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Kraev K, Uchikov P, Hristov B, Kraeva M, Basheva‐Kraeva Y, Popova‐Belova S, Sandeva M, Chakarov D, Dragusheva S, Geneva‐Popova M. Coexistence of ankylosing spondylitis and Behçet's disease: Successful treatment with upadacitinib. Immun Inflamm Dis 2024; 12:e1242. [PMID: 38578007 PMCID: PMC10996370 DOI: 10.1002/iid3.1242] [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: 10/10/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) and Behçet's disease (BD) are distinct inflammatory disorders, but their coexistence is a rare clinical entity. This case sheds light on managing this complex scenario with Janus kinase (JAK) inhibitors. CASE PRESENTATION A 42-year-old woman presented with a decade-long history of lower back pain, nocturnal spinal discomfort, recurrent eye issues, oral and genital ulcers, hearing loss, pus formation in the left eye, and abdominal pain. Multidisciplinary consultations and diagnostic tests confirmed AS (HLA-B27 positivity and sacroiliitis) and BD (HLA-B51). Elevated acute-phase markers were observed. CONCLUSION This case fulfills diagnostic criteria for both AS and BD, emphasizing their coexistence. Notably, treatment with upadacitinib exhibited promising efficacy, underscoring its potential as a therapeutic option in patients with contraindications for conventional treatments. Our findings illuminate the intricate management of patients presenting with these two diverse systemic conditions and advocate for further exploration of JAK inhibitors in similar cases.
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Affiliation(s)
- Krasimir Kraev
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of MedicineMedical University of PlovdivPlovdivBulgaria
| | - Petar Uchikov
- Department of Special Surgery, Faculty of MedicineMedical University of PlovdivPlovdivBulgaria
| | - Bozhidar Hristov
- Second Department of Internal Diseases, Section “Gastroenterology”, Medical FacultyMedical University of PlovdivPlovdivBulgaria
| | - Maria Kraeva
- Department of Otorhinolaryngology, Medical FacultyMedical University of PlovdivPlovdivBulgaria
| | | | - Stanislava Popova‐Belova
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of MedicineMedical University of PlovdivPlovdivBulgaria
| | - Milena Sandeva
- Department of Midwifery, Faculty of Public HealthMedical University of PlovdivPlovdivBulgaria
| | - Dzhevdet Chakarov
- Department of Propaedeutics of Surgical Diseases, Section of General Surgery, Faculty of MedicineMedical University of PlovdivPlovdivBulgaria
| | - Snezhanka Dragusheva
- Department of Nursing Care, Faculty of Public HealthMedical University of PlovdivPlovdivBulgaria
| | - Mariela Geneva‐Popova
- Department of Propaedeutics of Internal Diseases “Prof. Dr. Anton Mitov”, Faculty of MedicineMedical University of PlovdivPlovdivBulgaria
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Halilbasic M, Vodencarevic AN, Cosickic A, Halilbasic A, Cabric A. Adalimumab in Treatment of Uveitis in Pediatric Behcet's Disease-a Case Report. Mater Sociomed 2021; 33:78-81. [PMID: 34012357 PMCID: PMC8116094 DOI: 10.5455/msm.2021.33.78-81] [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: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Behcet's Disease (BD) is an inflammatory disease characterized by multisystemic involvement and featured by a chronic, relapsing disease course. Recurrent ocular inflammation and macular involvement may lead to severe loss of visual acuity. Prolonged use of local and systemic corticosteroids lead to numerous side effects and complications. Very often other immunosuppressive therapies are needed. Biologic agents are promising for the treatment of Behcet's disease-associated uveitis. AIM To report successful treatment of paediatric uveitis due to incomplete Behçet's disease with administration of adalimumab, after failing to react to all other modalities of treatment. CASE REPORT We present the case of a 15-year-old girl who was treated for reccurent uveitis in both eyes with developed complications on anterior and posterior ocular segment. She was earlier treated with topical and systemic steroids for uveitis, laser photocoagulation and methotrexate, however, relapses occurred inspite all treatment modalities. Patient was diagnosed with incomplete Behcet's disease, and adalimumab therapy was initiated. Inflammation was well-controlled by adalimumab administration without need for local or systemic corticosteroids. CONCLUSION Adalimumab is effective for treating children with Behcet's disease-associated uveitis. Control of ocular inflammation in our case was achieved without need for continuing local or systemic corticosteroids, thus preventing further complications and possible significant vision loss.
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Affiliation(s)
- Meliha Halilbasic
- Eye Clinic, University Clinical Center Tuzla, Bosnia and Herzegovina
| | | | - Almira Cosickic
- Clinic for Children’s Diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Amir Halilbasic
- Clinic for Children’s Diseases, University Clinical Center Tuzla, Bosnia and Herzegovina
| | - Arnes Cabric
- Public Institution, Polyclinic with a day care hospital Doboj-Jug, Bosnia and Herzegovina
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Citirik M, Ozdal P, Keles A, Haznedaroglu I. Platelet activation in ocular Behçet's patients with posterior segment involvement. Middle East Afr J Ophthalmol 2021; 28:203-207. [PMID: 35719287 PMCID: PMC9198532 DOI: 10.4103/meajo.meajo_324_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 12/16/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE: The aim of the present study was to assess platelet activation by analyzing three platelet activation parameters in ocular Behçet's disease (BD): mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT). METHODS: Twenty-nine patients with active ocular BD (Group 1), 40 patients with inactive ocular BD (Group 2), and 40 healthy adult individuals serving as controls (Group 3) were evaluated. All of the individuals had been performed the complete ophthalmologic evaluation. The levels of MPV, PDW, and PCT were measured in each group. RESULTS: The mean MPV level was 8.40 ± 0.97 in Group 1, 8.32 ± 1.04 in Group 2, and 7.77 ± 0.72 in Group 3. The mean PDW level was 15.12 ± 1.09 in Group 1, 14.97 ± 1.02 in Group 2, and 14.52 ± 0.82 in Group 3. The mean PCT level was 0.23 ± 0.07 in Group 1, 0.21 ± 0.04 in Group 2, and 0.18 ± 0.03 in Group 3. MPV, PDW, and PCT levels were significantly higher in ocular BD patients than controls (P < 0.05). CONCLUSION: Platelet activation may affect vascular occlusion in ocular Behçet's patients with posterior segment involvement. This result may be important in evaluating ocular BD patients.
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Costagliola G, Cappelli S, Consolini R. Behçet's Disease in Children: Diagnostic and Management Challenges. Ther Clin Risk Manag 2020; 16:495-507. [PMID: 32606709 PMCID: PMC7295757 DOI: 10.2147/tcrm.s232660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 05/21/2020] [Indexed: 12/28/2022] Open
Abstract
Behçet’s Disease (BD) is an inflammatory disease of unknown etiology with multisystemic involvement, being the main clinical manifestations represented by recurrent oral and genital ulcerations and uveitis. The disease has typically a chronic-relapsing course and may cause significant morbidity and mortality due to eye, vascular and neurological involvement. Although BD is more frequently diagnosed in adulthood, the disease onset can also be in pediatric age. Pediatric-onset BD is commonly featured by an incomplete clinical picture, and therefore the diagnosis represents a considerable clinical challenge for the physicians. The first classification criteria for pediatric BD, based on a scoring system, have been proposed few years ago. This work focuses on the main difficulties concerning both the diagnostic approach and the treatment of BD in pediatric age. The recommendation for the treatment of pediatric BD has been recently updated and allowed a considerable improvement of the therapeutic strategies. In particular, the use of anti-TNFα drugs as a second-line option for refractory BD, and as a first-line treatment in severe ocular and neurological involvement, has demonstrated to be effective in improving the outcome of BD patients. The knowledge about the molecular pathogenesis is progressively increasing, showing that BD shares common features with autoimmune and autoinflammatory disorders, and thus leading to the use of new biologic agents targeting the main mediators involved in the determination of BD. Anti-IL-17, anti-IL-23, anti-IL-1 and anti-IL-6 agents have shown promising results for the treatment of refractory BD in clinical trials and will represent an important alternative for the therapeutic approach to the disease.
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Affiliation(s)
- Giorgio Costagliola
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa, Pisa, Italy
| | - Susanna Cappelli
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa, Pisa, Italy
| | - Rita Consolini
- Laboratory of Immunology, Department of Clinical and Experimental Medicine, Division of Pediatrics, University of Pisa, Pisa, Italy
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Abstract
PURPOSE To evaluate the ocular surface alterations and tear film functions in patients with ocular Behçet disease (BD). METHODS This study included 48 eyes of 48 patients with inactive BD and a control group of 33 age- and sex-matched subjects. Schirmer I and tear break-up time (TBUT) tests were used to evaluate the tear film of the subjects. Impression cytology was used to evaluate morphological changes of the conjunctival surface epithelial cells. RESULTS The mean Schirmer I test result was 11.6 ± 5.9 mm/5 minutes and 16.1 ± 4.6 mm/5 minutes in the Behçet and control groups, respectively. The mean TBUT test result was 9.8 ± 5.6 seconds and 13.2 ± 5.7 seconds in the study and control groups, respectively. The Schirmer and TBUT test results were significantly lower in the study group than in the controls (P = 0.001 and P = 0.011, respectively). The mean impression cytology score was 1.3 ± 0.9 in the study group and significantly higher than the control group value of 0.4 ± 0.6 (P = 0.001). CONCLUSIONS Tear film functions and conjunctival surface epithelial morphology were significantly altered in patients with ocular BD.
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Reiff A, Kadayifcilar S, Özen S. Rheumatic Inflammatory Eye Diseases of Childhood. Rheum Dis Clin North Am 2013; 39:801-32. [DOI: 10.1016/j.rdc.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Musculoskeletal Findings in Behcet's Disease. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2012:653806. [PMID: 21961082 PMCID: PMC3180072 DOI: 10.1155/2012/653806] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 07/26/2011] [Indexed: 12/18/2022]
Abstract
Behcet's disease is a multisystem disease characterized by recurrent oral and genital ulcers, relapsing uveitis, mucocutaneous, articular, gastrointestinal, neurologic, and vascular manifestations. Rheumatologic manifestations may also occur in Behcet's disease, and arthritis and arthralgia are the most common musculoskeletal findings followed by enthesopathy, avascular necrosis, myalgia, and myositis. Although the main pathology of Behcet's disease has been known to be the underlying vasculitis, the etiology and exact pathogenesis of the disease are still unclear. Musculoskeletal findings of Behcet's disease, the relationship between Behcet's disease and spondyloarthropathy disease complex, and the status of bone metabolism in patients with Behcet's disease were discussed in this paper.
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Yoo WH. Coexisting Behçet's disease and ankylosing spondylitis presented with deep venous thrombosis: a case report and review of the literature. Rheumatol Int 2010; 32:1793-6. [PMID: 20352223 DOI: 10.1007/s00296-010-1439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 03/12/2010] [Indexed: 11/25/2022]
Abstract
The coexistence of Behçet's disease (BD) and ankylosing spondylitis (AS) is a rare combination and described only in case reports in the literature. Although the number of reports is increasing, vascular thrombosis, which is characteristic feature of BD, was not reported in this combination until now. We present a case of a male patient with both BD and AS, presenting with deep venous thrombosis. We also reviewed the clinical features of the cases with coexistence of BD and AS.
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Affiliation(s)
- Wan-Hee Yoo
- Department of Internal Medicine, Chonbuk National University Medical School and Research Institute of Clinical Medicine, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, Jeonbuk, 561-756, South Korea.
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Ashok D, Ayliffe WH, Kiely PDW. Necrotizing scleritis associated with rheumatoid arthritis: long-term remission with high-dose infliximab therapy. Rheumatology (Oxford) 2005; 44:950-1. [PMID: 15827040 DOI: 10.1093/rheumatology/keh635] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
BACKGROUND Behçet disease is a vasculitis with mucocutaneous, ocular, arthritic, vascular, and other manifestations. Its neurologic manifestations (neuro-Behçet disease) are relatively rare, but they must be thoroughly investigated due to their grave prognosis. REVIEW SUMMARY The frequency of neurologic manifestations, more common in male Behçet patients, is between 5% and 30%. Both the central and peripheral nervous systems can be involved. Central nervous system manifestations can be divided into 2 main groups: (1) parenchymal involvement, which includes brainstem involvement, hemispheric manifestations, spinal cord lesions, and meningoencephalitic presentations; (2) nonparenchymal involvement, including dural sinus thrombosis, arterial occlusion, and/or aneurysms. Peripheral neuropathy and myopathy are relatively rare. Cerebrospinal fluid analysis reveals pleocytosis and elevated protein levels. Magnetic resonance imaging is the investigation of choice which often reveals iso-/hypointense lesions in T1-weighted images and hyperintense lesions in T2-weighted images, mostly in the mesodiencephalic junction, cerebellar peduncles, and other parts of the brainstem. Corticosteroids and adjuvant immunosuppressive therapy are used for parenchymal manifestations, and corticosteroids and anticoagulants are used for treatment of dural sinus thrombosis. CONCLUSION Neuro-Behçet disease must be considered in the differential diagnosis of stroke in young adults, multiple sclerosis, movement disorders, intracranial hypertension, intracranial sinovenous occlusive diseases, and other neurologic syndromes.
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Abstract
Behçet's disease is a systemic vasculitis of unknown aetiology characteristically affecting venules. Onset is typically in young adults with recurrent oral and genital ulceration, uveitis, skin manifestations, arthritis, neurological involvement, and a tendency to thrombosis. It has a worldwide distribution but is prevalent in Japan, the Middle East, and some Mediterranean countries. International diagnostic criteria have been proposed, however diagnosis can be problematical, particularly if the typical ulcers are not obvious at presentation. Treatment is challenging, must be tailored to the pattern of organ involvement for each patient and often requires combination therapies.
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Affiliation(s)
- V Kontogiannis
- Clinical Immunology Unit, University Hospital, Queens Medical Centre, Nottingham NG7 2UH, UK
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Abstract
Behçet's disease (BD) is a chronic inflammatory condition involving several organs, such as skin, mucous membrane, eye, joint, intestine, lung and central nervous system. Ankylosing spondylitis (AS) is a prototype of seronegative spondyloarthropathy, and a chronic systemic inflammatory disorder of the axial skeleton, mainly affecting the sacroiliac joint and spine. In the latter, systemic complications may develop in addition to joint involvement. The coexistence of BD and AS has been rarely reported in the literature. The inclusion of BD among seronegative spondyloarthritides and whether sacroiliitis (SI) develops in BD are still being debated. We describe a 28-year-old man who has fulfilled the diagnostic criteria for BD and AS as well.
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Affiliation(s)
- H K Chang
- Department of Internal Medicine, Asan-Foundation Kangnung Hospital, Kangnung, Korea
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Abstract
Giant cell (temporal) arteritis continues to be a sight-threatening, systemic vasculitis with a poorly understood pathogenesis. The characteristic granulomatous inflammation of the vessel wall commonly leads to local ischemia. Recent advances in immunological investigations have characterized the cellular components of the disease process, but the etiology has so far remained unresolved. A reappraisal of the clinical features of giant cell (temporal) arteritis demonstrates the heterogeneity of the manifestations of the disease, including ischemic optic neuropathy. A range of new laboratory investigations and blood flow studies with color Doppler imaging have demonstrated promising roles, with respect to diagnosis and long-term follow-up. Prompt diagnosis and expeditious treatment require a high index of clinical suspicion, particularly for atypical cases. Corticosteroids remain the treatment of choice, other immuno-suppressive agents being used as second line steroid-sparing agents. Giant cell (temporal) arteritis leads to increased vascular and visual morbidity and, if untreated, may prove fatal. To maintain high standards of management of this enigmatic disorder, ophthalmologists need to be aware of the clinical spectrum of giant cell (temporal) arteritis and currently available diagnostic tests and treatment strategies.
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Affiliation(s)
- F D Ghanchi
- Tennent Institute of Ophthalmology, University of Glasgow, Western Infirmary, United Kingdom
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