1
|
Kılıç G, Körüklü KF, Kumcu MG, Çakır E, Karkucak M, Kılıç E. Gender disparities in Behçet's syndrome: identifying distinct phenotypes through cluster analysis. Immunol Res 2024:10.1007/s12026-024-09498-1. [PMID: 38806970 DOI: 10.1007/s12026-024-09498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
Behçet's syndrome (BS) is a complex, multi-systemic disorder with a global occurrence, notably concentrated along the Silk Road. This study aimed to investigate gender-specific expressions and clinical phenotypes in BS patients within the Eastern Black Sea Region of Turkey. A total of 290 BS patients were retrospectively analyzed between January 2013 and December 2023. Demographic characteristics, clinical manifestations, medical treatment, and pathergy test results were obtained from a review of medical records. The mean age was 45.79 ± 13.05, with a male-to-female ratio of 48.6:51.4. Male patients had higher papulopustular lesions (p < 0.001) and ocular involvement (p = 0.036), while females showed more frequent genital ulcers (p = 0.032). Medication usage showed gender-based variations, notably higher corticosteroid, azathioprine, and tumor necrosis factor-alpha inhibitor (TNFi) use in males (p < 0.001). Cluster analysis revealed five distinct clusters, each with unique features and gender predominance. Cardiovascular type, ocular type, and skin type predominantly featured male patients, while joint involvement type and neurologic and mucosal involvement type were more prevalent among female patients with BS. This research contributes valuable insights into the gender-related clinical variations of BS within a specific geographic region, fostering a more comprehensive understanding of this challenging syndrome. The identification of distinct clinical phenotypes facilitates the development of tailored treatment strategies, potentially leading to improved outcomes for patients with BS.
Collapse
Affiliation(s)
- Gamze Kılıç
- Division of Rheumatology, Department of PMR, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
| | - Kemal Faruk Körüklü
- Division of Rheumatology, Department of PMR, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Muhammed Galip Kumcu
- Division of Rheumatology, Department of PMR, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Elif Çakır
- Division of Rheumatology, Department of PMR, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Murat Karkucak
- Division of Rheumatology, Department of PMR, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Erkan Kılıç
- Rheumatology Clinic, Kanuni Training and Research Hospital, Trabzon, Turkey
| |
Collapse
|
2
|
Khoshbakht S, Başkurt D, Vural A, Vural S. Behçet's Disease: A Comprehensive Review on the Role of HLA-B*51, Antigen Presentation, and Inflammatory Cascade. Int J Mol Sci 2023; 24:16382. [PMID: 38003572 PMCID: PMC10671634 DOI: 10.3390/ijms242216382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/04/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Behçet's disease (BD) is a complex, recurring inflammatory disorder with autoinflammatory and autoimmune components. This comprehensive review aims to explore BD's pathogenesis, focusing on established genetic factors. Studies reveal that HLA-B*51 is the primary genetic risk factor, but non-HLA genes (ERAP1, IL-10, IL23R/IL-12RB2), as well as innate immunity genes (FUT2, MICA, TLRs), also contribute. Genome-wide studies emphasize the significance of ERAP1 and HLA-I epistasis. These variants influence antigen presentation, enzymatic activity, and HLA-I peptidomes, potentially leading to distinct autoimmune responses. We conducted a systematic review of the literature to identify studies exploring the association between HLA-B*51 and BD and further highlighted the roles of innate and adaptive immunity in BD. Dysregulations in Th1/Th2 and Th17/Th1 ratios, heightened clonal cytotoxic (CD8+) T cells, and reduced T regulatory cells characterize BD's complex immune responses. Various immune cell types (neutrophils, γδ T cells, natural killer cells) further contribute by releasing cytokines (IL-17, IL-8, GM-CSF) that enhance neutrophil activation and mediate interactions between innate and adaptive immunity. In summary, this review advances our understanding of BD pathogenesis while acknowledging the research limitations. Further exploration of genetic interactions, immune dysregulation, and immune cell roles is crucial. Future studies may unveil novel diagnostic and therapeutic strategies, offering improved management for this complex disease.
Collapse
Affiliation(s)
- Saba Khoshbakht
- Koç University Research Center for Translational Medicine, Istanbul 34010, Turkey; (S.K.); (A.V.)
| | - Defne Başkurt
- School of Medicine, Koç University, Istanbul 34010, Turkey;
| | - Atay Vural
- Koç University Research Center for Translational Medicine, Istanbul 34010, Turkey; (S.K.); (A.V.)
- Department of Neurology, Koç University School of Medicine, Istanbul 34010, Turkey
| | - Seçil Vural
- Koç University Research Center for Translational Medicine, Istanbul 34010, Turkey; (S.K.); (A.V.)
- Department of Dermatology and Venereology, Koç University School of Medicine, Istanbul 34010, Turkey
| |
Collapse
|
3
|
Boyvat A, Oktem A, Kalay Yildizhan I, Ates A, Yalcindag N, Koksoy C, Yucesan C. A Comparison of Adult and Juvenile Behcet Patients and a Look at Clinical Trends: Retrospective Data from a Turkish Follow-Up Cohort Study. Dermatology 2023; 239:958-965. [PMID: 37793347 DOI: 10.1159/000534316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/24/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Previous reports indicate that juvenile Behçet's disease (BD) may have a different course than adult BD. However, as a direct comparison with adult Behçet patients has only been made in a limited number of studies, the issue is still controversial. OBJECTIVES The primary aim of our study was to compare clinical manifestations in a large cohort of juvenile and adult Behçet patients registered in a single centre. The secondary aim of our study was to compare the data of newly diagnosed patients registered between 1998 and 2020 with the data of those registered between 1976 and 1997. METHODS Data were collected retrospectively from medical records of patients registered between 1998 and 2020. Juvenile BD was defined as fulfilment of International Criteria for Behçet's Disease at or before 16 years of age. RESULTS A similar course of disease was noted in juvenile and adult Behçet patients with no significant difference in the frequency of mucocutaneous findings, major organ involvement, and positivity of the pathergy test. A comparison of the periods, 1976-1997 and 1998-2020, revealed no significant difference in the prevalence of mucocutaneous lesions and major organ involvement. CONCLUSIONS Our results indicate that juvenile and adult Behçet patients have a similar course with a similar frequency of clinical manifestations. Contrary to reports suggesting an overall tendency to milder disease over time, no decrease in the risk of major organ involvements was observed. A significant trend towards a decline in pathergy test positivity was noted.
Collapse
Affiliation(s)
- Ayse Boyvat
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayse Oktem
- Department of Dermatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Askın Ates
- Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Nilufer Yalcindag
- Department of Ophthalmology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Cuneyt Koksoy
- Department of Surgery, Baylor College of Medicine/The Methodist Hospital, Houston, Texas, USA
| | - Canan Yucesan
- Department of Neurology, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
4
|
Tan H, Feng X, Yang P. Association between uveitis onset and economic development in mainland China. BMC Public Health 2023; 23:1711. [PMID: 37667273 PMCID: PMC10476315 DOI: 10.1186/s12889-023-16591-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Economic prosperity has fostered numerous changes that may translate into better or worse outcomes across all domains of health. This study aims to explore the associations of economic development with uveitis onset in mainland China. METHODS We used Poisson regression with generalized estimated equations to quantify the associations of per capita gross domestic product (GDP) with uveitis onset in 31 provinces of mainland China from 2006 to 2017. We further estimated the effects mediated by economic growth on the temperature-uveitis and PM2.5-uveitis associations established in our previous studies. RESULTS A total of 12,721 uveitis patients from 31 provinces of mainland China were studied. Overall, every 10,000 Chinese yuan ($ 1491.278, 2006-2017) increase in per capita GDP, with no weighted value or weighted by population, corresponded to 1.85% (95% confidence interval, 1.19-2.52%) and 1.43% (95% confidence interval, 0.37-2.51%) lnRR decrease in the uveitis onsets. Stratified analysis showed this negative association between per capita GDP and uveitis onset, only existed in male patients (P < .001), individuals aged 20-50 years (P < 0 .05), non-infectious uveitis, uveitis with systemic disease, and Bechet's disease (all P < 0 .05). Moreover, the increased per capita GDP, if above the national level, could reinforce both temperature-uveitis and PM2.5-uveitis association (both P < 0.001). CONCLUSIONS The findings suggest that economic development is negatively associated with uveitis onset. However, it may facilitate the uveitis onset mediated by both increased temperature and PM2.5 exposure if the per capita GDP is above national level.
Collapse
Affiliation(s)
- Handan Tan
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Xiaojie Feng
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China
| | - Peizeng Yang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing Key Lab of Ophthalmology, Chongqing Eye Institute, Chongqing Branch of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China.
| |
Collapse
|
5
|
Erturk A, Sarıkaya Y, Coşkun H, Turan Ç. Measuring the Whole Wall Thickness of the Common Femoral Vein as a Distinctive Diagnostic Tool to Distinguish Behçet's Disease Presenting with Oral Ulcers from Recurrent Aphthous Stomatitis. Diagnostics (Basel) 2023; 13:2705. [PMID: 37627964 PMCID: PMC10453469 DOI: 10.3390/diagnostics13162705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Recurrent oral ulcers, which are the first and most common manifestation of Behçet's disease (BD), have several etiological causes but are often idiopathic and known as recurrent aphthous stomatitis (RAS). In recent years, publications have drawn attention to the fact that whole-wall thickness (WWT) and intima-media thickness (IMT) measurements of the common femoral vein (CFV) may be useful in the diagnosis of BD, which are independent of organ involvement. In this study, the usefulness of the WWT and IMT of the CFV measured by venous Doppler ultrasound (US) was investigated in differentiating BD presenting with oral ulcers from RAS. Patients with BD (n = 84), patients with RAS (n = 85), and healthy controls (HCs) (n = 70) were the three groups included. Both the right and left WWT of the CFV were significantly higher in the BD compared with the HCs and RAS groups (p < 0.001). The diagnostic cutoff values of ≥0.58 mm for the WWT of the CFV performed well against both the patients with RAS and HCs for the discrimination of BD (sensitivity = 79.8%, specificity = 64.7%). In patients with recurrent oral ulcers, the WWT of the CFV measurement may be a distinctive new diagnostic tool for the differential diagnosis of BD and RAS.
Collapse
Affiliation(s)
- Adem Erturk
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey
| | - Yasin Sarıkaya
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey; (Y.S.); (H.C.)
| | - Hüseyin Coşkun
- Department of Radiology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey; (Y.S.); (H.C.)
| | - Çağrı Turan
- Department of Dermatology and Venereology, Faculty of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar 03030, Turkey;
| |
Collapse
|
6
|
Hassan F, Jeries H, Naffaa ME. Challenges in the Timely Diagnosis of Behcet's Disease. Life (Basel) 2023; 13:life13051157. [PMID: 37240802 DOI: 10.3390/life13051157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Behcet's disease (BD) is a chronic, multi-systemic inflammatory disorder mainly characterized by recurrent oral and genital ulcers, skin lesions, and uveitis. As no pathognomonic laboratory test exists for BD, the diagnosis relies solely on clinical features. Over the years, great efforts have been invested in creating clinical diagnostic and classification criteria. The international study group criteria introduced in 1990 were the first true multinational set of criteria. Despite improving the ability to diagnose BD, these criteria still have limitations, including the inability to diagnose patients presenting without oral ulcers or presenting with rare manifestations of the disease. This led to the introduction of the international criteria for BD in 2013, which improved the sensitivity with minimal compromise on specificity. Despite the efforts made and as our understanding of the clinical manifestations of BD and genetic pathogenesis continue to evolve, efforts should be made to further enhance the currently accepted international classification criteria, perhaps by incorporating genetic testing (e.g., family history or HLA typing) as well as ethnic group-specific features.
Collapse
Affiliation(s)
- Fadi Hassan
- Rheumatology Unit, Galilee Medical Center, Naharyia 2210001, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Helana Jeries
- Rheumatology Unit, Galilee Medical Center, Naharyia 2210001, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| | - Mohammad E Naffaa
- Rheumatology Unit, Galilee Medical Center, Naharyia 2210001, Israel
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed 1311502, Israel
| |
Collapse
|
7
|
Alibaz-Oner F, Direskeneli H. Update on the Diagnosis of Behçet's Disease. Diagnostics (Basel) 2022; 13:diagnostics13010041. [PMID: 36611332 PMCID: PMC9818538 DOI: 10.3390/diagnostics13010041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
Behçet's disease (BD) is a systemic inflammatory disease with unknown etiology. It is characterized by recurrent mucocutaneous lesions and major organ disease such as ocular, neurologic, vascular, and gastrointestinal manifestations. The diagnosis of BD is mainly based on clinical manifestations after ruling out other potential causes. There are no specific laboratory, histopathologic, or genetic findings for the diagnosis of BD. The International Study Group (ISG) criteria set is still the most widely used set for the diagnosis. The main limitation of this criteria set is the lack of major organ manifestations such as vascular, neurologic, and gastrointestinal involvement. The ICBD 2014 criteria are more sensitive, especially in early disease. However, patients with such as spondyloarthritis can easily meet this criteria set, causing overdiagnosis. Diagnosing BD can be a big challenge in daily practice, especially in patients presenting with only major organ involvement such as posterior uveitis, neurologic, vascular, and gastrointestinal findings with or without oral ulcers. These patients do not meet ISG criteria and can be diagnosed with "expert opinion" in countries with high BD prevalence. The pathergy test is the only diagnostic test used as diagnostic or classification criteria for BD. Our recent studies showed that common femoral vein (CFV) thickness measurement can be a valuable, practical, and cheap diagnostic tool for BD with sensitivity and specificities higher than 80% for the cut-off value of 0.5 mm. However, the diagnostic accuracy of CFV measurement should be investigated in other disease groups in the differential diagnosis of BD and in also different ethnic populations.
Collapse
|
8
|
Aboul Naga SH, Hassan LM, El Zanaty RT, Refaat M, Amin RH, Ragab G, Soliman MM. Behçet uveitis: Current practice and future perspectives. Front Med (Lausanne) 2022; 9:968345. [PMID: 36160151 PMCID: PMC9490079 DOI: 10.3389/fmed.2022.968345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Described as early as Hippocrates in his “Third Book of Endemic Diseases,” Behçet's Disease (BD), also known as “The Silk Road Disease” following its initial demographics, consists of a triad of recurrent oro-genital ulcers and associated uveitis. Current demographics and rising percentages of patients seen far beyond the Silk Road in Ocular Inflammatory Disease and Uveitis Clinics list BD uveitis as one of the frontliners of non-infectious autoinflammatory eye diseases. Clinical features of BD and juvenile-onset BD are detailed alongside various approaches in classification and suggested algorithms for diagnosis that are outlined in this review. With the ongoing Human Microbiome Project and studies such as the MAMBA study, the role of the human microbiome in BD is highlighted in the pathophysiology of BD to include the current research and literature perspective. Furthermore, with the advancement of recent diagnostic and investigative techniques, especially in the field of Optical Coherence Tomography (OCT), disease-related characteristics are updated to encompass SD, EDI and OCT-angiography characteristics of BD. Having entered the era of biologic therapy, the role of various specific cytokine-blocking biologic drugs, such as TNF-α inhibitors (e.g., adalimumab, infliximab), interferon α-2a inhibitors, IL-6 and IL-1 inhibitors are presented and contrasted alongside the conventional immunosuppressant drugs and the classic old gold standard: corticosteroids (systemic or local). Finally, with the ongoing SARS-CoV-2 pandemic, it was not possible to conclude the review without reviewing the latest evidence-based literature reporting BD morbidity in this era, the observed pattern and treatment recommendations as well as those related to reported post-vaccine complications and emergence of BD.
Collapse
Affiliation(s)
- Shereen H. Aboul Naga
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Lameece Moustafa Hassan
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Radwa T. El Zanaty
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Mohammad Refaat
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Rana H. Amin
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
| | - Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Giza, Egypt
- *Correspondence: Gaafar Ragab
| | - Mahmoud M. Soliman
- Ophthalmology Department, Faculty of Medicine, Cairo University Hospital, Uveitis Subspecialty Clinic, Giza, Egypt
- Mahmoud M. Soliman
| |
Collapse
|
9
|
Wakiya R, Ushio Y, Ueeda K, Kameda T, Shimada H, Nakashima S, Kato M, Miyagi T, Sugihara K, Mizusaki M, Mino R, Kadowaki N, Dobashi H. Efficacy and safety of apremilast and its impact on serum cytokine levels in patients with Behçet's disease. Dermatol Ther 2022; 35:e15616. [DOI: 10.1111/dth.15616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Risa Wakiya
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Yusuke Ushio
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Kiyo Ueeda
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Tomohiro Kameda
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Hiromi Shimada
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Shusaku Nakashima
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Mikiya Kato
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Taichi Miyagi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Koichi Sugihara
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Mao Mizusaki
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Rina Mino
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Norimitsu Kadowaki
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| | - Hiroaki Dobashi
- Division of Hematology, Rheumatology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine Kagawa University
| |
Collapse
|
10
|
Tomizuka T, Kikuchi H, Okubo M, Asako K, Miyata S, Kono H. Natural History of Behçet's Disease Focusing on Remission of Oral Ulcers. Mod Rheumatol 2022; 33:566-573. [PMID: 35445275 DOI: 10.1093/mr/roac035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/29/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To describe the long-term clinical course of each manifestation of Behçet's disease (BD) and clarify factors involved in oral ulcer (OU) remission using clinical information of BD patients. METHODS We retrospectively studied 155 BD patients visiting our hospital (1989-2020). We defined remission criteria for each manifestation and examined long-term clinical changes. Classification and regression trees and multivariable analyses were performed to investigate OU prognostic factors; hazard ratios were used to assign scores to prognostic factors deemed significant (OU prognosis score: OuP score). Risk stratification was examined by dividing the OuP scores into four stages. RESULTS OUs appeared earliest, with the slowest decline in prevalence observed post-BD diagnosis. OU presence was the most common factor inhibiting complete remission. Young age at OU onset, never smoker, presence of genital ulcers, positive pathergy test, no usage of tumour necrosis factor inhibitors or of immunosuppressants, and long-term non-treatment or symptomatic treatment for OUs were poor OU prognostic factors. Based on multivariable analysis, the area under the curve of the OuP score to predict OU prognosis was 0.678. CONCLUSIONS Remission criteria for each symptom clarified that OU had the greatest impact on complete BD remission. Faster OU remission was associated with earlier OU therapeutic intervention other than symptomatic treatment.
Collapse
Affiliation(s)
- Takafumi Tomizuka
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotoshi Kikuchi
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Mai Okubo
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kurumi Asako
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Satoshi Miyata
- Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hajime Kono
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| |
Collapse
|
11
|
Jones NP, Pockar S, Steeples LR. Changing Trends in Uveitis in the United Kingdom: 5000 Consecutive Referrals to a Tertiary Referral Centre. Ocul Immunol Inflamm 2022:1-6. [PMID: 35442852 DOI: 10.1080/09273948.2022.2067067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To demonstrate changes in the demography and diagnosis of uveitis in a specialist clinic in the United Kingdom. METHODS Retrieval of data including all new referrals to Manchester Uveitis Clinic from 1991 to 2020. The incidence and proportions of diagnoses between 4 quartiles was compared. RESULTS 5000 patients with uveitis were seen. Referral rates trebled over time. Highly significant increases in referrals were seen for multiple evanescent white dot syndrome-spectrum disorders, syphilis and tuberculosis; increases were also seen for herpetic retinitis, vitreoretinal lymphoma and sarcoidosis. Highly significant decreases were seen for Fuchs' uveitis, Behçet's uveitis and ocular toxoplasmosis. CONCLUSIONS Subspecialisation and de-skilling has changed referral patterns to specialist clinics; changes cannot be entirely attributed to disease incidences, which also vary between countries. International data are non-comparable. There are clear changes in referral patterns and disease incidence in this population, influenced by evolving diagnosis. Local data should steer care planning.
Collapse
Affiliation(s)
- N P Jones
- School of Biological Sciences, The University of Manchester, UK
| | - S Pockar
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - L R Steeples
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW To discuss clinical and pathogenic roles of HLA-B∗51 in Behçet's syndrome. RECENT FINDINGS HLA-B∗51 remains the most important genetic factor in Behçet's syndrome, despite the recent identification of several susceptibility genes. The prevalence of HLA-B∗51 has been shown to differ among phenotype-based clinical clusters in the same patient population. HLA-B∗51 shows epistatic interaction with the susceptible allele of endoplasmic reticulum aminopeptidase (ERAP)1 encoding the Hap10 allotype, which has the lowest trimming activity of the MHC-Class I binding peptides. Subsequent molecular studies have suggested that the disease-associated Hap10 allotype is implicated in the generation and selection of the disease protective or promoting peptides loading onto HLA-B∗51, although these pathogenic peptides have yet to be identified. SUMMARY HLA-B∗51 is a hallmark of Behçet's syndrome but genetic markers are not very useful in the diagnosis of Behçet's syndrome. Rather, it is considered an important factor in determining clinical phenotypes in this heterogeneous condition. The epigenetic interaction of HLA-B∗51 with ERAP1 sheds light on pathogenesis.
Collapse
Affiliation(s)
- Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, Kanagawa, Japan
| |
Collapse
|
13
|
Abstract
The many forms of vasculitis are characterized by inflammation of blood vessels, leading to potentially long-term sequelae including vision loss, aneurysm formation and kidney failure. Accurate estimation of the incidence and prevalence has been hampered by the absence of reliable diagnostic criteria and the rarity of these conditions; however, much progress has been made over the past two decades, although data are still lacking from many parts of the world including the Indian subcontinent, China, Africa and South America. Giant cell arteritis occurs in those aged 50 years and over and seems to mainly affect persons of northern European ancestry, whereas Takayasu arteritis occurs mainly in those aged under 40 years. By contrast, Kawasaki disease mainly occurs in children aged under 5 years and is most common in children of Asian ancestry, and IgA vasculitis occurs in children and adolescents. Although much less common than giant cell arteritis, the different forms of antineutrophil cytoplasmic antibody-associated vasculitis are being increasingly recognized in most populations and occur more frequently with increasing age. Behçet syndrome occurs most commonly along the ancient silk road between Europe and China. Much work needs to be done to better understand the influence of ethnicity, geographical location, environment and social factors on the development of vasculitis.
Collapse
|
14
|
Attia DHS. Behçet's disease phenotypes and clinical outcomes: A cohort study in egyptian patients. REUMATOLOGIA CLINICA 2021; 17:514-520. [PMID: 34756312 DOI: 10.1016/j.reumae.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 04/02/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic inflammatory disease with various presentations. The data on the course of BD in Egyptian patients are limited. OBJECTIVES The objective of the study was to describe the evolution and association of the different phenotypes of BD. MATERIAL AND METHODS This chronological cohort study included adult Egyptian patients suffering from BD. Demographic data and the chronological order of the disease's manifestations were collected. RESULTS The study included 233 patients. Their mean age at the onset of the disease was 26.3±6.9 years. The mean duration from onset of the disease to meeting the criteria was 11.2±30.3 months. The mean duration of the disease was 96.8±72.2 months. On onset of the disease, the most common phenotypes were mucocutaneous (84.5%), musculoskeletal (15.9%), ocular (14.6%) and peripheral venous disease (PVD) (7.3%); on the other hand, pulmonary, peripheral arterial and great vessel phenotypes evolved several years after onset of the disease. The mean time from meeting the criteria to the evolution of a new phenotype was 53.8±58.7 months. Associations between the different phenotypes were observed: PVD and superficial thrombophlebitis, peripheral arterial disease and PVD; another association was also observed between aortic involvement and cerebrovascular disease. CONCLUSION BD could continue to evolve several years after onset of the disease, making the previous belief about BD yield questionable. BD tends to respect the anatomy of the affected system. Some phenotypes tend to coexist, suggesting a shared aethiopathogeny and that the disease is of a systemic nature.
Collapse
Affiliation(s)
- Doaa H S Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| |
Collapse
|
15
|
Matsumoto H, Yashiro-Furuya M, Fujita Y, Asano T, Mori T, Sato S, Temmoku J, Matsuoka N, Watanabe H, Suzuki E, Migita K. Vascular Behcet's Disease Preceded by Fever of Unknown Origin: Usefulness of Ultrasonography for the Detection of Large-Vessel Vasculitis. TOHOKU J EXP MED 2021; 255:163-169. [PMID: 34707017 DOI: 10.1620/tjem.255.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Behcet's disease is a systemic vasculitis characterized by oral and genital ulcers, erythema nodosum, and ocular involvement. Fever of unknown origin is a relatively rare event in Behcet's disease. We present the case of a 17-year-old male patient who suffered from prolonged fever for two months. The patient tested positive for HLA-B52 and levels of acute phase reactants were elevated. He complained of sore throat and neck pain that were evaluated by cervical ultrasonography, which revealed thickening of the carotid arterial wall and narrowing of the vessel lumen. The patient was diagnosed with vascular Behcet's disease and treated with glucocorticoid, which improved the clinical symptoms and thickening of the carotid arterial wall as detected by color duplex ultrasonography. Since vascular Behcet's disease may lead to morbidity and mortality, we suggest the early use of ultrasonography to help detect medium/large-vessel vasculitis. Prolonged fever in patients with Behcet's disease should be promptly evaluated for vascular involvement.
Collapse
Affiliation(s)
- Haruki Matsumoto
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | | | - Yuya Fujita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tomoyuki Asano
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Tatsuhiko Mori
- Department of Dermatology, Fukushima Medical University School of Medicine
| | - Shuzo Sato
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Jumpei Temmoku
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Naoki Matsuoka
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Hiroshi Watanabe
- Department of Rheumatology, Fukushima Medical University School of Medicine
| | - Eiji Suzuki
- Department of Rheumatology, Ohta Nishinouchi General Hospital Foundation
| | - Kiyoshi Migita
- Department of Rheumatology, Fukushima Medical University School of Medicine
| |
Collapse
|
16
|
Choi SH, BA, Kim DY. Epidemiologic and Etiological Features of Korean Patients With Behçet's Disease. JOURNAL OF RHEUMATIC DISEASES 2021; 28:183-191. [PMID: 37476362 PMCID: PMC10324907 DOI: 10.4078/jrd.2021.28.4.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/25/2021] [Indexed: 07/22/2023]
Abstract
Behçet's disease (BD) is a multisystem disease in which environmental factors provoke an adverse immune response in patients with genetic susceptibility towards BD, subsequently leading to a cascade of dysregulated inflammation throughout the body. It is particularly prevalent in regions spanning the ancient Silk Road, including Korea, where the first known case of BD was reported in 1961. We summarize the history, epidemiology, and clinical presentation of BD in Korea, highlighting the clinical tendencies that are particularly seen in the Korean BD population as compared to European populations. Analysis of epidemiologic trends over the past three decades in Korea shows a decreasing prevalence of complete BD and a higher prevalence of intestinal BD. We also discuss the ever-evolving understanding of the pathogenesis of BD, noting the complex interplay among genetics, environment, and immunology. The HLA-B51 allele is the most significant known genetic risk factor in developing BD. We also discuss more recently studied associations between BD and immune factors such as IL-10, IL-23R-IL-12RB2, IL-1A-IL-1B, CCR1, ERAP1, and the GIMAP cluster, the last of which has been found to have an association with BD specifically in Korea. Environmental factors such as pollution and microbials are often the inciting event in developing BD, as they trigger an imbalanced immune response in genetically susceptible individuals, one that has been often found to exhibit an aberrant Th1/Th17 response. There would be value to further studying the pathogenesis and clinical characteristics of Korean BD.
Collapse
Affiliation(s)
- Soo Hyun Choi
- Tulane University School of Medicine, New Orleans, LA, USA
| | - BA
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Do-Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
17
|
Yazici Y, Hatemi G, Bodaghi B, Cheon JH, Suzuki N, Ambrose N, Yazici H. Behçet syndrome. Nat Rev Dis Primers 2021; 7:67. [PMID: 34531393 DOI: 10.1038/s41572-021-00301-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 12/17/2022]
Abstract
Behçet syndrome is a systemic vasculitis with an unknown aetiology affecting the small and large vessels of the venous and arterial systems. The presence of symptom clusters, regional differences in disease expression and similarities with, for example, Crohn's disease suggest that multiple pathological pathways are involved in Behçet syndrome. These disease features also make formulating disease criteria difficult. Genetic studies have identified HLA-B*51 as a genetic risk factor. However, the low prevalence of HLA-B*51 in many patients with bona fide disease, especially in non-endemic regions, suggests that other factors must also be operative in Behçet syndrome. Despite lacking a clear aetiological mechanism and definition, management of manifestations that include major vascular disease, eye disease and central nervous system involvement has improved with the help of new technology. Furthermore, even with our incomplete understanding of disease mechanisms, the prognoses of patients with Behçet syndrome, including those with eye disease, continue to improve. New treatment options and a better understanding of the underlying pathogenesis for various manifestations of this condition are required to further improve the management of the disease, which will improve patient quality of life.
Collapse
Affiliation(s)
- Yusuf Yazici
- Division of Rheumatology, New York University School of Medicine, New York, NY, USA.
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Bahram Bodaghi
- Sorbonne University, IHU FOReSIGHT, Pitié-Salpêtrière Hospital UMR 7211 UPMC/CNRS, U972 INSERM, Transimmunom Laboratory of Excellence Sorbonne University, Paris, France
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Seoul, Korea
| | - Noburu Suzuki
- Department of Immunology and Medicine, St. Marianna University School of Medicine, Miyamae-ku, Kawasaki, Japan
| | | | - Hasan Yazici
- (Rheumatology) Academic Hospital Istanbul, Istanbul, Turkey
| |
Collapse
|
18
|
Alibaz-Oner F, Ergelen R, Yıldız Y, Aldag M, Yazici A, Cefle A, Koç E, Artım Esen B, Mumcu G, Ergun T, Direskeneli H. Femoral vein wall thickness measurement: A new diagnostic tool for Behçet's disease. Rheumatology (Oxford) 2021; 60:288-296. [PMID: 32756998 DOI: 10.1093/rheumatology/keaa264] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/21/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Diagnosing Behçet's disease (BD) is a challenge, especially in countries with a low prevalence. Recently, venous wall thickness (VWT) in lower extremities has been shown to be increased in BD patients. In this study, we aimed to investigate the diagnostic performance of common femoral vein (CFV) thickness measurement in BD and whether it can be used as a diagnostic tool. METHODS . Patients with BD (n = 152), ankylosing spondylitis (n = 27), systemic vasculitides (n = 23), venous insufficiency (n = 29), antiphospholipid syndrome (APS; n = 43), deep vein thrombosis due to non-inflammatory causes (n = 25) and healthy controls (n = 51) were included in the study. Bilateral CFV thickness was measured with ultrasonography by a radiologist blinded to cases. RESULTS Bilateral CFV thickness was significantly increased in BD compared with all control groups (P < 0.001 for all). The area under the receiver operating characteristic curve for bilateral CFV thicknesses in all comparator groups was >0.95 for the cut-off value (0.5 mm). This cut-off value also performed well against all control groups with sensitivity rates >90%. The specificity rate was also >80% in all comparator groups except APS (positive predictive value: 79.2-76.5%, negative predictive value: 92-91.8% for right and left CFV, respectively). CONCLUSION Increased CFV thickness is a distinctive feature of BD and is rarely present in healthy and diseased controls, except APS. Our results suggest that CFV thickness measurement with ultrasonography, a non-invasive radiological modality, can be a diagnostic tool for BD with sensitivity and the specificity rates higher than 80% for the cut-off value ≥0.5 mm.
Collapse
Affiliation(s)
- Fatma Alibaz-Oner
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul
| | - Rabia Ergelen
- Department of Radiology, Marmara University School of Medicine, Istanbul
| | - Yasin Yıldız
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul
| | - Mustafa Aldag
- Department of Cardiovascular Surgery, School of Medicine, Bahçeşehir University, Istanbul
| | - Ayten Yazici
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli
| | - Ayşe Cefle
- Department of Internal Medicine, Division of Rheumatology, Kocaeli University School of Medicine, Kocaeli
| | | | - Bahar Artım Esen
- Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul
| | - Gonca Mumcu
- Department of Health Management, Marmara University Faculty of Health Sciences, Istanbul
| | - Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul
| | - Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, Marmara University School of Medicine, Istanbul
| |
Collapse
|
19
|
Soejima Y, Kirino Y, Takeno M, Kurosawa M, Takeuchi M, Yoshimi R, Sugiyama Y, Ohno S, Asami Y, Sekiguchi A, Igarashi T, Nagaoka S, Ishigatsubo Y, Nakajima H, Mizuki N. Changes in the proportion of clinical clusters contribute to the phenotypic evolution of Behçet's disease in Japan. Arthritis Res Ther 2021; 23:49. [PMID: 33522943 PMCID: PMC7851921 DOI: 10.1186/s13075-020-02406-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background We hypothesized that Behçet’s disease (BD) consists of several clinical subtypes with different severity, resulting in heterogeneity of the disease. Here, we conducted a study to identify clinical clusters of BD. Methods A total of 657 patients registered in the Yokohama City University (YCU) regional BD registry between 1990 and 2018, as well as 6754 patients who were initially registered in the Japanese Ministry of Health, Labour and Welfare (MHLW) database between 2003 and 2014, were investigated. The YCU registry data regarding the clinical manifestations of BD, human leukocyte antigen (HLA) status, treatments, and hospitalizations were analyzed first, followed by similar analyses of the MHLW for validation. A hierarchical cluster analysis was independently performed in both patient groups. Results A hierarchical cluster analysis determined five independent clinical clusters in the YCU cohort. Individual counterparts of the YCU clusters were confirmed in the MHLW registry. Recent phenotypical evolutions of BD in Japan, such as increased gastrointestinal (GI) involvement, reduced complete type according to the Japan Criteria, and reduced HLA-B51 positivity were associated with chronologically changing proportions of the clinical clusters. Conclusions In this study, we identified independent clinical clusters among BD patients in Japan and found that the proportion of each cluster varied over time. We propose five independent clusters namely “mucocutaneous”, “mucocutaneous with arthritis”, “neuro”, “GI”, and “eye.”
Collapse
Affiliation(s)
- Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School, Musashi Kosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Michiko Kurosawa
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yumiko Sugiyama
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Shigeru Ohno
- Yokohama City University Medical Center, Center for Rheumatic Diseases, 4-57 Urafunecho, Minami-ku, Yokohama, 232-0024, Japan
| | - Yukiko Asami
- Yokosuka Center for Rheumatic Diseases, Yokosuka City Hospital, 1-3-2 Nagasaka, Yokosuka, 240-0101, Japan
| | - Akiko Sekiguchi
- Department of Hematology and Rheumatology, Fujisawa City Hospital, 2-6-1 Fujisawa, Fujisawa, 251-8550, Japan
| | - Toshihisa Igarashi
- Department of Rheumatology, Yamato City Hospital, Fukaminishi, Yamato, 242-8602, Japan
| | - Shohei Nagaoka
- Department of Rheumatology, Yokohama Minami Kyosai Hospital, 1-21-1 Mutsuura Higashi, Yokohama, 236-0037, Japan
| | - Yoshiaki Ishigatsubo
- Yokohama City University, Yokohama, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| |
Collapse
|
20
|
Nakamura K, Tsunemi Y, Kaneko F, Alpsoy E. Mucocutaneous Manifestations of Behçet's Disease. Front Med (Lausanne) 2021; 7:613432. [PMID: 33598466 PMCID: PMC7882475 DOI: 10.3389/fmed.2020.613432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/30/2020] [Indexed: 11/16/2022] Open
Abstract
Behçet's disease (BD) is a chronic, relapsing, systemic inflammatory disease with clinical features showing mucocutaneous lesions involving the ocular, articular, and further miscellaneous organs. Mucocutaneous manifestations, one of the most characteristic signs of BD, have been most commonly observed upon onset or at any disease stage and are exceptionally important in its diagnosis. Given the lack of specific diagnostic laboratory tests for BD, diagnosis has been based on clinical findings. All diagnostic criteria published have thus far relied heavily on mucocutaneous manifestations, particularly oral ulcers (OU), genital ulcers (GU), cutaneous lesions, and pathergy test positivity. Worldwide, OU, GU, cutaneous lesions, and ocular and articular manifestations have been the most common symptoms, with erythema nodosum (EN)-like lesions and papulopustular lesions being the most prevalent cutaneous manifestations. While majority of the patients worldwide have reported OU as the most frequent symptom upon disease onset, GU, and EN-like lesions have also been identified upon onset. Considering that mucocutaneous symptoms precede severe organ involvement in most patients, familiarity with such symptoms is imperative for early diagnosis and prevention of potentially serious organ involvement through appropriate management.
Collapse
Affiliation(s)
- Koichiro Nakamura
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Yuichiro Tsunemi
- Department of Dermatology, Saitama Medical University, Saitama, Japan
| | - Fumio Kaneko
- Institute of Dermato-Immunology and Allergy, Southern Tohoku General Hospital, Fukushima, Japan
| | - Erkan Alpsoy
- Department of Dermatology and Venereology, School of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
21
|
Shimizu H, Usui Y, Asakage M, Nezu N, Wakita R, Tsubota K, Sugimoto M, Goto H. Serum Metabolomic Profiling of Patients with Non-Infectious Uveitis. J Clin Med 2020; 9:jcm9123955. [PMID: 33291298 PMCID: PMC7762156 DOI: 10.3390/jcm9123955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
The activities of various metabolic pathways can influence the pathogeneses of autoimmune diseases, and intrinsic metabolites can potentially be used to diagnose diseases. However, the metabolomic analysis of patients with uveitis has not yet been conducted. Here, we profiled the serum metabolomes of patients with three major forms of uveitis (Behҫet's disease (BD), sarcoidosis, and Vogt-Koyanagi-Harada disease (VKH)) to identify potential biomarkers. This study included 19 BD, 20 sarcoidosis, and 15 VKH patients alongside 16 healthy control subjects. The metabolite concentrations in their sera were quantified using liquid chromatography with time-of-flight mass spectrometry. The discriminative abilities of quantified metabolites were evaluated by four comparisons: control vs. three diseases, and each disease vs. the other two diseases (such as sarcoidosis vs. BD + VKH). Among 78 quantified metabolites, 24 kinds of metabolites showed significant differences in these comparisons. Four multiple logistic regression models were developed and validated. The area under the receiver operating characteristic (ROC) curve (AUC) in the model to discriminate disease groups from control was 0.72. The AUC of the other models to discriminate sarcoidosis, BD, and VKH from the other two diseases were 0.84, 0.83, and 0.73, respectively. This study provides potential diagnostic abilities of sarcoidosis, BD, and VKH using routinely available serum samples that can be collected with minimal invasiveness.
Collapse
Affiliation(s)
- Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Ryo Wakita
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| | - Masahiro Sugimoto
- Health Promotion and Preemptive Medicine, Research and Development Center for Minimally Invasive Therapies, Institute of Medical Sciences, Tokyo Medical University, Tokyo 160-8402, Japan;
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.S.); (M.A.); (N.N.); (R.W.); (K.T.); (H.G.)
| |
Collapse
|
22
|
Mumcu G, Alibaz Öner F, Ergun T, Direskeneli RH. Decreasing incidence and severity of Behçet’s disease: a changing trend in epidemiological spectrum possibly associated with oral health. Turk J Med Sci 2020; 50:1587-1590. [PMID: 32222130 PMCID: PMC7672345 DOI: 10.3906/sag-2003-147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 11/03/2022] Open
Abstract
Behçet’s disease (BD) is a systemic and inflammatory disorder that is mainly present along the ancient Silk Road, from the Mediterranean Sea to East Asia. A wide range of prevalence figures (0.1–420/100,000) have been reported for BD, also among Turkish populations of similar genetic background living in different countries. Recently, a decline in the incidence of BD and a change of the disease spectrum to less-severe manifestations have been reported from Japan and Korea, two genetically homogenous, affluent populations with limited immigration. It was hypothesized that a decline in infectious diseases, especially dental/periodontal infections, associated with the improvement in oral health, could be a part of these changes in the disease expression. Further epidemiological studies in other populations might demonstrate whether there is a worldwide similar trend and may provide a better understanding of the triggering factors for the onset and course of BD.
Collapse
Affiliation(s)
- Gonca Mumcu
- Faculty of Health Sciences Marmara University, İstanbul, Turkey
| | - Fatma Alibaz Öner
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Tülin Ergun
- Department of Dermatology, School of Medicine, Marmara University, İstanbul, Turkey
| | - Rafi Haner Direskeneli
- Department of Internal Medicine, Division of Rheumatology, School of Medicine, Marmara University, İstanbul, Turkey
| |
Collapse
|
23
|
Hirahara L, Kirino Y, Soejima Y, Takeno M, Takase-Minegishi K, Yoshimi R, Takeuchi M, Mizuki N, Nakajima H. Efficacy and safety of apremilast for 3 months in Behçet’s disease: A prospective observational study. Mod Rheumatol 2020; 31:856-861. [DOI: 10.1080/14397595.2020.1830504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Lisa Hirahara
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mitsuhiro Takeno
- Nippon Medical School Musashi Kosugi Hospital, Department of Allergy and Rheumatology, Kawasaki, Japan
| | - Kaoru Takase-Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
24
|
Jun JB, Kim HJ, Kazmi SZ, Kang T, Kim KB, Kang MJ, Ahn HS. Significant Decline in the Incidence of Behcet's Disease in South Korea: A Nationwide Population-Based Study (2004-2017). Arthritis Care Res (Hoboken) 2020; 73:1689-1696. [PMID: 32770715 DOI: 10.1002/acr.24408] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 08/04/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Change in the incidence of Behcet's disease (BD) from long term population-based data are scarce, although a possible decline has been reported. The objectives were to investigate the incidence, survival, and mortality of BD patients from 2004 to 2017 in South Korea. METHODS We analyzed a registry of rare intractable diseases and a claims database from the Health Insurance and Review Agency with information on BD patients between 2004 and 2017 using uniform diagnostic criteria. The study period was divided into three groups: 2004-2006, 2007-2010, and 2011-2017. RESULTS The annual incidence of BD decreased from 8.15 per 100,000 in 2004 to 1.51 in 2017, an 81.5% decrease. The annual percentage change was 6.32% for females and 6.15% for males. The decrease in BD incidence was greater for women and middle-aged people. The 3-year survival rate of BD patients during the 2011-2017 period was lower than those of the BD patients in 2004-2006 and 2007-2010, although there was no statistical difference. The standardized mortality rates increased significantly in the 2011-2017 period compared to the first two periods. CONCLUSION BD incidence decreased from 2004 to 2017 in South Korea. This decline in incidence might be attributable to changes in environmental factors, including a reduction in the burden of infectious diseases in the past decades and improvement of oral health during childhood. The unprecedented decline in the incidence of BD in South Korea without major changes in the genetic background suggests that environmental factors are very important to the development of BD.
Collapse
Affiliation(s)
- Jae-Bum Jun
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sayada Zartasha Kazmi
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Taeuk Kang
- National Health Insurance Policy Research Institute, Seoul, Korea
| | | | - Min Ji Kang
- Department of Public Health, Korea University, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| |
Collapse
|
25
|
Attia DHS. Behçet's Disease Phenotypes and Clinical Outcomes: A Cohort Study in Egyptian Patients. REUMATOLOGIA CLINICA 2020; 17:S1699-258X(20)30084-X. [PMID: 32690441 DOI: 10.1016/j.reuma.2020.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/02/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic inflammatory disease with various presentations. The data on the course of BD in Egyptian patients are limited. OBJECTIVES The objective of the study was to describe the evolution and association of the different phenotypes of BD. MATERIAL AND METHODS This chronological cohort study included adult Egyptian patients suffering from BD. Demographic data and the chronological order of the disease's manifestations were collected. RESULTS The study included 233 patients. Their mean age at the onset of the disease was 26.3±6.9 years. The mean duration from onset of the disease to meeting the criteria was 11.2±30.3 months. The mean duration of the disease was 96.8±72.2 months. On onset of the disease, the most common phenotypes were mucocutaneous (84.5%), musculoskeletal (15.9%), ocular (14.6%) and peripheral venous disease (PVD) (7.3%); on the other hand, pulmonary, peripheral arterial and great vessel phenotypes evolved several years after onset of the disease. The mean time from meeting the criteria to the evolution of a new phenotype was 53.8±58.7 months. Associations between the different phenotypes were observed: PVD and superficial thrombophlebitis, peripheral arterial disease and PVD; another association was also observed between aortic involvement and cerebrovascular disease. CONCLUSION BD could continue to evolve several years after onset of the disease, making the previous belief about BD yield questionable. BD tends to respect the anatomy of the affected system. Some phenotypes tend to coexist, suggesting a shared aethiopathogeny and that the disease is of a systemic nature.
Collapse
Affiliation(s)
- Doaa H S Attia
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
| |
Collapse
|
26
|
Romoli M, Tuna MA, Li L, Paciaroni M, Giannandrea D, Tordo Caprioli F, Lotti A, Eusebi P, Mosconi MG, Pellizzaro Venti M, Salvadori N, Gili A, Ricci S, Stracci F, Sarchielli P, Parnetti L, Rothwell PM, Calabresi P. Time trends, frequency, characteristics and prognosis of short-duration transient global amnesia. Eur J Neurol 2020; 27:887-893. [PMID: 32012408 PMCID: PMC7115816 DOI: 10.1111/ene.14163] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
Background and purpose Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia lasting up to 24 h. One major differential for TGA is transient epileptic amnesia, which typically lasts < 1 h. However, TGA can also be short in duration and little is known about the time trends, characteristics and prognosis of TGA cases lasting < 1 h. Methods We compared the clinical features of TGA ascertained in two independent cohort studies in Oxfordshire, UK [Oxford cohort 1977–1987 versus Oxford Vascular Study (OXVASC) 2002–2018] to determine the time trends of clinical features of TGA. Results were validated in another independent contemporary TGA cohort in Italy [Northern Umbria TGA registry (NU) 2002–2018]. We compared the risk factors, clinical features and long‐term prognosis (major cardiovascular events, recurrent TGA and seizure/epilepsy) of patients presenting with episodes lasting < 1 h versus those lasting ≥ 1 h. Results Overall, 639 patients with TGA were included (114 Oxford cohort, 100 OXVASC, 425 NU). Compared with the original Oxford cohort, there were more cases with TGA lasting < 1 h in OXVASC [32 (32.0%) vs. 9 (8.8%)] and NU (11.8% vs. 8.8% in Oxford cohort). In both OXVASC and NU, patient age, vascular risk factors and clinical features were largely similar between those with TGA lasting < 1 h versus those lasting ≥ 1 h. Moreover, there was no difference in the long‐term risk of seizure/epilepsy or major cardiovascular events between TGA lasting < 1 h versus TGA lasting ≥ 1 h. Conclusions Short‐duration TGA episodes (<1 h) were not uncommon and were more frequent than in earlier studies. The clinical features and long‐term prognosis of short‐duration TGA did not differ from more typical episodes lasting ≥ 1 h.
Collapse
Affiliation(s)
- M Romoli
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia.,Neurology Unit, Rimini 'Infermi' Hospital - AUSL Romagna, Rimini
| | - M A Tuna
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - L Li
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Paciaroni
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia
| | - D Giannandrea
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Città di Castello Hospital, Perugia, Italy
| | - F Tordo Caprioli
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - A Lotti
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - P Eusebi
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - M G Mosconi
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia
| | - M Pellizzaro Venti
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia.,Stroke Unit, Addenbrooke's Hospital - Cambridge University Hospital, Cambridge, UK
| | - N Salvadori
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - A Gili
- Public Health Department, University of Perugia, Perugia
| | - S Ricci
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Città di Castello Hospital, Perugia, Italy
| | - F Stracci
- Public Health Department, University of Perugia, Perugia
| | - P Sarchielli
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - L Parnetti
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - P M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - P Calabresi
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia.,IRCCS 'Santa Lucia', Rome, Italy
| |
Collapse
|
27
|
Oba MS, Murakami Y, Nishiwaki Y, Asakura K, Ohfuji S, Fukushima W, Nakamura Y, Suzuki Y. Estimated Prevalence of Cronkhite-Canada Syndrome, Chronic Enteropathy Associated With SLCO2A1 Gene, and Intestinal Behçet's Disease in Japan in 2017: A Nationwide Survey. J Epidemiol 2020; 31:139-144. [PMID: 32092751 PMCID: PMC7813772 DOI: 10.2188/jea.je20190349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background Cronkhite-Canada syndrome (CCS), chronic enteropathy associated with SLCO2A1 gene (CEAS), and intestinal Behçet’s disease (BD) are classified as intractable intestinal disorders in Japan. However, the national prevalence of these diseases remains unknown. We performed a nationwide survey to estimate the patient numbers and prevalence rates of these diseases throughout Japan in 2017. Methods We conducted a mail-based survey targeting hospitals across Japan to estimate the annual numbers of patients with CCS, CEAS, and intestinal BD in 2017. Using a stratified random sampling method, we selected 2,979 hospital departments and asked them to report the number of patients who met specific diagnostic criteria. The total number of patients for each disease was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate. The corresponding prevalence rates per 1,000,000 population were calculated based on the mid-year population of Japan in 2017. Results The overall survey response rate was 68.1% (2,029 departments). The estimated numbers of patients with CCS, CEAS, and intestinal BD were 473 (95% confidence interval [CI], 357–589), 388 (95% CI, 289–486), and 3,139 (95% CI, 2,749–3,529), respectively; the prevalence rates per 1,000,000 population were 3.7 (male: 4.0; female: 3.5), 3.1 (male: 3.0; female: 3.1), and 24.8 (male: 24.5; female: 25.0), respectively. The male-to-female ratios were 1.10, 0.94, and 0.93 for patients with CCS, CEAS, and intestinal BD, respectively. Conclusions Estimates of the national prevalence of CCS, CEAS, and intestinal BD in Japan were generated and found to be higher than those previously reported.
Collapse
Affiliation(s)
- Mari S Oba
- Department of Medical Statistics, Toho University
| | | | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, Toho University
| | - Keiko Asakura
- Department of Environmental and Occupational Health, Toho University
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine
| | | | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center
| |
Collapse
|
28
|
Mizuki Y, Horita N, Horie Y, Takeuchi M, Ishido T, Mizuki R, Kawagoe T, Shibuya E, Yuda K, Ishido M, Minegishi K, Yoshimi R, Kirino Y, Kato S, Arimoto J, Fukumoto T, Kurosawa M, Kitaichi N, Takeno M, Kaneko T, Mizuki N. The influence of HLA-B51 on clinical manifestations among Japanese patients with Behçet's disease: A nationwide survey. Mod Rheumatol 2019; 30:708-714. [PMID: 31386589 DOI: 10.1080/14397595.2019.1649103] [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] [Indexed: 10/26/2022]
Abstract
Objectives: To scrutinize the influence of HLA-B51 to each clinical manifestation of patients with Behçet's disease (BD) using a database of the Ministry of Health, Labour and Welfare of Japan.Methods: The database of newly registered patients with BD was obtained from the Japanese Ministry of Health, Labour and Welfare. Patients who met International Criteria for Behçet's Disease (ICBD) and had data for HLA-B51 were selected and analyzed.Results: Among the 3044 analyzable cases, 1334 (43.8%) were men and 1710 (56.2%) were women; the median age was 38 years (IQR 29-48). HLA-B51 was positive for 1334 (44.5%). Prevalence of selected manifestations was 98.5% for oral ulceration, 85.5% for skin lesion, 42.1% for ocular lesion, 69.1% for genital ulceration, and 29.0% for gastrointestinal symptom. HLA-B51-positive patients had higher risk for ocular lesion (OR 1.59, 95%CI: 1.37-1.84; p < .001) and lower risk for genital ulceration (OR 0.72, 95%CI: 0.62-0.84; p < .001) and gastrointestinal symptom (OR 0.65, 95%CI: 0.55-0.77; p < .001). No significant difference was observed for other organ involvement; oral ulceration, skin lesion, positive pathergy test, arthritis, epididymitis, vascular lesion, or neurological manifestation. Subgroup analyses revealed that HLA-B51 was not related to genital ulceration in the cases with an ICBD score of 6 or higher and that HLA-B51 tended to more largely affect the risk of three manifestations for men compared to that for women.Conclusion: HLA-B51 positive is a risk factor for ocular lesion and vice versa for genital ulceration and gastrointestinal symptoms in patients with Japanese BD.
Collapse
Affiliation(s)
- Yuki Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yukihiro Horie
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takehito Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryuta Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Shibuya
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kentaro Yuda
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mizuho Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kaoru Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shingo Kato
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Jun Arimoto
- Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
| | - Takeshi Fukumoto
- Gene Expression and Regulation Program, The Wistar Institute, Philadelphia, PA, USA
| | - Michiko Kurosawa
- Faculty of Medicine, Department of Epidemiology and Environmental Health, Juntendo University, Tokyo, Japan
| | - Nobuyoshi Kitaichi
- Department of Ophthalmology, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
29
|
Tsuchida N, Kirino Y, Soejima Y, Onodera M, Arai K, Tamura E, Ishikawa T, Kawai T, Uchiyama T, Nomura S, Kobayashi D, Taguri M, Mitsuhashi S, Mizuguchi T, Takata A, Miyake N, Nakajima H, Miyatake S, Matsumoto N. Haploinsufficiency of A20 caused by a novel nonsense variant or entire deletion of TNFAIP3 is clinically distinct from Behçet's disease. Arthritis Res Ther 2019; 21:137. [PMID: 31164164 PMCID: PMC6549368 DOI: 10.1186/s13075-019-1928-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/29/2019] [Indexed: 02/03/2023] Open
Abstract
Background Haploinsufficiency of A20 (HA20) is caused by loss-of-function TNFAIP3 variants. Phenotypic and genetic features of HA20 remain uncertain; therefore, the clinical distinction between HA20 and Behçet’s disease (BD) requires clarification. Methods We have collected 12 Japanese BD-like families. Probands of these families were analyzed by whole exome sequencing (WES) and subsequent Sanger sequencing. Clinical features were compared between 54 HA20 patients (including previously reported and new cases) and 520 Japanese BD patients. Results We identified c.1434C>A:p.(Cys478*) in one family and a 236 kb deletion at 6q23.3 containing TNFAIP3 in another family. Four HA20 patients in the two families presented with childhood-onset recurrent oral and genital ulcers and were initially diagnosed and treated as BD. Consistent with the clinical features of HA20, recurrent, refractory fever attacks (three of four patients), and digestive ulcers (two of the four patients) were observed. A comparison of clinical features between HA20 patients and cohorts of BD patients revealed several critical features specific to HA20. These were early-onset, familial occurrence, recurrent fever attacks, gastrointestinal involvement, and infrequent ocular involvement. Conclusions We identified a novel nonsense variant and deletion of the entire TNFAIP3 gene in two unrelated Japanese HA20 families. Genetic screening of TNFAIP3 should be considered for familial BD-like patients with early-onset recurrent fevers. Electronic supplementary material The online version of this article (10.1186/s13075-019-1928-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Naomi Tsuchida
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yutaro Soejima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masafumi Onodera
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Eiichiro Tamura
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Takashi Ishikawa
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshinao Kawai
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Toru Uchiyama
- Division of Immunology, National Center for Child Health and Development, Tokyo, Japan
| | - Shigeru Nomura
- Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Kobayashi
- Division of Clinical Nephrology and Rheumatology, Kidney Research Center, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University School of Data Science, Yokohama, Japan
| | - Satomi Mitsuhashi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takeshi Mizuguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Atsushi Takata
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Satoko Miyatake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Clinical Genetics Department, Yokohama City University Hospital, Yokohama, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| |
Collapse
|
30
|
Abstract
Patients with Behçet's disease (BD) suffer from episodic ocular and mucocutaneous attacks, resulting in a reduced quality of life. The phenotype of Japanese BD has been changing over the past 20 years, and the rate of human leukocyte antigen (HLA)-B*51-positive complete type is decreasing while that of intestinal type is increasing. This phenotypical evolution may be related to changes in as-yet-unknown environmental factors, as the immigration influx in Japan is low. Mechanisms discovered by genome-wide association studies include ERAP1-mediated HLA class I antigen bounding pathway, autoinflammation, Th17 cells, natural killer cells, and polarized macrophages, a similar genetic architecture to Crohn's disease, ankylosing spondylitis, and psoriasis. As for treatments, management guidelines have been implemented, and the development of tumor necrosis factor (TNF) inhibitors is markedly improving the outcome of BD, but evidence supporting treatment for special-type BD is limited. The classification of BD into distinct clusters based on clinical manifestations and genetic factors is crucial to the development of optimized medicine.
Collapse
Affiliation(s)
- Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University, Graduate School of Medicine, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University, Graduate School of Medicine, Japan
| |
Collapse
|
31
|
Nakahara H, Kaburaki T, Tanaka R, Yoshida A, Takamoto M, Kawata M, Fujino Y, Kawashima H, Aihara M. Comparisons of Clinical Features in Japanese Patients with Behçet's Uveitis Treated in the 1990s and the 2000s. Ocul Immunol Inflamm 2019; 28:262-269. [PMID: 30806114 DOI: 10.1080/09273948.2018.1559928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: We investigated clinical characteristics of ocular Behçet's disease (BD) patients treated in the 1990s and the 2000s.Methods: We retrospectively examined records of 68 newly arrived patients with ocular BD followed for more than 4 months during the 2000s and compared to those of 107 patients during the 1990s. Patient profiles, ocular and systemic symptoms, frequency of ocular attacks, BD ocular attack score 24-6 months (BOS24-6M), best-corrected visual acuity (BCVA), and immunomodulatory treatment were noted.Results: Clinical characteristics in the 2000s showed increases in iridocyclitis type, intestinal-, vasculo-, and neuro-BD cases, oral corticosteroid, methotrexate, and infliximab therapy usage, cataract and glaucoma surgery, and pseudophakia, and decreases in BOS24-6M and cyclophosphamide usage. BCVA of 20/30 or better at the final visit was slightly increased in the 2000s.Conclusions: Milder ocular BD tendency was seen in cases in the 2000s, whereas the incidence of special type of BD might be increasing.
Collapse
Affiliation(s)
- Hisae Nakahara
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Rie Tanaka
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Atsushi Yoshida
- Department of Ophthalmology, Cancer Institute Hospital, Tokyo, Japan
| | - Mitsuko Takamoto
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Mikiko Kawata
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| | - Yujiro Fujino
- Department of Ophthalmology, Japan Community Healthcare Organization Tokyo Shinjuku Medical Center, Tokyo Japan
| | - Hidetoshi Kawashima
- Department of Ophthalmology, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Makoto Aihara
- Department of Ophthalmology, University of Tokyo School of Medicine, Tokyo, Japan
| |
Collapse
|
32
|
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.
Collapse
|
33
|
Davatchi F, Shahram F, Chams-Davatchi C, Shams H, Abdolahi BS, Nadji A, Faezi T, Akhlaghi M, Ghodsi Z, Karimi N, Kavosi H, Mohtasham N, Masoumi M, Shadmanfar S, Mousavi M. Behcet's disease in Iran: Analysis of 7641 cases. Mod Rheumatol 2019; 29:1023-1030. [PMID: 30557064 DOI: 10.1080/14397595.2018.1558752] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: To analyze Behcet's Disease (BD) in Iran, from 1975 to 2018, and compare to 35 large/small reports from other countries.Methods: Patients from all over Iran, when suspected, were sent to the BD Unit. The diagnosis was done by expert opinion. All data were recorded in the BD registry (updated in each follow-up). The data are given in percentage with 95% confidence Intervals.Results: The mean age at onset was 25.6 years. Standard deviation (SD) was 9.8. The mean disease duration was 11.7 years (SD: 8.9). Males were 55.8% (54.7-56.9), Females 44.2% (43.1-45.3), Oral Aphthosis (OA) 97.5% (97.1-97.9), genital aphthosis (GA) 64.4% (63.3-65.5), skin lesions 62.2% (61.1-63.3), ocular lesions 55.6% (54.5-56.7), Joint Manifestations 38.1% (37.0-39.2), Gastrointestinal 6.8% (6.2-7.4), Vascular 8.9% (8.3-9.5), neurological (central-peripheral) 3.9% (3.5-4.3), epididymitis 4.6% (4.1-5.1). Lab tests were positive pathergy test 50.4% (49.3-51.5), elevated ESR 51.1% (50.0-52.2), abnormal urinalysis 13.4% (12.6-14.2). The International Study Group (ISG, 1990) criteria and the International Criteria for Behcet's Disease (ICBD, 2014) had respectively a sensitivity of 76.2% (75.2-77.2) and 96.6% (96.2-97.0). The specificity was 99.3% (99.1-99.5) and 97.3% (96.9-97.7). The accuracy was 86.4% (85.8-87.0) and 96.9% (96.6-97.2).Conclusion: The most frequent manifestations were OA, GA, skin manifestations, and ocular manifestations.
Collapse
Affiliation(s)
- Fereydoun Davatchi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Behcet's Disease Chair, National Elite Foundation, Iran
| | - Farhad Shahram
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Cheyda Chams-Davatchi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hormoz Shams
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Sadeghi Abdolahi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolhadi Nadji
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Tahereh Faezi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Massoomeh Akhlaghi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nooshin Karimi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hoda Kavosi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Mohtasham
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Masoumi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Soraya Shadmanfar
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mousavi
- Behcet's Disease Unit, Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
34
|
Hsu YR, Huang JCC, Tao Y, Kaburaki T, Lee CS, Lin TC, Hsu CC, Chiou SH, Hwang DK. Noninfectious uveitis in the Asia-Pacific region. Eye (Lond) 2018; 33:66-77. [PMID: 30323327 DOI: 10.1038/s41433-018-0223-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/19/2018] [Accepted: 08/23/2018] [Indexed: 12/19/2022] Open
Abstract
Uveitis is a sight-threatening disease. Up to 35% of patients may have impaired vision. Inflammation of the uvea tissue has more than 60 etiologies. Previous reports have shown that 20-40% of uveitis cases were noninfectious. Some of them may be associated with systemic rheumatological and autoimmune diseases but some may affect the eyes only. The epidemiology and clinical situations of some specific uveitis entities vary worldwide because they are influenced by genetic, ethnic, environmental, and socioeconomic factors. The Asia-Pacific region comprises more than 30 countries. Epidemiology and patterns of uveitis vary greatly in this region. However, some uveitis entities, such as Behcet's disease, sarcoidosis, and Vogt-Koyanagi-Harada disease, are more common in this region. Many studies on the epidemiology, risk factors, and immune pathogenesis of this disease have been conducted. In this article, we review the epidemiology of noninfectious uveitis and special situations of these three uveitis entities in the Asia-Pacific region.
Collapse
Affiliation(s)
- Yung-Ray Hsu
- Department of Ophthalmology, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Ophthalmology, National Taiwan University, Taipei, Taiwan
| | | | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Christopher Seungkyu Lee
- Department of Ophthalmology, Severance Hospital, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
| | - Tai-Chi Lin
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chien Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hwa Chiou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Medical Research & Education, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| |
Collapse
|
35
|
Abstract
Behçet disease (BD) is a variable vessel vasculitis that can involve several organs and systems. Gastrointestinal (GI) involvement has an acute exacerbating course with ulcers, most commonly in the ileocolonic area. These ulcers can be large and deep, causing perforation and massive bleeding. This article highlights the current knowledge on the epidemiology, clinical findings, diagnosis, and management of GI involvement of BD, with emphasis on recent findings.
Collapse
Affiliation(s)
- Ibrahim Hatemi
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Koca Mustafa Pasa Mahallesi, Cerrahpaşa Caddesi No:53, 34096 Fatih/Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Koca Mustafa Paşa Mahallesi, Cerrahpasa Caddesi No:53, 34096 Fatih/Istanbul, Turkey
| | - Aykut Ferhat Çelik
- Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Koca Mustafa Pasa Mahallesi, Cerrahpaşa Caddesi No:53, 34096 Fatih/Istanbul, Turkey.
| |
Collapse
|
36
|
Suwa A, Horita N, Ishido T, Takeuchi M, Kawagoe T, Shibuya E, Yamane T, Hayashi T, Meguro A, Ishido M, Minegishi K, Yoshimi R, Kirino Y, Kato S, Arimoto J, Fukumoto T, Ishigatsubo Y, Kurosawa M, Kaneko T, Takeno M, Mizuki N. The ocular involvement did not accompany with the genital ulcer or the gastrointestinal symptoms at the early stage of Behçet's disease. Mod Rheumatol 2018; 29:357-362. [PMID: 29583036 DOI: 10.1080/14397595.2018.1457424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This study aimed to identify patients with high-probability of ocular involvement of Behçet's disease (BD). METHODS The Japanese Ministry of Health, Labour and Welfare provided dataset of ongoing nationwide BD registration project. A patient who had confirmed BD and who was suspected to have BD was registered. We mainly analyzed newly registered patients who had the data for all demographic and diagnostic parameters regardless of fulfilment of any diagnostic criteria. RESULTS Among 3213 patients with confirmed or possible BD, 1382 (43.0%) were men and 1831 (57.0%) were women with a median age of 38 years (interquartile range (IQR) 30-49 years). The median duration between onset and registration was 0 year (IQR 0-3). A binomial multivariable logistic regression analysis revealed that being female (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.53-0.75, p < .001), duration since onset (OR 1.33 per 10 years, 95% CI 1.18-1.51, p < .001), genital ulceration (OR 0.28, 95% CI 0.23-0.34, p < .001), and gastrointestinal symptoms (OR 0.36, 95% CI 0.30-0.44, p < .001) were related to the ocular lesion. Analyses based on data of 2800 patients who satisfied International criteria of BD, age-, sex-, duration-based subgroup analyses, analyses targeting iridocyclitis and retino-uveitis, and analysis including patients with missing data confirmed that the four factors were associated with the probability of eye involvement. CONCLUSION The ocular involvement did not accompany with genital ulcer or gastrointestinal symptoms at the early stage of BD.
Collapse
Affiliation(s)
- Akiko Suwa
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Nobuyuki Horita
- b Department of Pulmonology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Takehito Ishido
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Masaki Takeuchi
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Tatsukata Kawagoe
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Etsuko Shibuya
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Takahiro Yamane
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Takahiko Hayashi
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Akira Meguro
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Mizuho Ishido
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kaoru Minegishi
- c Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Ryusuke Yoshimi
- c Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yohei Kirino
- c Department of Stem Cell and Immune Regulation , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Shingo Kato
- d Department of Gastroenterology and Hepatology , Yokohama City University School of Medicine , Yokohama , Japan
| | - Jun Arimoto
- d Department of Gastroenterology and Hepatology , Yokohama City University School of Medicine , Yokohama , Japan
| | - Takeshi Fukumoto
- e Gene Expression and Regulation Program , The Wistar Institute , Philadelphia , PA , USA
| | | | - Michiko Kurosawa
- g Department of Epidemiology and Environmental Health , Juntendo University Faculty of Medicine , Tokyo , Japan
| | - Takeshi Kaneko
- b Department of Pulmonology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Mitsuhiro Takeno
- h Department of Allergy and Rheumatology , Nippon Medical School Graduate School of Medicine , Tokyo , Japan
| | - Nobuhisa Mizuki
- a Department of Ophthalmology and Visual Science , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| |
Collapse
|
37
|
Lin YH, Tai TY, Pu CY, Hwang DK, Chung YM, Chou YJ. Epidemiology of Behcet's Disease in Taiwan: A Population-Based Study. Ophthalmic Epidemiol 2018; 25:323-329. [PMID: 29726724 DOI: 10.1080/09286586.2018.1469157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To study the incidence and epidemiology of Behcet's disease in Taiwan. METHODS This retrospective cohort study was conducted using the nationwide reimbursement database in Taiwan. One million registered beneficiaries of the Taiwan National Health Insurance system in 2000 were randomly selected. All medical claims of these persons were collected. The definition of having Behcet's disease was based on diagnostic codes. Persons who had incomplete registry data or diagnoses prior to 2001 were excluded. Annual incidence between 2001 and 2011 was calculated and risk factors for incidence were explored using the Cox proportional regression model. Characteristics of patients with Behcet's disease with and without uveitis were compared. RESULTS A total of 236 newly diagnosed patients with Behcet's disease were found between 2001 and 2011. The average incidence was 2.40 cases per 100,000 person-years (ranging from 1.29 to 3.53). Female patients and those aged between 40 and 65 years were at the highest risk of Behcet's disease. Only 18.2% of the patients had also suffered from uveitis. The subspecialties of doctors making initial diagnoses and the number of prescribed immunomodulatory agents differed significantly between the patients with and without uveitis (p < 0.001 and <0.05, respectively). CONCLUSION Incidence of Behcet's disease was not high in Taiwan and relatively few of the patients developed uveitis. Patients of working age or who were female were more likely to have Behcet's disease. However, age of onset and clinical severity differed between patients with and without uveitis.
Collapse
Affiliation(s)
- Yu-Hao Lin
- a Department of Ophthalmology , Taiwan Adventist Hospital , Taipei , Taiwan
| | - Tzu-Yang Tai
- b Department of Ophthalmology , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Cheng-Yun Pu
- c Department of Public Health and Institute or Public Health , National Yang-Ming University , Taipei , Taiwan
| | - De-Kuang Hwang
- b Department of Ophthalmology , Taipei Veterans General Hospital , Taipei , Taiwan.,d Department of Ophthalmology , National Yang-Ming University School of Medicine , Taipei , Taiwan
| | - Yu-Mei Chung
- b Department of Ophthalmology , Taipei Veterans General Hospital , Taipei , Taiwan
| | - Yiing-Jeng Chou
- c Department of Public Health and Institute or Public Health , National Yang-Ming University , Taipei , Taiwan
| |
Collapse
|
38
|
Abstract
Since the discovery of HLA 60 years ago, it has contributed to the understanding of the immune system as well as of the pathogenesis of several diseases. Aside from its essential role in determining donor-recipient immune compatibility in organ transplantation, HLA genotyping is meanwhile performed routinely as part of the diagnostic work-up of certain autoimmune diseases. Considering the ability of HLA to influence thymic selection as well as peripheral anergy of T cells, its role in the pathogenesis of autoimmunity is understandable. The aim of this paper is to provide a brief overview of the role and current clinical relevance of HLA-B27 in spondyloarthritis and HLA-B51 in Behçet's disease as well as HLA-DQ2/DQ8 in celiac disease and HLA-DRB1 in rheumatoid arthritis and to discuss possible future implications.
Collapse
Affiliation(s)
- Gergely Bodis
- Division of Rheumatology and Clinical Immunology, University Hospital, Mainz, Germany.,Institut für Medizinische Diagnostik GmbH, Bioscientia Labor Ingelheim, Ingelheim Am Rhein, Germany
| | - Victoria Toth
- Division of Rheumatology and Clinical Immunology, University Hospital, Mainz, Germany.,Institut für Medizinische Diagnostik GmbH, Bioscientia Labor Ingelheim, Ingelheim Am Rhein, Germany
| | - Andreas Schwarting
- Division of Rheumatology and Clinical Immunology, University Hospital, Mainz, Germany. .,ACURA Center for Rheumatic Diseases, Bad Kreuznach, Germany.
| |
Collapse
|
39
|
Abstract
The aim of this review is to provide a brief overview of the role and current clinical relevance of HLA-B27 in spondyloarthritis and HLA-B51 in Behcet's disease as well as HLA-DQ2/DQ8 in celiac disease and HLA-DRB1 in rheumatoid arthritis and to discuss possible future implications.
Collapse
Affiliation(s)
- Gergely Bodis
- Bioscientia Institut für Medizinische Diagnostik GmbH, Ingelheim, Germany
- Acura Rheumatology Center Rhineland Palatine, Bad Kreuznach, Germany
| | - Victoria Toth
- Bioscientia Institut für Medizinische Diagnostik GmbH, Ingelheim, Germany
- Acura Rheumatology Center Rhineland Palatine, Bad Kreuznach, Germany
| | - Andreas Schwarting
- Acura Rheumatology Center Rhineland Palatine, Bad Kreuznach, Germany.
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| |
Collapse
|
40
|
Ishido M, Horita N, Takeuchi M, Shibuya E, Yamane T, Kawagoe T, Ishido T, Minegishi K, Yoshimi R, Kirino Y, Hirohata S, Ishigatsubo Y, Takeno M, Kaneko T, Mizuki N. Distinct clinical features between acute and chronic progressive parenchymal neuro-Behçet disease: meta-analysis. Sci Rep 2017; 7:10196. [PMID: 28860590 PMCID: PMC5579041 DOI: 10.1038/s41598-017-09938-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/01/2017] [Indexed: 01/18/2023] Open
Abstract
Neuro-Behçet’s disease (NBD) is subcategorized into parenchymal-NBD (P-NBD) and non-parenchymal-NBD types. Recently, P-NBD has been further subdivided into acute P-NBD (A-P-NBD) and chronic progressive P-NBD (CP-P-NBD). Although an increasing number of studies have reported the various clinical features of A-P-NBD and CP-P-NBD over the last two decades, there was a considerable inconsistency. Two investigators systematically searched four electrical databases to detect studies that provided sufficient data to assess the specific characteristics of A-P-NBD and CP-P-NBD. All meta-analysis was carried out by employing the random-model generic inverse variance method. We included 11 reports consisted of 184 A-P-NBD patients and 114 CP-P-NBD patients. While fever (42% for A-P-NBD, 5% for CP-P-NBD, p < 0.001, I2 = 93%) was more frequently observed in A-P-NBD cases; sphincter disturbances (9%, 34%, P = 0.005, I2 = 87%), ataxia (16%, 57%, P < 0.001, I2 = 92%), dementia (7%, 61%, P < 0.001, I2 = 97%), confusion (5%, 18%, P = 0.04, I2 = 76%), brain stem atrophy on MRI (4%, 75%, P < 0.001, I2 = 98%), and abnormal MRI findings in cerebellum (7%, 54%, P = 0.02, I2 = 81%) were more common in CP-P-NBD. Cerebrospinal fluid cell count (94/mm3, 11/mm3, P = 0.009, I2 = 85%) was higher in A-P-NBD cases. We demonstrated that A-P-NBD and CP-P-NBD had clearly different clinical features and believe that these data will help future studies investigating P-NBD.
Collapse
Affiliation(s)
- Mizuho Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
| | - Masaki Takeuchi
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Etsuko Shibuya
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takahiro Yamane
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsukata Kawagoe
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takehito Ishido
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kaoru Minegishi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shunsei Hirohata
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Mitsuhiro Takeno
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhisa Mizuki
- Department of Ophthalmology and Visual Science, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| |
Collapse
|
41
|
Ishido T, Horita N, Takeuchi M, Kawagoe T, Shibuya E, Yamane T, Hayashi T, Meguro A, Ishido M, Minegishi K, Yoshimi R, Kirino Y, Kato S, Arimoto J, Ishigatsubo Y, Takeno M, Kurosawa M, Kaneko T, Mizuki N. Clinical manifestations of Behçet’s disease depending on sex and age: results from Japanese nationwide registration. Rheumatology (Oxford) 2017; 56:1918-1927. [DOI: 10.1093/rheumatology/kex285] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Indexed: 01/07/2023] Open
|