Clinical manifestations and anti-TNF alpha therapy of juvenile Behçet's disease in Taiwan
Journal
BMC Pediatrics
Journal Volume
19
Journal Issue
1
Pages
232
Date Issued
2019
Abstract
Backgrounds: Beh?et's disease (BD) is a rare vasculitic disorder affecting all sizes of vessels. Among BD patients, 4 to 25% of patients with diagnosed age younger than 16 years old are defined as juvenile BD (JBD). This study aimed to evaluate the clinical manifestations and treatments of patients with JBD, with a particular focus on the effectiveness and safety of anti-tumor necrosis factor (TNF)-alpha therapy. Methods: We retrospectively reviewed data of all patients diagnosed with JBD at age of 16 years or younger in a tertiary hospital in Taiwan. The clinical manifestations, laboratory data, treatments, disease courses, and clinical outcomes were evaluated. The effectiveness of anti-TNF-alpha therapy was measured based on changes in Beh?et's Disease Current Activity Form (BDCAF) scores, prednisolone dosages and the immunosuppression load scores. Results: Fifty-five patients were included in the study. The median age at disease onset was 11 years. The most common clinical presentation was recurrent oral aphthous ulcers (100%), followed by genital ulceration (69.1%), skin lesions (36.4%), gastrointestinal symptoms (29.1%), ocular involvement (27.3%), and arthralgia (27.3%). Ninety-one percent of the patients fulfilled the International Criteria for Beh?et's Disease, and 36.4% met the Paediatric Beh?et's Disease criteria. The most frequently used medications were prednisolone (74.5%) and colchicine (54.5%). Six patients with refractory or severe JBD received anti-TNF-alpha therapy. These patients were diagnosed at a younger age compared with those who did not receive anti-TNF-alpha therapy (7.5 vs 13 years; P = 0.012), the BDCAF scores reduced significantly at the 1st month, the 6th month and 1 year after the treatment. They did not use steroids after the first year of treatment, and, after treatment for 6 months, their immunosuppression load scores reduced significantly. Due to the limited case numbers, literature reviews of anti-TNF-alpha therapy for refractory JBD were conducted, which had a total 18 JBD patients receiving anti-TNF-alpha therapy, of which fifteen patients had favorable outcomes after treatment with minimal side effects. Conclusions: Anti-TNF-alpha therapy may be necessary for JBD patients with refractory disease courses. Anti-TNF-alpha therapy was effective and safe in these patients, especially regarding its corticosteroid- and immunosuppressive drug-sparing effects. ? 2019 The Author(s).
SDGs
Other Subjects
azathioprine; colchicine; prednisolone; tumor necrosis factor inhibitor; adalimumab; antirheumatic agent; etanercept; immunosuppressive agent; mesalazine; prednisolone; salazosulfapyridine; tumor necrosis factor; adolescent; adverse outcome; arthralgia; Article; bacterial endocarditis; Behcet disease; Behcet Disease Current Activity Form score; child; clinical effectiveness; clinical outcome; disease classification; disease course; disease severity; drug hypersensitivity; drug safety; eye disease; fatigue; female; fever; gastrointestinal symptom; genital ulcer; herpes zoster; human; human cell; immunosuppression load score; immunosuppressive treatment; laboratory test; major clinical study; male; mouth ulcer; pneumonia; retrospective study; scoring system; sinusitis; skin defect; Taiwan; tertiary care center; treatment duration; Behcet disease; combination drug therapy; follow up; severity of illness index; symptom assessment; treatment outcome; Adalimumab; Adolescent; Antirheumatic Agents; Behcet Syndrome; Child; Colchicine; Drug Therapy, Combination; Etanercept; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Male; Mesalamine; Prednisolone; Retrospective Studies; Severity of Illness Index; Sulfasalazine; Symptom Assessment; Taiwan; Tertiary Care Centers; Treatment Outcome; Tumor Necrosis Factor-alpha
Publisher
BioMed Central Ltd.
Type
journal article