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Eryavuz Onmaz D, Tezcan D, Abusoglu S, Sivrikaya A, Kuzu M, Yerlikaya FH, Yilmaz S, Unlu A. Elevated serum levels of kynurenine pathway metabolites in patients with Behçet disease. Amino Acids 2022; 54:877-887. [PMID: 35604497 DOI: 10.1007/s00726-022-03170-4] [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: 12/14/2021] [Accepted: 05/06/2022] [Indexed: 11/01/2022]
Abstract
Behçet disease (BD) is an inflammatory, multisystemic vasculitis of unknown etiopathogenesis. However, innate and adaptive immune system involvement and immune-mediated networks play a vital role in the inflammatory cascade. Indoleamine 2,3-dioxygenase 1 (IDO1) is activated in chronic inflammatory states and catalyzes the first and rate-limiting step of tryptophan (TRP) metabolism along the kynurenine pathway (KP). The study aimed to measure KP metabolites levels in patients with BD and investigate the relationship between disease activity and clinical findings with these metabolites. The study included 120 patients with BD and 120 healthy volunteers. Serum TRP, kynurenine (KYN), kynurenic acid (KYNA), 3-hydroxyanthranilic acid (3HAA), 3-hydroxykynurenine (3HK), and quinolinic acid (QUIN) levels were measured with the tandem mass spectrometric method. Demographic data, clinical manifestations, and disease activity score (BDCAF) were recorded. Serum KYN, KYNA, 3HK, 3HAA, QUIN levels, and KYN/TRP ratio were higher (p < 0.05) in patients with BD compared to the control group, while TRP levels were lower (p < 0.05). KYN/TRP ratio and QUIN levels were significantly higher in the presence of neuro-Behçet, while serum KYN levels were significantly higher in the presence of arthritis (p < 0.05). In addition, serum QUIN levels were significantly higher in the presence of thrombosis (p < 0.05). BDCAF score positively correlated with KYN/TRP ratio. Our findings showed that serum KP metabolite levels were elevated in patients with BD, and there is a relationship between these metabolites with disease activity, clinical findings, and inflammatory burden.
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Affiliation(s)
- Duygu Eryavuz Onmaz
- Department of Biochemistry, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey.
| | - Dilek Tezcan
- Division of Rheumatology, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Sedat Abusoglu
- Department of Biochemistry, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Abdullah Sivrikaya
- Department of Biochemistry, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Menekse Kuzu
- Department of Biochemistry, Faculty of Pharmacy, Biruni University, 34020, Istanbul, Turkey
| | | | - Sema Yilmaz
- Division of Rheumatology, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
| | - Ali Unlu
- Department of Biochemistry, Faculty of Medicine, Selcuk University, 42130, Konya, Turkey
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Khan A, Haroon M, Bashir F, Din ZU. Behcet's Disease: Pakistani Experience. Pak J Med Sci 2020; 36:1005-1010. [PMID: 32704279 PMCID: PMC7372659 DOI: 10.12669/pjms.36.5.1916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 05/16/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the clinical manifestation of patients with Behcet's disease, and performance of different classification criteria of Behcet's disease in our population. METHODS It was a retrospective analysis of all Behcet's disease patients attending Department of Rheumatology at Fatima Memorial Hospital, Lahore, Pakistan from April 2019 to July 2019. We performed a comprehensive clinical evaluation of patients with Behcet's disease, with focus on patients' age, gender and different clinical manifestations. RESULTS A consecutive cohort of 20 patients was studied. All patients met the International Criteria of Behcet's Disease criteria, and 18 out of 20 patients also met International Study Group criteria. Mean age of the cohort was 33.5±10.4 years and 45% was female (male to female ratio of 1:1.2). Around 90% of cohort had recurrent oral and genital ulcers. Ocular involvement was present in 80% patients, while Joint manifestations were present in 75% of patients. Cutaneous, neurological (both central and peripheral nervous system involvement), and GIT symptoms were present in 50%, 30%, and 15% of patients, consecutively. Joint pain and eye symptoms were major initial symptoms in males, while eye symptoms and neurological symptoms were more common in female patients at disease onset. Reaching border line significance, Cutaneous(p-value=0.479), ocular(p-value=0.61), and GIT involvement(p-value=0.59) were more prevalent in males while neurological involvement (p-value=0.336) in females. CONCLUSION Behcet's disease occurs commonly in middle age population with equal male to female ratio, with mucocutaneus aphthosis, ocular disease and joint pains being common manifestation. Gastrointestinal symptoms are more common in males while neurological symptoms in females.
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Affiliation(s)
- Asadullah Khan
- Asadullah Khan, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Muhammad Haroon
- Muhammad Haroon, FRSM, FFSEM, FACR, FRCP., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Farhan Bashir
- Farhan Bashir, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Zia ud Din
- Zia ud Din, FCPS (Medicine)., Division of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
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Abstract
PURPOSE OF REVIEW The incidence of aortic valve disease in inherited connective tissue disorders is well documented; however, recent studies have only begun to unravel the pathology behind this association. In this review, we aim to describe the etiology, clinical manifestations, management, and prognosis of aortic and aortic valvular disorders that co-exist in a variety of connective tissue diseases. An extensive literature review was performed in PubMed. Articles from 2008 to 2018 were included for review. Predetermined search terms used in PubMed include "aortic manifestation of connective tissue diseases" and "aortic valve disorders in rheumatologic disease." RECENT FINDINGS Manifestations of aortic valve disease in the context of connective tissue disorders include valvular stenosis, regurgitation, and/or thoracic aortic aneurysms. Both inherited and inflammatory connective tissue disorders contribute to aortic valve damage with increased susceptibility associated with specific gene variants. Anti-inflammatory and immunosuppressive therapies have demonstrated beneficial results in Marfan's syndrome, Behcet disease, rheumatoid arthritis, ankylosing spondylitis, and systemic sclerosis, often leading to remission. Yet, such therapy is less effective in other disorders compared to alternative treatments such as surgical intervention. Additionally, regular echocardiographic studies should be recommended to those suffering from these disorders, especially those at higher risk for cardiovascular involvement. Given the rates of relapse with immunosuppressants, even following aortic valve replacement, further studies are needed to determine if certain dosing and/or combinations of immunosuppressants could be given to those diagnosed with connective tissue diseases to prevent progression of aortic valve involvement.
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Affiliation(s)
- Bogna Grygiel-Górniak
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Mary-Tiffany Oduah
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Abdulbaril Olagunju
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Klokner
- Department of Rheumatology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
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Furuya MY, Temmoku J, Fujita Y, Matsuoka N, Asano T, Sato S, Kobayashi H, Watanabe H, Migita K. Vasculo-Behçet disease complicated by conversion disorder diagnosed with 18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography (PET/CT). Fukushima J Med Sci 2019; 65:55-60. [PMID: 31327803 DOI: 10.5387/fms.2019-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Vasculitis in Behçet's disease, termed "vasculo-Behçet's disease," is a major cause of mortality and morbidity. We report a case of vasculo-Behçet's disease complicated by conversion disorder, in which 18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography (FDG PET/CT) was useful for the diagnosis. A twenty-two-year-old woman recently diagnosed with tonsillitis presented with fever, right foot pain, left equinovarus foot, and numbness in both hands and feet. Laboratory data showed elevated levels of c-reactive protein (CRP). The patient was positive for HLA B51; pathergy testing was also positive. Nerve conduction velocity and electromyography were normal. MRI showed swelling of the left crural muscle group. PET/CT showed intense FDG uptake in the left popliteal artery, demonstrating active vasculitis. The patient was diagnosed with vasculo-Behçet's disease and treated with corticosteroids, colchicine, and infliximab, which led to obvious improvement of the MRI findings and reduction in CRP. However, left equinovarus foot and numbness in the extremities persisted. She also developed aphonia. They were attributed to psychogenic dystonia and conversion disorder, and psychiatric treatment was effective in relieving those symptoms. We suggest that PET/CT may be useful for the early diagnosis of medium-sized vessel vasculitis in patients with Behçet's disease.
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Affiliation(s)
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroko Kobayashi
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
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Liu HF, Wang M, Xu YS, Lu XR, Lei JQ. Left Circumflex Pseudoaneurysm and Left Anterior Descending Aneurysm in Coronary Artery Due to Behcet's Disease. Chin Med J (Engl) 2018; 131:2626-2627. [PMID: 30381603 PMCID: PMC6213832 DOI: 10.4103/0366-6999.244119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hai-Feng Liu
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Min Wang
- Department of Anesthesiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Yong-Sheng Xu
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xing-Ru Lu
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Jun-Qiang Lei
- Department of Radiology, First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
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Vision-Threatening Behcet's Disease: Severity of Ocular Involvement Predictors. J Ophthalmol 2018; 2018:9518065. [PMID: 29854430 PMCID: PMC5944234 DOI: 10.1155/2018/9518065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 02/21/2018] [Indexed: 11/18/2022] Open
Abstract
Purpose To examine and spot systemic findings commonly associated with a serious form of ocular Behcet's disease. This could potentially help ophthalmologists categorize their patients based on future risk and plan treatment accordingly. Subjects and Methods The data of 249 patients with Behcet's disease were examined thoroughly. Correlations between systemic and ocular findings were recorded. Patients were further subgrouped by the authors as having a vision-threatening form of the disease or not. Regression analysis was done to spot predictors for a vision-threatening form of the disease. Results The presence of systemic vasculitis and oral and genital ulcers in a patient with Behcet's disease was found to be associated with a milder form of ocular affection or none at all and vice versa. Certain correlations between findings were also found. Conclusion Certain findings in Behcet's disease may act as predictors for the severity of ocular affection. Directing our attention to these factors by the internist and ophthalmologist can help plan the frequency of follow-up as well as the aggressiveness of treatment in patients with Behcet's disease.
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