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London J, Rulka K, Bobba G, Joseph J, Tharayil Z, Gudesblatt M. A Changed Man: A Rare Case of Behcet's Disease Autoimmune Encephalitis. J Community Hosp Intern Med Perspect 2024; 14:89-92. [PMID: 39036570 PMCID: PMC11259489 DOI: 10.55729/2000-9666.1350] [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: 12/04/2023] [Revised: 02/16/2024] [Accepted: 03/21/2024] [Indexed: 07/23/2024] Open
Abstract
Behcet's disease (BD) is characterized by recurrent oral ulcers with concomitant systemic multi-organ involvement, which may include neurological disease, ocular disease, vascular disease, genital ulcers, skin lesions, and arthritis. The clinical symptoms arise from vasculitis that involves small, medium, and large blood vessels. We present the case of a young male who presented with atypical Behcet's autoimmune encephalitis with recurrent oral ulcers, neurological manifestations, HLA-B51 positivity, abnormal EEG findings, and improvement following multiple plasma exchange treatments.
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Affiliation(s)
- Jonathan London
- Department of Internal Medicine, Long Island Community Hospital,
United States
| | - Kevin Rulka
- Department of Internal Medicine, Long Island Community Hospital,
United States
| | - Gayatri Bobba
- Department of Internal Medicine, Long Island Community Hospital,
United States
| | - Justeena Joseph
- Department of Internal Medicine, Long Island Community Hospital,
United States
| | - Zubin Tharayil
- Department of Internal Medicine, Long Island Community Hospital,
United States
| | - Mark Gudesblatt
- Department of Neurology, Long Island Community Hospital,
United States
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Hamzaoui K, Louhaichi S, Salhi M, Sassi FH, Laathar A, Hamzaoui A. IL-38 in Behçet's disease: Gene expression in bronchoalveolar lavage from patients having pulmonary involvement. Immunol Lett 2024; 266:106840. [PMID: 38307260 DOI: 10.1016/j.imlet.2024.106840] [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: 01/17/2023] [Revised: 01/11/2024] [Accepted: 01/31/2024] [Indexed: 02/04/2024]
Abstract
The etiological complexity of Behçet disease (BD), an immune-mediated rare form of vasculitis characterized by multi-organ involvement, is still elusive due to an incomplete understanding of the synergy between genetic susceptibility, environmental triggers, and an abnormal immune response. The diagnosis of BD relies on clinical symptoms. Lung inflammatory disorders are severe conditions of patients with BD, here we focus on the expression of biomarkers in BD patients with pulmonary manifestations. Aiming to identify additional discriminating biomarker patterns, we measured and compared protein and gene expression of IL-38 and a broad panel of selected genes in bronchoalveolar cells of patients suffering from BD with and without pulmonary involvement compared to controls. ELISA and RT-PCR analysis were applied. The first principal analysis highlighted decreased IL-38 level in BD patients compared to Rheumatoid Arthritis (RA) patients and controls: BD patients expressed lower IL-38 levels, particularly in cases with pulmonary involvement. The area under the curve (AUC) of the receiver-operating characteristic curve showed that IL-38 may be an eventual biomarker for BD. Co-cultured recombinant IL-38 and stimulated memory PBMCs of active BD, were able to suppress IL-17 and NLRP3 inflammasome and ameliorate the secretion of IL-10 and TGFβ. Transcription factors of the IL-1 family (IL-1β, IL-18, IL-32, IL-33 and IL-37) along with IFN-γ, IL-17, RORγt, Foxp3, TGFβ, IL-10 and NLRP3 inflammasome were the parameters that are the main contributor to the segregation between BD with and without lung involvement. Our results indicate that IL-38 might be involved in the pathogenesis of BD and the combined gene expression in BAL suggests distinct mechanisms governing the inflammatory disorders in the lung.
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Affiliation(s)
- Kamel Hamzaoui
- University of Tunis El Manar, Tunis, Tunisia; Research Laboratory 19SP02 "Chronic Pulmonary Pathologies: From Genome to Management", Department of Respiratory Diseases, Pavillon B, Hospital A. Mami, Ariana, Tunisia.
| | - Sabrine Louhaichi
- University of Tunis El Manar, Tunis, Tunisia; Research Laboratory 19SP02 "Chronic Pulmonary Pathologies: From Genome to Management", Department of Respiratory Diseases, Pavillon B, Hospital A. Mami, Ariana, Tunisia; Department of Lung Diseases, Abderrahmane Mami Hospital of Pneumology, Ariana, Tunisia
| | - Mariem Salhi
- University of Tunis El Manar, Tunis, Tunisia; Research Laboratory 19SP02 "Chronic Pulmonary Pathologies: From Genome to Management", Department of Respiratory Diseases, Pavillon B, Hospital A. Mami, Ariana, Tunisia
| | - Fayçal Haj Sassi
- University of Tunis El Manar, Tunis, Tunisia; Research Laboratory 19SP02 "Chronic Pulmonary Pathologies: From Genome to Management", Department of Respiratory Diseases, Pavillon B, Hospital A. Mami, Ariana, Tunisia
| | - Ahmed Laathar
- University of Tunis El Manar, Tunis, Tunisia; Department of Rheumatology, Mongi Slim Hospital, La Marsa, Tunisia
| | - Agnes Hamzaoui
- University of Tunis El Manar, Tunis, Tunisia; Research Laboratory 19SP02 "Chronic Pulmonary Pathologies: From Genome to Management", Department of Respiratory Diseases, Pavillon B, Hospital A. Mami, Ariana, Tunisia; Department of Lung Diseases, Abderrahmane Mami Hospital of Pneumology, Ariana, Tunisia
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Altan Ferhatoğlu Z, Altinişik DD, Özdede A, Özkoca D, Güner S, Yildiz KA, Kutlubay Z, Seyahi E, Hamuryudan V. Folliculitis might be associated with pathergy-positivity in patients with Behçet syndrome. Medicine (Baltimore) 2024; 103:e37553. [PMID: 38518008 PMCID: PMC10957023 DOI: 10.1097/md.0000000000037553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/24/2024] Open
Abstract
Pathergy test indicates nonspecific hyper-reactivity of the skin to aseptic trauma in Behçet syndrome (BS) and is considered as an adjunctive diagnostic test with a good specificity albeit with low sensitivity. We tested the hypothesis that a relationship exists between active clinical manifestations of BS and the pathergy-positivity when performed simultaneously. Pathergy test and detailed dermatologic examination were done in 105 BS patients (60M/45F); who were seen consecutively at the multi-disciplinary BS outpatient clinic in a single tertiary center. Information regarding demographic and clinical characteristics, pathergy test results at diagnosis, and details about treatment were obtained from patient charts. Disease activity was assessed using Behçet Disease Current Activity Form. Among 105 patients, 27 (25.7%) were pathergy-positive at the time of the study visit whereas 40.9% were pathergy-positive at the time of the diagnosis. There was no relation between pathergy test and patient age or disease duration, either. Pathergy-positivity was significantly more common in patients with folliculitis compared to those without folliculitis (40.7% vs 19.2%; P = .026). The test was also positive in all 3 patients with leg ulcers due to venous stasis. We found that among all skin-mucosa lesions only the presence of folliculitis was associated with pathergy positivity with statistical significance. It was also remarkable that the current pathergy was positive in all 3 patients with active leg ulcers but this finding warrants further studies because of the low patient numbers.
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Affiliation(s)
- Zeynep Altan Ferhatoğlu
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | | | - Ayşe Özdede
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Defne Özkoca
- Department of Dermatology, Koç University, School of Medicine, Istanbul, Turkey
| | - Sabriye Güner
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Kadir Atacan Yildiz
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology Istanbul, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emire Seyahi
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Vedat Hamuryudan
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Omara A, Alkhuboli M, Nauman J, Al Nokhatha S, Almarshoodi M. Case report: Deep vein thrombosis as the sole clinical feature of Behcet's syndrome. Front Med (Lausanne) 2023; 10:1276867. [PMID: 38143445 PMCID: PMC10749191 DOI: 10.3389/fmed.2023.1276867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/25/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Behcet's syndrome is a rare, chronic, systemic condition often categorized within the group of vasculitides. It presents a diagnostic challenge due to its varied clinical manifestations and the absence of a definitive laboratory test. Its etiology remains unclear but may involve genetic, infectious, and environmental factors. Case presentation We report the case of a 16-year-old male who presented with deep vein thrombosis, followed by recurrent episodes of breakthrough thrombosis, despite adequate anticoagulant therapy. The patient did not meet the International Study Group (ISG) criteria nor the International Criteria for Behcet's syndrome (ICBD) due to the absence of characteristic features such as oral aphthous ulcers, genital ulcers, and uveitis. Later in the disease course, after ruling out other causes of breakthrough thrombosis, he tested positive for HLA-B51, an allele associated with Behcet's syndrome, and exhibited a pathergy reaction. Discussion The patient's clinical course underlines the diagnostic complexity associated with Behcet's syndrome and highlights the importance of maintaining a broad differential diagnosis in cases of recurrent thrombosis. Although HLA-B51 testing is not routinely recommended, it played a pivotal role in our case, underscoring the value of an integrated diagnostic approach. Furthermore, this case reinforces the potential for atypical presentations of Behcet's syndrome, necessitating vigilant clinical awareness. After establishing the diagnosis, we successfully treated the patient with immunosuppressive therapy, significantly improving his condition.
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Affiliation(s)
- Abdelrahman Omara
- Department of Academic Affairs, Ambulatory Healthcare Services, Al Ain, United Arab Emirates
| | - Mohamed Alkhuboli
- Department of Ambulatory Medicine - Medical Affairs, Tawam Hospital, Al Ain, United Arab Emirates
| | - Javaid Nauman
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, United States
| | - Shamma Al Nokhatha
- Rheumatology Department, Tawam Hospital, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
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Ellergezen P, Coşkun BN, Çeçen GS, Bozkurt ZY, Ağca H, Dalkılıç HE, Çavun S. Assessment of α 9β 1 ıntegrın as a new dıagnostıc and therapeutıc target ın Behcet's dısease. Clin Exp Med 2023; 23:5345-5353. [PMID: 37728818 DOI: 10.1007/s10238-023-01173-3] [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: 03/28/2023] [Accepted: 08/15/2023] [Indexed: 09/21/2023]
Abstract
This study aimed to investigate the roles of α9β1 integrin and its ligands in Behçet's disease (BD) by examining serum levels and gene expressions. 15 healthy controls and 30 BD patients (14 active and 16 inactive) were included in the study. Serum levels of ITGA9, ITGB1, TNC, OPN, VCAM-1, VEGF, TSP1, TGM2, Emilin-1, and vWF, were measured by ELISA. Gene expressions of α9β1 (ITGA9 and ITGB1) and its ligands (TNC and SPP1) were evaluated by RT-PCR. Laboratory findings (CRP, ESR, HGB, WBC, RBC, neutrophil, lymphocyte, PLT, RDW, MPV, PCT, and HLA-B51) were obtained from the electronic database. Active BD patients had higher serum levels of α9β1 integrin and its ligands than inactive patients and healthy controls. No significant difference was observed between healthy controls and inactive patients. Gene expressions of ITGB1 and SPP1 were increased in both patient groups compared to healthy controls. ITGA9 and TNC gene expression levels were lower in the active group than in the inactive group. No noticeable differences were found in ITGB1 and SPP1 gene expressions between the patient groups. BD patients exhibited elevated CRP, ESR, WBC, neutrophil, PLT, and PCT levels, while HGB, RBC, and RDW values were lower than healthy controls. Active patients had higher CRP, ESR, WBC, neutrophil, and PLT levels. Significant positive correlations were found between CRP, ESR, WBC, neutrophil, PLT, PCT and serum levels of α9β1 integrin and its ligands. Increased release of α9β1 integrin and its ligands is associated with BD, suggesting their potential as markers for disease severity.
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Affiliation(s)
- Pınar Ellergezen
- Bursa Uludag University Faculty of Medicine, Department of Medical Pharmacology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey.
| | - Belkıs Nihan Coşkun
- Bursa Uludag University Faculty of Medicine, Department of Rheumatology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
| | - Gülce Sevdar Çeçen
- Bursa Uludag University Faculty of Medicine, Department of Medical Pharmacology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
| | - Zeynep Yılmaz Bozkurt
- Bursa Uludag University Faculty of Medicine, Department of Rheumatology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
| | - Harun Ağca
- Bursa Uludag University Faculty of Medicine, Department of Medical Microbiology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
| | - Hüseyin Ediz Dalkılıç
- Bursa Uludag University Faculty of Medicine, Department of Rheumatology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
| | - Sinan Çavun
- Bursa Uludag University Faculty of Medicine, Department of Medical Pharmacology, Bursa Uludag University, Gorukle Campus, 16059, Nilufer-Bursa, Turkey
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Mir A, Ivory C, Cowan J. Concurrence of familial Mediterranean fever and Behçet's disease: a case report and review of the literature. J Med Case Rep 2023; 17:438. [PMID: 37865787 PMCID: PMC10590508 DOI: 10.1186/s13256-023-04185-5] [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: 03/20/2023] [Accepted: 09/20/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Familial Mediterranean fever and Behçet's disease are distinct disorders that are prevalent in the Mediterranean and Middle Eastern populations. They are characterized by unprovoked inflammatory episodes caused by overexpression of proinflammatory cytokines. Although reported previously, the overlapping presentation of familial Mediterranean fever and Behçet's disease remains uncommon. CASE PRESENTATION A 46-year-old Lebanese-Canadian man who presented with recurrent oral and genital ulcers, polyarticular synovitis, ocular swelling, recurrent infections, and fevers was later found to have heterozygous mutations of pathogenic MEFV c.2080A > G (p. Met 694Val) and c.2082G > A (p.Met694IIe) genes indicating familial Mediterranean fever. He was treated with prednisone, colchicine, and azathioprine, with inadequate symptoms control. Treatment was complicated by recurrent infections. CONCLUSIONS Our case contributes to the growing literature demonstrating the presentation of predominantly Behçet's disease-like features in the setting of diagnosis of familial Mediterranean fever. These findings emphasize that clinicians should be aware that patients with familial Mediterranean fever may present with Behçet's disease-like clinical manifestations.
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Affiliation(s)
- Adhora Mir
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada
| | - Catherine Ivory
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada
| | - Juthaporn Cowan
- Department of Medicine, University of Ottawa, 501 Smyth Rd, Ottawa, ON, Canada.
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Ma R, Zhu Y, Li X, Hu S, Zheng D, Xiong S, Xu S, Xiang L, Zhao M, Tang C, Zeng Z, Chen M, Feng R. A Novel Serum Metabolomic Panel for the Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2023; 29:1524-1535. [PMID: 37195904 DOI: 10.1093/ibd/izad080] [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: 01/04/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND A distinctive metabolic phenotype provides the opportunity to discover noninvasive biomarkers for the diagnosis of Crohn's disease (CD) and for differentiating it from other intestinal inflammatory diseases. The study sought to identify new biomarkers for CD diagnosis. METHODS Serum metabolites from 68 newly diagnosed and treatment-naïve patients with CD and 56 healthy control (HC) subjects were profiled using targeted liquid chromatography-mass spectrometry. Five metabolic biomarkers were identified to distinguish patients with CD from the HC subjects and validated in a separate cohort consisting of 110 patients with CD and 90 HC subjects using a combination of univariate analysis, orthogonal partial least-squares discriminant analysis, and receiver-operating characteristic curve analysis. Differences in the 5 metabolites were evaluated among patients with CD and patients with ulcerative colitis (n = 62), intestinal tuberculosis (n = 48), and Behçet's disease (n = 31). RESULTS Among the 185 quantified metabolites, a panel of 5 (pyruvate, phenylacetylglutamine, isolithocholic acid, taurodeoxycholic acid, and glycolithocholic acid) were found to distinguish patients with CD with high accuracy from HC subjects, with an area under the curve of 0.861 (P < .001). The performance of the model in assessing clinical disease activity was comparable to that of the present biomarkers: C-reactive protein and erythrocyte sedimentation rate. The 5 metabolites were significantly different among the patients and were valuable in the differentiation between CD and other chronic intestinal inflammatory diseases. CONCLUSIONS The combination of 5 serum metabolite biomarkers for the diagnosis of CD has the potential to provide an accurate, noninvasive, and inexpensive alternative to conventional tests and might be valuable for the differentiation from other diagnostically challenging intestinal inflammatory diseases.
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Affiliation(s)
- Ruiqi Ma
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yijun Zhu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaozhi Li
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shixian Hu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Danping Zheng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shanshan Xiong
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shu Xu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liyuan Xiang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Zhao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ce Tang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Feng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Gastroenterology, Guangxi Hospital Division of The First Affiliated Hospital, Sun Yat-sen University, Nanning, China
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Mahaju S, Achhami E, Lamichhane S, Chalise KN, Gautam R. A rare case of Behcet's disease in Nepal: multisystem manifestations and diagnostic challenges. Ann Med Surg (Lond) 2023; 85:5259-5262. [PMID: 37811046 PMCID: PMC10553148 DOI: 10.1097/ms9.0000000000001279] [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: 06/28/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023] Open
Abstract
Behcet's disease (BD) is a chronic inflammatory disorder characterized by a relapsing and remitting course and multisystem involvement. The authors present a case report of a 20-year-old male who presented with bilateral knee joint pain, oral and genital ulcers, and papulopustular skin lesions. The patient's clinical history, physical examination, laboratory findings, and biopsy results were consistent with the diagnosis of BD. The patient tested positive for the HLA-B51 allele, confirming a genetic predisposition. The diagnosis was supported by a positive pathergy test and a skin biopsy showing vasculitis. The diagnostic criteria established by the international study group and the International Criteria for Behcet's Disease were fulfilled. Treatment consisted of colchicine, azathioprine, and topical corticosteroids. This case highlights the importance of recognizing the varied clinical presentations of BD and the need for a multidisciplinary approach to diagnosis and management. Early and accurate diagnosis is crucial to prevent severe complications and improve patient outcomes.
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Affiliation(s)
| | - Eliz Achhami
- Sukraraj Tropical and Infectious Disease Hospital
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de Andrade FA, Porto LC, Gomes Ochtrop ML, Bacchiega ABS, de Almeida Neves R, Morette L, Santos G, de Souza AWS, Matos K, Abramino Levy R. HLA Alleles in a Behçet Disease Multiethnic Population With and Without Ophthalmic Manifestations. J Clin Rheumatol 2023; 29:341-346. [PMID: 37748433 DOI: 10.1097/rhu.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The aim of this study was to analyze HLA alleles in patients with Behçet disease (BD) and their correlation with ophthalmic manifestations (OMs) in a multiethnic Brazilian population. METHODS This case-control study compared 72 BD patients with or without OM who underwent a thorough ophthalmologic evaluation, including best-corrected visual acuity, bino-ophthalmoscopy, and HLA analysis, with 144 matched healthy controls. Fluorescein angiography was also performed in the patients with BD and OM. HLA class I (A, B, and C) and II (DRB1, DQB1, and DQA1) typing were performed using PCR-SSO. RESULTS Of 72 patients with BD, 42 (58%) had OM. The HLA-B*51 and -A*26 alleles were more frequent in patients with BD than in controls (23.6% vs 14.6% and 12.5% vs 4.3%, respectively), but could not differentiate OM risk. The HLA alleles of BD patients that differentiated those with and without OM were HLA-B*15 (40.5% vs 20.7%; odds ratio [OR], 2.59; p = 0.0059), HLA-C*02 (33.3% vs 13.4%; OR, 3.20; p = 0.0024), and HLA-DQB1*03 (64.3% vs 45.7%, p = 0.017), whereas HLA-A*03 (0.0% vs 13.3%, p = 0.006) and HLA-DRB1*15 (4.8% vs 19.5%; OR, 0.21; p = 0.0121) were protective against OM. CONCLUSIONS In this study of a Brazilian multiethnic BD population, alleles were similar between groups of BD patients with and without OM. We described HLA-B*15, -C*02, and -DQB1*03 as risk factors and -A*03 and -DRB1*15 as protective factors for OM in BD, which could function as biomarkers for predicting disease phenotypes.
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Affiliation(s)
- Francisco Assis de Andrade
- From the Ophthalmologist, PGCM, Faculdade de Ciências Médica, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luís Cristóvão Porto
- TIXUS-Technologic Core for Tissue Repair and Histocompatibility, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Manuella Lima Gomes Ochtrop
- Discipline of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Beatriz Santos Bacchiega
- Discipline of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ricardo de Almeida Neves
- Discipline of Ophthalmology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Morette
- TIXUS-Technologic Core for Tissue Repair and Histocompatibility, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Gilson Santos
- TIXUS-Technologic Core for Tissue Repair and Histocompatibility, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Alexandre Wagner Silva de Souza
- Discipline of Rheumatology, Hospital São Paulo-Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kimble Matos
- Department of Ophthalmology, Instituto da Visão, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Roger Abramino Levy
- Discipline of Rheumatology, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Silva L, Correia J, Santos E. [Diagnosis and Treatment of Neuro-Behçet: A Clinical Update]. ACTA MEDICA PORT 2023; 36:588-594. [PMID: 37345389 DOI: 10.20344/amp.19734] [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: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 06/23/2023]
Abstract
Behçet's disease is a relapsing multisystemic inflammatory syndrome characterized by recurrent oral and/or genital ulcers, uveitis, arthritis, skin lesions, and gastrointestinal and neurological involvement. Neuro-Behçet corresponds to nervous system involvement and is one of the most severe complications of Behçet disease. It occurs in 3% to 30% of cases and is categorized into parenchymal (most common) or non-parenchymal disease. The most common manifestation of parenchymal neuro-Behçet is meningoencephalitis with involvement of the brainstem, where patients present with cranial neuropathies, encephalopathy, sensory-motor syndromes, epilepsy, or myelitis. The main non-parenchymal manifestation is cerebral venous thrombosis. Neuro-Behçet has a predominantly subacute course, with remission within weeks, or clinical progression in one third of the cases. The diagnosis is essentially clinical and diagnostic tests help to corroborate the suspicion, distinguish from differential diagnoses, and exclude complications. Brain magnetic resonance imaging allows the identification of acute lesions (hypointense or isointense on T2-weighted and hypointense on T1-weighted sequences) contrast-enhanced, and chronic lesions characterized by non-contrast enhanced small lesions and brainstem atrophy. If non-parenchymal involvement is suspected, cerebral veno-magnetic resonance imaging /computed tomography should be performed. Cerebrospinal fluid shows elevated proteinorachia and pleocytosis in parenchymal and no changes in non-parenchymal neuro-Behçet (except increased opening pressure). Outbursts of parenchymal disease should be treated with high dose intravenous corticosteroid therapy, with subsequent switch to oral corticoids, followed by biologic therapy, usually an anti-TNF. The treatment of cerebral venous thrombosis is controversial and may consist of a combination of corticosteroids and anticoagulation.
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Affiliation(s)
- Lénia Silva
- Serviço de Neurologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
| | - João Correia
- Serviço de Medicina Interna. Centro Hospitalar Universitário de Santo António. Porto; Unidade Multidisciplinar de Investigação Biomédica. Instituto Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
| | - Ernestina Santos
- Serviço de Neurologia. Centro Hospitalar Universitário de Santo António. Porto; Unidade Multidisciplinar de Investigação Biomédica. Instituto Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
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Erturk A, Sarıkaya Y, Coşkun H, Turan Ç. Measuring the Whole Wall Thickness of the Common Femoral Vein as a Distinctive Diagnostic Tool to Distinguish Behçet's Disease Presenting with Oral Ulcers from Recurrent Aphthous Stomatitis. Diagnostics (Basel) 2023; 13:2705. [PMID: 37627964 PMCID: PMC10453469 DOI: 10.3390/diagnostics13162705] [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: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Recurrent oral ulcers, which are the first and most common manifestation of Behçet's disease (BD), have several etiological causes but are often idiopathic and known as recurrent aphthous stomatitis (RAS). In recent years, publications have drawn attention to the fact that whole-wall thickness (WWT) and intima-media thickness (IMT) measurements of the common femoral vein (CFV) may be useful in the diagnosis of BD, which are independent of organ involvement. In this study, the usefulness of the WWT and IMT of the CFV measured by venous Doppler ultrasound (US) was investigated in differentiating BD presenting with oral ulcers from RAS. Patients with BD (n = 84), patients with RAS (n = 85), and healthy controls (HCs) (n = 70) were the three groups included. Both the right and left WWT of the CFV were significantly higher in the BD compared with the HCs and RAS groups (p < 0.001). The diagnostic cutoff values of ≥0.58 mm for the WWT of the CFV performed well against both the patients with RAS and HCs for the discrimination of BD (sensitivity = 79.8%, specificity = 64.7%). In patients with recurrent oral ulcers, the WWT of the CFV measurement may be a distinctive new diagnostic tool for the differential diagnosis of BD and RAS.
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Affiliation(s)
- Adem Erturk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey; (Y.S.); (H.C.)
| | - Hüseyin Coşkun
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey; (Y.S.); (H.C.)
| | - Çağrı Turan
- Department of Dermatology and Venereology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey;
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12
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Kudsi M, Drie T, Haidar G, Al-Sayed S, Roumieh E. Genital Ulcers Associated with Systemic Lupus Erythematosus - What are the Possible Causes? A Case Report. Eur J Case Rep Intern Med 2023; 10:003972. [PMID: 37554473 PMCID: PMC10405874 DOI: 10.12890/2023_003972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 08/10/2023] Open
Abstract
UNLABELLED Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects many organs. In this report, we discuss the case of a patient with SLE who presented to an out-hospital clinic, complaining of fever and pain with genital ulcers. Negative evaluations for other causes of genital ulcers, indicated these ulcers as related to SLE. This case highlights the importance of including SLE ulcers in the differential diagnosis of genital ulcers. LEARNING POINTS Determining the cause of genital ulceration is a clinical challenge, especially in sexually active individuals.Genital ulcers associated with SLE are often underdiagnosed. Any patient with a history of SLE presenting with genital discomfort and/or pain must be evaluated for genital ulcers without delay.
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Affiliation(s)
- Maysoun Kudsi
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Tasneem Drie
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Ghina Haidar
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Safaa Al-Sayed
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
| | - Enas Roumieh
- Rheumatology Department, Faculty of Medicine, Damascus university / Syrian Private University, Damascus, Syria
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13
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Agliardi C, Guerini FR, Bolognesi E, Zanzottera M, Clerici M. VDR Gene Single Nucleotide Polymorphisms and Autoimmunity: A Narrative Review. BIOLOGY 2023; 12:916. [PMID: 37508347 PMCID: PMC10376382 DOI: 10.3390/biology12070916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 07/30/2023]
Abstract
The vitamin D/Vitamin D receptor (VDR) axis is crucial for human health as it regulates the expression of genes involved in different functions, including calcium homeostasis, energy metabolism, cell growth and differentiation, and immune responses. In particular, the vitamin D/VDR complex regulates genes of both innate and adaptive immunity. Autoimmune diseases are believed to arise from a genetic predisposition and the presence of triggers such as hormones and environmental factors. Among these, a role for Vitamin D and molecules correlated to its functions has been repeatedly suggested. Four single nucleotide polymorphisms (SNPs) of the VDR gene, ApaI, BsmI, TaqI, and FokI, in particular, have been associated with autoimmune disorders. The presence of particular VDR SNP alleles and genotypes, thus, was observed to modulate the likelihood of developing diverse autoimmune conditions, either increasing or reducing it. In this work, we will review the scientific literature suggesting a role for these different factors in the pathogenesis of autoimmune conditions and summarize evidence indicating a possible VDR SNP involvement in the onset of these diseases. A better understanding of the role of the molecular mechanisms linking Vitamin D/VDR and autoimmunity might be extremely useful in designing novel therapeutic avenues for these disorders.
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Affiliation(s)
| | | | | | | | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, LAMMB, 20148 Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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14
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Bettiol A, Fagni F, Mattioli I, Bagni G, Vitiello G, Grassi A, Della Bella C, Benagiano M, Troilo A, Holownia KS, Simon D, Argento FR, Sota J, Fabiani C, Becatti M, Fiorillo C, Schett G, Lopalco G, Cantarini L, Prisco D, Silvestri E, Emmi G, D'Elios MM. Serum Interleukin-36 α as a Candidate Biomarker to Distinguish Behçet's Syndrome and Psoriatic Arthritis. Int J Mol Sci 2023; 24:ijms24108817. [PMID: 37240162 DOI: 10.3390/ijms24108817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Behçet's syndrome (BS) is a rare systemic vasculitis characterized by different clinical manifestations. As no specific laboratory tests exist, the diagnosis relies on clinical criteria, and the differential diagnosis with other inflammatory diseases can be challenging. Indeed, in a relatively small proportion of patients, BS symptoms include only mucocutaneous, articular, gastrointestinal, and non-typical ocular manifestations, which are frequently found also in psoriatic arthritis (PsA). We investigate the ability of serum interleukin (IL)-36α-a pro-inflammatory cytokine involved in cutaneous and articular inflammatory diseases-to differentiate BS from PsA. A cross-sectional study was performed on 90 patients with BS, 80 with PsA and 80 healthy controls. Significantly lower IL-36α concentrations were found in patients with BS as compared to PsA, although in both groups IL-36α was significantly increased compared to healthy controls. An empirical cut-off of 420.6 pg/mL displayed a specificity of 0.93, with a sensitivity of 0.70 (AUC 0.82) in discriminating PsA from BS. This cut-off displayed a good diagnostic performance also in BS patients lacking highly specific BS manifestations. Our results indicate that IL-36α might be involved in the pathogenesis of both BS and PsA, and might be a candidate biomarker to support the differential diagnosis of BS.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Filippo Fagni
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Giacomo Bagni
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Gianfranco Vitiello
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Alessia Grassi
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Chiara Della Bella
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Arianna Troilo
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | | | - David Simon
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Flavia Rita Argento
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Firenze, 50134 Firenze, Italy
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, 53100 Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy
| | - Matteo Becatti
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Firenze, 50134 Firenze, Italy
| | - Claudia Fiorillo
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Firenze, 50134 Firenze, Italy
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich Alexander University Erlangen-Nuremberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organs Transplantation (DETO), University of Bari, 70124 Bari, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, 53100 Siena, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, 50134 Firenze, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, VIC 3168, Australia
| | - Mario Milco D'Elios
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
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15
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Jazeer M, Antony D, Pakkiyaretnam M. Aseptic Abscess of the Spleen as an Antecedent Manifestation of Behçet's Disease. Cureus 2023; 15:e38375. [PMID: 37265896 PMCID: PMC10230598 DOI: 10.7759/cureus.38375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
Behçet's disease (BD) is a multisystem autoimmune vasculitis that manifests as oral and genital ulcers with varying degrees of dermatological and ocular involvement. Aseptic splenic abscesses are a rare entity commonly occurring in autoinflammatory diseases and are rarely associated with BD. Here, we present the case of a 16-year-old male with BD who presented with prolonged fever and constitutional symptoms and was found to have an aseptic splenic abscess. Rapid resolution of the symptoms along with radiological evidence of abscess shrinkage was achieved with corticosteroid therapy.
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Affiliation(s)
- Mohamed Jazeer
- Internal Medicine, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Diroji Antony
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
| | - Mayurathan Pakkiyaretnam
- University Medical Unit, Teaching Hospital Batticaloa, Batticaloa, LKA
- Department of Clinical Sciences, Faculty of Health-Care Sciences, Eastern University of Sri Lanka, Batticaloa, LKA
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16
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Avnat E, Shapira G, Shoval S, Israel-Elgali I, Alkelai A, Shuldiner AR, Gonzaga-Jauregui C, Zidan J, Maray T, Shomron N, Friedman E. Comprehensive Genetic Analysis of Druze Provides Insights into Carrier Screening. Genes (Basel) 2023; 14:genes14040937. [PMID: 37107695 PMCID: PMC10137689 DOI: 10.3390/genes14040937] [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: 02/18/2023] [Revised: 03/24/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Druze individuals, like many genetically homogeneous and isolated populations, harbor recurring pathogenic variants (PV) in autosomal recessive (AR) disorders. METHODS Variant calling of whole-genome sequencing (WGS) of 40 Druze from the Human Genome Diversity Project (HGDP) was performed (HGDP-cohort). Additionally, we performed whole exome sequencing (WES) of 118 Druze individuals: 38 trios and 2 couples, representing geographically distinct clans (WES-cohort). Rates of validated PV were compared with rates in worldwide and Middle Eastern populations, from the gnomAD and dbSNP datasets. RESULTS Overall, 34 PVs were identified: 30 PVs in genes underlying AR disorders, 3 additional PVs were associated with autosomal dominant (AD) disorders, and 1 PV with X-linked-dominant inherited disorder in the WES cohort. CONCLUSIONS The newly identified PVs associated with AR conditions should be considered for incorporation into prenatal-screening options offered to Druze individuals after an extension and validation of the results in a larger study.
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Affiliation(s)
- Eden Avnat
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Guy Shapira
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shelly Shoval
- The Susanne Levy Gertner Oncogenetics Unit, Institute of Human Genetics, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Ifat Israel-Elgali
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Anna Alkelai
- Regeneron Genetics Center, Tarrytown, NY 10591, USA
| | | | - Claudia Gonzaga-Jauregui
- Regeneron Genetics Center, Tarrytown, NY 10591, USA
- International Laboratory for Human Genome Research, Laboratorio Internacional de Investigación sobre el Genoma Humano, Universidad Nacional Autónoma de México, Juriquilla 04510, Querétaro, Mexico
| | - Jamal Zidan
- The Oncology Department, Ziv Medical Center, and the Azrieli Faculty of Medicine, Bar-Ilan University, Zefat 13206, Israel
| | - Taiseer Maray
- Golan for Development, Majdal Shams 1243800, Golan Heights
| | - Noam Shomron
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Edmond J. Safra Center for Bioinformatics, Tel Aviv University, Tel Aviv 69978, Israel
- Sagol School of Neuroscience, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Eitan Friedman
- Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- The Meirav High Risk Clinic, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel
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17
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Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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18
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Tugal-Tutkun I. Uveitis in Behçet disease - an update. Curr Opin Rheumatol 2023; 35:17-24. [PMID: 36255985 DOI: 10.1097/bor.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Uveitis is a major manifestation of Behçet disease (BD) and potentially has a high morbidity. This article reviews recently published data on BD uveitis. RECENT FINDINGS A set of classification criteria and a diagnostic algorithm have been developed for BD uveitis. Recent reports have confirmed male predominance and posterior segment inflammation in the majority of BD uveitis patients. A high uveitis attack severity score, fluorescein angiographic leakage at the posterior pole, and disruption of outer retinal layers on optical coherence tomography (OCT) predict poor visual outcome. OCT-angiography studies have suggested subclinical changes of retinal capillaries in patients with or without ocular involvement. In a randomized controlled trial, interferon-α was superior to cyclosporine. Favorable outcomes were reported with earlier initiation, optimization, and withdrawal of infliximab after remission. Adalimumab as first-line was superior to conventional therapy. SUMMARY Classification criteria will be used to select a homogeneous group of patients for research and the diagnostic algorithm may help ophthalmologists predict the probability of BD uveitis based on ocular findings. Fluorescein angiography and OCT are the routine imaging modalities. Clinical relevance of OCT-angiography is unclear. Interferon-α, infliximab, and adalimumab have proven superior efficacy compared to conventional therapy.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University
- Bayrampasa Eye Hospital, Eye Protection Foundation, Istanbul, Turkey
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19
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Behçet's Disease: A Radiological Review of Vascular and Parenchymal Pulmonary Involvement. Diagnostics (Basel) 2022; 12:diagnostics12112868. [PMID: 36428928 PMCID: PMC9689730 DOI: 10.3390/diagnostics12112868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/13/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Behcet's disease (BD) is a chronic systemic inflammatory disorder characterized by underlying chronic vasculitis of both large- and small-caliber vessels. Thoracic involvement in BD can occur with various types of manifestations, which can be detected with contrast-enhanced MSCT scanning. In addition, MR can be useful in diagnosis. Characteristic features are aneurysms of the pulmonary arteries that can cause severe hemoptysis and SVC thrombosis that manifests as SVC syndrome. Other manifestations are aortic and bronchial artery aneurysms, alveolar hemorrhage, pulmonary infarction, and rarely pleural effusion. Achieving the right diagnosis of these manifestations is important for setting the correct therapy and improving the patient's outcome.
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20
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Jalali KS, Alhazzaa MA, Alqahtani S, Alattas MY. Pontine Infarction and Vertebral Artery Dissecting Aneurysm as the First Presentation of Behçet’s Disease: A Case Report. Cureus 2022; 14:e29204. [PMID: 36259031 PMCID: PMC9572958 DOI: 10.7759/cureus.29204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Behçet’s disease (BD) is a systemic disease of inflammatory origin that appears most often in the third or fourth decade of life. Behçet’s disease is hallmarked predominantly by mucocutaneous lesions and ocular involvement. Vertebral artery dissection and neurological manifestations are rare complications in Behçet’s disease. We examine the case of a medically free 33-year-old male who was admitted to the emergency department complaining of sudden-onset dizziness, vomiting, and tinnitus. Neurological examination revealed fluctuating consciousness, multiple gaze nystagmus, motor deficit in the upper and lower limbs, bilateral Babinski sign, and truncal ataxia. Magnetic resonance imaging (MRI) showed a right pontine hyperintense lesion on T2-weighted images (T2WI). A right vertebral angiogram four months after the incident showed a dissection in the mid-cervical third of an anomalous duplicated origin arm of the right vertebral artery. This case describes an uncommon form of initial presentation of Behçet’s disease via a pontine infarction triggered by a dissecting aneurysm in an anatomically rare variant of the vertebral artery.
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21
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Aboul Naga SH, Hassan LM, El Zanaty RT, Refaat M, Amin RH, Ragab G, Soliman MM. Behçet uveitis: Current practice and future perspectives. Front Med (Lausanne) 2022; 9:968345. [PMID: 36160151 PMCID: PMC9490079 DOI: 10.3389/fmed.2022.968345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Described as early as Hippocrates in his “Third Book of Endemic Diseases,” Behçet's Disease (BD), also known as “The Silk Road Disease” following its initial demographics, consists of a triad of recurrent oro-genital ulcers and associated uveitis. Current demographics and rising percentages of patients seen far beyond the Silk Road in Ocular Inflammatory Disease and Uveitis Clinics list BD uveitis as one of the frontliners of non-infectious autoinflammatory eye diseases. Clinical features of BD and juvenile-onset BD are detailed alongside various approaches in classification and suggested algorithms for diagnosis that are outlined in this review. With the ongoing Human Microbiome Project and studies such as the MAMBA study, the role of the human microbiome in BD is highlighted in the pathophysiology of BD to include the current research and literature perspective. Furthermore, with the advancement of recent diagnostic and investigative techniques, especially in the field of Optical Coherence Tomography (OCT), disease-related characteristics are updated to encompass SD, EDI and OCT-angiography characteristics of BD. Having entered the era of biologic therapy, the role of various specific cytokine-blocking biologic drugs, such as TNF-α inhibitors (e.g., adalimumab, infliximab), interferon α-2a inhibitors, IL-6 and IL-1 inhibitors are presented and contrasted alongside the conventional immunosuppressant drugs and the classic old gold standard: corticosteroids (systemic or local). Finally, with the ongoing SARS-CoV-2 pandemic, it was not possible to conclude the review without reviewing the latest evidence-based literature reporting BD morbidity in this era, the observed pattern and treatment recommendations as well as those related to reported post-vaccine complications and emergence of BD.
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Affiliation(s)
- Shereen H. Aboul Naga
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Lameece Moustafa Hassan
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Radwa T. El Zanaty
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Mohammad Refaat
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Rana H. Amin
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- *Correspondence: Gaafar Ragab
| | - Mahmoud M. Soliman
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
- Mahmoud M. Soliman
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22
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The eyes have it: when skin findings prompt referral to ophthalmology. Curr Opin Pediatr 2022; 34:381-389. [PMID: 35836396 DOI: 10.1097/mop.0000000000001143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW Co-presentation of ocular and cutaneous conditions is common and prompt recognition of known associations may be imperative to sight-saving intervention. There are currently limited reviews in the pediatric literature addressing comorbid ocular and dermatologic presentations. Recent diagnostic and therapeutic advances have drastically altered the prognostic landscape for several disease states when recognition and referral are timely. The aim of this report is to examine important oculocutaneous disease associations with emphasis on management of ocular complications and appropriate referral practices to ophthalmology specialists. RECENT FINDINGS Oculocutaneous associations can be broadly classified into four etiologic categories: infectious, inflammatory, genetic, and medication/nutrition induced pathology. Several conditions in all four categories have had recent advances in their etiologic understanding, diagnostic evaluation, and therapeutic approach. Thematically, these advances highlight increasing disease prevalence of certain conditions, previously unrecognized pediatric relevance of others, updated diagnostic criteria, and newer categories of iatrogenic illness induced by advances in medical therapy. SUMMARY This review is designed to provide the pediatric practitioner a vignette-based high-level overview of both common and sight threatening associations that should prompt consideration for ophthalmology consultation. Conditions were selected based on relevance, relative urgency, and recent advances in their etiologic/therapeutic understanding.
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Wu M, Li L, Tian L, Liu D, Jian J, Zhou Y, Xu Y. 5Apal, Taql, Fokl, and Bsml polymorphisms and the susceptibility of Behcet's disease: an updated meta-analysis. Immunol Res 2022; 70:781-792. [PMID: 35849257 DOI: 10.1007/s12026-022-09306-8] [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: 04/11/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate whether the gene polymorphisms of vitamin D receptor (VDR) had a genetic effect on the susceptibility of Behcet's disease (BD). MATERIAL AND METHODS We conducted a meta-analysis emphasizing the association between the VDR gene polymorphisms and the risk of BD. The strength of the association in five genetic models was assessed by pooled odds ratios (OR) with a corresponding 95%confidence interval (CI). RESULTS A total of seven independent comparisons with 478 cases and 666 healthy controls were included in this meta-analysis. The overall results suggested that a significant association between ApaI polymorphism and BD risk was found in allele comparison, recessive model, and homozygote model among total populations. Subgroup analysis indicated that a significant association of ApaI polymorphism in the development of BD existed under the allelic model among Africans, while for Caucasians, a similar link was identified in the recessive model and homozygote model. Regarding Bsml polymorphism, an obvious relationship was detected to be significant in allele comparison and recessive model in the Caucasian population. Interestingly, the Fokl variant decreased the risk of BD in Africans under five genetic models, while it increased the risk in Caucasians across the recessive model and homozygote model. CONCLUSION The results of this meta-analysis provide evidence of the link between the four widely studied polymorphisms in the VDR gene and BD, indicating a robust estimate of the genetic risk.
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Affiliation(s)
- Mingxing Wu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lanjiao Li
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lulu Tian
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Danning Liu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Jian
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Xu
- Department of Ophthalmology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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TEZCAN D, TURAN Ç, YİLMAZ S. The effect of colchicine treatment on complete blood cell count-based parameters in patients with Behçet's disease. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1062603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tezcan D, Özer H, Gülcemal S, Hakbilen S, Durmaz MS, Batur A, Yilmaz S. Diagnostic Performance of Lower Extremity Venous Wall Thickness and Laboratory Findings in the Diagnosis of the Behçet Disease. J Clin Rheumatol 2022; 28:e521-e527. [PMID: 34538847 DOI: 10.1097/rhu.0000000000001788] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Behçet disease (BD) is not a single unique entity but a syndrome with different clinical phenotypes that can involve arterial and venous vessels of all sizes. To date, there has been no specific test or serum marker to measure and determine the severity of BD, and diagnosis remains based on clinical findings. This study aimed to assess lower extremity venous wall thickness (VWT) measured by ultrasound and laboratory findings and diagnostic performance in patients with BD. METHODS A total of 106 participants were recruited from the rheumatology department in this single-center, case-control study. Participants meeting the eligibility criteria were divided into healthy controls (n = 52) and BD (n = 54). The VWT values of the common femoral vein, great saphenous vein, and popliteal vein were measured using ultrasonography. Laboratory data were obtained from the electronic registration database. Venous wall thicknesses and laboratory findings in patients with BD and healthy subjects were compared. RESULTS Venous wall thickness of the lower extremity veins was higher in the BD group and higher in those with a history of deep vein thrombosis than in those without. The mean leukocyte, monocyte, erythrocyte sedimentation rate (ESR), C-reactive protein, plateletcrit (PCT), red cell distribution width (RDW), mean platelet volume (MPV) values, and monocyte-to-lymphocyte ratio (MLR) were higher in BD patients than in the control group. There was a correlation among increased VWT, ESR, PCT, MPV, RDW, and MLR. CONCLUSIONS C-reactive protein, ESR, MPV, PCT, MLR, RDW, and VWT can be used to assist in the diagnosis of BD.
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Affiliation(s)
| | - Halil Özer
- Radiology, Selcuk University Faculty of Medicine, Selcuklu, Konya, Turkey
| | | | | | | | - Abdussamed Batur
- Radiology, Selcuk University Faculty of Medicine, Selcuklu, Konya, Turkey
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26
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Nguyen A, Upadhyay S, Javaid MA, Qureshi AM, Haseeb S, Javed N, Cormier C, Farooq A, Sheikh AB. Behcet's Disease: An In-Depth Review about Pathogenesis, Gastrointestinal Manifestations, and Management. Inflamm Intest Dis 2022; 6:175-185. [PMID: 35083283 DOI: 10.1159/000520696] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/03/2021] [Indexed: 11/19/2022] Open
Abstract
Background Behcet's disease (BD) is a complex inflammatory vascular disorder that follows a relapsing-remitting course with diverse clinical manifestations. The prevalence of the disease varies throughout the globe and targets different age-groups. There are many variations of BD; however, intestinal BD is not only more common but has many signs and symptoms. Summary BD is a relapsing-remitting inflammatory vascular disorder with multiple system involvement, affecting vessels of all types and sizes that targets young adults. The etiology of BD is unknown but many factors including genetic mechanisms, vascular changes, hypercoagulability, and dysregulation of immune function are believed to be responsible. BD usually presents with signs and symptoms of ulcerative disease of the small intestine; endoscopy being consistent with the clinical manifestations. The mainstay of treatment depends upon the severity of the disease. Corticosteroids are recommended for severe forms of the disease and aminosalicylic acids are used in maintaining remission in mild to moderate forms of the disease. Key Messages In this review, we have tried to summarize in the present review the clinical manifestations, differential diagnoses, and management of intestinal BD. Hopefully, this review will enable health policymakers to ponder over establishing clear endpoints for treatment, surveillance investigations, and creating robust algorithms.
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Affiliation(s)
- Anthony Nguyen
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Shubhra Upadhyay
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | | | - Abdul Moiz Qureshi
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shahan Haseeb
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Christopher Cormier
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Asif Farooq
- Department of Family and Community Medicine, Texas Tech Health Sciences Center, Lubbock, Texas, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Dehghan A, Soleimani Salehabadi H, Jamshidi A, Kamali Z, Mali M, Faezi ST, Baghdadi A, Alesaeidi S, Sahraei F, Azizi N, Zand S, Yasini SS, Namazi M, Daya A, Nazemian R, Shamsi F, Nejadhosseinian M, Davatchi F. Epidemiology of musculoskeletal symptoms, rheumatologic disorders, and disability in the Zoroastrian population in Yazd, Iran: a WHO-ILAR COPCORD study (stage 1). BMC Rheumatol 2021; 5:46. [PMID: 34724982 PMCID: PMC8561944 DOI: 10.1186/s41927-021-00214-2] [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: 01/06/2021] [Accepted: 07/07/2021] [Indexed: 11/22/2022] Open
Abstract
Background The purpose of this study was to determine the prevalence of musculoskeletal complaints, rheumatologic diseases, and disability among the Zoroastrian population in Iran. Methods The city of Yazd, in central Iran was selected for this study, with the highest population of Zoroastrians in Iran. Subjects were selected by cluster sampling of 9 neighborhoods populated with Zoroastrians. Subjects ≥15 years old were interviewed by trained interviewers in their houses. The validated Farsi translation of Community Oriented Program for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) was used for this study. Subjects with musculoskeletal complaints (pain, stiffness and/or swelling) were examined by a rheumatologist. Laboratory tests and radiographic exams were performed when deemed necessary. Results Two-thousand subjects were interviewed during a 12-month period, of which 956 were male, and 1044 were female. The mean age was 41.1 ± 18.3 years (95%CI: 40.3–41.9). 36.9% of the subjects had university-level education. In the 7 days prior to the interview, 27.6% of the subjects had musculoskeletal complaints, with the knee, dorsolumbar spine, and shoulder being the most common sites of complaints. The most common rheumatologic diagnoses were osteoarthritis (21.5%) and low back pain (10.3%). Rheumatoid arthritis was diagnosed in 1.2% of the subjects. Conclusions The epidemiology of musculoskeletal complaints and rheumatologic disorders was inconsistent with previous COPCORD studies in Iran, with a lower prevalence of musculoskeletal complaints in general, lower rates of Behçet and lupus, and a higher prevalence of rheumatoid arthritis. The findings of this study can be for development of better prevention, screening, and treatment programs for the vulnerable population of Zoroastrians in Iran.
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Affiliation(s)
- Ali Dehghan
- Department of Internal Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Soleimani Salehabadi
- Department of Internal Medicine, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ahmadreza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
| | - Zohre Kamali
- Diabetic Care Center, Shahid Sadoughi University, Yazd, Iran
| | - Mojgan Mali
- Ziayee Hospital, Shahid Sadoughi University, Ardakan, Yazd, Iran
| | - Seyedeh Tahereh Faezi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran.
| | - Azarakhsh Baghdadi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran.
| | - Sogol Alesaeidi
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Sahraei
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Sanaz Zand
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sara Sadat Yasini
- Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Atefe Daya
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ryan Nazemian
- Clinical Translational Science PhD Program, Case Western Reserve University, Cleveland, OH, USA
| | - Farimah Shamsi
- Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Nejadhosseinian
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Tehran University of Medical Sciences, North Amirabad Street, Tehran, 1411713137, Iran
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Tezcan D, Körez MK, Gülcemal S, Hakbilen S, Akdağ T, Yılmaz S. Evaluation of diagnostic performance of haematological parameters in Behçet's disease. Int J Clin Pract 2021; 75:e14638. [PMID: 34309974 DOI: 10.1111/ijcp.14638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/21/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Behçet's Disease (BD) is a polygenic and chronic autoinflammatory multisystemic vasculitis disease characterised by mucocutaneous, musculoskeletal, neurological, gastrointestinal and ophthalmologic lesions. There has been no specific test or serum marker to measure and determine the diagnosis and severity of BD. PURPOSE The study aimed to investigate the diagnostic performance of haematological parameters as MLR (monocyte to lymphocyte ratio), NLR (neutrophil to lymphocyte ratio), PLR (platelet to lymphocyte ratio), MPV (mean platelet volume), MPVPR (mean platelet volume to platelet ratio), LMR (lymphocyte to monocyte ratio), LPM (lymphocyte and platelet multiplication), WLP (lymphocyte and leukocyte multiplication), RDW (red blood cell distribution width) and PCT (plateletcrit) in BD and compare these with disease activity and clinical findings. METHODS A total of 266 participants (49 healthy control and 217 BD patients) were recruited from the rheumatology department in a single-centre as a case-control study. The laboratory data were obtained from the electronic registration database. BD Activity scores (BDCAF/Behcet's Disease Current Activity Form) were calculated. Laboratory findings of BD patients and healthy controls were compared and evaluated. RESULTS RDW, Platelet, PCT, NLR and PLR values were significantly higher in patient group than in the healthy controls. However, haemoglobin, MPVPR and LMR were significantly lower in the patient group which compared with the healthy controls. LPM in BD with genital ulcers, WLP in BD with genital ulcers and arthritis, MPR in BD with uveitis, RDW in BD with thrombosis and neuro-Behçet's disease (NBD), PLR in NBD were observed to be higher. However, LMR in NBD and MPV in BD with thrombosis were lower than those without. There was a positive correlation between BDCAF score and RDW, and NLR. CONCLUSION Haemoglobin, RDW, Platelet, PCT, NLR, LMR, PLR and MPVPR were statistically significant predictors for BD. RDW, PCT and NLR are the most valuable predictors for BD.
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Affiliation(s)
- Dilek Tezcan
- Department of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Muslu Kazım Körez
- Department of Biostatistics, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Semral Gülcemal
- Department of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Selda Hakbilen
- Department of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Turan Akdağ
- Division of Biochemistry, Meram Vocational School, Necmettin Erbakan University, Konya, Turkey
| | - Sema Yılmaz
- Department of Rheumatology, Faculty of Medicine, Selcuk University, Konya, Turkey
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Yoshikawa K, Watanabe T, Sekai I, Takada R, Hara A, Kurimoto M, Masuta Y, Otsuka Y, Yoshikawa T, Masaki S, Kamata K, Minaga K, Komeda Y, Chikugo T, Kudo M. Case Report: A Case of Intestinal Behçet's Disease Exhibiting Enhanced Expression of IL-6 and Forkhead Box P3 mRNA After Treatment With Infliximab. Front Med (Lausanne) 2021; 8:679237. [PMID: 34055846 PMCID: PMC8160115 DOI: 10.3389/fmed.2021.679237] [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] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Behçet's disease (BD) is a rare inflammatory condition characterized by oral and genital ulcers, skin lesions, as well as ophthalmological, neurological, and gastrointestinal manifestations. BD involving the gastrointestinal tract is known as intestinal BD. The mucosa of the gastrointestinal tract of patients with intestinal BD exhibits enhanced levels of proinflammatory cytokines, such as IL-1β, IL-6, and TNF-α. These proinflammatory cytokines play pathogenic roles in the development of BD, as evidenced by the fact that biologics targeting these cytokines effectively induce BD remission. It should be noted, however, that the molecular mechanisms by which the blockade of these cytokines suppresses chronic inflammatory responses in BD are poorly understood. Herein, we report a case of intestinal BD resistant to prednisolone that was successfully treated with infliximab (IFX). The induction of remission by IFX was accompanied by a marked elevation of IL-6 and forkhead box P3 (FOXP3) at mRNA level. This case suggests that induction of remission by IFX is mediated not only by the suppression of TNF-α-mediated signaling pathways, but also by the promotion of IL-6 expression and accumulation of regulatory T cells expressing FOXP3.
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Affiliation(s)
- Keisuke Yoshikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ikue Sekai
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ryutaro Takada
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Akane Hara
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Masayuki Kurimoto
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuhiro Masuta
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuo Otsuka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomoe Yoshikawa
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Sho Masaki
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Ken Kamata
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kosuke Minaga
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yoriaki Komeda
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takaaki Chikugo
- Department of Diagnostic Pathology, Kindai University Hospital, Osaka, Japan
| | - Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka, Japan
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