1
|
Bîrsanu L, Vulpoi GA, Cuciureanu DI, Antal CD, Popescu IR, Turliuc DM. Carpal tunnel syndrome related to rheumatic disease (Review). Exp Ther Med 2024; 28:389. [PMID: 39161613 PMCID: PMC11332155 DOI: 10.3892/etm.2024.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 07/16/2024] [Indexed: 08/21/2024] Open
Abstract
Carpal tunnel syndrome (CTS) is the most commonly occurring type of entrapment neuropathy in the world. Several conditions may contribute to the development of CTS, such as obesity, repetitive wrist movements, pregnancy, genetic predisposition and rheumatoid arthritis (RA) inflammation. CTS is characterized by a wide range of pathophysiological factors, including increased pressure, mechanical trauma and ischemic damage to the median nerve that runs through the wrist tunnel. In the present narrative literature review, the way rheumatic diseases (RDs) contribute to CTS occurrence is investigated. The epidemiological, clinical, paraclinical and pathogenesis aspects of the relationship are examined. CTS is the most common neurological finding in RA, and incidences of RA, psoriatic arthritis and CTS are closely related. The association of CTS with systemic lupus erythematosus, Sjögren's syndrome, Behcet's disease and systemic sclerosis is weaker. In these cases, the prevalence of CTS is similar to that in the general population. As the occurrence of CTS is increasing, understanding the common mechanism and making an early diagnosis are required to limit pain and costs. When patients with RD present with symptoms such as wrist pain, tingling sensations or numbness in their fingers, CTS should be suspected. This suspicion should not be interpreted in terms of RD. To accurately evaluate patients with RD, a detailed electrophysiological examination should be included in the evaluation process. A diagnostic algorithm should include neuromuscular ultrasound or magnetic resonance imaging for patients with RD.
Collapse
Affiliation(s)
- Lenuța Bîrsanu
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
- Department of Neurology, Clinical Rehabilitation Hospital, Iași 700081, Romania
| | - Georgiana-Anca Vulpoi
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
- Dorna Medical Clinic, Iași 700022, Romania
| | - Dan Iulian Cuciureanu
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
- Neurology Department 1, Clinical Emergency Hospital ‘Prof. Dr. Nicolae Oblu’, Iași 700309, Romania
| | - Cristian Dorin Antal
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
- Department of Neurology, Clinical Rehabilitation Hospital, Iași 700081, Romania
| | - Ionut Raducu Popescu
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
| | - Dana Mihaela Turliuc
- Faculty of Medicine, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iași 700115, Romania
- Neurosurgery Department 2, Clinical Emergency Hospital ‘Prof. Dr. Nicolae Oblu’, Iasi 700309, Romania
| |
Collapse
|
2
|
Zhang X, Yuan W, Xu J, Zhao F. Application of mendelian randomization in ocular diseases: a review. Hum Genomics 2024; 18:66. [PMID: 38886833 PMCID: PMC11184796 DOI: 10.1186/s40246-024-00637-1] [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] [Received: 03/20/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024] Open
Abstract
Ocular disorders can significantly lower patients' quality of life and impose an economic burden on families and society. However, for the majority of these diseases, their prevalence and mechanisms are yet unknown, making prevention, management, and therapy challenging. Although connections between exposure factors and diseases can be drawn through observational research, it is challenging to rule out the interference of confounding variables and reverse causation. Mendelian Randomization (MR), a method of research that combines genetics and epidemiology, has its advantage to solve this problem and thus has been extensively utilized in the etiological study of ophthalmic diseases. This paper reviews the implementation of MR in the research of ocular diseases and provides approaches for the investigation of related mechanisms as well as the intervention strategies.
Collapse
Affiliation(s)
| | - Weichen Yuan
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China
- Key Lens Research Laboratory of Liaoning Province, Shenyang, China
| | - Jun Xu
- Department of Ophthalmology, Shenyang the Fourth People's Hospital, Shenyang, China.
| | - Fangkun Zhao
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, China.
- Key Lens Research Laboratory of Liaoning Province, Shenyang, China.
| |
Collapse
|
3
|
Tadayon Z, Shahzadeh Fazeli SA, Gholijani N, Daryabor G. Toll-like receptor 9 (TLR9) genetic variants rs187084 and rs352140 confer protection from Behcet's disease among Iranians. BMC Rheumatol 2024; 8:13. [PMID: 38481344 PMCID: PMC10938651 DOI: 10.1186/s41927-024-00382-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Behcet's disease (BD) is a multisystem and multifactorial autoimmune disease characterized by relapsing episodes of oral aphthae, genital ulcers, and ocular and skin lesions. Toll-like receptor 9 (TLR9) has pro-inflammatory roles and its genetic variants might be involved in the pathogenesis of inflammatory diseases. METHODS: Two hundred five BD patients and 207 age and sex-matched healthy controls were evaluated for TLR9 single nucleotide polymorphisms - 1486 T/C (rs187084) and + 2848:G/A (rs352140) using polymerase chain reaction-restriction fragment length polymorphism (RFLP-PCR). RESULTS Healthy individuals had a significantly higher frequency of rs187084 AG and AG + GG genotypes than BD patients (p = 0.02 and p = 0.018; respectively). Of interest, healthy males had a significantly higher frequency of rs187084 AG + GG genotype and G allele than male BD patients (p = 0.035 and p = 0.045; respectively). However, rs187084 AG genotype and G allele frequencies were significantly higher in male patients with genital aphthous (p = 0.01 and p = 0.046; respectively). Furthermore, a significantly higher frequency of rs352140 CT and TT + CT genotypes was detected in healthy individuals than in BD patients (p = 0.01, and p = 0.032; respectively). Such results were also seen in healthy females than female patients (p = 0.001, and p = 0.004; respectively). Haplotype analysis revealed a significantly higher frequency of A-C and G-C haplotypes among patients and healthy subjects, respectively (p = 0.002 and p = 0.000; respectively). CONCLUSION Our data suggested that rs187084 AG and AG + GG genotypes and rs352140 CT and TT + CT genotypes protect Iranian individuals from BD but rs187084 AG genotype and G allele predispose male BD individuals to genital aphthous. However, additional studies are required to verify these results.
Collapse
Affiliation(s)
- Zahra Tadayon
- Department of Molecular and Cellular Biology, Faculty of Basic Sciences and Advanced Technologies in Biology, University of Science and Culture, ACECR, Tehran, Iran
| | | | - Nasser Gholijani
- Autoimmune Disease Research Center, School of Medicine, Shiraz University of Medical Sciences, PO Box: 71345-1583, Shiraz, Iran
| | - Gholamreza Daryabor
- Autoimmune Disease Research Center, School of Medicine, Shiraz University of Medical Sciences, PO Box: 71345-1583, Shiraz, Iran.
| |
Collapse
|
4
|
Shbeer AM, Ahmed Robadi I. The role of Interleukin-21 in autoimmune Diseases: Mechanisms, therapeutic Implications, and future directions. Cytokine 2024; 173:156437. [PMID: 37972478 DOI: 10.1016/j.cyto.2023.156437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
IL-21 is a multifunctional cytokine that regulates the functional activity of various immune cells. Initial studies have shown that IL-21 can influence the differentiation, proliferation and function of T and B cells, as well as promote the maturation and increase the cytotoxicity of CD8 + T cells and NK cells. During humoral immune responses, IL-21 has significant effects on B cell activation, differentiation and apoptosis. In addition, IL-21 promotes the differentiation of both naive and memory B cells, ultimately leading to the activation of plasma cells. The function of IL-21 in the immune system is complex, as it has the ability to either stimulate or inhibit immune responses. in addition, IL-21 facilitates the differentiation of naive and memory B cells into plasma cells. The functionality of IL-21 in the immune system is diverse, as it has the ability to stimulate or inhibit immune responses. This cytokine has been implicated in several diseases including cancer, allergies and autoimmune diseases. Research has suggested that this cytokine is involved in the development of autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Several studies have suggested that inhibition of IL-21 has a therapeutic effect on autoimmune diseases. Therefore, targeting both the cytokine's receptor and IL-21 in autoimmune diseases may be an effective approach to reduce the severity of the disease or to treat it. This review will examine the biological effects of IL-21 on various immune cells and the role of the cytokine in autoimmune diseases.
Collapse
Affiliation(s)
- Abdullah M Shbeer
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.
| | - Ibrahim Ahmed Robadi
- Department of pathology, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| |
Collapse
|
5
|
Gasperini B, Falvino A, Piccirilli E, Tarantino U, Botta A, Visconti VV. Methylation of the Vitamin D Receptor Gene in Human Disorders. Int J Mol Sci 2023; 25:107. [PMID: 38203278 PMCID: PMC10779104 DOI: 10.3390/ijms25010107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The Vitamin D Receptor (VDR) mediates the actions of 1,25-Dihydroxvitamin D3 (1,25(OH)2D3), which has important roles in bone homeostasis, growth/differentiation of cells, immune functions, and reduction of inflammation. Emerging evidences suggest that epigenetic modifications of the VDR gene, particularly DNA methylation, may contribute to the onset and progression of many human disorders. This review aims to summarize the available information on the role of VDR methylation signatures in different pathological contexts, including autoimmune diseases, infectious diseases, cancer, and others. The reversible nature of DNA methylation could enable the development of therapeutic strategies, offering new avenues for the management of these worldwide diseases.
Collapse
Affiliation(s)
- Beatrice Gasperini
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (B.G.); (A.F.); (V.V.V.)
| | - Angela Falvino
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (B.G.); (A.F.); (V.V.V.)
| | - Eleonora Piccirilli
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (E.P.); (U.T.)
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (E.P.); (U.T.)
| | - Annalisa Botta
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (B.G.); (A.F.); (V.V.V.)
| | - Virginia Veronica Visconti
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy; (B.G.); (A.F.); (V.V.V.)
| |
Collapse
|
6
|
Omara A, Alkhuboli M, Nauman J, Al Nokhatha S, Almarshoodi M. Case report: Deep vein thrombosis as the sole clinical feature of Behcet's syndrome. Front Med (Lausanne) 2023; 10:1276867. [PMID: 38143445 PMCID: PMC10749191 DOI: 10.3389/fmed.2023.1276867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/25/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Behcet's syndrome is a rare, chronic, systemic condition often categorized within the group of vasculitides. It presents a diagnostic challenge due to its varied clinical manifestations and the absence of a definitive laboratory test. Its etiology remains unclear but may involve genetic, infectious, and environmental factors. Case presentation We report the case of a 16-year-old male who presented with deep vein thrombosis, followed by recurrent episodes of breakthrough thrombosis, despite adequate anticoagulant therapy. The patient did not meet the International Study Group (ISG) criteria nor the International Criteria for Behcet's syndrome (ICBD) due to the absence of characteristic features such as oral aphthous ulcers, genital ulcers, and uveitis. Later in the disease course, after ruling out other causes of breakthrough thrombosis, he tested positive for HLA-B51, an allele associated with Behcet's syndrome, and exhibited a pathergy reaction. Discussion The patient's clinical course underlines the diagnostic complexity associated with Behcet's syndrome and highlights the importance of maintaining a broad differential diagnosis in cases of recurrent thrombosis. Although HLA-B51 testing is not routinely recommended, it played a pivotal role in our case, underscoring the value of an integrated diagnostic approach. Furthermore, this case reinforces the potential for atypical presentations of Behcet's syndrome, necessitating vigilant clinical awareness. After establishing the diagnosis, we successfully treated the patient with immunosuppressive therapy, significantly improving his condition.
Collapse
Affiliation(s)
- Abdelrahman Omara
- Department of Academic Affairs, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Mohamed Alkhuboli
- Department of Ambulatory Medicine - Medical Affairs, Tawam Hospital, Al Ain, United Arab Emirates
| | - Javaid Nauman
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, United States
| | - Shamma Al Nokhatha
- Rheumatology Department, Tawam Hospital, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | |
Collapse
|
7
|
D'Onghia M, Cinotti E, Cartocci A, Vitale A, Caggiano V, Tognetti L, La Marca F, Sota J, Gentileschi S, Rubegni G, Lopalco G, Guerriero S, Govoni M, Monti S, Ruscitti P, Angeli F, Carubbi F, Giacomelli R, Ciccia F, Piga M, Emmi G, Costi S, Sebastiani GD, Iannone F, Spedicato V, Alessio G, Ruffilli F, Milanesi A, Gentile M, Crisafulli F, Alunno A, Navarini L, Iacono D, Cauli A, Ricci F, Gaggiano C, Tarsia M, Bartoloni E, Conti G, Viapiana O, Gobbi FL, de Paulis A, Parronchi P, Del Giudice E, Barone P, Olivieri AN, Bizzi E, Maggio MC, Balistreri A, Frediani B, Tosi GM, Fabiani C, Rubegni P, Cantarini L. Unfolding dermatologic spectrum of Behçet's disease in Italy: real-life data from the International AIDA Network Behçet's disease Registry. Intern Emerg Med 2023; 18:2245-2252. [PMID: 37803193 PMCID: PMC10635974 DOI: 10.1007/s11739-023-03410-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/23/2023] [Indexed: 10/08/2023]
Abstract
Behçet's disease (BD) is a heterogeneous multifactorial autoinflammatory disease characterized by a plethora of clinical manifestations. Cutaneous lesions are considered hallmarks of the disease. However, their evolution over time and a thorough description are scarcely reported in non-endemic regions. The aim of this study was to detail BD skin manifestations and their evolution over time in Italy, as well as the dermatological prognostic impact of specific cutaneous features in long-standing disease. Data were collected in a double fashion, both retrospectively and prospectively, from the AutoInflammatory Disease Alliance (AIDA) international registry dedicated to BD, between January 2022 and December 2022. A total of 458 Italian patients were included. When assessing skin manifestations course, the constant or sporadic presence or absence of cutaneous involvement between onset and follow-up was considered. Oral ulcers (OU) (88.4%) and genital ulcers (GU) (52.6%), followed by skin involvement (53.7%) represented the most common presenting mucocutaneous manifestations at disease onset. Up to the time of enrolment into the AIDA registry, 411 (93.8%) patients had suffered from OU and 252 (57.9%) from GU; pseudofolliculitis (PF) accounted for the most common skin manifestation (170 patients, 37.1%), followed by erythema nodosum (EN) (102 patients, 22.3%), skin ulcers (9 patients, 2%) and pyoderma gangrenosum (4 patients, 0.9%). A prospective follow-up visit was reported in 261/458 patients; 24/148 (16.2%) subjects with skin involvement as early as BD onset maintained cutaneous lesions for the entire period of observation, while 120 (44.1%) patients suffered from sporadic skin involvement. Conversely, 94/113 (83.2%) with no skin involvement at disease onset did not develop skin lesions thereafter. At follow-up visits, cutaneous involvement was observed in 52 (20%) patients, with a statistically significant association between PF and constant skin involvement (p = 0.031). BD in Italy is characterized by a wide spectrum of clinical presentations and skin manifestations in line with what is described in endemic countries. Patients with skin disease at the onset are likely to present persistent cutaneous involvement thereafter; mucocutaneous lesions observed at the onset, especially PF, could represent a warning sign for future persistent skin involvement requiring closer dermatological care.
Collapse
Affiliation(s)
- Martina D'Onghia
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Alessandra Cartocci
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Francesca La Marca
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Giovanni Rubegni
- Department of Ophthalmology, University of Catania, 9298, Catania, Italy
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Marcello Govoni
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy
| | - Sara Monti
- Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Fabrizio Angeli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L'Aquila and ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Roberto Giacomelli
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Via Álvaro del Portillo 200, 00128, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Biomedico", Rome, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Medicine, Centre for Inflammatory Diseases, Monash Medical Centre, Monash University, Melbourne, Australia
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST Gaetano Pini-CTO, Milan, Italy
| | | | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Veronica Spedicato
- Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), Policlinic Hospital, University of Bari, Bari, Italy
| | - Giovanni Alessio
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S. Anna-Ferrara, University of Ferrara, Ferrara, Italy
| | - Alessandra Milanesi
- Rheumatology Department, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Martina Gentile
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alessia Alunno
- Department of Life, Health & Environmental Sciences and Internal Medicine and Nephrology Unit, Department of Medicine, University of L'Aquila and ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Luca Navarini
- Clinical and Research Section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Via Álvaro del Portillo 200, 00128, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, School of Medicine, University of Rome "Campus Biomedico", Rome, Italy
| | - Daniela Iacono
- Department of Precision Medicine, Università Degli Studi Della Campania Luigi Vanvitelli, Naples, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medical Sciences, University and AOU of Cagliari, Cagliari, Italy
| | - Francesca Ricci
- Pediatric Clinic, University of Brescia and Spedali Civili Di Brescia, Brescia, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Maria Tarsia
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinic G Martino, Messina, Italy
| | - Ombretta Viapiana
- Rheumatology Unit, University of Verona, Policlinico G. B. Rossi, Verona, Italy
| | | | - Amato de Paulis
- Department of Translational Medical Sciences, Section of Clinical Immunology, University of Naples Federico II, Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), World Allergy Organization (WAO) Center of Excellence, University of Naples Federico II, Naples, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Emanuela Del Giudice
- Department of Maternal Infantile and Urological Sciences, Polo Pontino, Sapienza University of Rome, Rome, Italy
| | - Patrizia Barone
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Alma Nunzia Olivieri
- Department of Woman, Child and of General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Bizzi
- Medicina Interna, Ospedale Fatebenefratelli, Milan, Italy
| | - Maria Cristina Maggio
- University Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurological Science, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
- Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center] Siena, Siena, Italy.
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinics, Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Policlinico "Le Scotte", Viale Bracci 16, 53100, Siena, Italy.
| |
Collapse
|
8
|
Mahaju S, Achhami E, Lamichhane S, Chalise KN, Gautam R. A rare case of Behcet's disease in Nepal: multisystem manifestations and diagnostic challenges. Ann Med Surg (Lond) 2023; 85:5259-5262. [PMID: 37811046 PMCID: PMC10553148 DOI: 10.1097/ms9.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023] Open
Abstract
Behcet's disease (BD) is a chronic inflammatory disorder characterized by a relapsing and remitting course and multisystem involvement. The authors present a case report of a 20-year-old male who presented with bilateral knee joint pain, oral and genital ulcers, and papulopustular skin lesions. The patient's clinical history, physical examination, laboratory findings, and biopsy results were consistent with the diagnosis of BD. The patient tested positive for the HLA-B51 allele, confirming a genetic predisposition. The diagnosis was supported by a positive pathergy test and a skin biopsy showing vasculitis. The diagnostic criteria established by the international study group and the International Criteria for Behcet's Disease were fulfilled. Treatment consisted of colchicine, azathioprine, and topical corticosteroids. This case highlights the importance of recognizing the varied clinical presentations of BD and the need for a multidisciplinary approach to diagnosis and management. Early and accurate diagnosis is crucial to prevent severe complications and improve patient outcomes.
Collapse
Affiliation(s)
| | - Eliz Achhami
- Sukraraj Tropical and Infectious Disease Hospital
| | | | | | | |
Collapse
|
9
|
Conejero Del Mazo R, García Forcén L, Navarro Aguilar ME. [Recurrent aphthous stomatitis]. Med Clin (Barc) 2023; 161:251-259. [PMID: 37357066 DOI: 10.1016/j.medcli.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/27/2023]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common clinical disease of the oral mucosa. Its prevalence in the general population varies between 5 and 25%, with its peak appearance in the second decade of life. So far, the etiopathogenesis is not clear. In genetically predisposed patients, the effect of certain triggering factors would initiate the proinflammatory cytokine cascade directed against certain regions of the oral mucosa. Ulcers are round or oval with well-defined erythematous margins and a shallow ulcerated center covered with a gray or yellowish fibrinous pseudomembrane. The ulcers may reappear at intervals of a few days and months. Given the appearance of periodic thrush in the oral mucosa, the first thing to do is to make a correct differential diagnosis, rule out associated systemic diseases and assess treatable causes before reaching the diagnosis of RAS. At present, there is no curative treatment.
Collapse
Affiliation(s)
| | - Laura García Forcén
- Centro de Salud Ejea de los Caballeros, Ejea de los Caballeros, Zaragoza, España
| | | |
Collapse
|
10
|
Chen Y, Wu D. Cervical ulcer caused by group B streptococcus with bacterial vaginosis: a case report. BMC Womens Health 2023; 23:516. [PMID: 37759233 PMCID: PMC10537103 DOI: 10.1186/s12905-023-02665-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
The female genital ulcer is a manifestation of many diseases, which may vary depending on the etiology, disease duration, age, and host immunity. A middle-aged (40-50 years) woman had a 4-month history of vaginal bleeding. The results of syphilis, herpes, the cervical cancer, tuberculosis, and fungi or acute cervical inflammation caused by Chlamydia trachomatis and Mycoplasma hominis were negative through the blood test and the biopsy. Cervical discharge culture revealed positive for group B Streptococcus and bacterial vaginosis. The patient was treated with oral antibiotics for 7 days. One month later, repeat colposcopy revealed a smooth cervix and complete ulcer disappearance, while cervical discharge culture retested no group B Streptococcus and bacterial vaginosis. The patient was diagnosed with cervical ulcer. Complete medical history taking and bacterial culture of cervical discharge are important for identifying the etiology of the cervical ulcer and deciding the appropriate treatment for the disease.
Collapse
Affiliation(s)
- Yi Chen
- Cervical Center of The International Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China
| | - Dan Wu
- Cervical Center of The International Peace Maternal and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200030, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, 200030, China.
| |
Collapse
|
11
|
Mota Freitas RFD, Guerra APBM. Behçet Disease and Bipolar Disorder: A Case Report and Review. J Psychiatr Pract 2023; 29:421-425. [PMID: 37624756 DOI: 10.1097/pra.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Behçet disease (BD) is a rare, multifactorial condition with multiple manifestations affecting various systems. Bipolar disorder has been reported as more frequent in individuals with BD than in the general population. We report a case of BD and bipolar disorder and summarize previous findings in the literature concerning this topic. Our case illustrates the relevance of managing comorbid BD and bipolar disorder. It is crucial to manage both conditions to maximize the patient's quality of life. Clinicians should be aware of the risk of bipolar disorder in patients with BD and vice versa and an integrated model of care could be useful. The exact biological and psychological aspects mediating the association between the 2 diagnoses remain unclear. Further, larger, prospective studies could help better clarify this relationship, leading to new advances in diagnosis and treatment.
Collapse
|
12
|
Piña-Ballantyne SA, Tirado-García LA, Tena-Suck ML, Calderón-Garcidueñas AL. Neuro-Behçet With a Thalamic Lesion: A Case Report. Cureus 2023; 15:e45925. [PMID: 37900411 PMCID: PMC10601357 DOI: 10.7759/cureus.45925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Behçet's disease (BD) is an autoimmune disease characterized by multisystemic variable-vessel vasculitis and oral, genital, and intestinal ulcers. Neurological involvement or "Neuro-Behçet" (NB) manifests due to parenchymal inflammation. We present the case of a 21-year-old male with a five-year-old history of intermittent chronic oral and genital ulcers who presented with headache, right hemiparesis, progressive loss of visual acuity, and a thalamic tumor-like lesion on magnetic resonance imaging (MRI). A brain biopsy showed multiple perivascular infarcts associated with vasculitis affecting arterioles, venules, and capillaries.
Collapse
Affiliation(s)
| | - Luis-Angel Tirado-García
- Neuropathology, Instituto Nacional de Neurologia y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Martha-Lilia Tena-Suck
- Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | |
Collapse
|
13
|
Amin M, Uchino K, Hajj-Ali RA. Central Nervous System Vasculitis: Primary Angiitis of the Central Nervous System and Central Nervous System Manifestations of Systemic Vasculitis. Rheum Dis Clin North Am 2023; 49:603-616. [PMID: 37331735 DOI: 10.1016/j.rdc.2023.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Central nervous system vasculitis (CNSV) is a group of disorders leading to inflammatory vasculopathy within the brain, spinal cord, and leptomeninges. CNSV is divided into primary angiitis of the central nervous system (PACNS) and secondary CNSV based on the underlying etiology. PACNS is a rare inflammatory disorder with poorly understood pathophysiology and heterogeneous and highly variable clinical features. The diagnosis depends on a combination of clinical and laboratory variables, multimodal imaging, and histopathological examination as well as exclusion of mimics. Several systemic vasculitides, infectious etiologies and connective tissue disorders have been shown to cause secondary CNSV and require prompt recognition.
Collapse
Affiliation(s)
- Moein Amin
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, USA
| | - Rula A Hajj-Ali
- Cleveland Clinic Center for Vasculitis Care and Research, Cleveland Clinic, 9500 Euclid Avenue, A50, Cleveland, OH 44195, USA.
| |
Collapse
|
14
|
Jari M, Nasiri S, Ghandehari M. Episcleritis; and posterior uveitis misdiagnosed as orbital cellulitis in a child patient with Behçet's disease. SAGE Open Med Case Rep 2023; 11:2050313X231182237. [PMID: 37440973 PMCID: PMC10333992 DOI: 10.1177/2050313x231182237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Behçet's disease is a chronic multisystem vasculitis that presented with several manifestations. Episcleritis is a benign inflammation of the episcleral tissue and is rarely reported in Behçet's disease. We reported an 11-year-old girl who was admitted due to pain and swelling around the left eye with initial diagnosis of preseptal cellulitis. The patient had a history of recurrent oral aphthous ulcers and genital ulcers. Episcleritis and posterior uveitis were reported in ophthalmic examination and ultrasonography. Pathergy skin test and human leukocyte antigens (HLA) B5 and HLA-B51 were positive, consistent with the diagnosis of Behcet's disease. This case report emphasizes that various pathological causes may cause episcleritis and uveitis in children, one of which is rheumatic diseases, that should always be considered.
Collapse
Affiliation(s)
- Mohsen Jari
- Department of Pediatric Rheumatology, Imam
Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shidrokh Nasiri
- School of Medicine, Isfahan University of
Medical Sciences, Isfahan, Iran
| | | |
Collapse
|
15
|
Zhao Z, Zhou C, Zhang M, Qian L, Xia W, Fan Y. Analysis of the potential relationship between COVID-19 and Behcet's disease using transcriptome data. Medicine (Baltimore) 2023; 102:e33821. [PMID: 37335738 DOI: 10.1097/md.0000000000033821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
To investigate the potential role of COVID-19 in relation to Behcet's disease (BD) and to search for relevant biomarkers. We used a bioinformatics approach to download transcriptomic data from peripheral blood mononuclear cells (PBMCs) of COVID-19 patients and PBMCs of BD patients, screened the common differential genes between COVID-19 and BD, performed gene ontology (GO) and pathway analysis, and constructed the protein-protein interaction (PPI) network, screened the hub genes and performed co-expression analysis. In addition, we constructed the genes-transcription factors (TFs)-miRNAs network, the genes-diseases network and the genes-drugs network to gain insight into the interactions between the 2 diseases. We used the RNA-seq dataset from the GEO database (GSE152418, GSE198533). We used cross-analysis to obtain 461 up-regulated common differential genes and 509 down-regulated common differential genes, mapped the PPI network, and used Cytohubba to identify the 15 most strongly associated genes as hub genes (ACTB, BRCA1, RHOA, CCNB1, ASPM, CCNA2, TOP2A, PCNA, AURKA, KIF20A, MAD2L1, MCM4, BUB1, RFC4, and CENPE). We screened for statistically significant hub genes and found that ACTB was in low expression of both BD and COVID-19, and ASPM, CCNA2, CCNB1, and CENPE were in low expression of BD and high expression of COVID-19. GO analysis and pathway analysis was then performed to obtain common pathways and biological response processes, which suggested a common association between BD and COVID-19. The genes-TFs-miRNAs network, genes-diseases network and genes-drugs network also play important roles in the interaction between the 2 diseases. Interaction between COVID-19 and BD exists. ACTB, ASPM, CCNA2, CCNB1, and CENPE as potential biomarkers for 2 diseases.
Collapse
Affiliation(s)
- Zhibai Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
- Department of General Dentistry, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Chenyu Zhou
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Mengna Zhang
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Ling Qian
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Wenhui Xia
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| | - Yuan Fan
- Department of Oral Mucosal Diseases, The Affiliated Stomatological Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Province Key Laboratory of Oral Diseases, Nanjing, China
| |
Collapse
|
16
|
Ramdoss J, Singh P, Ahmed AS, Biswas J. Clinical profile and management with immunosuppressants and biologics in Behcet's uveitis: A cohort of 25 patients from a tertiary eye care center in South India. Indian J Ophthalmol 2023; 71:1972-1976. [PMID: 37203067 PMCID: PMC10391413 DOI: 10.4103/ijo.ijo_1439_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose To report the clinical profile of Behcet's disease and its management with immunosuppressants and biologics in a cohort of 25 patients from a tertiary eye care center in South India. Methods This was a retrospective, observational study. Records of 45 eyes of 25 patients between January 2016 and December 2021 were retrieved from the hospital database. Complete ophthalmic evaluation and systemic examination by the rheumatologist with appropriate investigations had been done. Results were analyzed using Statistical Package for the Social Sciences (SPSS) software. Results Males (19, 76%) were found to be more affected than females (6, 24%). Mean age of presentation was 27.68 ± 11.08 years. Twenty patients had bilateral involvement (80%), and unilateral involvement was seen in five patients (20%). Seven eyes of four patients (16%) had isolated anterior uveitis, out of which one patient had unilateral and three patients had bilateral involvement. Twenty-six eyes of 16 patients (64%) had posterior uveitis, out of which six patients had unilateral and 10 had bilateral involvement. Twelve eyes of seven patients (28%) had panuveitis, out of which two patients had unilateral and five had bilateral involvement. Hypopyon was seen in five eyes (11.1%) and posterior synechiae in seven eyes (15.55%). Posterior segment findings included vitritis (24.44%), vasculitis (17.78%), retinitis (17.78%), disc hyperemia (11.11%), and disc pallor (8.89%). Steroids alone were given in five patients (20%) and intravenous methylprednisolone (IVMP) was given in four patients (16%). Immunosuppressive agents along with steroids were given in 20 patients (80%), of which azathioprine alone was given in seven patients (28%), cyclosporin alone was given in two patients (8%), mycophenolate mofetil alone was given in three patients (12%), combination of azathioprine and cyclosporin was given in six patients (24%), and combination of methotrexate and mycophenolate mofetil was given in one patient (4%). Biologics were given in 10 patients (40%) - adalimumab in seven patients (28%) and infliximab in three patients (12%). Conclusion Behcet's disease is an uncommon uveitis in India. Addition of immunosuppressants and biologics to conventional steroid therapy gives better visual outcomes.
Collapse
Affiliation(s)
- Jeyasooriya Ramdoss
- Junior Research Fellow, Departments of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Prerana Singh
- Advanced Medical Retina Fellow, Viteroretina Department, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Arshee S Ahmed
- Junior Research Fellow, Departments of Uvea, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Uveitis and Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
17
|
Smith MH, Mintline M. Acute Immune-Mediated Lesions of the Oral Cavity. Oral Maxillofac Surg Clin North Am 2023; 35:247-259. [PMID: 37019507 DOI: 10.1016/j.coms.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Although acute immune-mediated lesions of the oral cavity (AIML) can have an onset over several months, they often demonstrate rapid onset and can be self-limited. Despite the self-limiting nature of some disorders, patients with AIML can have significant pain and multisystem involvement. It is vital for the oral health care provider to arrive at the proper diagnosis with distinction from overlapping conditions, as the oral manifestations may be harbingers of more serious systemic complications.
Collapse
Affiliation(s)
- Molly Housley Smith
- Pathology and Cytology Laboratory, 290 Big Run Road, Lexington, KY 40503, USA.
| | - Mark Mintline
- WesternU Health Oral Pathology, 701 East 2nd Street, Room 3204, Pomona, CA 91766, USA
| |
Collapse
|
18
|
Deng J, Fan X, Guo H, Gao J, Li X, Wan W. Intestinal Behcet’s syndrome with an unusual complication bladder-intestines fistula and urinary tract infections—A case report. Front Cell Infect Microbiol 2023; 13:1108247. [PMID: 37065188 PMCID: PMC10090278 DOI: 10.3389/fcimb.2023.1108247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
A 33-year-old male patient with a 17-year Behcet’s syndrome history showed abdominal pain and fever symptoms. The abdominal CT was suggestive of an acute ileocecal intestinal perforation. In addition, the symptoms disappeared after the conservative treatment. Some related examinations, including capsule endoscopy, were performed to explain the phenomenon of the food residue urine. These results indicated the intestine-urinary tract fistula formation, supposed to be the outcome of intestinal Behcet’s syndrome perforation. This is a rare case of intestinal Behcet’s syndrome with abdominal symptoms as the main manifestation. It was complicated by entero-urinary fistula formation and urinary tract infections. Now, we report this story to emphasize that capsule endoscopy is conducive to the diagnosis and assessment of the intestinal Behcet’s syndrome; moreover, anti-inflammatory treatment including biological agents is effective to relieve the disease at the acute stage in addition to surgical methods.
Collapse
Affiliation(s)
- Jiewen Deng
- The Department of Cardiovascular Diseases, The First Affiliated Hospital of the Naval Military Medical University, Shanghai, China
| | - Xuanming Fan
- The Department of Gastroenterology, The First Affiliated Hospital of the Naval Military Medical University, Shanghai, China
| | - Hui Guo
- Department of Pharmacy, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jie Gao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of the Naval Military Medical University, Shanghai, China
- *Correspondence: Wei Wan,
| | - Xuan Li
- Shanghai Songjiang Fangta Hospital of TCM, Shanghai, China
| | - Wei Wan
- Department of Rheumatology and Immunology, The First Affiliated Hospital of the Naval Military Medical University, Shanghai, China
- *Correspondence: Wei Wan,
| |
Collapse
|
19
|
Tan X, Zhu J. Multiple small bowel perforation triggered by Betch's disease: A case report. Asian J Surg 2023; 46:1393-1394. [PMID: 36117062 DOI: 10.1016/j.asjsur.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Xiaolong Tan
- Dept.of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Jun Zhu
- Dept.of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China.
| |
Collapse
|
20
|
Fourcade L, Amatore F, Attia R, Berbis P, Gomes de Pinho Q, Granel B. [A typical triad]. Rev Med Interne 2023; 44:150-152. [PMID: 36863805 DOI: 10.1016/j.revmed.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/12/2022] [Indexed: 03/04/2023]
Affiliation(s)
- L Fourcade
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - F Amatore
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - R Attia
- Service d'ophtalmologie, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - P Berbis
- Service de dermatologie, CHU Nord, Assistance publique-Hôpitaux de Marseille, Aix-Marseille université, Marseille, France
| | - Q Gomes de Pinho
- Service de médecine interne, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France
| | - B Granel
- Service de médecine interne, Aix-Marseille université, CHU Nord, Assistance publique-Hôpitaux de Marseille, Marseille, France.
| |
Collapse
|
21
|
Acar O, Sarac GA, Rota DD, Aksoy H. Evaluation of pro-atherogenic lipid profile and high atherohenic indexes in patients with Behçet's disease: A case-control study. J Cosmet Dermatol 2023; 22:1887-1892. [PMID: 36762412 DOI: 10.1111/jocd.15647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/18/2022] [Accepted: 01/10/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Behçet's disease is a systemic auto-immune and auto-inflammatory chronic disease in which genetic and environmental factors play a role. Patients with Behçet's are at significant risk for developing many comorbidities, including cardiovascular diseases. AIMS It was aimed to investigate the relationship between serum lipid parameters and atherogenic indexes to evaluate the cardiovascular risk status in patients with Behçet's disease. PATIENTS/METHODS This study was designed as a single-center, retrospective case-control study. The study was conducted with 212 patients over 18 years of age, 106 in the case group and 106 in the control group. RESULTS There was a significant difference in lipid values between the patients with Behçet's disease and the control group. While the serum triglyceride, total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol (NHC) levels were significantly higher, the high-density lipoprotein cholesterol (HDL-C) level was low in patients with Behçet's disease. From atherogenic indexes, Atherogenic Index of Plasma (AIP) (0.03 ± 0.27 vs. -0.07 ± 0.23, p = 0.003), Castelli Risk Index I (CRI-I) (4.24 ± 1.07 vs. 3.02 ± 0.96, p < 0.001), Castelli Risk Index II (CRI-II) (2.65 ± 0.81 vs. 1.84 ± 0.59, p < 0.001) and Atherogenic Coefficient (AC) (3.24 ± 1.07 vs. 2.02 ± 0.96, p < 0.001) levels were significantly higher in patients with Behçet's disease. CONCLUSION Our study shows that patients with Behçet's have a higher pro-atherogenic lipid profile and atherogenic indexes at high risk. Patients with Behçet's have an increased risk of cardiovascular diseases associated with atherosclerosis.
Collapse
Affiliation(s)
- Onur Acar
- Ağrı Provincial Health Directorate, Republic of Turkey, Ministry of Health, Ağrı, Turkey
| | - Gulhan Aksoy Sarac
- Ufuk University Faculty of Medicine Department of Dermatology, Ankara, Turkey
| | - Didem Dinçer Rota
- Ufuk University Faculty of Medicine Department of Dermatology, Ankara, Turkey
| | - Hakan Aksoy
- Department of Cardiology, Memorial Ankara Hospital, Ankara, Turkey
| |
Collapse
|
22
|
Ishizu A, Kawakami T, Kanno H, Takahashi K, Miyazaki T, Ikeda E, Oharaseki T, Ogawa Y, Onimaru M, Kurata M, Nakazawa D, Muso E, Harigai M. Expert perspectives on pathological findings in vasculitis. Mod Rheumatol 2023; 33:1-11. [PMID: 35535676 DOI: 10.1093/mr/roac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 01/05/2023]
Abstract
Pathological findings are important in the diagnosis of vasculitis. However, due to the rarity of the disease, standard textbooks usually devote only a few pages to this topic, and this makes it difficult for clinicians not specializing in vasculitis to fully understand the pathological findings in vasculitis. To address the paucity of information, we present representative pathological findings in vasculitis classified in the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides (CHCC2012). The CHCC2012 classifies 26 vasculitides into seven categories: (1) large-vessel vasculitis, (2) medium-vessel vasculitis, (3) small-vessel vasculitis, including antineutrophil cytoplasmic antibody-associated vasculitis and immune complex small-vessel vasculitis, (4) variable-vessel vasculitis, (5) single-organ vasculitis, (6) vasculitis associated with systemic disease, and (7) vasculitis associated with probable aetiology. Moreover, representative pathological findings of vasculitis-related diseases and non-inflammatory vasculopathy not mentioned in the CHCC2012 are also presented. This will be useful for clinicians to refer to typical pathological findings of vasculitis in daily practice.
Collapse
Affiliation(s)
- Akihiro Ishizu
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Tamihiro Kawakami
- Division of Dermatology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kei Takahashi
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Eiji Ikeda
- Department of Pathology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Toshiaki Oharaseki
- Department of Pathology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Japan
| | - Mitsuho Onimaru
- Division of Pathophysiological and Experimental Pathology, Department of Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mie Kurata
- Department of Analytical Pathology, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Daigo Nakazawa
- Department of Rheumatology, Endocrinology, and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Eri Muso
- Department of Nephrology and Dialysis, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka, Japan
| | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| |
Collapse
|
23
|
Giani T, Luppino AF, Ferrara G. Treatment Options in Pediatric Behçet's Disease. Paediatr Drugs 2023; 25:165-191. [PMID: 36626047 PMCID: PMC9838500 DOI: 10.1007/s40272-022-00548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 01/11/2023]
Abstract
Behçet's disease is a rare and poorly understood vasculitis affecting blood vessels of all types and sizes. Uveitis and oral and genital ulcers represent the typical clinical triad. Populations along the ancient trading route connecting the Mediterranean basin with the Middle and Far East are most affected. Up to a quarter of the cases has a pediatric onset, typically around puberty. The aim of the treatment is early intervention to control inflammation, with symptom relief and prevention of relapses, damage, and complications. The heterogeneous clinical presentation often requires a multidisciplinary and tailored approach. Ocular, neurological, gastrointestinal, and vascular involvement is associated with a worse prognosis and needs more aggressive treatments. In young patients with expected prolonged disease, treatment should also focus on preventive measures and lifestyle advice. In recent years, the pharmacological armamentarium has grown progressively, although only a limited number of drugs are currently authorized for pediatric use. Most evidence for these drugs still derives from adult studies and experience; these are prescribed as off-label medications and are only available as adult formulations. Corticosteroids frequently represent the mainstay for the management of the initial acute phases, but their potential serious adverse effects limit their use to short periods. Different conventional disease-modifying anti-rheumatic drugs have long been used. Many other biologic drugs targeting different cytokines such as interleukin-1, interleukin-6, and interleukin-17 and treatments with small molecules including the phosphodiesterase 4 and Janus kinase inhibitors are emerging as novel promising therapeutic agents. In recent years, a growing interest has developed around anti-tumor necrosis factor agents that have often proven to be effective in severe cases, especially in those with a gastrointestinal and ocular involvement.
Collapse
|
24
|
Zinc and Zinc Transporters in Dermatology. Int J Mol Sci 2022; 23:ijms232416165. [PMID: 36555806 PMCID: PMC9785331 DOI: 10.3390/ijms232416165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Zinc is an important trace mineral in the human body and a daily intake of zinc is required to maintain a healthy status. Over the past decades, zinc has been used in formulating topical and systemic therapies for various skin disorders owing to its wound healing and antimicrobial properties. Zinc transporters play a major role in maintaining the integrity of the integumentary system by controlling zinc homeostasis within dermal layers. Mutations and abnormal function of zinc-transporting proteins can lead to disease development, such as spondylocheirodysplastic Ehlers-Danlos syndrome (SCD-EDS) and acrodermatitis enteropathica (AE) which can be fatal if left untreated. This review discusses the layers of the skin, the importance of zinc and zinc transporters in each layer, and the various skin disorders caused by zinc deficiency, in addition to zinc-containing compounds used for treating different skin disorders and skin protection.
Collapse
|
25
|
Liu M, Sun X, Chen B, Dai R, Xi Z, Xu H. Insights into Manganese Superoxide Dismutase and Human Diseases. Int J Mol Sci 2022; 23:ijms232415893. [PMID: 36555531 PMCID: PMC9786916 DOI: 10.3390/ijms232415893] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Redox equilibria and the modulation of redox signalling play crucial roles in physiological processes. Overproduction of reactive oxygen species (ROS) disrupts the body's antioxidant defence, compromising redox homeostasis and increasing oxidative stress, leading to the development of several diseases. Manganese superoxide dismutase (MnSOD) is a principal antioxidant enzyme that protects cells from oxidative damage by converting superoxide anion radicals to hydrogen peroxide and oxygen in mitochondria. Systematic studies have demonstrated that MnSOD plays an indispensable role in multiple diseases. This review focuses on preclinical evidence that describes the mechanisms of MnSOD in diseases accompanied with an imbalanced redox status, including fibrotic diseases, inflammation, diabetes, vascular diseases, neurodegenerative diseases, and cancer. The potential therapeutic effects of MnSOD activators and MnSOD mimetics are also discussed. Targeting this specific superoxide anion radical scavenger may be a clinically beneficial strategy, and understanding the therapeutic role of MnSOD may provide a positive insight into preventing and treating related diseases.
Collapse
Affiliation(s)
- Mengfan Liu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center, Shanghai Colleges for TCM New Drug Discovery, Shanghai 201203, China
| | - Xueyang Sun
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center, Shanghai Colleges for TCM New Drug Discovery, Shanghai 201203, China
| | - Boya Chen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, Institute of Pharmacology and Toxicology, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Rongchen Dai
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center, Shanghai Colleges for TCM New Drug Discovery, Shanghai 201203, China
| | - Zhichao Xi
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center, Shanghai Colleges for TCM New Drug Discovery, Shanghai 201203, China
- Correspondence: (Z.X.); (H.X.)
| | - Hongxi Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center, Shanghai Colleges for TCM New Drug Discovery, Shanghai 201203, China
- Correspondence: (Z.X.); (H.X.)
| |
Collapse
|
26
|
Analysis of the Risk of Oral Squamous Cell Carcinoma in Patients with and without Recurrent Aphthous Stomatitis: A Retrospective Evaluation of Real-World Data of about 150,000 Patients. Cancers (Basel) 2022; 14:cancers14236011. [PMID: 36497491 PMCID: PMC9736665 DOI: 10.3390/cancers14236011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Recurrent aphthous stomatitis (RAS) is found among the most frequent diseases of the oral cavity. It is characterized by repeated formation of painful ulcers. The question has risen if due to potential tumor-promoting inflammation and sustaining proliferative signaling RAS may contribute to oral cancer. Accordingly, the aim of the study was to assess if an association of RAS and the development oral squamous cell carcinoma (OSCC) could be found in a larger cohort. As recurrent aphthous stomatitis is not classified as an oral potentially malignant disorder, it was assumed that the risk of OSCC did not differ between patients with (cohort I) and without RAS (cohort II). Methods: Retrospective clinical data of patients diagnosed with and without RAS (International Classification of Diseases (ICD)-10 code K12) within the past 20 years and a body mass index of 19−30 kg/m2 were retrieved from the TriNetX database to gain initial cohort 0. Subjects suffering from RAS were assigned to cohort I, whereby cohort II was obtained from the remaining individuals, and by matching for age, gender, as well as (history of) nicotine and alcohol dependence. After defining the primary outcome as “OSCC” (ICD-10 codes C00-C14), a Kaplan−Meier analysis was performed, and risk and odds ratios were calculated. Results: Of a total of 24,550,479 individuals in cohort 0, 72,845 subjects were each assigned to cohort I (females: 44,031 (60.44%); males: 28,814 (39.56%); mean current age (±standard deviation) = 35.51 ± 23.55 years) and II (females: 44,032 (60.45%); males: 28,813 (39.55%); mean current age (±standard deviation) = 35.51 ± 23.56 years). Among the cohorts I and II, 470 and 135 patients were diagnosed with OSCC within five years. The according risk of developing oral cancer was 0.65% and 0.18%, whereby the risk difference of 0.47% was highly significant (p < 0.0001; Log-Rank test). The RR and OR were calculated as 3.48 (95% confidence interval (CI) lower: 2.88 and upper: 4.21) and 3.50 (95% CI lower: 2.89 and upper: 4.24). Conclusions: Among the patients suffering from RAS, a significantly augmented risk of developing OSCC was found. However, it has to be emphasized that the recent literature does not provide any confirmatory evidence that supports the retrieved results. Furthermore, the findings need to be interpreted cautiously due to specific limitations that come along with the applied methods. It should thus far only be concluded that further research is necessary to evaluate hypotheses that may be retrieved from the obtained results. Despite this controversy, oral ulcers suspicious of OSCC should undergo biopsy. Trial Registration: Due to the retrospective nature of the study, no registration was necessary.
Collapse
|
27
|
Abstract
RATIONALE Behçet's disease (BD) is an autoimmune disease presented with recurrent oral aphthous ulcers, genital ulcers, uveitis and skin lesions. The cutaneous manifestations are often refractory and more resistant to conventional therapy. This report provides a new treatment of low-dose interleukin-2 (IL-2) with refractory BD patient. PATIENT CONCERNS A 37-year-old female patient experienced oral ulcer and erythema nodosum on the right leg for over 12 months and resisted to Methylprednisolone and Thalidomide. DIAGNOSES The patient suffered from recurrent painful oral ulceration and an erythema nodosum. Pathergy test is also positive. Thus, we diagnosed her as BD according to the International Criteria for Behçet's Disease (ICBD). INTERVENTIONS The patient took Methylprednisolone 8 mg qd, Thalidomide 50 mg qn and Hydroxychloroquine 200 mg bid successively as treatment. However, the medicine didn't take effect. Finally, this patient was given low-dose IL-2 intramuscular injection qod for 3 months. OUTCOMES Oral ulcers and the erythema disappeared and the patient has been symptom-free for 6 months. LESSONS low-dose IL-2 is a safe and effective treatment for refractory BD.
Collapse
Affiliation(s)
- Wenyan Zhou
- Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing, China
| | - Tian Liu
- Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xian Xiao
- Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Jing He
- Department of Rheumatology & Immunology, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
- *Correspondence: Jing He, Department of Rheumatology and Immunology, Peking University People’s Hospital Beijing, ChinaBeijing 100044, China (e-mail: )
| |
Collapse
|
28
|
Vulvar Aphthous Ulcers in an Adolescent After Coronavirus Disease 2019 (COVID-19) Vaccination. Obstet Gynecol 2022; 140:514-517. [PMID: 35930388 PMCID: PMC9377366 DOI: 10.1097/aog.0000000000004885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Nonsexually acquired genital ulcers have been described among girls who are prepubertal after various viral illnesses due to mucosal inflammation from an immunologic response. Until recently, nonsexually acquired genital ulcers have only been associated with viral infections. CASE We present a case of an adolescent girl developing nonsexually acquired genital ulcers after both her first and second coronavirus disease 2019 (COVID-19) vaccine doses. Her course followed an expected timeline for severity and resolution of ulcers. CONCLUSIONS Aphthous ulcers may arise from inflammatory effects of COVID-19 vaccination. Clinical monitoring after COVID-19 vaccination from all formulations should include assessment for nonsexually acquired genital ulcers if vaginal pain is reported.
Collapse
|
29
|
Ciscato A, Sadeghi S, Speziale A, Hosseini M, Hu J. Behcet's Disease Mimicking Crohn's Disease: A Diagnostic Pitfall in GI Tract Biopsies. Int J Surg Pathol 2022:10668969221113477. [PMID: 35898181 DOI: 10.1177/10668969221113477] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Behcet's disease is a rare entity. It's a multi-systemic inflammatory disease of unknown etiology characterized by recurrent ulcers and vasculitis, mainly including the oral cavity, eyes, gastrointestinal tract and joints. Crohn's disease is a chronic inflammatory disorder that may affect the same organs as Behcet's disease, however more frequently the gastrointestinal tract. Distinguishing Behcet's disease from Crohn's disease can be challenging due to the overlapping clinical presentation and similar morphology features on pathology biopsy specimens. This is a case report of a 32-year-old female who first presented at the emergency department with fatigue, weight loss, arthralgia, and erythema nodosum. The patient was admitted for oral ulcers, skin rash, genital ulcers, and melena one month later. Treatment with prednisone was started at the time and further workup for Behcet's disease versus inflammatory bowel disease was started. Her esophagus biopsy shows granulomatous-like vasculitis, and her colon biopsies show overlapping features with Crohn's disease. Herein, we present a rare and interesting case in which Behcet's disease mimics inflammatory bowel disease on the gastrointestinal tract biopsies but with some unique findings and diagnostic pitfalls for gastrointestinal tract vasculitis and ulceration.
Collapse
Affiliation(s)
- Andreas Ciscato
- Department of Pathology, 8784University of California San Diego, La Jolla, CA, USA
| | - Saha Sadeghi
- Department of Pathology, 21380Sharp Memorial Hospital, San Diego, CA, USA
| | - Alissa Speziale
- Gastroenterology, 7123Sharp Rees-Stealy Medical Center, San Diego, CA, USA
| | - Mojgon Hosseini
- Department of Pathology, 8784University of California San Diego, La Jolla, CA, USA
| | - Jingjing Hu
- Department of Pathology, 8784University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
30
|
Gnesotto L, Mioso G, Alaibac M. Use of granulocyte and monocyte adsorption apheresis in dermatology (Review). Exp Ther Med 2022; 24:536. [PMID: 35837066 PMCID: PMC9257973 DOI: 10.3892/etm.2022.11463] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Adsorptive granulocyte and monocyte apheresis (GMA) is an extracorporeal treatment that selectively removes activated myeloid lineage leukocytes from peripheral blood. This technique consists of a column with cellulose acetate beads as absorptive leukocytapheresis carriers, and was initially used to treat ulcerative colitis. A literature search was conducted to extract recently published studies about the clinical efficacy of GMA in patients with different skin disorders, reporting information on demographics, clinical symptoms, treatment and clinical course. Dermatological diseases, in which GMA has been performed, include generalized pustular psoriasis, pyoderma gangrenosum, palmoplantar pustular psoriasis, Behcet's disease, Sweet's syndrome, adult-onset Still's disease, impetigo herpetiformis, reactive arthritis, acne and hidradenitis suppurativa syndrome, cutaneous allergic vasculitis and systemic lupus erythematosus. In most patients, GMA was started after the failure of conventional therapeutic options and it was helpful in the majority of cases. Based on the information summarized, GMA could be considered a valid non-pharmacological treatment option for patients with several dermatological conditions, which are difficult to treat with other pharmacological preparations.
Collapse
Affiliation(s)
- Laura Gnesotto
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Guido Mioso
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| | - Mauro Alaibac
- Dermatology Unit, Department of Medicine, University of Padova, I‑35128 Padova, Italy
| |
Collapse
|
31
|
Reingold RE, O'Hara MA, Levin LE. Skin Lesions on Sensitive Sites: Mimickers of Sexual Abuse in Children. Pediatr Rev 2022; 43:e15-e19. [PMID: 35641453 DOI: 10.1542/pir.2020-004317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Mandy A O'Hara
- Department of Pediatrics and.,New York-Presbyterian Hospital, New York, NY
| | - Laura E Levin
- Department of Dermatology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY.,New York-Presbyterian Hospital, New York, NY
| |
Collapse
|
32
|
An Evaluation of Choroidal and Retinal Nerve Fiber Layer Thicknesses Using SD-OCT in Children with Childhood IgA Vasculitis. Diagnostics (Basel) 2022; 12:diagnostics12040901. [PMID: 35453949 PMCID: PMC9029835 DOI: 10.3390/diagnostics12040901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: We aimed to evaluate choroidal and retinal nerve fiber layer (RNFL) thicknesses in children undergoing the childhood IgA vasculitis (IgAV). Methods: Fifty-two patients with IgAV aged 1−6 years and 54 healthy children were included. Cases’ age, sex, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), RNFL thicknesses, and choroidal thickness values were recorded. Results: Median foveal center choroidal thickness was 374.0 µm (315.0 to 452.0 µm) in the IgAV group and 349.5 µm (285.0 to 442.0 µm) in the control group (p = 0.001). Median average RNFL thickness was 110.0 µm (91.0 to 134.0 µm) in the IgAV group and 104.0 µm (89.0 to 117.0 µm) in the control group (p < 0.001). Choroidal and RNFL thicknesses were significantly greater in all quadrants in the IgAV group than in the control group. No correlation was determined between ESR or CRP and foveal center choroidal and average RNFL thicknesses. Conclusions: Our findings show that choroidal and RNFL thicknesses increased significantly in children undergoing childhood IgA vasculitis compared to the healthy control group. These findings show that the choroid and RNFL are also affected by the inflammatory process in IgAV, which is a systemic vasculitis. We think that the choroidal and RNFL thicknesses can be used as a biomarker for childhood IgAV.
Collapse
|
33
|
Bazzi N, Salloum A, Chebl JA, Hreibe W, Bazzi M, Fiani E, Benedetto A, Moussa M. Juvenile gangrenous vasculitis of the scrotum: systematic review. Int J Dermatol 2022; 61:1364-1371. [PMID: 35323998 DOI: 10.1111/ijd.16066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/21/2021] [Accepted: 12/30/2021] [Indexed: 11/29/2022]
Abstract
Juvenile gangrenous vasculitis of the scrotum (JGVS) is a rare entity with scant reports in the literature. The disease course, treatment, and prevalence have not been well described in the literature. It's hypothesized that JGVS is a variant of pyoderma gangrenosum or a male counterpart of Lipschütz ulcer. This review will analyze the current literature on JGVS and provide a current guide based on the best available data. The initial search of databases yielded 107 studies of which 14 pertained to the topic. The majority of the included studies were case reports (n = 9) reported in Spain. A total of 17 patients were included in the study. The mean age of patients was 22.45 years (range, 13-35 years). The majority of patients presented with multiple, acute, painful, well-circumscribed, round scrotal ulcerations. The majority of patients presented with flu-like symptoms. An increased level of awareness of JGVS diagnosis is now warranted among physicians. Despite the analogies with Lipschütz ulcer, we believe that JGVS is a distinct entity.
Collapse
Affiliation(s)
- Nagham Bazzi
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Antoine Salloum
- Dermatologic SurgiCenter, Philadelphia, PA, USA.,Roger Williams Medical Center, Providence, RI, USA
| | - Joanna Abi Chebl
- Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Walid Hreibe
- Faculty of Medicine, Plastic Surgery Department, Lebanese University, Beirut, Lebanon
| | - Mariam Bazzi
- Faculty of Public health, Saint Joseph University, Beirut, Lebanon
| | - Elias Fiani
- Saint George Hospital University Medical Center, Beirut, Lebanon.,Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Anthony Benedetto
- Dermatologic SurgiCenter, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | - Mohamad Moussa
- Urology Department, Al Zahraa Hospital University Medical Center, Jnah, Lebanon.,Urology Department, Lebanese University, Beirut, Lebanon
| |
Collapse
|
34
|
Cavalli S, Lonati PA, Gerosa M, Caporali R, Cimaz R, Chighizola CB. Beyond Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome: The Relevance of Complement From Pathogenesis to Pregnancy Outcome in Other Systemic Rheumatologic Diseases. Front Pharmacol 2022; 13:841785. [PMID: 35242041 PMCID: PMC8886148 DOI: 10.3389/fphar.2022.841785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/27/2022] [Indexed: 12/17/2022] Open
Abstract
Evidence about the relevance of the complement system, a highly conserved constituent of the innate immunity response that orchestrates the elimination of pathogens and the inflammatory processes, has been recently accumulated in many different rheumatologic conditions. In rheumatoid arthritis, complement, mainly the classical pathway, contributes to tissue damage especially in seropositive subjects, with complement activation occurring in the joint. Data about complement pathways in psoriatic arthritis are dated and poorly consistent; among patients with Sjögren syndrome, hypocomplementemia exerts a prognostic role, identifying patients at risk of extra-glandular manifestations. Hints about complement involvement in systemic sclerosis have been recently raised, following the evidence of complement deposition in affected skin and in renal samples from patients with scleroderma renal crisis. In vasculitides, complement plays a dual role: on one hand, stimulation of neutrophils with anti-neutrophil cytoplasmic antibodies (ANCA) results in the activation of the alternative pathway, on the other, C5a induces translocation of ANCA antigens, favouring the detrimental role of antibodies. Complement deposition in the kidneys identifies patients with more aggressive renal disease; patients with active disease display low serum levels of C3 and C4. Even though in dermatomyositis sC5b-9 deposits are invariably present in affected muscles, data on C3 and C4 fluctuation during disease course are scarce. C3 and C1q serum levels have been explored as potential markers of disease activity in Takayasu arteritis, whereas data in Behçet disease are limited to in vitro observations. Pregnancies in women with rheumatologic conditions are still burdened by a higher rate of pregnancy complications, thus the early identification of women at risk would be invaluable. A fine-tuning of complement activation is required from a physiological progression of pregnancy, from pre-implantation stages, through placentation to labour. Complement deregulation has been implicated in several pregnancy complications, such as recurrent abortion, eclampsia and premature birth; low complement levels have been shown to reliably identify women at risk of complications. Given its physiologic role in orchestrating pregnancy progression and its involvement as pathogenic effector in several rheumatologic conditions, complement system is an attractive candidate biomarker to stratify the obstetric risk among women with rheumatologic conditions.
Collapse
Affiliation(s)
- Silvia Cavalli
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Paola Adele Lonati
- Experimental Laboratory of Immunorheumatological Researches, IRCCS Istituto Auxologico Italiano, Cusano Milanino, Italy
| | - Maria Gerosa
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Clinical Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| | - Cecilia Beatrice Chighizola
- Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan, Milan, Italy.,Pediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
| |
Collapse
|
35
|
Trevisan G, Trevisini S, Bergamo S, DI Meo N, Bonin S, Ruscio M, Marini M, Gaggino A, Urban F, Pascazio L. Adamantiades-Behçet disease: from clinical heterogeneity to diagnosis during the COVID-19 pandemic. Minerva Cardiol Angiol 2022; 70:502-521. [PMID: 35212505 DOI: 10.23736/s2724-5683.21.05847-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adamantiades-Behçet Disease (ABD) is a systemic disease with vasculitis, characterised by recurrent oral aphthosis and ocular, cutaneous, articular, vascular, cardiopulmonary manifestations and it is mainly found in the territories of the antique "silk road. ABD pathogenesis remains unknown although genetic, infectious and environmental factors seem to be implicated in the development of the disease, which is considered an auto-inflammatory condition. COVID-19 infection can present some symptoms, in particular at the level of oral and pulmonary mucosa, which require a differential diagnosis with ABD. Furthermore, the immunological alterations of this disease, and the drugs used for its treatment could influence the infection by COVID-19, and its clinical evolution. Nevertheless, vaccination anti-COVID-19 is recommended in ABD patients. The most commonly used diagnostic criteria for ABD are those established in 2014 by the International Team for the Revision of the International Criteria for BD (ITR-ICBD). Furthermore, criteria for disease severity according to the Overall Damage Index of Behçet's syndrome (BODI) have recently been proposed in order to quantify the severity of the disease as well as the evolution during follow-up. In ABD patients it is mandatory to investigate on the presence of active/latent tuberculosis, because of the common organ involvement, such as eyes and bowel. ABD has a high morbidity and low mortality, sometimes linked to the rupture of an arterial aneurysm and/or neurological complications. This article is based on a general review on ABD ranging from the history of ABD to possible causes and clinical manifestations. A specific section has been dedicated to the COVID-19 pandemic.
Collapse
Affiliation(s)
- Giusto Trevisan
- DSM Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Sara Trevisini
- ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Serena Bergamo
- AULSS 2 Marca Trevigiana, Ospedale Ca' Foncello, Treviso, Italy
| | - Nicola DI Meo
- ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Serena Bonin
- DSM Department of Medical Sciences, University of Trieste, Trieste, Italy -
| | - Maurizio Ruscio
- ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | | | - Andrea Gaggino
- DSM Department of Medical Sciences, University of Trieste, Trieste, Italy.,ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Flavia Urban
- ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| | - Lorenzo Pascazio
- DSM Department of Medical Sciences, University of Trieste, Trieste, Italy.,ASUGI Azienda Sanitaria Universitaria Integrata Giuliano Isontina, Trieste, Italy
| |
Collapse
|
36
|
Trevisini S, Trevisan G, Zalaudek I, Bonin S. Adamantiades-Behçet's disease therapy - current treatment options and recommendations with regard to the COVID-19 pandemic. Dermatol Ther 2021; 35:e15286. [PMID: 34962035 DOI: 10.1111/dth.15286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/09/2021] [Accepted: 12/25/2021] [Indexed: 11/29/2022]
Abstract
Adamantiades-Behçet's disease (ABD) is a chronic, idiopathic, relapsing immune-mediate disease that may involve multiple organs. It is characterized by recurrent oral and genital ulcers, skin lesions, ocular, gastrointestinal, vascular, neurological and joint involvement. It can lead to significant morbidity and mortality. Due to its heterogeneity in clinical findings and physiopathology, its treatment can be various as ABD manifestations in different organs may differently respond to the same drug. The cornerstone of therapy for inducing remission is systemic corticosteroid, whereas immunomodulatory and immunosuppressive agents such as colchicine, azathioprine, cyclosporine-A, interferon-alpha, and cyclophosphamide are used as steroid-sparing agents and to prevent relapses. For aggressive, refractory or frequently relapsing cases, tumor necrosis factor (TNF) alpha inhibitors (infliximab, adalimumab, etanercept) have been reported beneficial. Herein, we describe our experience of 7 patients treated with TNF-alpha inhibitors with recommendations regarding treatment choice during the COVID-19 era. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Sara Trevisini
- Unit of Dermatology and Venereology, ASUGI, Trieste, Italy
| | - Giusto Trevisan
- Department of Medical Sciences, Unit of Dermatology- University of Trieste, Trieste, Italy
| | - Iris Zalaudek
- Unit of Dermatology and Venereology, ASUGI, Trieste, Italy.,Department of Medical Sciences, Unit of Dermatology- University of Trieste, Trieste, Italy
| | - Serena Bonin
- Department of Medical Sciences, Unit of Dermatology- University of Trieste, Trieste, Italy
| |
Collapse
|
37
|
Manfredini M, Guida S, Giovani M, Lippolis N, Spinas E, Farnetani F, Dattola A, Di Matteo E, Pellacani G, Giannetti L. Recurrent Aphthous Stomatitis: Treatment and Management. Dermatol Pract Concept 2021; 11:e2021099. [PMID: 34631263 DOI: 10.5826/dpc.1104a99] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 10/31/2022] Open
Abstract
Background Recurrent aphthous stomatitis consists of the presence of abrasions or ulcerations located on mucosae (oral or genital). Objectives The aim of this article is to review the current literature providing the main causes related to recurrent aphthous stomatitis and insights into treatment and management of this clinical condition. Methods Articles matching terms that correlated with "recurrent aphthous stomatitis" were searched on PubMed, EMBASE, and Cochrane Library and selected according to their pertinence. Results Several forms of aphthous stomatitis have been described, based on the extent (minor, major), morphology (herpetiform) and associations to other signs (Behçet syndrome or more complex inflammatory syndromes). Topical as well as systemic treatments have been described to obtain a faster remission of the aphthosis or to reduce associated symptoms such as pain. Conclusions Recurrent aphthous stomatitis can have a mild-to-severe clinical appearance, being mainly localized on the oral mucosa or at the level of the genital area. Different strategies have been described so far for its management and treatment.
Collapse
Affiliation(s)
- Marco Manfredini
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefania Guida
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Matteo Giovani
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Lippolis
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Enrico Spinas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Francesca Farnetani
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annunziata Dattola
- Dermatology Clinic, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Eleonora Di Matteo
- Dermatology Clinic, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giovanni Pellacani
- Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Giannetti
- Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, Dental Unit, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
38
|
Shenoi SJ, Baker EJ. Using hierarchical similarity to examine the genetics of Behçet's disease. BMC Res Notes 2021; 14:353. [PMID: 34507623 PMCID: PMC8434716 DOI: 10.1186/s13104-021-05767-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Behçet's disease (BD) is a multisystem inflammatory disease that affects patients along the historic silk road. Thus far, the pathogenesis of the disease has proved elusive due to the complex genetic interactions of the disease. In this paper, we seek to clarify the genetic factors of the disease while also uncovering other diseases of interest that present with a similar genotype as BD. RESULTS To do this, we employ a convergent functional genomics approach by leveraging the hierarchical similarity tool available in Geneweaver. Through our analysis, we were able to ascertain 7 BD consensus genes and 16 autoimmune diseases with genetic overlap with BD. The results of our study will inform further research into the pathogenesis of Behçet's disease.
Collapse
Affiliation(s)
- Samuel J. Shenoi
- Department of Computer Science, Baylor University, One Bear Place, Waco, TX USA
| | - Erich J. Baker
- Department of Computer Science, Baylor University, One Bear Place, Waco, TX USA
| |
Collapse
|
39
|
Nowowiejska J, Baran A, Krahel JA, Flisiak I. Behçet's Disease in a Polish Patient: A Case Report. Dermatol Ther (Heidelb) 2021; 11:1435-1441. [PMID: 34053033 PMCID: PMC8322377 DOI: 10.1007/s13555-021-00551-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/07/2021] [Indexed: 12/01/2022] Open
Abstract
Behçet's disease (BD) is a systemic autoinflammatory vasculitis. It occurs predominantly in Turkey but very rarely in Europe. The clinical manifestations of BD involve the skin and mucosal membranes; cardiovascular, gastrointestinal and nervous systems; and the eyes and joints. A 26-year-old man was repeatedly hospitalized at the Department of Dermatology of the Medical University of Bialystok. He had a family history of family members' deaths from unknown cause and a long personal history of recurring headaches and nonspecific pain in the chest as well as a 2-year history of recurring painful erosions on the oral mucosa. Recently, before admission to hospital, another erosion had appeared on the scrotum, which rapidly evolved into a painful ulceration. The patient also presented a large erosion in the area of the right hip and acne lesions. He consulted doctors of different specialties and underwent laboratory and imaging tests. Considering the symptoms, BD was diagnosed. Azathioprine was introduced, along with topical treatment. Great improvement of the skin lesions was achieved. He was later admitted to the department a few times for follow-up visits and remains in good general condition. BD is an extremely rare disease in Europe, especially in Poland. The fact that BD is a rare disease outside Asia leads to lower awareness and the possibility of not considering it in the differential diagnosis. The great diversity of symptoms also causes difficulties in tracking this disease. The various manifestations of BD require a broad spectrum of additional tests and an interdisciplinary approach to the patient.
Collapse
Affiliation(s)
- Julia Nowowiejska
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Anna Baran
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Julita A. Krahel
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| | - Iwona Flisiak
- Department of Dermatology and Venereology, Medical University of Bialystok, Zurawia 14 St, 15-540 Białystok, Poland
| |
Collapse
|
40
|
Neuroimaging findings in rheumatologic disorders. J Neurol Sci 2021; 427:117531. [PMID: 34130065 DOI: 10.1016/j.jns.2021.117531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/12/2021] [Accepted: 06/02/2021] [Indexed: 01/06/2023]
Abstract
Patients with rheumatological diseases may present with neurological manifestations of peripheral and/or central nervous system (CNS). Symptoms may be related to underlying rheumatological disease or CNS effects of immune-modulating drugs. Early diagnosis and therapy may help prevent serious complications. Magnetic resonance imaging (MRI), given its excellent soft tissue details, is the preferred imaging modality when evaluating patients with rheumatological disease and suspected CNS involvement. We present a review of the neuroimaging manifestations of various rheumatic diseases with emphasis on the imaging findings on MRI.
Collapse
|
41
|
Vestibular ulceration in a 20-year-old woman. J Am Dent Assoc 2021; 153:382-387. [PMID: 34049677 DOI: 10.1016/j.adaj.2021.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 11/22/2022]
|
42
|
Sbroglio LL, Araújo KMD, Santos BPLD, Gripp AC. Case for diagnosis. Ulcerated lesions: a diagnostic challenge in Behçet's syndrome. An Bras Dermatol 2021; 96:494-496. [PMID: 34034946 PMCID: PMC8245713 DOI: 10.1016/j.abd.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 11/17/2022] Open
Abstract
This study reports the clinical case of a 42-year-old patient with ulcerated lesions who was followed up by general practitioners with the diagnosis of recurrent cellulitis. However, when referred to the Dermatology division a diagnosis of Behçet's syndrome was established based on clinical criteria. Although there are defined clinical criteria for this syndrome, sometimes its diagnosis can be challenging, due to lack of knowledge of the disease and extremely heterogeneous clinical phenotype. The authors highlight the potential difficulties in establishing the diagnosis considering the multiple clinical findings during the investigation process, contributing to the risk of increased morbidity and mortality.
Collapse
Affiliation(s)
- Lissiê Lunardi Sbroglio
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Karin Milleni de Araújo
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Bianca Passos Leite Dos Santos
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Alexandre Carlos Gripp
- Department of Dermatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
43
|
Ball E, O'Kane D, McCourt C, McCarron M, Riddell C. Severe breast ulceration in Behcet's treated with cyclophosphamide: A Case Report. Rheumatology (Oxford) 2021; 60:e365-e366. [PMID: 33895802 DOI: 10.1093/rheumatology/keab379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Elisabeth Ball
- Belfast Health & Social Care Trust, Musgrave Park Hospital, Stockman's Lane, Belfast, Northern Ireland, BT9 7JB . ORCID ID 0000-0002-2263-7518
| | - Donal O'Kane
- Belfast Health & Social Care Trust, Dept of Dermatology, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
| | - Collette McCourt
- Dept of Dermatology, Belfast City Hospital, Belfast, Northern Ireland, BT9 7AB
| | - Maura McCarron
- Belfast Health & Social Care Trust, Dept of Dermatology, Royal Victoria Hospital, Belfast, Northern Ireland, BT12 6BA
| | - Claire Riddell
- Belfast Health & Social Care Trust, Musgrave Park Hospital, Stockman's Lane, Belfast, Northern Ireland, BT9 7JB . ORCID ID 0000-0002-2263-7518
| |
Collapse
|
44
|
Pólos M, Koppányi Á, Benke K, Daróczi L, Oláh A, Heltai K, Kiss E, Fintha A, Nagy B, Hartyánszky I, Lakatos B, Kovács A, Merkely B, Szabolcs Z. Behçet's disease: successful aortic root reconstruction in severely dilated aortoventricular junction after aortic valve replacement with novel surgical method - case report. J Cardiothorac Surg 2021; 16:85. [PMID: 33858452 PMCID: PMC8048072 DOI: 10.1186/s13019-021-01467-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 04/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Behçet’s disease is an auto-inflammatory disorder categorized as a primer systemic vasculitis of unknown aetiology. Genetic factors, infectious agents and the irregularity of T-cell homeostasis are presumed to be responsible for the emergence of Behçet’s disease. Characteristic symptoms are multisystemic. Although cardiovascular involvement is rare, it should be noted due to the difficulty of surgical treatment options. Case presentation Our 44-year-old male patient underwent aortic valve replacement due to aortic regurgitation. At the 15-month follow-up, echocardiography showed detachment of the prosthetic valve and in the aortic root, multiple pseudo-aneurysms were identified. We performed an aortic root reconstruction with a Bentall procedure using a special „skirted” conduit to reduce strain in the suture line between the conduit and the extremely dilated left ventricular outflow tract. Conclusions The surgical treatment of cardiovascular manifestations of Behçet’s disease remains challenging. This new technique may be beneficial in well-selected cases where the annulus of the aorta is extremely dilated or annular tissue disorder is present.
Collapse
Affiliation(s)
- Miklós Pólos
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary.
| | - Ádám Koppányi
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Kálmán Benke
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - László Daróczi
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Attila Oláh
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Krisztina Heltai
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Emese Kiss
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - Attila Fintha
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Beáta Nagy
- First Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Hartyánszky
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Bálint Lakatos
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Attila Kovács
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Béla Merkely
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| | - Zoltán Szabolcs
- Semmelweis University, Heart and Vascular Center, Varosmajor 68, Budapest, H-1122, Hungary
| |
Collapse
|
45
|
Wang Z, Cao H, Xiong J, Lu Y, Deng Y, Nan H, Zheng S, Ye H, Cao Z. Recent advances in the aetiology of recurrent aphthous stomatitis (RAS). Postgrad Med J 2021; 98:57-66. [PMID: 33574180 DOI: 10.1136/postgradmedj-2020-139421] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022]
Abstract
Recurrent aphthous stomatitis (RAS) is the most common disease of oral mucosa, which almost attacks each individual once in their lifespan. Although plenty of factors have been suggested to play a role in the pathogenesis of RAS, the aetiology of RAS is still controversial, which might lead to limited clinical therapies in accordance with each RAS patient. This review mainly illustrates recent advances in potential causes associated with RAS in detail. Deeper comprehension of the aetiology of RAS will support doctors and researchers to make a better management of RAS patients and to discover new treatments. The aetiology of RAS is complicated, hence we should take a comprehensive view into its aetiology, with multiple potential factors being considered. Sample collection of RAS patients have greatly limited the progress in the aetiology of RAS. A research model of multiagency cooperation can help achieve perfect sample collection of year-round and multiposition.
Collapse
Affiliation(s)
- Zihan Wang
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Haibo Cao
- Clinical Medicine School, Hebei University of Engineering, Handan, China
| | - Jianqi Xiong
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Yilong Lu
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Yixiao Deng
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Han Nan
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Shutian Zheng
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| | - Hui Ye
- Department of Biochemistry, School of Basic Medical Sciences, Wenzhou Medical University, Wenzhou, China
| | - Zhensheng Cao
- School of Stomatology, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
46
|
Yildiz M, Haslak F, Adrovic A, Sahin S, Koker O, Barut K, Kasapcopur O. Pediatric Behçet's Disease. Front Med (Lausanne) 2021; 8:627192. [PMID: 33614684 PMCID: PMC7886701 DOI: 10.3389/fmed.2021.627192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Behçet's Disease (BD) is a systemic vasculitis firstly described as a disorder causing aphthous lesion in oral and genital mucosae and uveitis. The disease has an extremely unique distribution characterized by the highest incidence in communities living along the historical Silk road. Although our understanding of the etiopathogenesis of BD has expanded over time, there are still lots of unidentified points in the underlying mechanisms of the disease. The accepted opinion in the light of the current knowledge is that various identified and/or unidentified infectious and/or environmental triggers can take a role as a trigger in individuals with genetic susceptibility. Although the disease usually develops in young adulthood, it is reported that about 15-20% of all Behçet's patients develop in childhood. Pediatric BD differs from adult BD not only with the age of onset but also in the frequency and distribution of clinical findings, disease severity and outcome. While gastrointestinal system involvement, neurological findings, arthralgia and positive family history are more common in children, genital lesions and vascular lesions are more common in adult patients. In addition, a better disease outcome with lower severity score and activity index has been reported in children. The diagnosis of the disease is made according to clinical findings. It can be challenging to diagnose the disease due to the absence of a specific diagnostic test, and the long time interval from the first finding of the disease to the full-blown disease phenotype in pediatric cases. Therefore, many classification criteria have been proposed so far. The widely accepted ones are proposed by the International Study Group. The new sets of classification criteria which is the only one for pediatric BD were also developed for pediatric cases by the PEDBD group. The primary goal for the treatment is preventing the organ damages by suppressing the ongoing inflammation and forestalling the disease flares. The treatment of the BD can be onerous due to its multisystemic nature and a multidisciplinary approach is essential for the management of the patients. In this review article, the definition, clinical findings, epidemiology, etiopathogenesis, and treatment will be discussed.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
47
|
Zorba M, Melidou A, Patsatsi A, Ioannou E, Kolokotronis A. The possible role of oral microbiome in autoimmunity. Int J Womens Dermatol 2020; 6:357-364. [PMID: 33898698 PMCID: PMC8060669 DOI: 10.1016/j.ijwd.2020.07.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The human microbiome refers to the entire habitat, including microorganisms, their genomes and the surrounding environmental conditions of the microbial ecosystem. When the equilibrium between microbial habitats and host is disturbed, dysbiosis is caused. The oral microbiome (OMB) has been implicated in the manifestation of many intra- and extraoral diseases. Lately, there has been an intense effort to investigate and specify the relationship between microbial complexes, especially that of the oral cavity and intestine and autoimmunity. This study aimed to review the current literature about the possible role of the OMB in the pathogenesis of autoimmune diseases. METHODS We searched for published articles in English indexed in PubMed, Medline, Research Gate and Google Scholar using a search strategy that included terms for oral microbiome, autoimmune diseases, dysbiosis and next-generation sequencing. RESULTS An important number of articles were gathered and used for the description of the possible impact of dysbiosis of OMB in the pathogenesis of Sjögren's syndrome, systemic lupus erythematosus, rheumatoid arthritis, Behcet's disease, Crohn's disease and psoriasis. CONCLUSION This review article draws attention to the relationship between OMB and the triggering of a number of autoimmune diseases. Although this specific topic has been previously reviewed, herein, the authors review recent literature regarding the full list of nosological entities related to the OMB, point out the interaction between the microbiome and sex hormones with regard to their role in autoimmunity and discuss novel and promising therapeutic approaches for systemic autoimmune diseases. Furthermore, the question arises of whether the OMB is associated with oral bullous autoimmune diseases.
Collapse
Affiliation(s)
- Matina Zorba
- Department of Oral Medicine and Maxillofacial Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| | - Angeliki Melidou
- Department of Microbiology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Aikaterini Patsatsi
- Second Dermatology Department of Papageorgiou General Hospital, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Eleftheria Ioannou
- Department of Biological Applications and Technology, Aristotle University of Thessaloniki, Greece
| | - Alexandros Kolokotronis
- Department of Oral Medicine and Maxillofacial Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece
| |
Collapse
|
48
|
Successful combination therapy using adalimumab and 5-aminosalicylic acid for a resistant case of intestinal Behçet's disease. Z Rheumatol 2020; 79:702-706. [PMID: 32494950 DOI: 10.1007/s00393-020-00816-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Behçet's disease (BD) is a recurrent, multisystemic, inflammatory blood vessel disorder that can result in mouth, genital, and skin ulcers; arthritis; and eye and intestinal inflammation. We describe a 21-year-old Korean female patient with intestinal BD refractory to conventional medical treatment and biologic drugs. The patient was initially treated with high-dose steroids and sulfasalazine. Two months later, a skin rash occurred as a side effect of sulfasalazine. Therefore, infliximab (IFX) was administered, and disease activity decreased. However, IFX also induced a skin rash; hence, the patient was switched to adalimumab. After 12 months, the patient experienced a relapse of intestinal BD. Hence, treatment was initiated using a combination of methotrexate and adalimumab; however, this treatment was ineffective. Methotrexate was discontinued and replaced with 5‑aminosalicylic acid while maintaining adalimumab, and no recurrence has been observed to date. We report this novel strategy involving the use of anti-tumor necrosis factor‑α agents for patients with resistant BD; however, further large cohort studies are required to verify its usefulness.
Collapse
|
49
|
Ekinci RMK, Esen E, Erol AH, Sızmaz S, Karagoz D, Altintas DU, Balcı S. Evaluation of different classification criteria in children with Behcet disease: results from a single referral center. Expert Rev Clin Immunol 2020; 16:1093-1097. [PMID: 33047996 DOI: 10.1080/1744666x.2021.1834853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Behcet Disease (BD) is a systemic vasculitis, first described with a triad of oral aphthous ulcers, genital ulcers, and uveitis. The authors aimed to share the clinical properties and utilities of three distinct classification criteria for BD in this study. METHODS This case-control study was conducted in pediatric BD patients, diagnosed between January 2012 and July 2019. The control group included 53 children with other rheumatic disorders. Sensitivity and specificity for International Study Group (ISG), International Criteria for BD (ICBD), and pediatric criteria for BD (PEDBD) criteria were tested. RESULTS The mean age at symptom onset and diagnosis of the 16 BD patients (6 females, 10 males) were 11.2 ± 3.6 and 13 ± 3.1 years, respectively. The sensitivity and specificity of ISG criteria were 87.5% and 100%. Furthermore, ICBD criteria had a sensitivity and specificity of 93.7% and 98.1%, whereas the authors found sensitivity and specificity as 93.7% and 96.2% for PEDBD. CONCLUSION ICBD and PEDBD reached higher sensitivity for pediatric BD diagnosis and ICBD had the highest specificity. The authors speculate that the utilization of ICBD may provide early diagnosis of BD in childhood, prevent related morbidities and misdiagnosis.
Collapse
Affiliation(s)
| | - Ebru Esen
- Department of Ophthalmology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ahmet Hakan Erol
- Department of Pediatrics, Cukurova University Faculty of Medicine , Adana, Turkey
| | - Selcuk Sızmaz
- Department of Ophthalmology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Dilek Karagoz
- Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine , Adana, Turkey
| | - Derya Ufuk Altintas
- Department of Pediatric Allergy and Immunology, Cukurova University Faculty of Medicine , Adana, Turkey
| | - Sibel Balcı
- Department of Pediatric Rheumatology, Cukurova University Faculty of Medicine , Adana, Turkey
| |
Collapse
|
50
|
Darjani A, Joukar F, Naghipour M, Asgharnezhad M, Mansour-Ghanaei F. Lifetime prevalence of recurrent aphthous stomatitis and its related factors in Northern Iranian population: The PERSIAN Guilan Cohort Study. Clin Oral Investig 2020; 25:711-718. [PMID: 33030579 DOI: 10.1007/s00784-020-03611-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Recurrent aphthous stomatitis (RAS) is one of the most prevalent oral inflammatory ulcerative lesions. The aim of this large population base study was estimated lifetime prevalence of RAS and its related factors among the Northern Iranian population. MATERIALS AND METHODS This study was conducted on 10,520 participants aged 35-70 years based on the PERSIAN Guilan Cohort Study (PGCS). Prevalence proportions and multivariate logistic regression models were constructed for lifetime RAS prevalence using the SPSS software. Data on potential correlates of RAS including demographic profiles, lifestyle habits, and self-reported past medical histories were obtained. RESULTS The lifetime prevalence of RAS was 8.3%. Multivariate logistic models showed that urbanization (adjusted odds ratio (AOR) = 1.2) and having a history of systemic disease, including rheumatic disease (AOR = 2.1), genital aphthous disease (AOR = 11.7), depression (AOR = 1.3), chronic headaches (AOR = 1.8), diabetes mellitus (AOR = 1.6), and epilepsy (AOR = 2), were independent predictors of RAS. In addition, smokers (AOR = 0.5) and individuals older than 50 years of age (AOR = 0.8) were less likely to have a history of RAS. The lifetime prevalence of RAS among the Northern Iranian population was relatively low. CONCLUSIONS It seems that predisposing factors, such as younger age, urbanization, and systemic disease, including rheumatic disease, genital aphthous disease, depression, chronic headaches, diabetes mellitus, epilepsy, and not smoking, could contribute to RAS prevalence.
Collapse
Affiliation(s)
- Abbas Darjani
- Department of Dermatology, School of Medicine Guilan University of Medical Sciences, Rasht, Iran
| | - Farahnaz Joukar
- GI Cancer Screening and Prevention Research center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammareza Naghipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences , Razi Hospital, Sardar-Jangle Ave., Rasht, 41448-95655, Iran
| | - Mehrnaz Asgharnezhad
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences , Razi Hospital, Sardar-Jangle Ave., Rasht, 41448-95655, Iran
| | - Fariborz Mansour-Ghanaei
- GI Cancer Screening and Prevention Research center and Caspian Digestive Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. .,Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences , Razi Hospital, Sardar-Jangle Ave., Rasht, 41448-95655, Iran.
| |
Collapse
|