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27-02-2020 | Rheumatology | News | Article

Behçet’s disease more common than previously thought

Claire Barnard

medwireNews: The prevalence of Behçet’s disease (BD) in the UK is higher than previously estimated, and patients with the disease have an elevated risk for developing cardiovascular and cerebrovascular conditions, researchers report.

“This study represents the largest population-based study on BD conducted in the Western world,” say Deva Situnayake (City Hospital, Birmingham, UK) and fellow investigators.

In their analysis of The Health Improvement Network, a large UK primary care database, the team found that the annual incidence of BD remained stable between 2000 and 2017, with rates of 0.62 and 0.61 per 100,000 person–years, respectively.

However, they report that prevalence of the disease “has steadily increased over time”, from 8.32 per 100,000 population in 2000 to 14.61 per 100,000 population in 2017, and these estimates are “much higher” than previously reported estimates from the 1990s, which ranged from 0.27 to 0.64 per 100,000 population.

“BD should therefore be considered at an earlier stage in the differential diagnoses amongst conditions with overlapping presenting clinical features,” write Situnayake et al in Rheumatology.

Incidence rates of cardiovascular disease (CVD) in patients with and without BD were 7.3 and 5.7 per 1000 person–years, respectively. People with BD did not have a significantly higher risk for developing CVD than the general population after adjustment for factors including age, sex, smoking, and comorbidities, but CVD risk was significantly elevated in those with BD when the analysis was restricted to incident cases of BD only, with an adjusted hazard ratio (HR) of 3.11.

Moreover, patients with BD had a significantly elevated risk for incident ischemic heart disease (IHD) compared with the general population (adjusted HR=3.09), and developed IHD or stroke/transient ischemic attack (TIA) at a significantly younger age, on average, than the general population (58 vs 61 and 53 vs 65 years, respectively).

Also, BD was associated with a significantly higher risk for venous thrombotic events (VTEs; deep vein thrombosis [DVT], cerebral venous thrombosis, or Budd–Chiari syndrome), both overall (HR=4.80) and for incident cases only (HR=4.28).

BD was not associated with a significantly increased risk for developing pulmonary embolism (PE), but among patients with PE, BD was significantly associated with younger age at diagnosis, at an average of 35 years compared with 58 years for the general population. Patients with BD also developed DVT at a significantly younger age than the general population, at a mean of 36 versus 42 years.

“Physicians should […] be aware of the increased risk of developing DVT, IHD, stroke and TIA in patients with BD at an earlier age compared with the general population, and consider the role for cardiovascular risk factor management,” recommend the researchers.

They add: “Further research is urgently required to ascertain whether the risk of embolism varies throughout the disease course or is influenced by immunosuppressive therapy that may be commenced after diagnosis.”

medwireNews is an independent medical news service provided by Springer Healthcare. © 2020 Springer Healthcare part of the Springer Nature group

Rheumatology 2020; doi:10.1093/rheumatology/keaa010

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