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Lin RT, Liu PK, Chang CW, Cheng KC, Chen KJ, Chang YC. Behcet's disease-related panuveitis following COVID-19 vaccination: A case report. World J Radiol 2024; 16:460-465. [DOI: 10.4329/wjr.v16.i9.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/15/2024] [Accepted: 08/23/2024] [Indexed: 09/27/2024] Open
Abstract
BACKGROUND Behcet's disease (BD) is an inflammatory disorder known for various symptoms, including oral and genital ulcers and ocular inflammation. Panuveitis, a severe eye condition, is rare as the first sign of BD.
CASE SUMMARY We present an unusual case of a 30-year-old man who developed panuveitis after receiving the mRNA-based coronavirus disease 2019 (COVID-19) vaccine (Moderna). Laboratory tests ruled out infections, but he had a positive HLA-B51 result and a history of genital ulcer and oral ulcers, leading to a BD diagnosis. Treatment with corticosteroids improved his condition. Interestingly, he had another episode of panuveitis after the second mRNA vaccine dose, which also responded to corticosteroids.
CONCLUSION This case highlights the rare onset of BD following mRNA COVID-19 vaccination, suggesting a potential link between these vaccines and BD's eye symptoms, emphasizing the importance of quick treatment in similar cases.
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Affiliation(s)
- Rou-Ting Lin
- School of Medicine, College of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Clinical Education and Training, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Pei-Kang Liu
- Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80737, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Chia-Wei Chang
- Department of Clinical Education and Training, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Kai-Chun Cheng
- Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80737, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Kuo-Jen Chen
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81201, Taiwan
| | - Yo-Chen Chang
- Department of Ophthalmology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80737, Taiwan
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Department of Ophthalmology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 81201, Taiwan
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Khan U, Elseby A, Qureshi H. Diarrhoea: An Inflammatory Disorder Mimicking an Infection. Cureus 2023; 15:e44101. [PMID: 37750152 PMCID: PMC10518136 DOI: 10.7759/cureus.44101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/27/2023] Open
Abstract
Diarrhoea is a common presentation in acute emergency with potentially multifactorial causes. Hence, the chances of misdiagnosis can be high. Among these causes are listed diseases which are primarily inflammatory in nature. Presented here is a rare case of Behcet's colitis with valuable clinical lessons, in a patient who is known to have Behcet's disease and was admitted with acute onset bloody diarrhoea. This was a gastrointestinal manifestation of the patient's multisystemic inflammatory disorder as proven by investigations via computed tomography (CT) scan, sigmoidoscopy, and histology. He was treated with steroids and mesalazine, and later switched to infliximab and made a quick recovery.
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Affiliation(s)
- Usman Khan
- Internal Medicine, Royal Preston Hospital, Preston, GBR
| | - Amr Elseby
- Family Medicine, Blackpool Victoria Hospital, Blackpool, GBR
| | - Hassan Qureshi
- Internal Medicine, Blackpool Victoria Hospital, Blackpool, GBR
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3
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Mohamed Mekawy D, Eissa M, Adly Sadik N, Mohamed Abd-Elrahman R, Fawzy A, Fathy Amer M. Vitamin D and miRNA-155 in Behçet's Disease: Possible Association with the Disease and Disease Activity. Rep Biochem Mol Biol 2023; 12:251-258. [PMID: 38317821 PMCID: PMC10838589 DOI: 10.61186/rbmb.12.2.251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/18/2023] [Indexed: 02/07/2024]
Abstract
Background Vitamin D (vit D) controls inflammation and immunity. In Behçet's disease (BD), microRNA-155 is recognized as a significant immune response regulator. We aimed to investigate the role of vit D on immunomodulation and downregulation of inflammatory pathways associated with BD and detect the role of miRNA-155 in BD. Methods miRNA-155 expression by Real Time -Polymerase Chain Reaction (RT-PCR), and vit D, nuclear factor Kappa-light-chain-enhancer of activated B cells (NF-κB), and Tumor necrosis fact of TNF-α) expression by Enzyme Linked Immunosorbent Assay (ELISA) were assessed. Results BD patients had a significantly higher relative expression of microRNA-155 (P< 0.001), it was significantly related to vascular manifestations (P< 0.001). Vit D relative expression was significantly low in BD (P< 0.001). There was a significant rise in miRNA-155 in the active group compared to the inactive group (P< 0.001). A significant decrease in vit D levels (IU) was found in inactive and active individuals suffering from BD when compared to controls (P< 0.001). A significant rise was found in vit D levels in inactive BD cases (P< 0.001). A significant positive correlations were found between miRNA-155, NF-κB, TNF-α, and negative correlations with vit D relative expression in BD patients. Conclusions miRNA-155 relative expression is higher in BD is significantly related to vascular manifestations. It may have a relationship to disease activity. Vitamin D relative expression is significantly low in BD patients, which can significantly influence immunomodulatory BD therapy. Vitamin D deficiency linked to active BD.
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Affiliation(s)
- Dina Mohamed Mekawy
- Medical Biochemistry & Molecular Biology, Faculty of Medicine, Cairo University, Egypt.
- Medical Biochemistry and Molecular Biology, Faculty of Medicine, Badr University, Egypt.
| | - Mervat Eissa
- Rheumatology Department, Faculty of Medicine, Cairo University, Egypt.
| | - Noha Adly Sadik
- Internal medicine Faculty of Medicine, Cairo University, Egypt.
| | | | - Ahmed Fawzy
- Medical Physiology, Faculty of Medicine, Cairo University, Egypt.
| | - Marwa Fathy Amer
- Medical Biochemistry & Molecular Biology, Faculty of Medicine, Cairo University, Egypt.
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Grzybowski A, Pawlikowska-Łagód K, Altenburg A, Zouboulis CC. Adamantiades-Behçet disease: Between dermatology and ophthalmology. Clin Dermatol 2023; 41:469-475. [PMID: 37572969 DOI: 10.1016/j.clindermatol.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
Adamantiades-Behçet disease is an inflammatory, vascular disease of unknown etiology. The disease is named after two physicians, Benediktos Adamantiades and Hulȗsi Behçet, who both made significant contributions to the study of the disease. It was probably first described by Hippocrates in 500 BCE. Adamantiades-Behçet disease is most common in the region encompassing the ancient trade route known as the Silk Road. In Turkey, the disease is estimated to affect 80 to 370 people per 100,000 inhabitants, and it is also the country with the highest incidence rate. The frequency of the disease associated with the clinical picture differs from the origin of the onset. The disease is characterized by recurrent aphthous ulcers of the mouth, genitals, skin lesions, and eye lesions. The disease process can also involve other organs, including the joints, nervous system, large vessels, heart, and gastrointestinal tract. Aphthous oral ulcers appear as the first harbinger of the disease and affect almost all patients (97%-99%). The scientific interest in Adamantiades-Behçet disease has increased exponentially in the past decade.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Institute for Research in Ophthalmology, Poznan, Poland
| | | | - Andreas Altenburg
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
| | - Christos C Zouboulis
- Departments of Dermatology, Venereology, Allergology, and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany
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Oğuz AK, Oygür ÇŞ, Taşır S, Özdağ H, Akar MN. Behçet syndrome: The disturbed balance between anti- (CLEC12A, CLC) and proinflammatory (IFI27) gene expressions. Immun Inflamm Dis 2023; 11:e836. [PMID: 37102643 PMCID: PMC10091377 DOI: 10.1002/iid3.836] [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: 12/10/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 04/28/2023] Open
Abstract
INTRODUCTION Behçet syndrome (BS) is a chronic, multisystemic inflammatory condition with unanswered questions regarding its pathogenesis and rational therapeutics. A microarray-based comparative transcriptomic analysis was performed to elucidate the molecular mechanisms of BS and identify any potential therapeutic targets. METHODS Twenty-nine BS patients (B) and 15 age and sex-matched control subjects (C) were recruited. Patients were grouped as mucocutaneous (M), ocular (O), and vascular (V) according to their clinical phenotypes. GeneChip Human Genome U133 Plus 2.0 arrays were used for expression profiling on peripheral blood samples of the patients and the control subjects. Following documentation of the differentially expressed gene (DEG) sets, the data were further evaluated with bioinformatics analysis, visualization, and enrichment tools. Validation of the microarray data was performed using quantitative reverse transcriptase polymerase chain reaction. RESULTS When p ≤ 0.05 and fold change ≥2.0 were chosen, the following numbers of DEGs were obtained; B versus C: 28, M versus C: 20, O versus C: 8, V versus C: 555, M versus O: 6, M versus V: 324, O versus V: 142. Venn diagram analysis indicated only two genes, CLEC12A and IFI27, in the intersection of M versus C ∩ O versus C ∩ V versus C. Another noteworthy gene appeared as CLC in the DEG sets. Cluster analyses successfully clustered distinct clinical phenotypes of BS. While innate immunity-related processes were enriched in the M group, adaptive immunity-specific processes were significantly enriched in the O and V groups. CONCLUSIONS Distinct clinical phenotypes of BS patients displayed distinct expression profiles. In Turkish BS patients, expression differences regarding the genes CLEC12A, IFI27, and CLC seemed to be operative in the disease pathogenesis. Based on these findings, future research should consider the immunogenetic heterogeneity of BS clinical phenotypes. Two anti-inflammatory genes, namely CLEC12A and CLC, may be valuable as therapeutic targets and may also help design an experimental model in BS.
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Affiliation(s)
- Ali Kemal Oğuz
- Department of Internal Medicine, Division of General Internal MedicineBaşkent University Faculty of MedicineAnkaraTurkey
| | - Çağdaş Şahap Oygür
- Department of Internal Medicine, Division of RheumatologyBaşkent University Faculty of MedicineAnkaraTurkey
| | - Seda Taşır
- Department of BiotechnologyAnkara University Biotechnology InstituteAnkaraTurkey
| | - Hilal Özdağ
- Department of BiotechnologyAnkara University Biotechnology InstituteAnkaraTurkey
| | - Mehmet Nejat Akar
- Department of PediatricsTOBB University of Economics & Technology School of MedicineAnkaraTurkey
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6
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Wang Z, Zu X, Xiong S, Mao R, Qiu Y, Chen B, Zeng Z, Chen M, He Y. The Role of Colchicine in Different Clinical Phenotypes of Behcet Disease. Clin Ther 2023; 45:162-176. [PMID: 36732153 DOI: 10.1016/j.clinthera.2023.01.004] [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: 04/18/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Behcet disease (BD) is a multisystemic disorder characterized by variable clinical manifestations that affect nearly all systems and organs. Colchicine, an alkaloid plant extract, is considered as the first-line therapy for gout, pericarditis, and familial Mediterranean fever. However, the role of colchicine in the treatment of different clinical phenotypes of BD has not been clearly described. This narrative review summarizes the clinical use of colchicine in BD. METHODS All relevant literature from 1980 to March 2021 was searched in PubMed, MEDLINE, and Cochrane Library. The Medical Subject Heading terms and related words that were searched are as follows: Behcet's disease, Behcet's syndrome, BD, colchicine, management, treatment, and therapy. FINDINGS BD is an autoimmune systemic vasculitis with various clinical phenotypes, with involvement of skin mucosa, joints, eyes, and gastrointestinal, vascular, and neurologic systems. Colchicine has been used for centuries, acts by binding to tubulin to prevent the mitotic process, and has anti-inflammatory, antitumor, and antifibrotic properties. Colchicine has been reported to be an effective option for the treatment of skin, mucosal, and joint involvement in patients with certain BD clinical phenotypes. IMPLICATIONS Colchicine reduces the severity of certain clinical phenotypes and may improve the overall disease activity index in patients with BD. More randomized clinical trials are needed to confirm the value of colchicine in the treatment of BD, and further elucidation of the mechanisms is also needed, which may reveal new application of colchicine that has been used for centuries.
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Affiliation(s)
- Zeyuan Wang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoman Zu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shanshan Xiong
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Baili Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Peine B, Figueroa C, Robinette N. Neuro-Behcet's syndrome: Case report and literature review. Radiol Case Rep 2022; 17:3064-3070. [PMID: 35769120 PMCID: PMC9234539 DOI: 10.1016/j.radcr.2022.05.070] [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: 05/19/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Behcet's disease (BD) is a multisystem, autoimmune vasculitis disorder affecting small, medium, and large blood vessels, with poorly understood pathogenesis. It commonly presents with recurrent aphthous ulcers, genital ulcers, skin lesions, and bilateral uveitis. Neurological symptoms are present in less than 10% of cases and develop, on average, 5-6 years after the first non-neurological symptoms. This presentation, known as Neuro-Behcet's disease (NBD), is associated with a worse prognosis of BD. Treatment for NBD is dependent on the severity of symptoms and the presence of other systemic manifestations but often initially involves glucocorticoids and a disease-modifying agent. This case report presents a 44-year-old female patient, previously diagnosed with BD, who presented with neurological symptoms and MRI findings consistent with NBD.
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Affiliation(s)
- Brian Peine
- Central Michigan University College of Medicine, 1280 East Campus Dr, Mt Pleasant, MI 48858, USA
- Corresponding author.
| | | | - Natasha Robinette
- Department of Radiology, Detroit Medical Center, Detroit, MI, USA
- Karmanos Cancer Center, Detroit, MI, USA
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8
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Novak T, Hamedi M, Bergmeier LA, Fortune F, Hagi-Pavli E. Saliva and Serum Cytokine Profiles During Oral Ulceration in Behçet's Disease. Front Immunol 2022; 12:724900. [PMID: 35003055 PMCID: PMC8727526 DOI: 10.3389/fimmu.2021.724900] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/22/2021] [Indexed: 12/31/2022] Open
Abstract
Behçet's disease (BD) is a chronic, multi-systemic disorder of unknown aetiology typified by recurrent oral and genital mucocutaneous lesions, uveitis and vasculitis. Innate and adaptive immune system dysregulation has been implicated in pathogenesis with alterations in serum cytokine profiles. Few studies have investigated salivary cytokines in BD, despite more than 90% of BD patients first presenting with oral ulceration. The aim of this pilot study was twofold; firstly to investigate whether cytokine levels in matched serum and saliva samples show a differential profile in BD (with and without oral ulcers), recurrent aphthous stomatitis (RAS) and healthy controls (HCs), and secondly, to explore if any differential profiles in serum and/or saliva could provide a panel of cytokines with diagnostic and therapeutic potential for BD. Concentrations of 12 cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-17A, IFN-γ, TNF-α, TNF-β) were measured using the Human Th1/Th2 11-Plex FlowCytomix™ kit with IL-17A, in BD (N=20), RAS (N=6) and HCs (N=10). A differential range of cytokines was detected in serum and saliva with the majority of cytokine levels higher in saliva. The most prevalent salivary cytokines were IL-1β, IL-2, IL-8, IL-10 and TNF-α present in all samples in contrast to serum where the most prevalent cytokine detected was IL-8 (91.9%). The least abundant cytokine was IFN-γ in both saliva (43.2%) and serum (2.7%). After normalizing saliva for protein content, BD patients with oral ulcers (BD-MA) had significantly higher levels of salivary IL-1β (p=0.01), IL-8 (p=0.02), TNF-α (p=0.004) and IL-6 (p=0.01) than HCs. Notably, BD patients without oral ulcers (BD-MQ) also had significantly higher salivary IL-1β, IL-8 and TNF-α (p ≤ 0.05) than HCs. During relapsed (BD-RE) and quiet (BD-Q) systemic episodes, salivary IL-β and TNF-α were also significantly increased with IL-8 significantly higher only in BD-Q (p=0.02). BD oral ulcers signify a potential reactivation of systemic inflammation. Identifying cytokines released during asymptomatic episodes and oral ulceration might lead to targeted drug therapy to prevent recurrent oral ulcers and possible disease relapse. This is the first study to report salivary cytokine levels in BD. The detectable levels suggests cytokine profiling of BD saliva may provide an alternative, less invasive, sensitive procedure for frequent monitoring of disease activity and progression.
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Affiliation(s)
- Tanya Novak
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital and Department of Anesthesia, Harvard Medical School, Boston, MA, United States
| | - Mojgan Hamedi
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and The London School, of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Lesley Ann Bergmeier
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and The London School, of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Farida Fortune
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and The London School, of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Eleni Hagi-Pavli
- Centre for Oral Immunobiology and Regenerative Medicine, Barts and The London School, of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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Mattioli I, Bettiol A, Saruhan-Direskeneli G, Direskeneli H, Emmi G. Pathogenesis of Behçet's Syndrome: Genetic, Environmental and Immunological Factors. Front Med (Lausanne) 2021; 8:713052. [PMID: 34692721 PMCID: PMC8531401 DOI: 10.3389/fmed.2021.713052] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Behçet's syndrome (BS) is a rare systemic vasculitis, characterized by a wide range of different clinical involvements and unpredictable phases of recurrence and remission. BS can be described as a multifactorial disease with an incompletely known etiopathogenesis; in fact, though presenting some peculiar features, such as its typical geographic distribution and the strong association with the well-known genetic predisposing factor HLA-B*51, the cause behind the onset and progression of the disease remains currently not fully understood. Besides genetic HLA and non-HLA predisposing associations and epigenetic influence, environmental factors also play an important role in the pathogenesis of the disease, and among these, infectious agents (both bacterial and viral) and specific microbiome alterations are considered of particular relevance in BS pathogenesis. BS has been included for decades among autoimmune diseases, in light of evidence showing T- and B-cell aberrant responses. However, because of recurrent mucocutaneous lesions and episodes of inflammation without antigen-specific T-cell or autoantibody responses, BS has also been classified among autoinflammatory disorders. Nevertheless, differently from autoinflammatory diseases, BS mildly responds to therapies targeting IL-1, its onset is not usually in childhood, and has high neutrophilic vasculitic involvement. Finally, given the association with HLA class I alleles, similar to spondyloarthropathies, the concept of BS as a major histocompatibility complex (MHC) I -opathy has been introduced. Understanding the complex etiopathogenesis of BS is essential to identify modifiable risk factors of BS occurrence or exacerbation and to develop targeted therapies. This review summarizes current evidence on the main genetic, environmental and immunological factors contributing to BS development.
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Affiliation(s)
- Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | | | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
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10
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Okamoto N, Ogawa N, Kitamura A, Yamakawa I, Kim H, Urushitani M. [A case of neuro-Behçet's disease triggered by herpes zoster-associated uveitis]. Rinsho Shinkeigaku 2021; 61:640-645. [PMID: 34433748 DOI: 10.5692/clinicalneurol.cn-001625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 69-year-old man was admitted for persistent fever, arthralgia, and visual impairment. Physical examination demonstrated bilateral uveitis and recurrent aphthous stomatitis. The PCR analysis of the aqueous humor of the anterior chamber was positive for the Varicella-zoster virus (VZV). Although no neurological defect was evident, the cerebrospinal fluid contained elevated monocytes but was negative for VZV-PCR. Brain MRI revealed Gd-enhanced lesions in the subcortical white matter, basal ganglia, and cerebellum. With his positive HLAB51, he was diagnosed with neuro-Behcet's disease (NBD) and was successfully treated with high-dose prednisolone. Although the pathogenesis of Behcet's disease is still unknown, the involvement of viral infection is reported. The present case implies that NBD could be triggered by herpes zoster virus associate-uveitis; the accumulation of such cases would help clarify the pathogenesis of Behcet's disease.
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Affiliation(s)
- Naoki Okamoto
- Department of Neurology, Shiga University of Medical Science
| | - Nobuhiro Ogawa
- Department of Neurology, Shiga University of Medical Science
| | | | - Isamu Yamakawa
- Department of Neurology, Shiga University of Medical Science
| | - Hyoh Kim
- Department of Neurology, Shiga University of Medical Science
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11
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Lin YP, Chiou CS. Fever, arthritis, and painful skin nodules. BMJ 2021; 374:n1956. [PMID: 34531259 DOI: 10.1136/bmj.n1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Yu-Pei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chi-Sheng Chiou
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
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12
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Simaan N, Filioglo A, Honig A, Aladdin S, Cohen JE, Leker RR. Characteristics of cerebral sinus venous thrombosis in men. Acta Neurol Scand 2021; 144:317-324. [PMID: 33977521 DOI: 10.1111/ane.13454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cerebral sinus venous thrombosis (CSVT) is a rare stroke subtype that is more common in women, yet data regarding sex-specific characteristics are sparse. We aimed to study male-specific characteristics among patients with CSVT. MATERIALS & METHODS Data of consecutive patients with CSVT, admitted to a single medical centre between 2005 and 2020, were retrospectively studied. Demographics, clinical presentations, radiological and outcome parameters were compared between male and female patients. Male patients were further divided into older and younger than 35 years old for additional comparisons. RESULTS Out of 15,224 patients diagnosed with stroke, 150 patients (1%) presented with CSVT and 47 (31.3%) of them were males. Males had significantly higher rates of previous thrombotic events (22% vs. 7%, p = .009), malignancies (32% vs. 16%, p = .022) and Behcet's disease (22% vs. 2%, p < .001). Additionally, we found that malignancies were significantly more prevalent in older males (48% vs. 17%, p = .022), while Behcet's disease was more often found in younger patients (35% vs. 9%, p = .032). Additional age-related differences in disease characteristics among male patients included a higher frequencies of papilledema (42% vs. 13%, p = .028), and cortical vein thromboses (21% vs. 0% p = .021) observed in the younger men. CONCLUSIONS There are important differences in risk factors for thrombosis between men and women with CSVT. Behcet's disease is common in younger men, while malignancies are major causes of CSVT in older men.
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Affiliation(s)
- Naaem Simaan
- Departments of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Andrei Filioglo
- Departments of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Asaf Honig
- Departments of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Shorooq Aladdin
- Departments of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Jose E. Cohen
- Departments of Neurosurgery Hadassah‐Hebrew University Medical Center Jerusalem Israel
| | - Ronen R. Leker
- Departments of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel
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Hysa E, Cutolo CA, Gotelli E, Pacini G, Schenone C, Kreps EO, Smith V, Cutolo M. Immunopathophysiology and clinical impact of uveitis in inflammatory rheumatic diseases: An update. Eur J Clin Invest 2021; 51:e13572. [PMID: 33851422 PMCID: PMC8365741 DOI: 10.1111/eci.13572] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Uveitis is one of the most frequent ophthalmologic manifestations in rheumatology. Uveal inflammation can underlie a systemic inflammatory rheumatic disease (SIRD) in approximately 30% of cases with a significant burden on the quality of life since it represents a cause of blindness in up to 20% of cases in Western countries. METHODS In this review, we provide a comprehensive overview of the pathophysiology of uveitis associated with SIRDs. According to our literature survey on the epidemiology of uveitis among SIRDs, spondyloarthritides, Behçet's disease and sarcoidosis get the major impact. RESULTS In Behçet's uveitis, the key players are highly polarized Th1 and Th17 lymphocytes, natural killer T cells and γδ T cells. All contribute to a great destructive inflammatory environment with the most serious visual damage resulting from the involvement of the posterior segment of the eye. In contrast, spondyloarthritides-related uveitis derives from a complex interaction between genetic background and extra-ocular inflammatory mediators originating from enthesitis, arthritis, psoriatic lesions and microbiome pro-inflammatory alterations. In such conditions, the immune infiltration of CD4+ T cells, Th17 and natural killer cells along with pro-inflammatory cytokines, TNF-α among all, leads to intraocular inflammation. Lastly, granuloma formation represents the primary hallmark lesion in sarcoid uveitis. This suggests a profound link between the innate system that mainly recruits activated macrophages and adaptive system involving by Th1, Th17 and Th17.1 cells. CONCLUSIONS Awareness among rheumatologists of a potential severe ocular involvement generates new insights into targeted therapeutic approaches and personalized treatments for each patient.
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Affiliation(s)
- Elvis Hysa
- Laboratory of Experimental Rheumatology and Academic Division of Clinical RheumatologyDepartment of Internal MedicineItaly – IRCCS Rheumatology UnitSan Martino PolyclinicUniversity of GenoaGenoaItaly
| | - Carlo Alberto Cutolo
- Ophthalmology Clinic DiNOGMIIRCCS Ophthalmology Unit San Martino PolyclinicUniversity of GenoaGenoaItaly
| | - Emanuele Gotelli
- Laboratory of Experimental Rheumatology and Academic Division of Clinical RheumatologyDepartment of Internal MedicineItaly – IRCCS Rheumatology UnitSan Martino PolyclinicUniversity of GenoaGenoaItaly
| | - Greta Pacini
- Laboratory of Experimental Rheumatology and Academic Division of Clinical RheumatologyDepartment of Internal MedicineItaly – IRCCS Rheumatology UnitSan Martino PolyclinicUniversity of GenoaGenoaItaly
| | - Carlotta Schenone
- Laboratory of Experimental Rheumatology and Academic Division of Clinical RheumatologyDepartment of Internal MedicineItaly – IRCCS Rheumatology UnitSan Martino PolyclinicUniversity of GenoaGenoaItaly
| | - Elke O Kreps
- Department of OphthalmologyGhent University HospitalGhentBelgium
| | - Vanessa Smith
- Department of Internal MedicineDepartment of RheumatologyGhent. University HospitalGhent UniversityGhentBelgium
- Unit for Molecular Immunology and InflammationVIB Inflammation Research Center (IRC)GhentBelgium
| | - Maurizio Cutolo
- Laboratory of Experimental Rheumatology and Academic Division of Clinical RheumatologyDepartment of Internal MedicineItaly – IRCCS Rheumatology UnitSan Martino PolyclinicUniversity of GenoaGenoaItaly
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14
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Alpsoy E, Bozca BC, Bilgic A. Behçet Disease: An Update for Dermatologists. Am J Clin Dermatol 2021; 22:477-502. [PMID: 34061323 DOI: 10.1007/s40257-021-00609-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Behçet disease (BD) is a chronic, relapsing, systemic vasculitis of unknown etiology with the clinical features of oral and genital ulcers, cutaneous vasculitic lesions, ocular, articular, vascular, gastrointestinal, neurologic, urogenital and cardiac involvement. BD usually appears around the third or fourth decade of life. Gender distribution is roughly equal. The disease is much more frequent in populations along the ancient 'Silk Road', extending from Eastern Asia to countries in the Middle East and the Mediterranean, compared with Western countries, but has universal distribution. Mucocutaneous manifestations are the clinical hallmarks of BD. The diagnostic criteria widely used in the disease's diagnosis are based on mucocutaneous manifestations because of their high sensitivity and/or specificity. Genetic factors are the key driver of BD pathogenesis, and HLA-B51 antigen is the strongest genetic susceptibility factor. Streptococcus sanguinis (S. sanguinis) or microbiome change can trigger innate immune system-mediated inflammation sustained by adaptive immune responses. Epistatic interaction between HLA-B51 and endoplasmic reticulum aminopeptidase 1 (ERAP1) in antigen-presenting cells disrupt T-cell homeostasis leading to downregulation of Tregs and expansion of Th1 and Th17. Thus, neutrophil activation and intense neutrophil infiltration of the affected organs develop in the early stage of inflammation. BD has a variable clinical course with unpredictable exacerbations and remissions. The disease is associated with a high mortality rate, especially in young male patients, and large-vessel, neurological, gastrointestinal system and cardiac involvement are the most important causes of death. The principal aim of treatment should be to prevent irreversible organ damage, especially during the disease's early, active phase. A better understanding of the disease's pathogenesis has provided important information on its management. New drugs, especially apremilast and anti-TNF-α agents are effective in the management of BD and have the potential to improve patients' quality of life, prognosis and survival.
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Affiliation(s)
- Erkan Alpsoy
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey.
| | - Burcin Cansu Bozca
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
| | - Asli Bilgic
- Department of Dermatology and Venereology, Akdeniz University School of Medicine, 07059, Antalya, Turkey
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15
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Zeng L, Meng WJ, Wen ZH, Chen YL, Wang YF, Tang CW. Management and outcomes of surgical patients with intestinal Behçet’s disease and Crohn’s disease in southwest China. World J Clin Cases 2021; 9:3858-3868. [PMID: 34141742 PMCID: PMC8180223 DOI: 10.12998/wjcc.v9.i16.3858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal involvement in Behçet's disease (GIBD) and Crohn’s disease (CD) are inflammatory diseases sharing a considerable number of similarities. However, different from CD, the operative and postoperative management of GIBD remains largely empirical because of the lack of comprehensive treatment guidelines.
AIM To compare surgical patients with GIBD and those with CD in a medical center and identify notable clinical features and effective postoperative treatment for surgical patients with GIBD.
METHODS We searched patients diagnosed with CD and GIBD who underwent operations for gastrointestinal complications from 2009 to 2015 at West China Hospital of Sichuan University. A total of 10 surgical patients with GIBD and 106 surgical patients with CD were recruited. Information including demographic data, medication, and operative and postoperative parameters were collected and analyzed. As the incidence of surgical GIBD is low, their detailed medical records were reviewed and compared to previous studies. Moreover, the prognoses of CD and GIBD were evaluated respectively between groups treated with biological and non-biological agents.
RESULTS Indication for first surgery was often acute intestinal perforation for GIBD patients (7/10 vs 0/106, P < 0.001), whereas intestinal fistulae (0/10 vs 44/106, P = 0.013) and ileus (0/10 vs 40/106, P = 0.015) were the indications for surgical CD patients. Approximately 40% of patients with GIBD and 23.6% of patients with CD developed postoperative complications, 50% of patients with GIBD and 38.7% of patients with CD had recurrence postoperatively, and 40% (4/10) of patients with GIBD and 26.4% (28/106) of patients with CD underwent reoperations. The average period of postoperative recurrence was 7.87 mo in patients with Behçet's disease (BD) and 10.43 mo in patients with CD, whereas the mean duration from first surgery to reoperation was 5.75 mo in BD patients and 18.04 mo in CD patients. Surgical patients with GIBD more often used corticosteroids (6/10 vs 7/106, P < 0.001) and thalidomide (7/10 vs 9/106, P < 0.001) postoperatively, whereas surgical patients with CD often used infliximab (27/106), azathioprine, or 6-mercaptopurine (74/106) for maintenance therapy.
CONCLUSION Patients suffering GIBD require surgery mostly under emergency situations, which may be more susceptible to recurrence and reoperation and need more aggressive postoperative treatment than patients with CD.
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Affiliation(s)
- Li Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Jian Meng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Zhong-Hui Wen
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Long Chen
- West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Fang Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Cheng-Wei Tang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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16
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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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17
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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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18
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Iwata D, Namba K, Yamamoto T, Mizuuchi K, Saito W, Ohno S, Kitaichi N, Ishida S. Recent Clinical Features of Intraocular Inflammation in Hokkaido, Japan - Comparison with the Previous Decade. Ocul Immunol Inflamm 2021; 30:848-854. [PMID: 33571416 DOI: 10.1080/09273948.2020.1836565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to investigate the clinical features of intraocular inflammation (uveitis) in Hokkaido and to assess the etiology trends in comparison with those of our previous survey. METHODS We retrospectively reviewed the medical records of 1,616 new referral uveitis patients (1,020 females and 596 males) in Hokkaido University Hospital between 2004 and 2014. RESULTS Sarcoidosis was the most frequent etiology (17.4%), followed by Vogt-Koyanagi-Harada disease (8.1%), Behçet's disease (4.5%), and human leukocyte antigen B27 -associated uveitis (2.5%). The etiologies in 48.7% of the patients were unclassified. Compared to the previous survey between 1994 and 2003, the rate of Behçet's disease decreased and that of sarcoidosis increased. The rates of infectious uveitis and vitreoretinal lymphoma increased. CONCLUSION Although the order of the top four etiologies was the same in the two surveys, the rate of sarcoidosis increased and that of Behçet's disease decreased.
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Affiliation(s)
- Daiju Iwata
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kenichi Namba
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taku Yamamoto
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuomi Mizuuchi
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Wataru Saito
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shigeaki Ohno
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Susumu Ishida
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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19
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Cheon JH. Advances in Management of Intestinal Behçet's Disease: A Perspective From Gastroenterologists. JOURNAL OF RHEUMATIC DISEASES 2021; 28:4-16. [PMID: 37476392 PMCID: PMC10324954 DOI: 10.4078/jrd.2021.28.1.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/09/2020] [Accepted: 08/10/2020] [Indexed: 07/22/2023]
Abstract
Intestinal Behçet's disease (intestinal BD) is a rare chronic inflammatory disorder of the intestine that is characterized by recurrent intestinal manifestations with other systemic features of BD. Intestinal BD is diagnosed when a typically shaped ulcer is observed in the gastrointestinal tract, and the clinical findings meet the diagnostic criteria for BD. Owing to the small number of patients, intestinal BD is easily underestimated. On the other hand, but it often requires surgical treatment because of severe complications, including intestinal perforations or massive bleeding. The same treatment strategies used for inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis, are used for intestinal BD. 5-Aminosalicylic acids, corticosteroids, and immunomodulators are considered conventional therapies, but a considerable number of patients eventually become unresponsive to these pharmaceutical treatments. Recently, biologic agents, such as anti-tumor necrosis factor-alpha inhibitors, have also been suggested as a new treatment option for intestinal BD. This article reviews the pathogenesis and diagnosis of intestinal BD and the current treatment strategies that are expected to be useful for rheumatologic specialists.
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Affiliation(s)
- Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
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20
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Shaat RM, El Meadawy S, Rizk EM, Elgawad MSA, Elsaid TO. The significance of α-defensins 1-3 in Behcet’s disease: a case-control study among Egyptian patients. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Behcet’s disease (BD) is associated with uveitis, oral ulcers, genital ulcers and arthritis. Enhanced activity of innate immunity components, such as neutrophils, natural killer (NK) cells and endothelial cells, is a prominent feature of BD. The aim of this study was to clarify the significance of α-defensins 1-3 in BD and detect their correlation with disease activity, severity and oral ulcer activity.
Results
Significant differences were found between Behcet’s patients and controls as regards serum α-defensins 1-3 (median 10.1, IQR 4–45 μg/ml versus median 7.4, IQR 0.6–13.2 μg/ml, p = 0.001) and salivary α-defensins 1-3 (median 17.4, IQR 5.7–44 μg/ml versus median 8.6, IQR 3.3–11 μg/ml, p < 0.001). Receiver operating characteristic (ROC) showed a fair area under curve (AUC) (AUC = 0.743), with sensitivity of 40% and specificity 100% at cutoff value of 17.3 μg/ml for serum α-defensins 1-3, while salivary α-defensins 1-3 showed excellent AUC (AUC = 0.936), with sensitivity of 93.3% and specificity of 86.7% at cutoff value of 9.8 μg/ml. The levels of serum and salivary α-defensins 1-3 > cutoff value were significantly higher in active severe Behcet’s patients with active oral ulcers (p < 0.001).
Conclusion
α-Defensins 1-3 may be involved in the pathogenesis of BD and could be valuable markers in the determination of disease activity, severity and oral ulcer activity.
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21
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Mumcu G, Alibaz Öner F, Ergun T, Direskeneli RH. Decreasing incidence and severity of Behçet’s disease: a changing trend in epidemiological spectrum possibly associated with oral health. Turk J Med Sci 2020; 50:1587-1590. [PMID: 32222130 PMCID: PMC7672345 DOI: 10.3906/sag-2003-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
Behçet’s disease (BD) is a systemic and inflammatory disorder that is mainly present along the ancient Silk Road, from the Mediterranean Sea to East Asia. A wide range of prevalence figures (0.1–420/100,000) have been reported for BD, also among Turkish populations of similar genetic background living in different countries. Recently, a decline in the incidence of BD and a change of the disease spectrum to less-severe manifestations have been reported from Japan and Korea, two genetically homogenous, affluent populations with limited immigration. It was hypothesized that a decline in infectious diseases, especially dental/periodontal infections, associated with the improvement in oral health, could be a part of these changes in the disease expression. Further epidemiological studies in other populations might demonstrate whether there is a worldwide similar trend and may provide a better understanding of the triggering factors for the onset and course of BD.
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Affiliation(s)
- Gonca Mumcu
- Faculty of Health Sciences Marmara University, İstanbul, Turkey
| | - Fatma Alibaz Öner
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Rafi Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, İstanbul, Turkey
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22
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Perazzio SF, Andrade LEC, de Souza AWS. Understanding Behçet's Disease in the Context of Innate Immunity Activation. Front Immunol 2020; 11:586558. [PMID: 33193413 PMCID: PMC7606308 DOI: 10.3389/fimmu.2020.586558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/28/2020] [Indexed: 12/24/2022] Open
Abstract
Behçet´s disease (BD) is a heterogeneous condition consisting of idiopathic systemic vasculitis affecting large and small blood vessels of different types (i.e., arteries, veins, or capillaries). The disease frequently occurs in young adults without gender predilection, differently from several other autoimmune conditions. This challenging illness has recently been proposed by some authors as an example of complex autoinflammatory syndrome. Although much remains unanswered about BD pathogenesis, recent understanding of some aspects of innate immunity have clarified a few issues (and raised others). HLA-B*51 represents the strongest genetic risk factor for BD to date, albeit several other HLA-independent loci have also been associated with the disease. The consistent hyper-reactivity against Streptococcus sanguinis antigens and alterations in oral and gut microbioma suggests that infectious agents may play an important role. Moreover, functional abnormalities of pattern recognition receptors, especially Toll-like receptors in monocytes, have been demonstrated in patients with BD and can be associated with the development of the disease. Neutrophil hyperactivity is one of the most consistent findings in BD pathogenesis, as demonstrated by exacerbated constitutive oxidative burst, chemotaxis and NET formation. However, some studies suggest that the phagocyte-activated status in BD is not primary to the disease itself, but rather restricted to a fraction of patients with severe disease activity, and probably secondary to activating soluble factors carried by serum/plasma from BD patients. Herein we review the state of the art on BD etiopathogenesis with special emphasis on the participation of the innate immune system
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Affiliation(s)
- Sandro F Perazzio
- Division of Rheumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luis E C Andrade
- Division of Rheumatology, Universidade Federal de São Paulo, São Paulo, Brazil
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23
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Tanacan E, Dincer D, Erdogan FG, Gurler A. A cutoff value for the Systemic Immune-Inflammation Index in determining activity of Behçet disease. Clin Exp Dermatol 2020; 46:286-291. [PMID: 32869876 DOI: 10.1111/ced.14432] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Behçet disease (BD) is an immune-mediated vasculitis-like syndrome characterized by recurrent aphthous lesions and various systemic manifestations. Inflammatory markers may be useful to assess disease severity. The Systemic Immune-Inflammation Index (SII) (neutrophils × platelets/lymphocytes) has been widely used in oncology since 2014, with promising results. AIM To assess the efficiency of the SII in determining activity of BD. METHODS This retrospective cohort study was conducted on patients with BD who were admitted to the outpatient clinic of the Department of Dermatology and Venereology, Ufuk University Hospital, between 1 January 2010 and 31 December 2019. Patients were divided into two groups based on their disease status upon admission: (i) active BD (n = 103), and (ii) inactive BD (n = 63). Clinical characteristics, demographic features, type of medications, full blood count parameters, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin and SII were compared between the groups. Furthermore, receiver operating characteristic curve analysis was performed to assess the performance of the SII in determining disease severity upon admission to hospital. RESULTS Higher numbers of white blood cells, platelets and neutrophils, greater red cell distribution width, higher levels of ESR, CRP and ferritin, and higher SII were observed in the active disease group (P < 0.001). The cutoff value of 552 × 103 /mm3 was found to have 81% sensitivity and 82% specificity. CONCLUSION The SII may be used as an additional indicator for the assessment of BD status and physicians should be cautious in patients with SII levels of > 552 × 103 /mm3 ) at the initial evaluation of the patients.
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Affiliation(s)
- E Tanacan
- Department of Dermatology and Venereology, Ufuk University Hospital, Ankara, Turkey
| | - D Dincer
- Department of Dermatology and Venereology, Ufuk University Hospital, Ankara, Turkey
| | - F G Erdogan
- Department of Dermatology and Venereology, Ufuk University Hospital, Ankara, Turkey
| | - A Gurler
- Department of Dermatology and Venereology, Ufuk University Hospital, Ankara, Turkey
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24
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Perazzio SF, Allenspach EJ, Eklund KK, Varjosalo M, Shinohara MM, Torgerson TR, Seppänen MRJ. Behçet disease (BD) and BD-like clinical phenotypes: NF-κB pathway in mucosal ulcerating diseases. Scand J Immunol 2020; 92:e12973. [PMID: 32889730 DOI: 10.1111/sji.12973] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
Behçet's disease (BD) is a heterogeneous multi-organ disorder in search of a unified pathophysiological theory and classification. The disease frequently has overlapping features resembling other disease clusters, such as vasculitides, spondyloarthritides and thrombophilias with similar genetic risk variants, namely HLA-B*51, ERAP1, IL-10, IL-23R. Many of the BD manifestations, such as unprovoked recurrent episodes of inflammation and increased expression of IL-1, IL-6 and TNFα, overlap with those of the hereditary monogenic autoinflammatory syndromes, positioning BD at the crossroads between autoimmune and autoinflammatory syndromes. BD-like disease associates with various inborn errors of immunity, including familial Mediterranean fever, conditions related to dysregulated NF-κB activation (eg TNFAIP3, NFKB1, OTULIN, RELA, IKBKG) and either constitutional trisomy 8 or acquired trisomy 8 in myelodysplastic syndromes. We review here the recent advances in the immunopathology of BD, BD-like diseases and the NF-κB pathway suggesting new elements in the elusive BD etiopathogenesis.
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Affiliation(s)
- Sandro F Perazzio
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA.,Division of Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eric J Allenspach
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA
| | - Kari K Eklund
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland
| | - Markku Varjosalo
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland.,Molecular Systems Biology Research Group and Proteomics Unit, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Michi M Shinohara
- Divisions of Dermatology and Dermatopathology, University of Washington, Seattle, WA, USA
| | | | - Mikko R J Seppänen
- Rare Disease and Pediatric Research Centers, Hospital for Children and Adolescents and Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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25
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Zhang T, Wu X, Wu Z. A right ventricular mass in a young man with Behçet's disease: A case report. J Card Surg 2020; 35:3620-3622. [PMID: 32985727 DOI: 10.1111/jocs.15073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 02/05/2023]
Abstract
Behçet's disease (BD) is a rarely seen immune disease with multiple systems involvements. Among them, a cardiac manifestation is a severe and rare complication of BD. Here we reported a young man with BD, complicated with a right ventricular thrombus. Surgery was performed successfully to remove the intracardiac thrombus, and a 2-year follow-up failed to find any new symptoms and pathological findings. Our experience provided a better example for diagnosing and early surgical treatment for intracardiac thrombus of BD.
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Affiliation(s)
- Tailong Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xuelin Wu
- Operating Room, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhong Wu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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26
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Khan A, Haroon M, Bashir F, Din ZU. Behcet's Disease: Pakistani Experience. Pak J Med Sci 2020; 36:1005-1010. [PMID: 32704279 PMCID: PMC7372659 DOI: 10.12669/pjms.36.5.1916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/16/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the clinical manifestation of patients with Behcet's disease, and performance of different classification criteria of Behcet's disease in our population. METHODS It was a retrospective analysis of all Behcet's disease patients attending Department of Rheumatology at Fatima Memorial Hospital, Lahore, Pakistan from April 2019 to July 2019. We performed a comprehensive clinical evaluation of patients with Behcet's disease, with focus on patients' age, gender and different clinical manifestations. RESULTS A consecutive cohort of 20 patients was studied. All patients met the International Criteria of Behcet's Disease criteria, and 18 out of 20 patients also met International Study Group criteria. Mean age of the cohort was 33.5±10.4 years and 45% was female (male to female ratio of 1:1.2). Around 90% of cohort had recurrent oral and genital ulcers. Ocular involvement was present in 80% patients, while Joint manifestations were present in 75% of patients. Cutaneous, neurological (both central and peripheral nervous system involvement), and GIT symptoms were present in 50%, 30%, and 15% of patients, consecutively. Joint pain and eye symptoms were major initial symptoms in males, while eye symptoms and neurological symptoms were more common in female patients at disease onset. Reaching border line significance, Cutaneous(p-value=0.479), ocular(p-value=0.61), and GIT involvement(p-value=0.59) were more prevalent in males while neurological involvement (p-value=0.336) in females. CONCLUSION Behcet's disease occurs commonly in middle age population with equal male to female ratio, with mucocutaneus aphthosis, ocular disease and joint pains being common manifestation. Gastrointestinal symptoms are more common in males while neurological symptoms in females.
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Affiliation(s)
- Asadullah Khan
- Asadullah Khan, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Muhammad Haroon
- Muhammad Haroon, FRSM, FFSEM, FACR, FRCP., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Farhan Bashir
- Farhan Bashir, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Zia ud Din
- Zia ud Din, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
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Hussain M, Chen P, Zhang Y, Tian Y, Du H. Moesin expression is correlated with its involvement in patients with Behcet's disease. Arch Med Sci 2020; 16:924-930. [PMID: 32542096 PMCID: PMC7286334 DOI: 10.5114/aoms.2020.92911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/16/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Behcet's disease (BD) is a rare, chronic autoimmune disorder of unknown etiology. Although the profile of autoantibodies for this disease is not yet completely understood, because of better disease recognition, its prevalence is increasing throughout the world. Among ERM proteins (ezrin/radixin/moesin), moesin is a member of a family which is involved in autoimmune diseases. The aim of this study is to confirm whether moesin is a potential anti-endothelial cell autoantigen (AECA) in Hans Chinese BD patients. MATERIAL AND METHODS First, a full length recombinant human moesin protein was over-expressed and purified. Second, it was identified by mass spectrometry and then purified moesin was used to perform Western blotting, immunoprecipitation and ELISA with confirmed BD patients. Finally, in vitro cytotoxicity experiments were conducted with anti-moesin antibodies by the resazurin reduction assay method. RESULTS : Purified moesin protein was successfully expressed and then its antigenicity was confirmed by Western blotting and immunoprecipitation techniques. Anti-moesin antibodies were detected in approximately one-third (38%) of BD patients by ELISA and the reactivity of BD serum IgG antibodies against moesin was found to be significantly higher than HC (p < 0.0001). Moreover, in order to validate our results, cytotoxicity experiments also confirmed that anti-moesin antibody had a significant inhibitory effect on endothelial cell activity. CONCLUSIONS Expression is correlated with the involvement of moesin as an autoantigen in BD pathology, which is a new finding. It might be a new candidate biomarker in the Han Chinese population.
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Affiliation(s)
- Muhammad Hussain
- 112 Lab, School of Chemistry and Biological Engineering, University of Science and Technology, Beijing, China
| | - Peng Chen
- 112 Lab, School of Chemistry and Biological Engineering, University of Science and Technology, Beijing, China
- Experimental Research Center, China Academy of Traditional Chinese Medicine, Beijing, China
| | - Yixuan Zhang
- 112 Lab, School of Chemistry and Biological Engineering, University of Science and Technology, Beijing, China
| | - Yaping Tian
- Department of Clinical Biochemistry, Chinese PLA General Hospital, Beijing, China
| | - Hongwu Du
- 112 Lab, School of Chemistry and Biological Engineering, University of Science and Technology, Beijing, China
- Corresponding author: Prof. Dr. Hongwu Du, School of Chemistry and Biological Engineering, University of Science and Technology, 30 Xueyuan Road, Haidian District, Beijing 100083, China, Phone: +86 10 62334497, Fax: +86 10 62332462. E-mail:
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28
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Mumcu G, Yay M, Aksoy A, Taş MN, Armağan B, Sarı A, Bozca BC, Tekgöz E, Karadağ DT, Badak SÖ, Tecer D, Bes C, Şahin A, Erken E, Cefle A, Çınar M, Yılmaz S, Karaçaylı Ü, Alpsoy E, Şenel S, Yaşar Bilge Ş, Kaşifoğlu T, Karadağ Ö, Aksu K, Keser G, Alibaz-Öner F, İnanç N, Ergun T, Direskeneli H. Predictive factors for work-day loss in Behçet's syndrome: A multi-center study. Int J Rheum Dis 2019; 23:240-246. [PMID: 31858715 DOI: 10.1111/1756-185x.13771] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this multi-center study was to assess predictive factors for work-day loss as an indirect cost element in Behçet's syndrome (BS). METHODS In this cross-sectional, multi-center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self-reported work-day loss during the previous year. RESULTS Work-day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration <5 years (74%) were higher in male patients with work-day loss (P < .05). The majority of males (90.9%) had more than four clinic visits during the previous year. Moreover, the mean work-day loss (30.8 ± 57.7 days) was higher in patients with vascular involvement (56.1 ± 85.9) than those without (26.4 ± 50.6 days) (P = .046). In addition, increased frequency of ocular involvement (25.9%) was also observed in patients with work-day loss compared to others (8.6%) (P = .059). CONCLUSION Work-day loss was associated with both vascular and ocular involvement. Close associations were observed among male gender, early period of the disease, frequent medical visits, being a smoker and treatment with IS medications in patients with work-day loss.
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Affiliation(s)
- Gonca Mumcu
- Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Meral Yay
- Department of Statistics, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Aysun Aksoy
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Mehmet Nedim Taş
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Berkan Armağan
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Alper Sarı
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Burçin Cansu Bozca
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Emre Tekgöz
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Duygu Temiz Karadağ
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Suade Özlem Badak
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Duygu Tecer
- Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Sanlıurfa, Turkey
| | - Cemal Bes
- Rheumatology Clinic, Istanbul Bakırköy Dr.Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ali Şahin
- Division of Rheumatology, Medical School, Cumhuriyet University, Sivas, Turkey
| | - Eren Erken
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Çınar
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Sedat Yılmaz
- Gulhane Medical Faculty, Division of Rheumatology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Ümit Karaçaylı
- Gulhane Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
| | - Erkan Alpsoy
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Soner Şenel
- Division of Rheumatology, Medical School, Erciyes University, Kayseri, Turkey
| | - Şule Yaşar Bilge
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Timuçin Kaşifoğlu
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Ömer Karadağ
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Kenan Aksu
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Fatma Alibaz-Öner
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Nevsun İnanç
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Tülin Ergun
- Dermatology Department, Medical School, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
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Yin H, Song Y, Zheng M, Han J, Tang J. Behcet's Disease With Cerebral Artery Infarction Caused by Cerebral Arteritis as an Early Symptom Only With Elevated Interleukin-8. Front Neurol 2019; 10:1102. [PMID: 31695669 PMCID: PMC6817676 DOI: 10.3389/fneur.2019.01102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/01/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Behcet's disease (BD) is multi-systemic vasculitis, which generally is repeated oral and genital ulcerations as well as ocular and skin lesions. Today, the pathogenesis of BD remains mostly unknown. It is also suggested that the disease is probably related to autoinflammatory and autoimmune disorders, and innate immunity damages were perceived as key in its pathologic process. Only 5% of BD patients have neurological involvement, and it usually occurs in 4–6 years after the initial symptoms. Early onset of neurological impairment makes it difficult to diagnose and treat definitely. Case Presentation: A 38-year-old man was admitted to our hospital with numbness and weakness of the left extremities. Diffusion magnetic resonance imaging (MRI) revealed focal infarction in the posterior limb of the internal capsule. Skin pathology suggested small vessel vasculitis, and high-resolution MRI revealed intracranial arteritis. The patient had a negative skin pathery test and then developed a scar at the venous puncture site at the early stage of disease. Laboratory examination showed that interleukin 8 (IL-8) increased. The patient was treated with an immunosuppressive agent including mycophenolate mofetil, hydroxychloroquine, and colchicine. All symptoms were alleviated after half a year's treatment. There was neither stroke nor recurrence of oral ulcer thereafter. Conclusion: This case demonstrates that neurological involvement might be an early symptom of BD. IL-8 could act as a novel target for the treatment of BD theoretically and probably play a key role in disease recovery.
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Affiliation(s)
- Hao Yin
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Yun Song
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Meimei Zheng
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Ju Han
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Jiyou Tang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China.,The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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30
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Hari G, Skeik N. Digital ischemia in Behçet's disease: case-based review. Rheumatol Int 2019; 40:137-143. [PMID: 31598753 DOI: 10.1007/s00296-019-04452-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 09/26/2019] [Indexed: 12/19/2022]
Abstract
Behçet's disease is a rare chronic autoimmune disease affecting primarily Middle and East Asian populations between the ages of 20 and 40 years. Behçet's disease manifests with oral and genital mucocutaneous lesions, ocular disease, venous thrombosis, and central nervous system degradation. Treatment can be challenging and may require immunosuppressive agents and/or topical wound-care. While larger vascular involvement has been reported, digital ischemia due to small-vessel involvement has not been well described in the literature. Based on a systematic literature review, we were only able to find seven published cases of limb ischemia, none of which reported digital involvement. We present a unique case of Behçet's disease with severe digital ischemia and ulceration caused by small-vessel involvement. The patient was managed successfully with antiplatelet, immunosuppressants, and anti-inflammatories with complete resolution of the ischemic symptoms. By focusing on small-vessel involvement and digital ischemia, we provide insight into clinical presentation and treatment for this very rare vascular manifestation of Behçet's disease.
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Affiliation(s)
- Gopika Hari
- Minneapolis Heart Institute®, Abbott Northwestern Hospital part of Allina Health, 33300, 920 E. 28th Street, Suite 300, Minneapolis, MN, 55407, USA
| | - Nedaa Skeik
- Minneapolis Heart Institute®, Abbott Northwestern Hospital part of Allina Health, 33300, 920 E. 28th Street, Suite 300, Minneapolis, MN, 55407, USA.
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31
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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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32
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Ata E, Kosem M, Ozsoy-Unubol T. Ultrasonographic assessment of femoral cartilage thickness in patients with and without uveitis in Behçet's disease. Rheumatol Int 2019; 40:75-80. [PMID: 31338569 DOI: 10.1007/s00296-019-04361-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 06/28/2019] [Indexed: 10/26/2022]
Abstract
The objective for this study is to evaluate the femoral cartilage thickness in patients with/without uveitis in Behçet's disease (BD). Patients with BD aged 18-70 years were included. The demographic and clinical characteristics of the patients were recorded. The thickness of femoral articular cartilage was measured with musculoskeletal ultrasound. Cartilage thickness was measured bilaterally from the central points of medial condyle (MFC), lateral condyle (LFC), and intercondylar area (ICA). 20 patients with uveitis [uveitis (+)] and 20 patients without uveitis [uveitis (-)] were included. Both right and left MFC and LFC had statistically significant thinner cartilage in uveitis (+) group (p < 0.05). For the ICA, uveitis (+) patients had thinner femoral cartilage than uveitis (-) patients; however, in the left side, statistically significance could not be detected. Femoral cartilage was thinner in uveitis (+) patients than in uveitis (-) patients in BD. This relationship between uveitis and femoral cartilage thickness may be helpful in the prevention and early treatment of cartilage degeneration.
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Affiliation(s)
- Emre Ata
- Department of Physical Medicine and Rehabilitation, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Murat Kosem
- Department of Physical Medicine and Rehabilitation, Yuksekova State Hospital, Hakkari, Turkey
| | - Tugba Ozsoy-Unubol
- Department of Physical Medicine and Rehabilitation, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
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33
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Maliyar K, Mufti A, Syed M, Selk A, Dutil M, Bunce PE, Alavi A. Genital Ulcer Disease: A Review of Pathogenesis and Clinical Features. J Cutan Med Surg 2019; 23:624-634. [PMID: 31253050 DOI: 10.1177/1203475419858955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Genital ulcer disease can be caused by a wide variety of sources. Most commonly, genital ulcer disease is grouped into infectious and noninfectious causes. HSV, syphilis, lymphogranuloma venereum, and chancroid represent some common infectious ulcers. Noninfectious causes on the other hand can be inflammatory, noninflammatory, or malignant (eg, squamous cell carcinoma). Depending on the etiology, genital ulcers may present with unique features that can help clinicians identify the etiology and start treatment in a timely manner. The clinical presentation and management of infectious and noninfectious genital ulcers will be discussed in this review.
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Affiliation(s)
| | | | - Maleeha Syed
- Faculty of Medicine, University of Ottawa, ON, Canada
| | - Amanda Selk
- Department of Obstetrics and Gynecology, Women's College Hospital, University of Toronto, ON, Canada
| | - Maha Dutil
- Division of Dermatology, Department of Medicine, University of Toronto, ON, Canada
| | - Paul E Bunce
- Division of Infectious Diseases, Department of Medicine, University of Toronto, ON, Canada
| | - Afsaneh Alavi
- Division of Dermatology, Department of Medicine, Women's College Hospital, University of Toronto, ON, Canada
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34
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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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35
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Bassyouni IH, Mohammed WHS, Taha FM, El Refai RM. Clinical significance of CCN2/connective tissue growth factor in Behçet's disease patients. Int J Rheum Dis 2019; 22:1459-1465. [PMID: 31124308 DOI: 10.1111/1756-185x.13597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 03/11/2019] [Accepted: 03/27/2019] [Indexed: 02/05/2023]
Abstract
AIM Behçet's disease (BD) is a chronic autoimmune vasculitic disorder of unclear pathogenesis. CCN2/CTGF (connective tissue growth factor) is one of the CCN family members which carry out pro-angiogenic biological functions and play an important role in inflammatory and autoimmune diseases. The aim of the present study was to assess CCN2 plasma concentrations in BD patients and to analyze their association with clinical features of the disease, activity and laboratory parameters. METHODS We included 87 BD patients and 60 healthy control subjects matched for age and gender. Demographic, clinical, disease activity and severity data were recorded. Plasma CCN2 concentrations were measured using enzyme-linked immunosorbent assay. RESULTS The plasma concentrations of CCN2 in BD patients were significantly elevated compared to healthy controls. The mean plasma CCN2 levels in patients with major organ involvement were significantly higher than those without. Patients who received steroids or cyclophosphamide showed a significant reduction in CCN2 levels. This was confirmed by the results of multivariate analysis. Patients with active ocular disease had a significant increase in CCN2 compared to the inactive group. On the other hand, CCN2 levels were not significantly correlated with overall disease activity and severity scores. CONCLUSION Behçet's disease patients showed a significant increase of CCN2 levels, especially in the group of patients with major organ involvement. A significant reduction of these levels was found in patients who received steroids or cyclophosphamide. Larger studies with further investigations of the precise role of CCN2 in BD pathogenesis might lead to novel therapies for the clinical management of this disease.
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Affiliation(s)
- Iman Hamed Bassyouni
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Fatma M Taha
- Department of Medical Biochemistry and Molecular biology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Rasha M El Refai
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
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36
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Nieto IG, Alabau JLC. Immunopathogenesis of Behçet Disease. Curr Rheumatol Rev 2019; 16:12-20. [PMID: 30987569 DOI: 10.2174/1573397115666190415142426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/02/2019] [Accepted: 04/04/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Behçet's Disease (BD, OMIM 109650) is a chronic relapsing inflammatory disease of unknown etiology with unpredictable exacerbations and remissions. First described in 1937 by the Turkish dermatologist HulusiBehçet, as a trisympton complex (oral and genital ulcers and uveitis), it is now recognized as a multisystemic disease. The syndrome can manifest in diverse ways and can involve nearly every organ system. Several studies have implicated T cells and monocytes in the pathogenesis of BD especially when these cells are stimulated by heat shock proteins and streptococcal antigen. This article presents a review of the relevant published literature about the immunopathogenesis of BD. RESULT The authors used MeSH terms "Behçet's disease" with "pathophysiology," "pathogenesis," "genetic", "epigenetic", "immunogenetic" or "immune response" to search the PubMed database. All the relevant studies identified were included.
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Affiliation(s)
- Israel Gañán Nieto
- Department of Immunology. Hospital Universitario Ramon y Cajal, Ctra. Colmenar Viejo, Km 9,100. C.P. 28034. Madrid, Spain
| | - José Luis Castañer Alabau
- Department of Immunology. Hospital Universitario Ramon y Cajal, Ctra. Colmenar Viejo, Km 9,100. C.P. 28034. Madrid, Spain
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37
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Emerging Roles of Redox-Mediated Angiogenesis and Oxidative Stress in Dermatoses. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:2304018. [PMID: 31178954 PMCID: PMC6501144 DOI: 10.1155/2019/2304018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/14/2019] [Accepted: 03/14/2019] [Indexed: 12/24/2022]
Abstract
Angiogenesis is the process of new vessel formation, which sprouts from preexisting vessels. This process is highly complex and primarily involves several key steps, including stimulation of endothelial cells by growth factors, degradation of the extracellular matrix by proteolytic enzymes, migration and proliferation of endothelial cells, and capillary tube formation. Currently, it is considered that multiple cytokines play a vital role in this process, which consist of proangiogenic factors (e.g., vascular endothelial growth factor, fibroblast growth factors, and angiopoietins) and antiangiogenic factors (e.g., endostatin, thrombospondin, and angiostatin). Angiogenesis is essential for most physiological events, such as body growth and development, tissue repair, and wound healing. However, uncontrolled neovascularization may contribute to angiogenic disorders. In physiological conditions, the above promoters and inhibitors function in a coordinated way to induce and sustain angiogenesis within a limited period of time. Conversely, the imbalance between proangiogenic and antiangiogenic factors could cause pathological angiogenesis and trigger several diseases. With insights into the molecular mechanisms of angiogenesis, increasing reports have shown that a close relationship exists between angiogenesis and oxidative stress (OS) in both physiological and pathological conditions. OS, an imbalance between prooxidant and antioxidant systems, is a cause and consequence of many vascular complains and serves as one of the biomarkers for these diseases. Furthermore, emerging evidence supports that OS and angiogenesis play vital roles in many dermatoses, such as psoriasis, atopic dermatitis, and skin tumor. This review summarizes recent findings on the role of OS as a trigger of angiogenesis in skin disorders, highlights newly identified mechanisms, and introduces the antiangiogenic and antioxidant therapeutic strategies.
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Muhammad JS, Ishaq M, Ahmed K. Genetics and Epigenetics Mechanism in the Pathogenesis of Behçet's Disease. Curr Rheumatol Rev 2019; 15:7-13. [PMID: 29779484 DOI: 10.2174/1573397114666180521090335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 04/20/2018] [Accepted: 05/13/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Behçet's Disease (BD) is characterized by numerous systemic manifestations and is known for its ability to affect both, arteries and the veins. However, the etiology of BD is only partially understood, and previous studies have demonstrated a role for genetic and epigenetic factors that contribute to disease pathophysiology. Several studies have implicated T cells and monocytes in the pathogenesis of BD especially when these cells are stimulated by heat shock proteins and streptococcal antigen. Furthermore, during disease exacerbations adenosine deaminase has an important role in activating lymphocyte proliferation, maturation, and differentiation in BD. This article presents a review of the published literature mainly from the last 20 years. The topics of main concern were the role of genetic and epigenetic factors as contributing factors in disease pathophysiology. RESULT AND CONCLUSION The authors used MeSH terms "Behçet's disease" with "pathophysiology," "pathogenesis," "genetic" or "epigenetic" to search the PubMed database. All the relevant studies identified were included and are described according to the aforementioned subheadings.
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Affiliation(s)
- Jibran Sualeh Muhammad
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Muhammad Ishaq
- Department of Internal Medicine, Jinnah Medical College Hospital, Korangi, Karachi, Pakistan
| | - Khalid Ahmed
- Department of Biological and Biomedical Sciences, the Aga Khan University Hospital, Karachi, Pakistan
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Akiyama M, Kaneko Y, Takeuchi T. Does microbiome contribute to HLA-B52-positive Takayasu arteritis? Mod Rheumatol 2019; 30:213-217. [DOI: 10.1080/14397595.2019.1584146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mitsuhiro Akiyama
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Yay M, Çelik Z, Aksoy A, Alibaz-Öner F, Inanç N, Ergun T, Direskeneli H, Mumcu G. Oral health is a mediator for disease severity in patients with Behçet's disease: A multiple mediation analysis study. J Oral Rehabil 2018; 46:349-354. [PMID: 30466164 DOI: 10.1111/joor.12750] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the study was to examine whether oral health as an infection focus could mediate disease course in patients with Behçet's disease (BD). METHODS In the study, oral health of 194 BD patients was examined at baseline and follow-up periods. The reasons for last dental visits were recorded as tooth extraction or regular control visits/planned treatments at the end of follow-up period. The Behçet's disease severity score was calculated with higher scores indicating a more severe course. Mediation analysis was carried out to assess the effects of oral health on disease severity score at follow-up period in the study. RESULTS Dental and periodontal indices were found to be higher at follow-up visit compared to those of baseline (P < 0.05). Disease severity score was found to be higher in males (5.3 ± 2.4) compared to females (4.4 ±2.5) in the whole group (P = 0.005). Moreover, patients having tooth extraction at their last dental visit and patients with dental caries had a more severe disease course (5.4 ± 2.4; 5.5 ± 2.5) compared to others (4.2 ± 2.3; 4.4 ± 2.4; P < 0.0001). In multiple mediation analysis, disease severity score was a dependent variable and was directly mediated by male gender (B = -0.8822, P = 0.0145) and indirectly mediated through the presence of dental caries (B = 0.9509 P = 0.0110) and need of tooth extraction (B = 0.8758, P = 0.0128). CONCLUSION Both presence of dental caries and need of tooth extraction were observed to be effective mediators for a more severe disease course in BD. Therefore, better oral health should be aimed to eliminate microbial factors, which are a part of pathogenic processes.
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Affiliation(s)
- Meral Yay
- Department of Statistics, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Zülal Çelik
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Aysun Aksoy
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Fatma Alibaz-Öner
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Nevsun Inanç
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Gonca Mumcu
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
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Mahmoudi M, Ashraf-Ganjouei A, Javinani A, Shahram F, Meguro A, Mizuki N, Ahmadzadeh N, Jafarinejad-Farsangi S, Mostafaei S, Kavosi H, Faezi ST, Akhlaghi M, Davatchi F. Epistatic Interaction of ERAP1 and HLA-B*51 in Iranian Patients with Behçet's Disease. Sci Rep 2018; 8:17612. [PMID: 30514861 PMCID: PMC6279803 DOI: 10.1038/s41598-018-35700-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 11/09/2018] [Indexed: 12/18/2022] Open
Abstract
Behçet's Disease (BD) pathogenesis remains unclear, but some genetic loci and environmental factors are proposed to play a role. Here, we investigate the association of the endoplasmic reticulum aminopeptidase-1 (ERAP1) gene variants and HLA-B*51 with BD susceptibility and clinical manifestations in Iranian patients. In the study, 748 BD patients and 776 healthy individuals were included. The MGB-TaqMan Allelic Discrimination method was used to genotype 10 common missense single nucleotide polymorphisms (SNPs) and one intronic SNP in the ERAP1 gene region. We found no significant association between the 11 SNPs and BD in allelic and genotypic association tests. However, rs30187 showed the strongest association with BD in the recessive genotype model of the risk T allele in HLA-B*51 carriers. Although this became insignificant after correcting for multiple comparisons, the homozygous rs30187 risk allele genotype (TT) increased disease susceptibility in HLA-B*51 carriers in epistasis analysis, and the rs30187 TT recessive genotype showed a significant association with risk of cardiac involvement in the all patients and articular involvements in HLA-B*51 positive patients. Our findings suggest that gene-gene interactions between HLA-B*51 and ERAP1 variants is important for BD development, however, ERAP1 variants which interact with HLA-B*51 may differ among disease phenotypes or populations.
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Affiliation(s)
- Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Ashraf-Ganjouei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Javinani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Akira Meguro
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nooshin Ahmadzadeh
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeideh Jafarinejad-Farsangi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Shayan Mostafaei
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Medicine, Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hoda Kavosi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maassoumeh Akhlaghi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Malek Mahdavi A, Khabbazi A, Yaaghoobian B, Ghojazadeh M, Agamohammadi R, Kheyrollahiyan A, Rashtchizadeh N. Cigarette smoking and risk of Behcet’s disease: a propensity score matching analysis. Mod Rheumatol 2018; 29:633-639. [DOI: 10.1080/14397595.2018.1493065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Aida Malek Mahdavi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Barmak Yaaghoobian
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Development and Coordination Center (RDCC), Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Agamohammadi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Kheyrollahiyan
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nadereh Rashtchizadeh
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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İris M, Özçıkmak E, Aksoy A, Alibaz-Öner F, İnanç N, Ergun T, Direskeneli H, Mumcu G. The assessment of contributing factors to oral ulcer presence in Behçet's disease: Dietary and non-dietary factors. Eur J Rheumatol 2018; 5:240-243. [PMID: 30501850 PMCID: PMC6267742 DOI: 10.5152/eurjrheum.2018.18094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 08/08/2018] [Indexed: 12/14/2022] Open
Abstract
Objective The aim of this study was to assess the contributing factors for oral ulcer activity in Behçet’s disease (BD). Methods Ninety-two patients with BD (F/M: 42/50, mean age: 38.7±10.02 years) participated in this cross-sectional study. Data regarding disease-related factors, smoking patterns, and self-reported dietary/non-dietary triggering factors for oral ulcer activity were collected by a questionnaire. Treatment protocol was categorized as mild and intensive groups associated with organ involvements. Results A mild treatment protocol was more common in females (52.4% vs 20%) than in males (p=0.002). During the last three months, the number of oral ulcers in female patients was higher in the mild treatment group (6.4±6.5) than in the intensive treatment group (3.3±4.9) (p=0.045). In patients with active oral ulcers (n=63), rate of being a non-smoker was also higher in females (86.7% vs 63.6%) than in males. Daily frequency of tooth brushing was 1.2±0.8 in patients with BD, and was higher in females (1.5±0.9 vs 0.9±0.6) (p=0.001). Stress and fatigue (78.3%) were reported as the most frequent triggering factors for oral ulcer presence in patients with BD. A total of 148 different dietary factors associated with oral ulcer presence were reported in the study. Conclusion A mild treatment protocol and being a non-smoker were found to be the contributing factors associated with oral ulcer activity in patients with BD. Being motivated for oral hygiene and being non-smokers were positive health behaviors observed in females. Irrespective of gender, stress and fatigue were defined as the most common self-reported triggering factors for oral ulcer presence in BD. In addition, the roles of some dietary factors were also reported.
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Affiliation(s)
- Merve İris
- Marmara University School of Medicine, İstanbul, Turkey
| | - Ezgi Özçıkmak
- Marmara University School of Medicine, İstanbul, Turkey
| | - Aysun Aksoy
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Fatma Alibaz-Öner
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Nevsun İnanç
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, Marmara University School of Medicine, İstanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, İstanbul, Turkey
| | - Gonca Mumcu
- Deparment of Health Management, Faculty of Health Sciences, Marmara University, İstanbul, Turkey
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Saeidinejad M, Kardash S, Connell L. Behcet’s disease and severe inflammatory reaction to 23-valent pneumococcal polysaccharide vaccine: a case report and review of literature. Scott Med J 2018; 63:119-121. [DOI: 10.1177/0036933018801215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Current European League Against Rheumatism guidelines strongly recommend considering the use of polysaccharide pneumococcal vaccine in all patients with autoimmune inflammatory rheumatic diseases. However, a previously published case series reports of reactions to 23-valent pneumococcal polysaccharide vaccine in patients with Behcet’s disease. The purpose of this report is to present a similar case of a systemic adverse reaction in a patient with Behcet’s disease to 23-valent pneumococcal polysaccharide vaccine.
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Affiliation(s)
| | - Sally Kardash
- Specialty Registrar in Rheumatology, Department of Rheumatology, Inverclyde Royal Hospital, Scotland
| | - Laura Connell
- Consultant Rheumatologist, Department of Rheumatology, Inverclyde Royal Hospital, Scotland
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Hernanz I, Horton S, Burke TR, Guly CM, Carreño E. Acute Macular Neuroretinopathy Phenotype in Behçet's Disease. Ophthalmic Surg Lasers Imaging Retina 2018; 49:634-638. [PMID: 30114310 DOI: 10.3928/23258160-20180803-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/28/2018] [Indexed: 12/12/2022]
Abstract
Acute macular neuroretinopathy (AMN) is a rare disease, the etiology of which remains unclear. An ischemic event at the level of the deep capillary plexus has been proposed. The authors present three cases of AMN in the context of active systemic Behçet's disease, with the support of multimodal imaging. All patients were known to have Behçet's disease before the diagnosis of AMN. AMN was confirmed in all three cases on spectral domain optical coherence tomography (SD-OCT), near infrared reflectance and OCT angiography. Behçet's disease is known to be a prothrombotic disease. The presentation of AMN in this context supports the presumed ischemic etiology of AMN. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:634-638.].
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Greco A, De Virgilio A, Ralli M, Ciofalo A, Mancini P, Attanasio G, de Vincentiis M, Lambiase A. Behçet's disease: New insights into pathophysiology, clinical features and treatment options. Autoimmun Rev 2018; 17:567-575. [PMID: 29631062 DOI: 10.1016/j.autrev.2017.12.006] [Citation(s) in RCA: 168] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
Behçet's disease (BD) is a rare systemic vasculitis characterized by oral aphthous ulcers, genital ulcers, ocular lesions and other systemic manifestations. BD occurs most frequently in Eurasian populations along the ancient trading route known as the "Silk Road" which extends from eastern Asia to the Mediterranean basin. The causes of BD are unknown: it is believed to be due to an autoimmune process triggered by an infectious or environmental agent in genetically predisposed individuals. HLA-B51 allele located in the MHC locus, on chromosome 6p, has been the most strongly associated risk factor for BD in areas along the Old Silk Route. Herpes simplex virus-1 and Streptococcus have been postulated as possible environmental triggers of BD. T cell homeostasis perturbation, especially Th1 and Th17 expansion and decreased regulation by Tregs are now supposed to be the cornerstone of BD pathogenesis. The histology shows vasculitis that involves both arteries and veins, and vessels of any size. BD is a systemic vasculitis with significant neutrophil infiltration, endothelial cell swelling, and fibrinoid necrosis. The diagnosis of BD is only supported by clinical criteria and requires the exclusion of other diagnoses based on clinical presentation. There are no pathognomonic laboratorial findings of BD. This rare disease often leads to blindness and fatal systemic involvement. Main causes of death include major vessel disease and central nervous system involvement. Corticosteroids are commonly used to treat clinical manifestations of BD in combination with immunosuppressant drugs. Tumor necrosis factor (TNF)-blocking agents such as Infliximab, Etanercept, and Adalimumab have been reported to have success in patients with BD.
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Affiliation(s)
- Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Armando De Virgilio
- Department of Otolaryngology-Head and Neck Surgery, Humanitas Clinical and Research Center, via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Massimo Ralli
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Andrea Ciofalo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Patrizia Mancini
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Giuseppe Attanasio
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
| | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00100 Rome, Italy.
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Morikawa S, Ouchi T, Asoda S, Horie N, Tsunoda K, Kawana H, Nakagawa T. Treatment of severe generalized chronic periodontitis in a patient with Behçet's disease: A case report. J Int Med Res 2018; 46:2037-2045. [PMID: 29557228 PMCID: PMC5991237 DOI: 10.1177/0300060518762267] [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] [Indexed: 11/16/2022] Open
Abstract
Behçet’s disease is a systemic disorder of unknown etiology. It involves multiple organ systems and is characterized by recurring episodes of oral ulcers as well as ocular, genital, and skin lesions. Oral ulcers can affect tooth brushing and impair proper oral hygiene. As a result, a dental biofilm accumulates, and the condition of the teeth and periodontal tissue deteriorates. The aim of this case report is to highlight the efficacy of periodontal treatment for patients with Behçet’s disease. A 51-year-old man with Behçet’s disease presented with generalized severe periodontitis. After basic treatment of the periodontal tissues, periodontal surgery was performed at several sites with bony defects. However, the patient developed severe stomatitis in the oral mucosa and gingiva after periodontal surgery. Administration of the antimicrobial agent cefdinir had little effect on recovery; however, subsequent administration of sitafloxacin resulted in significant improvement of the stomatitis. This case demonstrates that periodontal therapy is very useful for alleviating the oral signs and symptoms of Behçet’s disease. Systemic antibiotic treatment with sitafloxacin (but not cefdinir) and mechanical debridement were effective in preventing the recurrence of aphthous ulcer outbreaks after periodontal surgery.
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Affiliation(s)
- Satoru Morikawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takehito Ouchi
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Seiji Asoda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Nobuyuki Horie
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kazuyuki Tsunoda
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiromasa Kawana
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Taneaki Nakagawa
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Balkan E, Bilen H, Eyerci N, Keleş S, Kara A, Akdeniz N, Dogan H. Cytokine, C-Reactive Protein, and Heat Shock Protein mRNA Expression Levels in Patients with Active Behçet's Uveitis. Med Sci Monit 2018. [PMID: 29534057 PMCID: PMC5862094 DOI: 10.12659/msm.907918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To investigate the gene expression levels of interleukin 10 (IL10), IL18, interferon gamma (IFNG), IFN-gamma receptor (IFNGR), C-reactive protein (CRP), and heat shock protein 70 (HSP70) in patients with active Behçet’s uveitis. Material/Methods Forty patients with Behçet’s disease diagnosed according to the International Study Group criteria and 30 healthy individuals were included in the study. IL10, IL18, IFNG, IFNGR, CRP, and HSP70 gene expression levels were compared. Results Expression levels of IL18, IFNG, IFNGR, and CRP were significantly higher in patients with active Behçet’s uveitis than in control subjects (P<0.01 for all), whereas no significant differences were found in IL10 and HSP70 gene expression levels (P>0.01 for both). Conclusions IL18, IFNG, IFNGR, and CRP gene expression is significantly increased in active Behçet’s uveitis. There was no significant difference between active Behçet’s uveitis patients and controls in terms of IL10 and HSP70 gene expression levels. We conclude that drugs prescribed to Behçet’s patients with active uveitis downregulate gene expression.
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Affiliation(s)
- Eda Balkan
- Department of Medical Biology, Ataturk University, Erzurum, Turkey
| | - Handan Bilen
- Department of Dermatology, Ataturk University, Erzurum, Turkey
| | - Nilnur Eyerci
- Department of Medical Biology, Kafkas University, Kars, Turkey
| | - Sadullah Keleş
- Department of Ophthalmology, Ataturk University, Erzurum, Turkey
| | - Aslı Kara
- Department of Internal Medicine, Ataturk University, Erzurum, Turkey
| | | | - Hasan Dogan
- Department of Medical Biology, Ataturk University, Erzurum, Turkey
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Ocular antigen does not cause disease unless presented in the context of inflammation. Sci Rep 2017; 7:14226. [PMID: 29079770 PMCID: PMC5660195 DOI: 10.1038/s41598-017-14618-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/11/2017] [Indexed: 12/14/2022] Open
Abstract
Ocular antigens are sequestered behind the blood-retina barrier and the ocular environment protects ocular tissues from autoimmune attack. The signals required to activate autoreactive T cells and allow them to cause disease in the eye remain in part unclear. In particular, the consequences of peripheral presentation of ocular antigens are not fully understood. We examined peripheral expression and presentation of ocular neo-self-antigen in transgenic mice expressing hen egg lysozyme (HEL) under a retina-specific promoter. High levels of HEL were expressed in the eye compared to low expression throughout the lymphoid system. Adoptively transferred naïve HEL-specific CD4+ T cells proliferated in the eye draining lymph nodes, but did not induce uveitis. By contrast, systemic infection with a murine cytomegalovirus (MCMV) engineered to express HEL induced extensive proliferation of transferred naïve CD4+ T cells, and significant uveoretinitis. In this model, wild-type MCMV, lacking HEL, did not induce overt uveitis, suggesting that disease is mediated by antigen-specific peripherally activated CD4+ T cells that infiltrate the retina. Our results demonstrate that retinal antigen is presented to T cells in the periphery under physiological conditions. However, when the same antigen is presented during viral infection, antigen-specific T cells access the retina and autoimmune uveitis ensues.
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50
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Giza M, Koftori D, Chen L, Bowness P. Is Behçet's disease a 'class 1-opathy'? The role of HLA-B*51 in the pathogenesis of Behçet's disease. Clin Exp Immunol 2017; 191:11-18. [PMID: 28898393 DOI: 10.1111/cei.13049] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2017] [Indexed: 12/11/2022] Open
Abstract
The association between carriage of the human leucocyte antigen (HLA)-B*51 allele and development of Behçet's disease (BD) has been known since the early 1970s, but the exact mechanisms responsible for its role in pathogenesis remain much-debated. In an effort to explain the disease process, it has been suggested that BD constitutes one of a newly termed group of diseases, the 'MHC-I-opathies'. Other MHC-I-opathies include ankylosing spondylitis and HLA-B*27-associated spondyloarthropathies and HLA-C*0602-associated skin psoriasis. Recent work analysing the peptidome of HLA-B*51 suggests that altered peptide presentation by HLA-B*51 is vital to the disease process. In this review, we argue that immune receptor interactions with HLA-B*51 or the HLA-B*51-peptide complex could lead to development of inflammation in BD. The evidence for CD8+ T cell involvement is weak, and based on emerging studies it seems more likely that natural killer (NK) or other cell interactions, perhaps mediated by leucocyte immunoglobulin-like receptor (LILR) or killer immunoglobulin-like receptor (KIR) receptors, are culpable in pathogenesis. HLA misfolding leading directly to inflammation is another hypothesis for BD pathogenesis that deserves greater investigation. Ultimately, greater understanding of HLA-B*51's unique role in BD will probably lead to improved development of therapeutic strategies.
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Affiliation(s)
- M Giza
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - D Koftori
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - L Chen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - P Bowness
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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