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Espinosa G. Behçet syndrome. Med Clin (Barc) 2025; 165:106983. [PMID: 40378634 DOI: 10.1016/j.medcli.2025.106983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2024] [Revised: 01/31/2025] [Accepted: 02/04/2025] [Indexed: 05/19/2025]
Abstract
Behçet's syndrome (BS) is a systemic vasculitis that affects vessels of all calibers. It has several defining characteristics, such as its tendency for remission over time and a typical geographical distribution. Clinically, the association of venous thrombosis with arterial aneurysms, inflammatory parenchymal brain involvement, the classic pattern of posterior uveitis with retinal vasculitis, and the well-known triad of bipolar ulcers and erythema nodosum are distinctive features of this condition. Despite some advances in the pathogenesis of BS and the use of biological drugs that have improved prognosis, certain aspects remain controversial, such as the role of the pathergy test or the determination of HLA-B*51 in the diagnosis of the disease, or the actual value of anticoagulation in patients with BS and vascular thrombosis.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Centro de Referencia (UEC/CSUR) en Enfermedades Autoinmunes Sistémicas, Vasculitis y Enfermedades Autoinflamatorias; Miembro de ERN-ReCONNET/RITA; Hospital Clínic, Barcelona, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España; Facultat de Medicina i Ciències de la Salut; Universitat de Barcelona, Barcelona, España.
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Guzelant-Ozkose G, Yurttas B, Esatoglu SN, Ar MC, Hamuryudan V, Hatemi G. Factors associated with thrombosis in Behçet Syndrome: A systematic review and meta-analysis. Semin Arthritis Rheum 2025; 73:152736. [PMID: 40288105 DOI: 10.1016/j.semarthrit.2025.152736] [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: 02/07/2025] [Revised: 03/24/2025] [Accepted: 03/31/2025] [Indexed: 04/29/2025]
Abstract
OBJECTIVES Thrombosis is an important component of vascular involvement in Behçet syndrome (BS). Inflammation seems to be the main cause, while the contribution of factors associated with thrombosis is debated. METHODS We searched PubMed and EMBASE for studies that assessed factors associated with thrombosis in patients with BS. We separately analyzed studies that compared BS patients with thrombosis to BS patients without thrombosis and studies that compared BS patients with thrombosis to non-BS patients with thrombosis. The pooled odds ratios with 95%CI were calculated for binary outcomes and standardized mean differences were calculated for continuous outcomes. RESULTS A total of 87 factors were compared between BS patients with thrombosis and BS patients without thrombosis in 101 studies. Having a Factor V Leiden mutation increased the risk of thrombosis 2.58 times (95% CI 1.76 to 3.78) among patients with BS. Homocysteine levels and factor VIII levels were also significantly higher among BS patients with thrombosis. There were only 6 studies including 14 factors that compared BS patients with thrombosis to non-BS patients with thrombosis. The frequencies of JAK-2 mutation, activated protein C resistance, levels of tissue plasminogen activator (tPA) and activity of tPA were significantly higher among non-BS patients with thrombosis. CONCLUSION Prothrombotic factors do not seem to be the main driver of thrombosis in BS, but may pose an additional risk when present. Screening BS patients with thrombosis for common prothrombotic factors may be reasonable, especially in patients with unusual clinical and demographic features for vascular involvement of BS.
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Affiliation(s)
- Gul Guzelant-Ozkose
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Türkiye
| | - Berna Yurttas
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Türkiye
| | - Sinem Nihal Esatoglu
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Türkiye; Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
| | - Muhlis Cem Ar
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Türkiye
| | - Vedat Hamuryudan
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Türkiye; Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Gulen Hatemi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology, Istanbul, Türkiye; Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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3
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Esatoglu SN, Sonmez O, Ucar D, Kaymaz E, Ozguler Y, Ugurlu S, Seyahi E, Melikoglu M, Fresko I, Hamuryudan V, Uygunoglu U, Kutlubay Z, Hatemi AI, Celik AF, Hatemi G. De novo manifestations during adalimumab treatment in Behçet's syndrome. Rheumatology (Oxford) 2025; 64:2034-2040. [PMID: 39110537 DOI: 10.1093/rheumatology/keae416] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 07/24/2024] [Indexed: 04/04/2025] Open
Abstract
OBJECTIVES Treatment response may be variable across organ manifestations of Behçet's syndrome (BS). We aimed to determine the frequency of de novo manifestations during adalimumab treatment. METHODS We conducted a chart review of all BS patients who received adalimumab in our centre between 2008 and 2023. Demographic data, reasons for initiating adalimumab, concurrent medications, previous treatments, and outcomes were recorded. We defined de novo manifestations as new BS manifestations that occurred for the first time during treatment with adalimumab. For patients with vascular involvement, a new vascular event at another vessel was also considered as a de novo manifestation. RESULTS Among the 335 patients, a de novo manifestation developed in 14 (4%) patients. De novo manifestations were vascular involvement in five patients, arthritis in three, anterior uveitis in two, nervous system involvement in two, gastrointestinal involvement in one, and epididymitis in one patient. The primary reasons for adalimumab treatment were vascular involvement in five patients, uveitis in four, arthritis in three, mucocutaneous involvement in one, and epididymitis in one patient. Upon the development of de novo manifestation, adalimumab was switched to another biologic in four patients, dose was intensified in three, colchicine, conventional immunosuppressives and/or glucocorticoids were added in five, and topical eye drops were added in two patients, leading to remission of de novo manifestations in all patients. CONCLUSION De novo manifestations were infrequent (4%) among BS patients treated with adalimumab. Of these, 57% were major organ involvement, mainly vascular involvement. None of the patients developed posterior uveitis.
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Affiliation(s)
- Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ozge Sonmez
- Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Didar Ucar
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Department of Ophthalmology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Elif Kaymaz
- Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ugur Uygunoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Department of Neurology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Zekayi Kutlubay
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Department of Dermatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Ali Ibrahim Hatemi
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Aykut Ferhat Celik
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
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Arida A, Markomichelakis N, Fragoulis GE, Sfikakis PP. Very long-term remission in behcet's disease following withdrawal of anti-TNF treatment exceeds relapses: a reappraisal of an outcome study. Rheumatol Int 2025; 45:60. [PMID: 39992459 DOI: 10.1007/s00296-025-05806-6] [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] [Received: 12/23/2024] [Accepted: 02/01/2025] [Indexed: 02/25/2025]
Abstract
BACKGROUND Introduction of anti-TNF treatment has greatly improved prognosis of Behcet's disease (BD). Withdrawal of anti-TNF treatment in chronic inflammatory arthritis or bowel disease has been associated with sustained remission in subsets of patients. Herein, we examined the probability of very long-term quiescence after withdrawal of TNF inhibitors in BD. METHODS Retrospective longitudinal outcome single-center study focusing on BD patients who discontinued successful ant-TNF treatment since 2001. Endpoint was their proportion with sustained clinical remission for 5 years after withdrawal. RESULTS Thirty-three patients with severe BD refractory to non-biologic treatment (mean age 47.5 ± 11.5 years, 55% men) achieved TNF inhibitor-induced remission for a median of 2 years (IQR [1-2.6]). TNF inhibitors had been given for sight-threatening disease (28/33, 82%), for mucocutaneous (3/33), central nervous system (2/33) and gastrointestinal involvement (1/33). After withdrawal, BD remained in remission in 15/33 patients for 6.6 to 20.6 years (mean 13.5 ± 3.8). Conversely, 18/33 patients relapsed after a median of 9.5 months [IQR 8-12, range 4-32] following withdrawal but retreatment with TNF inhibitors was effective in 13/18. Of them, 9/13 discontinued for a second time and achieved again the study's endpoint, remaining in remission for median of 7.4 years ([IQR 5-9.3, range 5-15 years). Study's end-point was met by 24/33 patients (73%); 17and 7 patients remain any-drug free or on azathioprine only, respectively. CONCLUSION Discontinuation of successful anti-TNF treatment is frequently associated with durable very long-term remission in severe BD. Additional studies are needed since relapses not responding to anti-TNF re-treatment may occur.
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Affiliation(s)
- Aikaterini Arida
- First Department of Propaedeutic and Internal Medicine and Join t Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece.
| | - Nikos Markomichelakis
- First Department of Propaedeutic and Internal Medicine and Join t Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George E Fragoulis
- First Department of Propaedeutic and Internal Medicine and Join t Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine and Join t Rheumatology Program, National and Kapodistrian University of Athens Medical School, Athens, Greece
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Ucar D, Bircan BE, Rustamli N, Batu Oto B, Hamuryudan V, Hatemi G, Esatoglu SN. Development of Posterior Uveitis in Behçet Syndrome Patients with Vitreous Cells at Baseline. Ocul Immunol Inflamm 2025; 33:243-249. [PMID: 39079032 DOI: 10.1080/09273948.2024.2383315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 02/02/2025]
Abstract
PURPOSE The prognostic importance of vitreous cells (VC) in patients with Behçet syndrome (BS) is unknown. We aimed to determine the frequency of developing posterior uveitis (PU) and any additional risk factors associated with the development of PU in BS patients with VC at diagnosis. METHODS The charts of 572 consecutive BS patients who were registered between 2010 and 2012 were reviewed. Among the patients with a follow-up of ≥2 years, we included 110 patients with VC in one or both eyes and 147 patients without any eye findings in both eyes at baseline and compared them for the development of PU. RESULTS Among the 110 included patients with VC, 61 had VC in both eyes, 34 had VC in only one eye, and 15 had VC in one eye and PU in the other eye. There was anterior uveitis (AU) in addition to VC in the same eye in 13 patients at baseline. PU developed in 24 (22%) of these patients during a mean follow-up of 1.9 ± 1.1 years. This was significantly more frequent than the 147 patients without any eye findings at baseline, among whom there were only 2 patients who developed PU (p < 0.001). Multivariate logistic regression analysis showed that having AU in addition to VC in the same eye (OR, 5.03, 95% CI; 1.37-18.47) was an independent risk factor for the development of PU in patients with VC. CONCLUSION Careful follow-up is required for patients with VC at diagnosis, since 22% developed PU within 2 years.
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Affiliation(s)
- Didar Ucar
- Department of Ophthalmology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Basak Ecem Bircan
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Nigar Rustamli
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Bilge Batu Oto
- Department of Ophthalmology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Vedat Hamuryudan
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Gulen Hatemi
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
| | - Sinem Nihal Esatoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpasa, Istanbul, Türkiye
- Department of Internal Medicine, Division of Rheumatology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Türkiye
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Ucar D, Esatoglu SN. Behçet syndrome with eye involvement. Saudi J Ophthalmol 2025; 39:47-53. [PMID: 40182974 PMCID: PMC11964342 DOI: 10.4103/sjopt.sjopt_228_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/25/2024] [Accepted: 11/18/2024] [Indexed: 04/05/2025] Open
Abstract
Behçet's uveitis (BU) is a significant form of major organ involvement in Behçet syndrome and is associated with considerable morbidity. Ocular examination is crucial for diagnosing BS and detecting vitreous cells, even in asymptomatic patients. The primary goals in managing BU are to rapidly suppress ocular inflammation and prevent relapses. Initial treatment for posterior segment involvement in BU typically involves immunosuppressive agents combined with glucocorticoids. Biologic agents are increasingly used in BU management, including as first-line treatments for patients with poor prognostic risk factors or sight-threatening uveitis. There is no established consensus on when to discontinue or taper immunosuppressive therapy. Once remission is achieved, the absence of retinal vasculitis should be confirmed with fluorescein angiography, which should be utilized throughout the process of tapering immunosuppressive therapy. In addition to monoclonal tumor necrosis factor-alpha antagonists and tocilizumab, Janus kinase inhibitors may offer the potential for managing BU in the future.
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Affiliation(s)
- Didar Ucar
- Department of Ophthalmology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Behçet’s Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sinem N. Esatoglu
- Behçet’s Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Department of Internal Medicine, Division of Rheumatology, Cerrahpaşa Medical Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Deniz R, Emrence Z, Punar Ş, İleri B, Arga KY, Alibaz-Öner F, Bes C, Direskeneli H, Gül A, Erzik C. Cytokine Signature Differences in Major Phenotypic Groups of Behçet Disease. J Clin Rheumatol 2024; 30:e178-e184. [PMID: 39353077 DOI: 10.1097/rhu.0000000000002146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
OBJECTIVES Behçet disease (BD) has heterogeneous presentations, mainly mucocutaneous, vascular, and ocular manifestations. The mechanisms associated with different phenotypes have not been clarified. We aimed to investigate the expression of innate and adaptive immunity-related cytokines in these 3 main BD phenotypes in active and untreated states and remission after treatment to be able to develop a cytokine-based treatment algorithm. METHODS Serum samples were isolated from 41 patients with newly diagnosed active BD (aBD), which consisted of 19 mucocutaneous aBD, 11 ocular aBD (o-aBD), and 11 vascular aBD patients, 35 patients in remission (rBD), and 9 healthy controls (HC). Serum levels of each cytokine were measured with sandwich enzyme-linked immunosorbent assay and analyzed as both raw measurements and corrected levels for each 1 million white blood cells. RESULTS The study included 41 aBD patients (female/male [F/M]: 9/32; median age, 29 years), 35 rBD patients (F/M: 9/26; median age, 29 years), and 9 HC (F/M: 3/6; median age, 28 years). The serum interferon γ level was significantly higher in the aBD group than in the rBD (116 vs. 92 pg/mL, p = 0.022). The serum interleukin 35 (IL-35) level was significantly higher in the HC group compared with aBD and rBD ( p = 0.05). IL-17-related cytokines were lower in o-aBD. With treatment, they increased in o-aBD but decreased in mucocutaneous aBD and vascular aBD patients. CONCLUSION This study supports the involvement of both innate and T H 1-predominated adaptive immune responses across all BD phenotypes. The IL-17 and T H 17-related immune responses appear less prominent in ocular BD, which may explain the ineffectiveness of IL-17 blockade in treating ocular BD. These findings support the need for further studies using comprehensive gene expression analyses to develop targeted treatment strategies for BD phenotypes.
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Affiliation(s)
| | - Zeliha Emrence
- Department of Genetics; Istanbul University, Aziz Sancar Institute of Experimental Medicine
| | - Şeyma Punar
- Department of Genetics; Istanbul University, Aziz Sancar Institute of Experimental Medicine
| | - Berk İleri
- Department of Genetics; Istanbul University, Aziz Sancar Institute of Experimental Medicine
| | | | - Fatma Alibaz-Öner
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University
| | - Cemal Bes
- Department of Rheumatology, University of Health Sciences Başakşehir Çam and Sakura City Hospital
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University
| | - Ahmet Gül
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine
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Tang WZ, Huang KJ, Liu TH. Efficacy of combined immunomodulators in preventing uveitis relapses in patients with Behçet's disease on corticosteroids. THE LANCET. RHEUMATOLOGY 2024; 6:e822. [PMID: 39603758 DOI: 10.1016/s2665-9913(24)00300-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 09/23/2024] [Indexed: 11/29/2024]
Affiliation(s)
- Wei-Zhen Tang
- Department of Bioinformatics, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
| | - Kang-Jin Huang
- Department of Bioinformatics, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China
| | - Tai-Hang Liu
- Department of Bioinformatics, School of Basic Medical Sciences, Chongqing Medical University, Chongqing 400016, China.
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Zhong Z, Deng D, Gao Y, Bu Q, Dai L, Feng X, Tang C, Luo X, Wang Y, Zhou C, Su G, Yang P. Combinations of immunomodulatory agents for prevention of uveitis relapse in patients with severe Behçet's disease already on corticosteroid therapy: a randomised, open-label, head-to-head trial. THE LANCET. RHEUMATOLOGY 2024; 6:e780-e790. [PMID: 39236720 DOI: 10.1016/s2665-9913(24)00194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/30/2024] [Accepted: 07/01/2024] [Indexed: 09/07/2024]
Abstract
BACKGROUND Data from head-to-head trials of immunomodulatory therapies for Behçet's disease are scarce. We aimed to compare the efficacy and safety of ciclosporin, interferon alfa-2a, and adalimumab, each combined with corticosteroids, in preventing uveitis relapse in patients with severe Behçet's disease. METHODS We did a randomised, open-label, assessor-masked, head-to-head trial at a large, specialised uveitis centre in Chongqing, China. Patients aged 18 years or older with severe Behçet's disease uveitis on corticosteroids and naive to anti-TNF therapy were eligible. Patients were randomly assigned in a 1:1:1 ratio to ciclosporin (2-5 mg/kg per day orally), interferon alfa-2a (3 million IU per day subcutaneously), or adalimumab (40 mg every 2 weeks subcutaneously), each combined with a tapering dose of corticosteroids with subsequent dose adjustments. The primary outcome was the annualised relapse rate of uveitis, assessed in the full analysis set (all randomly assigned patients with at least one post-baseline assessment). The non-inferiority margin of difference between the interferon alfa-2a and adalimumab groups was set to 1·0 for the primary outcome. Safety was assessed in all patients who received at least one dose of trial drugs. Individuals with lived experience of Behçet's disease uveitis were involved in the trial design and implementation. This study is registered with Chinese Clinical Trial Registry, ChiCTR2000031637. The trial is ongoing, but is closed to new participants. FINDINGS Between May 12, 2020, and Feb 22, 2022, a total of 270 patients (mean age 38·1 years [SD 9·8]; 213 [79%] men, 57 [21%] women; 270 [100%] east Asian ethnicity) were randomly assigned to ciclosporin, interferon alfa-2a, or adalimumab (n=90 in each group); 261 patients were included in the full analysis set. For the primary outcome, the least-squares mean was 1·84 (95% CI 1·40 to 2·44) with ciclosporin, 1·44 (1·10 to 1·89) with interferon alfa-2a, and 0·95 (0·64 to 1·40) with adalimumab. The annualised relapse rate was significantly higher in patients receiving ciclosporin than in those receiving adalimumab (least-squares mean difference 0·90 [95% CI 0·27 to 1·53]; p=0·0054 for superiority). The least-squares mean difference between interferon alfa-2a and adalimumab was 0·50 (-0·04 to 1·04), which did not meet non-inferiority criteria (p=0·034 for non-inferiority). The primary outcome did not differ substantially between interferon alfa-2a and ciclosporin (least-squares mean difference -0·40 [-1·05 to 0·25]; p=0·23 for superiority). Serious adverse events were reported in 12 (13%) of 90 patients on ciclosporin plus corticosteroids, eight (9%) of 90 patients on interferon alfa-2a plus corticosteroids, and seven (8%) of 90 patients on adalimumab plus corticosteroids. There were no treatment-related deaths. INTERPRETATION Adalimumab plus corticosteroids was superior to ciclosporin plus corticosteroids with respect to uveitis relapse rate in patients with severe Behçet's disease naive to anti-TNF therapy, and interferon alfa-2a plus corticosteroids was not found to be non-inferior to adalimumab plus corticosteroids or superior to ciclosporin plus corticosteroids. FUNDING National Natural Science Foundation of China Key Program, Major Program of Medical Science and Technology Project of Health Commission of Henan Province, Chongqing Key Laboratory of Ophthalmology, and China National Postdoctoral Program for Innovative Talents.
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Affiliation(s)
- Zhenyu Zhong
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Dan Deng
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Yu Gao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Qingqing Bu
- School of Public Health, Chongqing Medical University, Chongqing, China
| | - Lingyu Dai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiaojie Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chong Tang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Xiang Luo
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Yao Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Chunjiang Zhou
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Guannan Su
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, China; The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Kechida M, Bazewicz M, Nabi W, Daadaa S, Willermain F, Abroug N, Makhoul D, Ksiaa I, Jelliti B, Khochtali S, Khairallah M. Recent advances in the diagnosis and management of Behçet’s syndrome uveitis. EXPERT REVIEW OF OPHTHALMOLOGY 2024; 19:423-442. [DOI: 10.1080/17469899.2024.2385652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/23/2024] [Indexed: 01/03/2025]
Affiliation(s)
- Melek Kechida
- Department of Internal Medicine and Endocrinology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - Magdalena Bazewicz
- Department of Ophthalmology, St-Pierre and Brugmann University Hospitals, Brussels, Belgium
| | - Wijdene Nabi
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Syrine Daadaa
- Department of Internal Medicine and Endocrinology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
| | - François Willermain
- Department of Ophthalmology, St-Pierre and Brugmann University Hospitals, Brussels, Belgium
| | - Nesrine Abroug
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Dorine Makhoul
- Department of Ophthalmology, St-Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Imen Ksiaa
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Bechir Jelliti
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Sana Khochtali
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Moncef Khairallah
- Faculty of Medicine, University of Monastir, Monastir, Tunisia
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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11
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van Laar JAM, van der Houwen TB. Chemotherapy or Immunotherapy in Behçet's Disease? NEJM EVIDENCE 2024; 3:EVIDe2400267. [PMID: 39437135 DOI: 10.1056/evide2400267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Affiliation(s)
- Jan A M van Laar
- Section of Clinical Immunology, Departments of Internal Medicine and Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Tim B van der Houwen
- Department of Medicine, Division of Clinical Immunology and Allergy, Vasculitis Center of Expertise, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam University Medical Center - Academic Medical Center, University of Amsterdam
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Saadoun D, Maalouf G, Vieira M, Trad S, Lazaro E, Sacre K, Plessier A, Sené T, Koné-Paut I, Noel N, Mekinian A, Lambert M, Ribeiro E, Mirault T, Mele N, Dellal A, Fain O, Melki I, Chiche L, Gaudric J, Redheuil A, Maillart E, Ghembaza A, Desbois AC, Mirouse A, Domont F, Leroux G, Ferfar Y, Rigolet A, Viallard JF, Vautier M, Resche-Rigon M, Cacoub P. Infliximab versus Cyclophosphamide for Severe Behçet's Syndrome. NEJM EVIDENCE 2024; 3:EVIDoa2300354. [PMID: 39437137 DOI: 10.1056/evidoa2300354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2024]
Abstract
BACKGROUND Cyclophosphamide and infliximab are recommended as induction therapies for severe Behçet's syndrome. Whether infliximab is safer and more effective than cyclophosphamide in treating severe Behçet's syndrome is not known. METHODS In this phase 2, Bayesian, multicenter randomized controlled trial, we assigned patients fulfilling the International Study Group's criteria for Behçet's syndrome who had major vascular or central nervous system involvement to receive either intravenous infliximab (5 mg/kg at weeks 0, 2, 6, 12, and 18) or cyclophosphamide (0.7 g/m2 intravenously at weeks 0, 4, 8, 12, 16, and 20, with a maximal dose of 1.2 g/infusion). All patients received the same glucocorticoid regimen. The primary outcome was complete response (clinical, biological, and radiological remission with a daily prednisone dose ≤0.1 mg/kg) at week 22. RESULTS Between May 2018 and April 2021, 52 patients with severe Behçet's syndrome (n=37 [71%] with vascular Behçet's syndrome and n=15 [29%] with neuro-Behçet's syndrome) were randomly assigned to receive either infliximab or cyclophosphamide. Complete response was achieved by 22 out of 27 (81%) and 14 out of 25 (56%) patients in the infliximab and cyclophosphamide treatment groups, respectively (estimated difference, 29.8 percentage points; 95% credible interval, 6.6 to 51.7). The posterior probability that at least 70% of treated individuals achieved complete response by week 22 was 97.4% for infliximab and 6.0% for cyclophosphamide. Overall, adverse events were recorded in 8 out of 27 (29.6%) patients receiving infliximab and 16 out of 25 (64%) patients receiving cyclophosphamide (estimated difference, -32.3 percentage points; 95% credible interval, -55.2 to -6.6). Serious adverse events were reported in 15% and 12% of patients receiving infliximab and cyclophosphamide, respectively. CONCLUSIONS Among patients with severe Behçet's syndrome, induction therapy with infliximab had a superior complete response rate at 22 weeks and fewer adverse events than induction with cyclophosphamide. (Funded by the French Ministry of Health.).
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Affiliation(s)
- David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Georgina Maalouf
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Matheus Vieira
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Salim Trad
- Department of Internal Medicine, Ambroise-Paré Hospital, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France
| | - Estibaliz Lazaro
- Internal Medicine Department, Bordeaux Hospital University, Bordeaux, France
- CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France
- Department of Internal Medecine, Hôpital Haut-Lévèque, Pessac, France
| | - Karim Sacre
- Department of Internal Medicine, Bichat-Claude Bernard Hospital, Paris
| | - Aurelie Plessier
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, Valdig, ERN RARE-LIVER, Centre de recherche sur l'inflammation, INSERM, UMR 1149, Paris
| | - Thomas Sené
- Department of Internal Medicine, Axium Clinic, Aix-en-Provence, France
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, CHU de Biĉetre, Assistance Publique-Hôpitaux de Paris, University of Paris Saclay, Le Kremlin-Biĉetre, France
| | - Nicolas Noel
- Department of Internal Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Arsène Mekinian
- Department of Internal Medicine, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris
| | - Marc Lambert
- Department of Internal Medicine, Hôpital Claude Huriez, Lille, France
| | - Emmanuel Ribeiro
- Department of Internal Medicine, Hôpital Saint-André, Groupe Hospitalier Saint-André - CHU de Bordeaux, Bordeaux, France
| | - Tristan Mirault
- Université Paris Cité, PARCC Inserm U970, CRMR MARS, VASCERN, Vascular Medicine, Hôpital Européen Georges-Pompidou APHP, F-75006 Paris
| | | | - Azeddine Dellal
- Department of Rheumatology, GHI Le Raincy-Montfermeil, Montfermeil, France
| | - Olivier Fain
- Department of Internal Medicine, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris
| | - Isabelle Melki
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Nord-Université Paris Cité, Paris
| | - Laurent Chiche
- Department of Vascular and Endovascular Surgery Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, Paris
| | - Julien Gaudric
- Department of Vascular and Endovascular Surgery Tertiary Aortic Center, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris and Sorbonne Médecine Universités, Paris
| | - Alban Redheuil
- Department of Radiology, Sorbonne Université, INSERM, Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Paris
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpêtrière University Hospital, Assistance Publique-Hôpitaux de Paris, Paris
- Centre de référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle
| | - Amine Ghembaza
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Anne-Claire Desbois
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Adrien Mirouse
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Gaëlle Leroux
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Yasmina Ferfar
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Aude Rigolet
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Jean-François Viallard
- Internal Medicine Department, Bordeaux Hospital University, Bordeaux, France
- CNRS-UMR 5164 Immuno ConcEpT, Bordeaux, France
- Department of Internal Medecine, Hôpital Haut-Lévèque, Pessac, France
| | - Mathieu Vautier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
| | - Matthieu Resche-Rigon
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, Paris
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière University Hospital, Centre national de références Maladies Autoimmunes et systémiques rares, National Reference Centre for Rare Autoinflammatory Diseases and Inflammatory Amyloidosis, INSERM, UMR S959, Immunology-Immunopathology-Immunotherapy, Paris
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Stefanadi E, Dimitrakakis G, Dimitrakaki IA, Sakellariou N, Punjabi S, Stefanadis C. Adamantiades-Behcet's disease: From the first known descriptions to the era of the biologic agents. Int J Rheum Dis 2024; 27:e15353. [PMID: 39352051 DOI: 10.1111/1756-185x.15353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 03/27/2025]
Affiliation(s)
- Ellie Stefanadi
- Dermatology Outpatient Clinic Municipality of Athens, Athens, Greece
| | | | | | | | - Sangeeta Punjabi
- Dermatology Department, Northwick Park and Middlesex Hospital, London, UK
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14
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Chadli S, Maamar M, Khibri H, Tazi Mezalek Z, Harmouche H. Beyond the ordinary: TNF-alpha inhibitor as a rescue therapy in relapsing Hughes-Stovin syndrome with intracardiac thrombosis-a case report and literature review. Eur Heart J Case Rep 2024; 8:ytae398. [PMID: 39184169 PMCID: PMC11342963 DOI: 10.1093/ehjcr/ytae398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/10/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
Background Hughes-Stovin syndrome (HSS) is a rare vasculitis characterized by the association of thrombophlebitis with pulmonary artery aneurysms (PAAs). Because it is rarely reported, there are currently no established diagnostic criteria or standardized treatment guidelines for HSS. While conventional immunosuppressants are generally effective as first-line treatment, relapsing and refractory cases urge the need to investigate alternative therapies, such as TNF-alpha inhibitors. However, with only five cases published in the literature, knowledge of their efficacy in HSS is very limited. Case summary A 28-year-old man, with no past medical history, presented with haemoptysis, chest pain, and dyspnoea on exertion. Physical examination found bilateral leg swelling, with no associated lesions. CT angiography showed multiple bilateral PAA, proximal pulmonary artery thrombosis (PAT), and deep venous thrombosis (DVT) in the superior mesenteric vein and spleno-mesaraic confluence. Echocardiography was performed, identifying right intracardiac thrombosis (ICT). Initial management included high-dose corticosteroids and monthly cyclophosphamide cycles, followed by maintenance treatment with oral azathioprine. Eighteen months later, the patient presented with haemoptysis revealing a relapse of ICT and two new PAA. Infliximab was initiated, allowing complete and sustained remission after one year of follow-up. Discussion We report the challenging case of an HSS patient presenting with multiple PAA, proximal PAT, right ICT, and extended abdominal DVT. The positive response of our patient to infliximab, following a relapse under conventional immunosuppressants, supports the efficacy of TNF-alpha inhibitors as second-line treatment in relapsing/refractory HSS.
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Affiliation(s)
- Sarra Chadli
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Mouna Maamar
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hajar Khibri
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Zoubida Tazi Mezalek
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
- Clinical Hematology Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
| | - Hicham Harmouche
- Internal Medicine Department, Ibn Sina University Hospital, Mohammed V University, 10100 Rabat, Morocco
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15
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Germe SA, Ozsoy Z, Bulat B, Durhan G, Fırlatan B, Kilic L, Akdogan A. Computed tomography imaging-based radiologic evaluation of pulmonary artery thrombosis in a series of patients with Behcet's disease. Int J Rheum Dis 2024; 27:e15267. [PMID: 39031279 DOI: 10.1111/1756-185x.15267] [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] [Received: 01/19/2024] [Revised: 06/10/2024] [Accepted: 07/10/2024] [Indexed: 07/22/2024]
Abstract
AIM Pulmonary artery involvement is a severe complication of Behcet's disease (BD). Although venous thrombosis is common in BD, pulmonary embolism is considered to be rare because the inflammatory nature makes the thrombi strongly adherent to the venous walls. This study aimed to define the radiological characteristics of pulmonary artery thrombosis (PAT) on computed tomography (CT) imaging in BD patients. METHODS We retrospectively evaluated 165 BD patients with vascular involvement. Among the patients with venous involvement (n = 146), we identified 65 patients who had undergone thorax CT imaging previously. Fourteen patients who were diagnosed with PAT were included in the study. Expert radiologists re-evaluated the patients' initial and control thorax CT scans, classified the PAT as acute or chronic based on their radiological features. RESULTS The patients' median age was 35 (min-max: 15-60) years at the time of the initial CT scan, and nine were male. Twelve (85.7%) patients were symptomatic at the time of CT evaluation. Upon re-evaluating the thorax CTs, acute PAT was diagnosed in six (42.8%); chronic PAT was detected in eight (57.1%) patients. Two patients with chronic PAT also had acute PAT. Pulmonary artery aneurysms were present in three (21.4%) patients, and intracardiac thrombus was found in three (21.4%) patients. CONCLUSION A significant number of BD patients with venous involvement had radiological findings consistent with acute PAT potentially due to pulmonary emboli in this study. The clinical importance of these lesions has to be defined with future studies.
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Affiliation(s)
- Serife Asya Germe
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Zehra Ozsoy
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Bugu Bulat
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gamze Durhan
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Büşra Fırlatan
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Levent Kilic
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
| | - Ali Akdogan
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University, Ankara, Turkey
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16
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Mastrolia MV, Matucci-Cerinic C, Ozen S, Kasapcopur O, Gaggiano C, Koné-Paut I, Cantarini L, Dusser P, Kaya-Akça Ü, Yildiz M, Brunner J, Filocamo G, Gallizzi R, Insalaco A, Pastore S, Rigante D, Sanchez-Manubens J, Tsitsami E, Ruperto N, Gattorno M, Simonini G. Thrombotic manifestations in pediatric Behcet syndrome: A multicenter comparative study from the EUROFEVER registry. Semin Arthritis Rheum 2024; 66:152454. [PMID: 38678817 DOI: 10.1016/j.semarthrit.2024.152454] [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] [Received: 10/06/2023] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Vascular events account for a considerable burden of morbidity and mortality in Behçet syndrome (BS). Thrombosis occurs in 1.8-21 % pediatric BS patients, even if the real prevalence is still largely unknown. OBJECTIVES To report clinical features and outcomes of pediatric BS patients with thrombosis and to compare the demographic and clinical characteristics of BS patients with and without thrombosis. METHODS Retrospective data collection of BS patients with thrombosis (T+) included in the EUROFEVER registry. BS patients without thrombosis (T-), belonging to the same rheumatology units, were matched in a 2:1 ratio. RESULTS 37 T+ were compared to 74 T- patients. At onset, ICBD criteria fulfillment was higher in the T- group (p = 0.015). Caucasian patients were more often T-, Turkish patients were more frequent in T+ group (p = 0.002). At onset, pustulosis was most frequently observed in the T- (p < 0.001) as well as gastrointestinal symptoms (p < 0.001) and ocular involvement (p = 0.022). Neurological symptoms were more often described in T+ (p = 0.034). As for T+, thrombosis was reported at BS presentation in 8/37 (21.6 %). For the T + e patients who developed thrombosis later, oral aphthosis (p = 0.003), genital aphthosis (p = 0.014) were more frequently observed at BS onset, while pustulosis (p = 0.005) and fever (p = 0.043) coexisted with thrombosis. Thrombosis was mainly venous (26/37,70.3 %), involving the cerebral sinuses (21/37, 56.8 %). After thrombosis, 35/37 (94.6 %) T+ patients received an immunomodulatory treatment compared with 16/29 (55.2 %) pre-thrombosis. A recurrence was reported in 6/31(19.4 %). CONCLUSION Thrombosis was reported at BS presentation in one fifth of cases. Pustolosis and fever were more frequently concomitant to thrombosis. Sinus veins were the most frequent site.
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Affiliation(s)
- Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET center, Meyer Children's Hospital IRCCS, Firenze, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
| | - Caterina Matucci-Cerinic
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto G. Gaslini, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Genova, Italy
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Instanbul, Türkiye
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Disorders and inflammatory amyloidosis, CEREMAIA, Bicêtre Hospital, University of Paris Saclay, ERN RITA member, Paris, France
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena and Azienda Ospedaliero-Universitaria Senese [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Siena, Italy
| | - Perrine Dusser
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory Disorders and inflammatory amyloidosis, CEREMAIA, Bicêtre Hospital, University of Paris Saclay, ERN RITA member, Paris, France
| | - Ümmüşen Kaya-Akça
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Instanbul, Türkiye
| | - Juergen Brunner
- Department of Pediatrics, Innsbruck Medical University, Faculty of Medicine and Dentistry, Danube Private University, Innsbruck, Austria
| | - Giovanni Filocamo
- Pediatric Immunorheumatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Romina Gallizzi
- Department of Medical of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonella Insalaco
- Division of Rheumatology, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Serena Pastore
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica Sacro Cuore Rome, Italy
| | - Judith Sanchez-Manubens
- Pediatric Rheumatology, Department of Pediatrics, Parc Taulí Sabadell University Hospital, Institute for Research and Innovation I3PT, Sant Joan de Deu Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena Tsitsami
- Pediatric Rheumatology Unit, 1st Department of Pediatrics, Children's Hospital "Aghia Sophia", University of Athens, Athens, Greece
| | - Nicola Ruperto
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto G. Gaslini, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Genova, Italy
| | - Marco Gattorno
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto G. Gaslini, [European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) Center], Genova, Italy.
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET center, Meyer Children's Hospital IRCCS, Firenze, Italy; NEUROFARBA Department, University of Florence, Firenze, Italy
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Izzedine H, Jhaveri KD. Behçet's Syndrome. N Engl J Med 2024; 390:1731. [PMID: 38718373 DOI: 10.1056/nejmc2403905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
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18
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Rabah K, Rabah N, Deeb H, Haidar G, Kudsi M. Prevalence, types, and characteristics of headache in Behcets disease without involvement of the central nervous system in the Syrian population: a case-cohort study. Ann Med Surg (Lond) 2024; 86:2549-2554. [PMID: 38694392 PMCID: PMC11060300 DOI: 10.1097/ms9.0000000000001903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 02/24/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Oral ulcers, genital ulcers, and uveitis represent the typical trial of Behcet's disease (BD). It is well common on the Old Silk Road. The mucocutaneous lesions are the hallmark of BD, but neurological involvement is one of the severe symptoms. Headaches may be an early sign of BD neurological involvement. This study aims to investigate the headache prevalence and its types, and characteristics in a Syrian sample of BD patients. Methods BD patients were clinically interviewed and examined to collect their information, symptoms, and signs. the International Study Group for Behcet's Disease diagnosis criteria was used to confirm the BD diagnosis. The International Classification of headaches was used when classifying the headaches. Results One hundred twenty participants were included in the study. half of them were BD patients and the control group was also 60 participants. Among Syrian BD patients, 36.7% suffer from primary headaches and 36.7% suffer from secondary headaches. These findings were not significantly different between the BD patients and the healthy population. Our results showed that there was no statistically significant difference between the two groups. Conclusion Headache should not be considered a predictor for neurological involvement among BD patients. Additional attention to BD patients or the specific treatment for headaches is not required and does not differ from the general population.
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Affiliation(s)
- Karam Rabah
- Faculty of Medicine, Syrian Private University
| | - Nour Rabah
- Faculty of Medicine, Syrian Private University
| | | | - Ghina Haidar
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Maysoun Kudsi
- Department of Rheumatology, Faculty of Medicine, Damascus University, Damascus, Syria
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19
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Moriano Morales C, Graña Gil J, Brito García N, Martín Varillas JL, Calvo Del Río V, Moya Alvarado P, Narváez García FJ, Espinosa G, Díaz Del Campo Fontecha P, Guerra Rodríguez M, Mateo Arranz J, López Gómez M, Francisco Hernández FM, Trujillo MM, Dos Santos Sobrín R, Martín Sánchez JI, Maese Manzano J, Suárez Cuba J. SER recommendations on treatment of refractory Behçet's syndrome. REUMATOLOGIA CLINICA 2024; 20:204-217. [PMID: 38614885 DOI: 10.1016/j.reumae.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/04/2023] [Indexed: 04/15/2024]
Abstract
OBJECTIVE To develop multidisciplinary recommendations based on available evidence and expert consensus for the therapeutic management of patients with refractory Behçet's syndrome (BS) (difficult to treat, severe resistant, severe relapse) to conventional treatment. METHODS A group of experts identified clinical research questions relevant to the objective of the document. These questions were reformulated in PICO format (patient, intervention, comparison and outcome). Systematic reviews of the evidence were conducted, the quality of the evidence was evaluated following the methodology of the international working group Grading of Recommendations Assessment, Development, and Evaluation (GRADE). After that, the multidisciplinary panel formulated the specific recommendations. RESULTS 4 PICO questions were selected regarding the efficacy and safety of systemic pharmacological treatments in patients with BS with clinical manifestations refractory to conventional therapy related to mucocutaneous and/or articular, vascular, neurological parenchymal and gastrointestinal phenotypes. A total of 7 recommendations were made, structured by question, based on the identified evidence and expert consensus. CONCLUSIONS The treatment of most severe clinical manifestations of BS lacks solid scientific evidence and, besides, there are no specific recommendation documents for patients with refractory disease. With the aim of providing a response to this need, here we present the first official Recommendations of the Spanish Society of Rheumatology for the management of these patients. They are devised as a tool for assistance in clinical decision making, therapeutic homogenisation and to reduce variability in the care of these patients.
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Affiliation(s)
| | - Jenaro Graña Gil
- Servicio de Reumatología, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Noé Brito García
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain.
| | - José Luis Martín Varillas
- Servicio de Reumatología, Hospital de Laredo, Laredo, Cantabria, Spain; Grupo de Inmunopatología, Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Cantabria, Spain
| | - Vanesa Calvo Del Río
- Grupo de Inmunopatología, Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla-IDIVAL, Santander, Cantabria, Spain
| | | | | | - Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Hospital Clínic, Barcelona, Spain
| | | | | | - José Mateo Arranz
- Unidad de Hemostasia y Trombosis, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - M Mar Trujillo
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias, Santa Cruz de Tenerife, Spain
| | - Raquel Dos Santos Sobrín
- Servicio de Reumatología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Juan Ignacio Martín Sánchez
- Instituto Aragonés de Ciencias de la Salud, Centro de Investigación Biomédica de Aragón (CIBA), Zaragoza, Spain
| | | | - Julio Suárez Cuba
- Servicio de Reumatología, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
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20
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Fonollosa A, Carreño E, Vitale A, Jindal AK, Ramanan AV, Pelegrín L, Santos-Zorrozua B, Gómez-Caverzaschi V, Cantarini L, Fabiani C, Hernández-Rodríguez J. Update on ocular manifestations of the main monogenic and polygenic autoinflammatory diseases. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1337329. [PMID: 38984133 PMCID: PMC11182141 DOI: 10.3389/fopht.2024.1337329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 01/30/2024] [Indexed: 07/11/2024]
Abstract
Autoinflammatory diseases include disorders with a genetic cause and also complex syndromes associated to polygenic or multifactorial factors. Eye involvement is present in many of them, with different extent and severity. The present review covers ophthalmological lesions in the most prevalent monogenic autoinflammatory diseases, including FMF (familial Mediterranean fever), TRAPS (TNF receptor-associated periodic syndrome), CAPS (cryopyrin-associated periodic syndromes), Blau syndrome, DADA2 (deficiency of adenosine deaminase 2), DITRA (deficiency of the interleukin-36 receptor antagonist), other monogenic disorders, including several ubiquitinopathies, interferonopathies, and the recently described ROSAH (retinal dystrophy, optic nerve edema, splenomegaly, anhidrosis, and headache) syndrome, and VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Among polygenic autoinflammatory diseases, ocular manifestations have been reviewed in Behçet's disease, PFAPA (periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis) syndrome, Still's disease and autoinflammatory bone diseases, which encompass CRMO (chronic recurrent multifocal osteomyelitis) and SAPHO (synovitis, acne, pustulosis, hyperostosis and osteitis) syndrome.
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Affiliation(s)
- Alex Fonollosa
- Department of Ophthalmology, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
- Department of Retina, Instituto Oftalmológico Bilbao, Bilbao, Spain
| | - Ester Carreño
- Department of Ophthalmology, Rey Juan Carlos University Hospital, Madrid, Spain
- Department of Ophthalmology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Siena, Italy
| | - Ankur K Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children and Translational Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Laura Pelegrín
- Department of Ophthalmology, Institut Clínic d'Oftalmologia (ICOF), Hospital Clinic de Barcelona, University of Barcelona, Institut de Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Borja Santos-Zorrozua
- Department of Biostatistics, Biocruces Bizkaia Health Research Institute, Bilbao, Spain
| | - Verónica Gómez-Caverzaschi
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Siena, Italy
| | - José Hernández-Rodríguez
- Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clínic de Barcelona, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Center of the European Reference Network (ERN) for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA), Spanish Center of the Centros, Servicios y Unidades de Referencia (CSUR) and Catalan Center of the Xarxa d'Unitats d'Expertesa Clínica (XUEC) for Autoinflammatory Diseases, Barcelona, Spain
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21
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Affiliation(s)
- David Saadoun
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
| | - Bahram Bodaghi
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
| | - Patrice Cacoub
- From Sorbonne Universités Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire, Institut Hospitalo-Universitaire FOReSIGHT, Inflammation-Immunopathology-Biotherapy Department, Clinical Investigation Center in Biotherapy, and INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP (D.S., P.C.), and Sorbonne Universités AP-HP, Centre National de Références Maladies Rares en Ophtalmologie, Institut Hospitalo-Universitaire FOReSIGHT, Groupe Hospitalier Pitié-Salpêtrière, Département d'Ophtalmologie (B.B.) - all in Paris
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22
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Akbaba TH, Ekici M, Çolpak Aİ, Brown KL, Karadağ Ö, Balci-Peynircioglu B. Behçet's syndrome: recent advances to aid diagnosis. Clin Exp Med 2023; 23:4079-4090. [PMID: 37897656 DOI: 10.1007/s10238-023-01226-7] [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: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
Behçet's syndrome is a recurring inflammatory multiorgan disorder affecting the skin, mucosa, eyes, joints, stomach, and central nervous system. Behçet's syndrome epidemiology varies greatly among populations (0.64-420/100,000), and Behçet's syndrome has gained increasing international acclaim in the recent 50 years due to raising awareness of the syndrome, although it is rare in most population. In addition to the unclear etiology of the syndrome, the diagnosis of Behçet's syndrome is complicated by a vague clinical presentation, phenotypic heterogeneity and/or incomplete representation, and the lack of any specific laboratory, radiographic, or histological findings. There exists a dire need to elucidate factors that contribute to disease pathogenesis and/or are associated with clinical features of Behçet's syndrome and the classification of different forms of the syndrome. The identification of such molecular, cellular, and/or clinical factors are crucial for timely diagnosis and efficacious management of Behçet's syndrome. We discuss recent advances in the clinical diagnosis of Behçet's syndrome and related contributions of genetics, epigenetics, microbiome, inflammasomes, and autoantibodies to the improved diagnosis, management, and understanding of Behçet's syndrome.
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Affiliation(s)
- Tayfun Hilmi Akbaba
- Department of Medical Biology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
- BC Children's Hospital Research Institute, Vancouver, Canada
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mustafa Ekici
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ayşe İlksen Çolpak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kelly L Brown
- BC Children's Hospital Research Institute, Vancouver, Canada
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ömer Karadağ
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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23
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Ucar D, Esatoglu SN, Cerme E, Batu-Oto B, Hamuryudan V, Seyahi E, Melikoglu M, Fresko I, Ozyazgan Y, Hatemi G. Mycophenolate mofetil may be an alternative for maintenance therapy of Behçet syndrome uveitis: a single-center retrospective analysis. Rheumatol Int 2023; 43:2099-2106. [PMID: 37592141 DOI: 10.1007/s00296-023-05420-4] [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] [Received: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Experience with mycophenolate in uveitis due to Behçet syndrome (BS) is limited. Twelve patients with panuveitis or posterior uveitis who were started mycophenolate were included. Data on demographic characteristics, therapies, ocular attacks, and adverse events were extracted from patient charts. Seven patients with BS uveitis were prescribed mycophenolate for remission induction, of which 6 were refractory/intolerant to conventional immunosuppressives. Mycophenolate was combined with anti-TNFs in 3 patients, resulting in no further ocular attacks. Mycophenolate had to be stopped in the fourth patient due to adverse events. The remaining 3 patients continued to have ocular attacks and were switched to other agents without any drop in visual acuity. Among the 5 patients who were prescribed mycophenolate for maintenance, 2 were relapse free, but 3 experienced ocular attacks. One patient had an exacerbation of mucocutaneous lesions, and 2 experienced adverse events. Mycophenolate monotherapy may not be adequate for remission induction of refractory BS uveitis, but it can be a safe and effective alternative when combined with a biologic agent. It may also be an option for maintenance therapy.
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Affiliation(s)
- Didar Ucar
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Emir Cerme
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Bilge Batu-Oto
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Emire Seyahi
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Melike Melikoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Izzet Fresko
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yılmaz Ozyazgan
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gulen Hatemi
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
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24
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Joubert M, Desbois AC, Domont F, Ghembaza A, Lejoncour A, Mirouse A, Maalouf G, Leclercq M, Touhami S, Cacoub P, Bodaghi B, Saadoun D. Behçet's disease uveitis. Rev Med Interne 2023; 44:546-554. [PMID: 37414674 DOI: 10.1016/j.revmed.2023.06.004] [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: 05/09/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior or panuveitis. It is non-granulomatous. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralisation usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10-15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, prevention of recurrent attacks, achievement of complete remission, and preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update previous article by our team on pathogenesis, diagnostic approaches, identification of factors associated with relapse and the therapeutic strategy of BD uveitis.
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Affiliation(s)
- M Joubert
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A-C Desbois
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - F Domont
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Ghembaza
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Lejoncour
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Mirouse
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Maalouf
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Leclercq
- Internal Medicine Department, CHU de Rouen, 76000 Rouen, France
| | - S Touhami
- Department of Ophtalmology, Sorbonne universités, Pitié-Salpêtrière University Hospital, Paris, France
| | - P Cacoub
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - B Bodaghi
- Department of Ophtalmology, Sorbonne universités, Pitié-Salpêtrière University Hospital, Paris, France
| | - D Saadoun
- Department of Internal Medicine and Clinical Immunology, centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, Sorbonne universités, Pitié-Salpêtrière University Hospital, AP-HP, Inserm, UMR_S 959, 83, boulevard de l'Hôpital, 75013 Paris, France.
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25
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Kidd DP. Neurological involvement by Behçet's syndrome: clinical features, diagnosis, treatment and outcome. Pract Neurol 2023; 23:386-400. [PMID: 37775123 DOI: 10.1136/pn-2023-003875] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Abstract
Neurological involvement in Behçet's syndrome arises predominately through an inflammatory meningoencephalitis characterised by perivenular inflammation due to activation of Th-17 immunological pathways. The brainstem is involved in 50% of cases, the diencephalon and other areas of the brain in 30%, and the spinal cord in 10%. Movement disorders and epilepsy may occur. Psychiatric syndromes may arise with brain and brainstem involvement, and cognitive disorders relate to the brain disease, to circulating inflammatory factors, and to fatigue and despondency. Eighty per cent of cases begin with a relapsing disease course, of whom 70% have only one attack, and 30% have a progressive disease course either from onset or following an initially relapsing course. Venous thrombosis leading to intracranial hypertension and cerebral venous infarction is less common and caused by inflammation in affected veins and a circulating prothrombotic state. Arterial involvement is rare and relates to an arteritis affecting large-sized and medium-sized vessels within the brain leading to infarction, subarachnoid and parenchymal haemorrhage, aneurysm formation and arterial dissection. There is a newly recognised disorder of cerebral cortical hypoperfusion. Cranial neuropathy, peripheral neuropathy and myositis are rare. There has been significant progress in understanding the pathophysiology and treatment of the systemic disease, leading to improved outcomes, but there has been no randomised trial of treatment in the neurological disorder.
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Li B, Li H, Huang Q, Zheng Y. Shaping the Future of Behçet's Uveitis Management: A Comprehensive Review of Efficacy, Challenges, and Prospects of Biologic Therapies. Ophthalmol Ther 2023; 12:2295-2321. [PMID: 37477857 PMCID: PMC10442050 DOI: 10.1007/s40123-023-00767-0] [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: 05/03/2023] [Accepted: 06/29/2023] [Indexed: 07/22/2023] Open
Abstract
Behçet's uveitis (BU), a vision-threatening manifestation of Behçet's disease, poses substantial management challenges due to its chronic, relapsing nature and potential for vision loss. This review explores the role of biologic therapies in the treatment of BU, providing a comprehensive overview of their effectiveness, drawbacks, and future possibilities. Traditionally, management has relied heavily on corticosteroids and conventional immunosuppressants. However, their long-term use is frequently associated with systemic side effects and insufficient control of ocular inflammation. Biologic therapies, particularly TNF-alpha inhibitors like infliximab and adalimumab, have emerged as effective alternatives, offering better disease control and a more favorable safety profile. We critically evaluated these agents, noting their clinical efficacy in reducing inflammatory flares and preserving visual acuity. Despite their benefits, several issues remain. Accessibility, cost, and lack of long-term safety data limit their widespread use. Additionally, individual variability in treatment response necessitates personalized therapeutic strategies. Recent research has shown promise in addressing these challenges, with the emergence of novel biologic agents and personalized medicine approaches. In summary, biologic therapies represent a paradigm shift in BU management, contributing to better patient outcomes. Yet, there are significant challenges to be overcome. As we move forward, continued research, development of novel biologic agents, and a precision medicine approach will shape the future landscape of BU treatment.
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Affiliation(s)
- Biao Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Haoran Li
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Qun Huang
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Yanlin Zheng
- Department of Ophthalmology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China.
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Tehrani-Banihashemi A, Faezi ST, Solaymani-Dodaran M, Mohammadi F, Shahram F, Paragomi P, Moradi K, Davatchi F. Protective effect of early immunomodulatory treatment on ocular involvement in Behcet's disease: Historical cohort of 1166 patients. Heliyon 2023; 9:e19981. [PMID: 37809442 PMCID: PMC10559670 DOI: 10.1016/j.heliyon.2023.e19981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Eye involvement is a main presentation of Behcet's disease. This study was performed to evaluate possible determinants affecting the occurrence of eye involvement, especially the role of early systemic treatment with immunomodulatory drugs on the incidence of ocular involvement. Methods This is a retrospective cohort study performed on 1166 Behcet's patients in the Behcet's Clinic of Rheumatology Research Center. All patients were followed up for at least 10 years and a maximum of 15 years. Data analysis was performed using survival analysis models including Kaplan-Meier Survival analysis, Logrank test, and Cox's proportional hazards regression. Results 1166 Behcet's patients were evaluated. 80 patients who had eye involvement as the first manifestation of the disease were excluded and 1086 participants entered the analysis. Among them, 647 patients (59.6%) developed ocular involvement 7.8 ± 6.7 years after the first symptom. Immunomodulatory treatment before ocular involvement reduced the risk by 3 times (P-value <0.001). Conclusion This study demonstrated that the initiation of immunomodulatory treatment prior to eye involvement can reduce the risk of eye involvement in Behcet's patients. Therefore, reducing the onset time of disease symptoms and providing appropriate treatment can reduce Behcet's disease ocular complications.
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Affiliation(s)
- Arash Tehrani-Banihashemi
- Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh-Tahereh Faezi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Solaymani-Dodaran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Faezeh Mohammadi
- Occupational Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Shahram
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pedram Paragomi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Moradi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereydoun Davatchi
- Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Chen GX, Wan JH, Chen CW, Huang B. Hybrid surgery management challenges of a Behcet's disease patient with recurrence of aortic aneurysms: a case report. Front Cardiovasc Med 2023; 10:1097129. [PMID: 37719979 PMCID: PMC10502721 DOI: 10.3389/fcvm.2023.1097129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 07/28/2023] [Indexed: 09/19/2023] Open
Abstract
Background Behcet's disease is a vasculitis of unknown origin that can involve multiple organs or tissues. Aneurysm or pseudoaneurysm, also one of the complications of Behcet's disease, is usually accompanied by a poor prognosis. Surgery is usually accompanied by a high risk of complications, such as the recurrence of anastomotic pseudoaneurysms and blockage of the target vessel. Using hybrid surgery, we successfully treated a complex and recurrent abdominal aortic pseudoaneurysm in a patient with BD. Methods We report a 32-year-old female diagnosed with Behcet's disease with recurrent thoracoabdominal aortic aneurysm. Adequate immunotherapy was given during the perioperative period. The splanchnic artery branches were reconstructed, and the aneurysm was sequestered with endovascular repair. The patient recovered uneventfully and was discharged from the hospital 8 days after hybrid surgery. At the 60-month follow-up, no aneurysm was observed, the stent had no displacement or internal leakage, and the reconstructed blood vessels were unobstructed. Conclusion Hybrid surgery could be a feasible and effective strategy for BD aneurysms. Adequate preoperative and postoperative immunotherapy with arterial anastomosis away from the diseased artery may be the key to success.
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Affiliation(s)
- Guo Xin Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jiang Hong Wan
- Department of Outpatient, West China Hospital, Sichuan University, Chengdu, China
| | - Chu Wen Chen
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Abstract
Behçet's syndrome is a systemic vasculitis affecting arteries and veins of all sizes as well as recurrent oral, genital, and intestinal ulcers, skin lesions, predominantly posterior uveitis, and parenchymal brain lesions. These can be present in various combinations and sequences over time and diagnosis is made by recognizing the manifestations, as there are no diagnostic biomarkers or genetic tests. Treatment modalities include immunomodulatory agents, immunosuppressives and biologics, tailored according to prognostic factors, disease activity, severity, and patients' preferences.
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Affiliation(s)
- Gülen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University - Cerrahpasa, School of Medicine, Istanbul, Turkey; Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey.
| | - Didar Uçar
- Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey; Department of Ophthalmology, Istanbul University - Cerrahpasa, School of Medicine, Istanbul, Turkey
| | - Uğur Uygunoğlu
- Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey; Department of Neurology, Istanbul University - Cerrahpasa, School of Medicine, Istanbul, Turkey
| | - Hasan Yazici
- Rheumatology, Academic Hospital, Istanbul, Turkey
| | - Yusuf Yazici
- Division of Rheumatology, New York University School of Medicine, New York, NY, USA
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Curtin BF, Hill KL, Bhattacharya S, Powers A, Venkatesan A, Bagi P, Joyal E, Alimchandani M, Goldbach-Mansky R, Grayson P, Quezado M, Sibley C, Heller T. Clinical, Endoscopic, and Histopathologic Gastrointestinal Disease in an American Cohort With Behçet's Disease. Clin Transl Gastroenterol 2023; 14:e00591. [PMID: 37114910 PMCID: PMC10461961 DOI: 10.14309/ctg.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
INTRODUCTION Behçet's disease (BD) is a chronic systemic vasculitis characterized by oral and genital ulcers, uveitis, and skin lesions. Patients with BD may develop gastrointestinal (GI) disease; however, characterization of GI disease in American cohorts is lacking. In this article, we present clinical, endoscopic, and histopathologic GI findings in an American cohort of patients with BD. METHODS Patients with established BD were evaluated prospectively at the National Institutes of Health. Demographic and clinical data were collected including BD manifestations and GI symptoms. Endoscopy with histopathologic sampling was performed for both clinical and research indications with written consent. RESULTS Eighty-three patients were evaluated. The majority were female (83.1%) and white (75.9%). Mean age was 36 ± 14.8 years. GI symptoms were reported in 75% of cohort with nearly half of reporting abdominal pain (48.2%) and significant numbers reporting acid reflux, diarrhea, and nausea/vomiting. Esophagogastroduodenoscopy was performed in 37 patients; erythema and ulcers were the most common found abnormalities. Colonoscopy was performed in 32 patients with abnormalities including polyps, erythema, and ulcers. Endoscopy was normal in 27% of esophagogastroduodenoscopies and 47% of colonoscopies. Vascular congestion was demonstrated on the majority of random biopsies throughout the GI tract. Inflammation was not highly prevalent on random biopsies except in the stomach. Wireless capsule endoscopy was performed on 18 patients; ulcers and strictures were the most common abnormalities. DISCUSSION GI symptoms were common in this cohort of American patients with BD. Endoscopic examination was often normal; however, histopathologic examination demonstrated vascular congestion throughout the GI tract.
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Affiliation(s)
- Bryan F. Curtin
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Kareen L. Hill
- Translational Hepatology Section, Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Sumona Bhattacharya
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Astin Powers
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Aradhana Venkatesan
- Radiology and Imaging Sciences Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Preet Bagi
- Digestive Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Joyal
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Meghna Alimchandani
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Diseases AU2 Section, National Institute of Arthritis andMusculoskeletal and Skin Diseases and National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Peter Grayson
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Martha Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Cailin Sibley
- Translational Autoinflammatory Diseases AU2 Section, National Institute of Arthritis andMusculoskeletal and Skin Diseases and National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA
| | - Theo Heller
- Translational Hepatology Section, Liver Disease Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Soares AC, Pires FR, de Oliveira Quintanilha NR, Santos LR, Amin Dick TN, Dziedzic A, Picciani BLS. Oral Lesions as the Primary Manifestations of Behçet's Disease: The Importance of Interdisciplinary Diagnostics-A Case Report. Biomedicines 2023; 11:1882. [PMID: 37509521 PMCID: PMC10377315 DOI: 10.3390/biomedicines11071882] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/28/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Behçet's disease (BD) is a rare chronic auto-inflammatory systemic disease with non-specific oral manifestations, categorised as generalised variable vessel vasculitis that requires an interdisciplinary approach to diagnose due to its phenotypic heterogeneity. Whilst the oral lesions that reoccur in BD underpin the complex diagnostic process, the crucial role of dental professionals is highlighted in a case report summarised herein. We present a case of a 47-year-old male referred to the Oral Medicine Department by a rheumatologist after previous hospitalization for thrombosis of the iliac vein and inferior vena cava. He had elevated inflammatory C-reactive protein biomarker and an increased erythrocyte sedimentation rate. Recurrent episodes of folliculitis, oral and genital ulcers were reported. Clinical examination revealed multiple ulcerations in the oral mucosa. The complementary, histopathological analysis performed to rule out other disorders, based on excisional biopsy, showed non-keratinised stratified squamous epithelium with areas of exocytosis and ulceration. The connective tissue presented an intense mixed inflammatory infiltrate, congested blood vessels, haemorrhage, vasculitis, and HLA-B genotyping identified the expression of HLA-B15, further supporting the BD diagnosis. Treatment was initiated with colchicine, prednisolone, and weekly subcutaneous administration of methotrexate and resulted in the complete remission of oral lesions and no recurrence of other manifestations. CONCLUSIONS This BD case report emphasizes the importance of a multidisciplinary approach in diagnosing BD, including the use of histopathological assessment and genetic profiling. It highlights the significance of thorough intraoral assessment and referral to a multidisciplinary team for diagnosis. The oral manifestations of BD as the primary symptoms often indicate underlying major systemic pathologies. The authors stress the need for a structured diagnostic algorithm to facilitate timely and effective management of BD.
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Affiliation(s)
- Alvaro Cavalheiro Soares
- Postgraduate Program in Dentistry, Nova Friburgo Health Institute, Fluminense Federal University, Nova Friburgo 28625-650, Brazil
| | - Fabio Ramoa Pires
- Department of Oral Pathology, School of Dentistry, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | | | - Lilian Rocha Santos
- Postgraduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói 24230-340, Brazil
| | - Thaylla Nunez Amin Dick
- Postgraduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói 24230-340, Brazil
| | - Arkadiusz Dziedzic
- Department of Conservative Dentistry with Endodontics, Medical University of Silesia, 40-055 Katowice, Poland
| | - Bruna Lavinas Sayed Picciani
- Postgraduate Program in Dentistry, Nova Friburgo Health Institute, Fluminense Federal University, Nova Friburgo 28625-650, Brazil
- Postgraduate Program in Pathology, School of Medicine, Fluminense Federal University, Niterói 24230-340, Brazil
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Coşkun S, Ekici Tekin Z, Güngörer V, Çelikel E, Kurt T, Polat MC, Tekgöz PN, Sezer M, Karagöl C, Kaplan MM, Öner N, Gürsu HA, Kavurt AV, Güzelküçük Z, Özbek NY, Çelikel Acar B. A case series of intracardiac thrombi and vascular involvement in pediatric Behçet's disease. Rheumatol Int 2023; 43:1161-1171. [PMID: 36890395 DOI: 10.1007/s00296-023-05292-8] [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] [Received: 12/21/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023]
Abstract
To evaluate the general characteristics of pediatric Behçet's disease (BD) patients with thrombus and to present the clinical features, treatment responses and prognosis of patients with intracardiac thrombus. The clinical characteristics and outcomes of 15 patients with thrombus among 85 pediatric BD patients followed in the Department of Pediatric Rheumatology were evaluated retrospectively. Of the 15 BD patients with thrombus, 12 (80%) were male, 3 (20%) were female. The mean age at diagnosis was 12.9 ± 1.1 years. Thrombus was present at the time of diagnosis in 12 patients (80%), while thrombus developed in three patients within the first three months after diagnosis. The most common site of thrombus was the central nervous system (n = 9, 60%), followed by deep vein thrombus (n = 6, 40%) and pulmonary artery thrombus (n = 4, 26.6%). Three male patients (20%) developed intracardiac thrombus. The overall intracardiac thrombus rate in the 85 patients was 3.5%. Two of the three patients had thrombus in the right, and one had thrombus in the left heart cavity. In addition to steroids, 2 of the 3 patients received cyclophosphamide, while the patient with thrombus localized in the left heart cavity was given infliximab. In the follow-up, the two patients with thrombus in the right heart cavity were switched to infliximab because of resistance to cyclophosphamide. Complete resolution was observed in 2 of the 3 patients on infliximab; a significant reduction in the thrombus of the other patient was achieved. Intracardiac thrombus is a rare presentation of cardiac involvement in BD. It is usually observed in males and in the right heart. Although steroids and immunosuppressive agents such as cyclophosphamide are recommended as first-line treatment, favorable outcomes can be achieved with anti-TNFs in resistant cases.
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Affiliation(s)
- Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey.
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Tuba Kurt
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Pakize Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Hazım Alper Gürsu
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Ahmet Vedat Kavurt
- Division of Pediatric Cardiology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Zeliha Güzelküçük
- Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Namık Yaşar Özbek
- Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800, Ankara, Turkey
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Joubert M, Desbois AC, Domont F, Ghembaza A, Le Joncour A, Mirouse A, Maalouf G, Leclercq M, Touhami S, Cacoub P, Bodaghi B, Saadoun D. Behçet's Disease Uveitis. J Clin Med 2023; 12:jcm12113648. [PMID: 37297843 DOI: 10.3390/jcm12113648] [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: 03/12/2023] [Revised: 04/26/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
Uveitis in Behçet's disease (BD) is frequent (40% of cases) and is a major cause of morbidity. The age of onset of uveitis is between 20 and 30 years. Ocular involvement includes anterior, posterior, or panuveitis. Uveitis may be the first sign of the disease in 20% of cases or it may appear 2 or 3 years after the first symptoms. Panuveitis is the most common presentation and is more commonly found in men. Bilateralization usually occurs on average 2 years after the first symptoms. The estimated risk of blindness at 5 years is 10-15%. BD uveitis has several ophthalmological features that distinguish it from other uveitis. The main goals in the management of patients are the rapid resolution of intraocular inflammation, the prevention of recurrent attacks, the achievement of complete remission, and the preservation of vision. Biologic therapies have changed the management of intraocular inflammation. The aim of this review is to provide an update to a previous article by our team on pathogenesis, diagnostic approaches, and the therapeutic strategy of BD uveitis.
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Affiliation(s)
- Morgane Joubert
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Anne-Claire Desbois
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Fanny Domont
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Amine Ghembaza
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Alexandre Le Joncour
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Adrien Mirouse
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Georgina Maalouf
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | | | - Sarah Touhami
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013 Paris, France
| | - Patrice Cacoub
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Universités, F-75013 Paris, France
| | - David Saadoun
- AP-HP. Centre de Référence des Maladies Auto-Immunes Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires et de l'Amylose Inflammatoire, F-75013 Paris, France
- Institut National de la Santé Et de la Recherche Médicale (INSERM), Unité Médical de Recherche (UMR)S 59, F-75013 Paris, France
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Vitale A, Caggiano V, Berlengiero V, Perfetti MO, Sota J, Tosi GM, Frediani B, Cantarini L, Fabiani C. Comparing biologic options for the management of Behcet's disease-related uveitis. Expert Rev Clin Immunol 2023; 19:315-328. [PMID: 36715297 DOI: 10.1080/1744666x.2023.2174103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Behçet's disease (BD) associated uveitis occurs in approximately 50-70% of the patients. Ocular involvement in BD may induce a severe affection of visual function, leading to a considerable decrease in patients' quality of life. The risk for severe visual loss increases when the ocular posterior segment is involved and in patients with no adequate treatment. AREAS COVERED Monoclonal tumor necrosis factor (TNF) biotechnological inhibitors represent a relatively recent milestone for the treatment of non-infectious uveitis (NIU) also in BD patients. In addition to TNF inhibitors, further biologic agents have been increasingly proposed for multi-recalcitrant cases, as for interleukin (IL)-1 and IL-6 inhibitors. However, evidence on these new opportunities requires to be widened in the next future. EXPERT OPINION Joining the forces for scientific efforts is essential to quickly obtain solid acquisitions useful for the everyday clinical practice. To this end, the Auto-Inflammatory Disease Alliance (AIDA) Network has recently supported the development of an international registry dedicated to NIU and other inflammatory ocular involvement observed in BD patients. This will be essential to resolve current and future unmet needs burdening the everyday clinical practice.
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Affiliation(s)
- Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Valeria Caggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Virginia Berlengiero
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Maria Orsetta Perfetti
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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Busto-Iglesias M, Rodríguez-Martínez L, Rodríguez-Fernández CA, González-López J, González-Barcia M, de Domingo B, Rodríguez-Rodríguez L, Fernández-Ferreiro A, Mondelo-García C. Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review. Pharmaceutics 2023; 15:pharmaceutics15030766. [PMID: 36986627 PMCID: PMC10051556 DOI: 10.3390/pharmaceutics15030766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
Biological drugs, especially those targeting anti-tumour necrosis factor α (TNFα) molecule, have revolutionized the treatment of patients with non-infectious uveitis (NIU), a sight-threatening condition characterized by ocular inflammation that can lead to severe vision threatening and blindness. Adalimumab (ADA) and infliximab (IFX), the most widely used anti-TNFα drugs, have led to greater clinical benefits, but a significant fraction of patients with NIU do not respond to these drugs. The therapeutic outcome is closely related to systemic drug levels, which are influenced by several factors such as immunogenicity, concomitant treatment with immunomodulators, and genetic factors. Therapeutic drug monitoring (TDM) of drug and anti-drug antibody (ADAbs) levels is emerging as a resource to optimise biologic therapy by personalising treatment to bring and maintain drug concentration within the therapeutic range, especially in those patients where a clinical response is less than expected. Furthermore, some studies have described different genetic polymorphisms that may act as predictors of response to treatment with anti-TNFα agents in immune-mediated diseases and could be useful in personalising biologic treatment selection. This review is a compilation of the published evidence in NIU and in other immune-mediated diseases that support the usefulness of TDM and pharmacogenetics as a tool to guide clinicians’ treatment decisions leading to better clinical outcomes. In addition, findings from preclinical and clinical studies, assessing the safety and efficacy of intravitreal administration of anti-TNFα agents in NIU are discussed.
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Affiliation(s)
- Manuel Busto-Iglesias
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Lorena Rodríguez-Martínez
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Carmen Antía Rodríguez-Fernández
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
- Ophthalmology Department, Bellvitge University Hospital, 08907 Barcelona, Spain
| | - Jaime González-López
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Miguel González-Barcia
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
| | - Begoña de Domingo
- Ophthalmology Department, University Clinical Hospital of Santiago Compostela (SERGAS), 15706 Santiago de Compostela, Spain
| | - Luis Rodríguez-Rodríguez
- Musculoskeletal Pathology Group, Hospital Clínico San Carlos, Instituto Investigación Sanitaria San Carlos (IdISSC), 28040 Madrid, Spain
- Correspondence: (L.R.-R.); (A.F.-F.)
| | - Anxo Fernández-Ferreiro
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
- Correspondence: (L.R.-R.); (A.F.-F.)
| | - Cristina Mondelo-García
- Pharmacy Department, University Clinical Hospital of Santiago de Compostela (SERGAS), 15706 Santiago de Compostela, Spain (C.M.-G.)
- Pharmacology Group, Health Research Institute of Santiago de Compostela (FIDIS), 15706 Santiago de Compostela, Spain
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Yazici Y, Hatemi G. Difficult-to-treat Behçet syndrome: A therapeutic approach. Clin Immunol 2023; 249:109272. [PMID: 36822253 DOI: 10.1016/j.clim.2023.109272] [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: 02/07/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
Behcet syndrome is a systemic vasculitis which can involve many different organ systems. As such, treatment decisions need to be based on organ system involved. In addition, specific patient characteristics potentially predict milder or more severe course, and all these factors need to be taken into consideration when making treatment decisions. In this paper, we review the current approaches to treating Behcet syndrome patients.
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Affiliation(s)
- Yusuf Yazici
- Medicine, NYU Grossman School of Medicine, United States.
| | - Gulen Hatemi
- Medicine, Division of Rheumatology, Department of Internal Medicine, School of Medicine, and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Turkey
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Bettiol A, Alibaz-Oner F, Direskeneli H, Hatemi G, Saadoun D, Seyahi E, Prisco D, Emmi G. Vascular Behçet syndrome: from pathogenesis to treatment. Nat Rev Rheumatol 2023; 19:111-126. [PMID: 36544027 DOI: 10.1038/s41584-022-00880-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
Abstract
Behçet syndrome is a rare, chronic inflammatory disease of unknown aetiopathogenesis, most commonly presenting with mucocutaneous and ocular manifestations. Vascular involvement, most frequently superficial vein and deep vein thrombosis, can occur in up to 50% of patients with Behçet syndrome. Venous thrombosis at atypical sites (inferior and superior vena cava, suprahepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses and right atrium and/or ventricle) and arterial involvement (mostly in situ thrombosis and aneurysms of the pulmonary arteries, as well as aneurysms of the abdominal aorta, and peripheral and visceral arteries) are also unique features of Behçet syndrome. Behçet syndrome is considered a natural model of inflammation-induced thrombosis in humans, with an impaired immune-inflammatory response rather than traditional cardiovascular risk factors contributing to thrombogenesis. Specifically, neutrophil hyperactivation and neutrophil-mediated mechanisms of damage directly promote endothelial dysfunction, platelet activation and thrombogenesis in Behçet syndrome. This unusual pathogenesis directly determines the treatment approach, which relies mostly on immunosuppressants rather than anticoagulants for treatment of thrombosis and for secondary prevention. This Review discusses the main histopathological, pathogenetic and clinical aspects of vascular Behçet syndrome, addressing their implications for therapeutic management. Future perspectives in terms of pathogenetic studies, disease monitoring and treatment strategies are also discussed.
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Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Fatma Alibaz-Oner
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Haner Direskeneli
- Vasculitis Clinic, Marmara University, School of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - David Saadoun
- Sorbonne Universités AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique, F-75013, Paris, France.,Centre National de Références Maladies Autoimmunes Systémiques Rares, Centre National de Références Maladies Autoinflammatoires et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitie-Salpetriere, AP-HP, Paris, France
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.,Behçet's Disease Research Centre, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy. .,Internal Interdisciplinary Medicine Unit, Behçet Center, Careggi University Hospital, Firenze, Italy. .,Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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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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Tazi Mezalek Z, Khibri H, El Fari S, Chadli S, Ammouri W, Maamar M, Harmouche H, Adnaoui M. [Vascular manifestations of Behcet's disease]. Rev Med Interne 2023; 44:72-78. [PMID: 36564248 DOI: 10.1016/j.revmed.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/26/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
Behçet disease is a multi-systemic complex vasculitis with unknown etiology characterized by different clinical involvements, including mucocutaneous, ocular, vascular, articular, neurological and gastrointestinal manifestations. Growing evidence supports that different phenotypes, characterized by clusters of co-existing involvements, can be distinguished. Namely, the vascular phenotype identifies a specific group of patients who suffer from recurrent inflammatory thrombosis and arterial involvement. Vascular disease develops in up to 40% with a definite male preponderance and is usually an early manifestation. It is one of the main causes of death in Behçet's disease. Venous involvement is significantly more common than arterial disease and lower extremity deep vein thrombosis is its most frequent manifestation. Arterial disease involves mostly pulmonary arteries and aorta and manifests mainly in the form of aneurysms. Glucocorticoids and immunosuppressant's are the recommended first-line treatments in vasculo-Behçet. Furthermore, randomized controlled trials are still needed to assess the role of adding anticoagulation to current standard therapy in venous thrombosis in Behçet's disease and to assess the role of anti-TNF alpha therapy in vasculo-Behçet.
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Affiliation(s)
- Z Tazi Mezalek
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc.
| | - H Khibri
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - S El Fari
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc
| | - S Chadli
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc
| | - W Ammouri
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - M Maamar
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - H Harmouche
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
| | - M Adnaoui
- Service médecine interne, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Service hématologie clinique, centre hospitalo-universitaire Ibn Sina, Rabat, Maroc; Université Mohammed V, faculté médecine et pharmacie, Rabat, Maroc
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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: 2.0] [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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YAĞIZ B, COŞKUN BN, ÇAKAN ZK, UÇAN GÜNDÜZ G, YALÇINBAYIR Ö, YAZİCİ S, SARICAOĞLU H, DALKILIÇ HE, PEHLİVAN Y. Biological Agent Use in Behçet's Patients Who Are Resistant to Conventional Treatments: A Multidisciplinary Retrospective Study. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1144532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Comparing treatment modalities is difficult in Behcet's syndrome, even if tumour necrosis factor-alpha (TNF-α) inhibitors are a treatment option for all involvements resistant to conventional therapy. This study evaluated how different departments dealt with treatment, particularly with TNF-α inhibitors.
Material and Methods The study comprised 111 patients from our Behcet's syndrome cohort who were treated with TNF-α inhibitors between 2010 and 2019. Data on patients were retrieved retrospectively from the rheumatology, ophthalmology, and dermatology clinics' patient records.
Results Patients followed up in rheumatology (n: 40) were classified as Group 1, and patients followed up in ophthalmology (n: 49) and dermatology (n: 5) as Group 2. In Group 1, genital ulcers, erythema nodosum (p=0.009, p=0.003, respectively), lower extremity deep vein thrombosis, arterial aneurysm and neurological involvement were more common (p=0.005, p=0.008, p=0.001, respectively). In Group 2, the use of cyclosporine and interferon-α before the anti-TNF agent was higher (p
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Tukek NB, Esatoglu SN, Hatemi G, Calıskan EB, Ozyazgan Y, Ucar D, Ozguler Y, Seyahi E, Melikoglu M, Uygunoglu U, Siva A, Kutlubay Z, Hatemi İ, Celik AF, Ugurlu S, Fresko I, Yurdakul S, Yazici H, Hamuryudan V. Emergence of new manifestations during infliximab treatment in Behçet's syndrome. Rheumatology (Oxford) 2022; 61:3746-3753. [PMID: 34958357 DOI: 10.1093/rheumatology/keab944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Infliximab (IFX) is increasingly being used for the treatment of severe manifestations of Behçet's syndrome (BS). However, emergence of new manifestations has also been occasionally reported during IFX treatment. We aimed to assess the frequency of new manifestations in our BS patients treated with IFX. METHODS A chart review was conducted to identify all BS patients treated with IFX in our clinic between 2004 and 2020. Demographic data, indications for IFX initiation, concomitant treatments and outcomes were recorded. A new manifestation was defined as the emergence of a new organ involvement or mucocutaneous manifestation developing for the first time during IFX treatment or within 12 weeks after the last infusion of IFX. RESULTS Among our 282 patients who used IFX, 19 (7%) patients had developed a total of 23 new manifestations during a mean follow-up of 20.0 (15.3) months. Patients with vascular involvement were more likely to develop a new manifestation (12/19, 63%). Initial manifestations that required IFX were in remission at the time of new manifestation in 14/19 patients. IFX treatment was intensified (n = 6) and/or glucocorticoids, immunosuppressives or colchicine was added to IFX (n = 21). IFX was switched to another agent for the remaining manifestations (n = 8). These treatment modifications led to remission in 17/19 patients. CONCLUSION New manifestations developed during IFX treatment in 7% of our patients with BS. They could be managed by intensifying IFX treatment or adding other agents in the majority of these manifestations.
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Affiliation(s)
| | | | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine
| | | | | | | | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine
| | | | | | | | | | - İbrahim Hatemi
- Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aykut Ferhat Celik
- Department of Gastroenterology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine
| | | | - Hasan Yazici
- Division of Rheumatology, Department of Internal Medicine
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Xia Q, Lyu C, Li F, Pang B, Guo X, Ren H, Xing Y, Chen Z. Candidate Drugs Screening for Behcet’s Disease Based on Bioinformatics Analysis and Mouse Experiments. Front Immunol 2022; 13:895869. [PMID: 35799784 PMCID: PMC9253297 DOI: 10.3389/fimmu.2022.895869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundBehcet’s disease (BD) is a chronic immune disease that involves multiple systems. As the pathogenesis of BD is not clear, and new treatments are needed, we used bioinformatics to identify potential drugs and validated them in mouse models.MethodsBehcet’s disease-related target genes and proteins were screened in the PubMed and UVEOGENE databases. The biological functions and pathways of the target genes were analyzed in detail by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. A protein-protein interaction (PPI) network was constructed by the STRING database, and hub genes were identified by the Cytoscape plug-in CytoHubba. Gene-drug interactions were identified from the DGIdb database. Experimental autoimmune uveitis (EAU) mice were used as an animal model for drug validation.ResultsA total of 249 target genes and proteins with significant differences in BD were screened, and the results of functional enrichment analysis suggested that these genes and proteins were more located on the cell membrane, involved in regulating the production of cytokines and affecting the activity of cytokines. They mainly regulated “Cytokine- Cytokine receptor interaction”, “Inflammatory bowel disease (IBD)” and “IL-17 signaling Pathway”. In addition, 10 hub genes were obtained through PPI network construction and CytoHubba analysis, among which the top 3 hub genes were closely related to BD. The DGIdb analysis enriched seven drugs acting together on the top 3 hub genes, four of which were confirmed for the treatment of BD or its complications. There is no evidence in the research to support the results in omeprazole, rabeprazole, and celastrol. However, animal experiments showed that rabeprazole and celastrol reduced anterior chamber inflammation and retinal inflammation in EAU mice.ConclusionsThe functional analysis of genes and proteins related to BD, identification of hub genes, and validation of potential drugs provide new insights into the disease mechanism and potential for the treatment of BD.
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Affiliation(s)
- Qinyun Xia
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chujun Lyu
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Li
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Binbin Pang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaoyu Guo
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - He Ren
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Yiqiao Xing, ; Zhen Chen,
| | - Zhen Chen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, China
- *Correspondence: Yiqiao Xing, ; Zhen Chen,
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Ghembaza A, Boussouar S, Saadoun D. [Thoracic manifestations of Behcet's disease]. Rev Mal Respir 2022; 39:523-533. [PMID: 35659162 DOI: 10.1016/j.rmr.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
Abstract
Behcet's disease (BD) is a multisystemic vasculitis involving arteries and veins of all sizes. While joint and dermatological manifestations are the most common features of BD and are associated with a good prognosis; vascular involvement, remains the principal cause of death. Arterial manifestations occur in 5-10% of cases and manifest as occlusion/thrombosis or aneurysms. Arterial aneurysms are likely multiple and the most common sites are pulmonary arteries, aorta and arteries of lower limbs. Parenchymal involvement is less frequent and may manifest as consolidation or nodules, which may evolve to excavation. Aneurysms may occur at the sites of arterial puncture; then, non-traumatic techniques are favored. Patients with arterial manifestations may present with fever and increased inflammatory markers. Artery damage is rare, serious, and may result in massive hemoptysis. The prognosis of pulmonary artery aneurysms is severe (mortality estimated up to 26%) but has been improved by earlier diagnosis and the introduction of immunosuppressants. Treatment of severe arterial manifestations is based on high-dose corticosteroids along with cyclophosphamide or anti-TNF antagonists. Anticoagulation could be added to immunosuppressants in case of venous thrombosis if a coexisting pulmonary aneurysm is ruled out. Endovascular treatment should be performed in case of severe symptomatic pulmonary aneurysms, along with an adequate medical management. Long-term maintenance therapy of these severe forms is of paramount importance because of relapse risk (40% at five years).
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Affiliation(s)
- A Ghembaza
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France
| | - S Boussouar
- Cardiovascular and Thoracic Imaging Unit, hôpital Pitié Salpêtrière, AP-HP, Paris, France; Inserm, laboratoire d'imagerie biomédicale, CNRS, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris, France
| | - D Saadoun
- Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France; Department of Internal Medicine and Clinical Immunology, Paris, France; Centre de référence des maladies auto-immunes systémiques rares, centre de référence des maladies auto-inflammatoires et de l'amylose inflammatoire, AP-HP, 75013 Paris, France; Institut national de la santé et de la recherche médicale, Paris, France; Inserm, UMR_S 959, 75013, Paris, France; RHU IMAP, CNRS, FRE3632, 75005 Paris, France.
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Hersant J, Maurel B, Espitia O. Multiple concomitant arterial aneurysms in Behçet’s disease. Vascular 2022; 31:463-466. [DOI: 10.1177/17085381221076668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Behçet’s disease (BD) is a rare form of systemic vasculitis that affects small to large vessels. It is characterized by mucocutaneous, pulmonary, cardiovascular, gastrointestinal, and neurological manifestations. Large vessel involvement may occur in a third of cases. Veins are usually more affected than arteries. Furthermore aneurysms are the most frequent arterial complication. Case presentation A 41-year-old man presented with multiple arterial aneurysms. He had previous medical history of a right popliteal aneurysm treated with a reversed femoro-popliteal venous bypass, long-term steroids and immunosuppressive treatment. On admission, diagnostic computed tomography angiography revealed multiple aneurysms, including an 87 mm aneurysm of the femoro-popliteal bypass and an abdominal aortic and left common iliac artery aneurysm. He received an intensification of medical treatment with methylprednisolone and infliximab intravenous infusion. Aorto iliac artery aneurysms were treated by infrarenal bifurcated stent graft implantation. The aneurysm of the venous femoro-popliteal bypass was treated by explantation and prosthetic repair. One month later, he presented with acute right limb ischemia related to occlusion of the right limb of the stent graft despite anticoagulation which was treated by mechanical thrombectomy. Conclusions Vascular BD can worsen the vascular outcome after surgery. Except in an urgent context, BD must be controlled before surgery. This case report illustrates the importance of combined medical and surgical management, with first BD activity control with corticosteroids and immunosuppressive treatment, then surgical or endovascular treatment.
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Affiliation(s)
- Jeanne Hersant
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
| | | | - Olivier Espitia
- Department of Internal and Vascular Medicine, CHU Nantes, Nantes, France
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Zhang Q, Ma C, Dong R, Xiang W, Li M, Ma Z, Yang Q. Efficacy and Safety of Anti-Tumor Necrosis Factor-Alpha Agents for Patients with Intestinal Behcet's Disease: A Systematic Review and Meta-Analysis. Yonsei Med J 2022; 63:148-157. [PMID: 35083900 PMCID: PMC8819411 DOI: 10.3349/ymj.2022.63.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/03/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Intestinal Behcet's disease (BD) is a systemic autoimmune disease for which treatment options are limited. As a prospective therapeutic strategy for intestinal BD, anti-tumor necrosis factor-alpha (anti-TNF-α) agents have received increasing attention. In this study, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of anti-TNF-α agents for patients with intestinal BD. MATERIALS AND METHODS We searched PubMed, Embase, and Cochrane Library databases up to July 1, 2021 and articles that met the eligibility criteria were further assessed. Pooled rates were synthesized by a randomized effects model using Stata software. RESULTS Eleven clinical trials covering 671 patients with intestinal BD were included. According to compositive data, the pooled rate for remission was 39% [95% confidence interval (CI) 26-52] in patients receiving anti-TNF-α agents. Intestinal symptoms were cured in 70% (95% CI 53-84) of the patients, and the rate for endoscopic healing was 65% (95% CI 52-78). Corticosteroid discontinuation was achieved in 43% (95% CI 28-58) of the patients, and the dose reduction of corticosteroid was 20.43 mg (95% CI 13.4-27.46). There were 239 adverse events and 80 serious adverse events during follow-up. CONCLUSION Our study indicated that anti-TNF-α agents may serve as an effective treatment with acceptable safety for patients with intestinal BD. However, more robust evidence from randomized controlled trials is urgently needed to assess the long-term efficacy and safety of anti-TNF-α agents for those patients.
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Affiliation(s)
- Qingfeng Zhang
- Department of Rheumatology and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Chunyan Ma
- Department of Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Rongrong Dong
- Department of Rheumatology and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Weizhen Xiang
- Department of Rheumatology and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Meiqi Li
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhenzhen Ma
- Department of Rheumatology and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
| | - Qingrui Yang
- Department of Rheumatology and Immunology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Rheumatology and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
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Patel SA, Okeagu C, Jones K, Chaudhry A, Berkenstock MK. Neuro-Behcet Disease and Ocular Inflammation: A Case Report and Literature Review. Ocul Immunol Inflamm 2022; 30:95-103. [DOI: 10.1080/09273948.2020.1787461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Shaivi A. Patel
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Chinwenwa Okeagu
- Department of Ophthalmology, University of Central Florida, Orlando, Florida, USA
| | - Krystyna Jones
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ammar Chaudhry
- Radiology Department, City of Hope National Medical Center, Duarte, California, USA
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A treat-to-target approach is needed for Behçet's syndrome. Curr Opin Rheumatol 2022; 34:39-45. [PMID: 34710886 DOI: 10.1097/bor.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Treat-to-target (T2T) approach has improved outcomes in chronic diseases. The aim of this review is to discuss the long-term goals and review the evidence for possible targets that would predict the achievement of these goals for developing a T2T strategy for Behçet's syndrome. RECENT FINDINGS There are no trials comparing a tight control strategy to standard care in Behçet's syndrome but recent studies suggest better outcomes with earlier use of biologic agents compared with sustained conventional treatment. Fluorescein angiography may be a reliable tool for assessing remission in uveitis as fluorescein angiography findings were shown to predict relapses and long-term visual outcome. Good recanalization on Doppler ultrasonography can be a target for venous involvement as this was the only predictor of relapse. Fecal calprotectin levels were associated with small intestinal and colonic ulcers and may be used as a surrogate for remission of gastrointestinal involvement. SUMMARY There are several new treatment modalities that are tried for Behçet's syndrome and ongoing work on outcome measures for reliable disease assessment. In order to ensure the wise and efficient use of treatment modalities, development and implementation of T2T strategies are needed through multidisciplinary and multinational efforts that include patient research partners.
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Sun L, Hou Y, Zhang L, Liu J, Li L, Wang Z, Yu X, Zhang M, Liu X, Zhao Y, Zheng W. Effectiveness and safety of low-dose interferon alpha-2a treatment in Behçet’s Syndrome with refractory vascular or neurological involvement: a case series. Ther Adv Chronic Dis 2022; 13:20406223221111285. [PMID: 35924012 PMCID: PMC9340357 DOI: 10.1177/20406223221111285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/16/2022] [Indexed: 11/15/2022] Open
Abstract
Objective: The aim of this study was to evaluate the effectiveness and safety of low-dose interferon alpha-2a (IFNα2a) in Behçet’s syndrome (BS) patients with refractory vascular/cardiac or neurological involvement. Methods: In this retrospective cohort study, we consecutively included 25 BS patients with refractory vascular/cardiac ( n = 16) or neurological involvement ( n = 9) who received IFNα2a treatment in our center between June 2018 and September 2021. The low-dose IFNα2a (3 million IU, every other day) was used as an add-on treatment with the continuation of glucocorticoids (GCs) and immunosuppressants. Results: In total, 25 patients (20 males, 5 females) with a mean age of 31.92 ± 9.25 years were included. IFNα2a was administered for BS patients with refractory vascular/cardiac involvement ( n = 16) and neurological involvement ( n = 9). Before the initiation of IFNα2a, patients had insufficient response or intolerance to conventional therapies. After a median follow-up of 23 [interquartile range (IQR), 11–30] months, all patients achieved clinical improvement. The Behçet’s disease Current Activity Form (BDCAF) score improved significantly (5 versus 0, median, p < 0.0001). BS Overall Damage Index (BODI) and vasculitis damage index (VDI) remain stable ( p > 0.05). Decrease in erythrocyte sedimentation rate [ESR; 24 (IQR, 12–43.5) versus 5 (IQR, 2.75–10.5) mm/h, p = 0.0001] and C-reactive protein [CRP; 6.64 (IQR, 3.67–19.82) versus 1.24 (IQR, 0.24–3.12) mg/liter, p < 0.005] was achieved effectively. The median GCs dosage tapered from 26.25 (IQR, 11.88–41.25) to 10.00 (IQR, 7.50–10.63) mg/d, p < 0.0001. Immunosuppressants were also reduced in number ( p < 0.005). No serious adverse events were observed during follow-up. Conclusion: Our study suggests that low-dose IFNα2a, combined with GCs and immunosuppressants, is well-tolerated and effective for BS patients with refractory vascular/cardiac or neurological involvement and has a steroid- and immunosuppressant-sparing effect.
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Affiliation(s)
- Luxi Sun
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Yunxia Hou
- Department of Rheumatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Lifan Zhang
- Department of Infectious Diseases, Centre for Tuberculosis Research, Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - JinJing Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Lu Li
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Zhimian Wang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xin Yu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Menghao Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Centre for Tuberculosis Research, Clinical Epidemiology Unit, International Epidemiology Network, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
| | - Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Dongcheng-qu, Beijing 100730, China
- State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
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Marinello D, Di Cianni F, Del Bianco A, Mattioli I, Sota J, Cantarini L, Emmi G, Leccese P, Lopalco G, Mosca M, Padula A, Piga M, Salvarani C, Taruscio D, Talarico R. Empowering Patients in the Therapeutic Decision-Making Process: A Glance Into Behçet's Syndrome. Front Med (Lausanne) 2021; 8:769870. [PMID: 34966756 PMCID: PMC8710680 DOI: 10.3389/fmed.2021.769870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 12/03/2022] Open
Abstract
Behçet's syndrome (BS) represents a challenging condition, characterized by a variable spectrum of disease profile and associated with a significant limitation of the daily activities as well as a potential negative impact on relationships and psychological status. Considering also the complexity of the therapeutic management of BS, that often includes biological off-label treatments, the participation in the therapeutic decision-making process of the BS patients is essential to ensure the integration of the care process into the life of the patient. For this reason, the empowerment of BS patients represents a crucial need and the present work is aimed at fully exploring all the potential variables implicated in the BS patient empowerment, also highlighting major points to consider and concrete actions to be planned in the immediate future in order to implement a pragmatic facilitation of the patients' empowerment.
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Affiliation(s)
- Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Federica Di Cianni
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | | | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Jurgen Sota
- Rheumatology Unit, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Luca Cantarini
- Rheumatology Unit, Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Pietro Leccese
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergence Medicine and Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Angela Padula
- Rheumatology Department of Lucania, Rheumatology Institute of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medical Sciences and Public Health, AOU University Clinic and University of Cagliari, Cagliari, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia and Università di Modena e Reggio Emilia, Modena, Italy
| | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
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