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Poddighe D, Turganbekova A, Mukusheva Z, Abdirakhmanova A, Assylbekova M, Abdrakhmanova S. HLA-B*51 allelic and carrier frequency in Kazakhstan: insights into Behçet's disease prevalence in Central Asia. Intern Emerg Med 2021; 16:325-331. [PMID: 32472479 DOI: 10.1007/s11739-020-02369-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis whose prevalence varies according to the ethnicity. HLA-B*51 is a well-known genetic factor predisposing to BD: populations with higher HLA-B*51 allelic frequencies are also those with a greater disease prevalence, as occurs in the Silk Road countries. However, the BD prevalence is unknown in many countries, including Kazakhstan and, in general, Central Asia, despite the location on or near the Silk Road. Due to the lack of clinical studies from this area, we analyzed the bone marrow donors registry in Kazakhstan, in order to assess the HLA-B*51 allelic and carrier frequencies, which resulted to be 8.14 and 15.28%, respectively. Through a comparison with the same parameters in other countries (by performing a data search in the medical literature and in the Allele Frequency Net Database), we might speculate a BD prevalence in Kazakhstan of 10-15/100.000 at least. This result should prompt a greater clinical consideration of this disease in Central Asia, as well as the publication of clinical data from this geographic area.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Kerei-Zhanibek Str. 5/1, 010000, Nur-Sultan, Kazakhstan.
| | - Aida Turganbekova
- RSE on REM Scientific-Production Center of Transfusion Medicine, Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
| | - Zaure Mukusheva
- Department of Pediatric Rheumatology, National Research Center for Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Altynay Abdirakhmanova
- Department of Medicine, Nazarbayev University School of Medicine, Kerei-Zhanibek Str. 5/1, 010000, Nur-Sultan, Kazakhstan
| | - Maikesh Assylbekova
- Department of Pediatric Rheumatology, National Research Center for Mother and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Saniya Abdrakhmanova
- RSE on REM Scientific-Production Center of Transfusion Medicine, Ministry of Health of the Republic of Kazakhstan, Nur-Sultan, Kazakhstan
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Bettiol A, Prisco D, Emmi G. Behçet: the syndrome. Rheumatology (Oxford) 2021; 59:iii101-iii107. [PMID: 32348523 DOI: 10.1093/rheumatology/kez626] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/15/2019] [Indexed: 01/20/2023] Open
Abstract
Behçet's syndrome (BS) is a systemic vasculitis characterized by a relapsing and remitting course. It can involve the skin, mucosa, joints, vessels (arteries and/or veins), eyes, and nervous and gastrointestinal systems, and so is referred to as a syndrome rather than as a unique and nosologically distinct condition. These involvements may present alone or co-exist in the same patient. Although all the possible combinations of the above-mentioned manifestations may occur, clusters of commonly co-existing involvements (also referred to as 'disease phenotypes') have been suggested, namely 'mucocutaneous and articular', 'peripheral vascular and extra-parenchymal neurological' and 'parenchymal neurological and ocular' phenotypes have been described. Patient-specific demographic and genetic features have been described as positively or negatively associated with specific disease phenotypes. This review will focus on the different clinical features of Behçet's syndrome, summarizing current evidence on the distinct disease manifestations as well as the major phenotypes.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | | | - Giacomo Emmi
- Department of Experimental and Clinical Medicine
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Yildiz M, Haslak F, Adrovic A, Sahin S, Koker O, Barut K, Kasapcopur O. Pediatric Behçet's Disease. Front Med (Lausanne) 2021; 8:627192. [PMID: 33614684 PMCID: PMC7886701 DOI: 10.3389/fmed.2021.627192] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Behçet's Disease (BD) is a systemic vasculitis firstly described as a disorder causing aphthous lesion in oral and genital mucosae and uveitis. The disease has an extremely unique distribution characterized by the highest incidence in communities living along the historical Silk road. Although our understanding of the etiopathogenesis of BD has expanded over time, there are still lots of unidentified points in the underlying mechanisms of the disease. The accepted opinion in the light of the current knowledge is that various identified and/or unidentified infectious and/or environmental triggers can take a role as a trigger in individuals with genetic susceptibility. Although the disease usually develops in young adulthood, it is reported that about 15-20% of all Behçet's patients develop in childhood. Pediatric BD differs from adult BD not only with the age of onset but also in the frequency and distribution of clinical findings, disease severity and outcome. While gastrointestinal system involvement, neurological findings, arthralgia and positive family history are more common in children, genital lesions and vascular lesions are more common in adult patients. In addition, a better disease outcome with lower severity score and activity index has been reported in children. The diagnosis of the disease is made according to clinical findings. It can be challenging to diagnose the disease due to the absence of a specific diagnostic test, and the long time interval from the first finding of the disease to the full-blown disease phenotype in pediatric cases. Therefore, many classification criteria have been proposed so far. The widely accepted ones are proposed by the International Study Group. The new sets of classification criteria which is the only one for pediatric BD were also developed for pediatric cases by the PEDBD group. The primary goal for the treatment is preventing the organ damages by suppressing the ongoing inflammation and forestalling the disease flares. The treatment of the BD can be onerous due to its multisystemic nature and a multidisciplinary approach is essential for the management of the patients. In this review article, the definition, clinical findings, epidemiology, etiopathogenesis, and treatment will be discussed.
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Affiliation(s)
| | | | | | | | | | | | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Soejima Y, Kirino Y, Takeno M, Kurosawa M, Takeuchi M, Yoshimi R, Sugiyama Y, Ohno S, Asami Y, Sekiguchi A, Igarashi T, Nagaoka S, Ishigatsubo Y, Nakajima H, Mizuki N. Changes in the proportion of clinical clusters contribute to the phenotypic evolution of Behçet's disease in Japan. Arthritis Res Ther 2021; 23:49. [PMID: 33522943 PMCID: PMC7851921 DOI: 10.1186/s13075-020-02406-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background We hypothesized that Behçet’s disease (BD) consists of several clinical subtypes with different severity, resulting in heterogeneity of the disease. Here, we conducted a study to identify clinical clusters of BD. Methods A total of 657 patients registered in the Yokohama City University (YCU) regional BD registry between 1990 and 2018, as well as 6754 patients who were initially registered in the Japanese Ministry of Health, Labour and Welfare (MHLW) database between 2003 and 2014, were investigated. The YCU registry data regarding the clinical manifestations of BD, human leukocyte antigen (HLA) status, treatments, and hospitalizations were analyzed first, followed by similar analyses of the MHLW for validation. A hierarchical cluster analysis was independently performed in both patient groups. Results A hierarchical cluster analysis determined five independent clinical clusters in the YCU cohort. Individual counterparts of the YCU clusters were confirmed in the MHLW registry. Recent phenotypical evolutions of BD in Japan, such as increased gastrointestinal (GI) involvement, reduced complete type according to the Japan Criteria, and reduced HLA-B51 positivity were associated with chronologically changing proportions of the clinical clusters. Conclusions In this study, we identified independent clinical clusters among BD patients in Japan and found that the proportion of each cluster varied over time. We propose five independent clusters namely “mucocutaneous”, “mucocutaneous with arthritis”, “neuro”, “GI”, and “eye.”
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Affiliation(s)
- Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yumiko Sugiyama
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yukiko Asami
- Yokosuka Center for Rheumatic Diseases, Yokosuka City Hospital, 1-3-2 Nagasaka, Yokosuka, 240-0101, Japan
| | - Akiko Sekiguchi
- Department of Hematology and Rheumatology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, 251-8550, Japan
| | - Toshihisa Igarashi
- Department of Rheumatology, Yamato City Hospital, Fukaminishi, Yamato, 242-8602, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura Higashi, Yokohama, 236-0037, Japan
| | - Yoshiaki Ishigatsubo
- Yokohama City University, Yokohama, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Zou J, Luo JF, Shen Y, Cai JF, Guan JL. Cluster analysis of phenotypes of patients with Behçet's syndrome: a large cohort study from a referral center in China. Arthritis Res Ther 2021; 23:45. [PMID: 33514418 PMCID: PMC7847001 DOI: 10.1186/s13075-021-02429-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Behcet's syndrome (BS) is a complex, heterogeneous disorder. However, classification of its subgroups is still debated. The purpose of this study was to investigate the clinical features and aggregation of patients with BS in China, based on manifestations and organ involvements. METHODS This was a cross-sectional study of BS patients in Huadong Hospital of Fudan University between September 2012 and January 2020. We calculated relative risks (RRs) of clinical variables according to sex. Moreover, we conducted a hierarchical cluster analysis applied according to eighteen variables to determine subgroups of patients. RESULTS A total of 860 BS patients were included. Male sex was associated with ocular involvement (RR 2.32, 95% CI 1.67, 3.22, P < 0.0001), vascular involvement (RR 2.00, 95% CI 1.23, 3.23, P = 0.004), cardiac lesion (RR 5.46, 95% CI 2.33, 12.77, P < 0.0001), and central nervous system involvement (RR 2.95, 95% CI 1.07, 6.78, P = 0.007) and was negatively associated with genital ulcers (RR 0.84, 95% CI 0.79, 0.91, P < 0.0001). Five clusters (C1-C5) were observed. C1 (n = 307) showed the skin and mucosa type. In C2 (n = 124), all had articular involvement, barely having major organ involvement except for 18 cases with intestinal lesions. In C3 (n = 156), the gastrointestinal type, 144 patients presented with intestinal involvement, and 36 patients with esophageal ulcers. In C4 (n = 142), all subjects presented with uveitis. C5 (n = 131) consisted of 44 patients with cardiac lesions, 58 with vascular involvement, and 26 cases having central nervous system involvement. CONCLUSION Our analysis confirmed sex differences in phenotypes of BS. Cluster analysis identified gastrointestinal, uveitis, and cardiovascular involvement cluster separately in different subsets, which represents the most commonly involved organs. Further research is required to replicate and clarify the patterns of phenotype in BS.
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Affiliation(s)
- Jun Zou
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Feng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, People's Republic of China
| | - Yan Shen
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Fei Cai
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China
| | - Jian-Long Guan
- Division of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, 200040, Shanghai, People's Republic of China.
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Cavalli G, Colafrancesco S, Emmi G, Imazio M, Lopalco G, Maggio MC, Sota J, Dinarello CA. Interleukin 1α: a comprehensive review on the role of IL-1α in the pathogenesis and treatment of autoimmune and inflammatory diseases. Autoimmun Rev 2021; 20:102763. [PMID: 33482337 DOI: 10.1016/j.autrev.2021.102763] [Citation(s) in RCA: 119] [Impact Index Per Article: 39.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022]
Abstract
The interleukin (IL)-1 family member IL-1α is a ubiquitous and pivotal pro-inflammatory cytokine. The IL-1α precursor is constitutively present in nearly all cell types in health, but is released upon necrotic cell death as a bioactive mediator. IL-1α is also expressed by infiltrating myeloid cells within injured tissues. The cytokine binds the IL-1 receptor 1 (IL-1R1), as does IL-1β, and induces the same pro-inflammatory effects. Being a bioactive precursor released upon tissue damage and necrotic cell death, IL-1α is central to the pathogenesis of numerous conditions characterized by organ or tissue inflammation. These include conditions affecting the lung and respiratory tract, dermatoses and inflammatory skin disorders, systemic sclerosis, myocarditis, pericarditis, myocardial infarction, coronary artery disease, inflammatory thrombosis, as well as complex multifactorial conditions such as COVID-19, vasculitis and Kawasaki disease, Behcet's syndrome, Sjogren Syndrome, and cancer. This review illustrates the clinical relevance of IL-1α to the pathogenesis of inflammatory diseases, as well as the rationale for the targeted inhibition of this cytokine for treatment of these conditions. Three biologics are available to reduce the activities of IL-1α; the monoclonal antibody bermekimab, the IL-1 soluble receptor rilonacept, and the IL-1 receptor antagonist anakinra. These advances in mechanistic understanding and therapeutic management make it incumbent on physicians to be aware of IL-1α and of the opportunity for therapeutic inhibition of this cytokine in a broad spectrum of diseases.
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Affiliation(s)
- Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy, and Rare Diseases, IRCCS San Raffaele Scientific Institute; Vita-Salute San Raffaele University, Milan, Italy.
| | - Serena Colafrancesco
- Dipartimento of Clinical Sciences (Internal Medicine, Anesthesia and Resuscitation, and Cardiology), Rheumatology Unit, Sapienza University of Rome, Rome, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, Careggi University Hospital, Firenze, Italy
| | - Massimo Imazio
- University Division of Cardiology, Cardiovascular and Throracic Department, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Giuseppe Lopalco
- Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari, Italy
| | - Maria Cristina Maggio
- Department of Health Promotion, Maternal and Infantile Care, Department of Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Charles A Dinarello
- Department of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.
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Zou J, Luo D, Shen Y, Guan JL. Characteristics and phenotype heterogeneity in late-onset Behçet's syndrome: a cohort from a referral center in China. Clin Rheumatol 2021; 40:2319-2326. [PMID: 33411142 DOI: 10.1007/s10067-020-05536-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the demographics, clinical aspects, and major organ involvement of patients with late-onset Behçet's syndrome (BS) in a tertiary center in China. METHODS We conducted a cross-sectional study of consecutive BS patients in Huadong Hospital of Fudan University from September 2012 to January 2020. We compared clinical variables between patients with disease onset before and after 40 years of age. The relative risks (RRs) of clinical variables were calculated between the two age groups. Moreover, a hierarchical cluster analysis was conducted according to 29 variables to determine homogeneous subgroups in patients with late-onset BS. RESULTS We enrolled 152 late-onset BS patients, with a median age at onset of 47 years (interquartile range, IQR: 43-52 years). There is a higher prevalence of intestinal ulcers in late-onset BS than in early-onset BS (RR 1.47), but a lower prevalence of ocular involvements (RR 0.54) and folliculitis (RR 0.46). Female sex was associated with genital ulcers, erythema nodosum, and arthritis. Four clusters (C1-C4) were formed. C1 (n = 71), the largest cluster, was defined as the mucocutaneous group, C2 (n = 20) as the arthritis group, C3 (n = 39) as the gastrointestinal group, in which all patients presented with intestinal lesions, and five cases with esophageal ulcers. In C4 (n = 22), showing a mixture of uveitis and vascular lesions, 15 patients presented with uveitis and 8 had vascular lesions, and 1 case had central nervous system lesions. CONCLUSION Four phenotype clusters were identified. Patients with skin lesions comprised the largest cluster, while gastrointestinal, panuveitis, and cardiovascular clusters are the most commonly involved organs in late-onset BS patients. Key Points • Our analysis demonstrated the phenotype discrepancy between early and late onset groups. • Four phenotype clusters were identified, with gastrointestinal, panuveitis and cardiovascular clusters representing commonly involved organs.
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Affiliation(s)
- Jun Zou
- Department of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, No. 221 west Yan'an Road Shanghai, 200040, Shanghai, People's Republic of China
| | - Dan Luo
- Department of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, No. 221 west Yan'an Road Shanghai, 200040, Shanghai, People's Republic of China
| | - Yan Shen
- Department of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, No. 221 west Yan'an Road Shanghai, 200040, Shanghai, People's Republic of China
| | - Jian-Long Guan
- Department of Rheumatology and Immunology, Shanghai Key Laboratory of Clinical Geriatric Medicine, Huadong Hospital, Research Center on Aging and Medicine, Huadong Hospital, Fudan University, No. 221 west Yan'an Road Shanghai, 200040, Shanghai, People's Republic of China.
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Yurttaş B, Oztas M, Tunc A, Balkan İİ, Tabak OF, Hamuryudan V, Seyahi E. Characteristics and outcomes of Behçet's syndrome patients with Coronavirus Disease 2019: a case series of 10 patients. Intern Emerg Med 2020; 15:1567-1571. [PMID: 32647946 PMCID: PMC7344029 DOI: 10.1007/s11739-020-02427-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/27/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Berna Yurttaş
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mert Oztas
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ali Tunc
- Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - İlker İnanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Omer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tecer D, Gogus F, Kalkanci A, Erdogan M, Hasanreisoglu M, Ergin Ç, Karakan T, Kozan R, Coban S, Diker KS. Succinivibrionaceae is dominant family in fecal microbiota of Behçet's Syndrome patients with uveitis. PLoS One 2020; 15:e0241691. [PMID: 33125440 PMCID: PMC7598488 DOI: 10.1371/journal.pone.0241691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 10/19/2020] [Indexed: 01/02/2023] Open
Abstract
Behçet’s Syndrome (BS) is a multisystem vasculitis with various clinical manifestations. Pathogenesis is unclear, but studies have shown genetic factors, innate immunity and autoinflammation to have an important role in the disease course. Diversity in the microbial community of gut microbiota may significantly contribute to the activation of the innate immune system. The clinical features of BS present themselves in clusters and each cluster may be a consequence of different disease mechanisms. For this reason we aimed to investigate the gut microbiota of BS patients with uveitis. In addition to healthy controls, we have aimed to compare the gut microbiota of BS with that of Familial Mediterranean Fever (FMF) and Crohn’s Disease (CD) as both diseases have innate and autoinflammatory features in their pathogenesis. Seven patients with BS, 12 patients with FMF, 9 patients with CD and 16 healthy controls (HC) were included in the study. Total genomic DNAs were isolated from fecal samples of the patients. Partial 16S rRNA gene was sequenced using the PGM Ion Torrent (Thermo Fisher Scientific, Waltham, MA, USA) for microbiota analysis. Statistical analysis showed that significant differences were detected on the microbial community of four groups. Succinivibrionaceae is dominant and the signature family, whereas Bacteroides was absent in BS patients.
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Affiliation(s)
- Duygu Tecer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Feride Gogus
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayse Kalkanci
- Department of Medical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
- * E-mail: ,
| | - Merve Erdogan
- Department of Medical Microbiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Murat Hasanreisoglu
- Department of Ophthalmology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Çagri Ergin
- Department of Medical Microbiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Tarkan Karakan
- Department of Internal Medicine, Division of Gastroenterology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ramazan Kozan
- Department of General Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Seda Coban
- Medical student, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kadir Serdar Diker
- Department of Microbiology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey
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60
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Kötter I. [Behçet's syndrome : Current diagnostics and treatment]. Z Rheumatol 2020; 79:873-882. [PMID: 33052453 DOI: 10.1007/s00393-020-00899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Behçet's syndrome (BS) in our latitude is a rare vasculitis of various vessels. It mainly consists of oral and genital aphthous ulcers, skin lesions, oligoarthritis and ocular manifestations, mostly a posterior uveitis with occlusive retinal vasculitis. This review article summarizes the diagnostic and classification criteria as well as possible differential diagnoses and current treatment recommendations.
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Affiliation(s)
- I Kötter
- Klinik für Rheumatologie und Immunologie, Klinikum Bad Bramstedt, Oskar-Alexander Str. 26, Bad Bramstedt, Deutschland.
- Sektion für Rheumatologie und Entzündliche Systemerkrankungen, III. Medizin, UKE, Martinistr. 52, Hamburg, Deutschland.
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61
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Perazzio SF, Allenspach EJ, Eklund KK, Varjosalo M, Shinohara MM, Torgerson TR, Seppänen MRJ. Behçet disease (BD) and BD-like clinical phenotypes: NF-κB pathway in mucosal ulcerating diseases. Scand J Immunol 2020; 92:e12973. [PMID: 32889730 DOI: 10.1111/sji.12973] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/08/2020] [Accepted: 08/30/2020] [Indexed: 02/06/2023]
Abstract
Behçet's disease (BD) is a heterogeneous multi-organ disorder in search of a unified pathophysiological theory and classification. The disease frequently has overlapping features resembling other disease clusters, such as vasculitides, spondyloarthritides and thrombophilias with similar genetic risk variants, namely HLA-B*51, ERAP1, IL-10, IL-23R. Many of the BD manifestations, such as unprovoked recurrent episodes of inflammation and increased expression of IL-1, IL-6 and TNFα, overlap with those of the hereditary monogenic autoinflammatory syndromes, positioning BD at the crossroads between autoimmune and autoinflammatory syndromes. BD-like disease associates with various inborn errors of immunity, including familial Mediterranean fever, conditions related to dysregulated NF-κB activation (eg TNFAIP3, NFKB1, OTULIN, RELA, IKBKG) and either constitutional trisomy 8 or acquired trisomy 8 in myelodysplastic syndromes. We review here the recent advances in the immunopathology of BD, BD-like diseases and the NF-κB pathway suggesting new elements in the elusive BD etiopathogenesis.
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Affiliation(s)
- Sandro F Perazzio
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA.,Division of Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eric J Allenspach
- Seattle Children's Research Institute, University of Washington and Center for Immunity and Immunotherapies, Seattle, WA, USA
| | - Kari K Eklund
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland
| | - Markku Varjosalo
- Division of Rheumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,ORTON Orthopaedic Hospital of the Orton Foundation, Helsinki, Finland.,Molecular Systems Biology Research Group and Proteomics Unit, Institute of Biotechnology, University of Helsinki, Helsinki, Finland
| | - Michi M Shinohara
- Divisions of Dermatology and Dermatopathology, University of Washington, Seattle, WA, USA
| | | | - Mikko R J Seppänen
- Rare Disease and Pediatric Research Centers, Hospital for Children and Adolescents and Adult Immunodeficiency Unit, Inflammation Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
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62
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Marvisi C. The geographic and clinical clusters of Behçet's syndrome. Intern Emerg Med 2020; 15:933-934. [PMID: 32227285 DOI: 10.1007/s11739-020-02319-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/20/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Chiara Marvisi
- Rheumatology Department, University of Modena and Reggio Emilia, Modena, Italy.
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63
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Sota J, Rigante D, Emmi G, Lopalco G, Orlando I, Tosi GM, Frediani B, Vitale A, Guerriero S, Iannone F, Vannozzi L, Fabiani C, Cantarini L. Behçet's syndrome in Italy: a detailed retrospective analysis of 396 cases seen in 3 tertiary referral clinics. Intern Emerg Med 2020; 15:1031-1039. [PMID: 32006221 DOI: 10.1007/s11739-019-02248-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
Behçet's syndrome (BS) is a multisystemic disorder displaying a marked variability across different geographic areas. The main aim of this study was to analyze demographic and clinical features of a cohort of BS patients diagnosed in three tertiary referral centers in Italy and detect potential associations between the different manifestations. Medical records of 396 patients (218 females, 178 males) were retrospectively analyzed. Mean age at onset was 30.00 ± 18.75 years with a female-to-male ratio of 1.22:1. Mucocutaneous features were the most frequent starting manifestations of BS, followed by eye inflammation. Erythema nodosum (p = 0.007), arthritis/arthralgias (p = 0.0115), and central nervous system (CNS) signs (p = 0.014) were significantly over-represented in female patients, whereas male gender was associated with lower mean age at onset (p = 0.031), higher frequency of pseudofollicular lesions, and uveitis (p = 0.00134 and p < 0.0001 respectively), particularly for posterior segment involvement and panuveitis (p < 0.0001). Regarding the association between disease features, genital ulcers were negatively associated with uveitis (p < 0.0001) and vascular involvement (p < 0.0001). Other negative associations were detected between uveitis and gastrointestinal involvement (p = 0.008), pseudofolliculitis and CNS signs (p = 0.031), vascular involvement (p = 0.002) and erythema nodosum (p = 0.013). Logistic regression identified male gender and genital ulcers, respectively, with a higher (OR 2.199 [1.397-3.461], p < 0.001) and lower risk (OR 0.157 [0.090-0.273], p < 0.0001) of developing major organ involvement. Our evaluations found that the disease had started mostly in the second and third decade with most severe features in the male gender, and that patients presenting with mucocutaneous manifestations were less prone to develop major organ involvement.
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Affiliation(s)
- Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica Sacro Cuore, Rome, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Ida Orlando
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy.
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64
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Toledo-Samaniego N, Galeano-Valle F, Pinilla-Llorente B, Del-Toro-Cervera J, Marra A, Proietti M, Demelo-Rodríguez P. Clinical features and management of venous thromboembolism in patients with Behçet's syndrome: a single-center case-control study. Intern Emerg Med 2020; 15:635-644. [PMID: 31802406 DOI: 10.1007/s11739-019-02237-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022]
Abstract
Almost one third of patients with Behçet's syndrome (BS) display vascular involvement. However, data regarding the prevalence and management of venous thromboembolism (VTE) in BS are scanty. We assessed the differential characteristics between patients with and without VTE and the factors associated with VTE incidence. A case-control study in a cohort of patients with BS was performed. 57 patients were included (56.1% women) with a mean follow-up of 10.56 (± 10.7) years. Mean age at diagnosis of BS and diagnosis of the first VTE episode was 34.7 (± 12.1) and 31.2 (± 8.9) years, respectively. Erythema nodosum (OR 4.6, CI 95% 1.2-18.1) and fever (OR 8.2, CI 95% 1.6-42.1) were associated with a higher risk of VTE. 26 episodes of VTE were registered in 12/57 (21%) patients. 83.3% of patients were not diagnosed with BS when the first episode of VTE occurred and, among them, the episode of VTE led to the diagnosis of BS in 40% of cases. Half of patients had at least one VTE recurrence. The absence of immunosuppressive treatment was associated with a higher risk of developing a first episode of VTE (OR 20 CI 95% 19.2-166.6). All patients were treated with anticoagulation and 75% were treated with immunosuppressants after the first VTE event. The diagnosis of VTE usually precedes that of BS, with a high frequency of VTE recurrence. Erythema nodosum and fever were associated with a higher risk of VTE, while the immunosuppressants showed a protective role for the development of VTE.
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Affiliation(s)
- Neera Toledo-Samaniego
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain.
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Blanca Pinilla-Llorente
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Alberto Marra
- Department of Cardiovascular Imaging, IRCCS (Istituto Di Ricovero E Cura a Carattere Scientifico)-SDN Research Institute, Via Giovanni Amendola 209, 70126, Bari, Italy
| | - Marco Proietti
- Department of Neuroscience, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milan, MI, Italy
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, RM, Italy
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
- School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Calle Doctor Esquerdo 46, 28007, Madrid, Spain
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65
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Abstract
PURPOSE OF THE REVIEW Rheumatic diseases usually have very diverse and complex pathophysiology resulting in different clinical phenotypes. Some certain phenotypes cluster together with a common presentation, course, and outcome. Our primary aim is to review the known disease clusters in certain rheumatological conditions. RECENT FINDINGS Cluster analysis has been reported in several rheumatic diseases, Behcet disease being the most common. Five individual clusters together with some clinical associations have been reported in Behcet patients. Certain antibody-phenotype associations and damage clusters have been reported in systemic lupus erythematosus (SLE) patients as well. Although there is no proper cluster analysis, two distinct phenotypes are evident in deficiency of ADA2 (DADA2): those with a polyarteritis nodosa-like vasculopathy and hematological involvement with pure red cell aplasia or bone marrow failure. The variants are claimed to be different regions of this gene for these 2 phenotypes. Lastly, there is a recent paper grouping ANCA-associated vasculitis according to disease phenotype and antibody associations. There are distinct clusters in certain rheumatic diseases which might help us to predict comorbidities, disease course, and treatment response.
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Affiliation(s)
- Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Selcan Demir
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey
| | - Seza Ozen
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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66
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Fagni F, Bettiol A, Talarico R, Lopalco G, Silvestri E, Urban ML, Russo PAJ, Di Scala G, Emmi G, Prisco D. Long-term effectiveness and safety of secukinumab for treatment of refractory mucosal and articular Behçet's phenotype: a multicentre study. Ann Rheum Dis 2020; 79:1098-1104. [PMID: 32381569 DOI: 10.1136/annrheumdis-2020-217108] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/04/2020] [Accepted: 04/20/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of secukinumab in patients with a mucosal and articular Behçet's phenotype resistant to conventional and biologic treatment. METHODS A multicentre retrospective study was performed on 15 patients with a mucosal and articular phenotype of Behçet's syndrome fulfilling the International Criteria for Behçet's Disease and refractory to treatment with colchicine, disease-modifying antirheumatic drugs and at least one antitumour necrosis factor-α agent. Minimum follow-up was set at 6 months. Six patients with a polyarticular involvement were treated with secukinumab 300 mg/month, while all other cases received secukinumab 150 mg/month. Dose increase from 150 to 300 mg per month and shortening of administration frequency were allowed for poor disease control. Response evaluation was based on the number of oral ulcers in the previous 28 days and Disease Activity Score-28 for articular manifestations. RESULTS At 3 months of follow-up, nine (66.7%) patients achieved a response (complete or partial), and this proportion further increased to 86.7% at 6 months, 76.9% at 12 months, 90.0% at 18 months and 100.0% after 24 months. Notably, all patients who started with secukinumab 300 mg/month achieved complete response by month 6. Seven (46.7%) patients could achieve a response only after switching to a higher dosage. CONCLUSIONS Our study suggests that secukinumab at a dose of 150 and 300 mg per month is safe and effective for the long-term treatment of patients with Behçet's syndrome with a mucosal and articular phenotype refractory to previous treatments. Notably, secukinumab 300 mg/month resulted in superior complete mucosal and articular responses with no serious or dose-related adverse effects.
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Affiliation(s)
- Filippo Fagni
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Alessandra Bettiol
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Elena Silvestri
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Paul A J Russo
- Chandlers Hill Surgery, Adelaide, South Australia, Australia
| | - Gerardo Di Scala
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
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67
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Yıldız M, Köker O, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Pediatric Behçet's disease - clinical aspects and current concepts. Eur J Rheumatol 2020; 7:S38-S47. [PMID: 31556871 PMCID: PMC7004268 DOI: 10.5152/eurjrheum.2019.19121] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022] Open
Abstract
Behçet's Disease was first described by a Turkish dermatologist, Hulusi Behçet, in 1937 as a triple symptom complex; aphthous stomatitis, genital ulcers, and uveitis. Today, in light of current trials and experiments, we know that the disease may have a wider involvement with a multisystemic recurrent course, causing significant morbidity and mortality. However, there are still unanswered questions, particularly about Pediatric Behçet's Disease. Although several immunological and genetic associations have been demonstrated, the real etiologic mechanism of the disease is unclear. The diagnosis is difficult due to its rarity in childhood, the lack of validation of the diagnostic criteria obtained from adult studies, and the inadequacy of large case-controlled studies. Also, the management is challenging and controversial due to the various geographic distribution of clinical spectrum. New therapeutic options under development in light of pathogenetic hypothesis seem to be promising.
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Affiliation(s)
- Mehmet Yıldız
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Oya Köker
- Department of Pediatric Rheumatology, İstanbul University, İstanbul School of Medicine, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa School of Medicine, İstanbul, Turkey
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68
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Tüzün E, Erdağ E, Şahin-Özkartal C, Küçükali C, Arıcıoğlu F. Serum immunoglobulin G of neuro-Behçet's Disease patients reduce cerebral expression levels of survival pathway factors. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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69
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Bettiol A, Hatemi G, Vannozzi L, Barilaro A, Prisco D, Emmi G. Treating the Different Phenotypes of Behçet's Syndrome. Front Immunol 2019; 10:2830. [PMID: 31921115 PMCID: PMC6915087 DOI: 10.3389/fimmu.2019.02830] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/18/2019] [Indexed: 12/13/2022] Open
Abstract
Behçet's syndrome (BS) is a multisystemic vasculitis, characterized by different clinical involvements, including mucocutaneous, ocular, vascular, neurological, and gastrointestinal manifestations. Based on this heterogeneity, BS can be hardly considered as a single clinical entity. Growing evidence supports that, within BS, different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, three major BS phenotypes have been reported: (a) the mucocutaneous and articular phenotype, (b) the extra-parenchymal neurological and peripheral vascular phenotype, and (c) the parenchymal neurological and ocular phenotype. To date, guidelines for the management of BS have been focused on the pharmacological treatment of each specific BS manifestation. However, tailoring the treatments on patient's specific phenotype, rather than on single disease manifestation, could represent a valid strategy for a personalized therapeutic approach to BS. In the present literature review, we summarize current evidence on the pharmacological treatments for the first-, second-, and third-line treatment of the major BS phenotypes.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Lorenzo Vannozzi
- Eye Clinic, Careggi Teaching Hospital, University of Florence, Florence, Italy
| | - Alessandro Barilaro
- Department of Neurology 2 and Multiple Sclerosis Regional Referral Centre, Careggi University Hospital, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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70
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Abstract
PURPOSE OF REVIEW To review the association of venous thrombosis and inflammatory disorders. RECENT FINDINGS Various systemic inflammatory diseases of which Behçet's syndrome is the prototype are associated with an increased risk of venous thrombosis. Recent data indicate that venous wall thickness is increased among Behçet's syndrome patients with no history of venous thrombosis and thrombosis in Behçet's syndrome could be a unique model of inflammation-induced thrombosis. Patients with inflammatory bowel disease (IBD) have a two to three time-fold increased risk of developing thromboembolic complications compared with general population. The risk of venous thrombosis is increased after surgical interventions and is higher in ulcerative colitis compared with Crohn's disease. Despite similarities with Behçet's syndrome, anticoagulation is advised as the main treatment in IBD, while there is uncertainty about the duration of antithrombotic prophylaxis. Antineutrophil cytoplasmic antibody-associated vasculitides and ankylosing spondylitis are also other inflammatory disorders associated with a thrombotic risk. SUMMARY Underlying mechanisms of venous thrombosis in inflammatory disorders are not clearly understood. How we might prevent thrombosis, should we screen asymptomatic patients, what should we use for the treatment (immunosuppression or anticoagulation or both) and what should be the duration of this treatment also need to be addressed. Finally, the link between inflammation and thrombosis should be more intensively studied.
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71
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Emmi G, Prisco D. Behçet's syndrome: focus on pathogenetic background, clinical phenotypes and specific treatments. Intern Emerg Med 2019; 14:639-643. [PMID: 31317313 DOI: 10.1007/s11739-019-02154-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/10/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy.
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Largo Brambilla 3, 50134, Florence, Italy
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72
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Adalimumab in the treatment of pediatric Behçet’s disease: case-based review. Rheumatol Int 2019; 39:1107-1112. [PMID: 30976833 DOI: 10.1007/s00296-019-04300-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022]
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