Pediatrik Behçet Hastalığında Kas İskelet Sistemi Tutulumu: Tek Merkez Deneyimi
Yıl 2023,
Cilt: 17 Sayı: 6, 483 - 487, 27.11.2023
Serkan Coşkun
,
Zahide Ekici Tekin
,
Elif Çelikel
,
Vildan Güngörer
,
Nilüfer Tekgöz
,
Müge Sezer
,
Cüneyt Karagöl
,
Melike Mehveş Kaplan
,
Nimet Öner
,
Merve Cansu Polat
,
Banu Acar
Öz
Amaç: Amaç: Behçet hastalığı (BH) tekrarlayan oral ülserler, genital ülserler, oküler bulgular ve vasküler tutulum ile karakterize inflamatuvar bir hastalıktır. Kas-iskelet sistemi semptomları hem başvuru sırasında hem de Behçet hastalığının seyri boyunca yaygındır. Bu çalışmanın amacı, kliniğimiz tarafından pediatrik Behçet hastalığı (PEDBH) tanısı ile takip edilen hastalarda kas-iskelet sistemi tutulumunun sıklığını ve özelliklerini bildirmektir.
Gereç ve Yöntemler: Bu retrospektif tıbbi kayıt incelemesi, Ocak 2010 ile Aralık 2022 tarihleri arasında 16 yaşından önce PEDBH tanısı alan hastaları kapsamaktadır.
Bulgular: Çalışmaya dahil edilen 90 hastanın 48’i (%53.3) kadındı. Ortalama tanı yaşı 12.4±3 yıldı. Tüm hastalarda (%100) tekrarlayan oral ülserler, 55’inde (%61.1) genital ülserler, 44’ünde (%48.9) kas-iskelet sistemi tutulumu, 37’sinde (%41.1) deri bulguları, 19’unda (%21.1) göz tutulumu, 17’sinde (%18.9) nörolojik tutulum ve 17’sinde (%18.9) vasküler tutulum vardı. Eklem tutulumu olan hastaların 27’sinde (%65.9) artrit, 41’inde (%100) artralji, 37’sinde (%90.1) oligoartiküler eklem tutulumu ve 29’unda (%70.7) asimetrik tutulum vardı. Hastalarda en sık etkilenen eklem diz (%63.4) olurken, bunu ayak bileği (%31.7), el bileği (%19.5), sakroiliak eklemler (%14.6), eller (%12.2) (Bir hastada metakarpofalangeal eklem ve dört hastada proksimal interfalangeal eklem tutulumu vardı), dirsek (%9.8) ve ayaklar (%4.9) (Hastalardan birinde metatarsofalangeal eklem tutulumu ve diğerinde proksimal interfalangeal eklem tutulumu vardı) takip etti.
Sonuç: Kas-iskelet sistemi semptomları PEDBH’de yaygındır ve tanı anında hastalığın erken bir belirtisi olarak gözlemlenebilir. Bu nedenle, kas-iskelet sistemi semptomları olan çocuklarda olası BH’nin ayrıntılı bir şekilde araştırılması önemlidir.
Kaynakça
- Batu E. D. Diagnostic/classification criteria in pediatric Behçet's disease. Rheumatol Int 2019; 39: 37–46.
- Bettiol A, Prisco D, Emmi G. Behçet: the syndrome. Rheumatology (Oxford, England) 2020; 59: 101–7.
- Koné-Paut I. Behçet's disease in children, an overview. Pediatr Rheumatol Online J 2016; 14:10.
- Vaiopoulos A. G, Kapsimali V, Kanakis M. A, Vaiopoulos G, Samarkos M, Zouboulis C. et al. The frequency of arthritis in Adamantiades-Behçet's disease in Greek patients. J Eur Acad Dermatol Venereol 2019; 33: 416–20.
- Bicer A. Musculoskeletal Findings in Behcet's Disease. Pathology res Int 2012; 653806.
- Yıldız M, Köker O, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Pediatric Behçet's disease- clinical aspects and current concepts. Eur J Rheumatol 2019; 5;7:1-10.
- Mülkoğlu C, Ayhan FF. A case with Behçet's disease involving erosive Metacarpophalangeal joint arthritis: the value of ultrasonography in the diagnosis of an Erosion. BMC Med Imaging 2020; 20: 60.
- Kötter I, Lötscher, F. Behçet's Syndrome Apart From the Triple Symptom Complex: Vascular, Neurologic, Gastrointestinal, and Musculoskeletal Manifestations. A Mini Review. Front Med (Lausanne) 2021; 8: 639758.
- Shahram F, Nadji A, Akhlaghi, M, Faezi S. T, Chams-Davatchi C, Shams H, et al. Paediatric Behçet's disease in Iran: report of 204 cases. Clin Exp Rheumatol 2018; 36: 135–40.
- Alibaz-Oner F, Direskeneli H. Update on the Diagnosis of Behçet's Disease. Diagnostics (Basel) 2022; 23;13:41.
- International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 2014; 28:338-47.
- Koné-Paut I, Shahram F, Darce-Bello M, Cantarini L, Cimaz R, Gattorno M. et al. PEDBD group. Consensus classification criteria for paediatric Behçet's disease from a prospective observational cohort: PEDBD. Ann Rheum Dis 2016;75:958-64.
- Tse S, Colbert R. Textbook of Pediatric Rheumatology. Eighth Edition. Philadelphia: Elsevier 2021:253-54.
- Yildiz M, Haslak F, Adrovic A, Sahin S, Koker O, Barut K, et al. Pediatric Behçet's Disease Front Med (Lausanne) 2021;8:627192.
- Köseoğlu H, Yücetürk T, Bayraktar N, Tufan M, Gencer M, Yücel A. Anti-CCP Antibodies in Behcet's Disease with or without articular Involvement. Yeni Tıp Dergisi 2011; 28: 92- 4.
- Rota D. D, Tanacan E, İbis O, Gündüz Ö, Erdoğan F. G, Gürler A. Clinical and Demographic Characteristics of 197 Behçet Patients. J Ankara Univ Fac Med 2021;74:60-7.
- Davatchi F, Chams-Davatchi C, Shams H, Nadji A, Faezi T, Akhlaghi M, et al. Adult Behcet's disease in Iran: analysis of 6075 patients. Int J Rheum Dis 2016;19: 95–103.
- Sarıcaoğlu H, Erdem H, Toker ÇS, Başkan EE, Yücel A, Tunalı Ş. The Clinical and Demographic Characteristics of Pediatric Behçet’s Patients. Güncel Pediatri 2008;6: 89-93.
- Davatchi F. Behçet's disease. Int J Rheum Dis 2018;21:2057-8.
- Zou J, Luo JF, Shen Y, Cai JF, Guan JL. Cluster analysis of phenotypes of patients with Behçet's syndrome: a large cohort study from a referral center in China. Arthritis Res Ther 2021;23:45.
- İlgen U. Clusters in Behçet's syndrome. Arthritis Res Ther 2022;24:242.
- Gaggiano C, Maselli A, Sfikakis PP, Laskari K, Ragab G, Hegazy MT, et al. Musculoskeletal manifestations in children with Behçet's syndrome: data from the AIDA Network Behçet's Syndrome Registry. Intern Emerg Med 2023;18:743-54.
- Yurtkuran, M, Yurtkuran M, Alp A, Sivriogl, K, Dilek K, Tamgaç F, et al. Hand involvement in Behçet's disease. Joint bone spine 2006;73:679–83.
- Frikha F, Marzouk S, Kaddour N, Frigui M, Bahloul Z. Destructive arthritis in Behçet's disease: a report of eight cases and literature review. Int J Rheum Dis 2009;12: 250–5.
- Özelçi R, Şahin Ö, Öztoprak İ, Hayta E, Kaptanoğlu E, Elden H. Determining the prevalence of sacroiliitis in Behçet’s disease by magnetic resonance imaging. Cumhuriyet Med J 2010; 32: 298-302.
- Hatemi G, Christensen R, Bang D, Bodaghi B, Celik A. F, Fortune F, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis 2018;77:808–18.
- Hatemi G, Seyahi E, Fresko I, Talarico R, Uçar D, Hamuryudan V. Behçet's syndrome: one year in review. Clin Exp Rheumatol 2022;40:1461-71.
- Alibaz-Oner F, Direskeneli H. Advances in the Treatment of Behcet's Disease. Curr Rheumatol Rep 2021; 20;23:47.
- Esatoglu SN, Hatemi G. Update on the treatment of Behçet's syndrome. Intern Emerg Med 2019; 14:661-75.
- Vitale A, Rigante D, Lopalco G, Emmi G, Bianco M. T, Galeazzi M, et al. New therapeutic solutions for Behçet's syndrome. Expert Opin Investig Drugs 2016; 25:827-40.
Musculoskeletal Involvement in Pediatric Behçet's Disease: A Single Center Experience
Yıl 2023,
Cilt: 17 Sayı: 6, 483 - 487, 27.11.2023
Serkan Coşkun
,
Zahide Ekici Tekin
,
Elif Çelikel
,
Vildan Güngörer
,
Nilüfer Tekgöz
,
Müge Sezer
,
Cüneyt Karagöl
,
Melike Mehveş Kaplan
,
Nimet Öner
,
Merve Cansu Polat
,
Banu Acar
Öz
Background: Behçet’s disease (BD) is an inflammatory disease characterized by recurrent oral ulcers, genital ulcers, ocular manifestations, and vascular involvement. Musculoskeletal symptoms are common both at the time of presentation and throughout the course of BD, and similar symptoms are also observed in pediatric Behçet’s disease (PEDBD). This study aims to report the frequency and role of musculoskeletal involvement in PEDBD followed by our clinic.
Method: This retrospective medical record review included a total of 90 patients diagnosed with PEDBD before the age of 16 years between January 2010 and December 2022.
Results: Of the patients, 48 (53.3%) were female and 42 (46.7%) were male. Their mean age at diagnosis was 12.4 years. All patients (100%) had recurrent oral ulcers, while 55 (61.1%) had genital ulcers, 44 (48.9%) had musculoskeletal involvement, 37 (41.1%) had skin manifestations, 19 (21.1%) had ocular involvement, 17 (18.9%) had neurological involvement, and 17 (18.9%) had vascular involvement. Among the patients with joint involvement, 27 (65.9%) had arthritis, 41 (100%) had arthralgia, 37 (90.1%) had oligoarticular joint involvement, and 29 (70.7%) had unilateral involvement. The most commonly affected joints in the patients was in the knee (63.4%), followed by the ankle (31.7%), the wrist (19.5%), sacroiliac joints (14.6%), the hands (12.2%), the elbow (9.8%), and the feet (4.9%).
Conclusions: Musculoskeletal symptoms are common in PEDBD and can be observed as an early sign of the disease at the time of diagnosis. Therefore, it is important to thoroughly inquire about possible BD in children with musculoskeletal symptoms.
Kaynakça
- Batu E. D. Diagnostic/classification criteria in pediatric Behçet's disease. Rheumatol Int 2019; 39: 37–46.
- Bettiol A, Prisco D, Emmi G. Behçet: the syndrome. Rheumatology (Oxford, England) 2020; 59: 101–7.
- Koné-Paut I. Behçet's disease in children, an overview. Pediatr Rheumatol Online J 2016; 14:10.
- Vaiopoulos A. G, Kapsimali V, Kanakis M. A, Vaiopoulos G, Samarkos M, Zouboulis C. et al. The frequency of arthritis in Adamantiades-Behçet's disease in Greek patients. J Eur Acad Dermatol Venereol 2019; 33: 416–20.
- Bicer A. Musculoskeletal Findings in Behcet's Disease. Pathology res Int 2012; 653806.
- Yıldız M, Köker O, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Pediatric Behçet's disease- clinical aspects and current concepts. Eur J Rheumatol 2019; 5;7:1-10.
- Mülkoğlu C, Ayhan FF. A case with Behçet's disease involving erosive Metacarpophalangeal joint arthritis: the value of ultrasonography in the diagnosis of an Erosion. BMC Med Imaging 2020; 20: 60.
- Kötter I, Lötscher, F. Behçet's Syndrome Apart From the Triple Symptom Complex: Vascular, Neurologic, Gastrointestinal, and Musculoskeletal Manifestations. A Mini Review. Front Med (Lausanne) 2021; 8: 639758.
- Shahram F, Nadji A, Akhlaghi, M, Faezi S. T, Chams-Davatchi C, Shams H, et al. Paediatric Behçet's disease in Iran: report of 204 cases. Clin Exp Rheumatol 2018; 36: 135–40.
- Alibaz-Oner F, Direskeneli H. Update on the Diagnosis of Behçet's Disease. Diagnostics (Basel) 2022; 23;13:41.
- International Team for the Revision of the International Criteria for Behçet's Disease (ITR-ICBD). The International Criteria for Behçet's Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatol Venereol 2014; 28:338-47.
- Koné-Paut I, Shahram F, Darce-Bello M, Cantarini L, Cimaz R, Gattorno M. et al. PEDBD group. Consensus classification criteria for paediatric Behçet's disease from a prospective observational cohort: PEDBD. Ann Rheum Dis 2016;75:958-64.
- Tse S, Colbert R. Textbook of Pediatric Rheumatology. Eighth Edition. Philadelphia: Elsevier 2021:253-54.
- Yildiz M, Haslak F, Adrovic A, Sahin S, Koker O, Barut K, et al. Pediatric Behçet's Disease Front Med (Lausanne) 2021;8:627192.
- Köseoğlu H, Yücetürk T, Bayraktar N, Tufan M, Gencer M, Yücel A. Anti-CCP Antibodies in Behcet's Disease with or without articular Involvement. Yeni Tıp Dergisi 2011; 28: 92- 4.
- Rota D. D, Tanacan E, İbis O, Gündüz Ö, Erdoğan F. G, Gürler A. Clinical and Demographic Characteristics of 197 Behçet Patients. J Ankara Univ Fac Med 2021;74:60-7.
- Davatchi F, Chams-Davatchi C, Shams H, Nadji A, Faezi T, Akhlaghi M, et al. Adult Behcet's disease in Iran: analysis of 6075 patients. Int J Rheum Dis 2016;19: 95–103.
- Sarıcaoğlu H, Erdem H, Toker ÇS, Başkan EE, Yücel A, Tunalı Ş. The Clinical and Demographic Characteristics of Pediatric Behçet’s Patients. Güncel Pediatri 2008;6: 89-93.
- Davatchi F. Behçet's disease. Int J Rheum Dis 2018;21:2057-8.
- Zou J, Luo JF, Shen Y, Cai JF, Guan JL. Cluster analysis of phenotypes of patients with Behçet's syndrome: a large cohort study from a referral center in China. Arthritis Res Ther 2021;23:45.
- İlgen U. Clusters in Behçet's syndrome. Arthritis Res Ther 2022;24:242.
- Gaggiano C, Maselli A, Sfikakis PP, Laskari K, Ragab G, Hegazy MT, et al. Musculoskeletal manifestations in children with Behçet's syndrome: data from the AIDA Network Behçet's Syndrome Registry. Intern Emerg Med 2023;18:743-54.
- Yurtkuran, M, Yurtkuran M, Alp A, Sivriogl, K, Dilek K, Tamgaç F, et al. Hand involvement in Behçet's disease. Joint bone spine 2006;73:679–83.
- Frikha F, Marzouk S, Kaddour N, Frigui M, Bahloul Z. Destructive arthritis in Behçet's disease: a report of eight cases and literature review. Int J Rheum Dis 2009;12: 250–5.
- Özelçi R, Şahin Ö, Öztoprak İ, Hayta E, Kaptanoğlu E, Elden H. Determining the prevalence of sacroiliitis in Behçet’s disease by magnetic resonance imaging. Cumhuriyet Med J 2010; 32: 298-302.
- Hatemi G, Christensen R, Bang D, Bodaghi B, Celik A. F, Fortune F, et al. 2018 update of the EULAR recommendations for the management of Behçet's syndrome. Ann Rheum Dis 2018;77:808–18.
- Hatemi G, Seyahi E, Fresko I, Talarico R, Uçar D, Hamuryudan V. Behçet's syndrome: one year in review. Clin Exp Rheumatol 2022;40:1461-71.
- Alibaz-Oner F, Direskeneli H. Advances in the Treatment of Behcet's Disease. Curr Rheumatol Rep 2021; 20;23:47.
- Esatoglu SN, Hatemi G. Update on the treatment of Behçet's syndrome. Intern Emerg Med 2019; 14:661-75.
- Vitale A, Rigante D, Lopalco G, Emmi G, Bianco M. T, Galeazzi M, et al. New therapeutic solutions for Behçet's syndrome. Expert Opin Investig Drugs 2016; 25:827-40.