Metabolic Syndrome in Behçets Disease Patients: Keep an Eye on the Eye

Abstract

Background: Metabolic syndrome (MetS) is characterized by insulin resistance, high blood pressure/sugar, dyslipidemia, and obesity. Whether MetS and its components affect the development of Behçet's Disease (BD) remains unclear. Aims: The aim was to determine the frequency of MetS among BD patients and to study its relation to the disease characteristics. Methods: The study included 1028 adult BD patients recruited from 18 specialized rheumatology centers. 51 healthy matched control were considered. Behçet Disease Current Activity Form (BDCAF) and the BD damage index (BDI) were estimated. Adult Treatment Panel-III criteria were used to define MetS. Results: The mean age of patients was 36.8±10.1 years, M:F 2.7:1 and disease duration 7.01±5.2 years. Their mean BDCAF was 5.1±4.6 and BDI 5.5±2.8. MetS was present in 22.8% of patients and in 5.9% of control (3.9 fold higher-risk). Patients with MetS had a significantly increased age at onset (31.8±9.2 vs 29±8.5 years) and higher frequency of genital ulcers (96.2% vs 79.7%), skin involvement (73.1% vs 50.4%), arthritis (48.3% vs 29.1%)(p<0.0001) and CNS manifestations (18.8% vs 13%)(p=0.042) compared to those without. Eye involvement was significantly increased in those with MetS (82.1% vs 74.2%)(p=0.003) with increased frequency of posterior uveitis (67.1% vs 43.5%), retinal vessel occlusion (35.9% vs 21.3%), retinal vasculitis (41.9% vs 26.4%)(p<0.0001) and vitritis (37.2% vs 24%)(p=0.001). BDCAF was significantly lower (3.9±4.3 vs 5.6±4.6) and BDI higher (7.4±2.7vs5±2.6)(p<0.0001). Conclusion: BD patients with MetS are predisposed to mucocutaneous, musculoskeletal, neuropsychiatric and ocular manifestations with consequently increased damage. The affection of the deeper structures of the eye should alarm rheumatologists to keep in mind that all patients should have an eye examination especially those with MetS.

Association of Behçet’s disease with the risk of metabolic syndrome and its components: a systematic review and meta-analysis

“…The results of the nine trials including 35,648 patients, also demonstrated an increased OR for hypertension in association with BD [ 27 , 30 , 32 – 38 ]. The meta-analysis revealed a significant association between BD and hypertension (pooled OR 1.39; 95% CI 1.13–1.70; P = 0.002), with considerable heterogeneity ( I 2 = 65%; P = 0.003; Fig.…”

“…Twelve studies recorded triglyceride levels [ 22 – 29 , 31 , 34 , 35 , 38 ], and nine studies recorded high-density lipoprotein (HDL) levels [ 22 – 28 , 34 , 38 ] in patients with BD. The meta-analysis illustrated that elevated triglyceride levels were not significantly related to BD (MD, 9.36; 95% CI −1.96–20.68; P = 0.11; Supplementary Fig.…”

“…3A). Excluding five studies that did not report the number of patients with diabetes mellitus among non-BD participants, pooled analysis of the other 10 case-control studies [27,28,[30][31][32][34][35][36][37][38] showed that diabetes mellitus was detected in 7.45% of patients with BD, and 7.00% of controls. The association between BD and diabetes mellitus was considered significant (OR 1.23; 95% CI 1.12-1.35; P < 0.0001; Fig.…”

Damage accrual in Behçet disease: Behçet's Syndrome Overall Damage Index (BODI) versus Behçet's Disease Damage Index (BDI)

“…Behçet's disease (BD) is a multi‐systemic inflammatory disorder associated with a wide variability of unpredictable clinical manifestations ranging from mild mucocutaneous lesions to severely morbid or life‐threatening conditions like central nervous system involvement, blindness, large vessel vasculitis and perforation of the gastrointestinal tract 1,2 . High disease activity for long periods together with the long courses of treatment with immunosuppressive drugs may lead to permanent organ damage with high morbidity and poor disease outcomes 3,4 . Discrimination among disease activity and damage is crucial for proper disease management and avoidance of unnecessary increase in immunosuppressive treatment 5,6 …”

“…1,2 High disease activity for long periods together with the long courses of treatment with immunosuppressive drugs may lead to permanent organ damage with high morbidity and poor disease outcomes. 3,4 Discrimination among disease activity and damage is crucial for proper disease management and avoidance of unnecessary increase in immunosuppressive treatment. 5,6 Accordingly, The Outcome Measures in Rheumatology (OMERACT) has emphasized that assessment of both BD activity and damage are mandatory, separate and complementary items in the BD outcome measures.…”