Behçet's disease in Japan and in Great Britain: a comparative study

Abstract

Behçet's disease (BD) is an important cause of visual morbidity throughout the world, but shows striking differences in racial predilection. Despite important advances in the therapeutic management of acute intraocular inflammation, the long-term impact of these new strategies on visual outcome of BD and their efficacy in different ethnic groups is unknown. A comparative study of patient characteristics, clinical ocular features and inflammatory score, and current therapy was undertaken on all patients fulfilling the International Study Group criteria for Behçet's disease and the Behçet's Disease Research Committee of Japan, who attended the Uveitis Clinics of Moorfields Eye Hospital (n=19) and Kurume University School of Medicine (KUS) (n=35) during a continuous consecutive four-week period. Japanese patients were significantly older (43.2+/-11.8 years) than the patients seen in London (35.4+/-8. 9 years). There was a predominance of male patients in both groups. All patients seen in KUS were Japanese, while the patients in London included 12 Caucasians, five Middle Eastern, one African, and one Asian. No significant differences were seen between the two populations in the duration of systemic disease or systems affected by the disease, such as mouth ulcers, genital ulcers, skin lesions including erythema nodosum, or arthritis. The duration of ocular disease was similar in both centres: around seven years. There was, however, a significant difference in the number of eyes with active anterior uveitis (59.7% KUS vs 18.4% London (chi-square: 5.4; p=0.006)) and/or posterior uveitis (31.3% KUS vs 18.4% London (chi-square: 5.42; p<0.02)). No significant differences were found in the number of eyes with optic disc swelling or optic atrophy and in each centre the number of eyes with vision greater than 6/9 or worse than 6/60 were the same. The treatment schedules were very different between the two centres. More patients were treated with topical steroids in Japan (68.7% KUS vs 10.5% London (chi-square: 30.5; p=0.001), but a similar number used concomitant intraocular pressure-lowering agents. More patients received systemic steroids in London (84.2% London vs 17% KUS (chi-square: 20.25; p<0.001)). Three patients received systemic steroids alone, five had prednisolone and cyclosporin, four had prednisolone and azathioprine, and four had triple therapy with prednisolone, cyclosporin, and azathioprine. Only one patient used colchicine. Cyclosporin use was similar in London and KUS (47.4% and 42.8%, respectively). In Japan, three patients used prednisolone alone and three tacrolimus (FK506). In addition, two patients, who were on steroids alone, took colchicine as well. More patients in Japan had undergone surgery for cataract and glaucoma (chi-square: 4.0; p=0.045). In KUS, seven of 67 eyes had cataract surgery. A further three eyes had visually significant cataract and two eyes had undergone glaucoma surgery. In contrast, no patients in London had undergone any surgery up to and including this period.

Comparison of Presenting Features and Three-year Disease Course in Turkish Patients with Behçet Uveitis Who Presented in the Early 1990s and the Early 2000s

“…Although the treatment schedules differed and Japanese patients had more active disease, visual results were comparable. 25 Visual acuity was worse than 6/60 in 31% of patients in Japan and 21% of patients in the United Kingdom. 25 428 A. K. Cingu et al…”

“…24 Muhaya and associates compared Behçet patients seen in Japan and the United Kingdom in a cross-sectional observational study conducted simultaneously at two centers. 25 The duration of ocular disease was around 7 years in both cohorts. Although the treatment schedules differed and Japanese patients had more active disease, visual results were comparable.…”

Behcet's disease: from Hippocrates to the third millennium

“…11 This dismal statistic has been reduced by modern immunosuppressive agents and more targeted immunomodulators, but up to 15% of ocular patients remain resistant to intervention. 12 Cyclosporine, tacrolimus (FK 506), azathioprine, and anti-T cell monoclonal antibodies have all proved useful in controlling ocular disease in the short term, but their effect over the duration of active eye disease, which may be two to three decades, remains unproved. [13][14][15][16] However, with increasing knowledge of the immune events that underlie Behçet's disease, newer interventions have become more targeted.…”

Pattern of uveitis in Behçet’s disease in a referral center in Tunisia, North Africa

“…The pattern of BU has been well documented in some countries where the disease is endemic [3,[6][7][8][9][10][11][12], and studies have shown similarities and distinct differences in epidemiologic profiles, ocular involvement, complications, and visual prognosis. However, recent data on BU from the North African region are scarce [13,14], and published studies in the English literature are lacking.…”