Oral ulcer activity in Behcet’s disease: Poor medication adherence is an underestimated risk factor

Abstract

Objective: The aim of this study was to evaluate the relationship between oral ulcer activity and medication adherence according to gender in Behçet's disease (BD) patients. Material and Methods:The study group included 330 BD patients (F/M: 167/163, mean age: 38.5±10.5 years). Oral ulcer activity and medication adherence were evaluated in the previous month. Medication adherence was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8) having a score range of "0" to "8" with high scores indicating better adherence. Low adherence was defined as <6 points on MMAS-8.Results: Over half of the group had active oral ulcers (n=219, 66.4%) within the month preceding the visit. The number of oral ulcers was significantly higher in female patients with low medication adherence (2.39±3.24) than in the rest of the female group (1.28±2.05; p=0.023). Although a similar trend was also observed in male patients (2.14±3.3 vs. 1.81±2.31), a significant relationship was not observed (p=0.89). The frequency of medication intake per day was lower in patients with high medication adherence than in the rest of the study group (p=0.04). Conclusion:Low medication adherence is a hidden risk factor in the management of BD. Poor adherence was associated with oral ulcer activity in female BD patients.

Moderation analysis exploring associations between age and mucocutaneous activity in Behçet’s syndrome: A multicenter study from Turkey

“…More aggressive treatments could be considered for mucocutaneous activity that could not be eliminated by non-IS medications in a limited period. 2,[11][12][13][14] These results were in accordance with the previous studies reporting that BS patients with systemic involvement were preceded by mucocutaneous manifestations, especially in younger patients. 40,41 Second, we addressed the moderational effect of age on mucocutaneous manifestations in BS.…”

“…BDCAF score was also observed to be higher in this group. More aggressive treatments could be considered for mucocutaneous activity that could not be eliminated by non‐IS medications in a limited period 2,11–14 . These results were in accordance with the previous studies reporting that BS patients with systemic involvement were preceded by mucocutaneous manifestations, especially in younger patients 40,41 …”

“…Mucocutaneous manifestations are the most commonly observed clinical features of BS, especially in women 12–14 . Oral ulcer activity is shown to be a predictive factor for the new onset of major organ involvement in young male patients with BS 15 .…”

“…2,11 Mucocutaneous manifestations are the most commonly observed clinical features of BS, especially in women. [12][13][14] Oral ulcer activity is shown to be a predictive factor for the new onset of major organ involvement in young male patients with BS. 15 However, mucocutaneous activity may decrease with increasing age, except oral ulcers which may persist.…”

Oral health is a mediator for disease severity in patients with Behçet’s disease: A multiple mediation analysis study

“…Although oral ulcer activity can be decreased through eliminating of oral infectious foci and antimicrobial treatments, complete remission of oral ulcers remains difficult without the use of effective anti‐inflammatory therapies . In addition, lack of adherence to medication, especially in patients with mucocutaneous involvement, seems to hamper the control of oral ulcers . Therefore, improving oral hygiene in patients with BD is difficult.…”