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Altıngöz EN, Yenisoy Y, Kapusuz A, Abacar K, Şişman-Kitapçı N, Yay M, Karacaylı U, Alibaz-Öner F, İnanç N, Ergun T, Fortune F, Direskeneli H. The mediator role of treatment response on oral health related quality of life in Behçet's syndrome. Med Oral Patol Oral Cir Bucal 2024; 29:e350-e355. [PMID: 38150605 PMCID: PMC11175573 DOI: 10.4317/medoral.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND The aim of the study was to analyse the effects of Treatment Response with oral ulcers on oral health related quality of life in Behçet's syndrome (BS). MATERIAL AND METHODS In the cross-sectional study, 339 BS patients (F/M: 179/160, mean age: 36,13±9,81 years) were included. Data were collected by clinical examinations and patient reported outcome measures (PROMs) regarding Oral Health Impact Profile-14 (OHIP-14) questionnaire and self-reported Treatment Responses coded by a 5-point Likert-type scale (1: symptoms were cured- 5: symptoms were worsened). Moderated Mediation analysis (MA) was used to understand how oral ulcer activity (independent variable; X) influenced OHIP-14 score (outcome variables, Y) through self-reported Treatment Response (M1) and age (M2) as possible mediator variables (M) and disease course (mucocutaneous and musculuskeletal involvement vs. major organ involvement) as a possible moderator variable (W) on these relationships. RESULTS In Moderated MA, OHIP-14 score (Y) was mediated by the presence of oral ulcer (X) (p=0.0000), the negative Treatment Response (M1) (p=0.0001) and being young (M2) (p=0.0053) with mucocutaneous involvement (W)(p=0.0039). CONCLUSIONS Self-reported Treatment Response as an underestimated issue has a Mediator role in relation to oral ulceration on oral health related quality of life in the framework of patient empowerment strategies. Therefore, study results give clues to assist physicians and dentists for better understanding of patients' perspective.
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Affiliation(s)
- E-N Altıngöz
- Faculty of Health Sciences Marmara University, Istanbul, Turkey
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2
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Musavian S, Farzaneh R, Rahimi M, Mahdavi AM, Gojazadeh M, Khabbazi A. Validity and reliability of the BODI for assessing damage in Behcet's disease. Ir J Med Sci 2023; 192:2549-2553. [PMID: 36567419 DOI: 10.1007/s11845-022-03260-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In the present study, we aimed to validate the Behçet's syndrome Overall Damage Index (BODI) and compare its performance with that of vasculitis damage index (VDI) in Iranian patients with BD. METHODS This study included 274 patients with a diagnosis of BD and median follow-up of 40 months. The medical records of the patients were reviewed and the demographic characteristics, disease activity status, clinical manifestations, and data on organs damage were collected from all patients. RESULTS To evaluate the construct/convergent validity, BODI and VDI were applied to all participants. We found a good correlation between BODI score and VDI score. There was a significant and strong correlation between physician global assessment with BODI (r = 0.869, P = 0.001) and VDI (r = 0.817, P = 0.001). The ability of BODI to determine the accumulation of damage over time was assessed by analyzing the changes in BODI score over time. The increase in BODI score was occurred in 53 (19.3%) patients. In comparison, the increase in VDI score occurred in 36 (13.1%) patients. The increase in median BODI was significantly more than median VDI (P < 0.001). Multiple linear regression analysis showed that age at disease onset, disease duration, and disease severity were independent predictors of BODI scores. Reliability of BODI was examined by comparing the BODI scores as determined by two independent assessors in 100 patients. Cronbach's α was 0.942. CONCLUSION The BODI demonstrated acceptable validity and reliability in assessing BD-related damage in Iranian patients with BD.
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Affiliation(s)
- Sevda Musavian
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St, P.O Box 5166614756, Tabriz, Iran
| | - Rojin Farzaneh
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St, P.O Box 5166614756, Tabriz, Iran
| | - Mehran Rahimi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St, P.O Box 5166614756, Tabriz, Iran
| | - Aida Malek Mahdavi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St, P.O Box 5166614756, Tabriz, Iran
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Rahat Breathe and Sleep Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Gojazadeh
- Research Center for Evidence-Based Medicine, A Joanna Briggs Institute Affiliated Group, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Golgasht St, P.O Box 5166614756, Tabriz, Iran.
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3
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Hatemi G, Yazıcı Y. Outcome measures in Behçet syndrome. Clin Immunol 2023; 251:109341. [PMID: 37100337 DOI: 10.1016/j.clim.2023.109341] [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: 03/11/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/28/2023]
Abstract
Disease assessment has been challenging in Behçet syndrome due to the heterogeneous disease course and multiorgan involvement with variable treatment response. There have been several recent improvements regarding outcome measures including development of a Core Set of Domains for Behçet syndrome and novel instruments for assessing specific organs and overall damage. This review focuses on the current state of outcome measures in Behçet syndrome, unmet needs, and a research agenda towards the development of standardized and validated outcome measure instruments.
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Affiliation(s)
- Gülen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Cerrahpaşa, Turkey.
| | - Yusuf Yazıcı
- Division of Rheumatology, New York University School of Medicine, New York, NY, USA.
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4
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Ozguler Y, Esatoglu SN, Hatemi G. Current pharmacological solutions for Behçet's syndrome. Expert Opin Pharmacother 2023; 24:221-231. [PMID: 36458741 DOI: 10.1080/14656566.2022.2155047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Behçet's syndrome (BS) has a heterogeneous clinical phenotype, and its clinical manifestations may respond differently to drugs commonly used to treat BS. The type, dose, and duration of immunomodulatory, immunosuppressive, and biologic agents should be tailored individually. AREAS COVERED We reviewed the literature for articles on BS management that were published until June 2022 and summarized the management options in BS for each type of organ involvement. We aimed to cover all currently available pharmacological agents used in BS, as well as surgical and interventional options, focusing on recent evidence. EXPERT OPINION The management aims in BS are to preserve function and quality of life and to avoid damage. The choice of treatment modalities depends on the organs that are actively involved, the severity of that involvement, and prognostic factors. A treat-to-attack strategy would help improve long-term outcomes in BS.
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Affiliation(s)
- Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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5
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Fragoulis GE, Bertsias G, Bodaghi B, Gul A, van Laar J, Mumcu G, Saadoun D, Tugal-Tutkun I, Hatemi G, Sfikakis PP. Treat to target in Behcet's disease: Should we follow the paradigm of other systemic rheumatic diseases? Clin Immunol 2023; 246:109186. [PMID: 36410686 DOI: 10.1016/j.clim.2022.109186] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022]
Abstract
During the last decades the efficacy of biologic agents, mainly of anti-TNFs, in controlling the activity of serious manifestations of Behcet's Disease (BD) has been established. On the other hand, the clinical heterogeneity of BD has precluded the validation of a widely-accepted composite index for disease assessment and for target disease-state definitions, such as low disease activity and remission, and the testing of their implementation in clinical practice. Therefore, in contrast to other systemic rheumatic diseases, a treat-to-target strategy has not yet been developed in BD. There are several challenges towards this approach, including standardization of outcome measures for assessing the disease activity in each-affected organ and construction of a composite disease activity index. The challenges for the development of a treat-to-target strategy and possible solutions are discussed in this position paper, which stemmed from a round table discussion that took place in the 19th International Conference on BD.
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Affiliation(s)
- George E Fragoulis
- Joint Rheumatology Program and First Department of Propaedeutic and Internal Medicine, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Bertsias
- Rheumatology and Clinical Immunology, University of Crete Medical School, Heraklion, Greece
| | - Bahram Bodaghi
- Dept of Ophthalmology, IHU FOReSIGHT, Sorbonne University, APHP, Paris, France
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Jan van Laar
- Departments of Internal Medicine and Immunology, Division Clinical Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gonca Mumcu
- Department of Health Management, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, National reference center for autoinflammatory diseases and for rare systemic autoimmune diseases, F-75013 Paris, France
| | - Ilknur Tugal-Tutkun
- Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey; Eye Protection Foundation Bayrampasa Eye Hospital, Istanbul, Turkey
| | - Gulen Hatemi
- Department of Internal Medicine, Division of Rheumatology, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Petros P Sfikakis
- Joint Rheumatology Program and First Department of Propaedeutic and Internal Medicine, National & Kapodistrian University of Athens Medical School, Athens, Greece.
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6
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Hatemi G, Mahr A, Takeno M, Kim D, Melikoğlu M, Cheng S, McCue S, Paris M, Chen M, Yazici Y. Impact of apremilast on quality of life in Behçet's syndrome: analysis of the phase 3 RELIEF study. RMD Open 2022; 8:rmdopen-2022-002235. [PMID: 35798511 PMCID: PMC9263903 DOI: 10.1136/rmdopen-2022-002235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/07/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess apremilast's impact on patient quality of life (QoL) in active Behçet's syndrome and correlations between improvement in patients' QoL and efficacy measures in the phase 3 RELIEF study. METHODS QoL measures included Behçet's Disease QoL (BDQoL), 36-Item Short-Form Health Survey V.2 (SF-36v2) Physical/Mental Component Summary (PCS/MCS) and eight subscale scores, focusing on Physical Functioning (PF). Pearson's correlation coefficients assessed relationships between efficacy endpoints (oral ulcer count, oral ulcer pain, Behçet's Syndrome Activity Scale (BSAS), Behçet's Disease Current Activity Form (BDCAF)) and QoL endpoints for apremilast at Week 12. RESULTS Apremilast (n=104) demonstrated significantly greater improvements versus placebo (n=103) in SF-36v2 PCS (3.1 vs 0.9), MCS (4.6 vs ─0.7) and PF (2.9 vs 0.14), respectively (all p<0.05). Mild correlations were observed in improvements of SF-36v2 measures (PCS, MCS, PF) with oral ulcer count (r=-0.11, PCS), and change in oral ulcer pain from baseline (r=-0.28, PCS; r=-0.10, PF) and BSAS (r=-0.38, PCS; r=-0.20, PF; r=-0.16, MCS). Correlations among BDCAF and SF-36v2 components and BDQoL were variable. BDQoL showed mild/moderate correlations with SF-36v2 components (r=-0.18, PCS; r=-0.13, PF; r=-0.45, MCS). CONCLUSIONS Apremilast was associated with significant improvements in QoL measures of SF-36v2 PCS, MCS and PF and BDQoL in patients with Behçet's syndrome. Correlations of improvement among QoL endpoints support the beneficial clinical effects of apremilast in Behçet's syndrome. TRIAL REGISTRATION NUMBER NCT02307513.
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Affiliation(s)
- Gülen Hatemi
- Cerrahpaşa School of Medicine and Behçet's Disease Research Center, Istanbul University, Istanbul, Turkey
| | - Alfred Mahr
- Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Doyoung Kim
- Yonsei University College of Medicine and Severance Hospital, Seoul, South Korea
| | - Melike Melikoğlu
- Cerrahpaşa School of Medicine and Behçet's Disease Research Center, Istanbul University, Istanbul, Turkey
| | - Sue Cheng
- Amgen Inc, Thousand Oaks, California, USA
| | | | | | - Mindy Chen
- Amgen Inc, Thousand Oaks, California, USA
| | - Yusuf Yazici
- New York University School of Medicine, New York, New York, USA
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7
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Mee H, Castano Leon A, Timofeev I, Adeleye A, Devi I, Marklund N, Muehlschlegel S, Bond K, Clement C, Grieve K, Owen N, Whiting G, Turner C, Rubiano A, Shukla D, Paul M, Allanson J, Pomeroy V, Viaroli E, Warburton E, Wells A, Hawryluk G, Helmy A, Anwar F, Honeybul S, Hutchinson P, Kolias A. Study Protocol: Core Outcome Set for cranioplasty following stroke or TBI 'COAST Study'. JMIR Res Protoc 2022; 12:e37442. [PMID: 35759752 PMCID: PMC10152332 DOI: 10.2196/37442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/15/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Core Outcome sets (COS) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury or stroke is becoming increasingly common leading to an ever growing clinical and research interest especially regarding the optimal material, cost-effectiveness, and timing of cranioplasty concerning neurological recovery and complications. Consequently, heterogeneous reporting of outcomes from such diverse studies has led to a limited meta-analysis ability, with the ongoing risk of outcome reporting bias. OBJECTIVE To define a standardized COS for reporting in all future TBI and stroke cranioplasty studies. METHODS An international steering committee has been formed to guide the development of the COS. In addition, recommendations from other clinical initiatives such as COMET (Core Outcomes and Effectiveness Trials) and OMERACT (Outcome Measures in Rheumatology) have been adhered to. The first phase of the project is data-collection through a systematic review and qualitative study. The second phase will be the COS-formation through a Delphi survey and consensus meeting. A definition of consensus will be decided and agreed upon before the Delphi survey begins to avoid bias, which is planned for the end of 2021. RESULTS The development of a cranioplasty COS that can be applied in future research, helping to align future studies, building an increased understanding of cranioplasty and its impact on a patients function and recovery. CONCLUSIONS This study should result in consensus on a COS for cranioplasty following TBI or stroke. CLINICALTRIAL The study has been registered on the Core Outcome Measures in Effectiveness Trials (COMET) database for COS development.
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Affiliation(s)
- Harry Mee
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, A blockAddenbrookes Hospital, Cambridge, GB.,Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Box 167, Level 4, AblockAddenbrookes Hosital, Cambridge, GB.,NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, GB
| | | | - Ivan Timofeev
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | | | - Indira Devi
- Department of Neurosurgery, Nimhans, Bangalore, IN
| | | | | | - Katie Bond
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Clare Clement
- Bristol Trials Centre, Bristol Medical School, Bristol, GB
| | - Kirsty Grieve
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Nicola Owen
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Gemma Whiting
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB.,NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, GB
| | - Andres Rubiano
- Department of Neurosciences and Neurosurgery, Valle Salud IPS Network, Cali, CO
| | | | | | - Judith Allanson
- Division of Anaesthesia, University of Cambridge, Cambridge, GB
| | - Valerie Pomeroy
- Neurorehabilitation Department, University of East Anglia, Norwich, GB
| | - Edoardo Viaroli
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Elizabeth Warburton
- Division of Stroke Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Adam Wells
- University of Adelaide, The Royal Adelaide Hospital, Adelaide, AU
| | | | - Adel Helmy
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | - Fahim Anwar
- Division of Rehabilitation Medicine, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB
| | | | - Peter Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB.,NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, GB
| | - Angelos Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, GB.,NIHR Global Health Research Group on NeuroTrauma, University of Cambridge, Cambridge, GB
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8
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Holl DC, Chari A, Iorio-Morin C, Dammers R, van der Gaag NA, Kolias AG, Hutchinson PJ, Edlmann E. Study Protocol on Defining Core Outcomes and Data Elements in Chronic Subdural Haematoma. Neurosurgery 2021; 89:720-725. [PMID: 34318894 PMCID: PMC8440066 DOI: 10.1093/neuros/nyab268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Core Outcome Sets (COSs) are necessary to standardize reporting in research studies. This is urgently required in the field of chronic subdural hematoma (CSDH), one of the most common disease entities managed in neurosurgery and the topic of several recent trials. To complement the development of a COS, a standardized definition and baseline Data Elements (DEs) to be collected in CSDH patients, would further improve study quality and comparability in this heterogeneous population. OBJECTIVE To, first, define a standardized COS for reporting in all future CSDH studies; and, second, to identify a unified CSDH Definition and set of DEs for reporting in future CSDH studies. METHODS The overall study design includes a Delphi survey process among 150 respondents from 2 main stakeholder groups: healthcare professionals or researchers (HCPRs) and Patients or carers. HCPR, patients and carers will all be invited to complete the survey on the COS, only the HCPR survey will include questions on definition and DE. EXPECTED OUTCOMES It is expected that the COS, definition, and DE will be developed through this Delphi survey and that these can be applied in future CSDH studies. This is necessary to help align future research studies on CSDH and to understand the effects of different treatments on patient function and recovery. DISCUSSION This Delphi survey should result in consensus on a COS and a standardized CSDH Definition and DEs to be used in future CSDH studies.
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Affiliation(s)
- Dana C Holl
- Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Rotterdam, the Netherlands
| | - Aswin Chari
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | | | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Centre, Erasmus MC Stroke Centre, Rotterdam, the Netherlands
| | - Niels A van der Gaag
- University Neurosurgical Centre Holland (UNCH), Leiden University Medical Centre, Haaglanden Medical Centre, Haga Teaching Hospital, the Netherlands
| | - Angelos G Kolias
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ellie Edlmann
- Department of Neurosurgery, South West Neurosurgical Centre, University Hospitals Plymouth NHS Trust, Plymouth, UK.,Faculty of Health, Peninsula Medical School, University of Plymouth, Plymouth, UK
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9
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Piga M, Floris A, Espinosa G, Serpa Pinto L, Kougkas N, Lo Monaco A, Lopalco G, Orlando I, Pirani V, Santos E, Bertsias G, Cantarini L, Cauli A, Cervera R, Correia J, Govoni M, Iannone F, Neri P, Martins Silva A, Vasconcelos C, Muntoni M, Mathieu A. Development and preliminary validation of the Behçet's syndrome Overall Damage Index (BODI). RMD Open 2021; 6:rmdopen-2020-001192. [PMID: 32703843 PMCID: PMC7425117 DOI: 10.1136/rmdopen-2020-001192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 06/21/2020] [Indexed: 01/22/2023] Open
Abstract
Objective To develop and validate the evidence-based and consensus-based Behçet’s Syndrome Overall Damage Index (BODI). Methods Starting from 120 literature-retrieved preliminary items, the BODI underwent multiple Delphi rounds with an international multidisciplinary panel consisting of rheumatologists, internists, ophthalmologists, neurologists, and patient delegates until consensus was reached on the final content. The BODI was validated in a cross-sectional multicentre cohort of 228 patients with Behçet’s syndrome (BS) through the study of (a) correlation between BODI and Vasculitis Damage Index (VDI) and (b) correlation between BODI and disease activity measures (ie, Behçet’s Disease Current Activity Form (BDCAF), Physician Global Assessment (PGA), Patient Global Assessment (PtGA)), c) content and face validity and (d) feasibility. Results The final BODI consists of 4 overarching principles and 46 unweighted-items grouped into 9 organ domains. It showed good to excellent reliability, with a mean Cohen’s k of 0.84 (95% CI 0.78 to 0.90) and a mean intra-class correlation coefficient of 0.88 (95% CI 0.80 to 0.95). Overall, 128 (56.1%) patients had a BODI score ≥1, with a median score of 1.0 (range 0–14). The BODI significantly correlated with the VDI (r=0.693, p<0.001), demonstrating to effectively measure damage (construct validity), but had greater sensitivity in identifying major organ damage and did not correlate with disease activity measures (ie, BDCAF: p=0.807, PGA: p=0.820, PtGA: p=0.794) discriminating damage from the major confounding factor. The instrument was deemed credible (face validity), complete (content validity) and feasible by an independent group of clinicians. Conclusions Pending further validation, the BODI may be used to assess organ damage in patients with BS in the context of observational and controlled trials.
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Affiliation(s)
- Matteo Piga
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Alberto Floris
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Luísa Serpa Pinto
- Hospital Santo Antonio Centro Hospitalar Do Porto, Unidade De Imunologia Clinica, Porto, Portugal
| | - Nikolaos Kougkas
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | - Andrea Lo Monaco
- Rheumatology Unit - AOU, S. Anna, Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Ida Orlando
- University of Siena, Rheumatology Unit, Siena, Italy
| | - Vittorio Pirani
- Ophthalmology Clinic, Università Politecnica Delle Marche, Ancona, Italy
| | - Ernestina Santos
- Centro Hospitalar Do Porto/Hospital De Santo António, Neurology Department, Porto, Portugal.,UMIB Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | | | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic of Cagliari, Cagliari, Italy
| | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - João Correia
- Hospital Santo Antonio Centro Hospitalar Do Porto, Unidade De Imunologia Clinica, Porto, Portugal
| | - Marcello Govoni
- Rheumatology Unit - AOU, S. Anna, Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Piergiorgio Neri
- Ophthalmology Clinic, Università Politecnica Delle Marche, Ancona, Italy.,Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Ana Martins Silva
- Centro Hospitalar Do Porto/Hospital De Santo António, Neurology Department, Porto, Portugal
| | - Carlos Vasconcelos
- UMIB Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Monica Muntoni
- Associazione Italiana Sindrome E Malattia Di Behçet (SIMBA), Pontedera, Italy
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10
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Nazareth T, Hart EM, Ronnebaum SM, Mehta S, Patel DA, Kötter I. Comparability of European League Against Rheumatology-Recommended Pharmacological Treatments of Oral Ulcers Associated with Behçet's Disease: A Systematic Literature Review of Randomized Controlled Trials. Open Access Rheumatol 2020; 12:323-335. [PMID: 33376418 PMCID: PMC7762439 DOI: 10.2147/oarrr.s277036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/31/2020] [Indexed: 12/31/2022] Open
Abstract
Objective Oral ulcers are the cardinal manifestation in Behçet's disease (BD). The 2018 European League Against Rheumatism (EULAR) recommendations describe treatments for BD-associated oral ulcers with mucocutaneous involvement; however, little comparative effectiveness information for these agents is available. In the absence of head-to-head trials, an indirect treatment comparison (ITC) could provide useful evidence regarding comparative effectiveness of BD treatments. The purpose of this study was to conduct a comparative systematic literature review (SLR) and similarity assessment of randomized controlled trials (RCTs) investigating the oral ulcer-related efficacy outcomes of EULAR-recommended treatments for BD-associated oral ulcers to determine the feasibility of an ITC. Methods An SLR was performed to identify relevant RCTs indexed in MEDLINE/Embase before May 29, 2019. RCT similarities for the ITC were assessed based on a step-wise process recommended by the International Society for Pharmacoeconomics and Outcomes Research. Results In total, 317 articles were identified, of which 14 RCTs, reflecting 11 EULAR-recommended treatments, were evaluated in a similarity assessment. Number of oral ulcers, resolution of oral ulcers, and healing time for oral ulcers were identified as the possible oral ulcer-related outcomes. After completing the similarity assessment of these outcomes, it was determined that a robust ITC was infeasible for the three oral ulcer-related outcomes due to heterogeneity in outcomes reporting, study design, and/or patient characteristics. More broadly, the results underscore the need for and consistent use of standardized measures for oral ulcer outcomes to facilitate comparative research. Conclusion In the absence of head-to-head RCTs and infeasibility of quantitative ITC, comparative assessments for BD-associated oral ulcers are limited, including comparative effectiveness and cost-effectiveness evaluations. Healthcare decision-makers must continue to base treatment decisions on the extent and strength of available evidence (eg, robust RCTs), clinical guidelines, real-world experience, and patient considerations.
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Affiliation(s)
| | - Erin M Hart
- Pharmerit - an OPEN Health Company, New York, NY, USA
| | | | | | - Dipen A Patel
- Pharmerit - an OPEN Health Company, Bethesda, MD, USA
| | - Ina Kötter
- Division of Rheumatology and Systemic Inflammatory Diseases, University Hospital Hamburg Eppendorf and Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany
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11
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Floris A, Espinosa G, Serpa Pinto L, Kougkas N, Lo Monaco A, Lopalco G, Orlando I, Bertsias G, Cantarini L, Cervera R, Correia J, Govoni M, Iannone F, Mathieu A, Neri P, Martins Silva A, Vasconcelos C, Muntoni M, Cauli A, Piga M. Discordance between patient and physician global assessment of disease activity in Behçet's syndrome: a multicenter study cohort. Arthritis Res Ther 2020; 22:278. [PMID: 33239083 PMCID: PMC7687797 DOI: 10.1186/s13075-020-02362-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/22/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND To compare the patients' and physician's global assessment of disease activity in Behçet's syndrome (BS) and investigate the frequency, magnitude, and determinants of potential discordance. METHODS A total of 226 adult BS patients with a median (IQR) age of 46.9 (35.6-55.2) years were enrolled across Italy, Greece, Portugal, and Spain. Demographic, clinical, and therapeutic variables, as well as the patient reported outcomes, were collected at the recruitment visit. The physical (PCS) and mental (MCS) component summary scores of the Short Form Questionnaire 36 (SF-36) and the Behçet's syndrome Overall Damage Index (BODI) were calculated. Disease activity was assessed by the patients' (PtGA) and physician's global assessment (PGA) in a 10-cm visual analog scale, as well as the Behçet Disease Current Activity Form (BDCAF). Discordance (∆) was calculated by subtracting the PGA from the PtGA and defined as positive (PtGA>PGA) and negative (PtGA RESULTS Median PtGA and PGA scores were 2.0 (0.3-5.0) and 1.0 (0.0-3.0) cm, respectively. The discordance prevalence varied (from 29.6 to 55.3%) according to the cutoff applied, and the majority (> 80%) of disagreements were due to patients rating higher their disease activity. Higher values of BDCAF were associated to increased rate of positive discordance. When BDCAF = 0, the median (IQR) values of PtGA and PGA were 0.2 (0-2) and 0 (0-1), respectively. PCS (adjusted odds ratio (adjOR) 0.96 per unit, 95% CI 0.93-0.98, p = 0.006) and MCS (adjOR 0.96 per unit, 95% CI 0.93-0.99, p = 0.003) were independently associated with positive discordance using both cutoffs. Active ocular involvement emerged as a potential determinant of negative discordance (adjOR 5.88, 95% CI 1.48-23.30, p = 0.012). CONCLUSIONS PtGA and PGA should be considered as complementary measures in BS, as patients and physicians may be influenced by different factors when assessing active disease manifestations. Particularly, PtGA may be a useful tool in the assessment of BS disease activity, as it carries a low risk to misclassify an inactive disease, and may allow to capture aspects of the patient's health that negatively affect his well-being and the treatment.
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Affiliation(s)
- Alberto Floris
- Rheumatology Unit, AOU University Clinic, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, SS 554, 09042, Monserrato, Cagliari, Italy
| | - Gerard Espinosa
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - Luisa Serpa Pinto
- Hospital Santo Antonio Centro Hospitalar do Porto, Unidade de Imunologia Clinica, Porto, Portugal
| | - Nikolaos Kougkas
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | - Andrea Lo Monaco
- Rheumatology Unit, AOU S. Anna di Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Ida Orlando
- Rheumatology Unit, University of Siena, Siena, Italy
| | - George Bertsias
- Rheumatology, Clinical Immunology and Allergy Unit, University of Crete, Heraklion, Greece
| | | | - Ricard Cervera
- Department of Autoimmune Diseases, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain
| | - João Correia
- Hospital Santo Antonio Centro Hospitalar do Porto, Unidade de Imunologia Clinica, Porto, Portugal
| | - Marcello Govoni
- Rheumatology Unit, AOU S. Anna di Ferrara, University of Ferrara, Ferrara, Italy
| | | | - Alessandro Mathieu
- Rheumatology Unit, AOU University Clinic, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, SS 554, 09042, Monserrato, Cagliari, Italy
| | - Piergiorgio Neri
- Ophthalmology Clinic, Università Politecnica delle Marche, Ancona, Italy
- Cleveland Clinic Abu Dhabi, Eye Institute, Abu Dhabi, United Arab Emirates
| | - Ana Martins Silva
- Neurology Department, Centro Hospitalar do Porto/Hospital de Santo António, Porto, Portugal
| | - Carlos Vasconcelos
- UMIB Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Monica Muntoni
- Associazione Italiana Sindrome e Malattia di Behçet (SIMBA), Pontedera, Italy
| | - Alberto Cauli
- Rheumatology Unit, AOU University Clinic, Cagliari, Italy
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, SS 554, 09042, Monserrato, Cagliari, Italy
| | - Matteo Piga
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, SS 554, 09042, Monserrato, Cagliari, Italy.
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12
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Hatemi G, Meara A, Ozguler Y, Direskeneli H, Mahr A, Shea B, Cam E, Gul A, Yazici Y, Tugwell P, Yazici H, Merkel PA. The OMERACT Core Set of Domains for Outcome Measures in Behçet Syndrome. Arthritis Care Res (Hoboken) 2020; 74:691-699. [PMID: 33202101 DOI: 10.1002/acr.24511] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 10/07/2020] [Accepted: 11/10/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE There is an unmet need for reliable, validated, and widely-accepted outcome measures for randomized clinical trials in Behçet syndrome (BS). The Outcome Measures in Rheumatology Clinical Trials (OMERACT) BS Working Group, a large, multi-disciplinary group of experts in BS and patients with BS, worked to develop a Core Set of data-driven outcome measures for use in all clinical trials of BS. METHODS The Core Domain Set was developed through a comprehensive, iterative, multi-stage project which included a systematic review, a focus group meeting and qualitative patient interviews, a survey among experts in BS, a Delphi exercise involving both patients and physician-experts in BS, and utilization of the data, insight, and feedback generated by these processes to develop a final Core Domain Set. RESULTS All steps were completed and domains were delineated across the organ systems involved in this disease. Since trials in BS often focus on specific manifestations and not the disease in its entirety, the final proposed Core Set includes 5 domains mandatory for study in all trials in BS (disease activity, new organ involvement, quality of life, adverse events, and death) with additional sub-domains mandatory for study of specific organ-systems. The final Core Set was endorsed at the 2018 OMERACT meeting. CONCLUSION The Core Set of Domains in BS provides the foundation through which the international research community, including clinical investigators, patients, biopharmaceutical industry, and government regulatory bodies can harmonize the study of this complex disease, compare findings across studies, and advance development of effective therapies.
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Affiliation(s)
- Gülen Hatemi
- Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Alexa Meara
- Division of Rheumatology and Immunology, Ohio State University, Columbus, Ohio, USA
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University, Faculty of Medicine, Istanbul, Turkey
| | - Alfred Mahr
- Clinic for Rheumatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Beverly Shea
- Division of Rheumatology, Department of Medicine, and School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Esen Cam
- Patient-Partner, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Yusuf Yazici
- New York University School of Medicine, New York, New York, USA
| | - Peter Tugwell
- Department of Medicine, University of Ottawa, Ottawa, Canada, Ontario
| | | | - Peter A Merkel
- Division of Rheumatology and Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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13
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Mumcu G, Yay M, Karaçaylı Ü, Aksoy A, Taş MN, Armağan B, Sarı A, Bozca BC, Tekgöz E, Temiz Karadağ D, Badak SÖ, Tecer D, Yıldırım A, Bes C, Şahin A, Erken E, Cefle A, Çınar M, Yılmaz S, Alpsoy E, Boyvat A, Şenel S, Bilge ŞY, Kaşifoğlu T, Karadağ Ö, Aksu K, Keser G, Alibaz-Öner F, İnanç N, Ergun T, Direskeneli H. Moderation analysis exploring associations between age and mucocutaneous activity in Behçet's syndrome: A multicenter study from Turkey. J Dermatol 2020; 47:1403-1410. [PMID: 32981075 DOI: 10.1111/1346-8138.15553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 07/19/2020] [Indexed: 11/30/2022]
Abstract
The aim of the present study was to examine the effects of age on mucocutaneous activity by using moderation analysis in Behçet's syndrome (BS). In this cross-sectional study, 887 BS patients (female : male, 481:406; mean age, 38.4 ± 10.9 years) followed in 13 tertiary centers in Turkey were included. Mucocutaneous activity was evaluated by using the Mucocutaneous Index (MI) according to sex and disease course. Moderation analysis was performed to test the effect of age on mucocutaneous activity. A moderator variable is a third variable and affects the relationship between independent and outcome variables. Age was chosen as a potential moderator variable (interaction effect), MI score as the outcome variable and sex as an independent variable in the analysis. The moderation analysis tested the effects of age in three steps: whole BS patient group, patients without systemic involvement and those with systemic involvement. The moderation model was only significant in BS patients with systemic involvement (P = 0.0351), and a significant relationship was observed between female sex and MI score (P = 0.0156). In addition, the interaction plot showed that female patients had increased MI scores compared with male patients, especially in the 28-year-old age group (P = 0.0067). Moreover, major organ involvement was newly diagnosed in the majority of these young female BS patients. Our results suggest that the relationship between sex and mucocutaneous activity was moderated by age in the systemic involvement group. Also, increased mucocutaneous activity may be associated with new major organ involvement in young female BS patients with systemic involvement.
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Affiliation(s)
- Gonca Mumcu
- Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Meral Yay
- Department of Statistics, Mimar Sinan Fine Arts University, Istanbul, Turkey
| | - Ümit Karaçaylı
- Department of Oral and Maxillofacial Surgery, Gulhane Faculty of Dentistry, Ankara, Turkey
| | - Aysun Aksoy
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Mehmet Nedim Taş
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Berkan Armağan
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Alper Sarı
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Burçin Cansu Bozca
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Emre Tekgöz
- Division of Rheumatology, Gulhane Medical Faculty, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Duygu Temiz Karadağ
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Suade Özlem Badak
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Duygu Tecer
- Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Sanlıurfa, Turkey
| | - Alper Yıldırım
- Division of Rheumatology, Medical School, Erciyes University, Kayseri, Turkey
| | - Cemal Bes
- Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Rheumatology Clinic, Istanbul, Turkey
| | - Ali Şahin
- Division of Rheumatology, Medical School, Cumhuriyet University, Sivas, Turkey
| | - Eren Erken
- Division of Rheumatology, Medical School, Cukurova University, Adana, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Muhammet Çınar
- Division of Rheumatology, Gulhane Medical Faculty, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Sedat Yılmaz
- Division of Rheumatology, Gulhane Medical Faculty, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Erkan Alpsoy
- Dermatology Department, Medical School, Akdeniz University, Antalya, Turkey
| | - Ayşe Boyvat
- Department of Dermatology, Medical School, Ankara University, Ankara, Turkey
| | - Soner Şenel
- Division of Rheumatology, Medical School, Erciyes University, Kayseri, Turkey
| | - Şule Yaşar Bilge
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Timuçin Kaşifoğlu
- Division of Rheumatology, Medical School, Osmangazi University, Eskisehir, Turkey
| | - Ömer Karadağ
- Division of Rheumatology, Medical School, Hacettepe University, Ankara, Turkey
| | - Kenan Aksu
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Gökhan Keser
- Division of Rheumatology, Medical School, Ege University, Izmir, Turkey
| | - Fatma Alibaz-Öner
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Nevsun İnanç
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
| | - Tülin Ergun
- Dermatology Department, Medical School, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Medical School, Marmara University, Istanbul, Turkey
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14
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Batu ED, Ozen S. Measuring Vasculitis with Numbers: Outcome Scores. Curr Rheumatol Rev 2019; 16:21-28. [PMID: 31804163 DOI: 10.2174/1573397115666191126093927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/31/2018] [Accepted: 11/09/2019] [Indexed: 11/22/2022]
Abstract
Primary Systemic Vasculitides (PSV) are a heterogeneous group of diseases. Outcome scores are important to evaluate vasculitis patients in a more structured and standard way and these help physicians to predict patients with poor prognosis or high risk of relapse. Furthermore, we need reliable outcome measures for clinical trials. There are a number of vasculitis outcome scores available in the clinical practice with different strengths and limitations. These are mainly measures of disease activity, disease damage, response to treatment and quality of life. Birmingham Vasculitis Activity Score (BVAS) and its pediatric version aim to evaluate a wide scope of PSV. On the other hand, some outcome studies have focused on a single vasculitis type since the whole group includes different diseases with heterogeneous clinical features. The aim of this review is to provide an overview on outcome measures currently being used in the evaluation of patients with PSV. We mainly focus on immunoglobulin A vasculitis/Henochschönlein purpura, Kawasaki disease, anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis, polyarteritis nodosa, Takayasu arteritis and Behçet's disease.
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Affiliation(s)
- Ezgi Deniz Batu
- Division of Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara Training and Research Hospital, Ankara, Turkey
| | - Seza Ozen
- Division of Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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15
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Hatemi G, Mahr A, Ishigatsubo Y, Song YW, Takeno M, Kim D, Melikoğlu M, Cheng S, McCue S, Paris M, Chen M, Yazici Y. Trial of Apremilast for Oral Ulcers in Behçet's Syndrome. N Engl J Med 2019; 381:1918-1928. [PMID: 31722152 DOI: 10.1056/nejmoa1816594] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The small-molecule phosphodiesterase 4 inhibitor apremilast modulates cytokines that are up-regulated in Behçet's syndrome. In a phase 2 trial involving patients with Behçet's syndrome, apremilast reduced the incidence and severity of oral ulcers. Data on the efficacy and safety of apremilast in patients with Behçet's syndrome who had active oral ulcers and had not previously received biologic agents are limited. METHODS In a phase 3 trial, we randomly assigned, in a 1:1 ratio, patients who had Behçet's syndrome with active oral ulcers but no major organ involvement to receive either apremilast at a dose of 30 mg or placebo, administered orally, twice daily for 12 weeks, followed by a 52-week extension phase. The primary end point was the area under the curve (AUC) for the total number of oral ulcers during the 12-week placebo-controlled period (with lower values indicating fewer ulcers). There were 13 secondary end points, including complete response of oral ulcers, change from baseline in pain associated with oral ulcers, disease activity, and change from baseline in the Behçet's Disease Quality of Life score (range, 0 to 30, with higher scores indicating greater impairment in quality of life). Safety was also assessed. RESULTS A total of 207 patients underwent randomization (104 patients to the apremilast group and 103 to the placebo group). The AUC for the number of oral ulcers was 129.5 for apremilast, as compared with 222.1 for placebo (least-squares mean difference, -92.6; 95% confidence interval [CI], -130.6 to -54.6; P<0.001). The change from baseline in the Behçet's Disease Quality of Life score was -4.3 points in the apremilast group, as compared with -1.2 points in the placebo group (least-squares mean difference, -3.1 points; 95% CI, -4.9 to -1.3). Adverse events with apremilast included diarrhea, nausea, and headache. CONCLUSIONS In patients with oral ulcers associated with Behçet's syndrome, apremilast resulted in a greater reduction in the number of oral ulcers than placebo but was associated with adverse events, including diarrhea, nausea, and headache. (Funded by Celgene; ClinicalTrials.gov number, NCT02307513.).
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Affiliation(s)
- Gülen Hatemi
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Alfred Mahr
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Yoshiaki Ishigatsubo
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Yeong-Wook Song
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Mitsuhiro Takeno
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Doyoung Kim
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Melike Melikoğlu
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Sue Cheng
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Shannon McCue
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Maria Paris
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Mindy Chen
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
| | - Yusuf Yazici
- From Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School and Behçet's Disease Research Center, Istanbul, Turkey (G.H., M.M.); Hospital Saint-Louis, University Paris Diderot, Paris (A.M.); Yokohama City University Graduate School of Medicine, Yokohama (Y.I.), and Nippon Medical School, Graduate School of Medicine, Tokyo (M.T.) - both in Japan; Seoul National University and Seoul National University Hospital (Y.-W.S.) and Yonsei University College of Medicine and Severance Hospital (D.K.), Seoul, South Korea; Celgene, Summit, NJ (S.C., S.M., M.P., M.C.); and New York University School of Medicine, New York (Y.Y.)
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Zulfiqar MH, Shamdas M, Bashir A, Douglas S, Murray PI. Longitudinal Study Investigating the Relationship between Disease Activity and Psychological Status of Patients with Behçet’s Disease. Ocul Immunol Inflamm 2019; 28:613-621. [PMID: 31393210 DOI: 10.1080/09273948.2019.1616770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Mehwaish H. Zulfiqar
- Birmingham National Centre of Excellence for Behçet’s Syndrome, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Mohith Shamdas
- Birmingham National Centre of Excellence for Behçet’s Syndrome, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Abida Bashir
- Birmingham National Centre of Excellence for Behçet’s Syndrome, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sarah Douglas
- Birmingham National Centre of Excellence for Behçet’s Syndrome, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Philip I. Murray
- Birmingham National Centre of Excellence for Behçet’s Syndrome, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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17
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van Tol RR, Kimman ML, Melenhorst J, Stassen LPS, Dirksen CD, Breukink SO. European Society of Coloproctology Core Outcome Set for haemorrhoidal disease: an international Delphi study among healthcare professionals. Colorectal Dis 2019; 21:570-580. [PMID: 30628177 DOI: 10.1111/codi.14553] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 12/11/2018] [Indexed: 02/07/2023]
Abstract
AIM There is considerable heterogeneity in outcomes in studies reporting on the treatment of haemorrhoidal disease (HD). The aim of this study was to develop a Core Outcome Set (COS) for HD in cooperation with the European Society of Coloproctology. METHOD A Delphi study was performed according to the Outcome Measures in Rheumatology (OMERACT) methodology. In total 38 healthcare professionals and 30 patients were invited to the panel. Previously, 10 outcome domains and 59 outcomes were identified through a systematic literature review. In this study, these domains and outcomes were formed into one questionnaire for healthcare professionals and a separate questionnaire for patients. Sequential questionnaire rounds prioritizing the domains and outcomes were conducted. Panel members were asked to rate the appropriateness of each domain and outcome on a nine-point Likert scale. During a face-to-face meeting, healthcare professionals agreed on the primary and secondary end-points of the COS for HD. Finally, a short survey was sent to the healthcare professionals in order to reach consensus on how the chosen end-points should be assessed and at which time points. RESULTS The response rate in questionnaire round 1 for healthcare professionals was 44.7% (n = 17). Sixteen out of 17 healthcare professionals also completed the questionnaire in round 2. The response rate for the patient questionnaire was 60% (n = 18). Seventeen healthcare professionals participated in the face-to-face meeting. The questionnaire rounds did not result in a clear-cut selection of primary and secondary end-points. Most domains and outcomes were considered important, and only three outcomes were excluded. During the face-to-face meeting, agreement was reached to select the domain 'symptoms' as primary end-point, and 'complications', 'recurrence' and 'patient satisfaction' as secondary end-points in the COS for HD. Furthermore, consensus was reached that the domain 'symptoms' should be a patient reported outcome measure and should include the outcomes 'pain' and 'prolapse', 'itching', 'soiling' and 'blood loss'. The domain 'complications' should include the outcomes 'incontinence', 'abscess', 'urinary retention', 'anal stenosis' and 'fistula'. Consensus was reached to use 'reappearance of initial symptoms' as reported by the patient to define recurrence. During an additional short survey, consensus was reached that 'incontinence' should be assessed by the Wexner Fecal Incontinence Score, 'abscess' by physical examination, 'urinary retention' by ultrasonography, 'anal stenosis' by physical examination, and 'fistula' by physical examination and MR imaging if inconclusive. During follow-up, the outcome 'symptoms' should be assessed at baseline, 7 days, 6 weeks and 1 year post-procedure. The outcomes 'abscess' and 'urinary retention' should be assessed 7 days post-procedure and 'incontinence', 'anal stenosis' and 'fistula' 1 year post-procedure. CONCLUSIONS We developed the first European Society of Coloproctology COS for HD based on an international Delphi study among healthcare professionals. The next step is to incorporate the patients' perspective in the COS. Use of this COS may improve the quality and uniformity of future research and enhance the analysis of evidence.
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Affiliation(s)
- R R van Tol
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Melenhorst
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - L P S Stassen
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - C D Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center +, Maastricht, The Netherlands
| | - S O Breukink
- Department of Surgery and Colorectal Surgery, Maastricht University Medical Center +, Maastricht, The Netherlands
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Robson JC, Jayne D, Merkel PA, Dawson J. Systemic vasculitis and patient-reported outcomes: how the assessment of patient preferences and perspectives could improve outcomes. Patient Relat Outcome Meas 2019; 10:37-42. [PMID: 30804691 PMCID: PMC6372855 DOI: 10.2147/prom.s163601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The systemic vasculitides are a group of multisystem diseases, which can be life and organ threatening. High-dose immunosuppressants are required to control inflammation in vital organs, such as the kidneys, lungs, skin, joints, and eyes. Patients report a range of impacts on their health-related quality of life due to symptoms, irreversible damage, and the adverse effects of medications. The measurement of patient perspectives within clinical studies in vasculitis is essential to capture outcomes of greatest importance to patients. Validated generic, disease-specific and symptom-specific patient-reported outcomes available for use in patients with systemic vasculitis are reviewed here.
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Affiliation(s)
- Joanna C Robson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK,
- Faculty of Health and Applied Sciences, University Hospitals Bristol NHS Trust, Bristol, UK,
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter A Merkel
- Division of Rheumatology, Department of Medicine
- Department of Biostatistics, Epidemiology, and Informatic, University of Pennsylvania, Philadelphia, PA, USA
| | - Jill Dawson
- Nuffield Department of Population Health (HSRU), University of Oxford, Oxford, UK
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19
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Braithwaite T, Calvert M, Gray A, Pesudovs K, Denniston AK. The use of patient-reported outcome research in modern ophthalmology: impact on clinical trials and routine clinical practice. PATIENT-RELATED OUTCOME MEASURES 2019; 10:9-24. [PMID: 30774489 PMCID: PMC6352858 DOI: 10.2147/prom.s162802] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This review article considers the rising demand for patient-reported outcome measures (PROMs) in modern ophthalmic research and clinical practice. We review what PROMs are, how they are developed and chosen for use, and how their quality can be critically appraised. We outline the progress made to develop PROMs in each clinical subspecialty. We highlight recent examples of the use of PROMs as secondary outcome measures in randomized controlled clinical trials and consider the impact they have had. With increasing interest in using PROMs as primary outcome measures, particularly where interventions have been found to be of equivalent efficacy by traditional outcome metrics, we highlight the importance of instrument precision in permitting smaller sample sizes to be recruited. Our review finds that while there has been considerable progress in PROM development, particularly in cataract, glaucoma, medical retina, and low vision, there is a paucity of useful tools for less common ophthalmic conditions. Development and validation of item banks, administered using computer adaptive testing, has been proposed as a solution to overcome many of the traditional limitations of PROMs, but further work will be needed to examine their acceptability to patients, clinicians, and investigators.
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Affiliation(s)
- Tasanee Braithwaite
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Moorfields Eye Hospital, London, UK,
| | - Melanie Calvert
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Alastair K Denniston
- Centre for Patient Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK, .,Department of Ophthalmology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Birmingham, UK.,Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,NIHR Biomedical Research Centre (Moorfields Eye Hospital/UCL), London, UK
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20
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Abstract
Behçet's disease (BD) is a chronic, multisystemic, inflammatory disease characterized by recurrent attacks of mucocutaneous, ocular, musculoskeletal, vascular, central nervous system and gastrointestinal manifestations. Treatment of BD changes according to organ involvement, gender and age of the patient with no golden standard therapeutic regimen. Vascular involvement is observed in up to 40% of the patients with BD, especially in young males and is one of the major causes of mortality and morbidity. Glucocorticoids, azathioprine and cyclophosphamide are still recommended as the first-line treatments in vascular BD. However, increasing data with the tumor necrosis factor inhibitors suggest that these agents may also be acceptable options for the management of refractory vascular BD in daily practice. Anticoagulant usage for vascular BD is also still controversial with limited data coming from retrospective studies. There is a clear need for randomized, controlled studies for the management of VBD.
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Affiliation(s)
- Fatma Alibaz-Oner
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
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21
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Akkoç N. Update on the epidemiology, risk factors and disease outcomes of Behçet's disease. Best Pract Res Clin Rheumatol 2018; 32:261-270. [DOI: 10.1016/j.berh.2018.08.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022]
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23
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Demir S, Sag E, Dedeoglu F, Ozen S. Vasculitis in Systemic Autoinflammatory Diseases. Front Pediatr 2018; 6:377. [PMID: 30560109 PMCID: PMC6287042 DOI: 10.3389/fped.2018.00377] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/15/2018] [Indexed: 12/14/2022] Open
Abstract
Autoinflammatory diseases (AID) are diseases of the innate immune system, characterized by recurrent episodes of localized or systemic inflammation. Vasculitis may accompany AID. The causes of the association of vasculitis with monogenic AID are still debated. Among the monogenic AID, Familial Mediterranean Fever (FMF) is the most common. IgA-related vasculitis (IgAV) and Polyarteritis Nodosa (PAN) involving small and/or medium-sized vessels have an increased frequency among FMF patients. There are also case reports revealing vasculitic features in Cryopyrin-Associated Periodic Fever Syndrome (CAPS), Tumor Necrosis Factor Receptor-Associated Periodic Syndrome (TRAPS), Mevalonate Kinase Deficiency (MKD), also known as Hyper IgD syndrome (HIDS), Deficiency of IL-1 Receptor Antagonist (DIRA) and Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA) patients. Central nervous system vasculitis and vasculopathy have been reported in DIRA and PAPA patients whereas small vessel involvement affecting skin has been reported in CAPS, TRAPS, and MKD patients. Alternatively, vasculitis can also be a leading feature especially in the recently defined monogenic AID (Otulipenia, Deficiency of Adenosine Deaminase 2-DADA2, Haploinsufficiency of A20) and interferonopathies (STING-associated vasculopathy with onset in infancy-SAVI). DADA2 often presents as a PAN-like disease. In otulipenia, patients have painful subcutaneous nodules caused by septal panniculitis with small and medium vessel vasculitis. Haploinsufficiency of A20 (also called Familial Behcet-like Autoinflammatory Syndrome) results in a phenotype very similar to the variable vessel vasculitis of Behcet's disease with recurrent oral-genital ulcers, in addition to, skin rash, uveitis, and polyarthritis. SAVI is an autoinflammatory vasculopathy with increased Interferon (IFN) signature, causing severe skin lesions resulting in ulceration, necrosis, and in some cases, amputation. Behcet's Disease (BD) is a multifactorial polygenic AID characterized by recurrent attacks of oral-genital ulcers, skin lesions, uveitis and a unique vasculitis affecting both arteries and veins of all sizes. Many clinical features overlap with other autoinflammatory diseases and overexpression of proinflammatory cytokines is an important feature of the disease.
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Affiliation(s)
- Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Dedeoglu
- Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, MA, United States
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Towards a core outcome set for hemorrhoidal disease-a systematic review of outcomes reported in literature. Int J Colorectal Dis 2018; 33:849-856. [PMID: 29680897 PMCID: PMC6002447 DOI: 10.1007/s00384-018-3046-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Previously published literature regarding treatment of hemorrhoidal disease (HD) revealed a lack of uniform defined outcomes. These differences between outcomes among studies limit transparency and lead to incomparability of results. The aim of this study was to systematically list the types of outcomes used in HD studies. This list will be used to develop a core outcome set. METHODS We searched Medline (Pubmed), Embase (OVID), and Cochrane for interventional studies for adult patients with HD. Two authors independently identified and reviewed eligible studies. This resulted in a list of outcomes reported by each clinical trial. All outcomes were categorized using the conceptual framework OMERACT filter 2.0. RESULTS A total of 34 randomized controlled trials and prospective observational studies were included in this study. A total of 59 different types of outcomes were identified. On average, 5.8 different outcomes (range 2-8) were used per study. The outcomes were structured into three core areas and10 ten domains. The most commonly reported core area was pathophysiological manifestations including the domain symptoms, complications, and recurrence. The most frequently reported outcomes were pain (91%), blood loss (94%), prolapse (71%), and incontinence (56%). There was a high variation in definitions of the common outcomes. And often there was no definition at all. CONCLUSION This study shows a substantial heterogeneity in the types of outcomes in HD studies. We provided an overview of the types of outcomes reported in HD studies and identified a list of potentially relevant outcomes required for the development of a COS.
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