunduz O. Markers of Endothelial Dysfunction and Evaluation of Vascular Reactivity Tests in Behçet Disease. Angiology 2013; 65:937-43. [DOI: 10.1177/0003319713512413] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed endothelial dysfunction (ED) in patients with Behcet disease (BD; n = 40) and healthy controls (n = 20). Serum lipid, homocysteine, asymmetric dimethylarginine (ADMA) and high-sensitivity C-reactive protein (hsCRP) levels, erythrocyte sedimentation rates (ESRs), and ultrasonographic flow-mediated dilatation (FMD) were measured. Mean hsCRP, ESR, homocysteine, and ADMA were significantly higher in the BD group ( P < .001 for all). Patients with active BD had higher serum levels of hsCRP, homocysteine, and ESR compared with those in remission ( P < .001, P < .001, and P = .005, respectively). Flow-mediated dilatation was significantly lower in patients with BD than in controls ( P = .001). Flow-mediated dilatation correlated negatively with BD duration and serum ADMA levels ( P < .001, r = −.745 and P < .001, r = −.682); a positive correlation was seen between serum ADMA levels and BD duration ( P < .001, r = .552). Only stepwise multivariate regression analysis revealed BD duration to have a significant effect on FMD. Flow-mediated dilatation, in conjunction with markers of inflammation, may evaluate ED in patients with BD.
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Affiliation(s)
- Pinar Ozuguz
- Department of Dermatology, Faculty of Medicine, Kocatepe University, Afyon Turkey
| | - Ayse Anil Karabulut
- Department of Dermatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Murat Tulmac
- Department of Cardiology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ucler Kisa
- Department of Biochemistry, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Mukadder Kocak
- Department of Dermatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Ozgur Gunduz
- Department of Dermatology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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22
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Balta I, Balta S, Koryurek OM, Demirkol S, Celik T, Akbay G, Cakar M, Sarlak H, Eksioglu M. Mean platelet volume is associated with aortic arterial stiffness in patients with Behçet's disease without significant cardiovascular involvement. J Eur Acad Dermatol Venereol 2013; 28:1388-93. [PMID: 24164056 DOI: 10.1111/jdv.12297] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behçet's disease (BD), is a chronic, systemic vasculitis, which may affect all types and sizes of blood vessels. BD is associated with endothelial dysfunction and chronic inflammation. Endothelial dysfunction is the critical early step in the process of atherogenesis, and it is commonly investigated by measuring arterial stiffness. Mean platelet volume (MPV) has been investigated in relation with both thrombosis and inflammation. We aimed to investigate the relationship between an increased arterial stiffness and MPV in patients with Behçet's disease without significant cardiovascular involvement. METHODS We studied 36 patients (20 males, mean age: 37.6 ± 11.7 years) who were diagnosed by the international diagnostic criteria of BD and 35 healthy controls (15 males, mean age: 35.0 ± 10.6 years), and the two groups were matched by age and gender. MPV levels and arterial stiffness measurements were compared in these groups. RESULTS Arterial stiffness was higher in patients with BD compared to control group. (BD and controls; 7.28 m/s, 6.64 m/s; respectively) (p: 0.02). MPV levels were also significantly higher in patients with BD compared to control group. (BD and controls; 8.86 ± 0.81 fl, 8.39 ± 0.96 fl, respectively) (p: 0.02). Additionally, arterial stiffness correlated positively with age, the duration of disease and MPV levels in patients with BD (p: 0.002, 0.03, 0.02 respectively). CONCLUSIONS In our study, increased MPV is associated with arterial stiffness in patients with BD without significant cardiovascular involvement. It shows that there is a relationship between thrombosis and chronic inflammation in BD. Furthermore, MPV is also a moderate predictor of cardiovascular disease and represents an increase in platelet activation. These findings provide further evidence of a link between inflammation and thrombosis in patients with BD.
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Affiliation(s)
- I Balta
- Department of Dermatology, Kecioren Training and Research Hospital, Ankara, Turkey
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23
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Messedi M, Frigui M, Chaabouni K, Turki M, Neifer M, Lahiyani A, Messaouad M, Bahloul Z, Ayedi F, Jamoussi K. Methylenetetrahydrofolate reductase C677T and A1298C polymorphisms and variations of homocysteine concentrations in patients with Behcet's disease. Gene 2013; 527:306-10. [PMID: 23827456 DOI: 10.1016/j.gene.2013.06.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 06/07/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Behcet's disease (BD) is a chronic, relapsing, multi-systemic inflammatory disorder of unknown causes. This disease is mainly characterized by mucocutaneous, ocular, vascular, and central nervous system manifestations. The aim of this study is to investigate the associations between C677T and A1298C polymorphisms in the methylenetetrahydrofolate reductase (MTHFR) gene and the plasma homocysteine (Hcy), folate, and B12 levels in a relatively large cohort of Tunisian patients with BD. METHODS The study included 142 patients with BD and 172 healthy controls. The C677T and A1298C polymorphisms were genotyped using PCR-RFLP. Serum Hcy level was determined using a fluorescence polarization immunoassay. Serum folate and vitamin B12 levels were measured by electrochemiluminescence immunoassay. RESULTS Genotype and allele frequencies of the two studied MTHFR polymorphisms did not show any significant differences among BD patients compared to controls. Patient carriers of the 677TT variant and the 677T allele displayed significantly higher Hcy concentration. Moreover, no significant association was found between neither A1298C polymorphism nor the C allele and Hcy, folate, and B12 levels. In multivariate analyses, we reported that 677T allele, male gender, and creatinine level were independent risk factors for hyperhomocysteinemia (HHC). CONCLUSIONS In the present study, we report the absence of any significant differences between genotype and allele frequencies for both studied polymorphisms among BD patients compared to healthy controls. Besides, we showed that the T allele of MTHFR C677T polymorphism influenced the Hcy level which is an independent risk factor for HHC in Tunisian BD patients.
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Affiliation(s)
- M Messedi
- Unit of Research Molecular Bases of Human Diseases, Sfax Medicine College, Sfax 3029, Tunisia.
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Caldas CAM, Borba EF, Bortolotto LA, Medeiros DM, Bonfa E, Gonçalves CR. Increased arterial stiffness assessed by pulse wave velocity in Behçet's disease and its association with the lipid profile. J Eur Acad Dermatol Venereol 2012; 27:454-9. [PMID: 22329367 DOI: 10.1111/j.1468-3083.2012.04458.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the structural and functional properties of vessels in Behçet's Disease (BD) using carotid-femoral pulse wave velocity (PWV) and an echo-tracking system. METHODS BD patients without traditional cardiovascular risk factors were selected. All BD patients performed PWV and carotid ultrasound. BD patients were divided into groups based on the presence of systemic (vascular and/or ocular and/or central nervous system involvement) and vascular involvement. Healthy controls age- and sex-matched with the same exclusion criteria were selected. RESULTS A total of 23 BD patients (mean age 35.0 ± 7.6 years) had significantly higher PWV levels compared with controls (8.48 ± 1.14 vs. 7.53 ± 1.40 m/s, P = 0.017). Intima-media thickness (594.87 ± 138.61 vs. 561.08 ± 134.26 μm, P = 0.371), diastolic diameter (6383.78 ± 960.49 vs. 6447.65 ± 1159.73 μm, P = 0.840), distension (401.95 ± 117.72 vs. 337.91 ± 175.36 μm, P = 0.225) and relative distension (6.26 ± 2.83 vs. 5.42 ± 2.46 μm, P = 0.293) were similar in both groups. The systemic disease group had significantly higher levels of PWV (8.79 ± 1.21 vs. 7.88 ± 0.72 m/s, P = 0.036) compared to those with exclusive mucocutaneous manifestations. BD patients with vascular involvement had similar PWV and echo-tracking parameters compared to those without vascular involvement (P > 0.05), but had higher total and LDL cholesterol levels (P = 0.019 and P = 0.012, respectively). The multivariate linear regression analysis identified triglycerides as the most important factor in increasing PWV levels (P = 0.001) in BD. CONCLUSIONS PWV is more useful than carotid ultrasound in detecting structural and functional vascular damage in BD and emphasizes the role of the disease itself in promoting these alterations. Our findings also reinforce the need for rigorous control of all risk factors in BD, particularly lipoproteins.
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Affiliation(s)
- C A M Caldas
- Rheumatology Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Pineton de Chambrun M, Wechsler B, Geri G, Cacoub P, Saadoun D. New insights into the pathogenesis of Behçet's disease. Autoimmun Rev 2011; 11:687-98. [PMID: 22197900 DOI: 10.1016/j.autrev.2011.11.026] [Citation(s) in RCA: 198] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/27/2011] [Indexed: 01/01/2023]
Abstract
Behçet's disease (BD) is a recurrent systemic inflammatory disorder of unknown origin characterized by oral and genital mucous ulcer, uveitis, and skin lesions. Involvement of large vessels, central nervous system (CNS), gastrointestinal tract and thrombotic events are less frequent but can be life threatening. The aim of this review is to provide new insights into the pathogenesis of BD. Over the past year substantial advances have been done in the understanding of the genetic [1,2] and immunology [3] of BD. BD is at the crossroad between autoimmune and autoinflammatory syndromes. In common with autoimmune diseases BD shares class I MHC association. However, in contrast to autoimmune disorders, BD has clinical features that seem to be mostly autoinflammatory. The pathogenesis of BD is still unknown, but major determinants of the genetic and immune system abnormalities have been reported recently. Triggering infectious factors are supposed to participate in the outbreak of BD in genetically predisposed patients. Two recent large genome-wide association study (GWAS) conducted in Turkey and Japan reported association between single nucleotide polymorphism (SNP) of interleukin (IL)-10 and IL-23R/IL-12RB2 genes and BD. New insights into the perturbations of T cell homeostasis of BD recently emerged. We have recently demonstrated the promotion of Th17 responses and the suppression of regulatory T cells (Tregs) that were driven by interleukin (IL)-21 production and that correlates with BD activity. Inflammatory cells within BD inflammatory lesions included mostly neutrophils, Th1 and Th17 cells, and cytotoxic CD8+ and γδ T cells. Altogether, the recent progresses in the knowledge of BD pathogenesis pave the way for innovative therapy.
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Affiliation(s)
- Marc Pineton de Chambrun
- Department of Internal Medicine and Laboratory I3 Immunology, Immunopathology, Immunotherapy, UMR CNRS 7211, INSERM U959, Groupe Hospitalier La Pitié-Salpetrière, Université Pierre et Marie Curie, Paris 6, Paris, France
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Özden MG, Caycı YT, Tekin H, Çoban AY, Aydın F, Sentürk N, Bek Y, Cantürk T, Turanlı AY. Serum galectin-3 levels in patients with Behçet's disease: association with disease activity over a long-term follow-up. J Eur Acad Dermatol Venereol 2011; 25:1168-73. [PMID: 21214630 DOI: 10.1111/j.1468-3083.2010.03941.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND There is a need for a laboratory marker that correlates with the clinical activity of Behçet's disease (BD). OBJECTIVE We aimed to investigate whether serum galectin-3 (Gal-3) levels were affected during the course of the disease with regard to disease activity. METHODS A total of 131 subjects were involved in the study as follows: Group 1: BD active (n = 39); Group 2: BD inactive (n = 31); Group 3: Disease controls with leucocytoclastic vasculitis confirmed with a skin biopsy (n = 22); and Group 4: Healthy control subjects (n = 39). The BD patients were followed regularly and samples were taken in their active and inactive periods of the disease over a 2-year period. RESULTS Serum Gal-3 levels were significantly higher in active BD patients (mean 2.38) than inactive BD patients (mean 0.63; P < 0.0001) and the healthy control subjects (mean 0.75; P < 0.0001). There was no significant difference between the leucocytoclastic vasculitis and active BD patients (P = 0.093). Serum Gal-3 levels were positively correlated with clinical activity scores of active BD patients (r = 0.66, P < 0.0001). In addition, the Gal-3 levels were significantly higher in the active disease period when compared with the inactive period during the follow-up. There were no significant differences between the two inactive periods of the disease among the same patients. Further analyses revealed that patients with vascular involvement had significantly higher Gal-3 levels than the other active BD patients (mean 7.57; P = 0.007). LIMITATIONS The limitation of the study is the small number of patients with vascular involvement in the active BD patient group. CONCLUSION Gal-3 levels are correlated with the activity of Behçet's disease especially with the vascular involvement.
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Affiliation(s)
- M G Özden
- Dermatology Department, Medical Faculty, Ondokuz Mayıs University, Samsun, Turkey.
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Hyperhomocysteinaemia in Behçet's Disease. Biochem Res Int 2010; 2010:361387. [PMID: 21188071 PMCID: PMC3005829 DOI: 10.1155/2010/361387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 02/15/2010] [Indexed: 11/17/2022] Open
Abstract
Objectives. The aim of this study was to investigate if hyperhomocysteinaemia is a contributive risk factor for the pathogenesis and the activity of Behçet's disease (BD). Design and Methods. Fifty four patients fullfiling the criteria of the International Study Group for BD were enrolled. Fifty healthy volunteers matched for age and sex with the BD group were included as a negative control group. Patients, with any condition that might affect plasma homocysteine concentration, were excluded. Results. Mean serum homocysteine concentration was significantly higher in patients with BD than in the healthy controls (P < .001), in patients with active disease (P = .04), and in masculine gender (P = .05). There was no significant difference between homocysteine level and clinical involvement. Conclusions. We demonstrated that plasma total homocysteine level (tHcy) is increased in BD and correlated with disease activity. No association was found between homocysteine levels and clinical involvement.
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KRUPA BRICE, CIMAZ ROLANDO, OZEN SEZA, FISCHBACH MICHEL, COCHAT PIERRE, KONÉ-PAUT ISABELLE. Pediatric Behçet’s Disease and Thromboses. J Rheumatol 2010; 38:387-90. [DOI: 10.3899/jrheum.100257] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To describe the characteristics of a group of pediatric patients with Behçet’s disease (BD) who presented at least 1 episode of thrombosis during their disease course.Methods.We made a retrospective chart review of the clinical, biological, and radiological data of children with BD who presented at least 1 episode of either arterial or venous thrombosis. Data were extracted from both an international pediatric Behçet cohort and files referred from 7 French centers.Results.Twenty-one patients were included. Diagnosis of BD was based on the criteria of the International Study Group for BD. Main locations for thrombosis were the cerebral sinuses, in 11 patients (52.4%); and lower limbs, in 9 patients (40.9%). Recurrent episodes were observed in 4 patients (21%). Thrombophilia measurements were normal in 14 patients out of 21, while anticardiolipin antibodies were positive in 4 patients, and 2 out of 21 had protein C deficiency. One patient had lupus anticoagulant. All patients were treated with colchicine. Corticosteroids were also added for variable periods in 13 patients. Five patients out of 21 were treated with anticoagulants (heparin, then anti-vitamin K) and 3 with antiplatelets (acetylsalicylic acid).Conclusion.Thromboses are a serious complication of BD and may occur early in the disease course. The presence of thrombophilic markers could increase the risk of thrombosis in BD, but the size of our population does not allow any conclusion. An international cohort (PED-BD) is currently in place and will allow study of such cases longitudinally, as well as assessment of the elements that correlate with an increased risk of thrombosis in children with BD.
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Acikgoz N, Ermiş N, Yağmur J, Cansel M, Karincaoğlu Y, Ataş H, Cuglan B, Barutcu İ, Pekdemir H, Özdemir R. Elevated Oxidative Stress Markers and its Relationship With Endothelial Dysfunction in Behçet Disease. Angiology 2010; 62:296-300. [DOI: 10.1177/0003319710382417] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behçet’s disease (BD) is a multisystemic disorder characterized by endothelial dysfunction. However, the relationship between oxidative stress and endothelial function has not been clearly shown. We investigated the relationship between oxidative stress markers and endothelial function in patients with BD. Patients with BD (n = 40) having active disease and sex- and age-matched 40 controls were included. Endothelial function was assessed by flow-mediated dilatation (FMD) technique. Serum gamma-glutamyltransferase (GGT) and high-sensitive C-reactive protein levels (hsCRP) were measured in all participants. Brachial artery FMD was significantly lower in patients with BD than in controls. Gamma-glutamyltransferase and hsCRP levels were higher in patients with BD than in controls. Also, GGT and hsCRP levels were inversely correlated with endothelial function. Oxidative stress markers are elevated in patients with BD having active disease. This may be one of the reasons behind the vasculitis in active BD.
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Affiliation(s)
- Nusret Acikgoz
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Necip Ermiş
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Jülide Yağmur
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Mehmet Cansel
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Yelda Karincaoğlu
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Halil Ataş
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Bilal Cuglan
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - İrfan Barutcu
- Department of Cardiology, Avicenna Hospital, İstanbul, Turkey,
| | - Hasan Pekdemir
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Ramazan Özdemir
- Department of Cardiology, Faculty of Medicine, Inonu University, Malatya, Turkey
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Etiopathogenesis of Behçet's disease with emphasis on the role of immunological aberrations. Clin Rheumatol 2010; 29:1211-6. [PMID: 20495938 DOI: 10.1007/s10067-010-1491-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 05/10/2010] [Indexed: 10/19/2022]
Abstract
Behçet's disease (BD) is a chronic multisystemic inflammatory disorder of unknown origin consisting of oral aphthous ulcers, ocular symptoms, skin lesions, and genital ulcerations. It has many features in common with systemic vasculitides and is more prevalent in countries along the ancient Silk route. Immune-mediated mechanisms play a major role in the pathogenesis of the disease, and inflammatory mediators are also involved. BD is not considered to be an autoimmune disorder, and the character of the disease needs to be clarified. Immunological aberrations in BD have been extensively studied by many investigators; genetic factors have been related to disease susceptibility, but their exact role in the development of disease is uncertain. Environmental factors such as infectious agents have also been implicated in the etiology of BD. However, the etiopathogenesis of the disease remains to be elucidated. Factors involved in the immunopathogenesis of BD with emphasis on the role of immunological aberrations are analyzed in this review.
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Acikgoz N, Karincaoglu Y, Ermis N, Yagmur J, Atas H, Kurtoglu E, Cansel M, Barutcu I, Pekdemir H, Özdemir R. Increased Mean Platelet Volume in Behçet's Disease with Thrombotic Tendency. TOHOKU J EXP MED 2010; 221:119-23. [DOI: 10.1620/tjem.221.119] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nusret Acikgoz
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Necip Ermis
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Jülide Yagmur
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Halil Atas
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Mehmet Cansel
- Inonu University Faculty of Medicine, Department of Cardiology
| | | | - Hasan Pekdemir
- Inonu University Faculty of Medicine, Department of Cardiology
| | - Ramazan Özdemir
- Inonu University Faculty of Medicine, Department of Cardiology
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Kartal Durmazlar SP, Akgul A, Eskioglu F. Hyperhomocysteinemia in patients with stasis dermatitis and ulcer: A novel finding with important therapeutic implications. J DERMATOL TREAT 2009; 20:336-9. [DOI: 10.3109/09546630902775069] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Nowatzky J, Chajek-Shaul T. Biomarkers in Behçet’s disease: diagnosis and disease activity. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.22] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Ates O, Azizi S, Alp HH, Kiziltunc A, Beydemir S, Cinici E, Kocer I, Baykal O. Decreased serum paraoxonase 1 activity and increased serum homocysteine and malondialdehyde levels in age-related macular degeneration. TOHOKU J EXP MED 2009; 217:17-22. [PMID: 19155603 DOI: 10.1620/tjem.217.17] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Age-related macular degeneration (AMD) is one of the most common causes of vision loss. AMD has been classified into two forms: atrophic and exudative forms. The exudative form is associated with choroidal neovascularization of the subretinal macular region, resulting in a sudden loss of central vision. However, the exact cause of AMD remains unknown. Several risk factors have been postulated, including smoking, atherosclerosis, and low levels of antioxidant enzymes. Malondialdehyde (MDA), a lipid peroxidation product, is used as a marker of oxidative stress. Paraoxonase 1 (PON1) metabolizes lipid peroxides and prevents oxidation of low-density lipoprotein. Increased levels of homocysteine may cause vascular endothelial injury by releasing free radicals. The purpose of this study is to investigate the relationships between serum PON1 activity and the serum levels of homocysteine and MDA in AMD. Forty patients with exudative-type AMD (63.3 +/- 5 years) and 40 controls (61+/- 4 years) were assessed in a cross-sectional study. The serum PON1 activity was significantly lower in the patients with AMD than that in the controls (p < 0.001). In contrast, the serum levels of MDA and homocysteine were significantly higher in the patients than those in the controls (p < 0.001, for both). In AMD patients, significant negative correlation was found between PON1 activity and MDA level (r = -0.493, p < 0.05) and between PON1 activity and homocysteine level (r = -0.557, p < 0.05). Increased serum homocysteine and MDA levels may be responsible for the decreased PON1 activity in patients with AMD.
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Affiliation(s)
- Orhan Ates
- Department of Ophthalmology, Medical Faculty, Atatürk University, Erzurum, Turkey.
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36
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Homocysteine may involve in the pathogenesis of Behcet's disease by inducing inflammation. Mediators Inflamm 2009; 2008:407972. [PMID: 19197380 PMCID: PMC2633607 DOI: 10.1155/2008/407972] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 11/02/2008] [Accepted: 11/17/2008] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate the significance of homocysteine (Hcy) in Behcet's disease (BD) and the association of elevated Hcy levels associated with the indices of inflammation in BD. METHODS Untreated 70 patients with BD and 33 healthy individuals were included into the study. Hcy, tumor necrosis alpha (TNF-alpha), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated with respect to activity and specific individual clinical manifestations of the disease. RESULTS Hcy levels were found significantly elevated in active BD when compared to inactive BD and healthy controls. Hcy levels were found to have high correlation with the number of active clinical manifestations increased. A significant positive correlation was found between serum Hcy and TNF-alpha levels, CRP, and ESR. Hcy was found to be the best predictor of TNF-alpha among other parameters. CONCLUSION Hcy may involve in the pathogenesis of BD by inducing inflammation.
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Protogerou AD, Sfikakis PP, Stamatelopoulos KS, Papamichael C, Aznaouridis K, Karatzis E, Papaioannou TG, Ikonomidis I, Kaklamanis P, Mavrikakis M, Lekakis J. Interrelated modulation of endothelial function in Behcet's disease by clinical activity and corticosteroid treatment. Arthritis Res Ther 2008; 9:R90. [PMID: 17845731 PMCID: PMC2212573 DOI: 10.1186/ar2289] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Revised: 07/18/2007] [Accepted: 09/11/2007] [Indexed: 01/01/2023] Open
Abstract
Corticosteroids are commonly used in empirical treatment of Behçet's disease (BD), a systemic inflammatory condition associated with reversible endothelial dysfunction. In the present study we aimed to dissect the effects of clinical disease activity and chronic or short-term corticosteroid treatment on endothelial function in patients with BD. In a case-control, cross-sectional study, we assessed endothelial function by endothelium dependent flow mediated dilatation (FMD) at the brachial artery of 87 patients, who either were or were not receiving chronic corticosteroid treatment, and exhibiting variable clinical disease activity. Healthy individuals matched for age and sex served as controls. Endothelial function was also assessed in a prospective study of 11 patients before and after 7 days of treatment with prednisolone given at disease relapse (20 mg/day). In the cross-sectional component of the study, FMD was lower in patients than in control individuals (mean ± standard error: 4.1 ± 0.4% versus 5.7 ± 0.2%, P = 0.003), whereas there was a significant interaction between the effects of corticosteroids and disease activity on endothelial function (P = 0.014, two-factor analysis of variance). Among patients with inactive BD, those who were not treated with corticosteroids (n = 33) had FMD comparable to that in healthy control individuals, whereas those treated with corticosteroids (n = 15) had impaired endothelial function (P = 0.023 versus the respective control subgroup). In contrast, among patients with active BD, those who were not treated with corticosteroids (n = 20) had lower FMD than control individuals (P = 0.007), but in those who were receiving corticosteroids (n = 19) the FMD values were comparable to those in control individuals. Moreover, FMD was significantly improved after 7 days of prednisolone administration (3.7 ± 0.9% versus 7.6 ± 1.4%, P = 0.027). Taken together, these results imply that although corticosteroid treatment may impair endothelial function per se during the remission phase of the inflammatory process, it restores endothelial dysfunction during active BD by counteracting the harmful effects of relapsing inflammation.
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Affiliation(s)
- Athanase D Protogerou
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Petros P Sfikakis
- 1Department of Propeudeutic and Internal Medicine, Laikon Hospital, Medical School, University of Athens, Ag. Thoma, 115 27, Athens, Greece
| | - Kimon S Stamatelopoulos
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Christos Papamichael
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Kostas Aznaouridis
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Emmanuil Karatzis
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Theodore G Papaioannou
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - Ignatios Ikonomidis
- 2Department of Cardiology, Attikon Hospital, Medical School, University of Athens, Rimini, 124 61, Athens, Greece
| | - Phedon Kaklamanis
- 1Department of Propeudeutic and Internal Medicine, Laikon Hospital, Medical School, University of Athens, Ag. Thoma, 115 27, Athens, Greece
| | - Myron Mavrikakis
- Vascular Laboratory, Department of Clinical Therapeutics, Alexandra Hospital, Medical School, University of Athens, V. Sofias,115 28, Athens, Greece
| | - John Lekakis
- 2Department of Cardiology, Attikon Hospital, Medical School, University of Athens, Rimini, 124 61, Athens, Greece
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Tavil Y, Ozturk MA, Sen N, Kaya MG, Hizal F, Poyraz F, Turfan M, Onder M, Gurer MA, Cengel A. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet’s disease. Clin Rheumatol 2007; 27:309-14. [PMID: 17674116 DOI: 10.1007/s10067-007-0707-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 07/09/2007] [Accepted: 07/11/2007] [Indexed: 10/23/2022]
Abstract
Vascular involvement is one of the major characteristics of Behcet's disease (BD). However, there are controversial findings regarding cardiac involvement in BD. Although early reports demonstrated that there is diastolic dysfunction in BD, conflicting results were found in the following trials. Hence, a new method for more objectively estimating the cardiac functions is needed. For this aim, we used high-usefulness tissue Doppler echocardiography for detailed analysis of cardiac changes in BD patients because this method was superior to other conventional echocardiographic techniques. The study population included 42 patients with BD (19 men, 23 women; mean age, 35 +/- 10 years, mean disease duration, 2.7 +/- 1.6 years) and 30 healthy subjects (14 men, 16 women; mean age, 38 +/- 7 years). Cardiac functions were determined using echocardiography, comprising standard two-dimensional and conventional Doppler and tissue Doppler imaging (TDI). Peak systolic myocardial velocity at mitral annulus, early diastolic mitral annular velocity (Em), late diastolic mitral annular velocity (Am), Em/Am, and myocardial performance index (MPI) were calculated by TDI. The conventional echocardiographic parameters and tissue Doppler measurements were similar between the groups. Tissue Doppler derived mitral relaxation time was longer (75 +/- 13 vs 63 +/- 16 msn, p = 0.021) in patients with BD. There was statistically significant difference between the two groups regarding left ventricular MPI (0.458 +/- 0.072 vs 0.416 +/- 0.068%, p = 0.016), which were calculated from tissue Doppler systolic time intervals. There was also significant correlation between the disease duration and MPI (r = 0.38, p = 0.017). We have demonstrated that tissue Doppler-derived myocardial left ventricular relaxation time and MPI were impaired in BD patients, although systolic and diastolic function parameters were comparable in the patients and controls.
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Affiliation(s)
- Yusuf Tavil
- Department of Cardiology, Gazi University School of Medicine, Beşevler, 06500, Ankara, Turkey.
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Abstract
PURPOSE OF REVIEW To summarize general concepts of Behçet's disease, as well as present recent scientific developments in delineating the pathogenesis and treatment of this disorder. RECENT FINDINGS Large, long-term follow-up studies on patients with Behçet's disease have shown improved visual outcomes in recent years when compared with decades ago, presumably due to the more aggressive use of immunosuppressive agents. Increased T-helper cell type 1 activity and increased hypercoagulability continue to be a focus of research into the pathogenesis of the disease. Advanced oxidation protein products and a Behçet's disease activity index may be useful tools for following disease activity. Finally, studies of new treatment modalities, particularly infliximab, interferon-alpha and granulocytapheresis, have reported encouraging results. SUMMARY Historically a scourge among uveitic disorders, there is new hope for improved long-term visual outcomes in patients with Behçet's disease based on recent scientific advances.
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Affiliation(s)
- Annabelle A Okada
- Department of Ophthalmology, Kyorin University School of Medicine, Tokyo, Japan.
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Abstract
Behçet disease is a systemic inflammatory disease of unknown etiology initially described as a triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis affecting young male adults. Internationally agreed diagnostic criteria have been proposed to assist in the diagnosis. We present the case of a 26-year-old African-American male who presented with right brachial plexopathy due to axillary aneurysm. Further evaluation revealed the presence of a common carotid artery aneurysm, superior vena cava, and left subclavian vein thrombosis. A few months later, he developed severe bilateral panuveitis with hypopyon, retinal vasculitis, and optic nerve inflammation. Although our patient had no recollection of oral or genital ulcers, the constellation of deep vein thrombosis, multiple arterial aneurysms, bilateral panuveitis, positive pathergy skin test, and elevated inflammatory markers led to the working diagnosis of Behçet disease. Arterial involvement occurs in 3%-5% of patients with Behçet disease and may manifest as either true or false aneurysms. Deep vein thrombosis is the most common venous manifestation and involvement of venae cavae and their tributaries is not uncommon. Anterior and posterior uveitis and retinal vasculitis not only have a prognostic value in Behçet disease but in this particular case supported the diagnosis. In conclusion, incomplete forms of Behçet vasculitis exist and clinicians should be alert to atypical presentations of the disease.
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Affiliation(s)
- Ancuta Pandrea
- Department of Medicine, Section of Rheumatology, Danbury Hospital, Yale Medical School Affiliate, Danbury, CT, USA
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Gullu H, Caliskan M, Erdogan D, Yilmaz S, Dursun R, Ciftci O, Topcu S, Yucel E, Muderrisoglu H. Patients with Behcet's disease carry a higher risk for microvascular involvement in active disease period. Ann Med 2007; 39:154-9. [PMID: 17453678 DOI: 10.1080/07853890701204866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Behcet's disease (BD) is characterized with remissions and exacerbations. However, to date, there is no study to investigate a possible association of disease activity (active versus inactive disease period) with cardiovascular complications. METHODS Forty patients with BD were evaluated in both active and in inactive disease period. For the control group 45 healthy volunteers, age and sex matched, were registered. Subjects with at least a 15-day lesion-free period were regarded in inactive disease period, and subjects with any oral, skin, and/or genital lesion was regarded as in active disease period. In each subject coronary diastolic peak flow velocities (DPFV) were measured at baseline and after dipyridamole infusion (0.84 mg/kg over 6 minutes) using an Acuson Sequoia C256 echocardiography system. Coronary flow reserve (CFR) was defined as the ratio of hyperemic to baseline DPFV. RESULTS CFR values were significantly lower in BD patients compared to the controls (2.57+/-0.50 versus 2.87+/-0.53, P = 0.006). In active disease period, basal DPFV (24.6+/-7.5 versus 27.3+/-6.6, P = 0.019) was significantly higher than in the inactive disease period. In the active disease period hyperemic DPFV (61.7+/-14.9 versus 56.8+/-16.7, P = 0.015) values decreased significantly. Therefore, in the active disease period CFR significantly decreased from 2.57+/-0.50 to 2.09+/-0.46, P<0.001. The only independent predictor of CFR within the active disease period was the disease duration (beta = -0.384, P = 0.012). CONCLUSION Within the active disease period, coronary microvascular function is more prominently impaired in BD patients. Therefore, BD patients are possibly more vulnerable to cardiovascular manifestations when they are in an active disease period.
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Affiliation(s)
- Hakan Gullu
- Baskent University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
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Ozkan Y, Yardim-Akaydin S, Sepici A, Engin B, Sepici V, Simşek B. Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease. Clin Chem Lab Med 2007; 45:73-7. [PMID: 17243919 DOI: 10.1515/cclm.2007.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behçet's disease is a multisystemic immunoinflammatory disease with a wide variety of clinical manifestations, whereas recurrent aphthous stomatitis is a local oral disease. The aim of this study was to examine the distribution of homocysteine levels in patients with active Behçet's disease, possible association of homocysteine with nitric oxide and neopterin levels, and to characterize the differences between patients with Behçet's disease and those with recurrent aphthous stomatitis in terms of these parameters compared with healthy controls. METHODS A total of 23 patients with active Behçet's disease, 25 patients with recurrent aphthous stomatitis as positive controls, and 21 healthy subjects were included in this study. Serum homocysteine and neopterin levels were measured flourimetrically by HPLC. Serum nitric oxide production was assayed by measuring total nitrite levels with Griess reagent. RESULTS Significantly higher homocysteine (12.9+/-3.3 micromol/L) and lower nitric oxide (41.5+/-10.9 micromol/L) and neopterin (6.4+/-1.0 nmol/L) levels were observed in patients with Behçet's disease compared with healthy controls (10.7+/-2.0 micromol/L, 49.7+/-16.2 micromol/L, 8.7+/-2.2 nmol/L, respectively) (p<0.03 for neopterin, p<0.04 for homocysteine and nitric oxide). However, homocysteine, nitric oxide, biopterin and neopterin levels and the neopterin/biopterin ratio for recurrent aphthous stomatitis patients were not significantly different compared to healthy controls. A significant positive correlation was observed between serum homocysteine and serum neopterin/biopterin ratio in patients with Behçet's disease (r=0.975, p<0.005). CONCLUSIONS In contrast to recurrent aphthous stomatitis, there is a higher prevalence of hyperhomocysteinemia in Behcet's disease. Homocysteine may have deleterious effects on the pathology of Behcet's disease by decreasing nitric oxide levels and interfering with the immune system.
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Affiliation(s)
- Yeşim Ozkan
- Department of Biochemistry, Faculty of Pharmacy, Gazi University, Ankara, Turkey.
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Caliskan M, Yilmaz S, Yildirim E, Gullu H, Erdogan D, Ciftci O, Kaynar G, Yucel E, Muderrisoglu H. Endothelial functions are more severely impaired during active disease period in patients with Behcet’s disease. Clin Rheumatol 2006; 26:1074-8. [PMID: 17089218 DOI: 10.1007/s10067-006-0449-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 09/13/2006] [Accepted: 09/13/2006] [Indexed: 10/24/2022]
Abstract
Oral apthous ulcers and skin lesions are the primary symptoms of Behcet's disease (BD). To date, there is no study to investigate possible associations between these lesions and endothelial functions. We have hypothesized that active BD period with oral and skin lesions might have more deteriorating effect on endothelial functions. Thirty-five patients with BD were registered for the study. Each subject was evaluated two times in both active and inactive disease periods. The subject with at least 30 days of lesion-free period was regarded in the inactive disease period, and the subject with any oral and/or skin lesions was regarded in the active disease period. For the control group, 35 healthy age- and sex-matched subjects were registered. In each subject, flow-mediated dilation (FMD) of the brachial artery after transient ischemia was evaluated in both active and inactive disease periods. High-sensitivity C-reactive protein (hsCRP) values (3.30 +/- 5.76 vs 14.19 +/- 13.55 vs 1.82 +/- 1.31, P < 0.001) and FMD values (13.89 +/- 5.57 vs 8.53 +/- 4.78 vs 15.83 +/- 5.29, P < 0.001) were significantly different among the BD patients in inactive and active disease periods and among control subjects. FMD values in inactive and active disease periods modestly correlated to hsCRP and low-density lipoprotein cholesterol values. Brachial FMD is more prominently impaired in BD patients within the active disease period. BD patients are possibly more vulnerable to cardiovascular manifestations when they are in the active disease period.
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Affiliation(s)
- Mustafa Caliskan
- Department of Cardiology, Faculty of Medicine, Baskent University, 06490 Ankara, Turkey.
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Domsic R, Maksimowicz-McKinnon K, Manzi S. Prevention of cardiovascular disease in patients with rheumatic diseases. Best Pract Res Clin Rheumatol 2006; 20:741-56. [PMID: 16979536 DOI: 10.1016/j.berh.2006.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cardiovascular disease (CVD), the leading cause of death in the USA, has emerged as an important comorbidity in the rheumatic diseases. As disease-modifying therapies have resulted in better disease control and decreases in disease-associated mortality, it is now apparent that the prevalence of CVD and cardiovascular (CV) events is significantly increased in a number of rheumatic disorders when compared with age and gender-matched subjects from the general population. Investigations into the mechanisms of CVD in the general population have provided insights into potential mechanisms in rheumatic disease patients and possible aetiologies for their increased risk. Although there are no evidence-based guidelines for CV risk factor screening and interventions specific to patients with rheumatic disease, the best current approach utilizes evidence-based recommendations for the general population (and higher-risk subgroups) modified by what is known of CV risk factor and event prevalence in these patients.
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Affiliation(s)
- Robyn Domsic
- University of Pittsburgh, Division of Rheumatology and Clinical Immunology, Pittsburgh, PA 15261, USA
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Mungan AG, Can M, Açikgöz S, Eştürk E, Altinyazar C. Lipid peroxidation and homocysteine levels in Behçet's disease. Clin Chem Lab Med 2006; 44:1115-8. [PMID: 16958606 DOI: 10.1515/cclm.2006.191] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
AbstractClin Chem Lab Med 2006;44:1115–8.
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Affiliation(s)
- A Görkem Mungan
- Department of Biochemistry, Karaelmas University, Faculty of Medicine, Zonguldak, Turkey
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Topal E, Ozdemir R, Aksoy Y, Acikgoz N, Ermis N, Sincer I, Akturk E, Ozcan B. Tissue Doppler velocities of the right and left ventricles and their association with C-reactive protein and homocysteine levels in Behcet's disease. Am J Cardiol 2005; 96:1739-42. [PMID: 16360368 DOI: 10.1016/j.amjcard.2005.07.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Revised: 07/11/2005] [Accepted: 07/11/2005] [Indexed: 11/17/2022]
Abstract
In the present study, we aimed to investigate whether tissue Doppler imaging could provide more information than standard echocardiography about left and right ventricular functions and their relations to homocysteine and C-reactive protein (CRP) levels in the course of Behcet's disease (BD). In the right ventricle, patients with BD had lower early diastolic tricuspid annular velocity and early diastolic/late diastolic tricuspid annular velocity ratios than the control group. Mitral and tricuspid annular systolic velocities did not significantly differ; however, diastolic velocities were correlated with duration of the disease. In addition, early/late diastolic mitral annular velocity ratio and early/late diastolic tricuspid annular velocity ratios showed an inverse relation with ocular involvement, serum homocysteine, and CRP levels in patients with BD.
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Affiliation(s)
- Ergun Topal
- Inonu University, Faculty of Medicine, Turgut Ozal Medical Center, Department of Cardiology, Malatya, Turkey
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Kayikçioğlu M, Aksu K, Hasdemir C, Keser G, Turgan N, Kültürsay H, Doganavsargil E. Endothelial functions in Behçet’s disease. Rheumatol Int 2005; 26:304-8. [PMID: 15739096 DOI: 10.1007/s00296-005-0590-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2004] [Accepted: 12/04/2004] [Indexed: 11/24/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis, capable of involving all types of vessels. Endothelial dysfunction (ED) has been previously documented in BD. The aim of the study was to see whether ED was more prominent in Behçet's patients with vascular involvement (VI) than in those without. The study population consisted of 65 patients with BD, 27 of whom had VI, and 30 healthy controls. High-resolution ultrasound was used to measure endothelium-dependent vasodilatation (EDVD) of brachial artery. Overall, regardless of VI, EDVD was significantly impaired in patients with BD compared with controls (11.4 +/- 6.3 vs 20.4 +/- 9.1%,P = 0.001); however, EDVD was similar in BD patients with and without VI (9.7 +/- 6.3% vs 12.6 +/- 6.1%, P = 0.07). Patients with BD had significantly-higher plasma homocysteine levels than controls (13 +/- 6 micromol/L vs 9 +/- 3 micromol/L, P = 0.001). Plasma homocysteine levels were significantly higher in the subgroup with VI than in those without (15 +/- 7 micromol/L vs 12 +/- 4 micromol/L, P = 0.03); however, we found no positive/significant correlation between plasma homocysteine levels and EDVD. ED is a constant feature of BD, regardless of VI. Etiology of ED in BD is probably multifactorial, including high homocysteine levels. As both ED and elevated homocysteine levels may represent an early atherosclerotic process, a more structured approach to risk factor assessment is needed in BD.
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Affiliation(s)
- Meral Kayikçioğlu
- Department of Cardiology, Ege University Medical School, Izmir, Turkey
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