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Andrea D. Birnbaum, Omar Saleh, Howard H. Tessler, Debra A. Goldstein; Behcet’s Uveitis In The American Midwest: Comparison Of Patients Of European And Non-European Descent. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4291.
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Behcet’s disease (BD) is typically described in patients from Middle Eastern and Asian countries. The aim of this report is to compare the clinical presentation and disease course of Behcet’s Uveitis (BU) in Caucasian patients of European descent (CEu) and patients of non-Caucasian or non-European descent (NCEu) in the United States.
Medical records of patients evaluated between 1983 and 2010 who met International Study Group (ISG) criteria for BU were reviewed. Clinical presentation and responses to therapy were analyzed.
36 patients diagnosed with BU by ISG criteria had available medical records; only 2 carried a diagnosis of BD at presentation. 53% were CEu, and 58% were male. Average age at presentation was 34 years (10-53 years). 32/36 (89%) had bilateral disease. 15/26 (58%) were HLA-B51 positive with no difference between CEu and NCEu. Retinal vasculitis occurred in 30/36 (83%) and panuveitis in 17/36 (39%). Isolated anterior uveitis was seen in 6/36 (17%), 5 of these patients were CEu. Anterior segment inflammation was present in all CEu and 10/17 (59%) NCEu. 14/19 (74%) CEu and 16/17 (94%) NCEu patients had posterior segment inflammation; the difference was not statistically significant. 32/36 (89%) patients received systemic immunosuppression. A significant decrease in the yearly average uveitis attack rate was measured with the use of both chlorambucil (3.7±1.1 to 0.9 ±0.8, p <0.0001) and TNF inhibitors (3.8±0.8 to 0.4±0.6, p<0.0001).
94% of BU patients in this series were diagnosed with BD as part of their uveitis evaluation. More than 50% of patients were Caucasian, not of Middle Eastern or Asian descent. All of the Caucasian patients of European descent had anterior segment inflammation in isolation or as part of their clinical picture. Physicians should consider the diagnosis of BD in patients with oral ulcers and anterior uveitis, retinal vasculitis, or panuveitis, regardless of racial or ethnic heritage. Excellent response to systemic immunosuppression was seen in both populations.
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