EN | TR
E-ISSN: 1308-6308 ISSN: 1304-9054
Pediatrik Behçet Hastalarında Ek İmmünsüpresif Tedavi Gereksiniminin Tahmin Edilmesi
PDF
Cite
Share
Request
Original Article
VOLUME: 21 ISSUE: 1
P: 43-51
April 2023

Pediatrik Behçet Hastalarında Ek İmmünsüpresif Tedavi Gereksiniminin Tahmin Edilmesi

J Curr Pediatr 2023;21(1):43-51
DOI: 10.4274/jcp.2022.46693
Seher Şener 1
Sermin Dalarslan 2
Ezgi Deniz Batu 1
1. Hacettepe Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Romatoloji Bilim Dalı, Ankara, Türkiye
2. Hacettepe Üniversitesi Tıp Fakültesi, Ankara, Türkiye
No information available.
No information available
Received Date: 24.07.2022
Accepted Date: 31.12.2022
Publish Date: 14.04.2023
PDF
Cite
Share
Request

ABSTRACT

Introduction:

In our study, we evaluated the demographic and clinical characteristics of patients with pediatric Behçet’s disease (BD) and our treatment approaches in these patients. In addition, we aimed to determine the predictive factors in patients who need additional immunosuppressive therapy in addition to colchicine and short-term corticosteroid therapy in the treatment of BD.

Materials and Methods:

Pediatric patients followed up with BD between 2004-2022 were included in the study. The patients were divided into two groups: those receiving colchicine and/or short-term corticosteroids (group A) and those needing additional immunosuppressive treatments (group B).

Results:

Of a total of 103 patients, 57 (55.3%) were being followed up with a diagnosis of BD, and 46 (44.7%) with a diagnosis of incomplete BD. The most preferred drug in the treatment was colchicine (92.2%). Corticosteroids (55.3%) were often preferred with additional immunosuppressive agents in patients with major organ involvement. Biologic agents were used in 15 (14.6%) patients who were resistant to other immunosuppressive treatments. There were 56 patients in group A and 47 patients in group B. Ocular involvement and venous thrombosis were more common in group B. In addition, acute phase reactants and BHAAF scores at the diagnosis were higher in group B than in group A patients. As a result of multivariate analysis, ocular involvement [odds ratio (OR) 4,045, 95% CI 6,205-525,470; p=0.001], venous thrombosis (OR 2,497, 95% CI 3.048-48.358; p=0.001) and elevated acute phase reactants (OR 1.312, 95% CI 0.086-0.842; p=0.024) were identified as independent factors predicting the need for additional immunosuppressive therapy.

Conclusion:

Correct management of pediatric BD cases is very important in order to prevent complications that may develop. Our results showed that patients with ocular or vascular involvement, high acute phase reactants, and BHAAF scores may need additional immunosuppressive therapy at admission. Determining the factors that predict the need for treatment is important in making the appropriate treatment and follow-up plan for patients.

References

1
Behçet H, Matteson EL. On relapsing, aphthous ulcers of the mouth, eye and genitalia caused by a virus. 1937. Clin Exp Rheumatol 2010;28:S2-5.
2
Yıldız M, Köker O, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Pediatric Behçet’s disease - clinical aspects and current concepts. Eur J Rheumatol 2019;7:1-10.
3
Batu ED, Ozen S. Pediatric vasculitis. Current Rheumatol Rep 2012;14:121-9.
4
Batu ED, Sönmez HE, Sözeri B, Butbul Aviel Y, Bilginer Y, Özen S. The performance of different classification criteria in paediatric Behcet's disease. Clin Exp Rheumatol 2017;35:119-23.
5
Koné-Paut I, Shahram F, Darce-Bello M, Cantarini L, Cimaz R, Gattorno M, et al. Consensus classification criteria for paediatric Behçet’s disease from a prospective observational cohort: PEDBD. Ann Rheum Dis 2016;75:958-64.
6
Yıldız M, Köker O, Kasapçopur Ö. Primer-değişken çapta damarları tutan vaskülitler: Behçet hastalığı ve Cogan sendromu. Ergüven M, (editör). 1. Baskı. Ankara: Türkiye Klinikleri; 2021. p.57-62.
7
Zayed HS, Medhat BM, Seif EM. Evaluation of treatment adherence in patients with Behçet's disease: its relation to disease manifestations, patients' beliefs about medications, and quality of life. Clin Rheumatol 2019;38:761-8.
8
Gezgin Yıldırım D, Bakkaloğlu SA, Hasanreisoglu M, Buyan N. Disease activity and outcomes in juvenile Behçet's disease: 10 years’ experience of a single centre. Clin Exp Rheumatol 2020;38:105-11.
9
Butbul Aviel Y, Batu ED, Sözeri B, Aktay Ayaz N, Baba L, Amarilyo G, et al. Characteristics of pediatric Behçet's disease in Turkey and Israel: A cross-sectional cohort comparison. Semin Arthritis Rheum 2020;50:515-20.
10
Atmaca L, Boyvat A, Yalcindag FN, Atmaca-Sonmez P, Gurler A. Behcet disease in children. Ocul Immunol Inflamm 2011;19:103-7.
11
Sungur GK, Hazirolan D, Yalvac I, Ozer PA, Yuksel D, Vural ET, et al. Clinical and demographic evaluation of Behçet disease among different paediatric age groups. Br J Ophthalmol 2009;93:83-7.
12
Karincaoglu Y, Borlu M, Toker SC, Akman A, Onder M, Gunasti S, et al. Demographic and clinical properties of juvenile-onset Behcet's disease: A controlled multicenter study. J Am Acad Dermatol 2008;58:579-84.
13
Ekici Tekin Z, Çelikel E, Aydin F, Kurt T, Sezer M, Tekgöz N, et al. Juvenile Behçet’s disease: a tertiary center experience. Clinical Rheumatol 2022;41:187-94.
14
Gallizzi R, Pidone C, Cantarini L, Finetti M, Cattalini M, Filocamo G, et al. A national cohort study on pediatric Behcet’s disease: cross-sectional data from an Italian registry. Pediatr Rheumatol Online J 2017;15:84.
15
Nanthapisal S, Klein NJ, Ambrose N, Eleftheriou D, Brogan PA. Paediatric Behçet’s disease: a UK tertiary centre experience. Clin Rheumatol 2016;35:2509-16.
16
Hamzaoui A, Jaziri F, Ben Salem T, Said Imed Ben Ghorbel F, Lamloum M, Smiti Khanfir M, et al. Comparison of clinical features of Behcet disease according to age in a Tunisian cohort. Acta Med Iran 2014;52:748-51.
17
Shahram F, Nadji A, Akhlaghi M, Faezi ST, Chams-Davatchi C, Shams H, et al. Paediatric Behçet’s disease in Iran: report of 204 cases. Clin Exp Rheumatol 2018;36:135-40.
18
Zeghidi H, Saadoun D, Bodaghi B. Ocular manifestations in Behçet’s disease. Rev Med Interne 2014;35:97-102.
19
Namba K, Goto H, Kaburaki T, Kitaichi N, Mizuki N, Asukata Y, et al. A Major Review: Current Aspects of Ocular Behçet's Disease in Japan. Ocul Immunol Inflamm 2015;23:S1-23.
20
Makmur EL, Myers SH, Hanns L, Haskard DO, Brogan P, Ambrose N. Comparing the clinical profile of adults and children with Behçet's syndrome in the UK. Clin Exp Rheumatol 2019;37:48-51.
21
Batu ED. Diagnostic/classification criteria in pediatric Behcet's disease. Rheumatol Int 2019;39:37-46.
22
Costagliola G, Cappelli S, Consolini R. Behçet's Disease in Children: Diagnostic and Management Challenges. Ther Clin Risk Manag 2020;16:495-507.
23
Hu YC, Yang YH, Lin YT, Wang LC, Yu HH, Lee JH, et al. Clinical manifestations and anti-TNF alpha therapy of juvenile Behçet’s disease in Taiwan. BMC Pediatr 2019;19:232.
24
Alpsoy E, Leccese P, Emmi G, Ohno S. Treatment of Behçet’s Disease: An Algorithmic Multidisciplinary Approach. Front Med (Lausanne) 2021;8:624795.
25
Alpsoy E, Akman A. Behçet’s disease: an algorithmic approach to its treatment. Arch Dermatol Res 2009;301:693-702.
26
Çakar Özdal P. Behçet’s Uveitis: Current Diagnostic and Therapeutic Approach. Turk J Ophthalmol 2020;50:169-82.
27
Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Huseyin Altunbas H, Urgancioglu M. Uveitis in Behçet disease: an analysis of 880 patients. Am J Ophthalmol 2004;138:373-80.
28
Alibaz-Oner F, Karadeniz A, Ylmaz S, Balkarl A, Kimyon G, Yazc A, et al. Behçet disease with vascular involvement: effects of different therapeutic regimens on the incidence of new relapses. Medicine (Baltimore). 2015;94:e494.