Background Behçet's Disease (BD) is a chronic immune-inflammatory disease characterized by multi-systemic involvement. Increased expression of proinflammatory cytokines (TNF-alpha, IL-6) is related with insulin resistance (IR) and the presence of metabolic syndrome (MetS) which is a cluster of metabolically related risk factors. Data to date regarding the prevalence of MetS in BD is unclear.
Objectives To evaluate the prevalence of MetS in an ethnically homogenous cohort of BD patients and to assess the clinical and laboratory parameters of BD associated with MetS.
Methods The study population comprised 44 (40 males, 4 females) BD patients, mean age 42.8 years and mean disease duration 7.5 years, all diagnosed according to the International Study Group. Clinical activity was assessed at the time of entry into the study. Patients with at least 3 of the following clinical features were regarded as active: oral ulcers, genital ulcers, eye lesions (retinal vasculitis, anterior or posterior uveitis), thrombophlebitis, active arthritis, positive pathergy test and laboratory findings (high ESR, elevated hsCRP and raised neutrophil count). Thirty-two of the 44 patients were active and 12/44 were inactive. Diagnosis of MetS was according to the National Cholesterol Education Program Adult Treatment Panel III criteria. Body mass index (BMI), waist and hip circumference, systolic blood pressure (BP), and diastolic BP were measured. IR was assessed by Homeostasis Model Assessment (HOMA) method. Blood samples were collected and levels of erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (hsCRP), tumour necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), total cholesterol, high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), triglycerides (TG) were measured. Thirty age-sex-BMI-matched healthy controls were also recruited to provide normal reference baseline values for laboratory measures.
Results MetS was present in 14/44 (31.8%) of patients versus 2/30 (6.67%) of controls, p=0.01. Fifty percent of the patients had ≥3 of the metabolic risk factors. IR was observed in 8/44 (18.18%) of the patients. On multivariate analysis, significant risk factors for developing MetS included age, age at onset of disease, duration of disease, activity of disease, vascular involvement, neurological involvement and higher BMI. Significant association was noted between prevalence of MetS in BD patients and the level of systemic proinflammatory markers (TNF-alpha, IL-6 and hsCRP).
Conclusions This study demonstrates an increased risk of MetS in BD patients compared to healthy controls. BD patients should be adequately assessed and monitored for MetS risk factors as chronic systemic inflammation may induce endothelial dysfunction, altered glucose metabolism and insulin resistance that help in the development of MetS.
Disclosure of Interest None declared