Background/Purpose: Major organ involvement such as vascular or ocular disease, 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 with only mucocutaneous symptoms which have the highest risk for new major organ involvement prospectively.

Methods: Thirty-six male patients with BD consecutively consulted in the outpatient clinics of Marmara University, Istanbul, 35 males with ankylosing spondylitis and 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 study 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 visits.

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 56.6 months. Major organ involvement developed in 5 (13.8%, 3 vascular and 2 ocular involvement) patients during follow-up. Immunsuppresive (IS) therapy was required in 27% (n=10) of patients, due to major organ involvement in 5 (13.8%), refractory mucocutaneous symptoms in four (11%) and chronic arthritis in one (2.7%) patient. 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). 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).

Table 1: Clinical characteristics of patients with immunosuppressive need during follow-up.

F/U:Follow-up, IS: Immunosuppressive, OU: Oral ulcer, EN: ertyhema nodosum

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. The decreased rate of baseline FMD in patients with later IS requirement suggest that FMD might be a predictor for major organ involvement in BD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/new-major-organ-involvement-is-lower-in-young-male-behcets-patients-compared-to-retrospective-series-five-year-results-of-a-prospective-cohort/