Behçet's disease medical therapy: Difference between revisions
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*Another Anti-TNF agent, [[etanercept]], may be useful in patients with mainly skin and mucosal symptoms.<ref>{{cite journal | author=Melikoglu M, Fresko I, Mat C, Ozyazgan Y, Gogus F, Yurdakul S, Hamuryudan V, Yazici H | title=Short-term trial of etanercept in Behçet's disease: a double blind, placebo controlled study | journal=J Rheumatol | year=2005 | pages=98-105 | volume=32 | issue=1 | id=PMID 15630733}}</ref> | *Another Anti-TNF agent, [[etanercept]], may be useful in patients with mainly skin and mucosal symptoms.<ref>{{cite journal | author=Melikoglu M, Fresko I, Mat C, Ozyazgan Y, Gogus F, Yurdakul S, Hamuryudan V, Yazici H | title=Short-term trial of etanercept in Behçet's disease: a double blind, placebo controlled study | journal=J Rheumatol | year=2005 | pages=98-105 | volume=32 | issue=1 | id=PMID 15630733}}</ref> | ||
*Interferon alfa-2a may also be an effective alternative treatment, particularly for patients with genital and oral ulcers<ref>{{cite journal | author=Alpsoy E, Durusoy C, Yilmaz E, Ozgurel Y, Ermis O, Yazar S, Basaran E | title=Interferon alfa-2a in the treatment of Behcet disease: a randomized placebo-controlled and double-blind study | journal=Arch Dermatol | year=2002 | pages=467-71 | volume=138 | issue=4 | id=PMID 11939808}}</ref> | *Interferon alfa-2a may also be an effective alternative treatment, particularly for patients with genital and oral ulcers as well as with ocular lesions.<ref>{{cite journal | author=Alpsoy E, Durusoy C, Yilmaz E, Ozgurel Y, Ermis O, Yazar S, Basaran E | title=Interferon alfa-2a in the treatment of Behcet disease: a randomized placebo-controlled and double-blind study | journal=Arch Dermatol | year=2002 | pages=467-71 | volume=138 | issue=4 | id=PMID 11939808}}</ref><ref>{{cite journal | author=Kotter I, Zierhut M, Eckstein AK, Vonthein R, Ness T, Gunaydin I, Grimbacher B, Blaschke S, Meyer-Riemann W, Peter HH, Stubiger N | title=Human recombinant interferon alfa-2a for the treatment of Behçet's disease with sight threatening posterior or panuveitis | journal=Br J Ophthalmol | year=2003 | pages=423-31 | volume=87 | issue=4 | id=PMID 12642304}}</ref> | ||
*[[Azathioprine]], when used in combination with interferon alfa-2b also shows promise,and [[Colchicine]] may also be useful for treating some genital ulcers, erythema nodosum, and arthritis.<ref>{{cite journal | author=Hamuryudan V, Ozyazgan Y, Fresko Y, Mat C, Yurdakul S, Yazici H | title=Interferon alfa combined with azathioprine for the uveitis of Behçet's disease: an open study | journal=Isr Med Assoc J | year=2002 | pages=928-30 | volume=4 | issue=11 Suppl | id=PMID 12455182}}</ref><ref>{{cite journal | author=Yurdakul S, Mat C, Tuzun Y, Ozyazgan Y, Hamuryudan V, Uysal O, Senocak M, Yazici H | title=A double-blind trial of colchicine in Behçet's syndrome | journal=Arthritis Rheum | year=2001 | pages=2686-92 | volume=44 | issue=11 | id=PMID 11710724}}</ref> | *[[Azathioprine]], when used in combination with interferon alfa-2b also shows promise,and [[Colchicine]] may also be useful for treating some genital ulcers, erythema nodosum, and arthritis.<ref>{{cite journal | author=Hamuryudan V, Ozyazgan Y, Fresko Y, Mat C, Yurdakul S, Yazici H | title=Interferon alfa combined with azathioprine for the uveitis of Behçet's disease: an open study | journal=Isr Med Assoc J | year=2002 | pages=928-30 | volume=4 | issue=11 Suppl | id=PMID 12455182}}</ref><ref>{{cite journal | author=Yurdakul S, Mat C, Tuzun Y, Ozyazgan Y, Hamuryudan V, Uysal O, Senocak M, Yazici H | title=A double-blind trial of colchicine in Behçet's syndrome | journal=Arthritis Rheum | year=2001 | pages=2686-92 | volume=44 | issue=11 | id=PMID 11710724}}</ref> | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Current treatment is aimed at easing the symptoms, reducing inflammation, and controlling the immune system. Anti-TNF therapy, such as infliximab, has shown promise in treating the uveitis associated with the disease. Another Anti-TNF agent, etanercept, may be useful in patients with mainly skin and mucosal symptoms. Interferon alfa-2a, azathioprine, colchicine, thalidomide, dapsone and rebamipide are among other agents that are used alternatives.
Medical Therapy
- Current treatment is aimed at easing the symptoms, reducing inflammation, and controlling the immune system.
- Anti-TNF therapy such as infliximab has shown promise in treating the uveitis associated with the disease.[1][2]
- Another Anti-TNF agent, etanercept, may be useful in patients with mainly skin and mucosal symptoms.[3]
- Interferon alfa-2a may also be an effective alternative treatment, particularly for patients with genital and oral ulcers as well as with ocular lesions.[4][5]
- Azathioprine, when used in combination with interferon alfa-2b also shows promise,and Colchicine may also be useful for treating some genital ulcers, erythema nodosum, and arthritis.[6][7]
- Thalidomide has been used due to its immune-modifying effect.[8]
- Dapsone and rebamipide have been shown, in small studies, to have beneficial results for mucocutaneous lesions.[9][10]
- A different origin could be explored in Behçet's disease particularly in regards to genetic linkage to HLA-B51 antigen, similar to the prevalence of HLA-B27 in ankylosing spondylitis which is a similar condition.
- Ankylosing spondylitis is not due to an 'overactive' immune system, but is a true autoimmune disease caused by molecular mimicry of the OSP (outer surface protein) with the Klebsiella pneumoniae germ (2 enzymes produced by this normally non-virulent pathogen), which is always present as a sub-clinical infection, typically at the ileocecal junction.
- The combination of antibiotics targeted to this specific germ, and dietary controls (elimination or severe restriction of all starches) could therefore potentially provide the most effective treatments, but such treatments have not yet been proven or generally approved.
References
- ↑ Sfikakis PP, Theodossiadis PG, Katsiari CG, Kaklamanis P, Markomichelakis NN (2001). "Effect of infliximab on sight-threatening panuveitis in Behçet's disease". Lancet. 358 (9278): 295–6. PMID 11498218.
- ↑ Sfikakis PP (2002). "Behçet's disease: a new target for anti-tumor necrosis factor treatment". Ann Rheum Dis. 61 Suppl 2: ii51–3. PMID 12379622.
- ↑ Melikoglu M, Fresko I, Mat C, Ozyazgan Y, Gogus F, Yurdakul S, Hamuryudan V, Yazici H (2005). "Short-term trial of etanercept in Behçet's disease: a double blind, placebo controlled study". J Rheumatol. 32 (1): 98–105. PMID 15630733.
- ↑ Alpsoy E, Durusoy C, Yilmaz E, Ozgurel Y, Ermis O, Yazar S, Basaran E (2002). "Interferon alfa-2a in the treatment of Behcet disease: a randomized placebo-controlled and double-blind study". Arch Dermatol. 138 (4): 467–71. PMID 11939808.
- ↑ Kotter I, Zierhut M, Eckstein AK, Vonthein R, Ness T, Gunaydin I, Grimbacher B, Blaschke S, Meyer-Riemann W, Peter HH, Stubiger N (2003). "Human recombinant interferon alfa-2a for the treatment of Behçet's disease with sight threatening posterior or panuveitis". Br J Ophthalmol. 87 (4): 423–31. PMID 12642304.
- ↑ Hamuryudan V, Ozyazgan Y, Fresko Y, Mat C, Yurdakul S, Yazici H (2002). "Interferon alfa combined with azathioprine for the uveitis of Behçet's disease: an open study". Isr Med Assoc J. 4 (11 Suppl): 928–30. PMID 12455182.
- ↑ Yurdakul S, Mat C, Tuzun Y, Ozyazgan Y, Hamuryudan V, Uysal O, Senocak M, Yazici H (2001). "A double-blind trial of colchicine in Behçet's syndrome". Arthritis Rheum. 44 (11): 2686–92. PMID 11710724.
- ↑ Hamuryudan V, Mat C, Saip S, Ozyazgan Y, Siva A, Yurdakul S, Zwingenberger K, Yazici H (1998). "Thalidomide in the treatment of the mucocutaneous lesions of the Behcet syndrome.
A randomized, double-blind, placebo-controlled trial". Ann Intern Med. 128 (6): 443–50. PMID 9499327. line feed character in
|title=at position 83 (help) - ↑ Matsuda T, Ohno S, Hirohata S, Miyanaga Y, Ujihara H, Inaba G, Nakamura S, Tanaka S, Kogure M, Mizushima Y (2003). "Efficacy of rebamipide as adjunctive therapy in the treatment of recurrent oral aphthous ulcers in patients with Behçet's disease: a randomised, double-blind, placebo-controlled study". Drugs R D. 4 (1): 19–28. PMID 12568631.
- ↑ Sharquie KE, Najim RA, Abu-Raghif AR (2002). "Dapsone in Behçet's disease: a double-blind, placebo-controlled, cross-over study". J Dermatol. 29 (5): 267–79. PMID 12081158.