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Modern Rheumatology Case Reports Dec 2023The current report presents two cases with leg ulcers related to Behçet's disease (BD) resistant to conventional immunosuppressive therapy (CIST) but successfully... (Review)
Review
The effectiveness of adalimumab as an add-on therapy in two cases with leg ulcers in Behçet's disease resistant to conventional immunosuppressive therapy alone and a review of the literature.
The current report presents two cases with leg ulcers related to Behçet's disease (BD) resistant to conventional immunosuppressive therapy (CIST) but successfully treated with adalimumab (ADA). BD, which can affect vessels of any size and type, is a systemic vasculitis. In the vascular system, veins are the most predominantly affected blood vessels, with deep vein thrombosis and recurrent superficial vein thrombophlebitis being the most common vascular signs of the disease in the lower extremities. Leg ulcers, commonly associated with vasculitis or deep vein thrombosis, are rare in patients with BD. Conventional immunosuppressive therapy is very critical to prevent relapses and diminish the risk of post-thrombotic syndrome. In patients with BD-associated venous thrombosis (deep vein thrombosis or superficial vein thrombophlebitis) resistant to these treatments, tumour necrosis factor-α inhibitors can be used alone or in combination with traditional disease-modifying antirheumatic drugs. In view of such information, add-on adalimumab treatment was considered appropriate for both patients. Response to this intervention was highly satisfying for the patients at the end of the 6-month treatment. Nonetheless, it warrants further studies directly evaluating the efficacy of tumour necrosis factor-α inhibitors alone in leg ulcers in BD.
Topics: Humans; Adalimumab; Behcet Syndrome; Tumor Necrosis Factor-alpha; Immunosuppressive Agents; Venous Thrombosis; Thrombophlebitis; Immunosuppression Therapy; Leg Ulcer
PubMed: 37534898
DOI: 10.1093/mrcr/rxad044 -
Journal of Clinical Rheumatology :... Sep 2023Behçet disease (BD) is a chronic inflammatory systemic disease that affects skin mucosa, joints, eyes, and blood vessels. Behçet disease shows some clinical...
BACKGROUND
Behçet disease (BD) is a chronic inflammatory systemic disease that affects skin mucosa, joints, eyes, and blood vessels. Behçet disease shows some clinical differences in terms of disease manifestations and prognosis among the Silk Road countries, as well as various ethnicities even in the same country. In this study, we aimed to evaluate the clinical features and disease course of BD using cluster analysis in Van province, Eastern Turkey.
METHODS
This study was carried out in a tertiary referral center in Van province, by reviewing medical records. Seven disease manifestations were included to the cluster analysis as follows: mucocutaneous findings (oral ulcer, genital ulcer, erythema nodosum-like lesions, pseudofolliculitis), uveitis, superficial thrombophlebitis, musculoskeletal involvement, gastrointestinal system involvement, vascular involvement, and parenchymal central nervous system involvement.
RESULTS
We identified 467 patients. After the exclusion of 6 patients who had missing data and 17 patients who did not live in Van, 444 patients (59.2% male) included into the study. Meeting the International Study Group and the International Criteria for Behçet Disease criteria were 91.6% and 96%, respectively, and 91.3% (n = 379/415) of these patients met both criteria. Four clusters were identified in the analyses: 132 patients (31.2%) in vascular (C1), 66 patients (15.6%) in ocular (C2), 60 patients (14.2%) in musculoskeletal (C3), and 165 patients (39%) in mucocutaneous (C4) clusters. Male gender ( p = 0.002; odds ratio [OR], 6.5; 95% confidence interval [CI], 2-21.4), superficial thrombophlebitis ( p = 0.001; OR, 4.7; 95% CI, 1.9-11.4), and uveitis ( p = 0.01; OR, 3.6; 95% CI, 1.3-9.9) were associated with vascular involvement in multivariate analysis.
CONCLUSIONS
In our study, 4 clusters were detected in patients with BD from Van province. The prevalence of severe manifestations of BD may be related to genetic or environmental factors, such as differences in ethnicity and/or geographical differences. Despite the higher proportion of patients with a more severe disease, a favorable outcome was observed in our cohort.
Topics: Humans; Male; Female; Behcet Syndrome; Tertiary Care Centers; Turkey; Disease Hotspot; Retrospective Studies; Uveitis; Thrombophlebitis
PubMed: 37370214
DOI: 10.1097/RHU.0000000000001996 -
Zeitschrift Fur Rheumatologie May 2024Hughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent... (Review)
Review
Hughes-Stovin syndrome (HSS) is a systemic inflammatory condition of unknown origin that is considered to be part of the Behçet's syndrome (BS) spectrum. Recurrent venous thrombosis and superficial thrombophlebitis in combination with bilateral pulmonary artery aneurysms (PAA) represent the hallmark of HSS. The diagnostic evaluation includes computed tomography pulmonary angiography to detect signs of pulmonary vasculitis. The management of HSS is based on the European Alliance of Associations for Rheumatology (EULAR) recommendations for BS and mainly comprises immunosuppressive therapy with glucocorticoids and cyclophosphamide. In addition to drug therapy, PAA should be evaluated for interventional treatment. Spontaneous PAA rupture due to fragile vessel architecture can occur even in cases of remission and/or PAA regression.
Topics: Humans; Aneurysm; Behcet Syndrome; Diagnosis, Differential; Evidence-Based Medicine; Glucocorticoids; Immunosuppressive Agents; Pulmonary Artery; Thrombophlebitis; Treatment Outcome; Venous Thrombosis
PubMed: 37280333
DOI: 10.1007/s00393-023-01371-0 -
Annals of the American Thoracic Society Jul 2023Little is known about the safety of infusing vasopressors through a midline catheter. To evaluate safety outcomes after vasopressor administration through a midline....
Little is known about the safety of infusing vasopressors through a midline catheter. To evaluate safety outcomes after vasopressor administration through a midline. We conducted a cohort study of adults admitted to 39 hospitals in Michigan (December 2017-March 2022) who received vasopressors while either a midline or peripherally inserted central catheter (PICC) was in place. Patients receiving vasopressors through a midline were compared with those receiving vasopressors through a PICC and, separately, to those with midlines in place but who received vasopressors through a different catheter. We used descriptive statistics to characterize and compare cohort characteristics. Multivariable mixed effects logistic regression models were fit to determine the association between vasopressor administration through a midline with outcomes, primarily catheter-related complications (bloodstream infection, superficial thrombophlebitis, exit site infection, or catheter occlusion). Our cohort included 287 patients with midlines through which vasopressors were administered, 1,660 with PICCs through which vasopressors were administered, and 884 patients with midlines who received vasopressors through a separate catheter. Age (median [interquartile range]: 68.7 [58.6-75.7], 66.6 [57.1-75.0], and 67.6 [58.7-75.8] yr) and gender (percentage female: 50.5%, 47.3%, and 43.8%) were similar in all groups. The frequency of catheter-related complications was lower in patients with midlines used for vasopressors than PICCs used for vasopressors (5.2% vs. 13.4%; < 0.001) but similar to midlines with vasopressor administration through a different device (5.2% vs. 6.3%; = 0.49). After adjustment, administration of vasopressors through a midline was not associated with catheter-related complications compared with PICCs with vasopressors (adjusted odds ratios [aOR], 0.65 [95% confidence interval, 0.31-1.33]; = 0.23) or midlines with vasopressors elsewhere (aOR, 0.85 [0.46-1.58]; = 0.59). Midlines used for vasopressors were associated with greater risk of systemic thromboembolism (vs. PICCs with vasopressors: aOR, 2.69 [1.31-5.49]; = 0.008; vs. midlines with vasopressors elsewhere: aOR, 2.42 [1.29-4.54]; = 0.008) but not thromboses restricted to the ipsilateral upper extremity (vs. PICCs with vasopressors: aOR, 2.35 [0.83-6.63]; = 0.10; model did not converge for vs. midlines with vasopressors elsewhere). We found no significant association of vasopressor administration through a midline with catheter-related complications. However, we identified increased odds of systemic (but not ipsilateral upper extremity) venous thromboembolism warranting further evaluation.
Topics: Adult; Humans; Female; Cohort Studies; Catheterization, Central Venous; Retrospective Studies; Catheters; Thrombosis; Catheterization, Peripheral; Postoperative Complications; Catheter-Related Infections; Risk Factors
PubMed: 37166852
DOI: 10.1513/AnnalsATS.202209-814OC -
Cureus Apr 2023Superficial thrombophlebitis, also known as superficial venous thrombosis, is an inflammatory condition involving the veins just below the surface of the skin secondary...
Superficial thrombophlebitis, also known as superficial venous thrombosis, is an inflammatory condition involving the veins just below the surface of the skin secondary to clotted blood within that vein. The majority of cases are self-limited or resolve with a short course of anti-inflammatory medications and the application of warm compresses. Due to the self-limited nature of this disease process, clinically significant complications have rarely been described but are being seen more often in recent literature. This case report discusses an instance of superficial thrombophlebitis that occurred secondary to a routine blood draw and progressed to potentially life-threatening deep vein thrombosis. This case highlights the need for physicians to be aware of the potential complications of superficial thrombophlebitis and the importance of delivering strict return precautions to every patient with this condition.
PubMed: 37122971
DOI: 10.7759/cureus.38260 -
Journal of Cutaneous and Aesthetic... 2022
PubMed: 37035593
DOI: 10.4103/JCAS.JCAS_246_20