A Controlled Study of Sacroiliitis in Behçet’s Disease

Maghraoui, A. El; Tabache, Fatima; Bezza, A.; Abouzahir, A.; Ghafir, D.; Ohayon, V.; Archane, M. I.

doi:10.1007/s100670170063

Cited by 31 publications

(22 citation statements)

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“…5-97% clinically based arthritis in BD was previously reported [3,20,[24][25][26]. In our study 12/25 (48%) had clinically evident arthritis and this concurs with the incidence (about 50%) in the Mediterranean (Turkey, Egypt and Lebanon), and North Africans (Tunisia and Morocco) [23,[26][27][28], however in Asia (Oman) [29] or far Asians (Korea) [24,26], this incidence shoots up to 75-97%. 2/25 (8%) of our cases had rheumatoid-like hand findings in the form of swelling of PIPs and MCPs.…”

Section: Discussionsupporting

confidence: 77%

“…Skin lesions and positive SPT were found in 24% & 16% respectively compared to 16% in a North African study [23], others reported higher positive SPT (51% & 61.4%) [20,30]. These differences are attributable to geographic, environmental and genetic factors variability [21].…”

Section: A B Cmentioning

confidence: 99%

“…Regarding sex ratio; our study population ( : ratio 2.1:1) was in concordance with the world wide reports. Reported examples are: (188 & 72 ) [22], and (128/183 & 54/183 ) [23]. Up to 50% BD patients display rheumatic features including arthritis being intermittent, self-limiting, nonerosive and non-deforming usually monoarticular or symmetrical oligoarticular subacute arthritis [10].…”

Section: Discussionmentioning

confidence: 99%

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The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

Amin¹,

Darweesh²,

Attia³

2010

TONMEDJ

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Abstract:Introduction: Behçet's disease (BD) is a chronic relapsing inflammatory disease. 40-70% of BD patients display rheumatic features with a 9% incidence as an initial presentation. However, there are no pathognomonic laboratory tests in BD and the diagnosis depends on the occurrence and grouping of sufficient clinical manifestations to allow the physician to either suspect, or definitely diagnose the condition. Our aim was to assess the utility of Tc-99m methylene diphosphonate (Tc-99m MDP) bone scintigraphy for the detection of articular involvement in BD patients and its impact on disease activity & severity scoring.Methods: 25 BD patients diagnosed according to the international study group criteria for BD diagnosis (ISG) [18 , 7 , mean age 32.44±7.78, disease duration 6.98±4.61year] were included and subjected to selected joint x-ray and bone scintigraphy.Results: 25/25 was scintigraphically positive for arthritis [100%, 64%, 44%, 40%, 36%& 20% in wrist, Metacarpophalangeal, proximal interphalangeal (PIPs), distal interphalangeal (DIPs), Knees & ankles respectively]. 13/25 were clinically negative while scintigraphically positive for arthritis. 11/25 (44%) and 8/25 (32%) turned from inactive to active BD and from mild to moderate disease severity, based on their positive hand scintigraphy with treatment modification. 4/25 (16%) had recurrent oral ulcers with normal laboratory data and only positive hand scintigraphy; with follow-up they met ISG criteria.Conclusion: skeletal scintigraphy is a simple diagnostic modality with a low radiation burden, when compared to conventional radiology. Hence, when used appropriately in the diagnostic algorithm of BD, bone scintigraphy can be used for detection of early joint involvement, assessment of the extent and activity status with guidance for the selected therapy.

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Section: Discussionsupporting

confidence: 77%

Section: A B Cmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

Amin¹,

Darweesh²,

Attia³

2010

TONMEDJ

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“…En s›k, diz ve dirsek gibi orta büyüklükteki eklemler etkilenir. Olgular›n % 6-38'inde sakroiliit görülür (5,6). Literatürde Behçet hastal›¤› ve subklavyen arter t›kan›k-l›¤› birlikteli¤ini bildiren bir olgu vard›r (7).…”

Section: Tart›flmaunclassified

Behçet’s Disease: A Case of Peripheral Ulcerative Keratitis Leading to Corneal Perforation

Pelit¹,

Yaǵmur²,

Aslan³

et al. 2010

tod

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ÖzetSa¤ gözde k›zar›kl›k yak›nmas›yla baflvuran 27 yafl›nda erkek hastada periferik ülseratif keratit tespit edildi ve tablo k›sa süre-de perforasyon ile sonland›. Kornea yama grefti ve amniyon membran transplantasyonu ile göz bütünlü¤ü sa¤land›ktan sonra, hasta Romatoloji bölümü ile birlikte de¤erlendirildi. A¤›zda tekrarlay›c› aftlar, büyük damar vasküliti ve bilateral sakroileit tespit edilen hastaya Behçet hastal›¤› tan›s› kondu. ‹mmün bask›lay›c› tedavi baflland›. Bu çal›flmada korneada perforasyona neden olan Behçet hastal›¤› olgusu sunulmaktad›r. SummaryA 27-year-old man was admitted to our hospital with peripheral ulcerative keratitis that rapidly resulted in perforation. After reconstruction of the ocular surface with a corneal patch graft and amniotic membrane transplantation, the patient was also evaluated by Rheumatology department. The presence of recurrent oral ulcers, large-vessel vasculitis, and bilateral sacroiliitis led to a diagnosis of Behçet's disease. Immunosuppressive treatment was started. Here, we present a case of Behçet's disease with peripheral ulcerative keratitis causing corneal perforation. (TOD Journal 2010; 40: 242-4 OlguYirmi yedi yafl›nda erkek hasta, sa¤ gözde 2 gündür devam eden k›zar›kl›k ve hafif a¤r› yak›nmas› ile Göz Klini¤ine baflvurdu. Görme keskinli¤i tamd›. Korneada saat 2-3 aras›nda limbusa yak›n, ön stromay› tutan incelme ve komflulu¤unda konjonktivada bölgesel k›zar›kl›k tespit edildi. Ön kamarada reaksiyon yoktu. Fundus muayenesi do¤ald›. Sol göz normaldi. Her iki gözde de kuru göz bulgusu yoktu. Hastan›n öyküsünde, geçmiflte göz flikayetinin olmad›¤› saptand›. Hastan›n, son 2 y›l-d›r, ayda 1-2 kez tekrarlayan a¤›z aftlar› ve 8 y›ld›r zaman zaman fliddetlenen s›rt a¤r›s› ve sabah sertli¤i ile diz eklemlerinde a¤r› öyküsü vard›.Ofloksasin göz damlas› ve koruyucu madde içerme-yen yapay gözyafl› damlas› baflland›.Üç gün sonraki kontrolünde korneadaki incelmenin arka stromay› da içerecek flekilde ilerledi¤i görüldü (Resim 1). Hastaya amniyon zar› ile onar›m önerildi, ancak hasta kabul etmedi. ‹ki gün sonra, hasta flikayetinin artmas› üzerine tekrar baflvurdu. Yap›lan muayenesinde lezyon yerinde 2x2 mm geniflli¤inde bir perforasyon tespit edildi, bu bölgeden iris dokusu d›flar› ç›km›flt› (Resim 2). Hastaya, sevk edildi¤i Çukurova Üniversitesi

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“…Aunque sea más frecuente la forma oligoarticular que la sacroiliaca, el hallazgo de sacroileitis en la EB hace que sea necesario realizar un diagnóstico diferencial con las espondiloartropatías seronegativas (7). Otro punto importante a destacar, a propósito de nuestro caso, es la necesidad de utilizar técnicas de imagen apropiadas, ya que en grados leves-moderados en donde la exploración y la radiografía simple pueden ser normales, es necesario la utilización de la TC o la RMN para el diagnóstico (8)(9)(10) gún internista podría estar en desacuerdo. No obstante, creo que quizá enfoca el tema de un modo demasiado tradicional y un tanto restrictivo.…”

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Misión del internista en el hospital moderno

Fernández-Miera

2006

An. Med. Interna (Madrid)

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Se ha sugerido en diversas ocasiones que la Enfermedad de Behçet (EB) formase parte del grupo de las espondiloartropatías seronegativas. Existen estudios donde se objetiva la existencia de sacroileitis en pacientes diagnosticados de EB, junto a la coexistencia de la positividad de los antígenos HLA-B51 y HLA-B27. Añadimos un caso más a la literatura destacando la existencia de una sacroileitis bilateral en una paciente con EB con exploración anodina y radiografía normal.Se trata de una mujer de 27 años, fumadora de 6 cig/día y diagnosticada de EB desde hacía dos años en base a una clínica ocular (uveitis anterior) y mucocutánea (pseudofoliculitis cutánea y aftas bucogenitales). No había presentado complicaciones y seguía tratamiento con prednisona (15 mg/día), pentoxifilina, talidomida y anticonceptivos orales. Refiere cuadro de una semana de dolor en cara posterior de muslo derecho progresivo y agudizado con los movimientos incapacitando la deambulación. Asimismo refiere dolor en hombro izquierdo autolimitado, sin signos inflamatorios, una semana antes. Niega antecedente traumático anterior o clínica similar previamente. Se acompaña de la aparición de pápulas-pústulas generalizadas de predominio en extremidades, junto a hiperemia conjuntival y aftas bucogenitales dolorosas. En los últimos días febrícula vespertina y síndrome general. Niega clínica digestiva. A la exploración se encuentra afectada por el dolor. Foliculitis palpebral bilateral con exploración de polo anterior normal. Afta en mucosa yugal derecha. No adenopatías cervicales. Auscultación cardiopulmonar normal. Abdomen sin masas o megalias, no doloroso. Lasegue -.Fabere derecho dudoso. Extremidades con papulopús-tulas, sin edemas, cordón venoso o signos de flogosis.En analítica destaca un aumento de parámetros inflamatorios (PCR: 4,1 mg/dl) con leve leucocitosis y anemia normocítica Resto de bioquímica completa normal. Las determinaciones del HLA-B27 y HLA-B51 resultaron negativas. Radiografías de tórax, columna lumbar, pelvis y caderas sin hallazgos significativos. TC pelvis con afectación de ambas sacroiliacas, predominantemente derecha, con esclerosis subcondral y discretos signos de erosión (Fig. 1). Gammagafía ósea: En la fase precoz vascular, aumento de captación con hiperemia en ambas sacroilíacas. En la fase tardía, ósea, aumento de la captación del trazador en sacroiliacas, de predominio en la derecha. Moderado aumento de captación de la articulación esternocostoclavicular izquierda compatible con artropatía inflamatoria.La afectación articular en la EB ocurre hasta en un 50% y suele ser oligoarticular, no erosiva y de predominio en miembros inferiores. Afecta a grandes articulaciones, sobretodo a rodillas, tobillos y codos presentando un curso subagudo, intermitente y no deformante. Las articulaciones sacroiliacas no suelen afectarse por lo que no se considera la EB dentro de las espondiloartropatías. Varios autores han descrito el hallazgo frecuente de sacroileitis en la EB, dependiendo en gran medida del grado de afectación y de la técni...

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A Controlled Study of Sacroiliitis in Behçet’s Disease

Cited by 31 publications

References 5 publications

The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

The Utility of Tc-99m MDP Bone Scintigraphy for the Detection of Articular Involvement in Behçet's Disease

Behçet’s Disease: A Case of Peripheral Ulcerative Keratitis Leading to Corneal Perforation

Misión del internista en el hospital moderno

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