Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Major organ involvement, especially in young males, is one of the main causes of mortality and morbidity in Behcet’s Disease (BD). However, the prognosis and predictors of major organ involvement is unsufficiently studied. We aimed to follow young, male BD patients which have the highest risk for major organ involvement prospectively.
Methods: Thirty-six male patients with BD consecutively consulted in the Outpatient Clinics of Marmara University, 35 males with ankylosing spondylitis(AS),36 healthy males were included in the study. Bilateral upper and lower extremity venous doppler ultrasonography(US) and brachial and carotid arterial US (for assessing endothelial dysfunction) were performed in baseline visit for all groups and in the first year follow-up visit for BD patients. Patients with BD were assessed prospectively with 3-6 months intervals and in any urgent visit.
Results: At baseline, the mean disease duration was 3.3 years in patients with BD. The rate of venous insufficiency was higher in male BD patients without vascular events, compared to healthy controls (BD vs HC: 30.5% vs 0%) and similar to patients with AS (BD vs AS. 30.5% vs 32%). Markers of endothelial dysfunction (FMD and NID) were similar between BD patients and healthy controls, however CIMT (Carotid intima media thickness) was significantly higher in BD (0.54 mm vs 0.47 mm, p=0.033). The mean follow-up duration was 44.6 months. Major organ involvement developed in 4 (11%, 3 vascular and 1 ocular involvement) patients during follow-up. All of them were in the first 2 years of follow-up. Immunsuppresive (IS) therapy was required in 22% (n=8) of patients, due to major organ involvement in 4 (11%) and refractory mucocutaneous symptoms in other four (11%) patients. In the first year follow-up visit, endothelial functions and CIMT were observed to be significantly improved compared to baseline (Baseline vs Follow-up: 6.8±4 vs 10.9±4.5, p=0.003 for FMD, 0.55±0.13 vs 0.47±0.1 for CIMT, p=0.004). The patients requiring IS treatment in the follow-up had significantly lower FMD at baseline compared to the rest of the group (4.4 vs 8.5, p=0.005).
Conclusion: Our study demonstrated a lower incidence of major vascular events in male BD patients during prospective follow-up compared to historic controls in the literature. However, our results confirmed an early onset of major organ involvement and IS use in the first year of disease follow-up. The decreased rate of baseline FMD in patients with later IS requirement suggest that FMD can be a predictor for major organ involvement in BD. Table 1: Clinical charecteristic of patients developing immunosuppressive need during follow-up.
|IS onset during follow-up.||Reason for IS use||Age||Disease duration when IS started||IS agent|
|Patient 1||1.month||Pulmonary aneurysm||35||1 year||Azatioprine|
|Patient 2||7.month||Refractory OU||25||5 years||Cyclosporine|
|Patient 3||6. month||Deep venous thrombosis||38||10 years||Azatioprine|
|Patient 4||10. month||Uveitis||20||5 years||Azatioprine|
|Patient 5||9. month||Refractory OU||28||7 years||Azatioprine|
|Patient 6||13. month||Refractory OU||23||6 years||Cyclosporine|
|Patient 7||9. month||Refractory EN||35||1 years||Azatioprine|
|Patient 8||8. month||Deep venous thrombosis||23||1 years||Azatioprine|
IS: Immunosuppressive, OU: Oral ulcer, EN: ertyhema nodosum
To cite this abstract in AMA style:Alibaz-Oner F, Karatay E, Aldag B, Akpınar IN, Ergun T, Direskeneli H. Baseline Endothelial Dysfunction Might Predict Immunosuppressive Need in Young, Male Behcet’s Patients with Early Disease: A Prospective Follow-up [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/baseline-endothelial-dysfunction-might-predict-immunosuppressive-need-in-young-male-behcets-patients-with-early-disease-a-prospective-follow-up/. Accessed June 4, 2020.
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