ROLE OF IMMUNOMODULATORY AND BIOLOGICAL THERAPY IN THE TREATMENT OF PATIENTS WITH BEHCET'S UVEITIS -CASES FROM CLINICAL PRACTICE

  • Natasa Trpevska Sekerinov University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Vesna Celeva Markovska University Clinic for Eye Diseases, Skopje, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia
  • Stefan Pandilov University Clinic for Eye Diseases, Skopje, Republic of North Macedonia
  • Filip Gucev University Clinic for Rheumatology, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia

Abstract

Morbus Behcet is a multisystemic, chronic disease, vasculitis, of unknown etiology. The highest incidence is in the countries of the so-called “silk roadâ€. In Macedonia, the frequency of this disease is currently unknown, but it is often under-diagnosed and unrecognized. In addition to the others, one of the main manifestations is ocular, which is presented by involvement of any of the structures of the uveal tract, the retina and the optic nerve. The diagnosis is established on the basis of clinical parameters, complemented by genetic analyses-HLA-B51 typing and Pathergy positive test and ophthalmic imaging-techniques such as OCT, OCT-A, FFA. Treatment of the condition is multidisciplinary with local and systemic corticosteroid therapy, conventional immunosuppressive drugs, and biological therapy. The aim of this paper is to present our experience in diagnosis and therapeutic modalities in patients with this disease.


Keywords: uveitis, retinitis, Behcet's disease, azathioprine, cyclosporine, adalimumab

References

1. Pasero G, Marson P. Hippocrates and rheumatology. Clin Exp Rheumatol. 2004 Nov-Dec;22(6):687-9. PMID: 15638041.
2. Adamantiades, B. "Sur un cas d'iritis à hypopion récidivant." Ann Ocul (Paris) 168 (1931): 271-278.
3. Behcet, H. J. D. W. "Uber rezidivierende, aphtose, durch ein virus verursachte geschrwre am mund, am auge und an den genitalien." Dermatol Wochenschr 105 (1937): 1152-1157.
4. Çakar Özdal P. Behçet's Uveitis: Current Diagnostic and Therapeutic Approach. Turk J Ophthalmol. 2020 Jun 27;50(3):169-182. doi: 10.4274/tjo.galenos.2019.60308. PMID: 32631005; PMCID: PMC7338748.
5. Paovic, J., Paovic, P., & Sredovic, V. (2013). Behcet's disease: systemic and ocular manifestations. BioMed research international, 2013, 247345. https://doi.org/10.1155/2013/247345
6. Saadoun D, Wechsler B, Desseaux K, Le Thi Huong D, Amoura Z, Resche-Rigon M, Cacoub P. Mortality in Behçet's disease. Arthritis Rheum. 2010 Sep;62(9):2806-12. doi: 10.1002/art.27568. PMID: 20496419.
7. Horie Y, Meguro A, Ohta T, Lee EB, Namba K, Mizuuchi K, Iwata D, Mizuki N, Ota M, Inoko H, Ishida S, Ohno S, Kitaichi N. HLA-B51 Carriers are Susceptible to Ocular Symptoms of Behçet Disease and the Association between the Two Becomes Stronger towards the East along the Silk Road: A Literature Survey. Ocul Immunol Inflamm. 2017 Feb;25(1):37-40. doi: 10.3109/09273948.2015.1136422. Epub 2016 Mar 8. PMID: 26954704.
8. Zając H, Turno-Kręcicka A. Ocular Manifestations of Behçet's Disease: An Update on Diagnostic Challenges and Disease Management. J Clin Med. 2021 Nov 5;10(21):5174. doi: 10.3390/jcm10215174. PMID: 34768694; PMCID: PMC8584626.
9. Shahram F, Mæhlen MT, Akhlaghi M, Davatchi F, Liao YJ, Weyand CM. Geographical variations in ocular and extra-ocular manifestations in Behçet's disease. Eur J Rheumatol. 2019 Jul 19;6(4):199-206. doi: 10.5152/eurjrheum.2019.18215. PMID: 31329543; PMCID: PMC6812895.
10. Leccese P, Alpsoy E. Behçet's Disease: An Overview of Etiopathogenesis. Front Immunol. 2019 May 10;10:1067. doi: 10.3389/fimmu.2019.01067. PMID: 31134098; PMCID: PMC6523006.
11. International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol. 2014 Mar;28(3):338-47. doi: 10.1111/jdv.12107. Epub 2013 Feb 26. PMID: 23441863.
12. Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet. 1990 May 5;335(8697):1078-80. PMID: 1970380.
13. Kirino Y, Nakajima H. Clinical and Genetic Aspects of Behçet's Disease in Japan. Intern Med. 2019 May 1;58(9):1199-1207. doi: 10.2169/internalmedicine.2035-18. Epub 2019 Jan 10. PMID: 30626832; PMCID: PMC6543215.
14. Karadag O, Bolek EC. Management of Behcet's syndrome. Rheumatology (Oxford). 2020 May 1;59(Suppl 3):iii108-iii117. doi: 10.1093/rheumatology/keaa086. PMID: 32348509.
15. Yalcinbayir O, Caliskan E, Ucan Gunduz G, Gelisken O, Kaderli B, Yucel AA. Efficacy of Dexamethasone Implants in Uveitic Macular Edema in Cases with Behçet Disease. Ophthalmologica. 2019;241(4):190-194. doi: 10.1159/000490674. Epub 2018 Sep 21. PMID: 30244248.
16. Standardization of Uveitis Nomenclature (SUN) Working Group. Classification Criteria for Behçet Disease Uveitis. Am J Ophthalmol. 2021 Aug;228:80-88. doi: 10.1016/j.ajo.2021.03.058. Epub 2021 May 11. PMID: 33845008; PMCID: PMC8545705.
17. Yazici H, Seyahi E, Hatemi G, Yazici Y. Behçet syndrome: a contemporary view. Nat Rev Rheumatol. 2018 Feb;14(2):107-119. doi: 10.1038/nrrheum.2017.208. Epub 2018 Jan 3. Erratum in: Nat Rev Rheumatol. 2018 Jan 24;14 (2):119. PMID: 29296024.
18. Tugal-Tutkun I, Onal S, Stanford M, Akman M, Twisk JWR, Boers M, Oray M, Özdal P, Kadayifcilar S, Amer R, Rathinam SR, Vedhanayaki R, Khairallah M, Akova Y, Yalcindag F, Kardes E, Basarir B, Altan Ç, Özyazgan Y, Gül A. An Algorithm for the Diagnosis of Behçet Disease Uveitis in Adults. Ocul Immunol Inflamm. 2021 Aug 18;29(6):1154-1163. doi: 10.1080/09273948.2020.1736310. Epub 2020 Apr 14. PMID: 32286112.
19. Emre S, Güven-Yılmaz S, Ulusoy MO, Ateş H. Optical coherence tomography angiography findings in Behcet patients. Int Ophthalmol. 2019 Oct;39(10):2391-2399. doi: 10.1007/s10792-019-01080-1. Epub 2019 Feb 1. PMID: 30710254.
20. Tugal-Tutkun I, Ozdal PC, Oray M, Onal S. Review for Diagnostics of the Year: Multimodal Imaging in Behçet Uveitis. Ocul Immunol Inflamm. 2017 Feb;25(1):7-19. doi: 10.1080/09273948.2016.1205100. Epub 2016 Aug 19. PMID: 27541278.
21. Tugal-Tutkun I, Gupta V, Cunningham ET. Differential diagnosis of behçet uveitis. Ocul Immunol Inflamm. 2013 Oct;21(5):337-50. doi: 10.3109/09273948.2013.795228. Epub 2013 Jun 3. PMID: 23730816.
22. Yalçindag FN, Can E, Ozdemir O. Intravenous methylprednisolone pulse therapy for acute posterior segment uveitis attacks in Behçet's disease. Ann Ophthalmol (Skokie). 2007 Fall;39(3):194-7. doi: 10.1007/s12009-007-0018-5. PMID: 18025624.
23. Hatemi G, Christensen R, Bang D, Bodaghi B, Celik AF, Fortune F, Gaudric J, Gul A, Kötter I, Leccese P, Mahr A, Moots R, Ozguler Y, Richter J, Saadoun D, Salvarani C, Scuderi F, Sfikakis PP, Siva A, Stanford M, Tugal-Tutkun I, West R, Yurdakul S, Olivieri I, Yazici H. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis. 2018 Jun;77(6):808-818. doi: 10.1136/annrheumdis-2018-213225. Epub 2018 Apr 6. PMID: 29625968.
24. Bettiol A, Hatemi G, Vannozzi L, Barilaro A, Prisco D, Emmi G. Treating the Different Phenotypes of Behçet's Syndrome. Front Immunol. 2019 Dec 6;10:2830. doi: 10.3389/fimmu.2019.02830. PMID: 31921115; PMCID: PMC6915087.
25. Martín-Varillas JL, Atienza-Mateo B, Calvo-Rio V, Beltrán E, Sánchez-Bursón J, Adán A, Hernández-Garfella M, Valls-Pascual E, Sellas-Fernández A, Ortego N, Maíz O, Torre I, Fernández-Espartero C, Jovani V, Peiteado D, Valle DD, Aurrecoechea E, Caracuel MA, García-González AJ, Álvarez ER, Vegas-Revenga N, Demetrio-Pablo R, Castañeda S, González-Gay MA, Hernández JL, Blanco R; Ricardo Blanco on behalf of the Spanish Collaborative Group of Refractory Behçet’s Disease. Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients. J Rheumatol. 2021 May;48(5):741-750. doi: 10.3899/jrheum.200300. Epub 2020 Oct 1. PMID: 33004539.
26. Duica I, Voinea LM, Mitulescu C, Istrate S, Coman IC, Ciuluvica R. The use of biologic therapies in uveitis. Rom J Ophthalmol. 2018 Apr-Jun;62(2):105-113. PMID: 30206553; PMCID: PMC6117529.
Published
2023-11-03
How to Cite
SEKERINOV, Natasa Trpevska et al. ROLE OF IMMUNOMODULATORY AND BIOLOGICAL THERAPY IN THE TREATMENT OF PATIENTS WITH BEHCET'S UVEITIS -CASES FROM CLINICAL PRACTICE. Journal of Morphological Sciences, [S.l.], v. 6, n. 2, p. 29-40, nov. 2023. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol6no2-4>. Date accessed: 27 july 2024.
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