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Elhani I, Riller Q, Boursier G, Hentgen V, Rieux-Laucat F, Georgin-Lavialle S. A20 Haploinsufficiency: A Systematic Review of 177 Cases. J Invest Dermatol 2024; 144:1282-1294.e8. [PMID: 38128752 DOI: 10.1016/j.jid.2023.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/04/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
A20 haploinsufficiency is an autoinflammatory disease caused by defective inactivation of the NF-κB pathway. We conducted a systematic literature review of articles reporting patients with TNFAIP3 sequence variants from 2016 to August 2023 following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data from 177 patients from 65 articles were retrieved (108 women). The principal features were mucosal ulcers (n = 129); fever (n = 93) followed by gastrointestinal (n = 81); skin features (n = 76); autoimmunity (n = 61), including thyroiditis (n = 25) and lupus (n = 16); and joint involvements (n = 54). Five patients had died at the time of publication. In 54 of 63 patients, CRP was significantly elevated during flares, with a median of 51 mg/l. The most commonly used treatment included corticosteroids and nonsteroidal anti-inflammatory drugs (n = 32), TNF blockers (n = 29), colchicine (n = 28), and methotrexate (n = 14). TNFAIP3 variants impacted the ovarian tumor domain in 92 cases and a Zinc finger domain in 68 cases. Geographic origin, reported sex, and variant type significantly impacted phenotype. A better understanding of the wide A20 haploinsufficiency phenotype could facilitate the diagnosis process. Much remains to be elucidated about pathogenesis and treatment to improve outcome in patients with A20 haploinsufficiency.
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Affiliation(s)
- Inès Elhani
- Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Saint-Antoine Research Center (CRSA) INSERM UMRS 938, Sorbonne Université, Paris, France; National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Montpellier, France; Department of General Pediatrics, Versailles Hospital, Versailles, France.
| | - Quentin Riller
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Guilaine Boursier
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Montpellier, France; Laboratory of Rare and Autoinflammatory Genetic Diseases, Department of genetics, CHU Montpellier, Univ Montpellier, Montpellier, France
| | - Véronique Hentgen
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Montpellier, France; Department of General Pediatrics, Versailles Hospital, Versailles, France
| | - Frédéric Rieux-Laucat
- Laboratory of Immunogenetics of Pediatric Autoimmune Diseases, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Sophie Georgin-Lavialle
- Department of Internal Medicine, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Saint-Antoine Research Center (CRSA) INSERM UMRS 938, Sorbonne Université, Paris, France; National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Montpellier, France.
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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.
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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
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Çakan ZK, Yağız B, Pehlivan Y. Clinical features of Behçet's disease and prediction of the use of biologics in 488 cases: a single tertiary center study. Rheumatol Int 2023; 43:2089-2097. [PMID: 37604938 DOI: 10.1007/s00296-023-05416-0] [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: 04/26/2023] [Accepted: 08/01/2023] [Indexed: 08/23/2023]
Abstract
The objectives are to describe the demographic and clinical properties of Behçet's disease (BD) and investigate their relationship with the use of biological agents. Four hundred-eighty-eight patients, (299 (61.3%) males, 189 (38.7%) females), who fulfilled the ISG classification criteria for BD were included, retrospectively. The patient's demographics, disease onset age (DOA), clinical findings of the disease, and the drugs were determined and analyzed statistically. The means of patient age and DOA were 40.7 ± 9.9 and 30.8 ± 8.8 years, respectively. The most common initial findings were oral ulcer (OU)s (30.1%), genital ulcer (GU) (27.5%), ocular involvement (OI) (12.5%), and papulopustular lesion (PPL)s (10.1%). The most common clinical manifestations were OUs (96.9%), PPLs (70.2%), HLA-B51 (64.4%), positive pathergy reaction (26.4%), GU (58.8%), OI (44.7%), erythema nodosum (29.8%), and vascular involvement (VSI) (27.3%). Although, the frequency of GU was higher in females (p = 0.01), PPLs (p = 0.001) and VSI (p = 0.001) were higher in males. Sixty-three (8.9%) patients used a biological agent. Its frequency was higher in younger patients (< 40 years) (p = 0.006), males (p = 0.012) and patients with OI (p = 0.001). Besides, the DOA (p = 0.012) and the current age (p = 0.001) were lower in biological agent users. The possibility of using biological agent was increased in males (OR = 2.2), patients with OI (OR = 2.7) and young patients (OR = 0.9). Mucocutaneous lesions are distinctive features of BD, especially OUs precede other findings. GU was more common in females and PPLs and VSI were in males. The probability of using biologics is higher in males, patients with OI, and young patients.
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Affiliation(s)
- Zeliha Kübra Çakan
- Division of Oncology, Department of Internal Medicine, Cerrahpasa School of Medicine, Istanbul University-Cerrrahpasa, Istanbul, Turkey.
| | - Burcu Yağız
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Uludağ University, Bursa, Turkey
| | - Yavuz Pehlivan
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Uludağ University, Bursa, Turkey
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. REUMATOLOGIA CLINICA 2022; 18:410-415. [PMID: 35940675 DOI: 10.1016/j.reumae.2021.03.011] [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: 12/06/2020] [Accepted: 03/25/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Üsküdar Cansu D, Korkmaz C. Age-related immunosenescence in Behçet's disease. Rheumatol Int 2022; 42:1513-1522. [PMID: 35593976 DOI: 10.1007/s00296-022-05144-x] [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: 03/23/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
Behçet's disease (BD) is a systemic vasculitis of unknown etiology causing recurrent mucocutaneous lesions, ocular involvement, central nervous system involvement, and vascular involvement. The disease is characterized by exacerbations and spontaneous remissions. Prognosis is poor in young men when the vessels are involved. The course is more active and severe in the first years of the disease. One of the most interesting features of BD is that the disease changes to a state of low activity and remission over time. Although the association between aging and lower disease activity is well established, there is limited literature data and research investigating the cause. Similarly, there are not many studies on the late onset of BD and its characteristics. In this regard, understanding the cause of the decline in disease activity over time may open new avenues for pathogenesis and treatment research. In this review, we focus on the immunosenescence caused by chronic inflammation and aging in BD. Based on the effect of testosterone on innate immune cells, we also briefly discussed the potential effects of this hormone on vascular involvement.
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Affiliation(s)
- Döndü Üsküdar Cansu
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey.
| | - Cengiz Korkmaz
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey
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Elgengehy FT, Gamal SM, Sobhy N, Siam I, Soliman AM, Elhady GW, Gheita TA. Vasculitis damage index in Behçet's disease. Adv Rheumatol 2021; 61:33. [PMID: 34108037 DOI: 10.1186/s42358-021-00193-5] [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: 01/06/2021] [Accepted: 05/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasculitis damage index (VDI) is a validated damage index for systemic vasculitis, and as Behçet's disease is considered one of systemic vascular disease we aimed to study the relationship of the vasculitis damage index to clinical manifestations and comorbidity in patients with Behçet's disease (BD) to determine if VDI could be used to assess damage in patients with BD. METHODS A total of 109 patients with BD were recruited from the Rheumatology Department (outpatient and inpatient clinic), Cairo University Hospitals. All patients were subjected to full history taking, clinical examination, and routine laboratory investigations. Disease activity was assessed by the BD current activity form, and the VDI was calculated in all patients. The relationship of the VDI to the disease clinical manifestations was studied. Mann-Whitney and Kruskal Wallis tests were used to estimate differences in quantitative variables. Spearman correlation test was used to test for correlation between quantitative variables. RESULTS In the current study, the VDI ranged from 1 to 10, with a mean of 3.5 ± 1.8. It was significantly associated with total thrombosis (P = 0.022); total neurological manifestations (P = 0.000), especially stroke and cranial nerve affection; uveitis (P = 0.005); avascular necrosis (AVN) (P = 0.015); osteoporosis (P = 0.01); impaired vision (P < 0.0001); cataract (P < 0.0001); and diabetes (P = 0.012). Generally, immunosuppressive treatment was significantly associated with VDI (P = 0.039), especially cyclophosphamide (P < 0.0001), biological agent (P = 0.008), chlorambucil (P = 0.003), and anticoagulant (P = 0.02). VDI was also significantly correlated with age (P = 0.033), disease duration (P = 0.029), and duration of eye involvement (P = 0.003). CONCLUSION VDI is significantly associated with most disease parameters of BD, except for parameters such as mucocutaneous manifestations and uncomplicated venous thrombosis; however, further studies may be needed to establish BD-specific damage index.
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Affiliation(s)
- Fatema T Elgengehy
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt.
| | - Sherif M Gamal
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
| | - Nesreen Sobhy
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
| | - Ibrahem Siam
- Internal Medicine Department, National Research Center, Cairo, Egypt
| | - Ahmed M Soliman
- Dermatology and venereology Department, National Research Center, Cairo, Egypt
| | - Ghada W Elhady
- Public Health Department, Cairo University, Cairo, Egypt
| | - Tamer A Gheita
- Rheumatology and Rehabilitation Department, Cairo University, Cairo, Egypt
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Serpa Pinto L, Xavier Pires S, Silva B, Farinha F, Vasconcelos C, Araújo Correia J. Predictive Factors of Severe Behçet's disease: A Longitudinal, Prospective Cohort Followed Between 1981-2020. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00121-2. [PMID: 34023233 DOI: 10.1016/j.reuma.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Behçet's disease (BD) is a systemic vasculitis of unknown cause. The spectrum of the disease ranges from mucocutaneous manifestations to other organ diseases with relevant morbidity. Associations between disease severity and male sex, earlier age at onset, and the presence of erythema nodosum have been described. OBJECTIVES To evaluate clinical factors associated with manifestations of severe disease in a single-center cohort. METHODS A longitudinal, prospective, unicentric cohort study with patients followed in a specialized outpatient clinic between 1981 and 2020. Severe BD was defined as a Krause total clinical severity score >4 points. RESULTS We included 243 patients, of whom 31% were male, with an average follow-up time of 14.6 years. Regarding organ manifestations, all patients had mucous manifestations (N=243, 100%), 133 (55%) skin, 104 (43%) joint, 71 (29%) ocular, 48 (20%) vascular, 47 (19%) neurological, 22 (9%) gastrointestinal and 1 (0.4%) cardiac involvement by BD. One hundred fifty-six (64%) patients were classified as having severe BD. Severe BD was more frequent in men (OR=2.004, p=0.024), increasing with age (OR=1.021 per year, p=0.037), in the presence of skin manifestations (OR=4.711, p<0.001), specifically erythema nodosum (OR=8.381, p<0.001), and pseudofolliculitis (OR=2.910, p<0.001). In the multivariate model, variables independently associated with severe BD were male gender (Adjusted OR=1.961, p=0.047), erythema nodosum (Adjusted OR=8.561, p<0.001) and pseudofolliculitis (Adjusted OR=2.372, p=0.007). DISCUSSION Male gender, erythema nodosum, and pseudofolliculitis were independently associated with severe BD forms and therefore should serve as warning signs to the clinician.
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Affiliation(s)
- Luísa Serpa Pinto
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal.
| | - Sara Xavier Pires
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal
| | - Berta Silva
- Imunogenetics Laboratory, Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Fátima Farinha
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Carlos Vasconcelos
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - João Araújo Correia
- Internal Medicine Department, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Clinical Immunology Unit, Centro Hospitalar e Universitário do Porto (CHUP), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica (UMIB), Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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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.
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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.
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Saikaly SK, Saikaly TS, Saikaly LE. Recurrent aphthous ulceration: a review of potential causes and novel treatments. J DERMATOL TREAT 2018; 29:542-552. [PMID: 29278022 DOI: 10.1080/09546634.2017.1422079] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of article: This review examines studies published between May 2012 and 2017 with a specific interest in potential recurrent aphthous ulceration (RAU) etiologies and treatment modalities/efficacy, including topical treatments, systemic regimens, vitamin repletion, and laser therapy, among others. MATERIALS AND METHODS PubMed MEDLINE and Cochrane Database of Systematic Reviews were searched using various combinations of: 'aphthous', 'ulcer', and 'treatment'. The titles and abstracts from the initial literature search were appraised to identify articles for full review and reference sections from each article were searched manually for relevant publications. Both randomized controlled trials and observational reports were included in this review, as some treatment types have not been formally examined in randomized trials. Relevant studies were reviewed, compared, and summarized. RESULTS RAU can result from systemic disease and trauma, but recent studies have shown a variety of potential etiologies, ranging from vitamin deficiencies, oral microbiota derangements, hematological considerations, stress, genetic polymorphisms to oxidant-antioxidant imbalances, among others. Many modalities of therapy are available and have proven efficacious. CONCLUSIONS As the exact etiology of RAU is still unknown, therapy is based on symptomatic relief.
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Affiliation(s)
- Sami Kameel Saikaly
- a Orlando Regional Medical Center , Orlando , FL , USA.,b University of Central Florida College of Medicine , Orlando , FL , USA
| | - Tanya Siham Saikaly
- c University of Alabama at Birmingham School of Dentistry , Birmingham , AL , USA
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