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Kaymaz S, Yilmaz H, Ufuk F, Ütebey AR, Çobankara V, Karasu U, Albayrak Yaşar C, Ulutaş F. Ultrasonographic measurement of the vascular wall thickness and intima-media thickness in patients with Behçet's disease with symptoms or signs of vascular involvement: A cross-sectional study. Arch Rheumatol 2021; 36:258-266. [PMID: 34527931 PMCID: PMC8418758 DOI: 10.46497/archrheumatol.2021.8423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022] Open
Abstract
Objectives
This study aims to measure and compare bilateral carotid intima-media thickness (CIMT), bilateral jugular, common femoral, and main portal vein wall thicknesses (VWTs) in Behçet’s disease (BD) patients with and without vascular involvement to obtain a cut-off value for vascular complications and determine their relationship with disease activity. Patients and methods
Sixty-three BD patients (41 males, 22 females; median age: 38.0 years; min 20 - max 71 years) and 30 healthy control subjects (14 males, 16 females; median age: 40.3 years; min 21 - max 60 years) were included in this cross-sectional study between February and March 2020. According to imaging findings, BD patients were divided into two groups as those with and without vascular complications. Disease duration, medical treatment and BD manifestations of patients were questioned. Disease activity was evaluated using the Behçet's Disease Current Activity Form (BDCAF) and the Behçet's Syndrome Activity Scale (BSAS). Two radiologists blinded to the diagnosis of BD used ultrasound to measure VWT and CIMT. Receiver operating characteristics were assessed to obtain sensitivity and specificity values for each VWT and CIMT. Results
The groups were similar in terms of age, sex, and body mass index (p>0.05). There was a significant difference between the BD groups when the BDCAF and BSAS scores were compared, while there was no difference between them in terms of disease duration and medical treatment (p>0.05). All VWTs and CIMTs were significantly higher in patients with BD compared to healthy controls (p<0.05). There was no significant difference between the BD groups in terms of CIMT, jugular and common femoral VWTs (p>0.05). But portal VWT was significantly higher in patients with vascular involvement (p<0.05). A cut-off value of ≥1.35 mm yielded a sensitivity of 79.2% and a specificity of 82.4% for the diagnosis of vascular involvement with the highest Youden's index (area under the curve, 0.869; 95% confidence interval, 0.783 to 0.956). Conclusion Portal VWT has high sensitivity and specificity for the screening of vascular involvement in patients with BD.
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Affiliation(s)
- Serdar Kaymaz
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Halil Yilmaz
- Department of Gastroenterology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Furkan Ufuk
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ayşe Rüksan Ütebey
- Department of Radiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Veli Çobankara
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Uğur Karasu
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Canan Albayrak Yaşar
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Firdevs Ulutaş
- Department of Internal Medicine, Division of Rheumatology, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Alibaz-Oner F, Ergelen R, Ergenc I, Seven G, Yazıcı A, Cefle A, Bes C, Atug O, Direskeneli H. Femoral Vein Wall Thickness Measurement May Be a Distinctive Diagnostic Tool to Differentiate Behçet's Disease with Intestinal Involvement and Crohn's Disease. Dig Dis Sci 2021; 66:2750-2755. [PMID: 32926263 DOI: 10.1007/s10620-020-06587-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 08/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUNDS Behçet's disease (BD) and Crohn's disease (CD) cannot be easily differentiated in young adults presenting with nonspecific gastrointestinal (GI) manifestations due to similar extraintestinal manifestations. We recently showed that increased common femoral vein (CFV) thickness is a distinctive feature of BD, rarely present in other inflammatory or vascular diseases with a specificity higher than 80% for the cutoff value of ≥ 0.5 mm. We suggest that CFV thickness measurement with ultrasonography (US) can be a diagnostic tool for BD. AIMS To assess the diagnostic performance of CFV thickness measurement in the differential diagnosis of BD and CD. METHODS Patients with BD (n = 69), CD (n = 38), and healthy controls (HC) (n = 38) were included in the study. Bilateral CFV thickness was measured with Doppler US. RESULTS Both right and left CFV thicknesses were significantly higher in BD compared to HC and CD (for right: 0.76 mm vs 0.33 mm, for left: 0.78 mm vs 0.35 mm, p < 0.001 for both). CFV thicknesses in CD were similar to HC (p > 0.05 for both). CFV thickness was also similar between BD patients with and without GI involvement (p = 0.367). The diagnostic cutoff values of ≥ 0.5 mm for CFV thickness performed well against to both CD and HCs for discrimination of BD. The sensitivity and specificity rates were > 85% for both HC and CD. Positive and negative predictive values in our tertiary clinical setting were > 90%. CONCLUSION We found significantly lower CFV thickness in CD compared to BD. Our results suggest that CFV wall thickness measurement is a distinctive diagnostic tool for the differentiation of BD and CD and can be helpful in daily practice for the differentiation of two diseases.
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Affiliation(s)
- Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey.
| | - Rabia Ergelen
- Department of Radiology, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Ilkay Ergenc
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Gizem Seven
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Ayten Yazıcı
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Cemal Bes
- Division of Rheumatology, Health Science University, Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Ozlen Atug
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Marmara University, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey
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Factors influencing the recurrence of arterial involvement after surgical repair in Behçet disease. J Vasc Surg 2020; 72:1761-1769. [DOI: 10.1016/j.jvs.2020.01.076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/25/2020] [Indexed: 11/17/2022]
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Abstract
Aim In this study, it was aimed to summarize the demographics, and clinical and laboratory findings of children who were diagnosed as having Behçet's disease, and also to determine the efficacy, duration, and adverse effects of the treatments. Material and Methods The records of 34 patients who were diagnosed according to the International Behçet Study Group criteria between 1980 and 2013 in the Department of Pediatric Nephrology and Rheumatology, Hacettepe University Faculty of Medicine, were retrospectively reviewed and all demographic and clinical features were recorded. In the light of these data, the sex and age distribution, clinical and laboratory findings, most commonly preferred treatment approaches, efficacy of treatments, and adverse effects during treatment were analyzed. Results Of the 34 children with Behçet's disease, 18 (53%) were male and 16 (47%) were female, and the mean age was 11.18±3.34 years. There was no significant difference in age distribution of the male and female patients (p<0.05). In 97% (n=33) of the patients, the first symptom was recurrent oral aphthae. In order of frequency, the other mucocutaneous findings were pseudofoliculitis and pustular lesions (82%), genital ulcers (62%), and pathergy positivity (50%). System involvements in order of frequency were as follows: joint findings (38%), ocular findings (35%), vascular involvement (32%), neurologic involvement (18%), gastrointestinal involvement (5.8%), and pulmonary involvement (5.8%). Colchicine was the most commonly preferred drug (88%). Steroids were added to treatment in patients with skin involvement. Azathioprine was added in patients with uveitis. Anticoagulant therapy, cyclophosphamide, and anti-tumor necrosis factor-alpha were added in patients with vascular involvement. In patients with gastrointestinal system involvement, sulfasalazine was added to treatment. Diarrhea was the most common adverse effect in patients who used colchicine. In the patients who used steroid treatment, gastrointestinal symptoms such as unintentional weight gain, acne, and agitation were observed (17%). One patient who received interferon treatment had symptoms of depression and agitation. Conclusion The aim of this study was to review the general characteristics of pediatric patients with Behçet's disease and to emphasize the importance of early diagnosis and correct treatment in terms of mortality and morbidity.
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Mirouse A, Barete S, Desbois AC, Comarmond C, Sène D, Domont F, Bodaghi B, Ferfar Y, Cacoub P, Saadoun D. Long-Term Outcome of Ustekinumab Therapy for Behçet's Disease. Arthritis Rheumatol 2019; 71:1727-1732. [PMID: 31008548 DOI: 10.1002/art.40912] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/16/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Oral ulcers, the hallmark lesion of Behçet's disease (BD), can be disabling and resistant to conventional treatment, and there is a need for safe and effective treatment. We undertook this study to investigate the long-term safety and efficacy of ustekinumab therapy for BD-related oral ulcers that are resistant to colchicine. METHODS This multicenter, prospective, open-label study included 30 patients who fulfilled the criteria of the International Study Group for BD and who were diagnosed as having active oral ulcers resistant to colchicine. Patients were treated subcutaneously with ustekinumab 90 mg at inclusion, at week 4, and then once every 12 weeks. Each patient was assessed longitudinally for the presence and number of oral ulcers, and median numbers of oral ulcers (with interquartile range [IQR]) were calculated. The primary efficacy end point was the proportion of patients at week 12 who experienced complete response, defined as having no oral ulcers. RESULTS The median number of oral ulcers per patient during ustekinumab therapy was significantly lower at week 12 compared to baseline (0 [IQR 0-1] versus 2 [IQR 2-3]; P < 0.0001). Complete response was achieved in 60.0% and 88.9% of patients at weeks 12 and 24, respectively. The median Behçet's Syndrome Activity Score (in which higher scores indicate more active disease) was significantly lower at weeks 12 and 24 (17.5 [IQR 10-42.5] and 10 [IQR 8-11], respectively) versus baseline (70 [IQR 50-70]; P < 0.0001). After a median follow-up of 12 months (IQR 6-16 months), 26 patients (86.7%) were still receiving ustekinumab treatment. Reasons for ustekinumab discontinuation included BD flare (n = 3) and side effects (n = 1). Seven patients (23.3%) experienced adverse events, including headaches (n = 4) and asthenia (n = 2), with no serious side effects. CONCLUSION Ustekinumab seems to be effective in treating BD-related oral ulcers that are resistant to treatment with colchicine.
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Affiliation(s)
- Adrien Mirouse
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Stéphane Barete
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, and Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biotherapie, Paris, France
| | - Anne-Claire Desbois
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Cloé Comarmond
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | | | - Fanny Domont
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bahram Bodaghi
- Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Yasmina Ferfar
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Patrice Cacoub
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - David Saadoun
- Sorbonne Université, Centre National de Référence Maladies Auoimmunes Systémiques Rares, Centre National de Référence Maladies Autoinflammatoires et Amylose Inflammatoire, INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Venous vessel wall thickness in lower extremity is increased in male patients with Behcet's disease. Clin Rheumatol 2019; 38:1447-1451. [PMID: 30758790 DOI: 10.1007/s10067-019-04470-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/17/2019] [Accepted: 02/06/2019] [Indexed: 01/10/2023]
Abstract
Vascular involvement, especially in young males, is seen in up to 40% of the patients with Behcet's disease (BD) and is a major cause of mortality and morbidity. In this study, we investigated vessel wall thickness (VWT) and dilatation in lower extremity veins with Doppler ultrasound (US) in male BD patients. Sixty-one male patients with BD, 37 healthy male controls (HC) and 27 male patients, with ankylosing spondylitis (AS), were included in the study. Venous Doppler US was performed by an experienced radiologist blinded to cases. Bilateral common femoral vein (CFV) wall thickness and great/small saphenous vein (SV) dilatations were assessed. All venous measurements were significantly higher in BD compared to AS and HC (p < 0.001 for all). Both right and left extremity CFV thicknesses had a high area under the ROC curve (> 0.8). Cut-off values for right and left CFV thicknesses for BD was 0.49 and 0.48 mm, respectively. High sensitivity and specificities are observed for both measurements (right CFV: sensitivity 81%, specificity 78.4%; left CFV: sensitivity 82.8%, specificity 81.1%). We found increased CFV thickness in BD patients independent of vascular involvement. As a similar change was not observed in controls, increased CFV thickness may be a specific sign of venous inflammation in BD. Our acceptable sensitivity and specificity values of CFV measurements suggest that assessment of femoral vein thickness with US may be a candidate diagnostic tool, especially in young males suspected of BD.
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Abstract
Behçet's disease (BD) is a chronic, multisystemic, inflammatory disease characterized by recurrent attacks of mucocutaneous, ocular, musculoskeletal, vascular, central nervous system and gastrointestinal manifestations. Treatment of BD changes according to organ involvement, gender and age of the patient with no golden standard therapeutic regimen. Vascular involvement is observed in up to 40% of the patients with BD, especially in young males and is one of the major causes of mortality and morbidity. Glucocorticoids, azathioprine and cyclophosphamide are still recommended as the first-line treatments in vascular BD. However, increasing data with the tumor necrosis factor inhibitors suggest that these agents may also be acceptable options for the management of refractory vascular BD in daily practice. Anticoagulant usage for vascular BD is also still controversial with limited data coming from retrospective studies. There is a clear need for randomized, controlled studies for the management of VBD.
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Affiliation(s)
- Fatma Alibaz-Oner
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
| | - Haner Direskeneli
- Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey
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Mirouse A, Cacoub P, Desbois AC, Comarmond C, Pagnoux C, Saadoun D. Investigational drugs in systemic vasculitis. Expert Opin Investig Drugs 2017; 26:1049-1061. [PMID: 28758504 DOI: 10.1080/13543784.2017.1361928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Treatment of systemic vasculitis is based on glucocorticoids (GC) in association with immunosuppressive therapy. There are still unmet needs, including earlier onset of response, more targeted therapies, reduction of relapse-risk and decrease of long-term GC and classic immunosuppressants toxicities. Areas covered: In this review, we discuss investigational drugs in early phase clinical trials for induction of remission in vasculitis. We focus on ANCA-associated vasculitis, Behçet's disease, giant cell arteritis, Takayasu arteritis, and cryoglobulinemic vasculitis. We performed a comprehensive review of articles published on pubmed and a review of clinical trials registered online ( https://clinicaltrials.gov ) for each vasculitis. Expert opinion: Recent progress in the pathogenesis identifies new therapeutic targets. Some of these therapies are promising in GC sparing effects, in reducing relapse rate, and for their safety profile. These results need to be confirmed in large-scale phase III studies.
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Affiliation(s)
- Adrien Mirouse
- a Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie (DHU i2B) , Sorbonne Universités , UPMC Université Paris 06, UMR 7211 , Paris , France.,b INSERM, UMR_S 959 , Paris , France.,c CNRS, FRE3632 , Paris , France.,d AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique , National Center for Autoimmune and Systemic Diseases and for Autoinflammatory Diseases , Paris , France
| | - Patrice Cacoub
- a Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie (DHU i2B) , Sorbonne Universités , UPMC Université Paris 06, UMR 7211 , Paris , France.,b INSERM, UMR_S 959 , Paris , France.,c CNRS, FRE3632 , Paris , France.,d AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique , National Center for Autoimmune and Systemic Diseases and for Autoinflammatory Diseases , Paris , France
| | - Anne Claire Desbois
- a Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie (DHU i2B) , Sorbonne Universités , UPMC Université Paris 06, UMR 7211 , Paris , France.,b INSERM, UMR_S 959 , Paris , France.,c CNRS, FRE3632 , Paris , France.,d AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique , National Center for Autoimmune and Systemic Diseases and for Autoinflammatory Diseases , Paris , France
| | - Cloé Comarmond
- a Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie (DHU i2B) , Sorbonne Universités , UPMC Université Paris 06, UMR 7211 , Paris , France.,b INSERM, UMR_S 959 , Paris , France.,c CNRS, FRE3632 , Paris , France.,d AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique , National Center for Autoimmune and Systemic Diseases and for Autoinflammatory Diseases , Paris , France
| | - Christian Pagnoux
- e Vasculitis Clinic, Mount Sinai Hospital , University of Toronto , Toronto , Canada
| | - David Saadoun
- a Département Hospitalo-Universitaire Inflammation-Immunopathologie-Biothérapie (DHU i2B) , Sorbonne Universités , UPMC Université Paris 06, UMR 7211 , Paris , France.,b INSERM, UMR_S 959 , Paris , France.,c CNRS, FRE3632 , Paris , France.,d AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département de Médecine Interne et Immunologie Clinique , National Center for Autoimmune and Systemic Diseases and for Autoinflammatory Diseases , Paris , France
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Mirouse A, Barete S, Monfort JB, Resche-Rigon M, Bouyer AS, Comarmond C, Sène D, Domont F, Ferfar Y, Cacoub P, Saadoun D. Ustekinumab for Behçet's disease. J Autoimmun 2017; 82:41-46. [DOI: 10.1016/j.jaut.2017.05.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/25/2017] [Accepted: 05/01/2017] [Indexed: 12/16/2022]
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Choi JY, Kim SH, Kwok SK, Jung JI, Lee KY, Kim TJ, Kang JY. A 30-year-old female Behçet's disease patient with recurrent pleural and pericardial effusion and elevated adenosine deaminase levels: case report. J Thorac Dis 2016; 8:E547-51. [PMID: 27499994 DOI: 10.21037/jtd.2016.05.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Behçet's disease is a systemic disease which may involve various organs. We describe a case of a patient diagnosed as pleuropericardial involvement of Behçet's disease. A 30-year-old woman visited our clinic presented with left pleuritic chest pain for s days. She had been diagnosed as Behçet's disease and admitted to our clinic due to pericardial and pleural effusion repeatedly in past two years. In the previous studies, effusion analysis revealed to be lympho-dominant exudate with high adenosine deaminase level. Acid-fast bacilli (AFB) culture and polymerase chain reaction (PCR) for mycobacterial tuberculosis (M.TB) were negative in the pericardial tissue, and pathologic finding showed mild endothelitis with micro-thrombi formation in the lumen. The patient had been treated with antituberculous medication for a year. In the current admission, chest computed tomography (CT) again showed left pleural effusion without other significant lesion. Pleural fluid analysis was similar with the previous study. Video-assisted thoracoscopic pleural biopsy was performed to obtain the definite diagnosis. Pathology confirmed the diagnosis as pleuropericardial involvement of Behçet's disease, and we treated the patient with oral steroid in the out-patient department. Pleuropericardial involvement of Behçet's disease may mimic TB pleurisy or pericarditis due to high adenosine deaminase (ADA) level in effusion analysis. Clinicians should keep in mind that Behçet's disease may manifest as pleural or pericardial effusion, and pathologic confirmation could be helpful for the definite diagnosis.
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Affiliation(s)
- Joon Young Choi
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Sung-Hwan Kim
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Seung-Ki Kwok
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Jung Im Jung
- Department of Radiology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Kyo-Young Lee
- Department of Clinical Pathology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Tae-Jung Kim
- Department of Clinical Pathology, College of Medicine, the Catholic University of Korea, Seoul, Korea
| | - Ji Young Kang
- Department of Internal Medicine, College of Medicine, the Catholic University of Korea, Seoul, Korea
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Barış S, Akyürek Ö, Dursun A, Akyol M. The impact of the IL-1β, IL-1Ra, IL-2, IL-6 and IL-10 gene polymorphisms on the development of Behcet's disease and their association with the phenotype. Med Clin (Barc) 2015; 146:379-83. [PMID: 26654556 DOI: 10.1016/j.medcli.2015.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/13/2015] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE This trial was designed to investigate the effects of the interleukin (IL)-1β, IL-1Ra, IL-2, IL-6, IL-10 gene polymorphisms on Behcet's disease (BD) occurrence and the association between the polymorphisms and the phenotype. MATERIALS AND METHOD The study population consisted of 71 patients and 70 age and gender-matched healthy subjects. Each of the participants had 2cc of blood withdrawn, which was placed into a whole blood tube, and the DNA was obtained using the NucleoSpin(®) Blood DNA Isolation kit. To display the band lengths, the products were amplified using the primary pairs of the interleukins investigated and developed in a 2% agarose gel. RESULTS There were no significant differences between the groups with respect to the IL-1Ra, IL-1β, IL-2, IL-6 and the IL-10 gene polymorphism distributions. In the patient group the IL-1RN2 gene polymorphism was detected to be statistically correlated with the presence of articular involvement (p=0.0283) and the IL-1β gene polymorphism was statistically correlated with the presence of an ocular lesion (p=0.0178). The evaluation of the IL-2 gene polymorphism (p=0.0065) and IL-10 gene polymorphism (p=0.0483) distributions with respect to age of BD onset revealed a statistically significant distribution. CONCLUSION The statistical correlations between the articular involvement and IL-1RN, the ocular involvement and the IL-1β, and the age of disease onset and the IL-2 and IL-10 gene polymorphisms, detected for the first time in the literature, suggest that these polymorphisms could be statistically associated with the disease symptoms and used as prognostic factors.
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Affiliation(s)
- Savaş Barış
- Department of Medical Genetics, Mevlana University Faculty of Medicine, Konya, Turkey
| | - Ömer Akyürek
- Department of Internal Medicine, Mevlana University Faculty of Medicine, Konya, Turkey.
| | - Ahmet Dursun
- Department of Medical Genetics, Zonguldak Karaelmas University Medical Faculty Training and Research Hospital, Zonguldak, Turkey
| | - Mesut Akyol
- Department of Biostatistics, Yıldırım Beyazıt University, Ankara, Turkey
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Abstract
PURPOSE Behçet's disease (BD) is a chronic inflammatory disease characterized by orogenital ulcers, skin and ocular lesions, in addition to articular, vascular, and neurologic symptoms. Carpal tunnel syndrome (CTS), can also occur in BD patients secondary to inflammation in the connective tissues, vessels, and tendons, as well as nerve involvement in BD itself. However, reports of patients who have CTS in BD are rare. The aim of this study was to evaluate the clinical characteristics of CTS in BD patients. MATERIALS AND METHODS Retrospective analysis of the medical records of 1750 BD patients, and 14 (0.8%) BD patients who were diagnosed with CTS was performed at the BD Specialty Clinic of Severance Hospital. Patient demographics, disease activity/severity for both diseases, and the clinical characteristics of CTS in BD were recorded and analyzed. RESULTS All 14 BD patients with CTS were women. Twelve patients (85.7%) were diagnosed with active BD. The CTS was mild in 8 patients (57.2%), moderate in 3 patients (21.4%), and severe in 3 patients (21.4%). Ten patients (71.4%) had BD prior to the diagnosis of CTS, and these 10 patients all had active BD. CONCLUSION CTS can occur as a result of the inflammation associated with BD and can also be the presenting symptom of nerve involvement in BD. CTS can also develop as the initial symptom of BD. Therefore, a higher degree of suspicion should be maintained for CTS in patients with BD and vice versa; however, the exact relationship is uncertain.
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Affiliation(s)
- Jungsoo Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Suhyun Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Do Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Zhenlong Zheng
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dongsik Bang
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Department of Dermatology, Catholic Kwandong University, International St. Mary's Hospital, Incheon, Korea.
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13
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Alibaz-Oner F, Karadeniz A, Ylmaz S, Balkarl A, Kimyon G, Yazc A, Çnar M, Ylmaz S, Yldz F, Bilge ŞY, Bilgin E, Coskun BN, Omma A, Çetin GY, Çağatay Y, Karaaslan Y, Sayarloğlu M, Pehlivan Y, Kalyoncu U, Karadağ Ö, Kaşifoğlu T, Erken E, Pay S, Çefle A, Ksack B, Onat AM, Çobankara V, Direskeneli H. Behçet disease with vascular involvement: effects of different therapeutic regimens on the incidence of new relapses. Medicine (Baltimore) 2015; 94:e494. [PMID: 25674739 PMCID: PMC4602744 DOI: 10.1097/md.0000000000000494] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Vascular involvement is one of the major causes of mortality and morbidity in Behçet disease (BD). There are no controlled studies for the management of vascular BD (VBD), and according to the EULAR recommendations, only immunosuppressive (IS) agents are recommended. In this study, we aimed to investigate the therapeutic approaches chosen by Turkish physicians during the initial event and relapses of VBD and the association of different treatment options with the relapses retrospectively.Patients with BD (n = 936, female/male: 347/589, mean age: 37.6 ± 10.8) classified according to ISG criteria from 15 rheumatology centers in Turkey were included. The demographic data, clinical characteristics of the first vascular event and relapses, treatment protocols, and data about complications were acquired.VBD was observed in 27.7% (n = 260) of the patients during follow-up. In 57.3% of the VBD patients, vascular involvement was the presenting sign of the disease. After the first vascular event, ISs were given to 88.8% and AC treatment to 59.8% of the patients. Median duration of AC treatment was 13 months (1-204) and ISs, 22 months (1-204). Minor hemorrhage related to AC treatment was observed in 7 (4.7%) patients. A second vascular event developed in 32.9% (n = 86) of the patients. The vascular relapse rate was similar between patients taking only ISs and AC plus IS treatments after the first vascular event (29.1% vs 22.4%, P = 0.28) and was significantly higher in group taking only ACs than taking only ISs (91.6% vs 29.1%, P < 0.001). During follow-up, a third vascular event developed in 17 (n = 6.5%) patients. The relapse rate was also similar between the patients taking only ISs and AC plus IS treatments after second vascular event (25.3% vs 20.8%, P = 0.93). When multivariate analysis was performed, development of vascular relapse negatively correlated with only IS treatments.We did not find any additional positive effect of AC treatment used in combination with ISs in the course of vascular involvement in patients with BD. Severe complications related to AC treatment were also not detected. Our results suggest that short duration of IS treatments and compliance issues of treatment are the major problems in VBD associated with vascular relapses during follow-up.
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Affiliation(s)
- Fatma Alibaz-Oner
- From the Marmara University, School of Medicine, Department of Rheumatology Istanbul (FA-O, AK, HD); Selçuk University, School of Medicine, Department of Rheumatology Konya (SY); Pamukkale University, School of Medicine, Department of Rheumatology Denizli (AB, VÇ); Gaziantep University, School of Medicine, Department of Rheumatology Gaziantep (GK, BK, AMO); Kocaeli University, School of Medicine, Department of Rheumatology Kocaeli (AY, AÇ); Gulhane Military School of Medicine, Department of Rheumatology Ankara (MÇ, SY, SP); Çukurova University, School of Medicine, Department of Rheumatology Adana (FY, EE); Osmangazi University, School of Medicine, Department of Rheumatology Eskişehir (ŞYB, TK); Hacettepe University, School of Medicine, Department of Rheumatology Ankara (EB, UK, ÖK); Uludağ University, School of Medicine, Department of Rheumatology Bursa (BNC, YP); Ankara Numune Training and Research Hospital, Department of Rheumatology, Ankara (AO); Sütçü İmam University, School of Medicine, Department of Rheumatology, Kahramanmaraş (GYÇ); Bilim University, School of Medicine, Department of Rheumatology, Istanbul (YÇ); Hitit University Medical Faculty, Department of Rheumatology, Çorum (YK); and Ondokuz Mayıs University, School of Medicine, Department of Rheumatology, Samsun, Turkey (MS)
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14
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Proinflammatory cytokines and C-reactive protein in uveitis associated with Behçet's disease. Mediators Inflamm 2014; 2014:396204. [PMID: 24994946 PMCID: PMC4068062 DOI: 10.1155/2014/396204] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/22/2014] [Indexed: 01/24/2023] Open
Abstract
The aim of the present study was to determine the serum cytokine profile and levels of high sensitivity C-reactive protein (hsCRP)
in patients with uveitis associated with Behçet's disease (BD) and to compare them with those obtained from healthy control subjects.
We determined the serum concentration of interferon-γ (IFN-γ),
interleukin-1β (IL-1β), IL-12p70, IL-17A,
tumor necrosis factor-α (TNF-α),
and hsCRP in 13 patients with active uveitis associated to BD, 24 inactive BD patients, and 20 controls. In a subgroup of 10 active patients,
a second serum sample was obtained when the disease was inactive. Cytokine profiles and hsCRP levels were correlated with disease activity,
severity, complications, and visual outcome.
Levels of IFN-γ and TNF-α were significantly
increased in patients with active uveitis associated to BD compared to controls
(P < 0.05).
IFN-γ, TNF-α,
and hsCRP were significantly higher during active uveitis associated to BD compared to inactive disease
(P < 0.05).
Furthermore, IL-17A was significantly increased in patients with active BD without pharmacological treatment compared to controls
(P < 0.05).
No significant correlations were found with specific cytokine profiles and disease severity, visual outcome, or complications.
In summary, increased serum levels of IFN-γ, TNF-α,
IL-17A, and hsCRP were associated with active uveitis associated with BD and might serve as markers of disease activity.
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15
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Daoudi S, Lounis M, Ait-Kaci-Ahmed M. [Parenchymal neuro-Behcet's disease. Clinical and paraclinical characteristics, a report of 40 cases]. Presse Med 2014; 43:e119-25. [PMID: 24703735 DOI: 10.1016/j.lpm.2013.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/20/2013] [Accepted: 07/26/2013] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Describe the clinical and paraclinical characteristics of parenchymal neuro-Behcet's disease. METHODS This is a prospective, descriptive study, concerning 40 patients with parenchymal neuro-Behcet's disease. The patients were followed during 3 years, benefited a thorough physical examination and paraclinical made of inflammatory laboratory tests, infectious serology, serum/CSF autoimmunity assessment, brain/spine MRI and evoked potentials. We also evaluated the frequency of HLA-B51. RESULTS We identified 22 men and 18 women. The average age was 32 years. The beginning was poly-symptomatic in 65% cases. Twenty-eight patients (70%) reported a decrease in visual acuity, 40% (16 cases) associated with uveitis, 33 cases (82.5%) complained of headache and 11 cases (27.5%) with dizziness. Inaugural signs consisted of motor disorders (50%) and balance disorders (40%). The inflammatory serum markers were positive in 75% and oligoclonal bands present in CSF were found in 7 patients. Infracentimetric demyelinating lesions in MRI study were located in the brainstem (52.5%), the subcortical white matter (40%), the periventricular region (42.5%), cerebellum (32.5%), basal ganglia (30%), internal capsule (25%) and corpus callosum (12.5%). The HLA-B51 was found in 53% of cases. CONCLUSION Behçet's disease mainly affects young male. The neurological complications are highly polymorphic, involving severe vital or functional prognosis.
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Affiliation(s)
- Smail Daoudi
- CHU Nedir Mohamed, service de neurologie, 15000 Tizi-Ouzou, Algérie.
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16
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Mesquida M, Molins B, Llorenç V, Hernández MV, Espinosa G, Dick AD, Adán A. Current and future treatments for Behçet's uveitis: road to remission. Int Ophthalmol 2013; 34:365-81. [PMID: 23729309 DOI: 10.1007/s10792-013-9788-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 05/02/2013] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is a multisystem inflammatory disorder of uncertain origin, although it remains defined within the spectrum of systemic immune-mediated vasculitic disorders and also represents a spectrum of putative autoimmune disease. Major symptoms include oral aphthous ulcers, genital ulcerations, skin lesions, and ocular lesions. Despite afflicting many systems, ocular complications of BD are some of the more devastating for the patient and their quality of life. Eye involvement, which affects 60-80 % of BD patients, is characterized in its more severe form by posterior or panuveitis including occlusive retinal vasculitis. While pathogenesis of BD remains complex, association with Class I MHC (HLA-B*51) predisposing to inflammation with engagement of the innate-immune system (neutrophils, NK cells), and perpetuated by the adaptive T cell responses against infectious- and/or auto-antigens. Despite the choice of conventional immunosuppressive therapies available, only recently with the advent of biologic therapy has visual prognosis and outcomes been substantially and favorably altered. For example, both interferon-α (IFN-α) and tumour necrosis factor (TNF)-α antagonists deliver promising results and for the first time improve prognosis. With IFN-α therapy, durable remissions of uveitis can be achieved and lead to drug-free remission. Similarly, anti-TNF therapy with infliximab is reported to be rapidly effective in inducing and maintaining remission. Most recently, rising evidence reports on the use of adalimumab, etanercept, and golimumab, while use of anti-interleukin (IL)-1 agents (anakinra, canakinumab, gevokizumab), IL-6 blockers (tocilizumab), and rituximab (depleting anti-CD20 antibody) is also increasing. The aim of this review is to provide evidence for the role of conventional therapies combined with evidence for advantages and disadvantages of biologic therapies in the treatment of ocular BD. Although randomized controlled trials remain sparse, evidence remains strong and enticing that biologic agents are invaluable for the treatment of sight-threatening Behçet's uveitis and makes it an exciting time for Behçet's specialists worldwide.
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Affiliation(s)
- Marina Mesquida
- Ophthalmology Department, Hospital Clinic of Barcelona, University of Barcelona, Sabino de Arana, 1, 08028, Barcelona, Spain,
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17
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Portanova A, Hakakian N, Mikulis DJ, Virmani R, Abdalla WMA, Wasserman BA. Intracranial Vasa Vasorum: Insights and Implications for Imaging. Radiology 2013; 267:667-79. [DOI: 10.1148/radiol.13112310] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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18
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Bilgin G, Sungur G, Kucukterzi V. Systemic and pulmonary screening of patients with Behçet's disease during periodic follow-up. Respir Med 2013; 107:466-71. [DOI: 10.1016/j.rmed.2012.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/04/2012] [Accepted: 04/10/2012] [Indexed: 10/27/2022]
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19
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Yigit S, Tural S, Rüstemoglu A, Inanir A, Gul U, Kalkan G, Akkanet S, Karakuş N, Ateş O. DD genotype of ACE gene I/D polymorphism is associated with Behcet disease in a Turkish population. Mol Biol Rep 2012; 40:365-8. [PMID: 23065219 DOI: 10.1007/s11033-012-2069-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 10/03/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Serbülent Yigit
- Department of Medical Biology, Faculty of Medicine, Gaziosmapaşa University, Tokat, Turkey.
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20
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Desbois AC, Wechsler B, Resche-Rigon M, Piette JC, Huong DLT, Amoura Z, Koskas F, Desseaux K, Cacoub P, Saadoun D. Immunosuppressants reduce venous thrombosis relapse in Behçet's disease. ACTA ACUST UNITED AC 2012; 64:2753-60. [DOI: 10.1002/art.34450] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Ben-Chetrit E, Touitou I, Fellig Y, Barat-Houari M. Kimura's disease and Behcet's syndrome in the same family--are they associated? Joint Bone Spine 2012; 80:44-7. [PMID: 22749664 DOI: 10.1016/j.jbspin.2012.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 04/10/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Behcet's disease (BD) and Kimura's disease (KD) are two inflammatory diseases commonly found in Japan. In Israel, both diseases are quite rare. Recently, we encountered a family whose three siblings suffer from BD and an additional brother suffers from KD. This observation raised the question as to whether both diseases have a common underlying genetic basis. AIM OF THE STUDY To describe this unique family and to search for possible common alleles in the IL10 gene between BD and KD, as several SNPs in this gene are known to be associated with BD. METHODS Three BD siblings and their brother with KD were interviewed and examined. Genomic DNA was prepared from blood samples taken from all nine members of the family. The DNA was genotyped for sequence variations of six SNPs on the IL10 gene. RESULTS The IL10 SNPs did not segregate with BD and KD suggesting that there was no association between the IL10 gene and these diseases in this family. CONCLUSIONS SNPs in the IL10 gene shown to be susceptibility factors in adult BD were not associated with BD in this family. The question regarding a possible common genetic basis for KD and BD requires further investigation.
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Affiliation(s)
- Eldad Ben-Chetrit
- Department of Medicine, Rheumatology Unit, Hadassah-Hebrew University Medical Center Head, POB 12000, Jerusalem, Israel.
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22
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Neurological manifestations of Behçet's disease: Evaluation of 40 patients treated by cyclophosphamide. Rev Neurol (Paris) 2012; 168:344-9. [DOI: 10.1016/j.neurol.2011.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/10/2011] [Accepted: 09/20/2011] [Indexed: 11/19/2022]
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23
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Saadoun D, Asli B, Wechsler B, Houman H, Geri G, Desseaux K, Piette JC, Huong DLT, Amoura Z, Salem TB, Cluzel P, Koskas F, Resche-Rigon M, Cacoub P. Long-term outcome of arterial lesions in Behçet disease: a series of 101 patients. Medicine (Baltimore) 2012; 91:18-24. [PMID: 22198498 DOI: 10.1097/md.0b013e3182428126] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The vasculitis of Behçet disease (BD) is distinctive because of involvement of both arteries and veins of all sizes. The concept of vasculo-Behçet disease has been adopted for cases in which vascular manifestations are present and often dominate the clinical features. While venous manifestations are frequent and have been reported in many publications, data regarding arterial lesions in patients with BD are rare and often isolated. In this study, we report the main characteristics, treatment, and long-term outcome of 101 patients with arterial lesions among a cohort of 820 (12.3%) BD patients. Factors that affect prognosis were assessed by multivariate analysis. There were 93 (91.2%) male patients; the median (Q1-Q3) age at diagnosis of BD was 33 (27-41) years. Arterial lesions included aneurysms (47.3%), occlusions (36.5%), stenosis (13.5%), and aortitis (2.7%). Lesions mainly involved the aorta (n = 25) and femoral (n = 23) and pulmonary (n = 21) arteries. Patients with arterial lesions were more frequently male (91.2% vs. 62.4%, respectively; p = 0.017) and had higher rates of venous involvement (80.4% vs. 29.8%, respectively; p < 0.001) compared to patients without arterial manifestations. Thirty-nine (38.6%) patients achieved complete remission. In multivariate analysis, the presence of venous involvement (odds ratio [OR], 0.29; 95% confidence interval [CI], 0.08-1.11) and arterial occlusive lesions (OR, 0.13; 95% CI, 0.01-1.25) were negatively associated with complete remission. The use of immunosuppressants (OR, 3.38; 95% CI, 0.87-13.23) was associated with the occurrence of complete remission. The 20-year survival rate was significantly lower in BD patients with arterial involvement than in those without arterial lesions (73% vs. 89%, respectively; p < 0.0001). In conclusion, the long-term outcome of arterial lesions in BD is poor, especially in the case of occlusive lesions and associated venous involvement. The use of immunosuppressants improved the prognosis.
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Affiliation(s)
- David Saadoun
- From Department of Internal Medicine (DS, BA, BW, GG, JCP, DLTH, ZA, P. Cacoub) and Laboratory I3 (DS) "Immunology, Immunopathology, Immunotherapy,'' UMR CNRS 7211, INSERM U959; Department of Radiology (P. Cluzel); and Department of Vascular Surgery (FK); Groupe Hospitalier Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris 6, Paris; Department of Biostatistics and Medical Data Processing (KD, MRR); INSERM U717, Hôpital Saint-Louis, Paris, France; and Department of Internal Medicine (HH, TBS), Hôpital La Rabta, Tunis, Tunisia
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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25
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Eckstein C, Saidha S, Levy M. A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. J Neurol 2011; 259:801-16. [DOI: 10.1007/s00415-011-6240-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 12/12/2022]
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26
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Yilmaz O, Yilmaz S, Kisacik B, Aydogdu M, Bozkurt Y, Erdem H, Pay S, Saglam M, Dinc A. Varicocele and epididymitis in Behcet disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:909-913. [PMID: 21705723 DOI: 10.7863/jum.2011.30.7.909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Behçet disease is a systemic disease with protean manifestations. Vasculitis is a hallmark of the disease and may involve arteries, veins, and capillaries. Varicocele is dilatation of the pampiniform plexus veins. We aimed to investigate the incidence of varicocele in patients with Behçet disease. METHODS The study included 47 male patients with Behçet disease and 31 healthy control participants. All underwent a clinical evaluation including a medical history and systemic and scrotal examinations. Subsequently, 2 investigators blinded to the clinical data performed sonographic examinations and measured pampiniform plexus vein diameters. RESULTS The mean age of the patients ± SD was 23.4 ± 3.2 years; disease durations ranged from 3 to 120 months (46 ± 31 months). Scrotal pain or a palpable mass was detected by clinical examination in 24 patients with Behçet disease (51.1%) and 5 healthy participants (16.1%; P = .002). By color Doppler examination, left varicocele was diagnosed in 26 patients with Behçet disease (55.3%) and 9 healthy participants (29%; P = .02). All patients with right varicocele also had left varicocele; that condition was detected in 10.6% (5 patients) of the Behçet disease group and 6.4% (2 patients) of the control group (P > .05). Eight patients with Behçet disease (17%) had epididymitis, whereas none of the healthy participants did (P = .019, Fisher exact test). Genital ulcers and erythema nodosum lesions were more common among patients with varicocele (P = .034 and .058, respectively). There were no differences in smoking, epididymitis, arthritis, uveitis, or other clinical parameters for distinguishing varicocele in patients with Behçet disease. CONCLUSIONS The incidence of varicocele was increased in Behçet disease. Whether varicocele confers fertility problems in patients with Behçet disease and the underlying mechanism for a possible association are yet to be determined.
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Affiliation(s)
- Omer Yilmaz
- Division of Radiology, Gulhane School of Medicine, Etlik, 06018 Ankara, Turkey.
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27
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Dogan EA, Ozturk BT, Mutluer M, Yıldız GU, Genc E, Yuruten B, Kocaogullar Y. Lumboperitoneal shunt in a patient with Behçet's disease with medically refractory intracranial hypertension. J Clin Neurosci 2011; 18:409-11. [PMID: 21237657 DOI: 10.1016/j.jocn.2010.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 05/14/2010] [Accepted: 05/15/2010] [Indexed: 11/24/2022]
Abstract
A 21-year-old male presented with severe throbbing headache, nausea, vomiting and progressive visual loss. Clinical examination revealed bilateral papilledema and left abducens nerve palsy. MRI showed findings consistent with dural sinus thrombosis. Combinging the clinical findings, MRI and a positive pathergy test, the patient was diagnosed with dural sinus thrombosis associated with Behçet's disease (BD). Despite acetazolamide, prednisone, azathioprine and repeated lumbar punctures, his signs and symptoms of intracranial hypertension gradually worsened. Therefore, lumboperitoneal shunting was planned after which rapid resolution of intracranial hypertension was observed. After reviewing similar reports, we suggest that lumboperitoneal shunt placement can be an effective treatment for patients with BD with medically refractory intracranial hypertension associated with dural sinus thrombosis.
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Affiliation(s)
- Ebru Apaydın Dogan
- Department of Neurology, Meram School of Medicine, Selcuk University, Noroloji AD, Meram 42080, Konya, Turkey.
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28
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Saadoun D, Wechsler B, Desseaux K, Le Thi Huong D, Amoura Z, Resche-Rigon M, Cacoub P. Mortality in Behçet's disease. ACTA ACUST UNITED AC 2010; 62:2806-12. [PMID: 20496419 DOI: 10.1002/art.27568] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To report the long-term mortality in patients with Behçet's disease (BD). METHODS A cohort of 817 patients fulfilling the international criteria for BD from a single center in France were analyzed for causes of death, the standardized mortality ratio (SMR), and the factors associated with mortality. RESULTS Among the 817 patients with BD, 41 (5%) died after a median followup of 7.7 years, of whom 95.1% were male. The mean ± SD age at death was 34.8 ± 11.9 years. Main causes of death included major vessel disease (mainly, arterial aneurysm and Budd-Chiari syndrome) (43.9%), cancer and malignant hemopathy (14.6%), central nervous system involvement (12.2%), and sepsis (12.2%). The mortality rate at 1 year and 5 years was 1.2% and 3.3%, respectively. There was an increased mortality among patients ages 15-24 years (SMR 2.99, 95% confidence interval [95% CI] 1.54-5.39) and those ages 25-34 years (SMR 2.90, 95% CI 1.80-4.49) as compared with age-and sex-matched healthy controls. The mortality decreased in patients older than age 35 years (SMR 1.23, 95% CI 0.75-1.92). In multivariate analyses, male sex (hazard ratio [HR] 4.94, 95% CI 1.53-16.43), arterial involvement (HR 2.51, 95% CI 1.07-5.90), and a high number of BD flares (HR 2.37, 95% CI 1.09-5.14) were independently associated with the risk of mortality. CONCLUSION The overall mortality in our BD cohort was 5% after a median followup of 7.7 years. Male sex, arterial involvement, and the number of flares were associated with mortality in BD.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, and Université Pierre et Marie Curie-Paris 6, Paris, France.
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29
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Saadoun D, Wechsler B, Terrada C, Hajage D, Le Thi Huong D, Resche-Rigon M, Cassoux N, Le Hoang P, Amoura Z, Bodaghi B, Cacoub P. Azathioprine in severe uveitis of Behçet's disease. Arthritis Care Res (Hoboken) 2010; 62:1733-8. [PMID: 20665749 DOI: 10.1002/acr.20308] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 07/20/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To investigate the efficacy and tolerance of azathioprine in severe uveitis related to Behçet's disease (BD). METHODS We reported 157 consecutive patients with severe uveitis (active posterior uveitis or panuveitis) fulfilling the international criteria for BD and treated with corticosteroids (0.5-1 mg/kg/day) and azathioprine (2.5 mg/kg/day). Long-term outcome and factors associated with complete remission were assessed. RESULTS Mean±SD age at diagnosis was 29.9±10.1 years, with 71.3% men. At baseline, 59 patients (37.6%) had loss of useful vision, 54 (34.4%) had retinal vasculitis, 66 (42.0%) had panuveitis, and 132 (84.1%) had bilateral uveitis. Following azathioprine therapy, 81 patients (51.6%) were complete responders, 65 (41.4%) were partial responders, and 11 (7%) were nonresponders. The visual acuity significantly improved (P<0.001), and a significant decrease in the mean oral prednisone dosage (55.3 to 10.5 mg/day; P<0.001) was observed after therapy. Patients with retinal vasculitis (odds ratio [OR] 0.45 [95% confidence interval (95% CI) 0.2-0.9], P=0.02) and severe visual loss (OR 0.28 [95% CI 0.2-0.7], P<0.0001) at diagnosis were less likely to be complete responders. Azathioprine was well tolerated, with only 3 withdrawals due to hepatotoxic effects (n=2) and bacterial septicemia (n=1). CONCLUSION Azathioprine represents an effective and safe therapy in patients with severe uveitis of BD.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière and Pierre et Marie Curie-Paris VI University, Paris, France.
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Varol A, Seifert O, Anderson CD. The skin pathergy test: innately useful? Arch Dermatol Res 2009; 302:155-68. [PMID: 20012749 DOI: 10.1007/s00403-009-1008-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 11/02/2009] [Accepted: 11/10/2009] [Indexed: 12/11/2022]
Abstract
Pathergy is the term used to describe hyper-reactivity of the skin that occurs in response to minimal trauma. A positive skin pathergy test (SPT), characterised by erythematous induration at the site of the needle stick with a small pustule containing sterile pus at its centre, is among the criteria required for a diagnosis of Behçet's disease (BD) and in certain population has been shown to be highly specific for this condition. Problems with standardising the induction manoeuvre for the SPT as well as the method of assessment of the response have limited the usefulness of the SPT in the clinical setting. Extensive investigation into histopathological and immunological aspects of pathergy has led to a number of hypotheses relating to the aetiology of the skin pathergy reaction and the disease itself, but the cause is considered to be unknown. Pathergy lesions, the development of new skin lesions or the aggravation of existing ones following trivial trauma, are also reported in pyoderma gangrenosum and has been noted in other neutrophilic dermatoses such as Sweet's syndrome. The response of such patient groups to the systematic application of the SPT has not been described. We propose that a new way of considering the pathergy reaction is to see it as an aberration of the skin's innate reactivity from a homeostatic reactive mode closely coupled to tissue healing to an abnormal destructive/inflammatory mode. Our understanding of BD and other similar conditions would profit by more detailed mechanistic knowledge of skin homeostasis to minimal trauma in both health and disease through a more structured and systematic use of the SPT.
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Affiliation(s)
- Alexandra Varol
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
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Shang Y, Han S, Li J, Ren Q, Song F, Chen H. The clinical feature of Behçet's disease in Northeastern China. Yonsei Med J 2009; 50:630-6. [PMID: 19881965 PMCID: PMC2768236 DOI: 10.3349/ymj.2009.50.5.630] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 12/17/2008] [Accepted: 01/06/2009] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Behçet's disease (BD) is a chronic, relapsing, multi-system vasculitis of unknown aetiology with complicated and diversified clinical features predominantly involving oral and genital ulcers, and ocular and cutaneous lesions. The clinical features of this disease have been described to be different according to geographical areas and gender. We investigated the specific clinical features of BD patients in Northeastern China. MATERIALS AND METHODS 116 patients involved in this study fulfilled the classification criteria of the International Study Group for BD. The clinical manifestations and results of laboratory tests of BD were recorded in each patient. RESULTS The onset was typically between 20-39 years with a slight female predominance. Oral ulcers were the most common manifestation, followed by skin lesions, positive pathergy reaction/genital ulcers, and ocular lesions. Vascular lesion and epididymitis were rare in patients with BD. The frequency of erythema nodosum-like lesion and articular involvement were significantly higher in females, while gastrointestinal involvement was significantly higher in males. The results of laboratory tests showed that the human leukocyte antigen (HLA)-B*51 alleles were positive in 30.9% of patients and the immunological abnormities were present in some patients. CONCLUSION The clinical features of BD showed geographical and gender difference. Genetic and immune factors might participate in aetiopathogenesis of BD.
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Affiliation(s)
- Yingbin Shang
- Department of Dermatology, No.1 Hospital of China Medical University, Shenyang, China.
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Abstract
Although most dementias are due to neurodegenerative or vascular disease, it is important to diagnose immunologically mediated dementias quickly because they can be both rapidly progressive and readily treatable. They usually affect function of limbic and cortical structures, but subcortical involvement can also occur. Because of the variety of symptoms and the rapid course, these dementias present a particular challenge to the clinician and may require evaluation and intervention in the inpatient setting. Diagnostic workup typically reveals evidence of an autoimmune process and, in some cases, cancer. In contrast to the neurodegenerative processes, many of the immunologically mediated dementias respond to immunomodulatory therapy.
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Karaman A, Kadı M, Kara F. Sister chromatid exchange and micronucleus studies in patients with Behçet’s disease. J Cutan Pathol 2009; 36:831-7. [DOI: 10.1111/j.1600-0560.2008.01180.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Saadoun D, Wechsler B, Resche-Rigon M, Trad S, Le Thi Huong D, Sbai A, Dormont D, Amoura Z, Cacoub P, Piette JC. Cerebral venous thrombosis in Behçet's disease. ACTA ACUST UNITED AC 2009; 61:518-26. [PMID: 19333987 DOI: 10.1002/art.24393] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To analyze the clinical findings, treatment, outcome, and prevalence of cerebral venous thrombosis (CVT) in a large cohort of patients with Behçet's disease (BD) from a single center. METHODS We reported a series of 64 consecutive patients with CVT who fulfilled the international criteria for BD. Multivariate analysis was performed to define factors that affect prognosis. RESULTS Among a cohort of 820 patients with BD, CVT was present in 64 (7.8%). Compared with BD patients without CVT, those with CVT had lower parenchymal central nervous system involvement (4.7% versus 28.7%; P = 0.0001) and higher extraneurologic vascular lesions (62.5% versus 38.8%; P = 0.03). Up to 90% of patients responded to anticoagulation therapy without severe hemorrhagic complications. Neither steroid nor immunosuppressant use provided better outcome. Severe visual loss due to optic atrophy was the main complication of CVT, being found in 15% of patients. In multivariate analysis, papilledema (odds ratio [OR] 7.1, 95% confidence interval [95% CI] 1.6-31.9) and concurrent prothrombotic risk factors (OR 4.6, 95% CI 1.1-20.2) were independently associated with the occurrence of sequelae. Factors associated with relapse of thrombosis were concurrent prothrombotic risk factors (hazard ratio [HR] 4.9, 95% CI 1.5-15.4) and a peripheral venous thrombosis (HR 2.8, 95% CI 0.7-10.5). After a mean +/- SD followup of 8.2 +/- 6.9 years, 4 deaths unrelated to CVT were noted. CONCLUSION CVT in patients with BD may result in serious neurologic outcomes. Anticoagulation represents a safe and effective therapy. Extensive investigation of prothrombotic disorders should be considered.
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Affiliation(s)
- D Saadoun
- Hôpital Pitié-Salpétrière and Pierre et Marie Curie-Paris VI University, Paris, France.
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Siva A, Saip S. The spectrum of nervous system involvement in Behçet's syndrome and its differential diagnosis. J Neurol 2009; 256:513-29. [PMID: 19444529 DOI: 10.1007/s00415-009-0145-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 08/25/2008] [Indexed: 01/30/2023]
Abstract
Behçet's Syndrome (BS) is a multi-system, vascular-inflammatory disease of unknown origin, involving the nervous system in a subgroup of patients. The growing clinical and imaging evidence suggests that primary neurological involvement in BS may be subclassified into two major forms: the first one, which is seen in the majority of patients, may be characterized as a vascular-inflammatory central nervous system (CNS) disease, with focal or multifocal parenchymal involvement mostly presenting with a subacute brainstem syndrome and hemiparesis; the other, which has few symptoms and a better neurological prognosis, may be caused by isolated cerebral venous sinus thrombosis and intracranial hypertension. These two types rarely occur in the same individual, and their pathogenesis is likely to be different. Isolated behavioral syndromes and peripheral nervous system involvement are rare, whereas a nonstructural vascular type headache is relatively common and independent from neurological involvement. Neurologic complications secondary to systemic involvement of BS such as cerebral emboli from cardiac complications of BS and increased intracranial pressure due to superior vena cava syndrome, as well as neurologic complications related to BS treatments such as CNS neurotoxicity with cyclosporine and peripheral neuropathy with the use of thalidomide or colchisin are considered as secondary neurological complications of this syndrome. As the neurological involvement in this syndrome is so heterogeneous, it is difficult to predict its course and prognosis, and response to treatment. Currently, treatment options are limited to attack and symptomatic therapies with no evidence for the efficacy of any long term preventive treatment.
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Affiliation(s)
- Aksel Siva
- Haci Emin Sok.No:20/7 Nisantasi, 34365, Istanbul, Turkey.
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Kisacik B, Akdogan A, Yilmaz G, Karadag O, Yilmaz FM, Koklu S, Yuksel O, Ertenli AI, Kiraz S. Serum adenosine deaminase activities during acute attacks and attack-free periods of familial Mediterranean fever. Eur J Intern Med 2009; 20:44-7. [PMID: 19237091 DOI: 10.1016/j.ejim.2008.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Revised: 03/20/2008] [Accepted: 04/26/2008] [Indexed: 11/17/2022]
Abstract
BACKGROUND Familial Mediterranean Fever (FMF) is a systemic relapsing autoinflammatory disorder. Adenosine deaminase (ADA) is an enzyme widely distribute in tissues and body fluids. Circulating levels of ADA have been shown to increase in several inflammatory conditions. This study was designed to evaluate the serum ADA in patients with FMF during acute attacks and attack-free periods. METHODS The study groups comprised 23 FMF patients in attack-free period (male/female: 11/12), 30 FMF patients in attack period (male/female: 11/19) and 20 healthy control (male/female:10/10). The groups were similar for age, gender and disease duration. RESULTS The mean age of FMF patients in attack-free period, patient with acute attack were 34.3+/-11.7 and 29.4+/-11.1 respectively. The disease durations were 13.1+/-10.2 and 8.2+/-7.6 years for patients in attack-free periods and patients with acute FMF attack, respectively. Patients with acute attack had significantly higher ADA levels than both patients with attack-free periods and healthy controls (for each, p<0.001). CONCLUSION In this study we demonstrated that FMF patients with acute attacks had higher serum ADA levels than attack-free periods and healthy controls. It is likely that ADA may have a role in the cytokine network of the inflammatory cascade of FMF. Also, elevated ADA levels may be a part of the activated Th1 response in the disease. ADA may be used as a supportive marker to differentiate FMF attacks from attack-free periods. Further larger-scale studies are needed to support this result.
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Affiliation(s)
- Bunyamin Kisacik
- Hacettepe University Faculty of Medicine Department of Internal Medicine Division of Rheumatology, Ankara, Turkey.
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Kamoun M, Houman MH, Hamzaoui A, Hamzaoui K. Vascular endothelial growth factor gene polymorphisms and serum levels in Behçet’s disease. ACTA ACUST UNITED AC 2008; 72:581-7. [DOI: 10.1111/j.1399-0039.2008.01145.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
In contrast with more common dementing conditions that typically develop over years, rapidly progressive dementias can develop subacutely over months, weeks, or even days and be quickly fatal. Because many rapidly progressive dementias are treatable, it is paramount to evaluate and diagnose these patients quickly. This review summarizes recent advances in the understanding of the major categories of RPD and outlines efficient approaches to the diagnosis of the various neurodegenerative, toxic-metabolic, infectious, autoimmune, neoplastic, and other conditions that may progress rapidly.
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Affiliation(s)
- Michael D Geschwind
- University of California San Francisco Memory & Aging Center, Department of Neurology, San Francisco, CA 94143-1207, USA.
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Serum levels of natriuretic peptides in patients with Behcet’s disease. Clin Rheumatol 2008; 27:1153-8. [DOI: 10.1007/s10067-008-0886-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 02/20/2008] [Accepted: 03/18/2008] [Indexed: 01/22/2023]
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Turker H, Terzi M, Bayrak O, Cengiz N, Onar M, Us O. Visual Evoked Potentials in Differential Diagnosis of Multiple Sclerosis and Neurobehcet's Disease. TOHOKU J EXP MED 2008; 216:109-16. [DOI: 10.1620/tjem.216.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hande Turker
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurology
| | - Murat Terzi
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurology
| | - Oytun Bayrak
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurology
| | - Nilgun Cengiz
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurology
| | - Musa Onar
- Ondokuz Mayis University, Faculty of Medicine, Department of Neurology
| | - Onder Us
- Marmara University, Faculty of Medicine, Department of Neurology and Department of Neurophysiology
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Abstract
Rapidly progressive dementias (RPDs) are neurologic conditions that develop subacutely over weeks to months or, rarely, acutely over days. In contrast to most dementing conditions that take years to progress to death, RPD quickly can be fatal. It is critical to evaluate patients who have RPD without delay, usually in a hospital setting, as they may have a treatable condition. This review discusses a differential diagnostic approach to RPD, emphasizing neurodegenerative, toxic and metabolic, infectious, autoimmune, neoplastic, and other conditions to consider.
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Affiliation(s)
- Michael D Geschwind
- Department of Neurology, Memory & Aging Center, University of California, San Francisco Medical Center, San Francisco, CA 94117, USA.
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Abstract
Behçet disease is a systemic inflammatory disease of unknown etiology initially described as a triad of recurrent oral ulcers, genital ulcers, and hypopyon uveitis affecting young male adults. Internationally agreed diagnostic criteria have been proposed to assist in the diagnosis. We present the case of a 26-year-old African-American male who presented with right brachial plexopathy due to axillary aneurysm. Further evaluation revealed the presence of a common carotid artery aneurysm, superior vena cava, and left subclavian vein thrombosis. A few months later, he developed severe bilateral panuveitis with hypopyon, retinal vasculitis, and optic nerve inflammation. Although our patient had no recollection of oral or genital ulcers, the constellation of deep vein thrombosis, multiple arterial aneurysms, bilateral panuveitis, positive pathergy skin test, and elevated inflammatory markers led to the working diagnosis of Behçet disease. Arterial involvement occurs in 3%-5% of patients with Behçet disease and may manifest as either true or false aneurysms. Deep vein thrombosis is the most common venous manifestation and involvement of venae cavae and their tributaries is not uncommon. Anterior and posterior uveitis and retinal vasculitis not only have a prognostic value in Behçet disease but in this particular case supported the diagnosis. In conclusion, incomplete forms of Behçet vasculitis exist and clinicians should be alert to atypical presentations of the disease.
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Affiliation(s)
- Ancuta Pandrea
- Department of Medicine, Section of Rheumatology, Danbury Hospital, Yale Medical School Affiliate, Danbury, CT, USA
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Akbulut L, Gur G, Bodur H, Alli N, Borman P. Peripheral neuropathy in Behçet disease: an electroneurophysiological study. Clin Rheumatol 2006; 26:1240-4. [PMID: 17149536 DOI: 10.1007/s10067-006-0466-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 10/08/2006] [Accepted: 10/09/2006] [Indexed: 01/30/2023]
Abstract
The aim of this study was to determine the peripheral nerve involvement electrophysiologically in Behçet patients without clinically evident neurological signs and symptoms. Sixty-three patients who fulfilled the International Study Group Classification Criteria for Behçet's disease (BD) and 49 healthy control subjects were enrolled to the study. Conventional electrophysiological studies of peripheral nerves including F latencies were performed to all subjects. Thirty-one male and 32 female Behçet patients with a mean age of 33.6+/-11.1 years and (22 male and 27 female healthy control subjects with a mean age of 35.8+/-9.9 years were included to the study. All but four of the patients were active. In the BD group, electrophysiologically diagnosed neuropathy was detected in nine (14.28%) patients. One (1.58%) patient had sensorimotor polyneuropathy, one patient (1.58%) had sural and ulnar sensorimotor neuropathy, three (4.75%) patients had median and one patient (1.58%) had ulnar sensorimotor neuropathy. Sural nerve sensorial action potential was unobtainable in two (3.17%) patients and prolonged F latencies were observed in two (3.17%) patients. In the control group only one subject (2.4%) had low sural sensorial conduction velocity. The frequency of neuropathy was higher in the patients with BD when compared with the control subjects. Sensory nerves were affected more prominently than motor nerves. There was no relationship between the clinical and laboratory characteristics of the patients and the electrophysiologic findings. No significant difference was observed between the clinical parameters of the patients with and without electrophysiologically detected neuropathy, except the levels of disease duration (8.8+/-5.1 vs 5.28+/-4.3 years, respectively, p<0.05). In conclusion, Behçet patients may have subclinical peripheral nerve involvement. Conventional electrophysiologic nerve conduction studies including F responses are recommended in routine examination to diagnose early neuropathy in Behçet patients without evident neurologic symptoms.
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Affiliation(s)
- Lale Akbulut
- Physical Therapy and Rehabilitation Department, Ankara Numune Education and Research Hospital, Birlik Mah. 14. sok 36/23, Cankaya Ankara, 06610, Turkey.
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Krause I, Yankevich A, Fraser A, Rosner I, Mader R, Zisman D, Boulman N, Rozenbaum M, Weinberger A. Prevalence and clinical aspects of Behcet's disease in the north of Israel. Clin Rheumatol 2006; 26:555-60. [PMID: 16897122 DOI: 10.1007/s10067-006-0349-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2006] [Revised: 05/15/2006] [Accepted: 05/18/2006] [Indexed: 12/27/2022]
Abstract
Behcet's disease (BD) has a higher prevalence in countries along the ancient silk route, but the actual prevalence in Israel is unknown. We evaluated the occurrence and clinical expression of BD in the northern region of Israel: in the whole population and by ethnic groups. The sample included all adult patients with BD (International Study Group criteria) treated at three medical centers in northern Israel. Patient data were collected by file review and physician survey. Relevant demographic data for the population served by the medical centers were obtained from the official Israeli authorities. A total of 112 patients were identified. The overall prevalence of BD was 15.2/100,000 and was similar in men and women. The prevalence rates among the Jewish, Arab, and Druze populations were 8.6, 26.2, and 146.4 per 100,000, respectively. Age at disease onset was similar in all ethnic groups and significantly lower in males (28.6+/-9.7 vs 32.9+/-11.3, p=0.03). There were no differences in disease manifestations by sex or ethnicity. All Druze patients were HLA-B5 positive, compared to 80.8% of the Arab patients and 72.0% of the Jewish patients. Recurrent oral ulcers in family members were more common in Arab patients (p=0.004). The BD severity index was significantly lower in Druze patients (p=0.05), mainly in males (p=0.03). This study confirms the high prevalence of BD in Israel and the variability in disease rates and expression by ethnic origin. Our findings, particularly regarding the Druze population, call for further field surveys and genetic studies.
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Affiliation(s)
- Ilan Krause
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petach Tiqva 49100, Israel.
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Kara N, Senturk N, Gunes SO, Bagci H, Yigit S, Turanli AY. Lack of evidence for association between endothelial nitric oxide synthase gene polymorphism (glu298asp) with Behçet’s disease in the Turkish population. Arch Dermatol Res 2006; 297:468-71. [PMID: 16463158 DOI: 10.1007/s00403-006-0643-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 09/14/2005] [Accepted: 01/15/2006] [Indexed: 11/25/2022]
Abstract
Endothelial nitric oxide synthase (eNOS) could be a candidate gene for Behçet's disease (BD). This study investigated the relationship of the eNOS Glu298 --> Asp polymorphism with the presence and severity of BD in the Turkish population. Ninety-two patients with BD and 100 controls were studied. Analyses of Glu298Asp polymorphism in exon 7 of the eNOS gene were made by the polymerase chain reaction (PCR)-restriction fragment length polymorphism technique. The frequencies of the eNOS genotypes were similar for BD patients (GG:GT:TT = 58.7%:38%:3.3%) and controls (59.2%:33.7%:7.1 %), P = 0.335. No evidence of difference was found in the frequency of the T allele between BD patients (22.3%) and controls (24%), [OR = 0.91, 95% CI (0.55-1.50), P = 0.690]. Glu298 --> Asp polymorphism of the eNOS gene does not appear to be associated with the presence of BD in the Turkish population.
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Affiliation(s)
- Nurten Kara
- Department of Medical Biology and Genetics, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139, Samsun, Turkey.
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Nam EJ, Han SW, Kim SU, Cho JH, Sa KH, Lee WK, Park JY, Kang YM. Association of vascular endothelial growth factor gene polymorphisms with behcet disease in a Korean population. Hum Immunol 2005; 66:1068-73. [PMID: 16386649 DOI: 10.1016/j.humimm.2005.08.238] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2005] [Indexed: 01/30/2023]
Abstract
Vascular endothelial growth factor (VEGF) is important for angiogenesis and inflammation, both of which are codependent and contribute to the pathophysiology of Behcet disease (BD). The increased expressions of VEGF have been observed in the active stage and in the ocular inflammation of BD. Polymorphisms of the VEGF gene have been associated with chronic inflammatory disease including rheumatoid arthritis. We sought to investigate whether polymorphisms on the regulatory region of the VEGF gene are associated with susceptibility of Korean patients with BD. One hundred one native Korean patients with BD and 138 healthy unrelated controls were recruited. Genotype and allele frequencies of the four selected polymorphisms (-2578, -1154, -634, and 936) were not different between the BD group and controls. Among the BD patients, the frequency of the -634 CC genotype decreased in patients with uveitis (2.6% vs. 20.6%, adjusted OR = 0.100, 95% CI 0.011-0.875, p = 0.037), although it became insignificant after correction for multiple comparisons. These results indicate that the VEGF gene polymorphisms are not associated with BD in the Korean population, but they may be involved in the development of the ocular inflammation of BD.
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Affiliation(s)
- Eon Jeong Nam
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
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Deshpande DM, Krishnan C, Kerr DA. Transverse myelitis after lumbar steroid injection in a patient with Behcet's disease. Spinal Cord 2005; 43:735-7. [PMID: 16010282 DOI: 10.1038/sj.sc.3101779] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Case report. OBJECTIVE We describe a patient who developed transverse myelitis (TM) following a nerve root injection of steroids and anesthetic at L2 for radicular pain. SETTING Baltimore, MD, USA. CLINICAL PRESENTATION A 42-year-old woman developed progressive lower extremity weakness and paresthesias, a T12 sensory level and urinary urgency 8 h following the injection of Marcaine and Celestone into the left L2 nerve root. Magnetic resonance imaging showed T2 signal abnormality with gadolinium enhancement from T12 to the conus medullaris and there was no evidence of traumatic injury to the spinal cord. The patient had undiagnosed Behcet's disease (BD) and had experienced multiple episodes of pathergy: hyper-responsiveness of the skin to local trauma, resulting in inflammation and edema. Intravenous steroids were initiated and the patient experienced a near total clinical resolution and a complete radiologic resolution. CONCLUSION Since the spinal cord inflammation developed after and immediately adjacent to local spinal trauma, we suggest that the TM in this patient was related to BD and was a pathergy response in the spinal cord.
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Affiliation(s)
- D M Deshpande
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Baltimore, MD 21287-6965, USA
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Calis M, Ates F, Yazici C, Kose K, Kirnap M, Demir M, Borlu M, Evereklioglu C. Adenosine deaminase enzyme levels, their relation with disease activity, and the effect of colchicine on adenosine deaminase levels in patients with Behçet's disease. Rheumatol Int 2005; 25:452-6. [PMID: 15868151 DOI: 10.1007/s00296-005-0612-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2004] [Accepted: 03/03/2005] [Indexed: 12/14/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis. Although its clinical characteristics are well defined, the etiology and immune pathogenesis are not clear yet. Neutrophilic vasculitis, which is a consequence of immunological events, is suggested as the underlying pathophysiological mechanism. Adenosine deaminase (ADA) is a non-specific marker of T-lymphocyte activation. A total of 75 patients with BD (45 women and 30 men) and 25 age-matched and gender-matched healthy control volunteers (13 women and 12 men) were included in this study. BD patients were divided into three groups according to their clinical findings: inactive BD patients (group 1, n=25); active BD patients under colchicine treatment (group 2, n=25); and active BD patients without colchicine treatment (group 3, n=25). Plasma ADA (p-ADA) levels of all BD patients and the control group were measured and compared. The relationship between p-ADA levels and disease activity, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels was evaluated and correlated. Patients with BD had significantly higher p-ADA levels (20.6+/-6.3 U/l) than control subjects (12.8+/-1.8 U/l; P<0.001). The p-ADA levels of patients with active BD were significantly (for each, P<0.05) higher than those of inactive BD patients or controls. On the other hand, the difference was not significant (P>0.05) between active patients with or without colchicine use. In addition, there were significantly positive correlations between p-ADA, ESR and CRP levels in patients with BD (for each, P<0.05). However, disease duration or haemoglobin levels were not relevant. ADA level may be a valuable and supportive indicator of disease activity and is not affected by colchicine therapy in BD.
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Affiliation(s)
- Mustafa Calis
- Department of Physical Medicine and Rehabilitation, Erciyes University Medical Faculty, Kayseri, 38039, Turkey.
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García-Pinilla JM, Pombo Jiménez M, Carretero Ruiz JF, González-Cocina E. Disfunción ventricular izquierda asociada a la enfermedad de Behçet. Med Clin (Barc) 2005; 124:558-9. [PMID: 15847760 DOI: 10.1157/13073959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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