THU0692 OCULAR MANIFESTATIONS IN BEHCET’S DISEASE MAY BE MORE COMMON IN CHILDREN THAN ADULTS: RESULTS OF A SYSTEMATIC REVIEW
Authors: Matthew Turk, Jacqueline Hayworth, Tatiana Nevskaya, Janet Pope
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Behcet's disease (BD) can develop in both children and adults, but they may have different clinical features. Ocular involvement is common in BD and causes substantial impairment. The frequency of ocular involvement in BD has a wide range (5 to 89%). <h3>Objectives:</h3> This study determined the frequency and type of ocular manifestations in childhood and adult BD and compared prevalence of ocular manifestations by geographic location in those with BD. <h3>Methods:</h3> The protocol of ocular conditions in rheumatic conditions was registered at clintrials.gov (NCT03753893). Search terms were: conjunctivitis, keratoconjunctivitis sicca, xeropthalmia, uveitis, eye hemorrhage, optic neuritis, papilledema, orbital disease, retinal artery/vein occlusion, macular edema, retinitis, chorioretinitis, scleritis, iridocyclitits, choroid hemorrhage, blindness and amaurosis fugax in patients with BD. The search was performed with the assistance of an information specialist. Medline, Cochrane and Web of Science were used searching papers that spanned from their inception (1966, 1991 and 1990 respectively) to October 5, 2018. Studies were included if they had a minimum of twenty patients and reported the frequency of ocular manifestations within BD. Random effects models were used to combine the prevalence of ocular manifestations using Revman 5.3. Heterogeneity was evaluated using I<sup>2</sup> and funnel plots. <h3>Results:</h3> The search resulted in 3129 articles, of which 33 were included for meta-analysis. Eye manifestations were more frequent in childhood onset BD with the mean [95% Confidence Interval] frequency of 50 [38-63]% compared to 34 [25-43]% in adults. In both children and adults, posterior uveitis (children 27% vs. adults 25%) was the most common ocular manifestation, followed by anterior uveitis (children 18% vs. adults 23%). When comparing the distribution of ocular manifestations in Behcet's in adults, there was geographic variation higher along the ancient Silk Road with ocular manifestations occurring in 40% of patients from Turkey and the Middle East. Ocular manifestations were similar in Europe (36%) and North America (36%), but less frequent in North Africa (26%) and East Asia (20%). <h3>Conclusion:</h3> The frequency of ocular involvement is higher in children when compared to adults with BD. The most common manifestation in the eyes is posterior and then anterior uveitis. Ocular involvement also presents regional differences. <h3>References:</h3> [1] Arevalo JF, Lasave AF, Al Jindan MY, Al Sabaani NA, Al-Mahmood AM, Al-Zahrani YA, et al. Uveitis in Behçet Disease in a Tertiary Center Over 25 Years: The KKESH Uveitis Survey Study Group. American Journal of Ophthalmology 2015;159:177-184.e2. [2] Frigui M, Kechaou M, Jemal M, Ben Zina Z, Feki J, Bahloul Z. Optic neuropathy in Behçet's disease: a series of 18 patients. Rev Med Interne 2009;30:486-91. [3] Keino H, Okada AA. Behçet's disease: global epidemiology of an Old Silk Road disease. Br J Ophthalmol 2007;91:1573-4. [4] Leonardo NM, McNeil J. Behcet's Disease: Is There Geographical Variation? A Review Far from the Silk Road. International Journal of Rheumatology 2015;2015:1-7. [5] Uva L, Miguel D, Pinheiro C, Filipe P, Freitas JP. Mucocutaneous manifestations of Behçet's disease. Acta Reumatol Port 2013;38:77-90. <h3>Disclosure of Interests:</h3> Matthew Turk: None declared, Jacqueline Hayworth: None declared, Tatiana Nevskaya: None declared, Janet Pope Consultant for: Eli Lilly and Company