BEHÇET SENDROMU BULGULARI İLE MEVSİMLER ARASINDAKİ İLİŞKİ

Öz

Amaç: Behçet sendromu ülkemizde yaygın olarak görülmekte olan bir hastalıktır ve bu hastalığın tüm komplikasyonlarının ve belirtilerinin şiddetlenmesinin mevsimsel ilişki gösterebileceği düşünülmektedir. Bu çalışmanın amacı Behçet sendromuna bağlı sistemik tutulumlar ile bu tutulumların mevsimsel ilişkisini incelemektir.

Gereç ve Yöntemler: Onsekiz yaşından büyük ve sistemik tutulumu olan 77 hasta bu retrospektif çalışmaya dahil edildi. Hastaların yaşı, cinsiyeti, Behçet sendromu ve sistem tutulumu tarihi bilgileri, C-reaktif protein değeri, eritrosit sedimantasyon hızı, hemoglobin, lökosit, trombosit, nötrofil, lenfosit, albümin, kreatinin değerleri kaydedildi. Behçet sendromuna bağlı sistemik tutulum kaydına ulaşılan hastaların tutulum paternleri, artrit, üveit, derin ven trombozu, üveit + derin ven trombozu, nörobehçet ve enterobehçet olarak gruplara ayrıldı.

Bulgular: Hastaların ortalama yaşı 41.6±9.8 yıl iken, 31 (%40) hasta kadındı. Paterji testi pozitifliği 38 (%49) hastada saptandı. Behçet sendromu sistem tutulumlarının dağılımı incelendiğinde 7 hastada artrit, 36 hastada üveit, 8 hastada derin ven trombozu, 14 hastada üveit ve derin ven trombozu birlikte mevcutken, 10 hastada nörobehçet ve 2 hastada enterobehçet mevcuttu. Behçet sendromu tutulumlarının tanı tarihlerinin mevsimlere göre dağılımı incelendiğinde üveit, derin ven trombozu ve bu iki tutulumun birlikte görüldüğü hastaların ilkbahar ve yaz mevsimlerinde sonbahar ve kış mevsimlerine göre daha yüksek oranda tanı aldığı görüldü (p<0.05).

Sonuç: Behçet sendromunın sistemik etkilerinin tanı alma dönemlerinin, diğer bir deyişle aktivasyon dönemlerinin mevsimlerle anlamlı şekilde ilişkili olduğu saptandı. Bu ilişkinin diğer otoimmün inflamatuar hastalıklarda olduğu gibi Behçet sendromunun da etiyolojisinde yer alan genetik yatkınlığa eşlik eden çevresel faktör etkisi nedeniyle olduğunu düşündürmektedir ve hastaların takibinde bu ilişki göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Behçet Sendromu
• Mevsimler *
• Üveit
• Venöz Tromboz

The Relationship Between Behçet's Syndrome Findings and Seasons

Öz

Objective: Behçet's syndrome is a common disease in our country and it is thought that there may be a seasonal relationship with the exacerbation of all complications and symptoms of this disease. The aim of this study is to examine the seasonal relationship of systemic involvement in Behçet's syndrome.

Material and Methods: Seventy-seven patients older than 18 years old with systemic involvement were included in this retrospective study. Age, gender, history of Behçet's syndrome and system involvement, C-reactive protein value, erythrocyte sedimentation rate, hemoglobin, leukocyte, thrombocyte, neutrophil, lymphocyte, albumin, and creatinine values were recorded. The involvement patterns of patients with systemic involvement record due to Behçet's disease were divided into groups as arthritis, uveitis, deep vein thrombosis, uveitis+ deep vein thrombosis, neurobehçet and enterobehçet.

Results: While the mean age of the patients was 41.6±9.8 years, 31 (40%) of them were female. Pathergy test positivity was found in 38 (49%) patients. When the distribution of Behçet's syndrome system involvement was examined, 7 patients had arthritis, 36 patients had uveitis, 8 patients had deep vein thrombosis, 14 patients had uveitis and deep vein thrombosis, 10 patients had neurobehçet and 2 patients had enterobehçet. When the distribution of diagnosis dates of Behçet's syndrome involvement by seasons was examined, it was seen that patients with uveitis, deep vein thrombosis and with both involvements were diagnosed at a higher rate in spring and summer than in autumn and winter (p<0.05).

Conclusion: It was determined that the diagnosis periods of the systemic effects of Behçet's syndrome, in other words, the activation periods were related to the seasons. This relationship is thought to be due to the environmental factor effect accompanying the genetic predisposition in Behçet's syndrome etiology as in other autoimmune inflammatory diseases, and this relationship should be considered in the follow-up of patients.

Anahtar Kelimeler

• Behcet Syndrome
• Seasons*
• Uveitis
• Venous Thrombosis

Kaynakça

1. 1. Uzkeser H, Haliloglu S, Cayir Y, Bilen N, Karaaslan Y, Kosar A, et al. Is mean platelet volume a new activity criteria in Behçet's disease? Blood Coagul Fibrinolysis. 2015;26(7):836-9.
2. 2. Zierhut M, Mizuki N, Ohno S, Inoko H, Gül A, Onoé K et al. Immunology and functional genomics of Behçet's disease. Cell Mol Life Sci. 2003;60(9):1903-22.
3. 3. Chavan M, Jain H, Diwan N, Khedkar S, Shete A, Durkar S. Recurrent aphthous stomatitis: a review. J Oral Pathol Med. 2012;41(8):577-83.
4. 4. Kiraz S, Ertenli I, Oztürk MA, Haznedaroğlu IC, Celik I, Calgüneri M. Pathological haemostasis and "prothrombotic state" in Behçet's disease. Thromb Res. 2002;105(2):125-33.
5. 5. Uzkeser H, Karatay S, Yildirim K, Karakuzu A, Uyanik MH. Antistreptolysin O levels in patients with Behcet's disease. Eurasian J Med. 2011;43(3):169-72.
6. 6. Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. Lancet. 1990;335(8697):1078-80.
7. 7. Lee JH, Cheon JH, Hong SP, Kim TI, Kim WH. Seasonal variation in flares of intestinal Behçet's disease. Dig Dis Sci. 2015;60(11):3373-8.
8. 8. Schlesinger N, Schlesinger M, Seshan SV. Seasonal variation of lupus nephritis: high prevalence of class V lupus nephritis during the winter and spring. J Rheumatol. 2005;32(6):1053-7.

9. 9. Hawley DJ, Wolfe F, Lue FA, Moldofsky H. Seasonal symptom severity in patients with rheumatic diseases: a study of 1,424 patients. J Rheumatol. 2001;28(8):1900-9.
10. 10. Duarte-García A, Fang H, To CH, Magder LS, Petri M. Seasonal variation in the activity of systemic lupus erythematosus. J Rheumatol. 2012;39(7):1392-8.
11. 11. Alpert P, Osetinsky I, Ziv B, Shafir H. A new seasons definition based on classified daily synoptic systems: an example for the eastern Mediterranean. International Journal of Climatology. 2004;24(8):1013-21.
12. 12. Amit M, Molad Y, Kiss S, Wysenbeek AJ. Seasonal variations in manifestations and activity of systemic lupus erythematosus. Br J Rheumatol. 1997;36(4):449-52.
13. 13. Haga HJ, Brun JG, Rekvig OP, Wetterberg L. Seasonal variations in activity of systemic lupus erythematosus in a subarctic region. Lupus. 1999;8(4):269-73.
14. 14. Krause I, Shraga I, Molad Y, Guedj D, Weinberger A. Seasons of the year and activity of SLE and Behcet's disease. Scand J Rheumatol. 1997;26(6):435-9.
15. 15. Szeto CC, Mok HY, Chow KM, Lee TC, Leung JY, Li EK et al. Climatic influence on the prevalence of noncutaneous disease flare in systemic lupus erythematosus in Hong Kong. J Rheumatol. 2008;35(6):1031-7.
16. 16. Jacoby RK, Jayson MI, Cosh JA. Onset, early stages, and prognosis of rheumatoid arthritis: a clinical study of 100 patients with 11-year follow-up. Br Med J. 1973;2(5858):96-100.
17. 17. Smedslund G, Hagen KB. Does rain really cause pain? A systematic review of the associations between weather factors and severity of pain in people with rheumatoid arthritis. Eur J Pain. 2011;15(1):5-10.
18. 18. Smedslund G, Mowinckel P, Heiberg T, Kvien TK, Hagen KB. Does the weather really matter? A cohort study of influences of weather and solar conditions on daily variations of joint pain in patients with rheumatoid arthritis. Arthritis Rheum. 2009;61(9):1243-7.
19. 19. Savage EM, McCormick D, McDonald S, Moore O, Stevenson M, Cairns AP. Does rheumatoid arthritis disease activity correlate with weather conditions? Rheumatol Int. 2015;35(5):887-90.
20. 20. Abasolo L, Tobías A, Leon L, Carmona L, Fernandez-Rueda JL, Rodriguez AB et al. Weather conditions may worsen symptoms in rheumatoid arthritis patients: the possible effect of temperature. Reumatol Clin. 2013;9(4):226-8.
21. 21. Terao C, Hashimoto M, Furu M, Nakabo S, Ohmura K, Nakashima R et al. Inverse association between air pressure and rheumatoid arthritis synovitis. PLoS One. 2014;9(1):e85376.
22. 22. Cay HF, Sezer I, Firat MZ, Kaçar C. Which is the dominant factor for perception of rheumatic pain: meteorology or psychology? Rheumatol Int. 2011;31(3):377-85.
23. 23. Jena AB, Olenski AR, Molitor D, Miller N. Association between rainfall and diagnoses of joint or back pain: retrospective claims analysis. Bmj. 2017;359:j5326.
24. 24. Mouterde G, Lukas C, Logeart I, Flipo RM, Rincheval N, Daurès JP et al. Predictors of radiographic progression in the ESPOIR cohort: the season of first symptoms may influence the short-term outcome in early arthritis. Ann Rheum Dis. 2011;70(7):1251-6.
25. 25. Sadamoto K, Ogawa T, Ogura T, Saito E. Season and activity of rheumatoid arthritis in Japan. APLAR Journal of Rheumatology. 2007;10(1):29-31.
26. 26. Schlesinger N. Acute gouty arthritis is seasonal: possible clues to understanding the pathogenesis of gouty arthritis. J Clin Rheumatol. 2005;11(4):240-2.
27. 27. Duret PM, Meyer N, Saraux A, Devauchelle-Pensec V, Seror R, Le-Guern V et al. Seasonal effect on fatigue, pain and dryness in primary Sjögren's syndrome. Arthritis Res Ther. 2020;22(1):39.
28. 28. Touma Z, Eder L, Zisman D, Feld J, Chandran V, Rosen CF et al. Seasonal variation in vitamin D levels in psoriatic arthritis patients from different latitudes and its association with clinical outcomes. Arthritis Care Res (Hoboken). 2011;63(10):1440-7.
29. 29. Bang D, Yoon KH, Chung HG, Choi EH, Lee ES, Lee S. Epidemiological and clinical features of Behçet's disease in Korea. Yonsei Med J. 1997;38(6):428-36.
30. 30. Kim HJ, Bang D, Lee SH, Yang DS, Kim DH, Lee KH et al. Behçet's syndrome in Korea: a look at the clinical picture. Yonsei Med J. 1988;29(1):72-8.
31. 31. Cansu D, Kaşifoğlu T, Korkmaz C. Is there any relationship between season/weather and oral ulcer in Behçet's disease? Eur J Rheumatol. 2014;1(3):89-91.
32. 32. Suzuki Kurokawa M, Suzuki N. Behcet's disease. Clin Exp Med. 2004;4(1):10-20.
33. 33. Hatemi G, Yazici H. Behçet's syndrome and micro-organisms. Best Pract Res Clin Rheumatol. 2011;25(3):389-406.