EFFICACY OF CYCLOSPORIN ON BEHCET'S DISEASE VASCULOPATHY: A COMPARATIVE STUDY OF CYCLOSPORIN AND CORTICOSTEROID ON LONG-TERM PROGNOSIS. | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 19, Issue 2, April 2000, Page 169-177 PDF (962.94 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2000.378676 | ||||
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| Authors | ||||
Mosaad Soliman   ; Abdel Azeem Ali; Hisham Abdel Monem
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| Mansoura University Hospital, Vascular Surgery Unit, Department of Surgery Mansoura, Egypt | ||||
| Abstract | ||||
| Behcet's disease is a vasculitis typified by intimal hyperplasia, internal elastic membrane disruption with medial thining, and an advential/periadvential infiltrate of plasma cells and neutrophils. It is more common in the Mediterranean and is seen slightly more often in males. This multisystem vasculitis is characterized by clinical triad of oral ulcerations that recur at least 3 times a year, recurrent genital ulceration and uvietis. Vasculo-Behcet's disease affect veins more often than arteries. Arterial complications occur in about 10 % of those affected, and venous thrombosis occurs in about 30 %. Thirtyfive patients with vasculo-Behcet's disease were included in the study. Diagnosis was based on the clinical criteria, namely, recurrent oral ulceration and involvement of the skin, eye or genitalia in addition to positive pathergy test and duplex scan. Twenty patients (group A ) were given Cyclosporin (5mg / kg daily for 6 months) and 15 patients (group B) were given corticosteroids (60 mg daily for 6 months). Eighteen patients of group A had complete reversion of the disease process without further vascular complications and 2 patients developed iliofemoral and caval thrombosis although they were on anticoagulation therapy. Seven patients of group B underwent revascularization surgery for peripheral aneurysms and developed anastomotic disruption. Two patients developed aortic aneurysms. One patient had pseudoaneyrysm at the puncture site for angiography. One patient had progressive ocular deterioration ended with blindness. Conclusions. 1- Cyclosporin is acting by suppressing HLA expressions which is an initial step in triggering the immune system to the vessel wall, a mechanism that is different from that achieved by cortiosteroids 2-Cyclosporin should be used as a first option in the treatment of Behcet's disease as the goal of therapy is to minimize systemic complications by the use of appropriate immunosuppressive agents. 3-Patients with complex aphthosis should be monitored for the onset of Behcet's disease through close follow-up and investigations of systemic complaints. 4-Revascularization should be deferred until acneiform eruption subsides because these eruptions signify the disease activity during which operative tasks will carry a high risk of complications. | ||||
| Keywords | ||||
| Behcet; cyclosporin; prednisone; vasculopathy | ||||
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