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Bölük KN, Akdağ Köse A. Characteristics of late-onset Behçet's disease and comparison with juvenile and adult-onset Behçet's disease. Int J Dermatol 2024. [PMID: 39215427 DOI: 10.1111/ijd.17456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 08/01/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND The course of late-onset Behçet's disease (LBD) is unknown. This study aimed to determine the characteristics and systemic involvement of LBD. METHODS In this retrospective, cross-sectional, and comparative study, 700 patient files from 4100 patients diagnosed with Behçet's disease (BD) were selected and divided into three groups: LBD, adult BD (ABD), and juvenile BD (JBD). The age limits for LBD and JBD were determined to be 42 and 16, respectively. LBD patients were compared to ABD and JBD patients in terms of demographics, systemic involvement, and disease duration. RESULTS The LBD rate among BD patients was 4.7% (183/4,100). The time from initial symptom occurrence to the age at which the BD criteria were met was longer in LBD than in ABD or JBD. Except for genital ulcers, the frequencies of involvement in LBD were similar to those in ABD and JBD. The frequency of family history was significantly lower in LBD (12%) than in ABD (15.9%) or JBD (18.2%). The time from the initial symptom to oral aphthae, genital ulcers, and eye involvement was longer in LBD than in ABD or JBD. Furthermore, erythema nodosum was observed after a longer duration in LBD than in ABD. CONCLUSION Considering that involvement occurs much later in LBD and there are no differences in the frequencies of involvement except for genital ulcers, LBD patients should be followed up as closely as ABD and JBD patients.
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Affiliation(s)
- Kübra Nursel Bölük
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Afet Akdağ Köse
- Department of Dermatology and Venereology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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2
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Akbaba TH, Ekici M, Çolpak Aİ, Brown KL, Karadağ Ö, Balci-Peynircioglu B. Behçet's syndrome: recent advances to aid diagnosis. Clin Exp Med 2023; 23:4079-4090. [PMID: 37897656 DOI: 10.1007/s10238-023-01226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
Behçet's syndrome is a recurring inflammatory multiorgan disorder affecting the skin, mucosa, eyes, joints, stomach, and central nervous system. Behçet's syndrome epidemiology varies greatly among populations (0.64-420/100,000), and Behçet's syndrome has gained increasing international acclaim in the recent 50 years due to raising awareness of the syndrome, although it is rare in most population. In addition to the unclear etiology of the syndrome, the diagnosis of Behçet's syndrome is complicated by a vague clinical presentation, phenotypic heterogeneity and/or incomplete representation, and the lack of any specific laboratory, radiographic, or histological findings. There exists a dire need to elucidate factors that contribute to disease pathogenesis and/or are associated with clinical features of Behçet's syndrome and the classification of different forms of the syndrome. The identification of such molecular, cellular, and/or clinical factors are crucial for timely diagnosis and efficacious management of Behçet's syndrome. We discuss recent advances in the clinical diagnosis of Behçet's syndrome and related contributions of genetics, epigenetics, microbiome, inflammasomes, and autoantibodies to the improved diagnosis, management, and understanding of Behçet's syndrome.
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Affiliation(s)
- Tayfun Hilmi Akbaba
- Department of Medical Biology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- BC Children's Hospital Research Institute, Vancouver, Canada
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mustafa Ekici
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşe İlksen Çolpak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kelly L Brown
- BC Children's Hospital Research Institute, Vancouver, Canada
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ömer Karadağ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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3
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Zhong Z, Su G, Yang P. Risk factors, clinical features and treatment of Behçet's disease uveitis. Prog Retin Eye Res 2023; 97:101216. [PMID: 37734442 DOI: 10.1016/j.preteyeres.2023.101216] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/23/2023]
Abstract
Behçet's disease is a systemic vasculitis frequently associated with intraocular inflammation. Recent findings identified independent clinical clusters in Behçet's disease, each involving distinct combinations of affected organs. Ocular Behçet's disease, mainly manifested as uveitis, is characterized as an independent cluster with a low likelihood of association with other system involvements, such as intestinal, cardiovascular, or central nervous system. A prevailing theory suggests that the pathogenesis of the disease is multifactorial, where a variety of genetic and infectious agents may interact with each other to cause the disease. Among sporadic cases, the human leukocyte antigen (HLA) genes, including HLA-B51, HLA-A26, HLA-B15, and HLA-B5701, have been found to be a key component conferring genetic susceptibility. Outside the HLA region, a set of susceptibility variants are identified, closely related to interleukin (IL)-23/IL-17 pathway, tumor necrosis factor (TNF) signaling, and pattern recognition receptor systems. Microbial infections, such as Streptococcus sanguinis, Mycobacterium tuberculosis, and Herpes simplex virus (HSV), are linked to play the triggering of disease in immunogenetically predisposed individuals. Clinically, due to the notable relapsing-remitting course of ocular Behçet's disease, the prevention of recurrent attack would be the primary treatment goal. Combination of corticosteroids and immunomodulatory drugs, such as anti-TNF agents, interferon, and conventional immunosuppressants (e.g. cyclosporine, azathioprine), have been the mainstream regimen for the disease. Future research may focus on comparing the effectiveness of immunomodulatory drugs and identifying the most suitable subgroups for a specific drug on the basis of the knowledge of the molecular heterogeneity of the disease.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Laboratory of Ophthalmology, Chongqing Eye Institute, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China.
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4
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Chen T, Shao X, Li H, Chen Y, Liu L, Zhong J, Chen J. Association of Behçet's disease with the risk of metabolic syndrome and its components: a systematic review and meta-analysis. Clin Exp Med 2023; 23:2855-2866. [PMID: 36939969 PMCID: PMC10543763 DOI: 10.1007/s10238-023-01044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
The present meta-analysis aimed to elucidate the association of Behçet's disease (BD) with the risk of metabolic syndrome (MetS) and its components. Observational cohort studies were searched from the Embase, Web of Science, Medline, and Cochrane Library databases. The primary outcome was the association of BD with the risk of MetS and its relevant components. Effect estimates with odds ratios (ORs) were pooled using either the random-effects or fixed-effects models, according to heterogeneity. Leave-one-out sensitivity analyses were used to determine the stability of the results. Twenty-three studies, comprising 42,834 patients with BD, were included. Overall, a significant association between BD and the risk of MetS was found (pooled OR 2.26; 95% confidence interval [CI] 1.61-3.17; P < 0.0001). Among the components of MetS, significant associations were found between BD and diabetes mellitus (OR 1.21; 95% CI 1.10-1.33; P < 0.0001), BD and hypertension (OR 1.39; 95% CI 1.13-1.70; P = 0.002), and BD and dyslipidemia (OR 1.21; 95% CI 1.01-1.45; P = 0.04). Our study indicated an association between BD and the risk of MetS and some of its components (diabetes mellitus, hypertension, and dyslipidemia). Physician should consider these associations so that specific treatments are available for patients with comorbidities. Moreover, patients with BD should regularly monitor their blood pressure, fasting plasma glucose, and blood lipid levels.
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Affiliation(s)
- Tingqiao Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xinyi Shao
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hao Li
- Department of Dermatology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Yangmei Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Lin Liu
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Judan Zhong
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jin Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Kim D, Nakamura K, Kaneko F, Alpsoy E, Bang D. Mucocutaneous manifestations of Behçet's disease: Pathogenesis and management from perspectives of vasculitis. Front Med (Lausanne) 2022; 9:987393. [PMID: 36530905 PMCID: PMC9755684 DOI: 10.3389/fmed.2022.987393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/27/2022] [Indexed: 09/23/2023] Open
Abstract
Behçet's disease (BD) is a systemic inflammatory disorder characterized by vasculitis affecting blood vessels of any caliber or type. It can present with a wide spectrum of vasculitic lesions, including erythema nodosum-like lesions and retinal vasculitis, and may also lead to larger vessel diseases, such as aortic aneurysm and deep vein thrombosis. The full etiology of BD remains unclear, but it is considered a polygenetic disease with multiple genetic risk factors that promote immune dysregulation and thrombophilia. Inflammation can be triggered by environmental factors, such as bacteria or viruses, and the dysregulation of innate and adaptive immune cell subsets. Neutrophils and lymphocytes are the primary players involved in BD pathogenesis, with specific innate (i.e., neutrophil-derived reactive oxygen species and neutrophil extracellular traps) and adaptive (i.e., anti-endothelial cell antibodies) processes inducing endothelial cell activation and chemotaxis of inflammatory cells, leading to coagulation and vasculitis. These inflammation-induced vasculitic or vasculopathic features are observed in most mucocutaneous BD lesions, although vasculitis per se is often pathologically evident only during a brief period of the disease process. Due to the multifactorial nature of BD-associated inflammation, broad-spectrum anti-inflammatory medications, including glucocorticoids and immunosuppressive drugs, have been the mainstay for managing BD. In addition, inhibitors of interleukin (IL)-1, tumor necrosis factor (TNF)-α, and IL-17, which target innate and adaptive immune functions dysregulated in BD, have emerged as promising new therapeutics. In this review, we discuss the muco-cutaneous manifestations of BD by focusing on the underlying vasculitic components in their pathologies, as well as the current array of treatment options.
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Affiliation(s)
- Doyoung Kim
- Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Fumio Kaneko
- Institute of Dermato-Immunology and Allergy, Southern Tohoku General Hospital, Fukushima, Japan
| | - Erkan Alpsoy
- Department of Dermatology and Venereology, School of Medicine, Akdeniz University, Antalya, Turkey
| | - Dongsik Bang
- Department of Dermatology, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, South Korea
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6
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Kim YH, Kim HJ, Park JW, Han KD, Park YG, Lee YB, Lee JH. Risk for Behçet's disease gauged via high-density lipoprotein cholesterol: a nationwide population-based study in Korea. Sci Rep 2022; 12:12735. [PMID: 35882901 PMCID: PMC9325767 DOI: 10.1038/s41598-022-17096-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease. Low levels of plasma high-density lipoprotein cholesterol (HDL-C) are associated with Crohn’s disease, another chronic inflammatory disease. However, the effects of low HDL-C levels on BD are unclear. We investigated the effects of HDL-C levels, and variability therein, on the risk for BD. We used the Korean National Health Insurance System database to identify 5,587,754 adults without a history of BD who underwent ≥ 3 medical examinations between 2010 and 2013. Mean HDL-C levels at each visit were used to calculate variability independent of the mean (VIM) and the coefficient of variation (CV). There were 676 new cases of BD (0.012%). The risk for BD was increased in participants with highly variable and low mean HDL-C levels. In a multivariate-adjusted model, the hazard ratios (95% confidence intervals) for BD incidence were 1.335 (1.058–1.684) in a high mean/high VIM group, 1.527 (1.211–1.925) in a low mean/low VIM group, and 2.096 (1.67–2.63) in a low mean/high VIM group compared to a high mean/low VIM group. Low mean HDL-C levels, and high variability therein, are independent risk factors for BD.
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Affiliation(s)
- Yeong Ho Kim
- Department of Dermatology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Hyun Jee Kim
- Department of Dermatology, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Park
- Department of Dermatology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, 271 Chunbo Street, 07345, Uijeongbu, Seoul, Republic of Korea.
| | - Ji Hyun Lee
- Department of Dermatology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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7
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David E, Fauvernier M, Saadoun D, Gerfaud-Valentin M, Maurcort-Boulch D, Sève P, Jamilloux Y. Mortality associated with Behçet’s disease in France assessed by multiple-cause-of-death analysis. Clin Rheumatol 2022; 41:1749-1758. [DOI: 10.1007/s10067-021-06027-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/22/2022]
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Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
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Affiliation(s)
- Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology and Behçet's Disease Research Centre, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Division of Rheumatology, Lund University and Department of Rheumatology, Skåne University Hospital, Lund, Sweden
- Department of Medicine, University of Cambridge, Cambridge, UK
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Choi SH, BA, Kim DY. Epidemiologic and Etiological Features of Korean Patients With Behçet's Disease. JOURNAL OF RHEUMATIC DISEASES 2021; 28:183-191. [PMID: 37476362 PMCID: PMC10324907 DOI: 10.4078/jrd.2021.28.4.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 07/22/2023]
Abstract
Behçet's disease (BD) is a multisystem disease in which environmental factors provoke an adverse immune response in patients with genetic susceptibility towards BD, subsequently leading to a cascade of dysregulated inflammation throughout the body. It is particularly prevalent in regions spanning the ancient Silk Road, including Korea, where the first known case of BD was reported in 1961. We summarize the history, epidemiology, and clinical presentation of BD in Korea, highlighting the clinical tendencies that are particularly seen in the Korean BD population as compared to European populations. Analysis of epidemiologic trends over the past three decades in Korea shows a decreasing prevalence of complete BD and a higher prevalence of intestinal BD. We also discuss the ever-evolving understanding of the pathogenesis of BD, noting the complex interplay among genetics, environment, and immunology. The HLA-B51 allele is the most significant known genetic risk factor in developing BD. We also discuss more recently studied associations between BD and immune factors such as IL-10, IL-23R-IL-12RB2, IL-1A-IL-1B, CCR1, ERAP1, and the GIMAP cluster, the last of which has been found to have an association with BD specifically in Korea. Environmental factors such as pollution and microbials are often the inciting event in developing BD, as they trigger an imbalanced immune response in genetically susceptible individuals, one that has been often found to exhibit an aberrant Th1/Th17 response. There would be value to further studying the pathogenesis and clinical characteristics of Korean BD.
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Affiliation(s)
- Soo Hyun Choi
- Tulane University School of Medicine, New Orleans, LA, USA
| | - BA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Do-Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Yalçındağ FN, Çakar Özdal P, Özyazgan Y, Batıoğlu F, Tugal-Tutkun İ. Comparison of Sociodemographic Features Between Behçet Uveitis and Other Non-infectious Uveitis. Turk J Ophthalmol 2021; 51:206-211. [PMID: 34461696 PMCID: PMC8411281 DOI: 10.4274/tjo.galenos.2020.28485] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: To analyze and compare sociodemographic features between Behçet uveitis and other non-infectious uveitis. Materials and Methods: The data of adults with non-infectious uveitis in the nationwide uveitis database were analyzed and the sociodemographic features of patients with and without Behçet disease were compared. Results: This study included data of 4,978 eyes of 3,363 patients from 33 centers. The mean age at presentation was 38.7±13.3 (17- 87) years. The mean age was 34.3±10.5 years in the Behçet uveitis group and 41.1±14.0 years in the other non-infectious uveitis group (p<0.001). Male predominance was seen in the Behçet uveitis group (67.7% vs. 32.3%) while female patients were more common in the other non-infectious uveitis group (54.4% vs. 45.6%, p<0.001). Regarding education level, the proportion of patients with low education was higher in the Behçet uveitis group than the other non-infectious uveitis group (49.6% vs. 43.4% in males, p=0.004; 61.5% vs. 59.2% in females, p=0.021). Having a low-income job or being currently unemployed, indicators of poor income, were more frequent in the Behçet uveitis group than in the other non-infectious uveitis group (32.0% vs. 22.8%, p<0.001). In the comparison of places of residence, the proportion of patients who lived in cities with low gross national product was 37.0% in the Behçet uveitis group and 31.1% in the other non-infectious uveitis group (p<0.001). Conclusion: Patients with Behçet disease had lower education level and socioeconomic status than patients with other non-infectious uveitis entities.
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Affiliation(s)
- F Nilüfer Yalçındağ
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Pınar Çakar Özdal
- University of Health Sciences Turkey Faculty of Medicine, Department of Ophthalmology, Ankara Ulucanlar Göz SUAM, Ankara, Turkey
| | - Yılmaz Özyazgan
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Figen Batıoğlu
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İlknur Tugal-Tutkun
- İstanbul University, İstanbul Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
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Mumcu G, Fortune F. Oral Health and Its Aetiological Role in Behçet's Disease. Front Med (Lausanne) 2021; 8:613419. [PMID: 34095159 PMCID: PMC8172597 DOI: 10.3389/fmed.2021.613419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/26/2021] [Indexed: 12/31/2022] Open
Abstract
Behçet's disease (BD) is a chronic multi-systemic inflammatory disorder characterised by oro-genital ulcers, cutaneous manifestations, ocular, vascular, neurologic and gastrointestinal involvement. Complex interactions operating on the genetic background e.g.(HLA51), of infectious and other environmental agents, together with immune dysregulation impacts on the pathogenesis of BD. This suggests that the environmental factors triggering immune responses may activate clinical manifestations in genetically susceptible individuals. Since oral health forms the basis of all general health both dental and systemic, it is an important component of both Dentistry and Medicine. Oral ulcers are the most common clinical manifestation of oral mucosal health. Changes in the oral environment consequently acts as an infective and immune trigger. In this review, complex interactions between the oral ulcers, the oral microbiome and immune responses together with the course of oral and systemic disease manifestations in BD are discussed in the context of the aetiologic role of oral health.
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Affiliation(s)
- Gonca Mumcu
- Department of Health Management, Faculty of Health Science, Marmara University, Istanbul, Turkey
| | - Farida Fortune
- Centre for Immuno-Biology and Regenerative Medicine, Behçet's Centre of Excellence, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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12
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Lee J, Yoo S, Han KD, Han JH, Bang CH, Park Y, Lee JY, Park YG, Lee Y. Association between metabolic syndrome and Behçet's disease: A nationwide population-based study. J Dermatol 2021; 48:1062-1066. [PMID: 33961305 DOI: 10.1111/1346-8138.15809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
Metabolic syndrome (MetS) is characterized by insulin resistance, high blood pressure/sugar, dyslipidemia, and obesity. Whether MetS and its components affect the development of Behçet's disease (BD) remains unclear. This study was performed to investigate the associations between metabolic syndrome and risk of BD using nationwide population data. We conducted a retrospective cohort study of 10 505 818 Korean subjects who received health checkups in 2009-2012. Patients were classified into a MetS and its components group and were followed-up until 2016 for new-onset BD. A Cox proportional hazards model was used to assess the independent or synergistic effects of MetS and its components on the risk of incident BD. Compared to subjects without MetS components, the hazard ratio (HR) for development of BD in patients with MetS was 0.874 (95% confidence interval [CI]: 0.819-0.933) and this association was more prominent when all components of MetS were present (HR = 0.675, 95% CI = 0.571-0.798). Subjects with low high density lipoprotein (HDL) has a significantly increased risk of the development of BD (HR = 1.51, 95% CI = 1.4-1.594) compared to controls. This study showed that the incidence of Behçet's disease was reduced in subjects with MetS. Moreover, the presence of MetS components, with the exception of HDL, was negatively related to the development of BD.
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Affiliation(s)
- JiHyun Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - SeungAh Yoo
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyung Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ju Hee Han
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Hwan Bang
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - YoungMin Park
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun Young Lee
- Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong-Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - YoungBok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Jung JH, Han KD, Lee YB, Park YG. Behçet's Disease Is Associated with Multiple Sclerosis and Rheumatoid Arthritis: A Korean Population-Based Study. Dermatology 2021; 238:86-91. [PMID: 33756455 DOI: 10.1159/000514634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 01/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND No epidemiologic study has previously reported on the associations among Behçet's disease (BD) and autoimmune disorders. OBJECTIVES To investigate the association between BD and the autoimmune disorders multiple sclerosis and rheumatoid arthritis. METHODS Medical records of patients newly diagnosed with BD (n = 6,214) in 2012-2017 were analyzed using data entered into a large, nationwide database from 2007 to 2017. An age- and sex-matched control population of individuals without BD was sampled at a ratio of controls:BD cases of 3:1 (n = 18,642). Both cohorts were analyzed for the presence of multiple sclerosis or rheumatoid arthritis within a minimum of 5 years prior to their BD diagnosis. RESULTS Patients with BD had significantly higher odds ratios (ORs) for multiple sclerosis (8.85 [95% CI 2.36-33.17]) and rheumatoid arthritis (4.62 [95% CI 3.35-6.35]) than the control group after adjustment for diabetes mellitus, hypertension, and dyslipidemia. BD patients aged <40 years had a higher proportion of rheumatoid arthritis (OR 23.91, 95% CI 5.50-103.9) than older patients (OR 3.96, 95% CI 2.83-5.54). CONCLUSION Our results suggest that BD is associated with multiple sclerosis and rheumatoid arthritis.
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Affiliation(s)
- Jin Hyung Jung
- Department of Biomedicine and Health Science, Graduate School, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Chen YY, Lai YJ, Yen YF, Chen HH, Chou P. Uveitis as a potential predictor of acute myocardial infarction in patients with Behcet's disease: a population-based cohort study. BMJ Open 2021; 11:e042201. [PMID: 33452196 PMCID: PMC7813367 DOI: 10.1136/bmjopen-2020-042201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate whether uveitis is a predictor of acute myocardial infarction (AMI) among patients with Behcet's disease (BD). DESIGN Retrospective cohort study. SETTING Patients with BD were retrieved from the whole population of the Taiwan National Health Insurance Research Database from 1 January 2001 to 31 December 2013. PARTICIPANTS Among the 6508 patients with BD, 2517 (38.7%) were in the uveitis group and 3991 were in the non-uveitis group. PRIMARY AND SECONDARY OUTCOME MEASURES Kaplan-Meier curves were generated to compare the cumulative hazard of AMI in the uveitis and non-uveitis groups. Multivariate Cox regression analysis was used to estimate the adjusted HRs and 95% CI of AMI, and was adjusted for age, gender, systemic comorbidities (eg, hypertension, diabetes, hyperlipidaemia, smoking) and clinical manifestation of BD (eg, oral ulcers, genital ulcers, skin lesions, arthritis and gastrointestinal involvement). RESULTS The mean age of the BD cohort was 38.1±15.1 years. Compared with non-uveitis patients, uveitis patients were significantly younger and male predominant. There was no significant difference between the two groups for most proportions of systemic comorbidities and clinical manifestations. The Kaplan-Meier method with the log-rank test showed that the uveitis group had a significantly higher cumulative hazard for patients with AMI compared with the non-uveitis group (p<0.0001). In the multivariable Cox regression after adjustment for confounding factors, patients with uveitis had a significantly higher risk of AMI (adjusted HR 1.87; 95% CI 1.52 to 2.29). Other significant risk factors for AMI were age, hypertension, smoking, and skin lesions. CONCLUSIONS Statistical analyses from the nationwide database demonstrated that uveitis is a potential predictor of AMI in patients with BD.
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Affiliation(s)
- Yu-Yen Chen
- Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ju Lai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan
- Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Yung-Feng Yen
- Section of Infectious Diseases, Taipei City Hospital, Yangming Branch, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Hua Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
| | - Pesus Chou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Sota J, Rigante D, Emmi G, Lopalco G, Orlando I, Tosi GM, Frediani B, Vitale A, Guerriero S, Iannone F, Vannozzi L, Fabiani C, Cantarini L. Behçet's syndrome in Italy: a detailed retrospective analysis of 396 cases seen in 3 tertiary referral clinics. Intern Emerg Med 2020; 15:1031-1039. [PMID: 32006221 DOI: 10.1007/s11739-019-02248-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
Behçet's syndrome (BS) is a multisystemic disorder displaying a marked variability across different geographic areas. The main aim of this study was to analyze demographic and clinical features of a cohort of BS patients diagnosed in three tertiary referral centers in Italy and detect potential associations between the different manifestations. Medical records of 396 patients (218 females, 178 males) were retrospectively analyzed. Mean age at onset was 30.00 ± 18.75 years with a female-to-male ratio of 1.22:1. Mucocutaneous features were the most frequent starting manifestations of BS, followed by eye inflammation. Erythema nodosum (p = 0.007), arthritis/arthralgias (p = 0.0115), and central nervous system (CNS) signs (p = 0.014) were significantly over-represented in female patients, whereas male gender was associated with lower mean age at onset (p = 0.031), higher frequency of pseudofollicular lesions, and uveitis (p = 0.00134 and p < 0.0001 respectively), particularly for posterior segment involvement and panuveitis (p < 0.0001). Regarding the association between disease features, genital ulcers were negatively associated with uveitis (p < 0.0001) and vascular involvement (p < 0.0001). Other negative associations were detected between uveitis and gastrointestinal involvement (p = 0.008), pseudofolliculitis and CNS signs (p = 0.031), vascular involvement (p = 0.002) and erythema nodosum (p = 0.013). Logistic regression identified male gender and genital ulcers, respectively, with a higher (OR 2.199 [1.397-3.461], p < 0.001) and lower risk (OR 0.157 [0.090-0.273], p < 0.0001) of developing major organ involvement. Our evaluations found that the disease had started mostly in the second and third decade with most severe features in the male gender, and that patients presenting with mucocutaneous manifestations were less prone to develop major organ involvement.
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Affiliation(s)
- Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica Sacro Cuore, Rome, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Ida Orlando
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy.
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16
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Jun JB, Kim HJ, Kazmi SZ, Kang T, Kim KB, Kang MJ, Ahn HS. Significant Decline in the Incidence of Behcet's Disease in South Korea: A Nationwide Population-Based Study (2004-2017). Arthritis Care Res (Hoboken) 2020; 73:1689-1696. [PMID: 32770715 DOI: 10.1002/acr.24408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/04/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Change in the incidence of Behcet's disease (BD) from long term population-based data are scarce, although a possible decline has been reported. The objectives were to investigate the incidence, survival, and mortality of BD patients from 2004 to 2017 in South Korea. METHODS We analyzed a registry of rare intractable diseases and a claims database from the Health Insurance and Review Agency with information on BD patients between 2004 and 2017 using uniform diagnostic criteria. The study period was divided into three groups: 2004-2006, 2007-2010, and 2011-2017. RESULTS The annual incidence of BD decreased from 8.15 per 100,000 in 2004 to 1.51 in 2017, an 81.5% decrease. The annual percentage change was 6.32% for females and 6.15% for males. The decrease in BD incidence was greater for women and middle-aged people. The 3-year survival rate of BD patients during the 2011-2017 period was lower than those of the BD patients in 2004-2006 and 2007-2010, although there was no statistical difference. The standardized mortality rates increased significantly in the 2011-2017 period compared to the first two periods. CONCLUSION BD incidence decreased from 2004 to 2017 in South Korea. This decline in incidence might be attributable to changes in environmental factors, including a reduction in the burden of infectious diseases in the past decades and improvement of oral health during childhood. The unprecedented decline in the incidence of BD in South Korea without major changes in the genetic background suggests that environmental factors are very important to the development of BD.
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Affiliation(s)
- Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sayada Zartasha Kazmi
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Taeuk Kang
- National Health Insurance Policy Research Institute, Seoul, Korea
| | | | - Min Ji Kang
- Department of Public Health, Korea University, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
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17
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Changing pattern of clinical manifestations of Behçet's disease in Tunisia: comparison between two decades. Reumatologia 2020; 58:87-92. [PMID: 32476681 PMCID: PMC7249524 DOI: 10.5114/reum.2020.95362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 04/17/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the changes over time in extraocular and ocular manifestations of Behçet’s disease (BD) in Tunisian patients. Material and methods Retrospective study of 246 patients divided into two groups: group 1 (147 patients examined from 1995 to 2005) and group 2 (99 patients examined from 2006 to 2017). Results Active or scarred genital ulcers observed by physician at presentation were significantly less frequent in group 2 (47.2% vs. 29.6%; p = 0.007), as were articular involvement (50.3% vs. 34.7%; p = 0.016) and erythema nodosum (18.4% vs. 8.1%; p = 0.024). One hundred-seven patients (43.5%) developed ocular manifestations during the 23-year study period. Intermediate uveitis was significantly more frequent in group 2 than in group 1 (11.7% vs. 28.4%; p = 0.003), and posterior uveitis less frequent in group 2 than in group 1 (34.2% vs. 19.7%; p = 0.016). Patients from group 2 were more likely to have macular edema (19.8% vs. 45.6%; p = 0.001). However, better visual prognosis, with a lower rate of legal blindness, was noted in group 2. Conclusions Changes over time included a decrease in the rate of articular involvement and cutaneous involvement. There was an increase in the rate of intermediate uveitis and a decrease in the rate of posterior uveitis over time. Despite an increase in the rate of macular edema, there was an improvement in visual prognosis, with less legal blindness over time.
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18
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Ahn HS, Lee D, Lee SY, Kim YH, Lee JH, Yu DS, Han KD, Park YG, Lee YB. Increased Cardiovascular Risk and All-cause Death in Patients with Behçet Disease: A Korean Nationwide Population-based Dynamic Cohort Study. J Rheumatol 2019; 47:903-908. [PMID: 31371649 DOI: 10.3899/jrheum.190408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Behçet disease (BD) is a chronic inflammatory multiorgan disease. An increased risk of cardiovascular disease (CVD) and heightened death rate with BD have been suggested, but to our knowledge, a nationwide large-scale study has not been conducted to date. This study aimed to determine the overall CV risk and death rate in patients with BD versus controls using the Korean National Health Insurance Service claim database. METHODS Patients with BD (n = 5576) with no previous history of CVD were selected from 2010 to 2014. An age- and sex-matched control population of individuals without BD (n = 27,880) was randomly sampled at a ratio of 5:1. Both cohorts were followed for incident CVD or all-cause death until 2015. RESULTS The risks of myocardial infarction (HR 1.72, 95% CI 1.01-2.73) and stroke (HR 1.65, 95% CI 1.09-2.50) were significantly higher in patients with BD than in controls. Patients with BD also had a significantly higher risk of all-cause death (HR 1.82, 95% CI 1.40-2.37) compared to controls. CONCLUSION Korean patients with BD had a higher overall risk of CVD than did those without BD. Therefore, patients with BD must be carefully monitored for the potential development of CVD to ensure that appropriate early treatments are delivered.
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Affiliation(s)
- Hyo-Suk Ahn
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dongjae Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Soo Young Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yeong Ho Kim
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Ji Hyun Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Dong Soo Yu
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Kyung-Do Han
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Yong Gyu Park
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
| | - Young Bok Lee
- From the Departments of Cardiology and Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea. .,H.S. Ahn, MD, PhD, Associate Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D. Lee, MD, Assistant Professor, Department of Cardiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; S.Y. Lee, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; Y.H. Kim, MD, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; J.H. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea; D.S. Yu, MD, PhD, Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea; K. Han, PhD, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.G. Park, PhD, Professor, Department of Biostatistics, College of Medicine, The Catholic University of Korea; Y.B. Lee, MD, PhD, Assistant Professor, Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
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Mumcu G, Direskeneli H. Triggering agents and microbiome as environmental factors on Behçet's syndrome. Intern Emerg Med 2019; 14:653-660. [PMID: 30523495 DOI: 10.1007/s11739-018-2000-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 11/29/2018] [Indexed: 12/13/2022]
Abstract
Environmental and other triggering factors are suggested to cause the onset and the clinical relapses of Behçet's syndrome (BS), a multi-systemic inflammatory disorder. In this review, environmental factors are discussed according to their interactions with etiopathogenesis, immune response and disease activity. Stress is a common self-triggering factor for most BS patients. Stimuli such as some foods can activate oral ulcers, and may be linked to the histamine content of the food. Oral/skin trauma and menstruation associated with hormonal factors aggravate, whereas allergy/atopy seem to alleviate the symptoms of BS. Infections are associated with BS, and microbial stimuli can activate inflammation in mucosal surfaces with increased Th1/Th17 responses. Fecal and oral microbiome patterns change in diversity and composition in BS. Better oral hygiene applications and anti-microbial interventions might be helpful to suppress oral ulcers in BS.
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Affiliation(s)
- Gonca Mumcu
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey.
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20
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Park HY, Lee JH, Lee SY, Yu DS, Han KD, Park YG, Lee YB. Risk for Parkinson's Disease in Patients with Behçet's Disease: A Nationwide Population-Based Dynamic Cohort Study in Korea. JOURNAL OF PARKINSONS DISEASE 2019; 9:583-589. [PMID: 31227655 DOI: 10.3233/jpd-191622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although several studies have reported a correlation between Behçet's disease (BD) and Parkinson's disease, this association has not yet been clarified. OBJECTIVE To determine the risk of Parkinson's disease in patients with BD. METHODS BD patients (n = 17,179; mean age, 51.12±8.09 years; male, 34.95%) without known previous diagnosis of Parkinson's disease were selected from the Korean National Health Insurance Database between 2010 and 2013. An age- and gender-matched control population of individuals without BD was randomly sampled at a ratio of 3:1 (n = 34,575). Both cohorts were followed for development of Parkinson's disease until 2015. RESULTS Among a total of 11,525 BD patients, 50 (0.43%) developed Parkinson's disease, whereas only 51 among the 34,575 individuals in the non-BD group developed Parkinson's (0.15%, P < 0.0001). The incidence of Parkinson's disease was significantly higher in BD patients than in controls. In addition, during the follow-up period, patients with BD were more likely to be diagnosed with Parkinson's disease than those in the non-BD group. CONCLUSIONS BD patients had a higher risk of Parkinson's disease compared to non-BD controls. Physicians should carefully monitor patients with BD for potential development of Parkinson's disease.
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Affiliation(s)
- Ho Youn Park
- Department of Orthopedics, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Hee Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo Young Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong Soo Yu
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Gyu Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Bok Lee
- Department of Dermatology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee Y, Lee J, Lee S, Lee J, Yu D, Han K, Park Y. Association between smoking and Behçet's disease: a nationwide population‐based study in Korea. J Eur Acad Dermatol Venereol 2019; 33:2114-2122. [DOI: 10.1111/jdv.15708] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Y.B. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - J.H. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - S.Y. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - J.H. Lee
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - D.S. Yu
- Department of Dermatology College of Medicine The Catholic University of Korea Seoul Korea
| | - K.D. Han
- Department of Biostatistics College of Medicine The Catholic University of Korea Seoul Korea
| | - Y.G. Park
- Department of Biostatistics College of Medicine The Catholic University of Korea Seoul Korea
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22
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Gheita TA, El-Latif EA, El-Gazzar II, Samy N, Hammam N, Abdel Noor RA, El-Shebeiny E, El-Najjar AR, Eesa NN, Salem MN, Ibrahim SE, El-Essawi DF, Elsaman AM, Fathi HM, Sallam RA, El-Shereef RR, Abd-Elazeem MI, Said EA, Khalil NM, Shahin D, El-Saadany HM, ElKhalifa MS, Nasef SI, Abdalla AM, Noshy N, Fawzy RM, Saad E, Moshrif AH, El-Shanawany AT, Abdel-Fattah YH, Khalil HM. Behçet’s disease in Egypt: a multicenter nationwide study on 1526 adult patients and review of the literature. Clin Rheumatol 2019; 38:2565-2575. [DOI: 10.1007/s10067-019-04570-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/14/2019] [Accepted: 04/18/2019] [Indexed: 12/19/2022]
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23
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Hsu YR, Huang JCC, Tao Y, Kaburaki T, Lee CS, Lin TC, Hsu CC, Chiou SH, Hwang DK. Noninfectious uveitis in the Asia-Pacific region. Eye (Lond) 2018; 33:66-77. [PMID: 30323327 DOI: 10.1038/s41433-018-0223-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/19/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022] Open
Abstract
Uveitis is a sight-threatening disease. Up to 35% of patients may have impaired vision. Inflammation of the uvea tissue has more than 60 etiologies. Previous reports have shown that 20-40% of uveitis cases were noninfectious. Some of them may be associated with systemic rheumatological and autoimmune diseases but some may affect the eyes only. The epidemiology and clinical situations of some specific uveitis entities vary worldwide because they are influenced by genetic, ethnic, environmental, and socioeconomic factors. The Asia-Pacific region comprises more than 30 countries. Epidemiology and patterns of uveitis vary greatly in this region. However, some uveitis entities, such as Behcet's disease, sarcoidosis, and Vogt-Koyanagi-Harada disease, are more common in this region. Many studies on the epidemiology, risk factors, and immune pathogenesis of this disease have been conducted. In this article, we review the epidemiology of noninfectious uveitis and special situations of these three uveitis entities in the Asia-Pacific region.
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Affiliation(s)
- Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Ophthalmology, National Taiwan University, Taipei, Taiwan
| | | | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tai-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
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24
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Akkoç N. Update on the epidemiology, risk factors and disease outcomes of Behçet's disease. Best Pract Res Clin Rheumatol 2018; 32:261-270. [DOI: 10.1016/j.berh.2018.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022]
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