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Liu R, Ji T, Jiang Y, Li H. A Challenging Diagnosis of Behçet's Disease Starting from Unexplained Fever Recurrence with Pulmonary Embolism: A Case Report. J Inflamm Res 2024; 17:5801-5805. [PMID: 39224656 PMCID: PMC11368112 DOI: 10.2147/jir.s466840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose Recurrent inflammatory fevers with multisystem involvement occur clinically and may indicate an autoimmune disease. Case We present a young male diagnosed with pulmonary embolism who experienced recurrent fever during hospitalization and was unresponsive to antibiotics and antipyretics. A follow-up history revealed chronic oral and genital ulcers, leading to a final diagnosis of Behçet's disease. Conclusion The patient's temperature normalized rapidly after corticosteroid therapy, and infection markers returned to normal. Complete remission was achieved with immunosuppression and glucocorticoid therapy. Reporting characteristics, treatment experience, and outcomes of such cases are essential to inform future diagnosis and management strategies.
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Affiliation(s)
- Rong Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Tingfen Ji
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Lishui People’s Hospital, Lishui, Zhejiang, People’s Republic of China
| | - Yixia Jiang
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Hequan Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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2
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Hu D, She CH, Bao HF, Zou J, Cai JF, Ye JF, Shen Y, Ma HF, Luo D, Guan JL. Clinical heterogeneity and five phenotypes identified in pediatric Behçet's syndrome: a cohort study from Shanghai Behçet's syndrome database. World J Pediatr 2024; 20:801-808. [PMID: 38315355 PMCID: PMC11402839 DOI: 10.1007/s12519-023-00785-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/30/2023] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Behçet's syndrome (BS) is a rare disease of unknown etiology, with limited reports especially in pediatric BS. The clinical characteristics and phenotypes of pediatric BS as a highly heterogeneous variable vessel vasculitis were investigated in this study. METHODS A cross-sectional study was conducted to compare clinical variables and descriptive characteristics of BS by age of onset and gender. Cluster analysis was then performed to identify the phenotypes of pediatric BS. RESULTS A total of 2082 BS patients were included in this study, 1834 adults and 248 children. Compared with adult-onset BS, pediatric BS had a higher incidence of folliculitis [relative risks (RR) and 95% confidence interval (CI) 1.3 (1.0-1.5)], uveitis of the left eye [RR and 95% CI 2.3 (1.0-5.0)], intestinal ulcer complications [RR and 95% CI 2.1 (1.1-4.2)], pericarditis [RR and 95% CI 2.5 (1.0-6.2)], and psychiatric disorders [RR and 95% CI 2.8(1.0-7.9)], while the incidence of thrombocytopenia was lower [RR 0.2 (0.1-1.0)]. Among pediatric BS, females had more genital ulcers, while males were more likely to have skin lesions, panuveitis, vascular involvement, venous lesions, cardiac involvement, and aortic aneurysms. Cluster analysis classified pediatric BS into five clusters (C1-C5): C1 (n = 61, 24.6%) showed gastrointestinal (GI) involvement; C2 (n = 44, 17.7%) was the central nervous system (CNS) type where 23 cases overlapped joint involvement; in C3 (n = 35, 14.1%), all patients presented with arthritis or arthralgia; all patients in C4 (n = 29, 11.7%) manifested ocular involvement, with a few patients overlapping with GI involvement or joint damage; C5 (n = 79, 31.9%) was the mucocutaneous type, presenting both oral ulcers, genital ulcers, and skin lesions. CONCLUSIONS The clinical features of pediatric and adult BS differ significantly. Male and female pediatric BS also have a distinct demography. Five phenotypes including GI, CNS, joint, ocular, and mucocutaneous types were identified for pediatric BS.
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Affiliation(s)
- Dan Hu
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Chun-Hui She
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Hua-Fang Bao
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Jun Zou
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Jian-Fei Cai
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Jing-Fen Ye
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Yan Shen
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Hai-Fen Ma
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Dan Luo
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, 221 Yan'an West Road, 200040, Shanghai, China.
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Hegazi Abdelsamie A, Al-Asiri N. Recurring ST-Elevation Myocardial Infarction With No-Reflow Caused by Hypercoagulable State: A Behcet Disease Case Report. J Clin Med Res 2024; 16:264-271. [PMID: 38855780 PMCID: PMC11161190 DOI: 10.14740/jocmr5132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024] Open
Abstract
Acute myocardial infarction (AMI) in young patients is an important issue because of its impact on health and social life. The mechanisms and disease courses of ST-elevation myocardial infarction (STEMI) in young individuals may differ from those in the elderly. Behcet disease (BD) is a multisystem autoimmune disorder of unknown etiology. Cardiac involvement is rare, yet it was reported to affect 6% of patients, with 17% of the cases presenting as the first manifestation. We present the case of a 33-year-old male heavy smoker with negative medical history, who presented with acute inferior myocardial infarction. His coronary angiography showed huge thrombosis in proximal right coronary artery. He was treated with primary coronary intervention and implantation of drug-eluting stent, with subsequent intervention and implantation of two more drug-eluting stents due to acute stent thrombosis within 48 h. Rheumatologic assessment revealed the history of four different attacks of oral ulcers and one attack of genital ulcer. His workup showed positive human leukocyte antigen (HLA) allele (B51) which is strongly associated with BD. AMI in young adults due to arterial thrombosis can be attributed to hypercoagulable state related to early manifestation of BD. Increased knowledge of AMI in young adults and its presentation in BD is necessary to reduce morbidity and mortality. Corticosteroids and colchicine may improve cardiac manifestations in BD.
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Affiliation(s)
| | - Nayef Al-Asiri
- Cardiac Center, Mouwasat Hospital Al-Jubail Industrial City, Jubail, Saudi Arabia
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4
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Kartal SP, Taş-Aygar G, Erdem ÜG, Yalçındağ A, Gönül M. Can the mucosal attacks of Behçet's disease be predicted? Arch Dermatol Res 2024; 316:76. [PMID: 38236279 PMCID: PMC10796681 DOI: 10.1007/s00403-023-02805-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 12/02/2023] [Accepted: 12/14/2023] [Indexed: 01/19/2024]
Abstract
The primary objective of this study was to investigate the association between disease activity and serum and salivary procalcitonin (Pct) levels in patients with Behçet's disease (BD). The study included patients diagnosed with BD and age-matched healthy volunteers (N: 48, N: 32). Serum and salivary Pct levels were quantified using enzyme-linked immunosorbent assay (ELISA) in the laboratories of Diskapi Yildirim Beyazit Training and Research Hospital. No significant disparity was observed in serum and salivary Pct levels between the patient and control groups (p > 0.05). Furthermore, there was no noteworthy correlation between disease activity and serum and salivary Pct values (p > 0.05). However, the serum Pct level in patients with active oral ulcers was significantly elevated compared to those without active oral ulcers (p: 0.003). Serum Pct emerges as a valuable marker for monitoring oral aphthous ulcer attacks within the patient population.
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Affiliation(s)
- Selda Pelin Kartal
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, 06170, Turkey
| | - Gamze Taş-Aygar
- University of Health Sciences, Etlik City Hospital, Dermatology Clinic, Ankara, 06170, Turkey.
| | - Ümmü Gül Erdem
- University of Health Sciences, Etlik City Hospital, Microbiology Clinic, Ankara, 06170, Turkey
| | - Ali Yalçındağ
- Universty of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Biochemistry Clinic, Ankara, 06110, Turkey
| | - Müzeyyen Gönül
- University of Health Sciences Etlik City Hospital, Dermatology Clinic, Ankara, 06170, Turkey
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Shinoda-Ito Y, Hirai A, Omori K, Ideguchi H, Yamamoto H, Kato F, Obata K, Ogawa T, Nakano K, Nakadoi T, Katsuyama E, Ibaragi S, Yamamoto T, Nagatsuka H, Hirasawa A, Takashiba S. Ligneous periodontitis exacerbated by Behçet's disease in a patient with plasminogen deficiency and a stop-gained variant PLG c.1468C > T: a case report. BMC Oral Health 2023; 23:843. [PMID: 37940896 PMCID: PMC10633900 DOI: 10.1186/s12903-023-03586-8] [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: 09/25/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Plasminogen serves as the precursor to plasmin, an essential element in the fibrinolytic process, and is synthesized primarily in the liver. Plasminogen activation occurs through the action of plasminogen activator, converting it into plasmin. This conversion greatly enhances the fibrinolytic system within tissues and blood vessels, facilitating the dissolution of fibrin clots. Consequently, congenital deficiency of plasminogen results in impaired fibrin degradation. Patients with plasminogen deficiency typically exhibit fibrin deposits in various mucosal sites throughout the body, including the oral cavity, eyes, vagina, and digestive organs. Behcet's disease is a chronic recurrent systemic inflammatory disease with four main symptoms: aphthous ulcers of the oral mucosa, vulvar ulcers, skin symptoms, and eye symptoms, and has been reported worldwide. This disease is highly prevalent around the Silk Road from the Mediterranean to East Asia. We report a case of periodontitis in a patient with these two rare diseases that worsened quickly, leading to alveolar bone destruction. Genetic testing revealed a novel variant characterized by a stop-gain mutation, which may be a previously unidentified etiologic gene associated with decreased plasminogen activity. CASE PRESENTATION This case report depicts a patient diagnosed with ligneous gingivitis during childhood, originating from plasminogen deficiency and progressing to periodontitis. Genetic testing revealed a suspected association with the PLG c.1468C > T (p.Arg490*) stop-gain mutation. The patient's periodontal condition remained stable with brief intervals of supportive periodontal therapy. However, the emergence of Behçet's disease induced acute systemic inflammation, necessitating hospitalization and treatment with steroids. During hospitalization, the dental approach focused on maintaining oral hygiene and alleviating contact-related pain. The patient's overall health improved with inpatient care and the periodontal tissues deteriorated. CONCLUSIONS Collaborative efforts between medical and dental professionals are paramount in comprehensively evaluating and treating patients with intricate complications from rare diseases. Furthermore, the PLG c.1468C > T (p.Arg490*) stop-gain mutation could contribute to the association between plasminogen deficiency and related conditions.
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Affiliation(s)
- Yuki Shinoda-Ito
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Anna Hirai
- Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Kazuhiro Omori
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Hidetaka Ideguchi
- Department of Periodontics and Endodontics, Division of Dentistry, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Hideki Yamamoto
- Department of Clinical Genomic Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Fumino Kato
- Department of Clinical Genomic Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Kyoichi Obata
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Tatsuo Ogawa
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Keisuke Nakano
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Takato Nakadoi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Eri Katsuyama
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Tadashi Yamamoto
- The Center for Graduate Medical Education (Dental Division), Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Hitoshi Nagatsuka
- Department of Oral Pathology and Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan
| | - Akira Hirasawa
- Department of Clinical Genomic Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Shogo Takashiba
- Department of Pathophysiology-Periodontal Science, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, 700-8525, Japan.
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6
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Hu D, Guan JL. The roles of immune cells in Behçet's disease. Adv Rheumatol 2023; 63:49. [PMID: 37814339 DOI: 10.1186/s42358-023-00328-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023] Open
Abstract
Behçet's disease (BD) is a systemic vasculitis that can affect multiple systems, including the skin, mucous membranes, joints, eyes, gastrointestinal and nervous. However, the pathogenesis of BD remains unclear, and it is believed that immune-inflammatory reactions play a crucial role in its development. Immune cells are a critical component of this process and contribute to the onset and progression of BD. By regulating the function of these immune cells, effective control over the occurrence and development of BD can be achieved, particularly with regards to monocyte activation and aggregation, macrophage differentiation and polarization, as well as T cell subset differentiation. This review provides a brief overview of immune cells and their role in regulating BD progression, which may serve as a theoretical foundation for preventing and treating this disease.
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Affiliation(s)
- Dan Hu
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, #221 Yan'an West Road, Shanghai, 200040, P.R. China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Huadong Hospital affiliated with Fudan University, #221 Yan'an West Road, Shanghai, 200040, P.R. China.
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7
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Le Joncour A, Régnier P, Maciejewski-Duval A, Charles E, Barete S, Fouret P, Rosenzwajg M, Klatzmann D, Cacoub P, Saadoun D. Reduction of Neutrophil Activation by Phosphodiesterase 4 Blockade in Behçet's Disease. Arthritis Rheumatol 2023; 75:1628-1637. [PMID: 36862398 DOI: 10.1002/art.42486] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Behçet's disease (BD) is a systemic vasculitis with inflammatory lesions mediated by cytotoxic T cells and neutrophils. Apremilast, an orally available small-molecule drug that selectively inhibits phosphodiesterase 4 (PDE4), has been recently approved for the treatment of BD. We aimed to investigate the effect of PDE4 inhibition on neutrophil activation in BD. METHODS We studied surface markers and reactive oxygen species (ROS) production by flow cytometry, and neutrophil extracellular traps (NETs) production and molecular signature of neutrophils by transcriptome analysis before and after PDE4 inhibition. RESULTS Activation surface markers (CD64, CD66b, CD11b, and CD11c), ROS production, and NETosis were up-regulated in BD patient neutrophils compared to healthy donor neutrophils. Transcriptome analysis revealed 1,021 significantly dysregulated neutrophil genes between BD patients and healthy donors. Among dysregulated genes, we found a substantial enrichment for pathways linked to innate immunity, intracellular signaling, and chemotaxis in BD. Skin lesions of BD patients showed increased infiltration of neutrophils that colocalized with PDE4. Inhibition of PDE4 by apremilast strongly inhibited neutrophil surface activation markers as well as ROS production, NETosis, and genes and pathways related to innate immunity, intracellular signaling, and chemotaxis. CONCLUSION We highlight key biologic effects of apremilast on neutrophils in BD.
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Affiliation(s)
- Alexandre Le Joncour
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - Paul Régnier
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, France
| | - Anna Maciejewski-Duval
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, France
| | - Erwan Charles
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, France
| | - Stéphane Barete
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Unit of Dermatology, Paris, France
| | - Pierre Fouret
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Anatomopathology, Paris, France
| | - Michelle Rosenzwajg
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, France
| | - David Klatzmann
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, and Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | - David Saadoun
- Sorbonne Université, INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Laboratoire d'excellence TRANSIMMUNOM, Paris, and Biotherapy (CIC-BTi), Hôpital Pitié-Salpêtrière, Paris, and AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
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Feng M, Wang X, Zhou S, Li M, Liu T, Wei X, Lin W. CD83 + B cells alleviate uveitis through inhibiting DCs by sCD83. Immunology 2023; 170:134-153. [PMID: 37137669 DOI: 10.1111/imm.13654] [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: 12/13/2022] [Accepted: 04/18/2023] [Indexed: 05/05/2023] Open
Abstract
Soluble CD83 (sCD83) exerts immunosuppressive functions in many autoimmune diseases, including experimental autoimmune uveitis (EAU), but the cells and mechanisms involved are unclear. This study showed that CD83+ B cells were the main sources of sCD83. They alleviated the symptoms of EAU and decreased the percentage of T cells and DCs in the eyes and lymph nodes. These CD83+ B cells decreased IL-1β, IL-18 and IFN-γ secretion by DCs through sCD83. sCD83 interacted with GTPase Ras-related protein (Rab1a) in DCs to promote Rab1a accumulation in autolysosomes and inhibit mTORC1 phosphorylation and NLRP3 expression. Hence, CD83+ B cells play a regulatory role in EAU by secreting sCD83. The lack of regulation of CD83+ B cells might be an important factor leading to hyperimmune activation in patients with autoimmune uveitis. CD83+ B cells suppress activated DCs in uveitis, indicating the potential therapeutic role of CD83+ B cells in uveitis.
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Affiliation(s)
- Meng Feng
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medicine, Shandong First Medical University &Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Xin Wang
- Department of Clinical Laboratory, Qilu Hospital, Shandong University, Jinan, China
- Shandong Engineering Research Center of Biomarker and Artificial Intelligence Application, Jinan, China
| | - Shuping Zhou
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medicine, Shandong First Medical University &Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Minghao Li
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medicine, Shandong First Medical University &Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Tingting Liu
- Shandong Eye Hospital, State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Shandong Eye Institute, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Xunbin Wei
- Biomedical Engineering Department, Peking University, Beijing, China
- School of Biomedical Engineering, Anhui Medical University, Hefei, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, China
- International Cancer Institute, Peking University, Beijing, China
| | - Wei Lin
- Department of Rheumatology and Autoimmunology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Clinical and Basic Medicine, Shandong First Medical University &Shandong Academy of Medical Sciences, Jinan, China
- Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Medicine and Health Key Laboratory of Rheumatism, The First Affiliated Hospital of Shandong First Medical University, Jinan, China
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9
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Jankowska L, Adamski Z, Polańska A, Bowszyc-Dmochowska M, Plagens-Rotman K, Merks P, Czarnecka-Operacz M, Żaba R. Challenges in the Diagnosis of Tertiary Syphilis: Case Report with Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16992. [PMID: 36554872 PMCID: PMC9778711 DOI: 10.3390/ijerph192416992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Tertiary syphilis is a large diagnostic challenge. It is rarely the case that it affects the skin, bone tissue and the eyes at the same time. The presented case shows that extensive symptomatology of syphilis poses a challenge in making a proper diagnosis in patients whose history does not suspect STDs. The study aims to present the case of a young woman hospitalized with a suspected autoimmune disease, diagnosed with symptomatic late syphilis with involvement of the skin, bones and eyes.
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Affiliation(s)
- Lucyna Jankowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Zygmunt Adamski
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Adriana Polańska
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Monika Bowszyc-Dmochowska
- Department of Dermatology, Heliodor Święcicki Clinical Hospital, Poznan University of Medical Sciences, 60-806 Poznan, Poland
| | - Katarzyna Plagens-Rotman
- Center for Pediatric, Adolescent Gynecology and Sexology Division of Gynecology, Department of Perinatology and Gynecology, Poznan University of Medical Sciences, 61-758 Poznan, Poland
| | - Piotr Merks
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, 01-938 Warszawa, Poland
| | - Magdalena Czarnecka-Operacz
- Allergic and Occupational Skin Diseases Unit, Department of Dermatology, Medical University of Poznań, 60-355 Poznan, Poland
| | - Ryszard Żaba
- Department of Dermatology and Venenerology, Poznan University of Medical Sciences, 60-806 Poznan, Poland
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10
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Messedi M, Guidara W, Grayaa S, Khrouf W, Snoussi M, Bahloul Z, Bonnefont-Rousselot D, Lamari F, Ayadi F. Selected plasma oxysterols as a potential multi-marker biosignature panel for Behçet's Disease. J Steroid Biochem Mol Biol 2022; 221:106122. [PMID: 35588947 DOI: 10.1016/j.jsbmb.2022.106122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
Clinical, genetic, and medical evidence has shown the inflammatory vasculitis aspect of Behçet's Disease (BD). Whereas oxysterols are vital factors in inflammation and oxidative stress, it is still unknown whether they are involved in the pathophysiology of BD. The current study aims to explore the profile of oxysterols in plasma of BD patients. Thirty patients diagnosed with BD and forty healthy controls matched for age and gender were included. Results showed that the cholestane-3β,5α,6β-triol, 27-hydroxycholesterol (27-OHC) and cholestanol levels were higher in BD than controls. In addition, plasma levels of 7-ketocholesterol (7-KC) and 25-hydroxycholesterol (25-OHC) were lower in BD patient. However, levels of 24S-hydroxycholesterol (24-OHC) did not significantly differ. For BD patients, the plasma 7-KC level was negatively correlated with the BD activity index (BDAI) while 27-OHC was positively correlated with high-sensitivity C-reactive protein (hs-CRP) in patients with active course of the disease. According to ROC analysis, a remarkable increase in the area under the curve (AUC) with a higher sensitivity (Se) and specificity (Sp) for 7-KC, 25-OHC and 27-OHC combined markers was observed. The present study indicated that the identification of the predictive value of these three-selected biomarkers related to oxidative stress and inflammation in patients should lead to a better identification of the etiological mechanism of BD.
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Affiliation(s)
- Meriam Messedi
- Research Laboratory "Molecular Basis of Human Diseases", LR19ES13, Sfax Medicine School, University of Sfax, Tunisia.
| | - Wassim Guidara
- Research Laboratory "Molecular Basis of Human Diseases", LR19ES13, Sfax Medicine School, University of Sfax, Tunisia
| | - Sahar Grayaa
- Research Laboratory "Molecular Basis of Human Diseases", LR19ES13, Sfax Medicine School, University of Sfax, Tunisia
| | - Walid Khrouf
- Service de Biochimie Métabolique, AP-HP.Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, DMU BioGeM, Paris F-75013, France
| | - Mouna Snoussi
- Internal medicine department, Hedi Chaker Hosptital, Sfax, Tunisia
| | - Zouhir Bahloul
- Internal medicine department, Hedi Chaker Hosptital, Sfax, Tunisia
| | - Dominique Bonnefont-Rousselot
- Service de Biochimie Métabolique, AP-HP.Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, DMU BioGeM, Paris F-75013, France; Université de Paris, CNRS, Inserm, UTCBS, Paris F-75006, France
| | - Foudil Lamari
- Service de Biochimie Métabolique, AP-HP.Sorbonne Université, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, DMU BioGeM, Paris F-75013, France
| | - Fatma Ayadi
- Research Laboratory "Molecular Basis of Human Diseases", LR19ES13, Sfax Medicine School, University of Sfax, Tunisia
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11
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Ghembaza A, Boussouar S, Saadoun D. [Thoracic manifestations of Behcet's disease]. Rev Mal Respir 2022; 39:523-533. [PMID: 35659162 DOI: 10.1016/j.rmr.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).
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Affiliation(s)
- A Ghembaza
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France
| | - S Boussouar
- Cardiovascular and Thoracic Imaging Unit, hôpital Pitié Salpêtrière, AP-HP, Paris, France; Inserm, laboratoire d'imagerie biomédicale, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - D Saadoun
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France.
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12
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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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13
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An Abdominal Aortic Pseudoaneurysm Revealing Behçet’s Disease. Case Rep Vasc Med 2022; 2022:8286579. [PMID: 35127194 PMCID: PMC8813256 DOI: 10.1155/2022/8286579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 01/06/2022] [Indexed: 11/22/2022] Open
Abstract
Behçet's disease (BD) is a vasculitis with multisystemic manifestations. Articular involvement is frequent and benign whereas vascular complications are rare but serious and can form the onset of the disease. The assessment of the thickness of the common femoral vein wall is a new tool for the diagnosis of BD with good sensitivity and specificity. We report the case of a 52-year-old man diagnosed with BD revealed by an abdominal aortic pseudoaneurysm and a chronic monoarthritis. The first flare-up of BD can occur in men over 50 years of age. In a context of a multisystemic disease, lumbar pain should lead to the search of abdominal aortic aneurysm. The assessment of the thickness of the common femoral vein wall is accessible and should be used especially in challenging cases.
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14
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Crawshaw H, Wells M, Austin K, Janagan S, Robson JC. Patient reported outcomes in systemic vasculitis. Curr Opin Rheumatol 2022; 34:33-38. [PMID: 34738981 DOI: 10.1097/bor.0000000000000850] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review paper evaluates the use of patient reported outcome (PROs) in systemic vasculitis and the increasing incorporation of these measures in the evaluation of clinical outcomes and healthcare provision. RECENT FINDINGS Generic PROs such as the SF-12, SF-36, EQ-5D have been used to evaluate health-related quality of life (HRQOL) across the spectrum of vasculitis; including giant cell arteritis, antineutrophil cytoplasmic antibody (ANCA)-related vasculitis and immunoglobulin A vasculitis (IgA) vasculitis. More recently disease-specific PROs have been developed including the associated vasculitis (AAV)-PRO and GCA-PRO, whilst further work is ongoing including a Steroid-PRO. SUMMARY Generic and disease-specific PROs are complimentary in nature, but the advent of disease-specific PROs allows evaluation of the impact of specific symptoms and intervention on patient HRQOL. Following the COVID-19 pandemic, the advent of increasing virtual work has brought the potential for electronic-PRO measures to the forefront and is a current area of interest.
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Affiliation(s)
- Helena Crawshaw
- Rheumatology Department, Gloucester Royal Hospital, Gloucester
| | - Matthew Wells
- Rheumatology Department, North Bristol NHS Trust, Bristol
| | - Keziah Austin
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath
| | - Shalini Janagan
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust
| | - Joanna C Robson
- Rheumatology Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust
- Centre for Health and Clinical Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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15
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Zou Y, Li JJ, Xue W, Kong X, Duan H, Li Y, Wei L. Epigenetic Modifications and Therapy in Uveitis. Front Cell Dev Biol 2021; 9:758240. [PMID: 34869347 PMCID: PMC8636745 DOI: 10.3389/fcell.2021.758240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Abstract
Uveitis is a sight-threatening intraocular inflammation, and the exact pathogenesis of uveitis is not yet clear. Recent studies, including multiple genome-wide association studies (GWASs), have identified genetic variations associated with the onset and progression of different types of uveitis, such as Vogt–Koyanagi–Harada (VKH) disease and Behcet’s disease (BD). However, epigenetic regulation has been shown to play key roles in the immunoregulation of uveitis, and epigenetic therapies are promising treatments for intraocular inflammation. In this review, we summarize recent advances in identifying epigenetic programs that cooperate with the physiology of intraocular immune responses and the pathology of intraocular inflammation. These attempts to understand the epigenetic mechanisms of uveitis may provide hope for the future development of epigenetic therapies for these devastating intraocular inflammatory conditions.
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Affiliation(s)
- Yanli Zou
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China.,State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Jing Jing Li
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Wei Xue
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
| | - Xiangbin Kong
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Hucheng Duan
- Department of Ophthalmology, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Yiqun Li
- Department of Orthopaedics, Affiliated Foshan Hospital, Southern Medical University, Foshan, China
| | - Lai Wei
- State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, China
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16
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Ghozali N, Belguendouz H, Messaoudene D, Hadjimi Z, Ihammichene S, Chekaoui A, Benchabane S, Terahi M, Kediha I, Ali Pacha L, Touil-Boukoffa C. In-vitro immunomodulatory effects of nicotine on Nitric Oxide, interleukin 1β and interleukin 37 production in human peripheral blood mononuclear cells (PBMC) from patients with Behçet disease. Int Immunopharmacol 2021; 101:108189. [PMID: 34601327 DOI: 10.1016/j.intimp.2021.108189] [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: 05/26/2021] [Revised: 09/03/2021] [Accepted: 09/20/2021] [Indexed: 11/15/2022]
Abstract
Behçet's disease is a chronic systemic inflammatory disorder associated with a cytokine profile disruption and increased nitric oxide levels. In our current study we sought to evaluate the in-vitro modulatory effect of nicotine, the principal alkaloid of tobacco, on nitric oxide (NO), interleukin 1β (IL-1β) and interleukin 37 (IL-37) production during Behçet's disease. Peripheral blood mononuclear cells cultures were performed with or without nicotine (200 μg/ml). Culture supernatants were harvested after 24 h of incubation. NO, IL-1β and IL-37 measurements were, respectively, performed by modified Griess method and ELISA sandwich. Our results showed that nicotine significantly reduced NO and IL-1β levels in patients with Behçet's disease, while it increased IL-37 production. Our results showed no sex differences in the effects of nicotine on the production of nitric oxide and IL-1β nor IL-37 in PBMC of patients. Our findings suggest that nicotine may provide a potential therapeutic strategy targeting inflammation during Behçet's disease.
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Affiliation(s)
- Nourelhouda Ghozali
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria; Laboratory of valorization and conservation of biological resources, FS, UMBB, Boumerdes, Algeria.
| | - Houda Belguendouz
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Djamel Messaoudene
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Zohra Hadjimi
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Sarah Ihammichene
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Arezki Chekaoui
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Sara Benchabane
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria
| | - Malika Terahi
- Ophthalmology Department, Nafissa Hammoud Hospital, Algiers, Algeria
| | - Islam Kediha
- Neurology Department, Mustapha Bacha Hospital, Algiers, Algeria
| | - Lamia Ali Pacha
- Neurology Department, Mustapha Bacha Hospital, Algiers, Algeria
| | - Chafia Touil-Boukoffa
- Team "Cytokines and NO synthases: Immunity and pathogenesis", LBCM, FSB, USTHB, Algiers, Algeria.
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17
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Leyens J, Bender TTA, Mücke M, Stieber C, Kravchenko D, Dernbach C, Seidel MF. The combined prevalence of classified rare rheumatic diseases is almost double that of ankylosing spondylitis. Orphanet J Rare Dis 2021; 16:326. [PMID: 34294115 PMCID: PMC8296612 DOI: 10.1186/s13023-021-01945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases (RDs) affect less than 5/10,000 people in Europe and fewer than 200,000 individuals in the United States. In rheumatology, RDs are heterogeneous and lack systemic classification. Clinical courses involve a variety of diverse symptoms, and patients may be misdiagnosed and not receive appropriate treatment. The objective of this study was to identify and classify some of the most important RDs in rheumatology. We also attempted to determine their combined prevalence to more precisely define this area of rheumatology and increase awareness of RDs in healthcare systems. We conducted a comprehensive literature search and analyzed each disease for the specified criteria, such as clinical symptoms, treatment regimens, prognoses, and point prevalences. If no epidemiological data were available, we estimated the prevalence as 1/1,000,000. The total point prevalence for all RDs in rheumatology was estimated as the sum of the individually determined prevalences. RESULTS A total of 76 syndromes and diseases were identified, including vasculitis/vasculopathy (n = 15), arthritis/arthropathy (n = 11), autoinflammatory syndromes (n = 11), myositis (n = 9), bone disorders (n = 11), connective tissue diseases (n = 8), overgrowth syndromes (n = 3), and others (n = 8). Out of the 76 diseases, 61 (80%) are classified as chronic, with a remitting-relapsing course in 27 cases (35%) upon adequate treatment. Another 34 (45%) diseases were predominantly progressive and difficult to control. Corticosteroids are a therapeutic option in 49 (64%) syndromes. Mortality is variable and could not be determined precisely. Epidemiological studies and prevalence data were available for 33 syndromes and diseases. For an additional eight diseases, only incidence data were accessible. The summed prevalence of all RDs was 28.8/10,000. CONCLUSIONS RDs in rheumatology are frequently chronic, progressive, and present variable symptoms. Treatment options are often restricted to corticosteroids, presumably because of the scarcity of randomized controlled trials. The estimated combined prevalence is significant and almost double that of ankylosing spondylitis (18/10,000). Thus, healthcare systems should assign RDs similar importance as any other common disease in rheumatology.
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Affiliation(s)
- Judith Leyens
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Neonatology and Pediatric Care, Children's University Hospital, Bonn, Germany
| | - Tim Th A Bender
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Institute of Human Genetics, University Hospital, Bonn, Germany
| | - Martin Mücke
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
| | - Christiane Stieber
- Institute of General Practice and Family Medicine, University Hospital, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Dmitrij Kravchenko
- Center for Rare Diseases Bonn (ZSEB), University Hospital, Bonn, Germany
- Department of Radiology, University Hospital, Bonn, Germany
| | - Christian Dernbach
- Division of Medical Psychology and Department of Psychiatry, University Hospital, Bonn, Germany
| | - Matthias F Seidel
- Department of Rheumatology, Spitalzentrum-Centre hospitalier, Biel-Bienne, Switzerland.
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18
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Smith R, Moots RJ, Murad M, Wallace GR. A Darwinian View of Behçet's Disease. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2021; 2:91-99. [PMID: 36465976 PMCID: PMC9524781 DOI: 10.2478/rir-2021-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 06/30/2021] [Indexed: 04/25/2023]
Abstract
Behçet's disease (BD) is a multisystem inflammatory disorder of unknown etiology, characterized by oral and genital ulceration, with other complications including eye, skin, joint, and central nervous system (CNS) lesions. Diagnosis is based on clinical findings, which may differ between patients. There is a strong genetic basis for BD; however, only a few genes have been associated with the disease across the geographical spread of BD. In this article, we discuss the history and combination of genes involved in this complex disease in relation to the geographical range and present our view that the disease has developed from a Darwinian perspective, with different gene polymorphisms that affect the same biological pathway. Moreover, these mutations individually are protective mechanisms against the disease relevant to each region, which affected both archaic and modern humans.
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Affiliation(s)
- Rhodri Smith
- Department of Rheumatology, Aintree Hospital, Liverpool, UK
| | | | - Mariam Murad
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Graham R. Wallace
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- E-mail:
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19
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Hammami AS, Jellazi M, Arfa S, Daada S, Ben Hamda K, Achour A, Ouali S. Getting to the <em>heart</em> of the matter: diagnostic tools and therapeutic approach to cardiac involvement in Behçet syndrome A Tunisian case series. Reumatismo 2021; 73:32-43. [PMID: 33874645 DOI: 10.4081/reumatismo.2021.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/23/2021] [Indexed: 11/23/2022] Open
Abstract
The aim was to investigate the frequency and spectrum of cardiac involvement (CI) in patients with Behçet syndrome (BS) in the Tunisian context, and to assess the clinical and imaging features, treatment, and outcomes. We retrospectively retrieved the medical records of patients with CI among 220 BS patients admitted to the hospital internal medicine department between February 2006 and April 2019, who fulfilled the International Study Group diagnostic criteria for BS. Ten patients (8 men, 2 women) were eligible for the study. Mean age was 37.3 years. Three patients had 2 isolated episodes of cardiac BS. The different types of CI were coronary artery disease (5/10), intracardiac thrombus (4/10), pericarditis (1/10), myocarditis (1/10), and myocardial fibrosis (1/10). Five patients had associated vascular involvement (50%). Medical treatment was based on corticosteroids and colchicine in all patients (100%), anticoagulants in 8 (80%), and cyclophosphamide followed by azathioprine in 9 (90%). The clinical course was favorable in 9 patients; 1 patient died. CI remains an important feature of BS because of its association with increased risk of mortality and morbidity. Therefore, early screening and detection with imaging methods are paramount. Also, better cooperation between rheumatologists and cardiologists could improve outcomes.
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Affiliation(s)
- A S Hammami
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
| | - M Jellazi
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Arfa
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Daada
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - K Ben Hamda
- Department of Cardiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - A Achour
- Department of Radiology, Hospital Fattouma Bourguiba of Monastir, Monastir.
| | - S Ouali
- Department of Internal Medicine, Geriatric Unit, Hospital Fattouma Bourguiba of Monastir, Monastir, Tunisia; Biochemistry Laboratory, LR12ES05 LR-NAFS Nutrition - Functional Food and Vascular Health, Faculty of Medicine, University of Monastir, Monastir.
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Jun JH, Ang L, Choi TY, Lee HW, Lee MS. Integrative Medicine (Herbal Medicine Combined with Drug Therapy) for Behcet's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pharmaceutics 2021; 13:pharmaceutics13040476. [PMID: 33915947 PMCID: PMC8065893 DOI: 10.3390/pharmaceutics13040476] [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: 03/11/2021] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
This review aimed to investigate the efficacy of integrative medicine (herbal medicine combined with drug therapy) in the treatment of Behcet’s disease (BD). Eleven databases were searched from their inception to 7 December 2020, for randomized control trials (RCTs) that reported the effects of integrative medicine in treating BD. The risk of bias was assessed using seven domain criteria from the Cochrane Collaboration tool. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. The direction of the effect is also shown in the form of an albatross plot. Sixteen trials met the inclusion criteria and were analyzed. The overall risk of bias was determined to be uncertain. The meta-analysis showed a superior response rate with herbal medicine plus drug therapy (relative risk (RR) 1.19, 95% confidence interval (CI) 1.13 to 1.25, n = 1034, p < 0.00001, I2 = 0%, low certainty of evidence (CoE)) compared to drug therapy. Integrative medicine also lowered the recurrence rate after 2 months of follow-up (RR 0.27, 95% CI 0.09 to 0.76, n = 120, p = 0.01, I2 = 0%, low CoE). The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and skin lesions were also significantly improved using integrative medicine, but equivalent effects were seen for oral ulcers, genital ulcers, and eye inflammation. Minor adverse events were reported in both groups. Our findings suggest that herbal medicine combined with drug therapy is more effective for the treatment of BD than drug therapy alone. Although the type of drug therapy used varied across the studies, integrative medicine was shown to improve the total response rate, skin lesions, the ESR, and the CRP level. However, the overall risk of bias of the studies was concerning, and the CoE was low. Information on adverse events (AEs) was also insufficient. In addition, the number of studies included for data synthesis for most outcomes was small. Future studies with rigorous RCTs may help establish the efficacy of integrative medicine in the treatment of BD.
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Affiliation(s)
- Ji Hee Jun
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Korea; (J.H.J.); (L.A.); (T.Y.C.)
| | - Lin Ang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Korea; (J.H.J.); (L.A.); (T.Y.C.)
- Korean Convergence Medicine, University of Science and Technology, Daejeon 34113, Korea
| | - Tae Young Choi
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Korea; (J.H.J.); (L.A.); (T.Y.C.)
| | - Hye Won Lee
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon 34054, Korea;
| | - Myeong Soo Lee
- Clinical Medicine Division, Korea Institute of Oriental Medicine, 1672 Yuseongdae-ro, Yuseong-gu, Daejeon 34054, Korea; (J.H.J.); (L.A.); (T.Y.C.)
- Korean Convergence Medicine, University of Science and Technology, Daejeon 34113, Korea
- Correspondence: or ; Tel.: +82-42-868-9266; Fax: +82-42-863-9299
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21
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Vieira M, Buffier S, Vautier M, Le Joncour A, Jamilloux Y, Gerfaud-Valentin M, Bouillet L, Lazaro E, Barete S, Misery L, Gobert D, Goulenok T, Fain O, Sacre K, Sève P, Cacoub P, Comarmond C, Saadoun D. Apremilast in Refractory Behçet's Syndrome: A Multicenter Observational Study. Front Immunol 2021; 11:626792. [PMID: 33613571 PMCID: PMC7889954 DOI: 10.3389/fimmu.2020.626792] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/16/2020] [Indexed: 12/17/2022] Open
Abstract
Objective Mucocutaneous and joint disorders are the most common manifestations in Behçet's syndrome (BS) and are frequently clustered in the so-called minor forms of BS. There remains a need for safe and effective treatment for joint lesions in BS. We report the long-term safety and effectiveness of apremilast in refractory joint and mucocutaneous manifestations of BS. Methods French nationwide multicenter study including 50 BS patients with either active joint and/or mucocutaneous manifestations resistant to colchicine and/or DMARDs. Patients received apremilast 30 mg twice a day. Primary effectiveness endpoint was the proportion of patients with complete response (CR) of articular symptoms at month 6 (M6), defined as resolution of inflammatory arthralgia and arthritis, with joint count equal to zero. Results At inclusion, the median tender and swollen joint count was of 4 [2-6] and 2 [1-2], respectively. The proportion of CR in joint disease at M6 was 65% (n = 15/23), and 17% (n = 4/23) were partial responders. CR of oral and genital ulcers, and pseudofolliculitis at M6 was 73% (n = 24/33), 94% (n = 16/17) and 71% (n = 10/14), respectively. The overall response at M6 was 74% for the entire cohort and 70% for the mucocutaneous-articular cluster (n = 27). The median Behçet's syndrome activity score significantly decreased during study period [50 (40-60) vs. 20 (0-40); p <0.0001]. After a median follow-up of 11 [6-13] months, 27 (54%) patients were still on apremilast. Reasons for apremilast withdrawal included adverse events (n = 15, 30%) and treatment failure (n = 8, 16%). Thirty-three (66%) patients experienced adverse events, mostly diarrhea (n = 19, 38%), nausea (n = 17, 34%) and headache (n = 16, 32%). Conclusion Apremilast seems effective in BS-related articular disease refractory to colchicine and DMARDs. Discontinuation rates were significantly higher than that reported in clinical trials.
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Affiliation(s)
- Matheus Vieira
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Solène Buffier
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Mathieu Vautier
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Alexandre Le Joncour
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Laurence Bouillet
- Service de Médecine Interne, CHUGA, Unité Inserm 1036, Université Grenoble Alpes (UGA), Grenoble, France.,Department of Internal Medicine, Centre de référence national des angioedèmes (CREAK), Grenoble, France
| | - Estibaliz Lazaro
- Department of Internal Medicine, Haut-Lévêque Hospital, Pessac, France
| | - Stéphane Barete
- Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie (DHU i2B), Sorbonne Universités, UPMC Université Paris 06, UMR 7211, Paris, France.,INSERM, UMR_S 959, Paris, France.,UF de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France
| | - Laurent Misery
- Department of Dermatology, Brest University Hospital, Brest, France Univ Brest, Brest, France
| | - Delphine Gobert
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, Hôpital Saint Antoine, Sorbonne Universités AP-HP, Paris, France
| | - Tiphaine Goulenok
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Olivier Fain
- Service de Médecine Interne et Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Faculté de Médecine Sorbonne Université, Hôpital Saint Antoine, Sorbonne Universités AP-HP, Paris, France
| | - Karim Sacre
- Département de Médecine Interne, Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP), Institut national de la santé et de la recherche médicale (INSERM) U1149, Université de Paris, Paris, France
| | - Pascal Sève
- Department of Internal Medicine, Hopital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Patrice Cacoub
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Cloé Comarmond
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,Inflammation-Immunopathology-Biotherapy Department (DMU 3iD), Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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22
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El Jammal T, Loria O, Jamilloux Y, Gerfaud-Valentin M, Kodjikian L, Sève P. Uveitis as an Open Window to Systemic Inflammatory Diseases. J Clin Med 2021; 10:E281. [PMID: 33466638 PMCID: PMC7828680 DOI: 10.3390/jcm10020281] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/06/2021] [Accepted: 01/11/2021] [Indexed: 12/11/2022] Open
Abstract
Spondyloarthritis (Spa), Behçet's disease (BD) and sarcoidosis are major systemic inflammatory diseases worldwide. They are all multisystem pathologies and share a possible ocular involvement, especially uveitis. We hereby describe selected cases who were referred by ophthalmologists to our internal medicine department for unexplained uveitis. Physical examination and/or the use of laboratory and imaging investigations allowed to make a diagnosis of a systemic inflammatory disease in a large proportion of patients. In our tertiary referral center, 75 patients have been diagnosed with Spa (n = 20), BD (n = 9), or sarcoidosis (n = 46) in the last two years. There was a significant delay in the diagnosis of Spa-associated uveitis. Screening strategies using Human Leukocyte Antigen (HLA)-B27 determination and sacroiliac magnetic resonance imaging in patients suffering from chronic low back pain and/or psoriasis helped in the diagnosis. BD's uveitis affects young people from both sexes and all origins and usually presents with panuveitis and retinal vasculitis. The high proportion of sarcoidosis in our population is explained by the use of chest computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography CT that helped to identify smaller hilar or mediastinal involvement and allowed to further investigate those patients, especially in the elderly. Our results confirm how in these sight- and potentially life-threatening diseases a prompt diagnosis is mandatory and benefits from a multidisciplinary approach.
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Affiliation(s)
- Thomas El Jammal
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Olivier Loria
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Yvan Jamilloux
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Mathieu Gerfaud-Valentin
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (O.L.); (L.K.)
- Laboratoire UMR-CNRS 5510 Matéis, 69004 Villeurbane, France
| | - Pascal Sève
- Department of Internal Medicine, Hôpital de la Croix-Rousse, Université Claude Bernard Lyon I, 69004 Lyon, France; (T.E.J.); (Y.J.); (M.G.-V.)
- IMER Department, Hospices Civils de Lyon, 69424 Lyon, France
- Department of Formation and Research in Human Biology, Université Claude Bernard Lyon 1, HESPER EA 7425, 69008 Lyon, France
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23
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Shin YB, Jo JW, Yoon TJ. Palisaded Neutrophilic and Granulomatous Dermatitis in a Patient with Behçet's Disease: A Case Report. Ann Dermatol 2020; 33:73-76. [PMID: 33911815 PMCID: PMC7875227 DOI: 10.5021/ad.2021.33.1.73] [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: 06/11/2019] [Revised: 11/07/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022] Open
Abstract
Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption and characterized histopathologically by the presence of granulomatous inflammation with or without leukocytoclastic vasculitis. PNGD is known to be associated with various immune-mediated connective tissue diseases such as rheumatoid arthritis and lupus erythematosus. However, to our knowledge, a case of PNGD in a patient with Behçet's disease is extremely rare and only one case has been reported in foreign literature to date. Herein, we report an unusual case of a 60-year-old female with Behçet's disease who presented multiple erythematous to flesh-colored papules on the extremities, buttocks, and ear lobes and was diagnosed with PNGD. After the treatment of systemic corticosteroids, colchicine and azathioprine, the skin lesions and oral ulcers improved. The patient is under observation without recurrence of skin lesions for 6 months.
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Affiliation(s)
- Young-Bin Shin
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jeong-Won Jo
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae-Jin Yoon
- Department of Dermatology, Gyeongsang National University School of Medicine, Jinju, Korea.,Gyeongsang Institute of Health Sciences, Jinju, Korea
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24
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Brown NW, Orchard G, Rhodes A. British Journal of Biomedical Science in 2020. What have we learned? Br J Biomed Sci 2020; 77:159-167. [PMID: 33252323 DOI: 10.1080/09674845.2020.1827578] [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: 12/24/2022]
Abstract
Each year the British Journal of Biomedical Science publishes a 'What have we learned' editorial designed to introduce readers within the major disciplines of laboratory medicine to developments outside their immediate area. In addition it is designed to inform a wider readership of the advances in the diagnosis and treatment of disease. To this end, in 2020 the journal published 39 articles covering the disciplines within Biomedical Science in the 4 issues comprising volume 77. These included a review of COVID-19 in this issue, 27 original articles, 6 Biomedical Science 'In Brief' and 4 case histories. 27 of the articles involved molecular techniques, with one of these comparing results with a mass spectrometry based method. The preponderance of molecular genetic studies gives us a good idea of the likely future direction of the disciplines.
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Affiliation(s)
- N W Brown
- Toxicology, Wansbeck General Hospital, Ashington, UK
| | - G Orchard
- St John's Dermatopathology, St Thomas' Hospital, London, UK
| | - A Rhodes
- International Medical University , Bukit Jalil, School of Health Sciences, Kuala Lumpur, Malaysia
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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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Alkhurassi HF, Ocheltree MR, Alsomali A, Alqunfoidi RA, Saadallah A. Pleural Effusion Presenting in a Young Man With Behcet's Disease. Cureus 2020; 12:e10273. [PMID: 32923298 PMCID: PMC7478535 DOI: 10.7759/cureus.10273] [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] [Indexed: 12/31/2022] Open
Abstract
Behcet's disease (BD) is a rare multisystem chronic vasculitis of variable clinical presentation and unknown origin. Pulmonary involvement in BD is uncommon, with pleural effusion being an even rarer and difficult to diagnose manifestation. Herein, we report a challenging case of a young man who presented with recurrent pleural effusion and hepatic vein thrombosis and a recent history of papilledema with idiopathic intracranial hypertension. The patient was hospitalized for diagnostic and therapeutic thoracocentesis. Biochemistry and cytological analysis showed an exudative aspect of the collected pleural fluid with lymphocyte-dominated cytology. A multidisciplinary discussion was held, and thorough investigation was carried out to rule out malignant and infectious etiologies, among other differentials. During the second hospitalization, the patient complained of genital ulcers, which were verified to be recurrent along with oral ulcers. The diagnosis of BD was established based on the International Classification Criteria for BD, and the symptoms improved significantly upon using colchicine and immune-suppressive drugs.
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Affiliation(s)
| | | | - Ahlam Alsomali
- Internal Medicine/Geriatric, International Medical Center, Jeddah, SAU
| | - Reem A Alqunfoidi
- Internal Medicine/Hematology, International Medical Center, Jeddah, SAU
| | - Asmaa Saadallah
- Internal Medicine, International Medical Center, Jeddah, SAU
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27
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Suzuki Y, Hagiwara T, Kobayashi M, Morita K, Shimamoto T, Hibi T. Is adalimumab safe and effective in patients with intestinal Behcet's disease in real-world practice? Intest Res 2020; 19:301-312. [PMID: 32814420 PMCID: PMC8322033 DOI: 10.5217/ir.2020.00013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background/Aims The safety and effectiveness of adalimumab was demonstrated in a phase 3 trial in Japanese patients with intestinal Behçet’s disease. The aim of this study was to evaluate the long-term safety and effectiveness of adalimumab in Japanese patients with intestinal Behçet’s disease. Methods This prospective, all-case, post-marketing study was conducted at 254 centers in Japanese patients with intestinal Behçet’s disease receiving adalimumab. The primary endpoint was incidence of adverse drug reactions. Effectiveness endpoints included global improvement rating and change in C-reactive protein levels. Results Of the 473 registered patients, 462 and 383 included in the safety and effectiveness populations were administered adalimumab for a mean of 515.3 and 579.5 days, respectively. Overall, 395 patients (85.5%) received adalimumab at the recommended dose. Adverse drug reactions and serious adverse drug reactions were reported in 120 (25.97%) and 51 (11.04%) patients, respectively. The incidence of adverse drug reactions was significantly higher in patients with comorbidities (P<0.0001), patients taking concomitant oral corticosteroids (P<0.0001), and those not self-administering adalimumab (P=0.0257). At study end, global improvement rating was “effective” (n = 156, 40.7%) or “markedly effective” (n = 168, 43.9%) in 324 patients (overall effective, 84.6%). Mean C-reactive protein levels (mg/dL) decreased from 1.96 at baseline (n = 324) to 0.58 at week 24 (n = 208) and 0.25 at week 156 (n = 37). Conclusions This large real-world study confirmed the long-term safety and effectiveness of adalimumab in patients with intestinal Behçet’s disease. No new safety concerns were identified. (Clinical trial registration number: NCT01960790)
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Affiliation(s)
- Yasuo Suzuki
- Department of Internal Medicine, Sakura Medical Center, Toho University, Chiba, Japan
| | | | | | | | | | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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28
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Abreu L, Marmelo B, Gil J, Antunes H, Gonçalves ML, Ferreira P, Correia E, Cabral C. Double coronary thrombosis in a patient with Behçet's disease. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Abreu L, Marmelo B, Gil J, Antunes H, Gonçalves ML, Ferreira P, Correia E, Cabral C. Double coronary thrombosis in a patient with Behçet's disease. Rev Port Cardiol 2020; 39:407.e1-407.e4. [DOI: 10.1016/j.repc.2017.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022] Open
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30
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BaŞ İkİzoĞlu N, AtaĞ E, Ergenekon AP, Yilmaz YeĞİt C, GÖkdemİr Y, Erdem Eralp E, BÜge Öz A, Karadag B. An Adolescent Presented With Hemoptysis: Pulmonary Artery Aneurysm in Pediatric Behçet's Disease. Arch Rheumatol 2020; 35:283-286. [PMID: 32851380 PMCID: PMC7406172 DOI: 10.46497/archrheumatol.2020.7459] [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] [Received: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 11/03/2022] Open
Abstract
Behçet's disease (BD) is a rare autoimmune and chronic inflammatory vasculitis, characterized by relapsing episodes of oral aphthous and genital ulcers, skin lesions, ocular lesions and vascular involvement. Pulmonary artery involvement is rare in BD but it carries a high mortality risk. In this article, we report a 15-year-old male patient presented with a two-month history of hemoptysis, cough, fewer and weight loss. On physical examination, auscultation revealed decreased breath sounds at left lung base. Bronchoscopy showed narrowed left lower lobe bronchus due to the external compression. Computed tomography angiography revealed multiple bilateral pulmonary artery aneurysms. Pathergy test was positive and he was diagnosed with BD. BD should be considered in the differential diagnosis of childhood hemoptysis.
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Affiliation(s)
- Nilay BaŞ İkİzoĞlu
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Emine AtaĞ
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pınar Ergenekon
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cansu Yilmaz YeĞİt
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Yasemin GÖkdemİr
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ela Erdem Eralp
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ayşim BÜge Öz
- Department of Pathology, Istanbul University Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
| | - Bulent Karadag
- Department of Pediatrics, Division of Pediatric Pulmonology, Marmara University School of Medicine, Istanbul, Turkey
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Zhou P, Wu Q, Li J. Vocal cord involvement and hoarseness in a patient with Behcets disease: A rare case report. Medicine (Baltimore) 2020; 99:e20221. [PMID: 32481292 PMCID: PMC7249930 DOI: 10.1097/md.0000000000020221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/22/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Behcets disease (BD) is a type of chronic systemic vasculitis that typically manifests as a mucocutaneous disease with orogenital ulcers, skin damage, and uveitis. The clinical diagnosis is often difficult because of the diversity of organs that may be involved and lack of specific pathological diagnosis. PATIENT CONCERNS A 26-year-old woman presented as a nearly 2-week history of hoarseness with throat pain. DIAGNOSES In the present case, Fiber laryngoscopy showed multiple ulcers involving the epiglottic tubercle, bilateral false vocal cord, middle area of the left vocal cord, and full length of the right vocal cord. Multidisciplinary physicians combined the patients clinical manifestations and pathological findings to make the Behcets disease diagnosis. INTERVENTIONS As the diagnosis confirmed, immediately began appropriate medical therapy (prednisolone at 30 mg once per day and thalidomide at 50 mg once per night in a month). OUTCOMES The ulcer on the right vocal cord disappeared but left a scar. Therefore, the patient experienced only partial recovery from the hoarseness. LESSONS Behcets disease can cause damage to multiple organs. Although the combination of vocal cord ulcers and hoarseness is rare in patients with BD and has not been previously reported to date, such patients should be treated with caution in clinical practice.
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Affiliation(s)
- Peng Zhou
- Otorhinolaryngology-Head and Neck Department
| | - Qi Wu
- Otorhinolaryngology-Head and Neck Department
| | - Jinnan Li
- Pathology Department, West China Hospital, Sichuan University, China
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Merlino L, Del Prete F, Lobozzo B, Priori R, Piccioni MG. Behcet's disease and pregnancy: a systematic review. ACTA ACUST UNITED AC 2020; 72:332-338. [PMID: 32403914 DOI: 10.23736/s0026-4784.20.04564-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Behcet's disease (BD) is a rare inflammatory, multisystemic, autoimmune disorder with unknown origin. BD is included in vasculitic disorders with a more frequent onset characterized by oral and genital ulcers associated with eye inflammation. However, BD has several clinical manifestations, and the most fearful complication is thrombotic involvement. BD occurs mainly in women of childbearing age, therefore it is important to identify the potential risks of pregnancy on the mother and fetus. EVIDENCE ACQUISITION The aim of our review is to identify, through the study of existing literature, the possible consequences of pregnancy on the course of this disease, the potential risks for the mother and fetus in gestation period and in puerperium, in order to identify a correct pregnancy management in patient affected by BD. EVIDENCE SYNTHESIS Currently, there are few studies that have analyzed the consequences of the disease on the course of pregnancy and pregnancy on the activity of the pathology. Some authors believe that pregnancy may worsen the symptoms of the disease, while others may even improve the course. Many authors believe that thromboembolic events are the main problems for which focus attention on these patients, both in pregnancy and in puerperium. Different opinions exist about pregnancy complications and neonatal outcomes, although events such as abortion, intrauterine growth restriction and C-section appear to have a higher incidence in BD patients. CONCLUSIONS There are no contraindications for the onset of pregnancy in BD patients. In most cases pregnancy can improve the course of the disease. However, in view of the potential adverse events, a thorough follow-up of the pregnancy is necessary in order to minimize any risks to the mother and fetus.
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Affiliation(s)
- Lucia Merlino
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Federica Del Prete
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy -
| | - Benedetta Lobozzo
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Roberta Priori
- Unit of Rheumatology, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy
| | - Maria G Piccioni
- Department of Maternal and Child Health and Urological Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
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Akyurek F, Tuncez Akyurek F. Investigation of pregnancy associated plasma protein-A and neopterin levels in Behçet's patients. Dermatol Ther 2020; 33:e13443. [PMID: 32307820 DOI: 10.1111/dth.13443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/31/2020] [Accepted: 04/16/2020] [Indexed: 01/14/2023]
Abstract
Behçet's disease (BD) is an autoimmune disease that affects many organs. We aimed to investigate the relationship between BD and these pregnancy-associated plasma protein A (PAPP-A), neopterin, and high sensitive C-reactive protein (hsCRP) parameters. The study included 57 BD patients and 54 healthy controls. After evaluating the active and inactive disease status of the patients, analyzes were performed. When comparing the patient and control groups, neopterin (111.27 ± 37.49; 76.77 ± 38.27 [nmol/L]; P < .001) and hsCRP (11.81 ± 16.8; 3.62 ± 5.06 [mg/L]; P = .001) parameters were significantly higher in patients. Neopterin (117.68 ± 41.67; 94.85 ± 14.75 [nmol/L]; P = .038) and hsCRP (14.68 ± 18.7; 4.47 ± 7.27 [mg/L]; P = .002) found different in active and inactive patients. The sensitivities of neopterin and hsCRP were also found to be high in BD (respectively 93%, 67%). PAPP-A was especially elevated in skin pathologies (P = .02) and neopterin in joint involvement (P = .03). We think that the use of neopterin and hsCRP can help in diagnosis and follow-up of BD.
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Affiliation(s)
- Fikret Akyurek
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Fatma Tuncez Akyurek
- Department of Dermatology, Faculty of Medicine, Selcuk University, Konya, Turkey
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34
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Association between serum homocysteine and arterial stiffness in patients with Behçet’s disease. EGYPTIAN RHEUMATOLOGIST 2020. [DOI: 10.1016/j.ejr.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Houacine S, Kang A, Parkinson EK, Wan H, Fortune F. Induction of p53 in keratinocyte cultures treated with Behçet's patient sera. J Oral Pathol Med 2020; 49:435-442. [DOI: 10.1111/jop.13005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/11/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Sihem Houacine
- Centre for Oral Immunobiology and Regenerative Medicine Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Angray Kang
- Centre for Oral Immunobiology and Regenerative Medicine Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Eric Kenneth Parkinson
- Centre for Oral Immunobiology and Regenerative Medicine Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Hong Wan
- Centre for Oral Immunobiology and Regenerative Medicine Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Farida Fortune
- Centre for Oral Immunobiology and Regenerative Medicine Institute of Dentistry, Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
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Sediq AM, Esawy MM, Hassanin HM, Abdul-Maksoud RS, Salama MA, Abdelwahab SM. TNFSF15 (rs3810936) in Behçet's disease. Br J Biomed Sci 2020; 77:156-158. [PMID: 31902306 DOI: 10.1080/09674845.2019.1710910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - S M Abdelwahab
- Department of Rheumatology, Faculty of Medicine, Zagazig University , Zagazig, Egypt
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Kambayashi H, Omori T, Saito S, Murasugi S, Kashiwagi H, Ito A, Yonezawa M, Nakamura S, Tokushige K. The Efficacy of Medium- to Long-term Anti-TNF-α Antibody-based Maintenance Therapy in Behçet's Disease Patients with Intestinal Lesions. Intern Med 2020; 59:2343-2351. [PMID: 32999263 PMCID: PMC7644480 DOI: 10.2169/internalmedicine.5000-20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective Anti-tumor necrosis factor (TNF)-α antibody-based regimens are effective in Behçet's disease (BD) with intestinal lesions. We therefore evaluated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance therapy of BD intestinal and non-intestinal lesions. Methods In this retrospective study, the response to the treatment was assessed endoscopically and clinically. Treatment responders were transferred to maintenance therapy. We evaluated the sustain rate of maintenance therapy, reductions in the dose of prednisolone (PSL), and the presence of non-intestinal BD involvement before and after the start of anti-TNF-α antibody-based the maintenance therapy. Patients We assessed 20 BD patients with intestinal lesions who underwent anti-TNF-α antibody-based therapy. Results Treatment was discontinued in 3 patients (18%). Loss of response was noted in 1 (5.9%) patient. Maintenance therapy was continued in 13 (76%) patients. The cumulative sustain rates to maintenance therapy after 2, 4, and 6 years were 94%, 87%, and 72%, respectively. In the 13 patients with remission of intestinal lesions, the mean PSL dose decreased from 13.4±2.16 mg/day before treatment to 0.92±0.47 after treatment (p<0.0001). PSL was discontinued in 9 (69%) patients. Five of the 13 (38%) patients developed clinical features of non-intestinal BD during the remission-maintenance treatment. Conclusion Our results demonstrated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance treatment against BD intestinal lesions. Nevertheless, some cases with well-controlled intestinal lesions developed active non-intestinal BD symptoms. The results highlight the importance of a carefully planned treatment strategy for BD patients with intestinal involvement.
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Affiliation(s)
| | - Teppei Omori
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
| | - Satomi Saito
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
| | - Shun Murasugi
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
| | | | - Ayumi Ito
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
| | - Maria Yonezawa
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
| | - Shinichi Nakamura
- Institute of Gastroenterology, Tokyo Women's Medical University, Japan
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Mohammadpour M, Kosari M, Khorrami-Nejad M. Behcet's Disease Presenting With Bilateral Hypopyon Masquerading Post Cataract Surgery Endophthalmitis. Int Med Case Rep J 2019; 12:363-365. [PMID: 31819669 PMCID: PMC6886532 DOI: 10.2147/imcrj.s232948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/07/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To report a case of Behcet’s disease presented with bilateral hypopyon after sequential cataract surgery masquerading delayed onset post-operative endophthalmitis. Methods A 53-year-old man with a history of sequential uneventful cataract surgeries came to our clinic with decreased vision (0.3 LogMAR) since 2 days ago and bilateral hypopyon in his both eyes. The primary diagnosis was chronic late-onset endophthalmitis. Results There was no lid edema or chemosis on the external examination. On slit-lamp examination, the cornea was clear, the pupil was well reactive with no posterior synechia, the intraocular lens was centered with good red reflex, however, bilateral hypopyon was detected in his both eyes which was more prominent in the left eye. The eyes were fairly calm and absence of vitreous reaction on slit-lamp examination, there was no pain and photophobia. Further, on physical examination, oral mucosal ulcerations were detected. His systemic workup revealed Behcet’s disease with HLA-B5 positive serology. Conclusion In cases with delayed onset hypopyon following cataract surgery, inflammatory diseases such as Behcet’s disease should be considered. Appropriate history taking and physical examinations in the context of serologic laboratory investigations may lead to the proper diagnosis.
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Affiliation(s)
- Mehrdad Mohammadpour
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Kosari
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Vural U, Kizilay M, Aglar AA. Coronary Involvement in Behçet's Disease: what are its Risks and Prognosis? (Rare Cases and Literature Review). Braz J Cardiovasc Surg 2019; 34:749-758. [PMID: 31241876 PMCID: PMC6894034 DOI: 10.21470/1678-9741-2019-0003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective In our clinic, we aimed to investigate the effect of preoperative risk factors and postoperative complications on reoperation and mortality in cases with Behçet's disease which presents very rare coronary artery involvement. Methods Thirteen patients with Behçet's Disease who had undergone coronary artery bypass grafting in our center between 2003 and 2015 were analyzed. We evaluated the clinical and laboratory findings, complications and mortality rates of our patients in light of the literature. Results The mean age was 38.5 (30-55; 3 women). The mean time from onset of Behçet's disease to coronary artery disease was 4,7 (3-11) years. Fifty-four percent of the patients were asymptomatic. Coronary artery disease of these was exposed while peripheral vascular surgery was planned due to complications of Behçet's disease. Symptomatic patients presented angina pectoris (31%), acute coronary syndrome (8%) and arrhythmia (8%). In coronary pathology of patients, distal type obstruction (31%), aneurysm and pseudoaneurysm (31%), proximal segment thrombus (15%), chronic type stenosis and occlusions (31%) were present. Early mortality (15%) was due to acute myocardial infarction while the late mortality (15%) was due to cerebral and gastrointestinal bleeding. Reoperation was due to bleeding in one case on the 1st postoperative day and due to acute pulmonary embolism in another case in the 3rdpostoperative year. Conclusion In Behçet's disease, coronary artery bypass grafting is a procedure with high mortality, especially in the acute period. The on-pump surgery technique in these cases can be safely performed for multiple bypasses and in patients above 40 years old.
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Affiliation(s)
- Unsal Vural
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
| | - Mehmet Kizilay
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
| | - Ahmet Arif Aglar
- Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi Cardiovascular Surgery Istanbul Turkey Doktor Siyami Ersek Gogus Kalp ve Damar Cerrahisi Egitim ve Arastirma Hastanesi - Cardiovascular Surgery, Istanbul, Turkey
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40
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Wu CY, Yu HS, Chai CY, Wen YH, Wu SS, Chang YP, Lin CHR, Tsai JH. Increased ischemic stroke risk in patients with Behçet's disease: A nationwide population-based cohort study. PLoS One 2019; 14:e0218652. [PMID: 31237911 PMCID: PMC6592528 DOI: 10.1371/journal.pone.0218652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/06/2019] [Indexed: 12/29/2022] Open
Abstract
Background Behçet’s disease (BD) is a recurrent, multisystemic, inflammatory disorder that mainly affects blood vessels. Because recurrent inflammation of blood vessels in the brain plays a crucial role in the development of ischemic stroke, we hypothesized that patients with BD might have an elevated risk of ischemic stroke. This potential association has been suggested in a few case reports, but not epidemiological studies. Hence, the present study aimed to examine the relation between BD and subsequent ischemic stroke in Taiwan using a nationwide, population-based database. Methods To establish a study cohort, the longitudinal data of 306 patients newly diagnosed with BD during 2000–2010 were extracted from the National Health Insurance Research Database, Taiwan. For comparison of ischemic stroke incidence, a control cohort of 1224 subjects without BD was established using a frequency-matched ratio of 1:4 for age, sex, and pre-existing comorbidities. Results During the 10-year follow-up, 13 (4.2%) patients with BD and 20 (1.6%) control subjects experienced ischemic stroke. Kaplan–Meier analysis revealed the higher prevalence of ischemic stroke in the BD group (log-rank test, p = 0.001). After adjusting for comorbidities and demographic characteristics, Cox regression analysis revealed that patients with BD had a 2.77-fold risk of ischemic stroke (95% confidence interval, 1.38–5.57) compared to control subjects. Conclusions Patients with BD have an elevated risk of ischemic stroke. Hence, BD may affect the vascular system in the brain, resulting in a stroke event.
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Affiliation(s)
- Ching-Ying Wu
- Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Cosmetic Science, College of Human Ecology, Chang Gung University of Science and Technology, Kweishan, Taoyuan, Taiwan
| | - Hsin-Su Yu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Clinical Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Chee-Yin Chai
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Pathology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Hsia Wen
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shihn-Sheng Wu
- School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Hung Richard Lin
- Department of Computer Science and Engineering, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
| | - Jui-Hsiu Tsai
- Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
- * E-mail: (H-S Y); (C-HR L); (J-H T)
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Successful Treatment of Amyloid A–Type Amyloidosis Due to Behçet Disease With Tocilizumab. J Clin Rheumatol 2019; 25:43-45. [DOI: 10.1097/rhu.0000000000000724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Le Joncour A, Martos R, Loyau S, Lelay N, Dossier A, Cazes A, Fouret P, Domont F, Papo T, Jandrot-Perrus M, Bouton MC, Cacoub P, Ajzenberg N, Saadoun D, Boulaftali Y. Critical role of neutrophil extracellular traps (NETs) in patients with Behcet's disease. Ann Rheum Dis 2019; 78:1274-1282. [PMID: 31147357 DOI: 10.1136/annrheumdis-2018-214335] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Behçet's disease (BD) is a chronic systemic vasculitis. Thrombosis is a frequent and life-threatening complication. The pathogenesis of BD is poorly understood and evidence supporting a role for primed neutrophils in BD-associated thrombotic risk is scant. To respond to inflammatory insults, neutrophils release web-like structures, known as neutrophil extracellular traps (NETs), which are prothrombotic. We evaluated the role of NETs and markers of NETs in BD. METHODS Blood samples were collected from patients with BD, according to the International Study Group Criteria for Behçet's disease, and healthy donors (HD). NET components, including cell-free DNA (CfDNA) and neutrophil enzymes myeloperoxidase (MPO), were assessed in serum or in purified neutrophils from patients with BD and HD. RESULTS Patients with active BD had elevated serum cfDNA levels and MPO-DNA complexes compared with patients with inactive BD and to HD. In addition, levels of cfDNA and MPO-DNA complexes were significantly higher in patients with BD with vascular involvement compared with those without vascular symptoms. Purified neutrophils from patients with BD exhibited spontaneous NETosis compared with HD. Thrombin generation in BD plasma was significantly increased and positively correlated with the levels of MPO-DNA complexes and cfDNA. Importantly, DNAse treatment significantly decreased thrombin generation in BD plasma but not in HD plasma. In addition, biopsy materials obtained from patients with BD showed NETs production in areas of vasculitic inflammation and thrombosis. CONCLUSIONS Our data show that NETs and markers of NETS levels are elevated in patients with BD and contribute to the procoagulant state. Targeting NETs may represent a potential therapeutic target for the reduction or prevention of BD-associated thrombotic risk.
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Affiliation(s)
- Alexandre Le Joncour
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière-APHP, Paris, France.,INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3, Sorbonne Université, Paris, France
| | | | | | | | - Antoine Dossier
- Department of Internal Medicine, Université Paris Diderot, Sorbonne Paris, Hôpital Bichat- APHP, Paris, Île-de-France, France
| | - Aurelie Cazes
- Department of Internal Medicine, Université Paris Diderot, Sorbonne Paris, Hôpital Bichat- APHP, Paris, Île-de-France, France
| | - Pierre Fouret
- Department of Anatomopathology, Hôpital de la Pitié-Salpêtrière-APHP, Paris, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière-APHP, Paris, France
| | - Thomas Papo
- Department of Internal Medicine, Université Paris Diderot, Sorbonne Paris, Hôpital Bichat- APHP, Paris, Île-de-France, France
| | | | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière-APHP, Paris, France.,INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3, Sorbonne Université, Paris, France
| | - Nadine Ajzenberg
- LVTS, INSERM 1148, Paris, France.,Department of Hematology, Université Paris Diderot, Sorbonne Paris, Hôpital Bichat- APHP, Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière-APHP, Paris, France.,INSERM UMR_S 959, Immunologie-Immunopathologie-Immunotherapie, i3, Sorbonne Université, Paris, France
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Lee S, Czuzoj-Shulman N, Abenhaim HA. Behcet's disease and pregnancy: obstetrical and neonatal outcomes in a population-based cohort of 12 million births. J Perinat Med 2019; 47:381-387. [PMID: 30763266 DOI: 10.1515/jpm-2018-0161] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/09/2019] [Indexed: 01/29/2023]
Abstract
Background Behcet's disease (BD) is a rare, multi-systemic inflammatory disorder for which only limited and contradictory data exists in the context of pregnancy. Our objective was to estimate the prevalence of BD in pregnancy and to evaluate maternal and fetal outcomes associated with pregnant women living with BD. Methods Using the 1999-2013 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the United States, we performed a population-based retrospective cohort study consisting of pregnancies that occurred during this time period. ICD-9 codes were used to identify delivery admissions to women with or without BD. Multivariate logistic regression was used to estimate the adjusted effects of BD on maternal and fetal outcomes. Results Among the 12,592,676 pregnancies in our cohort, 144 were to women with BD, for an overall prevalence of 1.14 cases/100,000 births between 1999 and 2013. Over the study period, the prevalence of BD rose from 0.5 to 2.4/100,000 births. Women with BD demonstrated a two-fold greater frequency of non-delivery hospital admissions during pregnancy, and were more likely to be Caucasian, have private medical insurance, be of the upper income quartiles, and deliver at an urban teaching hospital. Women with BD were at greater risk for preterm labor and postpartum venous thromboembolism, while their newborns were more likely to be born premature. Conclusion BD-associated pregnancies are increasing in prevalence and are associated with a greater risk for adverse maternal and fetal outcomes in pregnancy. Appropriate thromboprophylaxis during pregnancy should be considered given the increased risk for venous thromboembolism.
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Affiliation(s)
- Seohyuk Lee
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicholas Czuzoj-Shulman
- Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
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Paschalis T, Shami NM, Mandal AK, Missouris CG. Neuro-Behçet's masquerading as progressive bulbar palsy: a case report and literature review. JRSM Open 2019; 10:2054270419834841. [PMID: 30937175 PMCID: PMC6434437 DOI: 10.1177/2054270419834841] [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: 11/17/2022] Open
Abstract
In patients with progressive bulbar palsy without an obvious cause, there should be a high index of suspicion for the potential diagnosis of Neuro-Behçet’s Disease, even in the absence of the acute classical peripheral manifestations of Bechet’s Disease, with emphasis in prompt diagnosis using ‘The International Criteria for Behçet’s Disease’ and rapid, effective treatment in order to improve outcome.
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Affiliation(s)
- Theodoros Paschalis
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge CB2 0SP, UK
| | - Noor M Shami
- Department of Medicine, St George's Medical School, Nicosia, 2408, Cyprus
| | - Amit Kj Mandal
- Departments of Medicine and Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, SL2 4HL, UK
| | - Constantinos G Missouris
- Departments of Medicine and Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, SL2 4HL, UK.,Departments of Medicine and Clinical Cardiology, University of Cyprus Medical School, Nicosia, 2029, Cyprus
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Jiang YY, Chi C, Zeng YP, Jin HZ. Erythematous plaques and nodules with orogenital ulcerations. J Dtsch Dermatol Ges 2019; 17:464-467. [PMID: 30933422 DOI: 10.1111/ddg.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yan-Yun Jiang
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cheng Chi
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yue-Ping Zeng
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong-Zhong Jin
- Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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46
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Diagnostic/classification criteria in pediatric Behçet's disease. Rheumatol Int 2018; 39:37-46. [PMID: 30430200 DOI: 10.1007/s00296-018-4208-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 11/09/2018] [Indexed: 12/25/2022]
Abstract
Behçet's disease (BD) is a variable vessel vasculitis characterized by recurrent oral and genital aphthosis accompanied by skin, ocular, gastrointestinal, neurologic, and articular involvement. BD is not common in childhood and the disease characteristics considerably differ between adults and children. 18 diagnostic/classification criteria have been published for BD to date. The pediatric BD (PEDBD) criteria, published in 2015, focused on pediatric BD, while the others mainly based on adult studies and are not validated for children. The aim of this review is to summarize the data about diagnostic/classification criteria for BD and to discuss the use and performance of the current criteria in pediatric BD. The covered topics are the characteristics of the diagnostic/classification criteria sets for BD, the factors restricting the universal use/acceptance of these criteria, and pediatric studies testing the performance of BD criteria sets. Having valid and universally accepted criteria with high performance is very important in pediatric BD as they help us determine patients for our studies and guide us through our clinical practice. There are less than 10 pediatric studies testing the performances of BD diagnostic/classification criteria. Their results suggest that revised ICBD (The International Criteria for BD) has the highest sensitivity, while ISG (The International Study Group) criteria remain as the most specific criteria set. Larger multinational pediatric BD cohorts with adequate control groups are required to compare the performance of the different criteria sets in children and to improve the performance of the existing PEDBD criteria.
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Messedi M, Naifar M, Grayaa S, Frikha F, Messoued M, Sethom MM, Feki M, Kaabach N, Bahloul Z, Jamoussi K, Ayedi F. Plasma Saturated and Monounsaturated Fatty Acids in Behçet's Disease. Open Rheumatol J 2018; 12:139-151. [PMID: 30258503 PMCID: PMC6128021 DOI: 10.2174/1874312901812010139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/09/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022] Open
Abstract
Background: Fatty Acid (FA) composition of serum has been associated with many markers of inflammation. In this study, we tried to examine plasma Saturated Fatty Acid (SFA) and Monounsaturated Fatty Acid (MUFA) composition in Behçet's Disease (BD) patients. The associations between the circulating FA levels and some markers of inflammation have also been investigated. Methods: This study is a cross-sectional one. In fact, a total of 101 BD patients and healthy controls group of 99 subjects are enrolled. Gas Chromatograph equipped with a Capillary Split/Splitless Injector and flame ionization detector was used to analyze the plasma SFA and MUFA compositions. The high sensitivity C-Reactive Protein (hsCRP) and fibrinogen levels were measured using standard techniques. Results: BD patients had significantly higher proportions of Mystiric Acid (MA), Palmitic Acid (PAM), Palmitoleic Acid (POA) and Stearoyl-CoA Desaturase (SCD)-16, compared to controls. The results revealed that patients with severe involvements had high levels of POA and total MUFA associated with higher SCD-16 activity compared to those with minor ones. The receiver operator characteristic curve analysis revealed that POA could well discriminate BD patients with severe clinical manifestations. In the bivariate analysis, hsCRP was found to be positively correlated with total SAFA and POA elongase activity index but negatively correlated with SCD-18 activity index. The STA, POA, elongase and SCD-16 activity index are correlated with fibrinogen. On the other hand, the multivariate analysis showed that POA remained associated with higher levels of hsCRP. Conclusion: Unfavourable plasma SFA and MUFA profile were reported in BD patients. POA, which is associated with higher plasma hsCRP level, may play a role in the pathogenesis of BD.
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Affiliation(s)
- Meriam Messedi
- Unit of Research Molecular Bases of Human Diseases, 12ES17, Faculty of Medicine of Sfax, University of Sfax, 3029 Sfax, Sfax, Tunisia
| | - Manel Naifar
- Biochemistry laboratory, Habib Bourguiba University Hospital, 3029 Sfax, Sfax, Tunisia
| | - Sahar Grayaa
- Unit of Research Molecular Bases of Human Diseases, 12ES17, Faculty of Medicine of Sfax, University of Sfax, 3029 Sfax, Sfax, Tunisia
| | - Faten Frikha
- Internal Medicine Department, Hedi Chaker Hospital, 3029 Sfax, Sfax, Tunisia
| | - Mariem Messoued
- Unit of Research Molecular Bases of Human Diseases, 12ES17, Faculty of Medicine of Sfax, University of Sfax, 3029 Sfax, Sfax, Tunisia
| | - Mohamed Marouene Sethom
- Faculty of Medicine of Tunis, Biochemistry laboratory, La Rabta Hospital and UR05/08-08, Tunis 1007, Tunisia
| | - Moncef Feki
- Faculty of Medicine of Tunis, Biochemistry laboratory, La Rabta Hospital and UR05/08-08, Tunis 1007, Tunisia
| | - Naziha Kaabach
- Faculty of Medicine of Tunis, Biochemistry laboratory, La Rabta Hospital and UR05/08-08, Tunis 1007, Tunisia
| | - Zouheir Bahloul
- Internal Medicine Department, Hedi Chaker Hospital, 3029 Sfax, Sfax, Tunisia
| | - Kamel Jamoussi
- Unit of Research Molecular Bases of Human Diseases, 12ES17, Faculty of Medicine of Sfax, University of Sfax, 3029 Sfax, Sfax, Tunisia
| | - Fatma Ayedi
- Unit of Research Molecular Bases of Human Diseases, 12ES17, Faculty of Medicine of Sfax, University of Sfax, 3029 Sfax, Sfax, Tunisia.,Biochemistry laboratory, Habib Bourguiba University Hospital, 3029 Sfax, Sfax, Tunisia
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Deng Y, Zhu W, Zhou X. Immune Regulatory Genes Are Major Genetic Factors to Behcet Disease: Systematic Review. Open Rheumatol J 2018; 12:70-85. [PMID: 30069262 PMCID: PMC6040213 DOI: 10.2174/1874312901812010070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 06/04/2018] [Indexed: 12/15/2022] Open
Abstract
Behcet's disease (BD) is a chronic refractory multi-system autoimmune disorder that occurs in a genetically susceptible host. Multiple genetic factors have been identified that may contribute to the pathogenesis of BD. The major genes with polymorphisms associated with BD include HLA-B and -A, CIITA, ERAP1, MICA, IL10, IL12A, IL12RB2, IL23R, MEFV, IRF8, TNFAIP3, REL, TLR4, NOD1,2, CCR1,CCR3, GIMAP1,2,4, KLRC4, STAT4, NCOA5, FOXP3, PSORS1C1, FUT2, UBAC2, SUMO4, ADO-EGR2, CEBPB-PTPN1, and JPKL-CNTN5. These genes encode proteins involved mainly in immune regulation and inflammation, and some in transcription and post-translational modification. A complete view of these BD-associated genes may provide a clue to this complex disease in terms of its pathogenesis and exploring potentially targeted therapies for BD.
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Affiliation(s)
- Yan Deng
- The Second Affiliated Hospital of Nanchang University, Nanchangine>, China.,Department of Internal Medicine/Rheumatology, University of Texas Health Science Center at Houston McGovern Medical School, USA
| | - Weifeng Zhu
- Department of Internal Medicine/Rheumatology, University of Texas Health Science Center at Houston McGovern Medical School, USA.,College of Basic Medical Sciences, Nanchang University, Nanchang, China
| | - Xiaodong Zhou
- Department of Internal Medicine/Rheumatology, University of Texas Health Science Center at Houston McGovern Medical School, USA
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Salmaninejad A, Gowhari A, Hosseini S, Aslani S, Yousefi M, Bahrami T, Ebrahimi M, Nesaei A, Zal M. Genetics and immunodysfunction underlying Behçet's disease and immunomodulant treatment approaches. J Immunotoxicol 2018; 14:137-151. [PMID: 28693405 DOI: 10.1080/1547691x.2017.1346008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Behçet's disease (BD) is a chronic autoimmune condition primarily prevalent in populations along the Mediterranean Sea. The exact etiology of BD has not been fully explained yet, but the disease occurrence is associated with a genetic factor, human leukocyte antigen (HLA)-B51 antigen. Among the various immunodysfunctions that are found in BD, patients are increased neutrophil motility and superoxide production, as well as elevated production of tumor necrosis factor (TNF)-α and decreased production of interleukin (IL)-10. Elevated levels of inflammatory cytokines like IL-1 and IL-17 in BD have been found associated with aberrant expression of microRNA. Gene polymorphisms in BD patients have been observed in molecules involved in responses to pathogens that can ultimately modulate the host antimicrobial response. Moreover, several single nucleotide polymorphisms (SNPs) have been reported in genes encoding chemokines and adhesion molecules; many of these changes manifest as increases in vascular inflammation and vascular damage. Lastly, genetic and epigenetic changes have been suggested as involved in the pathogenesis of BD. Modifications in DNA methylation have been found in BD patient monocytes and lymphocytes, leading to adverse function of these cells. This review presents a comprehensive compilation of the literature with regard to the immunodysfunction underlying BD, as well as of the genetics, newly described clinical specifications and novel treatment strategies using immunomodulants based on the current understanding of BD.
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Affiliation(s)
- Arash Salmaninejad
- a Drug Applied Research Center , Tabriz University of Medical Sciences , Tabriz , Iran.,b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran.,c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Arezoo Gowhari
- d Department of Immunology, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Seyedmojtaba Hosseini
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Saeed Aslani
- c Rheumatology Research Center , Tehran University of Medical Sciences , Tehran , Iran
| | - Meysam Yousefi
- b Medical Genetics Research Center, Student Research Committee, Department of Medical Genetics, Faculty of Medicine , Mashhad University of Medical Sciences , Mashhad , Iran
| | - Tayyeb Bahrami
- e Genetics Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Masoume Ebrahimi
- f Department of Biology, Faculty of Sciences , University of Guilan , Rasht , Iran
| | - Abolfazl Nesaei
- g Department of Basic Sciences , Gonabad University of Medical Sciences , Gonabad , Iran
| | - Masoud Zal
- h Department of Medical Genetics , Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Islam SMS, Choi B, Choi J, Lee ES, Sohn S. Frequencies of IL-15Rα+ cells in patients with Behçet's disease and the effects of overexpressing IL-15Rα+ on disease symptoms in mice. Cytokine 2018; 110:257-266. [PMID: 29396044 DOI: 10.1016/j.cyto.2018.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/05/2018] [Accepted: 01/10/2018] [Indexed: 12/20/2022]
Abstract
It has been suggested higher serum levels of IL-15 and lower expression levels of IL-15 receptor alpha (IL-15Rα) are correlated with pathogenesis of Behçet's disease (BD). However, whether overexpressing IL-15Rα could be used as a therapeutic candidate for BD is currently unclear. Therefore, the purpose of this study was to determine whether overexpressing IL-15Rα could affect BD symptoms in a mouse model. IL-15/IL-15Rα complex expressing vector or protein complex of IL-15/IL-15Rα-Fc was used to treat BD mice. Frequencies of IL-15Rα+ cells in peripheral blood leukocytes (PBL) and lymph node cells were determined using a flow cytometer. BD symptoms in mice improved after treatment with IL-15/15Rα expression vector or IL-15/IL-15Rα-Fc protein complex. In addition, treatment with pIL-15/15Rα significantly (p = .016) decreased disease severity score of BD mice compared to treatment with control vector. Frequencies of IL-15Rα+ cells were also significantly (p = .01) higher in peritoneal macrophages of pIL-15/15Rα treated BD mice than those of mice treated with control vector. Frequencies of IL-15Rα+ PBL were also significantly higher in BD mice treated with IL-15/IL-15Rα-Fc protein complex than those in the control group. These results suggest up-regulating IL-15Rα+ cells could be used as novel therapeutic strategies to control BD in the future.
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Affiliation(s)
- S M Shamsul Islam
- Department of Biomedical Science, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Bunsoon Choi
- Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Juyoung Choi
- Department of Biomedical Science, Ajou University School of Medicine, Suwon 16499, Republic of Korea
| | - Eun-So Lee
- Department of Dermatology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
| | - Seonghyang Sohn
- Department of Biomedical Science, Ajou University School of Medicine, Suwon 16499, Republic of Korea; Department of Microbiology, Ajou University School of Medicine, Suwon 16499, Republic of Korea.
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