THU0290 THE EARLIER IMMUNOSUPPRESIVE TREATMENT MAY PREVENT MAJOR ORGAN INVOLVEMENT IN BEHCET DISEASE
Authors: T. Bozkurt, S. Kutluğ Ağaçkiran, H. Karataş, M. Karabacak, P. Atagündüz, N. Inanc, G. Mumcu, T. Ergun, H. Direskeneli, F. Alibaz-Oner
Journal: Annals of the Rheumatic Diseases (2020)

Background: Immunosuppressive(IS) agents are used for the treatment and prevention of major organ involvement in Behçet’s disease. Objectives: We aimed to investigate the rate of new major organ involvement development in patients under IS treatment for any reason during follow-up,and to compare the rate with patients never receiving IS treatments. Methods: Data were collected retrospectively from files of patients who had a minimum follow-up duration of 6 months and were diagnosed with Behçet’s disease according to the ISG criteria.Major organ manifestations were defined as ocular, vascular, neurologic, and gastrointestinal involvement.ISs were defined as azathioprine,cyclophosphamide, corticosteroids,interferon alfa,TNF inhibitors and cyclosporine. Results: 640 patients were included in the study,of which 354 (55%) were male.The median age at diagnosis was 28(IQR: 23-35); the median follow-up duration was 5.75 (IQR: 3-8.91) years.Erythema nodosum was more common in females, but uveitis and vascular involvement were more prevalent among male patients (Table 1).198 (31%) patients had uveitis, 163 (26%) patients had vascular involvement, 63 (10%) patients had neurological involvement and 11(2%) patients had gastrointestinal involvement.The distribution of these 241 vascular events is displayed in Figure 1. 324 (51%) patients were not receiving any immunosuppressives when they developed their first major organ involvement.On the other hand, a total number of 348 (53%) patients were started on immunosuppressives [324 (51%) for major organ involvement, 24 (3%) for mucocutaneous involvement].38 (11%) of these patients developed a different major organ involvement (Table 2) under ISs. 23 of these 38 patients were on Azathioprine; eight were on Cyclophosphamide and Azathioprine, three were on interferon-alfa.Among patients receiving IS for any reason, 91 (28%) experienced relapses in the same organ. Conclusion: During follow-up in our tertiary rheumatology center, about 40 % of patients receiving immunosuppressives, either experienced a new and different organ manifestation or had a relapse in the same organ.Our results suggest that earlier and more aggressive treatment may be necessary for the treatment of patients with BD to prevent both relapses and new major organ involvement in daily practice. Table 1. Organ involvement among genders* Male (n= 354 ) Female (n = 286 ) p All patients (n=640 ) Oral ulcer 350 (99) 277 (99) 0.699 632 (99) Genital ulcer 268 (76) 226 (81) 0.091 498 (78) Erythema Nodosum 166 (47) 173 (62) &lt;0.001 343 (54) Pathergy 191 (64) 145 (60) 0.433 341 (54) Arthritis 59 (17) 55 (20) 0.308 114 (18) Family history 70 (20) 74 (27) 0.051 144 (23) Uveitis 130 (37) 68 (25) 0.001 198 (31) Gastrointestinal 7 (2) 4 (1) 0.763 11 (2) Vascular 124 (35) 37 (13) &lt;0.001 163 (26) Neurologic 36 (10) 27 (10) 0.851 63 (10) Parenchyma 14 (4) 17 (6) 0.220 31 (5) Venous Sinus Thrombosis 18 (5) 10 (4) 0.356 28 (4) * Values denote the number (%) of patients Table 2. Distribution of major organ involvement developed in patients under and without immunosuppressive treatments No immunosuppressives (n= 302) While on immunosuppressives (n= 38) Vascular 99 (31) 16 (5) Uveitis 150 (46) 9 (3) Neurological 28 (9) 7 (2) Gastrointestinal 4 (1) 3 (1) Others† 21 (6) 3 (1) * Values denote the number (%) of patients †Simultaneous involvement of more than one organ Figure 1. Distribution of vascular events* Disclosure of Interests: None declared