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Djaballah-Ider F, Djaballah A, Djeraba Z, Chaib S, Touil-Boukoffa C. Auto-immunity profile evaluation during different clinical manifestations of Behçet disease in Algerian patients: effect of corticosteroid treatment. Inflammopharmacology 2019; 27:1113-1122. [DOI: 10.1007/s10787-019-00567-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 01/18/2019] [Indexed: 01/01/2023]
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La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behçet's Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010; 4:71-7. [PMID: 20360979 PMCID: PMC2847254 DOI: 10.2174/1874192401004020071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/23/2009] [Accepted: 12/12/2009] [Indexed: 01/11/2023] Open
Abstract
Behçet's disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow's triad of venous thrombosis. Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Periodic Fevers Research Centre, Catholic University, Rome, Italy
| | | | | | - Domenico Prisco
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Regina ML, Gasparyan AY, Orlandini F, Prisco D. Behçet’s Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010. [DOI: 10.2174/1874192401004010071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%.
In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow’s triad of venous thrombosis.
Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Hosaka A, Miyata T, Shigematsu H, Shigematsu K, Okamoto H, Ishii S, Miyahara T, Yamamoto K, Akagi D, Nagayoshi M, Nagawa H. Long-term outcome after surgical treatment of arterial lesions in Behçet disease. J Vasc Surg 2005; 42:116-21. [PMID: 16012460 DOI: 10.1016/j.jvs.2005.03.019] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Surgical treatment of arterial lesions associated with Behçet disease (BD) is often complicated by graft occlusion and recurrence of aneurysms. The purpose of this study was to clarify the long-term outcome of surgical intervention for arterial involvement in BD. METHODS Ten patients with BD (9 men, 1 woman) who underwent surgical treatment for arterial aneurysms between 1980 and 2004 were included in the study. The age of patients at the first operation ranged from 36 to 69 years (mean, 50.4 +/- 9.0 years). The mean period between the onset of BD and that of arterial manifestations was 8.0 +/- 5.0 years. We retrospectively reviewed their postoperative courses, including survival, graft occlusion, formation of anastomotic false aneurysms, and the development of aneurysms at different sites. The Kaplan-Meier method was used to calculate the chronologic incidence of complications after surgery. RESULTS The mean follow-up period was 133 +/- 92 months, ranging from 5 to 285 months. One patient died of rupture of a dissecting aortic aneurysm after undergoing several surgical interventions for multiple aneurysms. There were five graft occlusions among 21 grafts. The cumulative primary graft patency rate in the infrainguinal region was 83.9% at 3 years. Five anastomotic false aneurysms formed among 49 anastomoses between grafts and host arteries. The overall cumulative incidence of formation of anastomotic pseudoaneurysm was 12.9% at 5 and 10 years. All of them formed within 18 months after surgery. Development of new aneurysms in different arteries was observed in two patients. CONCLUSIONS Early occurrence of anastomotic false aneurysm is characteristic of BD. Further investigation is necessary to establish effective postoperative treatment.
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Affiliation(s)
- Akihiro Hosaka
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
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Musabak U, Baylan O, Cetin T, Yesilova Z, Sengul A, Saglam K, Inal A, Kocar IH. Lipid Profile and Anticardiolipin Antibodies in Behcet's Disease. Arch Med Res 2005; 36:387-92. [PMID: 15950080 DOI: 10.1016/j.arcmed.2005.03.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2004] [Accepted: 01/19/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Behcet's disease (BD) is a multisystem disorder characterized by a relapsing inflammatory process of unknown etiology. It is well known that atherothrombosis in systemic inflammatory disorders is closely related to coagulation and lipid metabolism abnormalities. The purpose of this study was to investigate some parameters of lipid metabolism, lipoprotein (a) [Lp(a)] and anticardiolipin antibody (ACA) levels and the relationship of these parameters with the clinical activity of BD. METHODS Thirty three patients with BD (15 active, 18 inactive cases) and 20 healthy controls participated in the study. After performing a detailed physical exam, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), very-low-density lipoprotein cholesterol (VLDL-C), apoprotein A and B (apo-A, apo-B), Lp(a), and ACA levels (ACA-IgG and IgM) were measured in all participants. RESULTS Patients with active BD had higher ESR, CRP and Lp(a) levels, and lower apo-A and HDL-C levels compared with the patients with inactive BD and healthy controls. ACA-IgG and IgM levels were higher in patients with active BD than healthy controls but not higher than patients with inactive BD. On the other hand, ACA-IgG level was higher in active and inactive cases with vascular involvement than in those of active and inactive cases without vascular involvement. In the analyses of correlation, in active BD patients we found a positive correlation between CRP and Lp(a) levels. CONCLUSIONS Our findings suggest that Lp(a) behaves as an acute phase reactant and ACA levels are increased in patients with active BD. Data from patients with active BD may be compatible with the serum profile, which is accepted as a risk for the development of atherothrombosis.
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Affiliation(s)
- Ugur Musabak
- Department of Immunology, Gulhane Military Medical Academy and School of Medicine, Ankara, Turkey.
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Nakano H, Oka H, Matsuda T, Ooka S, Imamura Y, Suzuki T, Yamasaki Y, Itoh G, Azuma K, Ozaki S. Behçet's disease with vascular involvement: the contribution of anticardiolipin antibodies and thrombomodulin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:395-8. [PMID: 12918732 DOI: 10.1007/0-306-48382-3_81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- H Nakano
- Division of Rheumatology and Allergy, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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Espinosa G, Font J, Tàssies D, Vidaller A, Deulofeu R, López-Soto A, Cervera R, Ordinas A, Ingelmo M, Reverter JC. Vascular involvement in Behçet's disease: relation with thrombophilic factors, coagulation activation, and thrombomodulin. Am J Med 2002; 112:37-43. [PMID: 11812405 DOI: 10.1016/s0002-9343(01)01048-8] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Thrombosis, usually venous, occurs in 10% to 25% of patients with Behçet's disease, but its pathogenesis is poorly understood. We evaluated parameters of hemostasis and their relation with thrombosis in a series of patients with Behçet's disease. SUBJECTS AND METHODS We studied 38 patients with Behçet's disease (13 with venous thrombosis), 38 patients with venous thrombosis without thrombophilia, and 100 control subjects. Levels or presence of protein C, protein S, antithrombin, methylenetetrahydrofolate reductase C677T, factor V Leiden, prothrombin gene G20210A, antiphospholipid antibodies, plasminogen, tissue-type plasminogen activator (tPA), type-1 tPA inhibitor (PAI-1), PAI-1 4G/5G polymorphism, prothrombin fragment 1+2, plasmin/alpha(2)-antiplasmin complexes, thrombomodulin, and activated factors VII and XII were determined. RESULTS There were no deficiencies in protein C, protein S, antithrombin, or factor V Leiden in the patients with Behçet's disease, nor was there evidence of most other thrombotic abnormalities. Compared with control subjects, however, the Behçet's disease group had elevated mean (+/- SD) levels of prothrombin fragment 1+2 (2091 +/- 1323 pmol/L vs. 804 +/- 398 pmol/L, P <0.001), plasmin/alpha2-antiplasmin complexes (410 +/- 220 microg/L vs. 214 +/- 92 microg/L, P <0.001), and thrombomodulin (37 +/- 24 ng/mL vs. 27 +/- 10 ng/mL, P <0.001). These levels did not differ between patients with or without thrombosis. CONCLUSIONS Thrombophilic factors do not seem to explain most thromboses in Behçet's disease. There is increased thrombin generation, fibrinolysis, and thrombomodulin in Behçet's disease, but these abnormalities are not related to thrombosis.
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Affiliation(s)
- Gerard Espinosa
- Systemic Autoimmune Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic, Barcelona, Spain
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Akarsu M, Demirkan F, Ozsan GH, Onen F, Yüksel F, Ozkan S, Undar B. Increased levels of tissue factor pathway inhibitor may reflect disease activity and play a role in thrombotic tendency in Behçet's disease. Am J Hematol 2001; 68:225-30. [PMID: 11754410 DOI: 10.1002/ajh.1186] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tissue factor pathway inhibitor (TFPI) is a Kunitz-type proteinase inhibitor that has a crucial role in haemostasis and is primarily synthesized in the vascular endothelium. We investigated plasma total TFPI, antiphospholipid antibodies, and some other coagulation and fibrinolytic system parameters in 30 patients with Behçet's disease and 15 controls by the enzyme-linked immunosorbent assay method. TFPI levels were significantly higher in the Behçet's group (119 +/- 57.5 ng/ml) compared with the control group (74.8 +/- 31.5) (P < 0.009). We also noted a statistical significance in TFPI levels between patients with active disease (n:16) (139 +/- 55) and patients without activation (n:14) (96 +/- 53) (P < 0.03), whereas inactive patients lacked any significance when compared with the control group (P < 0.29). Other parameters disclosed no statistical significance between patients and control group except for elevated fibrinogen and plasminogen activator inhibitor-1 levels in the patient group (P < 0.003). Increased levels of TFPI may reflect a defensive mechanism like in other diseases characterized by thrombotic tendency and represent a parameter of disease activity.
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Affiliation(s)
- M Akarsu
- Department of Medicine, Division of Hematology/Oncology, Dokuz Eylül University School of Medicine, Izmir, Turkey
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Mukai Y, Tsutsui H, Todaka K, Mohri M, Hirai N, Arai H, Takeshita A. Total occlusion of inferior vena cava in a patient with antiphospholipid antibody syndrome associated with behçet's disease. JAPANESE CIRCULATION JOURNAL 2001; 65:837-8. [PMID: 11548886 DOI: 10.1253/jcj.65.837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Behçet's disease frequently involves the venous system, usually affecting small vessels, but sometimes large vessels such as the vena cava. Antiphospholipid antibody syndrome is associated with an increased incidence of arterial and venous thrombosis. A 29-year-old male with Behçet's disease developed bilateral leg edema secondary to thrombotic occlusion of the inferior vena cava. Laboratory tests revealed positive antiphospholipid antibodies and lupus anticoagulant. Treatment with steroid and warfarin subsequent to intravenous administration of uro-kinase resulted in improvement of symptoms. The association of antiphospholipid antibody syndrome and Behçet's disease may have caused the total thrombotic occlusion of the vena cava in this case.
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Affiliation(s)
- Y Mukai
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Harmouche H, Tazi Mezalek Z, Adnaoui M, Aouni M, Mohattane A, Maaouni A, Berbich A. [Association of pulmonary artery aneurysm, right heart thromboses and antiphospholipid antibodies in Behcet's disease]. Rev Med Interne 1998; 19:512-5. [PMID: 9775202 DOI: 10.1016/s0248-8663(99)80009-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Cardiac thromboses are unusual in the course of Behçet's disease and are frequently associated with endomyocardial fibrosis of the right heart. Vascular pulmonary involvement with either pulmonary aneurysm or parenchyma alterations is also often observed. However, pathogenesis of thromboses occurring in the course of Behçet's disease is still unclear. CASE REPORT The authors report the case of a 28-year-old man who presented with Behçet's disease accompanied by pulmonary aneurysm, multiple thrombi of the right heart and antiphospholipid antibodies. CONCLUSION The choice of therapeutical strategies for curative treatment of this association as well as the interpretation of the role of antiphospholipid antibodies in this polyvascular disease raises questions.
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Affiliation(s)
- H Harmouche
- Service de médecine interne A, Hôpital Ibn Sina, Rabat, Maroc
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Ebo DG, Bracke PG, De Clerck LS, Francx LM, Stevens WJ. Anticardiolipin (aCL) antibodies in a patient with Behçet's syndrome with vena cava inferior thrombosis. Clin Rheumatol 1997; 16:96-8. [PMID: 9132335 DOI: 10.1007/bf02238771] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This case report describes a patient with Behçet's syndrome with sustained anticardiolipin antibodies presenting a vena cava inferior thrombosis in a period of anabolic steroid use. The vascular manifestations and occurrence of antiphospholipid antibodies in Behçet's syndrome are reviewed. The possible thrombogenicity of anabolic steroids is reemphasized.
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Affiliation(s)
- D G Ebo
- Department of Immunology-Allergology-Rheumatology, University of Antwerp
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Karmochkine M, Boffa MC, Wechsler B, Piette JC, Godeau P. Absence of antiphospholipid antibodies in Behçet's disease. Ann Rheum Dis 1993; 52:623. [PMID: 8215632 PMCID: PMC1005127 DOI: 10.1136/ard.52.8.623-a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Moyle G, Chard S, Boag F. Mucosal presentation of Behcet's disease. J Eur Acad Dermatol Venereol 1993. [DOI: 10.1111/j.1468-3083.1993.tb00021.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zouboulis CC, Büttner P, Tebbe B, Orfanos CE. Anticardiolipin antibodies in Adamantiades-Behçet's disease. Br J Dermatol 1993; 128:281-4. [PMID: 8471511 DOI: 10.1111/j.1365-2133.1993.tb00172.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Moderately raised levels of circulating anticardiolipin antibodies were found in 14 of 30 patients with active Adamantiades-Behçet's disease (46.7%) who were not receiving treatment. Three patients showed the IgG isotype, nine the IgM isotype, and two had both IgG and IgM isotypes. Statistical analysis, to determine possible correlations between anticardiolipin antibodies and clinical features, and meta-analysis of the data available, were performed. A positive correlation between erythema nodosum and histologically confirmed cutaneous vasculitis and the presence of circulating anticardiolipin antibodies of the IgM isotype was found (P = 0.017 and 0.018, respectively), whereas the IgG isotype did not correlate with any clinical feature. Evaluation of data on other clinical manifestations showed no correlation, either with the IgG or IgM isotypes. In particular, there was no association of circulating anticardiolipin antibodies with the incidence of thrombosis, systemic vasculitis, retinal involvement or neurological features. These results suggest that anticardiolipin antibodies do not play a major pathogenetic role in Adamantiades-Behçet's disease, but they may serve as an additional marker for a risk of the development of cutaneous vasculitis such as erythema nodosum.
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Affiliation(s)
- C C Zouboulis
- Department of Dermatology, University Medical Center Steglitz, Free University of Berlin, Germany
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