Endothelial functions are more severely impaired during active disease period in patients with Behcet’s disease

Abstract

Oral apthous ulcers and skin lesions are the primary symptoms of Behcet's disease (BD). To date, there is no study to investigate possible associations between these lesions and endothelial functions. We have hypothesized that active BD period with oral and skin lesions might have more deteriorating effect on endothelial functions. Thirty-five patients with BD were registered for the study. Each subject was evaluated two times in both active and inactive disease periods. The subject with at least 30 days of lesion-free period was regarded in the inactive disease period, and the subject with any oral and/or skin lesions was regarded in the active disease period. For the control group, 35 healthy age- and sex-matched subjects were registered. In each subject, flow-mediated dilation (FMD) of the brachial artery after transient ischemia was evaluated in both active and inactive disease periods. High-sensitivity C-reactive protein (hsCRP) values (3.30 +/- 5.76 vs 14.19 +/- 13.55 vs 1.82 +/- 1.31, P < 0.001) and FMD values (13.89 +/- 5.57 vs 8.53 +/- 4.78 vs 15.83 +/- 5.29, P < 0.001) were significantly different among the BD patients in inactive and active disease periods and among control subjects. FMD values in inactive and active disease periods modestly correlated to hsCRP and low-density lipoprotein cholesterol values. Brachial FMD is more prominently impaired in BD patients within the active disease period. BD patients are possibly more vulnerable to cardiovascular manifestations when they are in the active disease period.

Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis

“…2B). Pooled data from inactive disease patients [20,22,23,25,26,[37][38][39] also revealed impaired FMD with moderate heterogeneity (SMD ¼ À0.74, 95% CI: À 0.97 to À 0.51, p ¼ 0.0001, I 2 ¼ 35.5%) (Fig. 2C).…”

“…1), 24 studies met the criteria for inclusion in the analysis: 9 investigated FMD and/or EMD [18][19][20][21][22][23][24][25][26], 11 IMT [8,[27][28][29][30][31][32][33][34][35][36] and 4 investigated both [37][38][39][40].…”

“…Several inflammatory, immunological and metabolic factors may contribute to early FMD dysfunction in BD: elevated plasma concentration of homocysteine [19,26] Creactive protein [22,26], enhanced oxidative [24] and nitrative stress [45], impaired biological activity of nitric oxide [42,43] and an abnormal lipid profile [19,22,43]. However, because these data were not uniformly present in the studies included in the metaanalysis we could not perform a meta-regression that would have explained to what extent the abovementioned factors contributed to the FMD difference between BD and controls.…”

“…BD patients were then split according to active and inactive disease where possible: we arbitrarily considered patients with vascular involvement [20,37,38] as having active disease and pooled them with active disease patients proper [20,22,23,25,26,40]: FMD was significantly lower with moderate heterogeneity (SMD ¼ À1.17, 95% CI: À 1.45 to À 0.89, p ¼ 0.0001, I 2 ¼ 37.5%) (Fig. 2B).…”

Association between peripheral vascular endothelial dysfunction and livedoid vasculopathy

“…[8][9][10] Brachial FMD has also been used to detect peripheral endothelial dysfunction in patients with Behçet disease and ocular glaucomatocyclitic crisis. 11,12 The presence of endothelial dysfunction in patients with LV has never been evaluated. Therefore, our study assessed vascular endothelial function in patients with LV and matched control subjects to determine the pathogenesis of this disease.…”