1
|
Lavalle S, Caruso S, Foti R, Gagliano C, Cocuzza S, La Via L, Parisi FM, Calvo-Henriquez C, Maniaci A. Behçet's Disease, Pathogenesis, Clinical Features, and Treatment Approaches: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:562. [PMID: 38674208 PMCID: PMC11051811 DOI: 10.3390/medicina60040562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024]
Abstract
Behçet's disease is a systemic inflammatory disorder of unknown etiology. The disease manifests with diverse clinical symptoms, most commonly recurrent oral and genital ulcers, skin lesions, and uveitis, though it can affect multiple organ systems. Diagnosis is primarily clinical due to the lack of a definitive diagnostic test, and management involves a multidisciplinary approach to control inflammation and manage symptoms. Current treatment strategies involve corticosteroids, immunosuppressive agents, and, increasingly, biological therapies. Behçet's disease exhibits a higher prevalence along the Silk Road, suggesting a role of environmental and genetic factors. Despite significant progress in understanding its clinical characteristics and treatment approaches, gaps remain in our understanding of its pathogenesis. Future research is needed to elucidate the disease's pathophysiology and optimize treatment strategies.
Collapse
Affiliation(s)
- Salvatore Lavalle
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (S.L.); (C.G.)
| | - Sebastiano Caruso
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (S.C.); (S.C.); (F.M.P.)
| | - Roberta Foti
- Division of Rheumatology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy;
| | - Caterina Gagliano
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (S.L.); (C.G.)
- Ophthalmology Clinic, San Marco Hospital, University of Catania, 95123 Catania, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (S.C.); (S.C.); (F.M.P.)
| | - Luigi La Via
- Department of Anaesthesia and Intensive Care, University Hospital Policlinico-San Marco, 24046 Catania, Italy;
| | - Federica Maria Parisi
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, ENT Section, University of Catania, Via S. Sofia, 78, 95125 Catania, Italy; (S.C.); (S.C.); (F.M.P.)
| | - Christian Calvo-Henriquez
- Service of Otolaryngology, Hospital Complex of Santiago de Compostela, 15701 Santiago de Compostela, Spain;
| | - Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna “Kore”, 94100 Enna, Italy; (S.L.); (C.G.)
| |
Collapse
|
2
|
Mathur K, Kurbanova N, Qayyum R. Platelet-lymphocyte ratio (PLR) and all-cause mortality in general population: insights from national health and nutrition education survey. Platelets 2019; 30:1036-1041. [PMID: 30759051 DOI: 10.1080/09537104.2019.1571188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Platelet lymphocyte ratio (PLR) is a novel marker of inflammation that has gained popularity, especially in prognostication of cardiac diseases and malignant conditions. Several studies have examined the relationship between PLR and disease-specific mortality but none has examined this relationship with all-cause mortality in general population. Therefore, we examined the relationship between PLR and all-cause mortality using data from the National Health and Nutrition Examination Survey (NHANES) from the year 1999 to 2010. The role of PLR in predicting all-cause mortality was evaluated using Cox proportional hazards model adjusting for age, race, gender, smoking history, diabetes, hypertension, serum cholesterol, estimated glomerular filtration rate, serum c-reactive protein, and body mass index. Differential effect of age was examined using difference of differences analysis. Of the 27321 individuals, 2581 died during 171223 person-year follow-up. Mean PLR was significantly higher in participants who died than those who were living at the end of follow-up (145.7 vs. 133.0, respectively, p < 0.001). Individuals in the fourth quartile of PLR were at significantly higher risk of mortality than those in the first quartile (HR = 1.26, 95% CI: 1.08-1.47, p = 0.004 and adjusted HR = 1.33, HR, 95% CI: 1.15-1.54, p < 0.001, respectively). When examining the differential effect of age, association between PLR and mortality was seen in the elderly but not in the middle age or younger participants. Elevated PLR is associated with increased all-cause mortality, especially in the elderly. Further studies examining the mechanism through which PLR may increase mortality are needed.
Collapse
Affiliation(s)
- Kanupriya Mathur
- Division of Hospital Medicine, Virginia Commonwealth University , Richmond , VA , USA
| | - Nargiza Kurbanova
- Division of Hospital Medicine, Virginia Commonwealth University , Richmond , VA , USA
| | - Rehan Qayyum
- Division of Hospital Medicine, Virginia Commonwealth University , Richmond , VA , USA
| |
Collapse
|
3
|
Hammad M, Shehata OZ, Abdel-Latif SM, El-Din AMM. Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio in Behçet's disease: which and when to use? Clin Rheumatol 2018; 37:2811-2817. [PMID: 29980877 DOI: 10.1007/s10067-018-4194-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/04/2018] [Accepted: 06/26/2018] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is an uncommon autoimmune/autoinflammatory disease. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were investigated in many diseases as a marker of inflammation. In this study, we investigated NLR and PLR in patients with BD as a marker of disease activity and its association with different clinical manifestations. The study included 23 BD patients; their mean age was (32.5 ± 6.76) and M:F ratio was 16:7. Complete blood picture was done for all patients. NLR and PLR were compared in both active and inactive BD patients and its relation with different clinical manifestations was assessed. NLR was higher in active BD patients than in inactive BD patients (P < 0.01). Although both NLR and PLR were correlated with Behçet's Disease Current Activity Form (BDCAF), the correlation of NLR with BDCAF was much stronger than that of PLR. NLR was associated with some mucocutaneous lesions. Both NLR and PLR were associated with articular and GIT manifestations, but also NLR showed more significant results. In our studied patients, both NLR and PLR were not informative about any ongoing ocular activity (P > 0.05). Both ratios were not affected by the presence of neurologic deficits nor previous vascular events (P > 0.05). NLR was superior to PLR as an indicator of disease activity. NLR was closely related to skin manifestations while PLR was not. In our study, both were not considered reliable in representing ocular activity.
Collapse
Affiliation(s)
- Marwa Hammad
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Omaima Zakaria Shehata
- Rheumatology and Rehabilitation, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | | |
Collapse
|
4
|
Acikgoz N, Kurtoğlu E, Yagmur J, Kapicioglu Y, Cansel M, Ermis N. Elevated Monocyte to High-Density Lipoprotein Cholesterol Ratio and Endothelial Dysfunction in Behçet Disease. Angiology 2017; 69:65-70. [PMID: 28421814 DOI: 10.1177/0003319717704748] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behçet disease (BD) is a multisystemic disorder characterized by endothelial dysfunction and inflammation. Monocyte to high-density lipoprotein cholesterol ratio (MHR) is a recently emerged indicator of inflammation and oxidative stress. Sixty patients with BD and 50 control individuals were included to investigate the relationship between MHR and endothelial dysfunction. Endothelial function was assessed by flow- and nitroglycerin-mediated dilatation technique (FMD and NMD, respectively). Serum high-sensitivity C-reactive protein (hsCRP) levels were measured in all study participants. The MHR and hsCRP levels were significantly higher in patients with active BD than in controls. Brachial artery FMD was significantly lower in patients with active BD than in controls. Brachial artery NMD was similar between groups. There was a strong inverse correlation between MHR and FMD and a strong positive correlation between MHR and serum hsCRP levels. Thus, elevated MHR may be a useful marker reflecting impaired endothelial function and systemic inflammation in patients with BD.
Collapse
Affiliation(s)
- Nusret Acikgoz
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertuğrul Kurtoğlu
- 2 Department of Cardiology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Julide Yagmur
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Yelda Kapicioglu
- 3 Department of Dermatology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Mehmet Cansel
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Necip Ermis
- 1 Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
5
|
AVALIAÇÃO DA FUNÇÃO ENDOTELIAL NOS PACIENTES COM DOENÇA DE BEHÇET – RESULTADOS PRELIMINARES. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
|
7
|
HnRNP A1 is Involved in Deep Vein Thrombosis Patients with Behçet's Disease. EBioMedicine 2016; 6:215-221. [PMID: 27211563 PMCID: PMC4856785 DOI: 10.1016/j.ebiom.2016.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/03/2016] [Accepted: 03/05/2016] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to verify the hypothesis originated from bioinformatics and literature reviews that hnNRP A1 may be a new immune target of Behçet's disease (BD). Methods First, bioinformatics was used to show the correlation between hnRNP A1 and A2/B1 in amino acid sequences and three dimensional structures. Second, hnRNP A1 was expressed, purified, and immunologically confirmed by systematic immunology methods including: Western blotting, immunoprecipitation and Dot-ELISA. Then, ELISA was used to screen the anti-hnRNP A1 autoantibodies in newly confirmed clinical samples and the clinical significance was compared between anti-hnRNP A1 antibody positive and negative groups. Finally, the endothelial cells antigen profile of one anti-hnRNP A1 antibody positive BD patient was detected using immunoprecipitation with liquid chromatography tandem mass spectrometry (LC–TMS). Results In total 720 subjects enrolled and tested in this study. Our results demonstrated hnRNP A1 as a new immune target of BD. The reactivity of BD serum IgG antibodies against hnRNP A1 was significantly higher than healthy controls (P < 0.0001), and deep vein thrombosis (DVT) showed a significant higher in the anti-hnRNP A1 antibodies positive group (P < 0.05). Bioinformatics was used to predict that hnRNP A1 may play a role in BD. HnRNP A1 was immunologically confirmed as an autoantigen of BD. Deep vein thrombosis has a close relationship with anti-hnRNP A1 antibody in patients' blood circulation.
Behçet's disease (BD) is a chronic systemic autoimmune disease. The pathogenesis of BD is still not clear, and the diagnosis is based on typical clinical syndromes. Autoantigen identification was considered a key to solve this problem. This study was to verify the hypothesis suggested by bioinformatics that hnRNP A1 may be a new autoantigen of BD. Among the 720 subjects enrolled and systemic tested, our results demonstrated hnRNP A1 as a new autoantigen of BD, and associated with deep vein thrombosis.
Collapse
|
8
|
Balta S, Ozturk C, Balta I, Demirkol S, Demir M, Celik T, Iyisoy A. The Neutrophil–Lymphocyte Ratio and Inflammation. Angiology 2015; 67:298-9. [DOI: 10.1177/0003319715615252] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Sevket Balta
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Ilknur Balta
- Department of Dermatology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Mustafa Demir
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| |
Collapse
|
9
|
Balta S, Mikhailidis DP, Demirkol S, Ozturk C, Celik T, Iyisoy A. Endocan: A novel inflammatory indicator in cardiovascular disease? Atherosclerosis 2015; 243:339-43. [DOI: 10.1016/j.atherosclerosis.2015.09.030] [Citation(s) in RCA: 142] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
|
10
|
Affiliation(s)
- Nusret Acikgoz
- Department of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| |
Collapse
|
11
|
Kucuk A, Uslu AU, Arslan S, Balta S, Ozturk C, Uysal S, Yılmaz R, Sakız D, Kayrak M. Ischemia-Modified Albumin and Atherosclerosis in Patients With Familial Mediterranean Fever. Angiology 2015; 67:456-60. [DOI: 10.1177/0003319715595744] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The constriction of vessels due to atherosclerotic lesions causes hypoxia/ischemia and oxidative changes resulting in transformation of free albumin to ischemia-modified albumin (IMA) in the circulation and increased carotid intima–media thickness (cIMT). We investigated the reliability of IMA increase in evaluating atherosclerosis in patients with familial Mediterranean fever (FMF) compared with cIMT. Patients with FMF (n = 58) diagnosed by the Tel-Hashomer criteria in attack-free period and 38 healthy people were included in the study. Patient demographics as well as the clinical and laboratory characteristics of the healthy controls and patients with FMF were noted. The IMA levels and cIMT in patients with FMF were 0.30 ± 0.09 absorbance units (ABSUs) and 1.12 ± 0.27 mm, respectively, and in the control group, IMA levels and cIMT were 0.25 ± 0.07 ABSU and 0.74 ± 0.26 mm, respectively. The IMA levels and cIMT were significantly higher in patients with FMF than in controls ( P = .020 and P < .0001, respectively). The IMA values showed positive correlation with cIMT in patients with FMF( r = .302, P = .041). Our results reveal that IMA—an oxidative stress marker—may be an indicator of atherosclerosis in patients with FMF. This finding deserves further investigation.
Collapse
Affiliation(s)
- Adem Kucuk
- Department of Internal Medicine, Division of Rheumatology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ali Ugur Uslu
- Department of Internal Medicine, Eskisehir Military Hospital, Eskisehir, Turkey
| | - Sevket Arslan
- Department of Internal Medicine, Division of Immunology and Allergy, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Sevket Balta
- Department of Cardiology, Gulhane School of Medicine, Ankara, Turkey
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane School of Medicine, Ankara, Turkey
| | - Saliha Uysal
- Department of Biochemistry, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Ramazan Yılmaz
- Department of Physical Medicine and Rehabilitation, Bingol State Hospital, Bingol, Turkey
| | - Davut Sakız
- Department of Internal Medicine, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kayrak
- Department of Cardiology, Meram School of Medicine, Necmettin Erbakan University, Konya, Turkey
| |
Collapse
|
12
|
Affiliation(s)
- Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sevket Balta
- Department of Cardiology, Eskişehir Military Hospital, Eskişehir, Turkey
| | - Ilknur Balta
- Department of Dermatology, Eskişehir State Hospital, Eskişehir, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| |
Collapse
|
13
|
Balta S, Aparci M, Demirkol S, Ozturk C, Celik T. Red cell distribution width in primary glomerulonephritides. Ren Fail 2015; 37:358. [PMID: 25644969 DOI: 10.3109/0886022x.2014.986622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sevket Balta
- Department of Cardiology, Eskişehir Military Hospital , Eskişehir , Turkey and
| | | | | | | | | |
Collapse
|
14
|
Balta I, Balta S, Ozturk C, Demirkol S. Plasma homocysteine level in patients with Behçet's disease. Int J Rheum Dis 2014; 18:582. [PMID: 25546109 DOI: 10.1111/1756-185x.12526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ilknur Balta
- Department of Dermatology, Eskişehir State Hospital, Eskişehir, Turkey
| | - Sevket Balta
- Department of Cardiology, Eskişehir Military Hospital, Eskişehir, Turkey
| | - Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| |
Collapse
|
15
|
Balta S, Aparcı M, Ozturk C, Demirkol S, Celik T. Neutrophil-lymphocyte ratio as an useful mortality marker. Am J Emerg Med 2014; 32:1546-7. [DOI: 10.1016/j.ajem.2014.09.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/23/2014] [Indexed: 01/15/2023] Open
|
16
|
Ozturk C, Balta S, Balta I, Demirkol S, Celik T, Turker T, Iyisoy A, Eksioglu M. Neutrophil–Lymphocyte Ratio and Carotid–Intima Media Thickness in Patients With Behçet Disease Without Cardiovascular Involvement. Angiology 2014; 66:291-6. [DOI: 10.1177/0003319714527638] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Behçet disease (BD) is associated with endothelial dysfunction and chronic inflammation. The neutrophil–lymphocyte (N/L) ratio and carotid intima–media thickness (cIMT) are markers of inflammation and vascular risk, respectively. We assessed the relationship between cIMT values and N/L ratio in BD (65 patients and 62 control participants). There were statistically significant differences in N/L ratios and cIMT values between the patients with BD and control group ( P < .001). There were moderate positive correlations between cIMT value, C-reactive protein, and N/L ratio in patients with BD. Receiver–operating characteristic curve analysis suggested that the optimum N/L ratio cutoff point for patients with BD was 1.29, with a sensitivity, specificity, negative predictive value, and positive predictive value of 97, 77, 96, and 75%, respectively (area under curve: 0.691, 95% confidence interval = 0.600-0.782, P < .001). The N/L ratio may be a useful index of BD activity.
Collapse
Affiliation(s)
- Cengiz Ozturk
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Sevket Balta
- Department of Cardiology, Eskişehir Military Hospital, Eskişehir, Turkey
| | - Ilknur Balta
- Department of Dermatology, Eskisehir State Hospital, Ankara, Turkey
| | - Sait Demirkol
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Turgay Celik
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Turker Turker
- Department of Epidemiology, Gulhane Medical Academy, Ankara, Turkey
| | - Atila Iyisoy
- Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey
| | - Meral Eksioglu
- Department of Dermatology, Ankara Training and Research Hospital, Ankara, Turkey
| |
Collapse
|