Increased atherosclerosis defined as the presence of plaques was not observed in patients with FMF. The significance of increased C- and F-IMT among patients with FMF must be further assessed.

Objectives Lower extremity deep vein thrombosis (LEDVT) is a serious complication of Behçet’s syndrome. Management constitutes mainly of administration of immunosuppressives, but the predictors of relapse and the optimal choice of immunosuppressives remain unclear. In this prospective study, we aimed to detect the risk and predictors of relapse and treatment response to different modalities. Methods All Behçet’s syndrome patients who presented with a first episode of acute LEDVT between 2010 and 2014 were prospectively followed with a standard protocol. Acute LEDVT was confirmed by Doppler ultrasonography. Serial planned Doppler ultrasonography assessments were performed during follow-up and additionally repeated in case of clinical suspicion. Recanalization rate was assessed at each visit. Our first-line treatment strategy consisted of AZA and CSs. IFN-alpha was used in patients who were refractory to or could not tolerate AZA or had concomitant eye involvement requiring further treatment. Results Thirty-three patients with LEDVT (26 M/7 F) were prospectively followed for 40.7 ± 13.4 months. Among the 33 patients, 23 relapses were observed in 15 patients. Relapse rates were 29%, 37% and 45% at 6, 12 and 24 months, respectively. Among the possible predictors of relapse, poor recanalization was the only significant factor [hazard ratio 4.34 (95% CI 1.96, 10.0)]. Overall 29 patients were treated with AZA and 17 with IFN-alpha. The relapse rate was lower and recanalization rate was higher with IFN-alpha compared with AZA (12% vs 45% and 86% vs 45%). Conclusion The relapse rate for LEDVT in Behçet’s syndrome is high despite AZA treatment. IFN-alpha seems to be a promising agent for preventing LEDVT relapses and achieving good recanalization.

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Background 15-50% of patients with Behçet’s syndrome have vascular involvement (BS). Lower extremity deep vein thrombosis (LEDVT) makes up 70% of all vascular involvement (1,2). Objectives The aim of this study was to determine the clinical course of LEDVT about which there has been little data. Methods Consecutive BS patients attending our BS outpatient clinic were included after an acute or subacute first episode of LEDVT in one leg. They might have had previous contralateral LEDVT. The same radiologist performed a structured and detailed lower extremity Doppler ultrasonography (US). All deep veins, VCI and major superficial veins were examined at 1,3,6,18 and 24 months after the index event. Nodular lesions that evolved during follow-up were also examined for their US structure to differentiate between superficial vein thrombosis and erythema nodosum. Results Within 20 months 31 patients (4F, 27M) with LEDVT in a previously uninvolved leg were studied. 10 patients had had a previous episode of LEDVT in the opposite leg. Mean age was 29.5±7, mean disease duration since disease onset was 49.5±34.6, and the mean follow-up duration during the study was 13.4±6.2 months. Veins involved in order of frequency were popliteal vein (42%), superficial femoral vein (31%), crural veins (29%) and common femoral vein (27%). VCI was involved in 3 (5%) patients. 14 patients (45%) relapsed during follow-up. 11 patients relapsed with a superficial thrombophlebitis and 5 patients relapsed with a new deep vein thrombosis. Mean time to relapse was 2.83±1.99 months when the relapse was a superficial thrombophlebitis and 6.0±2.3 months when the relapse was a LEDVT (P=0.001). Only 3 out of 19 patients who had a recanalization (≥50%) at month 3 follow-up had a relapse whereas a relapse was observed in 11 of the 12 patients with poor recanalization (<50%) (P=0.001). All 3 patients with VCI involvement had venous skin ulcers in the lower extremity and these 3 patients were also the only patients with skin ulcers in the whole group. 17/31 (55%) patients developed nodular lesions during the study. 13/17 had had previous episodes of nodular lesions while in 4 patients these appeared for the first time. Doppler ultrasonographic examination of these nodules revealed superficial thrombophlebitis in 12 (70%). Conclusions The more common vascular relapse after an episode of LEDVT is superficial thrombophlebitis. Relapses of a superficial thrombophlebitis occur earlier than relapses with a LEDVT. Poor recanalization of the index LEDVT at 3 months is associated with relapses. The presence of skin ulcers seems to go along with inferior vena caval thrombosis. As expected, LEDVT in BS is associated more with superficial thrombophlebitis than with erythema nodosum-type lesions (3). References Melikoglu M, Ugurlu S, Tascilar K, et al. Large vessel involvement in Behçet’s syndrome: a retrospective survey. Ann Rheum Dis. 2008; 67 (Suppl II): 67. Sarica-Kucukoglu R, Akdag-Kose A, Kayabali M, et al; Vascular involvement in Behçet’s disease: a retrospe...

BackgroundLower extremity deep vein thrombosis (LEDVT) is a disabling complication of Behçet’s syndrome (BS). Relapses are frequent and cause permanent disability due to post-thrombotic syndrome.1 The management of LEDVT in Behcet’s syndrome (BS) constitutes mainly of azathioprine (AZA) and corticosteroids (CS) as first-line agents.2 Interferon-α (IFN) has been used with good results in the management of eye involvement of BS. However data regarding its efficacy for vascular involvement has been scarse.3 ObjectivesWe aimed to evaluate the efficacy and safety of IFN for LEDVT in BS.MethodsAll BS pts who had a first episode of acute LEDVT since March 2010 are being prospectively followed with a standard protocol in our dedicated BS centre. Acute LEDVT is confirmed by Doppler ultrasonography (DUS) at initial diagnosis and serial DUS assessment is performed and also repeated in case of clinical suspicion of relapse. Our standard treatment strategy consists of AZA and CSs as first-line treatment in pts with LEDVT. IFN has been used in pts who were refractory or intolerant to this regimen, or who had co-existing eye involvement. Our endpoints for assessing efficacy of IFN have been recanalisation of the index thrombus and prevention of relapses. Presence of recanalisation of thrombosed vein and extension of thrombosis have been assessed at each visit. Recanalisation has been assessed in the transverse plane and defined as the ratio of the vein area at maximum compressibility to the non-compressed vein area. Good recanalisation was defined as a ratio of at least 50%. Adverse events during IFN use were recorded.Results33 pts with LEDVT (26 M/7 F) were prospectively followed for a mean of 40.7±13.4 mo. Among these IFN was started in 18/33. In 2 pts IFN was started at the first episode of LEDVT due to co-existing uveitis. Seven pts were treated with IFN due to LEDVT relapses under AZA. In the remaining 9 pts, the reasons for switching from AZA to IFN were adverse events with AZA (n=2), relapse of superficial thrombophlebitis (n=4), leg ulcers due to severe post-thrombotic syndrome (n=2) and eye involvement (n=1). Among 17 pts treated with IFN mainly for vascular involvement during a mean follow-up of 29±20 mo, 3 pts already had good recanalisation when starting IFN. In the remaining 14 pts, 13 (93%) had good recanalisation under IFN. Two pts (11%) experienced relapses. One of the 2 pts who had a relapse had had poor recanalisation despite IFN. In contrast, among the 29 pts treated with AZA, only 13 (45%) had good recanalisation and 13 (45%) pts experienced relapses. Nine fo the 13 pts who had relapses under AZA had poor recanalisation. Overall we observed 23 LEDVT relapses in 15 pts. Relapse rates were 29%, 37% and 45% at 6, 12 and 24 months respectively. The only adverse event with interferon-alpha causing drug withdrawal was thyroiditis in 1 patient.ConclusionsRelapse rate for LEDVT in BS is high despite AZA treatment. IFN seems to be a promising agent for preventing LEDVT relapses and achieving good recanalisation, an im...