Background Behçet's disease (BD) is a systemic inflammatory condition sharing the clinical features of both auto- inflammatory diseases and variable vessel vasculitis. Endothelial dysfunction (ED) plays an important role in the pathogenesis of BD. Several markers can be used to evaluate ED as mean platelet volume (MPV), red cell distribution width (RDW), neutrophil-lymphocyte ratio (NLR) and vascular endothelial growth factor (VEGF).
Objectives The aim of the present study was to measure the MPV, RDW, NLR and serum level of VEGF in BD patients and to study their relation with disease manifestations and activity.
Methods Ninety six BD patients and 60 matched controls were enrolled in this study. The MPV, NLR, RDW and serum VEGF level were measured. Disease activity was assessed by the BD Current Activity Form (BDCAF). The influence of an associated metabolic syndrome (MetS) was also considered.
Results The mean age of the 96 patients was 34.9±10.1 years (18–73 years), male:female 4.7:1 and the disease duration was 9±7 years (0.6–40 years). MetS was present in 13.7%. Two patients were siblings and 5 had juvenile-onset BD. The RDW and NLR were significantly higher in patients (15.5±2% and 2.7±2.9) than controls (14.3±1.03% and 1.5±0.8) (p<0.001 each), while the MPV and VEGF were comparable. The MPV was significantly decreased in patients with vascular involvement (p=0.04) and increased in those with psychiatric disorders (p=0.02). The RDW was significantly higher in patients with vascular involvement (p=0.04) especially those with venous thrombosis and in those with neurological manifestations (p=0.03). The NLR was higher in males (p=0.01) and in those with retinal vasculitis (p=0.03) and vein occlusion (p=0.02). None of the parameters significantly correlated with the BDCAF. However, the NLR was the most valuable parameter to predict disease activity at a cut-off level of 1.69 ng/L (sensitivity 75%, specificity 55.6%). The MPV significantly correlated with the body mass index (BMI) (p=0.008), cholesterol (p=0.01) and low density lipoprotein (LDL) (p<0.001); the RDW correlated with the erythrocyte sedimentation rate (ESR) (p=0.003) and total leucocytic count (TLC) (p=0.04); the NLR with TLC (p=0.001) and blood urea (p=0.001) and VEGF with the TLC (p=0.048) and high density lipoprotein (HDL) (p=0.02). None of the parameters was significantly different according to the presence of MetS. Regarding the medications received, the RDW was significantly higher in patients who received cyclophosphamide and warfarin than those who did not (p=0.003 and p<0.001 respectively) and the level of VEGF tended to be lower in patients who received colchicine (p=0.06).
Conclusions In BD, only the RDW and NLR were significantly increased raising the possibility of a potential role in the disease susceptibility and pathogenesis with no obvious relation to the disease activity or to an associated MetS. Together with the serum VEGF, they may all serve as useful markers to reveal the pattern of organ involvement while the NLR was the most valuable cost effective parameter to signify the disease activity. The influence of medications warrants further studies.
Disclosure of Interest None declared