THE COURSE OF BEHÇET’S DISEASE FOLLOWING COVID-19 DIAGNOSIS: A LARGE RETROSPECTIVE COHORT STUDY

Year 2024, Volume: 87 Issue: 3, 202 - 208, 19.07.2024

Tuğba Atcı , Yasemin Erdem , Dilay Yerlioğlu Ak , Afet Akdağ Köse

https://doi.org/10.26650/IUITFD.1402339

Abstract

Objective: Behçet’s disease (BD) is a chronic vasculitic disease with mucocutaneous and systemic involvements. This study aims to examine the effects of COVID-19 on the symptoms and course of BD.
Material and Method: The BD patients who were followed up in our department with a history of COVID-19 were evaluated regarding the course of infection and the course of BD postCOVID diagnosis, assessed by Behçet’s Disease Activity Index (BDAI).
Result: Among 449 BD patients, 68 (15.1%) had contracted COVID-19. The mean age of the patients was 42.7±11.8 years of whom 63.2% (n=43) were female. While most (n=48, 70.6%) had only mucocutaneous symptoms, others also had systemic symptoms (n=20, 29.4%) during their BD course; 86.8% (n=59) had received colchicine only at the time of infection. Prior to infection, 85.3% (n=58) had been in remission (BDAI score of 0), while 14.7% (n=10) already had active BD (BDAI score between 1-3). Post-COVID-19 diagnosis, activation or exacerbation of activation was seen in 39.7% (n=27) of BD patients, as characterized by increased BDAI scores (BDAI score between 1-4). No change was recorded in 60.3% (n=41) of the patients. Disease activation in the BD patients was mostly mucocutaneous (n=21, 30.9%). Comparison of the BD patients’ BDAI scores pre- and post-COVID-19 diagnosis revealed the scores to be significantly elevated (p<0.001; z=-4.691), demonstrating the possible effects of COVID-19 on BD severity.
Conclusion: COVID-19 infection may lead to activation of BD symptoms, with new organs being involved in some patients, which should be confirmed by prospective large series.

Keywords

Behcet’s disease, COVID-19, disease activity

Ethical Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board (Approval number: E-29624016-050.99-518561).

Supporting Institution

None

Thanks

None

COVID-19 TANISINI TAKİBEN BEHÇET HASTALIĞININ SEYRİ: GENİŞ BİR RETROSPEKTİF KOHORT ÇALIŞMASI

Abstract

Amaç: Behçet hastalığı mukokutanöz ve sistemik bulgularla seyredebilen kronik vaskülitik bir hastalıktır. Bu çalışmada Covid-19 enfeksiyonunun Behçet hastalığı semptomları ve seyri üzerine etkisini incelemeyi amaçladık.
Gereç ve Yöntem: Üçüncü basamak bir Dermatoloji merkezinde takip edilen Behçet hastaları Covid-19 enfeksiyonu açısından sorgulandı. Daha önce PCR ile kanıtlanmış Covid-19 geçiren hastalarda Behçet hastalığı seyri ve aktivasyonu Behçet Hastalığı Aktivite İndeksi (BHAİ) ile retrospektif olarak değerlendirildi.
Bulgular: Bu çalışma sürecinde poliklinik kontrolüne başvuran 449 Behçet hastasının 68'inin (%15,1) Covid-19 enfeksiyonu geçirme öyküsü mevcuttu. Hastaların yaş ortalaması 42,7±11,8 yıl olup, %63,2'si (n=43) kadındı. Behçet hastalarımızın çoğunda (n=48, %70,6) Behçet hastalığı sadece mukokutanöz tutulum ile seyrederken, bir kısmında (n=20, %29,4) çeşitli sistemik tutulumlar hastalık sürecinde gelişmişti. Bu hastaların büyük bir çoğunluğu (n=59, %86,8) enfeksiyon öncesinde sadece kolşisin tedavisi almaktaydı. Covid-19 enfeksiyonu öncesi BHAİ skorlama sistemine bakıldığında hastalarımızın %85,3'ü (n=58) remisyondaydı (BHAİ0), %14,7'si (n=10) ise halihazırda aktivasyondaydı (BHAİ-1-3). Covid-19 enfeksiyonunu takiben hastaların %39,7'sinde (n=27) aktivasyon veya hastalık şiddetinde artış görüldü (BHAİ-1-4). Behçet hastalarımızda enfeksiyonu takiben görülen hastalık aktivasyonu çoğunlukla mukokutanöz (n=21, %30,9) lezyonlar ile karakterizeydi. Hastaların %60,3'ünde (n=41) ise hastalık seyrinde herhangi bir değişiklik kaydedilmedi. Behçet hastalarında Covid-19 enfeksiyonu öncesi ve enfeksiyon sonrası BHAİ skorları karşılaştırıldığında anlamlı düzeyde (p<0,001 ve z=-4,691) Behçet hastalık şiddetinde artış tespit edildi.
Sonuç: Covid-19 enfeksiyonu bazı hastalarda Behçet hastalığı semptomlarının aktivasyonuna, alevlenmesine ve hatta yeni organ tutulumuna yol açabilmektedir. Bu durum prospektif geniş serilerle doğrulanmalıdır.

Keywords

Behçet hastalığı, Covid-19, hastalık aktivitesi

References

• 1. Davatchi F, Chams-Davatchi C, Shams H, Shahram F, Nadji A, Akhlaghi M, et al. Behcet’s disease: epidemiology, clinical manifestations, and diagnosis. Expert Rev Clin Immunol 2017;13(1):57-65. [CrossRef] google scholar
• 2. Muralidar S, Ambi S, Sekaran S, Krishnan UM. The emergence of COVID-19 as a global pandemic: Understanding the epidemiology, immune response and potential therapeutic targets of SARS-CoV-2. Biochimie 2020;179:85-100. [CrossRef] google scholar
• 3. Esatoglu S, N Tascilar, Babaoglu H, Bes C, Yurttas B, Akar S, et al. COVID-19 among patients with inflammatory rheumatic diseases. Front Immunol 2021;12:651715. [CrossRef] google scholar
• 4. Pakhchanian H, Raiker R, Kardeş, S. COVID-19 among patients with Behçet syndrome in the United States. Clin Rheumatol 2022;41(1):317-9. [CrossRef] google scholar
• 5. Espinosa G, Araujo O, Amaro S, Bodro M, Moreno PJ, Moreno R, et al. COVID-19 and Behçet’s disease: clinical case series. Ann Rheum Dis 2021;80(3):e41. [CrossRef] google scholar
• 6. Mattioli I, Bettiol A, Silvestri E, Urban ML, Palermo A, Fagni F, et al. Prevalence and clinical course of SARS-CoV-2 infection in patients with Behçet’s syndrome. Clin Exp Rheumatol 2021;132(5):47-50. [CrossRef] google scholar
• 7. Zouboulis CC, van Laar JAM, Schirmer M, Emmi G, Fortune F, Gül A, et al. Adamantiades-Behçet’s disease (Behçet’s disease) and COVID-19. J Eur Acad Dermatol Venereol 2021;35(9):e541-3. [CrossRef] google scholar
• 8. Yurttaş B, Oztas M, Tunc A, Balkan İİ, Tabak OF, Hamuryudan V, et al. Characteristics and outcomes of Behçet’s syndrome patients with Coronavirus Disease 2019: a case series of 10 patients. Intern Emerg Med 2020;15(8):1567-71. [CrossRef] google scholar
• 9. AlBloushi AF, Alfawaz AM, Abu El Asrar AM. Implications of COVID-19 infection on patients with uveitis under biologic treatment. Br J Ophthalmol 2022;106(11):1538-41. [CrossRef] google scholar
• 10. Ozcifci G, Aydin T, Atli Z, Balkan II, Tabak F, Oztas M, et al. The incidence, clinical characteristics, and outcome of COVID-19 in a prospectively followed cohort of patients with Behçet’s syndrome. Rheumatol Int 2022;42(1):101-13. [CrossRef] google scholar
• 11. Shahram F, Esalatmanesh K, Khabbazi A, Rezaieyazdi Z, Mirfeizi Z, Sadeghi A, et al. Coronavirus disease 2019 in patients with Behcet’s disease: a report of 59 cases in Iran. Clin Rheumatol 2022;41(4):1177-83. [CrossRef] google scholar
• 12. Oztas M, Bektas M, Karacan I, Aliyeva N, Dag A, Aghamuradov S, et al. Frequency and severity of COVID-19 in patients with various rheumatic diseases treated regularly with colchicine or hydroxychloroquine. J Med Virol 2022;94(7):3431-7. [CrossRef] google scholar
• 13. Polat B, Erden A, Güven SC, Armağan B, Karakaş Ö, Özdemir B, et al. COVID-19 in patients with Behçet’s disease: Outcomes and rate of Behçet’s exacerbations in a retrospective cohort. Mod Rheumatol 2022;32(2):455-9. [CrossRef] google scholar
• 14. Bourguiba R, Kyheng M, Kone-Paut I, Rouzaud D, Avouac J, Devaux M, et al. COVID-19 infection among patients with autoinflammatory diseases: a study on 117 French patients compared with 1545 from the French RMD COVID-19 cohort: COVIMAI - the French cohort study of SARS-CoV-2 infection in patient with systemic autoinflammatory diseases. RMD Open 2022;8(1):e002063. [CrossRef] google scholar
• 15. Correa-Rodrîguez M, Callejas-Rubio JL, Rueda-Medina B, Rıos-Fernandez R, Hera-Fernândez J, Ortego-Centeno N. Clinical course of Covid-19 in a cohort of patients with Behçet disease. Med Clin (Barc) 2022;159(6):262-7. [CrossRef] google scholar
• 16. Enginar A, Gundogdu M. The course of COVID-19 in patients with Behçet’s disease. Reumatologia/ Rheumatology 2021;59(6):356-1. [CrossRef] google scholar
• 17. Landewe RB, Machado PM, Kroon F, Bijlsma HW, Burmester GR, Carmona L, et al. EULAR provisional recommendations for the management of rheumatic and musculoskeletal diseases in the context of SARS-CoV-2. Ann Rheum Dis 2020;79(7):851-8. [CrossRef] google scholar
• 18. Wang Q, Liu J, Shao R, Han X, Su C, Lu W. Risk and clinical outcomes of COVID-19 in patients with rheumatic diseases compared with the general population: a systematic review and meta-analysis. Rheumatol Int 2021;41(5):851-61. [CrossRef] google scholar
• 19. Sardana K, Sinha S, Sachdeva S. Colchicine in dermatology: Rediscovering an old drug with novel uses. Indian Dermatol Online J 2020;11(5):693-700. [CrossRef] google scholar
• 20. Tardif JC, Bouabdallaoui N, L’Allier PL, Gaudet D, Shah B, Pillinger MH, et al. Colchicine for community-treated patients with COVID-19 (COLCORONA): a phase 3, randomised, double-blinded, adaptive, placebo-controlled, multicentre trial. Lancet Respir Med 2021;9(8):924-32. [CrossRef] google scholar
• 21. Cavalli G, Colafrancesco S, Emmi G, Imazio M, Lopalco G, Maggio MC, et al. Interleukin 1a: a comprehensive review on the role of IL-1a in the pathogenesis and treatment of autoimmune and inflammatory diseases. Autoimmun Rev 2021;20(3): 102763. [CrossRef] google scholar
• 22. O’Keefe J, Grall K. Profound weakness and blurry vision in a pandemic: a case report. Clin Pract Cases Emerg Med 2021;5(2):230-3. [CrossRef] google scholar