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Zhu K, Lv F, Hou X, Wang F, Pang L, Zhong M. Thrombosis in vasculitis: An updated review of etiology, pathophysiology, and treatment. Heliyon 2024; 10:e30615. [PMID: 38975109 PMCID: PMC11225688 DOI: 10.1016/j.heliyon.2024.e30615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Thromboembolic disease is a complication of many vasculitides. A common observation is that thromboembolic events coincide with the period of vasculitic disease, but the mechanism by which this occurs remains unclear. Inflammatory thrombosis is now recognized as a symptom of arteritis rheumatic, and vasculitides such as Behçet's syndrome (BS), and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) or giant cell arteritis (GCA). This systematic review aimed to explain recent findings related to etiology, pathophysiology, and treatment methods for BS, AAV, and medium/large-vessel vasculitis. Methods A comprehensive literature search on English sources from PubMed, Scopus, MEDLINE, Science Direct, ProQuest, AIM, CINAHIL, and ELDIS databases was used to find the relevant articles and reports. The relevant papers (having full text) were obtained until June 2023. Two independent reviewers screened the titles and abstracts of the obtained articles, and a third arbitrator resolved disputes between the reviewers. Results and conclusion It is becoming increasingly clear that certain systemic inflammatory diseases, like vasculitis, are linked to a higher risk of both venous and arterial thrombosis. An increased incidence of thromboembolic disease in AAV has been noted, particularly during times of active disease. Growing evidence supports the use of immunosuppression in the management of venous thrombosis in vasculitis. These patients also have a higher risk of developing ischemic disease.
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Affiliation(s)
- Kai Zhu
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Lv
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Xiangqian Hou
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Feng Wang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Linbin Pang
- Department of Vascular Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou City, 2530000, China
| | - Miqian Zhong
- Department of Hematopathology, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, 2530000, China
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Teshigawara T, Meguro A, Takeuchi M, Ishido M, Soejima Y, Hirahara L, Kirino Y, Ohno S, Mizuki N. Replication Study of the Association of GAS6 and PROS1 Polymorphisms with Behçet's Disease in a Japanese Population. Ocul Immunol Inflamm 2024; 32:447-453. [PMID: 37133403 DOI: 10.1080/09273948.2023.2173239] [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: 02/10/2022] [Accepted: 01/22/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate whether polymorphisms of GAS6 and PROS1, which each encode protein ligands for a family of tyrosine kinase receptors, are associated with Behçet's disease (BD) in a Japanese population. METHODS We recruited 734 Japanese patients with BD and 1789 Japanese healthy controls. In all participants, we genotyped two single-nucleotide polymorphisms (SNPs) reportedly associated with BD: rs9577873 in GAS6 and rs4857037 in PROS1. RESULTS We found that GAS6 rs9577873 was not significantly associated with BD. In contrast, PROS1 rs4857037, specifically the A allele, was associated with increased risk for BD. The A allele was also significantly associated with BD under additive and recessive genetic models. Expression analysis revealed that this allele was significantly associated with increased PROS1 expression. CONCLUSIONS Our findings suggest that increased PROS1 expression related to the A risk allele of rs4857037 affects tyrosine kinase receptor signaling, contributing to the development of BD.
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Affiliation(s)
- Takeshi Teshigawara
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Ophthalmology, Yokosuka Chuoh Eye Clinic, Yokosuka, Japan
- Department of Ophthalmology, Tsurumi Chuoh Eye Clinic, Yokohama, Japan
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mizuho Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Lisa Hirahara
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Advanced Medicine for Ocular Diseases, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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3
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Washington J, Ritch R, Liu Y. Homocysteine and Glaucoma. Int J Mol Sci 2023; 24:10790. [PMID: 37445966 DOI: 10.3390/ijms241310790] [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: 04/08/2023] [Revised: 06/10/2023] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Elevated levels of homocysteine (Hcy), a non-proteinogenic amino acid, may lead to a host of manifestations across the biological systems, particularly the nervous system. Defects in Hcy metabolism have been associated with many neurodegenerative diseases including glaucoma, i.e., the leading cause of blindness. However, the pathophysiology of elevated Hcy and its eligibility as a risk factor for glaucoma remain unclear. We aimed to provide a comprehensive review of the relationship between elevated Hcy levels and glaucoma. Through a systemic search of the PubMed and Google Scholar databases, we found that elevated Hcy might play an important role in the pathogenesis of glaucoma. Further research will be necessary to help clarify the specific contribution of elevated Hcy in the pathogenesis of glaucoma. A discovery and conceptual understanding of Hcy-associated glaucoma could be the keys to providing better therapeutic treatment, if not prophylactic treatment, for this disease.
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Affiliation(s)
- Joshua Washington
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Robert Ritch
- New York Eye & Ear Infirmary, New York, NY 10003, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, 4 Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
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Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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5
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Merashli M, Bucci T, Pastori D, Pignatelli P, Arcaro A, Gentile F, Marottoli V, Ames PRJ. Plasma Homocysteine in Behcet's Disease: A Systematic Review and Meta-Analysis. Thromb Haemost 2022; 122:1209-1220. [PMID: 34996122 DOI: 10.1055/s-0041-1740637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To evaluate the relevance of plasma homocysteine (HC) in Behcet's disease (BD) and its clinical manifestations. METHODS Systematic review of EMBASE and PubMed databases according to PRISMA guidelines from inception to July 2021; random-effects meta-analyses for continuous outcomes. RESULTS The search strategy retrieved 48 case-control (2,669 BD and 2,245 control participants) and 5 cohort studies (708 BD participants). Plasma HC was higher in BD than in controls (p < 0.0001) with wide heterogeneity (I2 = 89.7%) that remained unchanged after sensitivity analysis according to year of article publication, age of BD participants, study size, study quality, method of HC determination, and male/female ratio >1.5; some pooled ethnicities explained a small part of the heterogeneity (I2 = 16.3%). Active BD participants had higher HC than inactive ones (p < 0.0001), with moderate heterogeneity (I2 = 49.2%) that disappeared after removal of an outlier study with very high disease activity. BD participants with any vascular involvement had higher HC than those without (p < 0.0001) with wide heterogeneity (I2 = 89.7%); subgroup analysis on venous thrombosis only changed neither effect size (p < 0.0001) nor heterogeneity (I2 = 72.7%). BD participants with ocular involvement had higher HC than those without (p < 0.0001) with moderate heterogeneity (I2 = 40.3%). CONCLUSION Although causality cannot be inferred, the consistency of the elevation of plasma HC in BD, particularly in patients with active disease, with vascular and ocular involvement suggests an intrinsic involvement of HC in these clinical manifestations.
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Affiliation(s)
- Mira Merashli
- Department of Rheumatology, American University of Beirut, Bliss, Beirut, Lebanon
| | - Tommaso Bucci
- Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini," Sapienza University of Rome, Rome, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Pasquale Pignatelli
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessia Arcaro
- Department of Medicine and Health Sciences 'V. Tiberio', Università del Molise, Campobasso, Italy
| | - Fabrizio Gentile
- Department of Medicine and Health Sciences 'V. Tiberio', Università del Molise, Campobasso, Italy
| | | | - Paul R J Ames
- Immune Response and Vascular Disease Unit, CEDOC, Nova University Lisbon, Rua Camara Pestana, Lisbon Portugal.,Department of Haematology, Dumfries Royal Infirmary, Cargenbridge, Dumfries, United Kingdom
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6
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Du L, Wang P, Liu C, Li S, Yue S, Yang Y. Multisystemic manifestations of IgA vasculitis. Clin Rheumatol 2020; 40:43-52. [PMID: 32557258 DOI: 10.1007/s10067-020-05166-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 01/27/2023]
Abstract
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein Purpura, is one of the most common kind of systemic vasculitis in children, and due to the involvement of small blood vessels throughout the body, this disease can cause a variety of symptoms in different organs. Our aim was to review the data on various systemic manifestations of IgAV. A research of the literature was performed in PubMed database, utilizing the MeSH terms "IgA vasculitis" and "Henoch Schönlein Purpura". According to the predetermined structure of the manuscript, we extracted and sorted out the relevant data. Clinically, almost all the patients will present with palpable skin purpura, together with arthritis, gastrointestinal tract involvement, or kidney damage. Other rare systemic manifestations include neurological symptoms, scrotal involvement, and cardiopulmonary disease. When uncommon complications occur, patients may be misdiagnosed as other diseases, thus delaying treatment. Although the course of IgAV is mostly self-limited, misdiagnosis can also lead to a poor prognosis. A comprehensive awareness to the clinical manifestations of IgAV is the necessary prerequisite for its timely diagnosis. Prompt diagnosis and adequate treatment are essential for optimal results.
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Affiliation(s)
- Lina Du
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Panpan Wang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Chang Liu
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Shaojing Li
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Shuang Yue
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China
| | - Yan Yang
- Department of Chinese Medicine, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, No. 56 Nanlishi Road, Beijing, 100045, China.
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Lazzerini P, Capecchi P, Selvi E, Lorenzini S, Bisogno S, Galeazzi M, Laghi Pasini F. Hyperhomocysteinemia: a cardiovascular risk factor in autoimmune diseases? Lupus 2016; 16:852-62. [DOI: 10.1177/0961203307084176] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Epidemiological studies conducted over the past 25 years have provided ample support for the association of mild hyperhomocysteinemia (HHcy) with an elevated risk of atherothrombosis. Since autoimmune disorders (AD) are frequently associated with relevant and early signs of atherothrombotic damage not adequately explained by the traditional risk factors involved in the onset of cardiovascular disease (CVD), a large interest has been shown to the putative role of mild HHcy in this setting. On the basis of such considerations, we focused the attention on the relationship between homocysteine (Hcy) and CVD in patients affected with autoimmune diseases, reviewing the most recent literature data and also providing our original experience. Although the large amount of available studies clearly shows that HHcy represents a common finding in patients affected with several autoimmune diseases, the actual role of Hcy in the development of CVD in the course of AD is not clear yet, perhaps, with the only exception of the systemic lupus erythematosus. In the other conditions, the role of Hcy in the pathogenesis of vascular complications is still a matter of debate, as the result of conflicting reports and/or lack of an adequate body of investigation. Lupus (2007) 16, 852—862.
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Affiliation(s)
- P.E. Lazzerini
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
| | - P.L. Capecchi
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
| | - E. Selvi
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - S. Lorenzini
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - S. Bisogno
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - M. Galeazzi
- Rheumatology, Department of Clinical Medicine and Immunological Sciences, University of Siena, Siena, Italy
| | - F. Laghi Pasini
- Divisions of Clinical Immunology, University of Siena, Siena, Italy
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8
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Seyahi E, Cakmak OS, Tutar B, Arslan C, Dikici AS, Sut N, Kantarci F, Tuzun H, Melikoglu M, Yazici H. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome: An Observational Study. Medicine (Baltimore) 2015; 94:e1899. [PMID: 26554787 PMCID: PMC4915888 DOI: 10.1097/md.0000000000001899] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes.All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed.Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS.Lower-extremity vein thrombosis associated with BS, when compared to LEVT due to other causes, had distinctive demographic and ultrasonographic characteristics, and had clinically a more severe disease course.
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Affiliation(s)
- Emire Seyahi
- From the Division of Rheumatology, Department of Medicine (ES, MM, HY); Department of Medicine (OSC); Department of Radiology (BT, ASD, FK); Department of Cardiovascular Surgery, Cerrahpaşa Medical Faculty, University of Istanbul, Istanbul (CA, HT); and Department of Biostatistics, Medical Faculty, University of Trakya, Edirne, Turkey (NS)
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Ulusan Z, Karadag AS, Tasar M, Kalender M, Darcin OT. Behcet's disease and cardiovascular involvement: our experience of asymptomatic Behcet's patients. Cardiovasc J Afr 2015; 25:63-6. [PMID: 24844550 PMCID: PMC4026764 DOI: 10.5830/cvja-2014-003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 02/04/2014] [Indexed: 12/03/2022] Open
Abstract
Abstract Behcet’s syndrome is a systemic inflammatory disease associated with vasculitis, and arterial, venous and cardiac disorders. Thirty-eight Behcet’s disease patients were examined prospectively with echocardiography, ultrasonography and computed tomography, and coagulation parameters were determined. Deep venous insufficiency was found in 16 patients, venous thrombosis in seven, one patient had iliac artery stenosis, three had carotid arterial intimal proliferation, two patients had aortic annulus dilatation, six had aortic valve insufficiency, and three had mitral valve insufficiency. None had coagulation defects. To decrease morbidity and mortality rates, a multidisciplinary approach is important for early diagnosis of cardiovascular involvement in Behcet’s disease.
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Affiliation(s)
- Zeynep Ulusan
- Kecioren Research and Training Hospital, Ankara, Turkey.
| | - Ayse Serap Karadag
- Department of Dermatology, 100.yil University Medical School, Van, Turkey
| | - Mehmet Tasar
- Department of Surgery, Konya Education and Research Hospital, Konya, Turkey
| | - Mehmet Kalender
- Department of Surgery, Konya Education and Research Hospital, Konya, Turkey
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Bittencourt MDJS, Dias CM, Lage TL, Barros RS, Paz OAG, Vieira WDB. Behçet disease in association with Budd-Chiari syndrome and multiple thrombosis -- case report. An Bras Dermatol 2014; 88:448-51. [PMID: 23793200 PMCID: PMC3754383 DOI: 10.1590/abd1806-4841.20131930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 07/11/2012] [Indexed: 11/22/2022] Open
Abstract
Behçet's disease is a chronic inflammatory disease of unknown aetiology, characterized by recurrent oral and genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in Behçet's disease. The frequency of vascular lesions in Behçet's disease, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. Budd-Chiari syndrome is a rare and serious complication of Behçet's disease and implies thrombosis of the hepatic veins and/or the intrahepatic or suprahepatic inferior vena cava. We report a case of a 25-year-old man with Behçet's disease that developed Budd-Chiari syndrome. The correlation of dermatological, pathological and imaging studies confirmed the diagnosis.
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11
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Alkaabi JK, Gravell D, Al-Haddabi H, Pathare A. Haemostatic Parameters in Patients with Behçet's Disease. Sultan Qaboos Univ Med J 2014; 14:e190-e196. [PMID: 24790741 PMCID: PMC3997535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 12/11/2013] [Accepted: 01/09/2014] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the cause of thrombosis in Behçet's disease (BD) patients, since abnormalities in coagulation and fibrinolytic parameters have shown contradictory results. METHODS Haemostatic parameters were retrospectively evaluated in BD patients treated between January 2007 and January 2011 at Sultan Qaboos University Hospital, Oman. The blood samples of 35 Omani BD patients and 30 healthy controls were analysed for factor VIII:C levels, activated protein C resistance (APCR), von Willebrand factor (vWF) antigens (Ag), collagen binding and ristocetin co-factor activity (RiCoF), antithrombin (AT), protein C (chromogenic and clotting), protein S, homocysteine, tissue plasminogen activator, plasminogen activator inhibitor, plasminogen, alpha 2-antiplasmin, lupus anticoagulant and anticardiolipin and beta2-glycoprotein-1 antibodies. RESULTS The mean values of factor VIII:C, vWF Ag, AT and protein S were significantly higher in the patient group (P = 0.01, 0.006, 0.04 and 0.01, respectively). There was no deficiency in protein C. Screening for APCR, anticardiolipin antibodies, anti-beta2-glycoprotein-1 antibodies and lupus anticoagulant was negative and there were no differences in homocysteine levels, nor were there differences between patients with and without thrombosis. Six patients had elevated factor VIII:C levels (>150 IU/dL, P <0.02) which normalised on repeat measurements after three months. CONCLUSION The elevation of factors VIII:C, vWF Ag and AT most likely represent an acute phase phenomenon. In this study, thrombophilic factors did not seem to explain thrombotic tendency. Therefore, further mechanistic studies in a larger group of patients are needed to elucidate the basis for thrombosis in BD. We hypothesise that active BD causes vasculitic endothelial perturbation with dysfunction, leading to the observed increased propensity for thrombosis.
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Affiliation(s)
- Juma K. Alkaabi
- Rheumatology Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - David Gravell
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hamood Al-Haddabi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anil Pathare
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
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Shadmanfar S, Shahram F, Nadji A, Akhlaghi M, Faezi ST, Sadeghi-Abdollahi B, Faridar A, Madanchi N, Davatchi F. The relationship between plasma homocysteine level and HLA-B51 in patients with Behcet's disease: a case-control study. Int J Rheum Dis 2014; 17:466-70. [PMID: 24428874 DOI: 10.1111/1756-185x.12271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various coagulation disorders have been reported to explain hypercoagulability state in Behcet's disease (BD). A possible negative association between human leukocyte antigen (HLA)-B51 and increased homocysteine level has been suggested in a previous report from Iranian patients with BD. The aim of this study was to find any possible relationship between plasma homocysteine levels and HLA-B51. METHODS In a case-control study, BD patients (fulfilling the new International Criteria for BD) and controls (who had similar clinical symptoms but BD was clinically excluded in them) were included. Mean plasma homocysteine levels measured by enzyme-linked immunosorbent assay in HLA-B51 positive and negative individuals both in patients and controls were compared by t-test, Mann-Whitney test and analysis of variance (F-test). RESULTS Ninety-six BD patients and 152 controls were recruited. There was no significant difference between HLA-B51 positive and negative individuals either in the mean plasma homocysteine levels (13.59 ± 9.03 vs. 12.95 ± 4.98 μmol/L, P = 0.514), or in the prevalence of hyperhomocysteinemia (17% vs. 21.4%, P = 0.504). This was true both for BD and control groups. In HLA-B51 positive and negative BD patients, mean plasma homocysteine levels were 14.29 ± 12.02 and 12.62 ± 4.79 μmol/L, respectively (P = 0.33), and the prevalence of hyperhomocysteinemia was 20.8% versus 19.5% (P = 0.55). In the control group, the mean plasma homocysteine levels in HLA-B51 positive and negative individuals were 12.85 ± 4.28 and 13.14 ± 5.10 μmol/L, respectively (P = 0.794), and the prevalence of hyperhomocysteinemia was 13% versus 22.1% (P = 0.23). The difference was non-significant regarding sex (P > 0.71) and disease activity (P > 0.31). CONCLUSION In contrast to our previous report, we found no relationship between plasma homocysteine levels and HLA-B51 in this study, either in BD or in the control group.
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Affiliation(s)
- Soraya Shadmanfar
- Rheumatology Department, Baqyiatallah University of Medical Sciences, Baghiatallah Hospital, Tehran, Iran; Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Abdel Badaee H, Edrees A, Amin S, El Amir M, Ragab G. Activated protein C resistance in Behcet's disease. Thromb J 2013; 11:17. [PMID: 24004911 PMCID: PMC3846854 DOI: 10.1186/1477-9560-11-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/09/2013] [Indexed: 11/10/2022] Open
Abstract
Behcet's disease is a chronic multi-system disorder of unknown etiology with protean manifestations. Venous thromboembolism is more common than arterial thrombosis, with deep vein thrombosis being the most frequent. Endothelial dysfunction resulting from vascular inflammation is considered to be an important factor of thrombosis, although the endothelial injury itself cannot completely explain the hypercoagulable state of the disease because other vasculitis syndromes do not increase the risk of thrombosis. The aim of this study is to evaluate the prevalence of activated protein C resistance (APC-R) in Egyptian patients with Behcet's disease. Also, to detect hyperhomocysteinemia in selected cases (with vascular complications) to assess their relationship with thromboembolic complications. The APC resistance ratio mean in the group of patients with vascular involvement was 2.6 ± 0.8 which was less than the group with no vascular involvement 2.8 ± 0.6, with non- significant P-value (0.5). There was more incidence of ocular lesions in the group of patients with high homocysteine level than the group of patients with normal homocytsteine level with significant P-value (0.08).
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Affiliation(s)
- Hoda Abdel Badaee
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas, USA.
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Yaşar Bilge NŞ, Akay OM, Kaşifoğlu T, Kuş G, Korkmaz C. The role of hemostatic mechanisms in the development of thrombosis in Behcet's disease: an analysis by modified rotation thromboelastogram (ROTEM). Clin Rheumatol 2013; 32:1815-8. [PMID: 23975360 DOI: 10.1007/s10067-013-2368-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/04/2013] [Accepted: 08/08/2013] [Indexed: 11/24/2022]
Abstract
Behcet's disease (BD) is a multisystemic disorder characterised by recurrent oral and genital ulcers. Vasculitis and thrombotic events are the most important causes of mortality. Thrombosis is the major clinical finding in patients with BD, but the cause of the thrombosis is still unclear. Thromboelastography is an alternative method to evaluate almost all steps of the hemostatic system. Today, the modified rotation thromboelastogram (ROTEM) is a newer coagulation test and a more powerful technique. Our aim in this study was to investigate whether hemostatic mechanisms play a role in the development of thrombosis in BD patients by using ROTEM. Thirty BD patients, 20 ankylosing spondylitis patients, and 14 healthy controls who are not taking anti-aggregant or anti-coagulant therapy were included in the study. Whole blood count, protrombin time, activated protrombin time, fibrinogen, D-dimer levels, and ROTEM parameters (clotting time, clot formation time (CFT), and maximum clot formation(MCF)) were determined by INTEM and EXTEM analysis. Of the 30 patients with BD, 19 were women and 11 were men, and mean age was 40.6 ± 11.2. Two of the BD patients had vascular involvement, but none of them were in active phase of the disease during the study. In INTEM assay, MCF (p < 0,001) value was significantly increased, and CFT (p>0.05) value was decreased in BD patients compared with the control group. In the EXTEM assay, there was a similar significant increase in MCF (p=0.002) value and a decrease in CFT (p=0.002) value in BD patients compared with the control group. The results of our study indicated that primary hemostatic mechanisms which can be detected by ROTEM may play a role in the development of thrombosis in patients with BD.
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Affiliation(s)
- N Şule Yaşar Bilge
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey,
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Fernández-Bello I, López-Longo FJ, Arias-Salgado EG, Jiménez-Yuste V, Butta NV. Behçet's disease: new insight into the relationship between procoagulant state, endothelial activation/damage and disease activity. Orphanet J Rare Dis 2013; 8:81. [PMID: 23711081 PMCID: PMC3669042 DOI: 10.1186/1750-1172-8-81] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/21/2013] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Behçet disease (BD) is associated with a prothrombotic state of unknown origin that may lead to life-threatening events. Calibrated Automated Thrombogram (CAT) and Rotational Thromboelastometry (ROTEM) are two global haemostasis assays that may reveal new insights into the physiopathological mechanisms of the disease and its procoagulant condition. METHODS 23 BD patients who had no signs or symptoms of current thrombosis and 33 age- and sex-matched controls were included in the study. We performed ROTEM and CAT tests and assessed erythrocyte count, platelet count, platelet contribution to clot formation and plasma levels of tissue-type plasminogen activator, plasminogen activator inhibitor type 1 (PAI-1), fibrinogen, C-reactive protein (CRP), thrombin-antithrombin III complex (TAT), D-dimer and E-selectin (ES). RESULTS Both ROTEM and CAT tests showed a hypercoagulable state in the BD patients. Plasma levels of PAI-1, fibrinogen, TAT, CRP and ES were significantly increased in this group compared to controls. The disease activity (DA) was significantly correlated with levels of ES and the maximum clot firmness, and this last one, in turn, correlated with rising levels of ES, PAI-1, CRP and fibrinogen. CAT parameters did not correlate with DA or ES. CONCLUSIONS Both ROTEM and CAT tests reveal that patients with BD have a procoagulant state even in the absence of thrombosis. ROTEM test indicates that increased levels of fibrinogen and PAI-1 may be involved in the prothrombotic state of this pathology, while platelets do not significantly contribute. Moreover, CAT assay demonstrate that plasma from BD patients is able to generate more thrombin than controls in response to the same stimulus and that this effect is independent of the DA and the endothelial impairment suggesting the involvement of another factor in the hypercoagulable state observed in BD patients. This study also shows that endothelium activation/damage may be a contributing factor in both the procoagulant and clinical conditions of BD, as shown by the direct correlation between ES levels, ROTEM parameters and DA.
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Navarro S, Bonet E, Medina P, Martos L, Ricart JM, Vayá A, Todolí J, Fontcuberta J, Estellés A, España F. Haplotypes of the endothelial protein C receptor gene and Behçet's disease. Thromb Res 2012; 129:459-64. [DOI: 10.1016/j.thromres.2011.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Revised: 07/14/2011] [Accepted: 07/15/2011] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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Birengel S, Yalçındağ FN, Yalçındağ A, Sahli E, Batıoğlu F. Urokinase plasminogen activator receptor levels in Behcet's disease. Thromb Res 2011; 128:274-6. [DOI: 10.1016/j.thromres.2011.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 02/02/2011] [Accepted: 03/06/2011] [Indexed: 11/29/2022]
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Behçet's Syndrome and Thrombosis. Mediterr J Hematol Infect Dis 2011; 3:e2011026. [PMID: 21869912 PMCID: PMC3152448 DOI: 10.4084/mjhid.2011.026] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 06/09/2011] [Indexed: 01/17/2023] Open
Abstract
Behçet syndrome (BS) is a multisystem vasculitis with unknown etiology and a unique geographic distribution. The disease course is characterized by exacerbations and remissions while abating as the years pass. The usual onset is in the third decade. Recurrent skin mucosa lesions and sight threatening panuveitis are the hallmark of the disease. Males are more severely affected than females. Vascular involvement can occur in up to 40% of cases. BS is unique among the vasculitides in that it may involve all sizes and types of vessels. It affects the veins more than the arteries. Lower extremity vein thrombosis is the most frequent manifestation of vascular involvement, followed by vena cava thrombosis, pulmonary artery aneurysms, Budd-Chiari syndrome, peripheral artery aneurysms, dural sinus thrombosis and abdominal aorta aneurysms. Vascular involvement is frequently associated with constitut onal symptoms and increased acute phase response and is the major cause of increased mortality. A predominantly neutrophilic vasculitis around the vaso vasorum is typical of BS. The thrombus is tightly adherent to the vessel wall which probably explains why thromboembolism is so rare despite the high frequency of venous disease. Thrombophilic factors do not seem to explain thrombotic tendency in BS. Immunosuppressive treatment is essential in suppression and preventing the attacks.
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Messedi M, Jamoussi K, Frigui M, Laporte F, Turki M, Chaabouni K, Mnif E, Jaloulli M, Kaddour N, Bahloul Z, Ayedi F. Atherogenic Lipid Profile in Behçet’s Disease: Evidence of Alteration of HDL Subclasses. Arch Med Res 2011; 42:211-8. [DOI: 10.1016/j.arcmed.2011.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 04/18/2011] [Indexed: 01/06/2023]
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Vayá A, Plumé G, Bonet E, Carrasco P, Morales-Suárez-Varela MM. Hyperhomocysteinemia and the methylene tetrahydrofolate reductase C677T mutation in splanchnic vein thrombosis. Eur J Haematol 2010; 86:167-72. [DOI: 10.1111/j.1600-0609.2010.01551.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Hyperhomocysteinaemia in Behçet's Disease. Biochem Res Int 2010; 2010:361387. [PMID: 21188071 PMCID: PMC3005829 DOI: 10.1155/2010/361387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 02/15/2010] [Indexed: 11/17/2022] Open
Abstract
Objectives. The aim of this study was to investigate if hyperhomocysteinaemia is a contributive risk factor for the pathogenesis and the activity of Behçet's disease (BD). Design and Methods. Fifty four patients fullfiling the criteria of the International Study Group for BD were enrolled. Fifty healthy volunteers matched for age and sex with the BD group were included as a negative control group. Patients, with any condition that might affect plasma homocysteine concentration, were excluded. Results. Mean serum homocysteine concentration was significantly higher in patients with BD than in the healthy controls (P < .001), in patients with active disease (P = .04), and in masculine gender (P = .05). There was no significant difference between homocysteine level and clinical involvement. Conclusions. We demonstrated that plasma total homocysteine level (tHcy) is increased in BD and correlated with disease activity. No association was found between homocysteine levels and clinical involvement.
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La Regina M, Orlandini F, Prisco D, Dentali F. Homocysteine in vascular Behcet disease: a meta-analysis. Arterioscler Thromb Vasc Biol 2010; 30:2067-74. [PMID: 20634474 DOI: 10.1161/atvbaha.110.207068] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Behçet disease (BD) is a vasculitis of unknown etiology, characterized by oral or genital aphtosis and uveitis. Homocysteine (hcy) is an independent risk factor for venous and arterial thrombosis. The association between hyperhomocysteinemia and thrombosis has been investigated in some studies in BD patients. However, information on this association is based only on the results of small studies with conflicting results. To overcome such limitations, we performed a metaanalysis comparing the plasma levels of hcy in BD patients with and without history of thrombosis. METHODS AND RESULTS We searched for all published studies using the Medline and Embase databases. Two reviewers performed study selection independently. Studies were included if hcy was measured in adult BD patients with and without thrombosis. Two reviewers independently extracted data on study and population characteristics. The mean value of hcy in BD patients and the presence of hyperhomocysteinemia in patients with and without thrombosis were collected. Association between thrombosis and hyperhomocysteinemia, and the mean difference of hcy levels in BD patients with and without thrombosis were calculated. Sixteen studies, for a total of 979 patients, were included. Hyperhomocysteinemia was more prevalent in patients with thrombosis than in those without (odds ratio 3.14; 95% CI 1.26 to 7.80) Mean levels of hcy were significantly higher in patients with thrombosis in comparison with patients without (mean difference 3.30 μmol/L; 95% CI 2.09 to 4.51). CONCLUSIONS Our results suggest that hyperhomocysteinemia may be considered to be associated with thrombosis in BD patients.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Ligurian East Hospital, 19124 La Spezia, Italy.
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Caramaschi P, Poli G, Bonora A, Volpe A, Tinazzi I, Pieropan S, Bambara LM, Biasi D. A study on thrombophilic factors in Italian Behcet's patients. Joint Bone Spine 2010; 77:330-4. [PMID: 20452800 DOI: 10.1016/j.jbspin.2010.02.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Accepted: 02/03/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Behcet's disease (BD) may complicate with arterial and venous thrombosis. The purpose of this work is to evaluate in an Italian group of BD patients with thrombotic events a large panel of inherited and acquired thrombophilic factors. METHODS Thirty BD patients, of which nine with previously arterial or venous thrombosis and 21 without, underwent the following investigations: plasma antithrombin activity, protein C activity, free protein S level, sensitivity to APC, total plasma homocysteine concentration, serum folate level, determination of anti-phospholipid antibodies, serum Lp(a) levels, tests for gene polymorphisms of factor V Leiden, prothrombin and methylenetetrahydrofolate reductase genes. Tests for the gene polymorphisms were also performed in a group of healthy control subjects. RESULTS All the six patients with arterial or deep venous thrombosis showed thrombophilic conditions such as protein C or protein S deficiency (one case each), hyperhomocysteinemia (two cases), positivity of anti-phospholipid antibodies associated with APC resistance or hyperhomocysteinemia (one case each). Among three subjects with superficial thrombophlebitis only one showed a mild hyperhomocysteinemia. No differences were found between BD patients and control subjects concerning polymorphisms of the genes considered. Among BD patients the Factor V H1299R mutation showed a weak association with venous thrombosis (P=0.048). CONCLUSION In BD patients different concomitant significant thrombophilic risk factors may contribute to the development of thrombotic events. Patients affected by vasculo-Behcet should be evaluated for the presence of coexisting major thrombophilic conditions.
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Affiliation(s)
- Paola Caramaschi
- Dipartimento di Medicina Clinica Sperimentale, Policlinico G.B. Rossi, Piazzale Scuro, 37134 Verona, Italy.
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Combined thrombophilic factors increase the risk of recurrent thrombotic events in Behcet’s disease. Clin Rheumatol 2010; 29:1367-72. [DOI: 10.1007/s10067-010-1455-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/19/2010] [Accepted: 03/24/2010] [Indexed: 11/26/2022]
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Gönül M, Gül U, Kilinç C, Cakmak SK, Soylu S, Kiliç A. Homocysteine levels in patients with Behçet's disease and patients with recurrent aphthous stomatitis. Clin Rheumatol 2009; 28:1153-6. [PMID: 19575262 DOI: 10.1007/s10067-009-1214-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 05/25/2009] [Accepted: 06/03/2009] [Indexed: 11/26/2022]
Abstract
The mechanism for vascular involvement of Behçet disease (BD) includes arterial and venous thrombosis. Although the exact etiology of systemic vasculitis and thrombosis is still unknown, many hypotheses have been suggested. One of these hypotheses is that hyperhomocysteinemia causes vascular disease and thrombosis. The aim of this study was to compare the levels of homocysteine, vitamin B(12), and folic acid of BD patients with those of recurrent aphthous stomatitis (RAS) patients and healthy controls. Forty-five BD patients, 47 RAS patients, and 69 healty control subjects were included in this study. Vitamin B(12), folic acid, and homocysteine levels of the patients and controls were measured, and statistical differences among the groups were determined. BD patients had mostly cutaneous symptoms. Arthritis and ocular and vascular involvement were seen in 24.4%, 22%, and 11% of BD patients, respectively. No significant difference was detected among the groups in the levels of vitamin B(12), folic acid, and homocysteine. There was no significant difference in any parameters according to sex and age of the patients and activity of BD and if the patients with BD were treated or not. Homocysteine level inversely correlated with vitamin B(12) and folic acid levels in the BD group. We could not find any differences in homocysteine, vitamin B(12), and folic acid levels between BD and RAS patients and controls. This may be due to the fact that our patients mostly had cutaneous symptoms rather than vascular involvement.
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Affiliation(s)
- Müzeyyen Gönül
- 2nd Dermatology Clinic, Ankara Numune Education and Research Hospital, Ankara, Turkey.
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Benedetti R, Brignone A, Incerti Vecchi L, Orlandini F. An atypical vascular case of Behçet's disease and consequent treatment. Intern Emerg Med 2009; 4:179-80. [PMID: 19082903 DOI: 10.1007/s11739-008-0210-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Accepted: 11/14/2008] [Indexed: 10/21/2022]
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Homocysteine may involve in the pathogenesis of Behcet's disease by inducing inflammation. Mediators Inflamm 2009; 2008:407972. [PMID: 19197380 PMCID: PMC2633607 DOI: 10.1155/2008/407972] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2008] [Revised: 11/02/2008] [Accepted: 11/17/2008] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Our aim was to evaluate the significance of homocysteine (Hcy) in Behcet's disease (BD) and the association of elevated Hcy levels associated with the indices of inflammation in BD. METHODS Untreated 70 patients with BD and 33 healthy individuals were included into the study. Hcy, tumor necrosis alpha (TNF-alpha), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were evaluated with respect to activity and specific individual clinical manifestations of the disease. RESULTS Hcy levels were found significantly elevated in active BD when compared to inactive BD and healthy controls. Hcy levels were found to have high correlation with the number of active clinical manifestations increased. A significant positive correlation was found between serum Hcy and TNF-alpha levels, CRP, and ESR. Hcy was found to be the best predictor of TNF-alpha among other parameters. CONCLUSION Hcy may involve in the pathogenesis of BD by inducing inflammation.
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High factor VIII or homocysteine levels and thrombosis in Henoch-Schönlein purpura. Rheumatol Int 2008; 29:1251-2. [DOI: 10.1007/s00296-008-0812-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/20/2008] [Indexed: 10/21/2022]
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Yalçındağ FN, Batıoğlu F, Özdemir Ö, Cansızoğlu E, Eğin Y, Akar N. Soluble endothelial protein C receptor levels in Behçet patients with and without ocular involvement. Graefes Arch Clin Exp Ophthalmol 2008; 246:1603-8. [DOI: 10.1007/s00417-008-0873-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/04/2008] [Accepted: 05/11/2008] [Indexed: 11/29/2022] Open
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Thymidylate synthase genotype and serum concentrations of homocysteine and folate in Behçet’s disease. Clin Rheumatol 2008; 27:1221-5. [DOI: 10.1007/s10067-008-0889-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 03/03/2008] [Accepted: 03/25/2008] [Indexed: 10/22/2022]
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Ozkan Y, Yardim-Akaydin S, Sepici A, Engin B, Sepici V, Simşek B. Assessment of homocysteine, neopterin and nitric oxide levels in Behcet's disease. Clin Chem Lab Med 2007; 45:73-7. [PMID: 17243919 DOI: 10.1515/cclm.2007.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behçet's disease is a multisystemic immunoinflammatory disease with a wide variety of clinical manifestations, whereas recurrent aphthous stomatitis is a local oral disease. The aim of this study was to examine the distribution of homocysteine levels in patients with active Behçet's disease, possible association of homocysteine with nitric oxide and neopterin levels, and to characterize the differences between patients with Behçet's disease and those with recurrent aphthous stomatitis in terms of these parameters compared with healthy controls. METHODS A total of 23 patients with active Behçet's disease, 25 patients with recurrent aphthous stomatitis as positive controls, and 21 healthy subjects were included in this study. Serum homocysteine and neopterin levels were measured flourimetrically by HPLC. Serum nitric oxide production was assayed by measuring total nitrite levels with Griess reagent. RESULTS Significantly higher homocysteine (12.9+/-3.3 micromol/L) and lower nitric oxide (41.5+/-10.9 micromol/L) and neopterin (6.4+/-1.0 nmol/L) levels were observed in patients with Behçet's disease compared with healthy controls (10.7+/-2.0 micromol/L, 49.7+/-16.2 micromol/L, 8.7+/-2.2 nmol/L, respectively) (p<0.03 for neopterin, p<0.04 for homocysteine and nitric oxide). However, homocysteine, nitric oxide, biopterin and neopterin levels and the neopterin/biopterin ratio for recurrent aphthous stomatitis patients were not significantly different compared to healthy controls. A significant positive correlation was observed between serum homocysteine and serum neopterin/biopterin ratio in patients with Behçet's disease (r=0.975, p<0.005). CONCLUSIONS In contrast to recurrent aphthous stomatitis, there is a higher prevalence of hyperhomocysteinemia in Behcet's disease. Homocysteine may have deleterious effects on the pathology of Behcet's disease by decreasing nitric oxide levels and interfering with the immune system.
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Affiliation(s)
- Yeşim Ozkan
- Department of Biochemistry, Faculty of Pharmacy, Gazi University, Ankara, Turkey.
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Caramaschi P, Volpe A, Canestrini S, Bambara LM, Faccini G, Carletto A, Biasi D. Correlation between homocysteine plasma levels and nailfold videocapillaroscopic patterns in systemic sclerosis. Clin Rheumatol 2006; 26:902-7. [PMID: 17047894 DOI: 10.1007/s10067-006-0425-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 07/26/2006] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
The aim of the study is to investigate the relationship between microangiopathy as assessed by nailfold videocapillaroscopy (NVC) and plasma level of homocysteine (Hcy) in systemic sclerosis (SSc). As known, Hcy is a nonessential amino acid that interferes with normal properties of a vascular tree. Sixty patients affected by SSc (4 men and 56 women, mean age 54.6) underwent the determination of plasma Hcy level; at the same time, NVC was performed. Hcy level was also determined in 30 sex- and age-matched controls. In patients affected by SSc the plasma Hcy level was significantly higher than in healthy controls (11.8 and 6.5 micromol/l, respectively; p < 0.001). A significant correlation was found between plasma Hcy concentration and the pattern of NVC with a progressive increase from early to active and above all to late pattern (10.7, 11.8, and 17.4 micromol/l, respectively; p < 0.001). Subjects with high Hcy level (i.e., >75th percentile of Hcy level in controls and in patients considered altogether) were mostly represented in the scleroderma patients with late nailfold videocapillaroscopic pattern; the crude odds ratio was 9.0 (significant; 95% CI from 2.1 to 38.8). In conclusion, Hcy plasma level is related to microvascular involvement in patients affected by SSc; the concentration increases with the progression of the nailfold videocapillaroscopic pattern. Hyperhomocysteinemia may represent an aggravating factor among the complex mechanisms involved in scleroderma damage contributing to the injury of endothelium.
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Affiliation(s)
- Paola Caramaschi
- Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Policlinico GB Rossi, P.le Scuro, Verona, 37134, Italy.
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Kwon SR, Lim MJ, Park SG, Moon YS, Park W. Decreased protein S activity is related to the disease activity of Behcet's disease. Rheumatol Int 2006; 27:39-43. [PMID: 16969634 DOI: 10.1007/s00296-006-0214-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2005] [Accepted: 08/14/2006] [Indexed: 10/24/2022]
Abstract
We wanted to see whether the active inflammation in Behcet's disease (BD) can cause a thrombotic disorder by decreasing the protein S (PS) activity, and we evaluated the relationship between the decreased PS activity and the disease activity of BD. We included 122 patients with BD whose PS activity levels were measured. In 51 patients, the PS activity was measured again when there were changes in the number of items of "The Behcet's Disease Current Activity Form (BDCAF)". The thrombosis rate was 2.5% (3/122), and the PS activity was low in all three of the patients with thrombosis. The incidence of low PS activity in the total 122 BD patients was 27% (33/122). The incidence of the low PS activity in the active BD patients was 33.7% (31/92), and this was significantly more frequent than in the inactive BD patients, (6.7%, 2/30) (chi(2)-test, P value = 0.0038). The decrease of PS activity had good correlation with the increase of the number of BDCAF items (r = -0.351, P value = 0.012). The PS activity decrease is related to the BD activity. The low PS activity can be the risk factor for thrombotic disorder and also the activity marker for BD and other inflammatory diseases.
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Affiliation(s)
- Seong Ryul Kwon
- Department of Internal Medicine, College of Medicine, Inha University, Inchon, 400-711, South Korea
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Yapişlar H, Aydogan S, Borlu M, Ascioglu O. Decreased nitric oxide and increased platelet aggregation levels in patients with Behçet's disease. Thromb Res 2006; 119:461-5. [PMID: 16806408 DOI: 10.1016/j.thromres.2006.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 02/20/2006] [Accepted: 02/20/2006] [Indexed: 11/19/2022]
Affiliation(s)
- Hande Yapişlar
- Erciyes University, Medical Faculty, Department of Physiology, 38039-Kayseri, Turkey.
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Ricart JM, Vaya A, Todolí J, Calvo J, Contreras MT, España F, Aznar J, Corella D. Haemorheological alterations in Behçet's disease are not related to a tendency for venous thrombosis. Thromb Res 2005; 115:399-404. [PMID: 15810159 DOI: 10.1016/j.thromres.2004.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Behçet's disease is associated with an increased risk of thrombosis, although the prothrombotic mechanisms are unclear. Alterations in blood rheology, particularly increased erythrocyte aggregation, might play a role in the development of such thrombotic events. MATERIALS AND METHODS We measured plasma lipids, fibrinogen, haematocrit, erythrocite aggregation, erythrocyte deformability, blood viscosity, plasma viscosity and erythrocyte indexes in patients with a nonactive disease at sampling, and in a well-matched control group. The patient group comprised 42 patients with BD (21 male, 21 female aged 43+/-12 years) and the control group comprised 46 healthy volunteers (23 male, 23 female aged 45+/-13 years). Twelve of the 42 patients with BD had a previous documented history of deep vein thrombosis at least 6 months before entering the study, and the other 30 did not. RESULTS Compared with controls, patients showed statistically higher fibrinogen concentrations (P=0.001), plasma viscosity (P=0.002), blood viscosity (P=0.006) and erythrocyte aggregation, both at stasis (P=0.001) and at a low shear rate (P=0.002): the other rheological parameters were not statistically significant. No differences were observed in the rheological parameters when patients with and without previous thrombotic episodes were compared. CONCLUSIONS Although patients with BD show a moderate hyperviscosity syndrome, possibly related to chronic inflammation, this does not seem to play a role in the development of thrombotic events.
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Affiliation(s)
- Jose Ma Ricart
- Hemorheology and Thrombosis Unit, Department of Clinical Pathology, La Fe University Hospital, Valencia, Spain
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Beyan E, Sadikoğlu B, Ertuğrul E, Beyan C. Von Willebrand factor antigen levels in Behçet disease. Am J Hematol 2005; 79:70-2. [PMID: 15849757 DOI: 10.1002/ajh.20317] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High von Willebrand factor antigen (vWF:Ag) levels can be found due to vascular endothelial injury in Behçet disease. The aim of this study is to evaluate whether there is any relationship between vWF:Ag levels and vascular or other organ involvements and acute-phase reactants in Behçet disease. Fifteen controls and 17 Behçet's patients were included; 10 had oral ulcers, 5 had genital ulcers, 3 had skin lesions, 6 had ocular involvement, 5 had arthritis, and 6 had vascular involvement. VWF:Ag levels were higher in Behçet's patients than controls. VWF:Ag levels in Behçet's patients with oral ulcers, genital ulcers, and ocular and vascular involvement were statistically higher than in the control group. Differences between vWF:Ag levels in Behçet's patients with and without organ involvement were not statistically significant. A linear correlation between serum ferritin levels and vWF:Ag levels was observed. These results demonstrate that elevated levels of plasma vWF:Ag are related to Behçet disease exacerbation rather than vascular involvement.
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Affiliation(s)
- Esin Beyan
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Navarro S, Ricart JM, Medina P, Vayá A, Villa P, Todolí J, Estellés A, Micó ML, Aznar J, España F. Activated protein C levels in Behçet's disease and risk of venous thrombosis. Br J Haematol 2004; 126:550-6. [PMID: 15287949 DOI: 10.1111/j.1365-2141.2004.05072.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Behçet's disease is a multi-systemic inflammatory disorder of unknown cause. Most abnormalities have been associated with endothelial injury caused by vasculitis. Thrombosis occurs in about 25% of patients, although the mechanism is unknown. The objective of this study was to evaluate the protein C activation system in Behçet's disease and its correlation with venous thromboembolism (VTE). Thirty-nine patients (12 with VTE) and 78 age- and sex-matched controls were included in the study, and levels of protein C, protein S, activated protein C (APC), protein C inhibitor (PCI), soluble thrombomodulin (TM), antithrombin (AT), alpha(1)-antitrypsin, fibrinogen, factor VIII, von Willebrand factor (VWF) and C-reactive protein (CRP) were measured. APC and TM levels were significantly lower in patients than in controls, whereas protein S, AT, alpha(1)-antitrypsin, fibrinogen, factor VIII, VWF and CRP levels were significantly higher in patients than in controls. APC, PCI and TM levels were lower in patients with VTE (0.65 +/- 0.19 ng/ml, 86% +/- 22% and 15.5 +/- 7.1 ng/ml respectively) than in those without VTE (0.78 +/- 0.17 ng/ml, 100% +/- 15% and 22.1 +/- 15.3 ng/ml) (P < 0.05). In patients, APC levels below 0.75 ng/ml (10th percentile of the control group) increased the risk of VTE about fivefold (odds ratio = 5.1; 95% confidence interval = 1.1-23.4). These results show that reduced APC levels are associated with the high incidence of VTE in Behçet's disease.
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Affiliation(s)
- Silvia Navarro
- Research Centre, Hospital Universitario La Fe, Valencia, Spain
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Probst K, Fijnheer R, Rothova A. Endothelial cell activation and hypercoagulability in ocular Behçet's disease. Am J Ophthalmol 2004; 137:850-7. [PMID: 15126149 DOI: 10.1016/j.ajo.2003.12.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the presence of a hypercoagulable state and vascular endothelial dysfunction in patients with ocular Behçet's disease and relate the results to the activity of ocular and systemic involvement. DESIGN Cross-sectional laboratory and clinical study. METHODS Prospective study of blood samples of 24 patients diagnosed with ocular Behçet's disease, which were analyzed for factor VIII, factor XI, von Willebrand factor antigen and ristocetin (vWF ag and risto), antithrombin III (ATIII), protein C and S, fibrinogen and activated protein C (APC) resistance. The results were compared with 40 healthy controls and analyzed for association with ocular and systemic clinical features. RESULTS The mean values of factor VIII, factor XI, vWF ag, vWF risto, ATIII, and fibrinogen were significantly raised compared to healthy population (for all: P <.001). Most striking were factor VIII activity levels above 130% in 79% (19 of 24) of our patients. 67% (16 of 24) had levels of factor VIII above 150%, which correlates with a fivefold increase in risk of thrombosis. Other prothrombogenic factors were negative in all but 2 patients (1 protein C deficiency, 1 factor V Leiden mutation). Endothelial cell activation, measured by vWF activity, revealed elevated levels in 42% (10/24). Complete/incomplete Behçet's disease patients with present or previous macular edema had significantly higher FVIII levels than complete/incomplete Behçet's disease patients who had never shown any signs of macular edema (P =.04). Further correlations between the laboratory results and clinical symptoms were not found. CONCLUSIONS We found a generalized hypercoagulable state with endothelial cell activation in ocular Behçet's disease, irrespectively of current ocular disease activity.
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Affiliation(s)
- Kiki Probst
- F. C. Donders Institute of Ophthalmology and the Department of Hematology, University Medical Center Utrecht, PO Box 85 500, 3508 GA Utrecht, The Netherlands.
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Yesilova Z, Pay S, Oktenli C, Musabak U, Saglam K, Sanisoglu SY, Dagalp K, Erbil MK, Kocar IH. Hyperhomocysteinemia in patients with Behçet’s disease: is it due to inflammation or therapy? Rheumatol Int 2004; 25:423-8. [PMID: 15057566 DOI: 10.1007/s00296-004-0466-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2003] [Accepted: 03/03/2004] [Indexed: 11/29/2022]
Abstract
Considerable discrepancies exist in the literature with respect to plasma total homocysteine (tHcy) levels in Behçet's disease (BD). The aim of this study was to evaluate tHcy concentrations in these patients. Thirty-two patients with BD and 20 age- and body mass index-matched healthy volunteers were enrolled. Plasma tHcy concentrations were significantly higher, while vitamin B12 and folate levels were significantly lower in patients with thrombosis and eye involvement than those without. C-reactive protein levels also correlated significantly in a negative manner with vitamin B12 and folate but positively with tHcy. In conclusion, increased use or accelerated catabolism of folate and vitamin B12 due to chronic inflammation and moderately increased tHcy concentrations related with deficiency of these cofactors, and immunosuppressive drug administration might be potential threats of vascular disease in BD.
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Affiliation(s)
- Zeki Yesilova
- Department of Gastroenterology, Gülhane Military Medical Academy, 06018 Etlik, Ankara, Turkey.
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Feki M, Houman H, Ghannouchi M, Smiti-Khanfir M, Hamzaoui K, El Matri L, Mebazaa A, Kaabachi N. Hyperhomocysteinaemia is associated with uveitis but not with deep venous thrombosis in Behçet's disease. Clin Chem Lab Med 2004; 42:1417-23. [PMID: 15576305 DOI: 10.1515/cclm.2004.263] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractPlasma homocysteine was assessed in Behçet's disease (BD) patients in order to determine the prevalence of hyperhomocysteinaemia in BD and to test its association with clinical manifestations of the disease. The study included 59 patients with BD and 118 age- and sex-matched healthy subjects. Plasma homocysteine, vitamin B
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Affiliation(s)
- Moncef Feki
- LAB-SM-01 Research Laboratory & Department of Biochemistry, Rabta University Hospital, 1007 Jebbari, Tunis, Tunisia.
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Houman H, Feki M, Ghorbel IB, Gadhoum H, Hsairi M, Omar S, Lamloum M, Kaabachi N, Mebazaa A, Miled M. Does hyperhomocysteinemia increase the risk of thrombosis in Behçet's disease? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:413-7. [PMID: 12918735 DOI: 10.1007/0-306-48382-3_84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- H Houman
- Department of Internal Medicine, La Rabta Hospital, Tunis, Tunisia
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Ateş A, Aydintuğ O, Olmez U, Düzgün N, Duman M. Serum homocysteine level is higher in Behçet’s disease with vascular involvement. Rheumatol Int 2003; 25:42-4. [PMID: 14586553 DOI: 10.1007/s00296-003-0398-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2003] [Accepted: 08/23/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behçet's disease (BD) is a multisystemic inflammatory disorder of unknown etiology that is sometimes associated with thrombosis. However, the mechanism of hypercoagulability is not known. In this study, we investigated whether hyperhomocysteinemia, being a well-known risk factor for thrombosis, is also a contributing risk factor to venous and arterial thromboses of BD. METHODS Forty-five patients with BD and 40 healthy subjects were included in the study. Sixteen patients had vascular involvement. Serum homocysteine levels were determined by fluorescence polarization immunoassay. RESULTS In male patients, the frequency of vascular involvement was significantly higher than in females (46.7% vs 13.3%, P < 0.05). Serum homocysteine levels were significantly higher in patients with BD than healthy controls (P < 0.01), in patients with vascular involvement than those with mucocutaneous involvement (P < 0.01) and healthy controls (P = 0.001), and in male patients than in female patients (P < 0.001). There was no significant difference in homocysteine levels between the BD patients with mucocutaneous involvement and healthy subjects. In multiple regression analysis, serum homocysteine level was independently associated with thrombosis (odds ratio 1.29, P < 0.01), but male sex was not. CONCLUSIONS This preliminary study suggests that elevated serum homocysteine levels may play some role in the development of venous and arterial thromboses in BD.
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Affiliation(s)
- Aşkin Ateş
- Department of Clinical Immunology and Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey.
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Erkiliç K, Evereklioglu C, Cekmen M, Ozkiris A, Duygulu F, Dogan H. Adenosine deaminase enzyme activity is increased and negatively correlates with catalase, superoxide dismutase and glutathione peroxidase in patients with Behçet's disease: original contributions/clinical and laboratory investigations. Mediators Inflamm 2003; 12:107-16. [PMID: 12775361 PMCID: PMC1781598 DOI: 10.1080/0962935031000097754] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AIM Behçet's disease (BD) is an inflammatory vasculitis with immunologic, endothelial and neutrophil alterations. Adenosine deaminase (AD) is a marker of T-cell activation and is related to the production of reactive oxygen species by neutrophils with the production of NO(*), O(2)(*-), H(2)O(2) and OH(*). We reported increased tumour necrosis factor-alpha, soluble interleukin-2 receptor, interleukin-6, interleukin-8 and NO(*) in active BD. As there is a relation between cytokines, T cells and oxidative stress in inflammatory diseases, this study further evaluated: (1) plasma AD activity and its correlation with acute phase reactants; (2) thiobarbituric acid-reactive substances (TBARS) as an indicator for lipid peroxidation; and (3) antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GSHPx) and catalase in patients with BD. The effect of disease activity and correlations between the measured parameters were explored. METHODS A total of 35 active (n=17) or inactive (n=18) patients with BD (16 men, 19 women) satisfying International Study Group criteria, and 20 age-matched and sex-matched controls (nine men, 11 women) were included in this cross-sectional case-control study. AD and TBARS were measured in plasma, catalase in red blood cells (RBC), and SOD and GSHPx in both plasma and RBC in both groups. Acute phase reactants (alpha(1)-antitrypsin, alpha(2)-macroglobulin, neutrophils, erythrocyte sedimentation rate) were used to classify patients as active or inactive. RESULTS Plasma AD (mean+/-standard error of the mean, 36.1+/-0.7 U/l) and TBARS (4.2+/-0.1 nmol/ml) levels were significantly (for each, p<0.001) higher in BD than in controls (24.1+/-0.8 U/l and 1.6+/-0.1 nmol/ml, respectively). RBC catalase activity was significantly (p<0.001) lower in BD than in controls (120.9+/-3.8 versus 160.3+/-4.1 k/g haemoglobin). SOD and GSHPx activities were significantly lower in both plasma and erythrocytes of patients with BD than in controls (plasma SOD, 442.4+/-8.6 versus 636.4+/-9.2 U/ml, p<0.001; RBC SOD, 3719.2+/-66.0 versus 4849.7+/-49.0 U/g haemoglobin, p<0.001; plasma GSHPx, 73.1+/-1.5 versus 90.6+/-2.9 U/ml, p<0.001; RBC GSHPx, 600.7+/-8.0 versus 670.6+/-10.1 U/g haemoglobin, p<0.001). Active BD patients had significantly lower antioxidant enzymes (except RBC catalase) and higher AD and TBARS levels than inactive subjects (for each, p<0.01). When considering all BD patients, a significant positive correlation was present between AD and TBARS (p<0.001) whereas both AD and TBARS were negatively correlated with antioxidant enzymes (for each, p<0.05). CONCLUSIONS AD and lipid peroxidation are increased and associated with defective antioxidants in BD, suggesting interactions between activated T cells and neutrophil hyperfunction. Measures of pro-oxidative stress and antioxidative defence with AD activity as an indicator of T-cell activation can be considered as significant supportive diagnostic indicators, especially in active disease. In addition, strengthening the antioxidant defence may contribute to treatment modalities.
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Affiliation(s)
- Kuddusi Erkiliç
- Department of Ophthalmology, Erciyes University Medical Faculty, Sivas Cad, Cebeci Apt. A-Blok 175/15, TR-38020 Kayseri, Turkey
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