Management of skin, mucosa and joint involvement of Behçet's syndrome

A systematic review for update of the EULAR recommendations for the management of Behçet's syndrome

Pietro Leccese, Yesim Ozguler, Robin Christensen, Sinem Nihal Esatoglu, Dongsik Bang, Bahram Bodaghi, Aykut Ferhat Celik, Farida Fortune, Julien Gaudric, Ahmet Gül, Ina Kötter, Alfred Mahr, Robert J. Moots, Jutta Richter, David Saadoun, Carlo Salvarani, Francesco Scuderi, Petros P. Sfikakis, Aksel Siva, Miles Stanford & 6 others Ilknur Tugal-Tutkun, Richard West, Sebahattin Yurdakul, Ignazio Olivieri, Hasan Yazici, Gulen Hatemi

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: The aim of this systematic review was to inform the update of European League Against Rheumatism (EULAR) Recommendations for the management of Behçet's syndrome (BS), on the evidence for the treatment of skin, mucosa and joint involvement of BS. Methods: A systematic literature search, data extraction, statistical analyses and assessment of the quality of evidence were performed according to a pre-specified protocol using the PRISMA guidelines. Studies that assessed the efficacy of an intervention in comparison to an active comparator or placebo for oral ulcers, genital ulcers, papulopustular lesions, nodular lesions or arthritis were included. Where possible, risk ratios were calculated for binary outcomes and mean difference for continuous outcomes. Results: Among the 3927 references that were screened, 37 were included in the analyses. Twenty-seven of these assessed mucocutaneous and 17 assessed joint involvement. Twenty-one of these studies were randomised controlled trials (RCTs). RCTs with colchicine, azathioprine, interferon-alpha, thalidomide, etanercept and apremilast showed beneficial results with some differences according to lesion type and gender. These agents were generally well tolerated with few adverse events causing withdrawal from the study. Conclusions: RCTs comprised more than a half (21/37, 57%) of the sources included in the evidence synthesis related to skin, mucosa and joint involvement applicable for the EULAR Recommendations for the management of BS. Differences in the outcome measures that were used across the included studies often made it difficult to combine and compare the results.

Original languageEnglish
Pages (from-to)752-762
Number of pages11
JournalSeminars in Arthritis and Rheumatism
Volume48
Issue number4
DOIs
Publication statusPublished - Feb 1 2019

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Rheumatic Diseases
Mucous Membrane
Randomized Controlled Trials
Joints
Skin
Oral Ulcer
Statistical Data Interpretation
Thalidomide
Azathioprine
Colchicine
Interferon-alpha
Ulcer
Arthritis
Odds Ratio
Placebos
Outcome Assessment (Health Care)
Guidelines
Therapeutics

Keywords

  • Anti-TNF
  • Behçet's disease
  • Systematic review
  • Treatment

ASJC Scopus subject areas

  • Rheumatology
  • Anesthesiology and Pain Medicine

Cite this

Management of skin, mucosa and joint involvement of Behçet's syndrome : A systematic review for update of the EULAR recommendations for the management of Behçet's syndrome. / Leccese, Pietro; Ozguler, Yesim; Christensen, Robin; Esatoglu, Sinem Nihal; Bang, Dongsik; Bodaghi, Bahram; Celik, Aykut Ferhat; Fortune, Farida; Gaudric, Julien; Gül, Ahmet; Kötter, Ina; Mahr, Alfred; Moots, Robert J.; Richter, Jutta; Saadoun, David; Salvarani, Carlo; Scuderi, Francesco; Sfikakis, Petros P.; Siva, Aksel; Stanford, Miles; Tugal-Tutkun, Ilknur; West, Richard; Yurdakul, Sebahattin; Olivieri, Ignazio; Yazici, Hasan; Hatemi, Gulen.

In: Seminars in Arthritis and Rheumatism, Vol. 48, No. 4, 01.02.2019, p. 752-762.

Research output: Contribution to journalArticle

Leccese, P, Ozguler, Y, Christensen, R, Esatoglu, SN, Bang, D, Bodaghi, B, Celik, AF, Fortune, F, Gaudric, J, Gül, A, Kötter, I, Mahr, A, Moots, RJ, Richter, J, Saadoun, D, Salvarani, C, Scuderi, F, Sfikakis, PP, Siva, A, Stanford, M, Tugal-Tutkun, I, West, R, Yurdakul, S, Olivieri, I, Yazici, H & Hatemi, G 2019, 'Management of skin, mucosa and joint involvement of Behçet's syndrome: A systematic review for update of the EULAR recommendations for the management of Behçet's syndrome', Seminars in Arthritis and Rheumatism, vol. 48, no. 4, pp. 752-762. https://doi.org/10.1016/j.semarthrit.2018.05.008
Leccese, Pietro ; Ozguler, Yesim ; Christensen, Robin ; Esatoglu, Sinem Nihal ; Bang, Dongsik ; Bodaghi, Bahram ; Celik, Aykut Ferhat ; Fortune, Farida ; Gaudric, Julien ; Gül, Ahmet ; Kötter, Ina ; Mahr, Alfred ; Moots, Robert J. ; Richter, Jutta ; Saadoun, David ; Salvarani, Carlo ; Scuderi, Francesco ; Sfikakis, Petros P. ; Siva, Aksel ; Stanford, Miles ; Tugal-Tutkun, Ilknur ; West, Richard ; Yurdakul, Sebahattin ; Olivieri, Ignazio ; Yazici, Hasan ; Hatemi, Gulen. / Management of skin, mucosa and joint involvement of Behçet's syndrome : A systematic review for update of the EULAR recommendations for the management of Behçet's syndrome. In: Seminars in Arthritis and Rheumatism. 2019 ; Vol. 48, No. 4. pp. 752-762.
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abstract = "Objectives: The aim of this systematic review was to inform the update of European League Against Rheumatism (EULAR) Recommendations for the management of Beh{\cc}et's syndrome (BS), on the evidence for the treatment of skin, mucosa and joint involvement of BS. Methods: A systematic literature search, data extraction, statistical analyses and assessment of the quality of evidence were performed according to a pre-specified protocol using the PRISMA guidelines. Studies that assessed the efficacy of an intervention in comparison to an active comparator or placebo for oral ulcers, genital ulcers, papulopustular lesions, nodular lesions or arthritis were included. Where possible, risk ratios were calculated for binary outcomes and mean difference for continuous outcomes. Results: Among the 3927 references that were screened, 37 were included in the analyses. Twenty-seven of these assessed mucocutaneous and 17 assessed joint involvement. Twenty-one of these studies were randomised controlled trials (RCTs). RCTs with colchicine, azathioprine, interferon-alpha, thalidomide, etanercept and apremilast showed beneficial results with some differences according to lesion type and gender. These agents were generally well tolerated with few adverse events causing withdrawal from the study. Conclusions: RCTs comprised more than a half (21/37, 57{\%}) of the sources included in the evidence synthesis related to skin, mucosa and joint involvement applicable for the EULAR Recommendations for the management of BS. Differences in the outcome measures that were used across the included studies often made it difficult to combine and compare the results.",
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AU - Ozguler, Yesim

AU - Christensen, Robin

AU - Esatoglu, Sinem Nihal

AU - Bang, Dongsik

AU - Bodaghi, Bahram

AU - Celik, Aykut Ferhat

AU - Fortune, Farida

AU - Gaudric, Julien

AU - Gül, Ahmet

AU - Kötter, Ina

AU - Mahr, Alfred

AU - Moots, Robert J.

AU - Richter, Jutta

AU - Saadoun, David

AU - Salvarani, Carlo

AU - Scuderi, Francesco

AU - Sfikakis, Petros P.

AU - Siva, Aksel

AU - Stanford, Miles

AU - Tugal-Tutkun, Ilknur

AU - West, Richard

AU - Yurdakul, Sebahattin

AU - Olivieri, Ignazio

AU - Yazici, Hasan

AU - Hatemi, Gulen

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N2 - Objectives: The aim of this systematic review was to inform the update of European League Against Rheumatism (EULAR) Recommendations for the management of Behçet's syndrome (BS), on the evidence for the treatment of skin, mucosa and joint involvement of BS. Methods: A systematic literature search, data extraction, statistical analyses and assessment of the quality of evidence were performed according to a pre-specified protocol using the PRISMA guidelines. Studies that assessed the efficacy of an intervention in comparison to an active comparator or placebo for oral ulcers, genital ulcers, papulopustular lesions, nodular lesions or arthritis were included. Where possible, risk ratios were calculated for binary outcomes and mean difference for continuous outcomes. Results: Among the 3927 references that were screened, 37 were included in the analyses. Twenty-seven of these assessed mucocutaneous and 17 assessed joint involvement. Twenty-one of these studies were randomised controlled trials (RCTs). RCTs with colchicine, azathioprine, interferon-alpha, thalidomide, etanercept and apremilast showed beneficial results with some differences according to lesion type and gender. These agents were generally well tolerated with few adverse events causing withdrawal from the study. Conclusions: RCTs comprised more than a half (21/37, 57%) of the sources included in the evidence synthesis related to skin, mucosa and joint involvement applicable for the EULAR Recommendations for the management of BS. Differences in the outcome measures that were used across the included studies often made it difficult to combine and compare the results.

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