Session Information
Date: Tuesday, November 10, 2015
Title: Vasculitis Poster III
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Diagnosis of Behcet’s syndrome (BS) is based on clinical signs and symptoms, without the use laboratory or imaging tests and the most commonly used diagnostic criteria are the ISG criteria. Patients have also been diagnosed with BS not meeting ISBD criteria based on the clinical impression of the treating physicians.
Objective:
To determine differences in disease activity among BS patients meeting and not meeting the ISBD criteria.
Methods:
Behcet’s patients seen at the NYU Behcet’s Center had their demographic, clinical features and outcomes data abstracted. Confirmed BS diagnosis was determined if ISG criteria were met at any time during the course of observation. Multiple linear regression estimated any association between meeting ISG criteria and gender with the patient-reported outcomes Behcet’s Syndrome Activity Score (BSAS), Pain Visual Analog Scale (VAS), Fatigue VAS, Patient Global Assessment VAS, and RAPID3 as well as Physician Global Assessment VAS.
Results:
First observation data on 832 subjects were abstracted for this analysis. 504 (63%) met ISG criteria for Behcet’s, 616 (74%) were female with an average age of 35 years (+ 13.8). Mean scores for BSAS, pain, fatigue, patient global, RAPID3 and physician global were uniformly higher in those meeting criteria vs not meeting criteria. Meeting ISG criteria was significantly associated with increases in all clinical outcomes independently of gender, ranging from 5 points on the Physician Global VAS to 13 points on the Fatigue VAS (Table). Conversely, female gender was only associated with significant increases in BSAS, Fatigue and RAPID3 independent of meeting ISG criteria. Not surprising, meeting ISG criteria was associated with increased odds of eye involvement; CNS or vascular involvement were not associated with meeting ISG criteria, however. Notably, males [N=63 (29%)] were are significantly increased odds of having eye involvement compared to females [N=155 (25%)] [OR=1.6, 95% CI:1.11, 2.41), P=0.013] independent of meeting ISG criteria, race, age and education. No association between gender and CNS [males N=12 (10%) vs female N=45 (12%)] or vascular involvement [males N=3 (2%) vs female N=3 (1%)] was detected.
Conclusion:
Behcet’s patients who fulfill ISG criteria have more active disease, based on all measures of disease activity, including patient and physician based outcomes. Interestingly, females were also at risk for more active disease as measured by composite patient reported outcome measures, reflecting possibly the different character of Behcet’s in non-endemic areas, such as the US. Males were more likely to have eye involvement, suggesting that even though females may have more activity overall, males may have more severe disease.
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Table. Change in Outcomes Associated with Criteria and Gender |
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|
Met Behcets Criteria |
Gender |
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|
Outcomes* |
N |
Yes |
No |
P† |
Female |
Male |
P† |
|
|
BSAS |
832 |
47.0 (21.6) |
33.6 (19.3) |
<0.001 |
|
43.8 (21.4) |
36.9 (21.9) |
0.001 |
|
Function |
784 |
17.8 (19.8) |
8.8 (13.5) |
<0.001 |
14.7 (18.2) |
13.8 (18.4) |
0.720 |
|
|
Fatigue VAS |
812 |
55.2 (34.0) |
41.1 (35.1) |
<0.001 |
52.7 (34.2) |
42.4 (36.6) |
<0.001 |
|
|
Pt Global VAS |
810 |
49.2 (29.2) |
38.1 (29.0) |
<0.001 |
46.3 (29.5) |
41.7 (29.6) |
0.052 |
|
|
MD Global VAS |
781 |
27.5 (13.2) |
22.5 (13.1) |
<0.001 |
25.6 (12.4) |
25.8 (15.8) |
0.385 |
|
|
RAPID3 |
768 |
40.5 (24.0) |
29.3 (22.1) |
<0.001 |
|
37.6 (23.6) |
32.5 (24.6) |
0.008 |
|
*All outcomes are scaled [0-100]. |
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†P-values reported from multiple linear regression modeling independent association with Criteria Status, Gender, Race, Age and Formal Education Level as covariates. |
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To cite this abstract in AMA style:
Yazici Y, Bernstein H, Swearingen C. Patients Treated for Behcet Syndrome in the US Have Higher Disease Activity Scores at Presentation If They Fulfill ISG Criteria and If They Are Females, However Have Less Severe Disease Overall [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/patients-treated-for-behcet-syndrome-in-the-us-have-higher-disease-activity-scores-at-presentation-if-they-fulfill-isg-criteria-and-if-they-are-females-however-have-less-severe-disease-overall/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/patients-treated-for-behcet-syndrome-in-the-us-have-higher-disease-activity-scores-at-presentation-if-they-fulfill-isg-criteria-and-if-they-are-females-however-have-less-severe-disease-overall/