A case of coexisting Behçet's disease and ankylosing spondylitis

Coexistence of ankylosing spondylitis and Behçet's disease: Successful treatment with upadacitinib

BACKGROUND

Ankylosing spondylitis (AS) and Behçet's disease (BD) are distinct inflammatory disorders, but their coexistence is a rare clinical entity. This case sheds light on managing this complex scenario with Janus kinase (JAK) inhibitors.

CASE PRESENTATION

A 42-year-old woman presented with a decade-long history of lower back pain, nocturnal spinal discomfort, recurrent eye issues, oral and genital ulcers, hearing loss, pus formation in the left eye, and abdominal pain. Multidisciplinary consultations and diagnostic tests confirmed AS (HLA-B27 positivity and sacroiliitis) and BD (HLA-B51). Elevated acute-phase markers were observed.

CONCLUSION

This case fulfills diagnostic criteria for both AS and BD, emphasizing their coexistence. Notably, treatment with upadacitinib exhibited promising efficacy, underscoring its potential as a therapeutic option in patients with contraindications for conventional treatments. Our findings illuminate the intricate management of patients presenting with these two diverse systemic conditions and advocate for further exploration of JAK inhibitors in similar cases.

Ankylosing spondylitis occurring in a patient with Behçet disease after chronic brucellosis infection: A case report and review of the literature

Behçet disease and ankylosing spondylitis are rarely seen together. This report presents a rare case of ankylosing spondylitis occurring in a patient with Behçet disease after chronic brucellosis infection. Infectious agents have long been considered one of the triggers for autoimmune and autoinflammatory diseases. Therefore, rheumatic processes should be kept in mind, especially in treatment-resistant cases.

A case with Behçet's disease involving erosive Metacarpophalangeal joint arthritis: the value of ultrasonography in the diagnosis of an Erosion

Background

Behçet’s disease (BD) is a chronic multisystemic vasculitis that may emerge with musculoskeletal system involvements, oral-genital recurrent aphthae, mucocutaneous lesions, and ocular symptoms. Arthritis in BD is usually non-erosive and not related to crippling disease. Erosive arthropathy is a very rare manifestation of BD.

Case presentation

Herein, we present a 60-year-old male patient suffering from BD for 33 years with erosive arthritis in his second metacarpophalangeal joint. After we assessed his finger by X-ray, we diagnosed erosive arthropathy quickly by musculoskeletal ultrasonography. In addition, a systematic literature search was performed via the PubMed and Scopus databases using the keywords, ‘Behçet’s disease [AND] erosive/destructive arthritis’.

Conclusions

Erosive arthritis due to BD can be evaluated by ultrasonography in an easy, fast and cost-effective manner. The literature search between 1985 and December 2019 revealed a total of 19 patients with peripheral erosive arthropathy related to BD and the characteristics of the results are summarized in the paper.

Risk of immune-mediated inflammatory diseases in newly diagnosed ankylosing spondylitis patients: a population-based matched cohort study

Objective

To investigate the risk of immune-mediated inflammatory diseases (IMIDs) in patients with ankylosing spondylitis (AS).

Methods

Using 2003–2012 claims data from the Taiwanese National Health Insurance Research Database, we identified 30,911 newly diagnosed AS patients requiring medical therapy from 2006 to 2012. In addition, we randomly selected 309,110 non-AS individuals matching (1:10) the AS patients with regard to age, sex and the year of the index date. After excluding subjects with the corresponding prior IMIDs, we calculated the incidence rates (IRs) of various IMIDs in the AS and non-AS cohorts and estimated the hazard ratios (HRs) with 95% confidence intervals after adjusting for age, sex, the Charlson comorbidity index, the frequency of ambulatory visits during the follow-up period and medications. We conducted sensitivity analyses by excluding those who developed IMIDs within 3 months after the index date.

Results

In the follow-up period, we found that newly diagnosed AS patients had significantly increased risks of acute anterior uveitis, psoriasis, Sjögren’s syndrome, thromboangiitis obliterans, Behcet’s disease and sarcoidosis. However, the risk of Sjögren’s syndrome did not increase in AS patients in the sensitivity analysis. In the same period, this study found no significant differences in the risks of Crohn’s disease, ulcerative colitis, systemic lupus erythematosus, systemic sclerosis, dermatomyositis, polymyositis, pemphigus and vitiligo between newly diagnosed AS patients and non-AS individuals. AS patients had a significantly reduced risk of rheumatoid arthritis.

Conclusion

Newly diagnosed Taiwanese AS patients had increased risks of acute anterior uveitis, psoriasis, thromboangiitis obliterans, Behcet’s disease and sarcoidosis, but a reduced risk of rheumatoid arthritis.

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1980-1) contains supplementary material, which is available to authorized users.

Coexisting Behçet's disease and ankylosing spondylitis presented with deep venous thrombosis: a case report and review of the literature

The coexistence of Behçet's disease (BD) and ankylosing spondylitis (AS) is a rare combination and described only in case reports in the literature. Although the number of reports is increasing, vascular thrombosis, which is characteristic feature of BD, was not reported in this combination until now. We present a case of a male patient with both BD and AS, presenting with deep venous thrombosis. We also reviewed the clinical features of the cases with coexistence of BD and AS.

Erosive arthritis in a patient with Behçet's disease

We report on a 35-year-old female patient suffering from Behçet's disease for 20 years who developed recurrent oral ulcerations during the onset of the disease. This was followed by recurrent genital ulcerations and joint symptoms involving knee, wrist and feet joints and bilateral heel pain. X-rays of the feet revealed erosive and destructive changes in the 1st metatarsophalangeal and 1st proximal interphalangeal joints of the right foot and enthesopathy on calcaneus. A literature review indicated that erosive arthritis is a rare event in Behçet's disease.

Behçet's disease and sacroiliitis in a child

Abstract We describe the case of a Japanese girl who suffered from both Behçet's disease (BD) and bilateral sacroiliitis. This patient was diagnosed with BD at 8 years of age, and began to complain of buttock pain when she was 10 years old. X-rays of her pelvis showed bilateral grade 3 sacroiliitis, and bone scintigraphy showed an increased uptake in the sacroiliac joints. Movements of the spine and chest expansion were not restricted. HLA typing was positive for B44 and DR4, but negative for B27. The patient was not diagnosed as having seronegative spondyloarthropathy. This case indicates that erosive sacroiliitis is an intrinsic condition of BD.