Metabolic Syndrome in Behçets Disease Patients: Keep an Eye on the Eye

Suzan S ElAdle; Eiman Abdel Latif; Yousra H Abdel-Fattah; Emad El Shebini; Iman I El-Gazzar; Hanan M El-Saadany; Nermeen Samy; Reem El-Mallah; Mohamed N Salem; Nahla Eesa; Rawhya El Shereef; Marwa El Khalifa; Samar Tharwat; Samah I Nasef; Maha Emad Ibrahim; Noha M Khalil; Ahmed M Abdalla; Mervat I Abd Elazeem; Rasha Abdel Noor; Rehab Sallam; Amany El-Bahnasawy; Amira El Shanawany; Soha Senara; Hanan M Fathi; Samah A El Bakry; Ahmed Elsaman; Amany El Najjar; Usama Ragab; Esraa A Talaat; Nevin Hammam; Aya K El-Hindawy; Tamer A Gheita; Faten Ismail

doi:10.2174/1573397118666220610123242

Metabolic Syndrome in Behçets Disease Patients: Keep an Eye on the Eye

Curr Rheumatol Rev. 2023;19(2):180-188. doi: 10.2174/1573397118666220610123242.

Authors

Suzan S ElAdle¹, Eiman Abdel Latif², Yousra H Abdel-Fattah³, Emad El Shebini⁴, Iman I El-Gazzar¹, Hanan M El-Saadany⁵, Nermeen Samy⁶, Reem El-Mallah⁷, Mohamed N Salem⁸, Nahla Eesa¹, Rawhya El Shereef⁹, Marwa El Khalifa¹⁰, Samar Tharwat¹¹, Samah I Nasef¹², Maha Emad Ibrahim¹², Noha M Khalil¹³, Ahmed M Abdalla¹⁴, Mervat I Abd Elazeem¹⁵, Rasha Abdel Noor¹⁶, Rehab Sallam¹⁷, Amany El-Bahnasawy¹⁷, Amira El Shanawany¹⁸, Soha Senara¹⁹, Hanan M Fathi¹⁹, Samah A El Bakry⁶, Ahmed Elsaman²⁰, Amany El Najjar²¹, Usama Ragab²², Esraa A Talaat²³, Nevin Hammam²³, Aya K El-Hindawy¹, Tamer A Gheita¹, Faten Ismail⁹

Affiliations

¹ Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt.
² Ophthalmology Department, Faculty of Medicine, Alexandria University, Egypt.
³ Rheumatology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
⁴ Internal Medicine Department, Rheumatology Unit, Menoufia University, Menoufia, Egypt.
⁵ Rheumatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
⁶ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Ain-Shams University, Cairo, Egypt.
⁷ Rheumatology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
⁸ Internal Medicine Department, Faculty of Medicine, Rheumatology Unit, Beni-Suef University, Beni-Suef, Egypt.
⁹ Rheumatology Department, Faculty of Medicine, Minia University, Minia, Egypt.
¹⁰ Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
¹¹ Internal Medicine Department, Faculty of Medicine, Mansoura University, Rheumatology Unit, Dakahlia, Egypt.
¹² Rheumatology Department, Faculty of Medicine, Suez-Canal University, Ismailia, Egypt.
¹³ Internal Medicine Department, Faculty of Medicine, Cairo University, Rheumatology Unit, Cairo, Egypt.
¹⁴ Rheumatology Department, Faculty of Medicine, Aswan University, Aswan, Egypt.
¹⁵ Rheumatology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.
¹⁶ Internal Medicine Department, Rheumatology Unit, Tanta University, Gharbia, Egypt.
¹⁷ Rheumatology Department, Faculty of Medicine, Mansoura University, Dakahlia, Egypt.
¹⁸ Rheumatology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt.
¹⁹ Rheumatology Department, Faculty of Medicine, Fayoum University, Fayoum, Egypt.
²⁰ Rheumatology Department, Faculty of Medicine, Sohag University, Sohag, Egypt.
²¹ Rheumatology Department, Faculty of Medicine, Zagazig University, Sharkia, Egypt.
²² Internal Medicine Department, Clinical Immunology Unit, Zagazig University, Sharkia, Egypt.
²³ Rheumatology Department, Faculty of Medicine, Assuit University, Assuit, Egypt.

PMID: 35692166
DOI: 10.2174/1573397118666220610123242

Abstract

Background: Metabolic syndrome (MetS) is characterized by insulin resistance, high blood pressure/ sugar, dyslipidemia, and obesity. Whether MetS and its components affect the development of Behçet's Disease (BD) remains unclear.

Aims: The aim was to determine the frequency of MetS among BD patients and to study its relationship with disease characteristics.

Methods: The study included 1028 adult BD patients recruited from 18 specialized rheumatology centers. 51 healthy matched control were considered. Behçet Disease Current Activity Form (BDCAF) and the BD damage index (BDI) were estimated. Adult Treatment Panel-III criteria were used to define MetS.

Results: The mean age of patients was 36.8 ± 10.1 years, M:F 2.7:1 and disease duration 7.01 ± 5.2 years. Their mean BDCAF was 5.1 ± 4.6 and BDI 5.5 ± 2.8. MetS was present in 22.8% of patients and in 5.9% of control (3.9 fold higher-risk). Patients with MetS had a significantly increased age at onset (31.8 ± 9.2 vs. 29 ± 8.5 years) and higher frequency of genital ulcers (96.2% vs. 79.7%), skin involvement (73.1% vs. 50.4%), arthritis (48.3% vs. 29.1%) (p<0.0001) and CNS manifestations (18.8% vs. 13%) (p=0.042) compared to those without it. Eye involvement was significantly increased in those with MetS (82.1% vs. 74.2%) (p=0.003) with increased frequency of posterior uveitis (67.1% vs. 43.5%), retinal vessel occlusion (35.9% vs. 21.3%), retinal vasculitis (41.9% vs. 26.4%) (p<0.0001) and vitritis (37.2% vs. 24%) (p=0.001). BDCAF was significantly lower (3.9 ± 4.3 vs. 5.6 ± 4.6) and BDI higher (7.4 ± 2.7vs5 ± 2.6) (p<0.0001).

Conclusion: BD patients with MetS are predisposed to mucocutaneous, musculoskeletal, neuropsychiatric and ocular manifestations with consequently increased damage. The involvement of the deeper structures of the eye should alarm rheumatologists to keep in mind that all patients should have an eye examination, especially those with MetS.

Keywords: BDI; Behçets disease; Metabolic syndrome; eye; neuropsychiatric.

MeSH terms

Adult
Arthritis*
Behcet Syndrome* / complications
Behcet Syndrome* / epidemiology
Humans
Metabolic Syndrome* / epidemiology
Middle Aged
Obesity
Severity of Illness Index