Behçet Hastalarında Paterji Testi

Amaç: Çalışmanın birincil amacı aktif Behçet Hastalarında (BH), ilk tanı anındaki paterji pozitiflik sıklığını araştırmaktır. İkincil amacı ise paterji durumu ile sosyodemografik, klinik ve laboratuvar özellikleri karşılaştırmaktır. Materyal ve metod: Çalışmada 110 BH retrospektif olarak incelendi. Hastaların ilk tanı anındaki sosyodemografik özellikleri (yaş, cinsiyet), klinik bulguları, paterji test (PT) sonuçları, sedimentasyon (mm/sa) ve C-reaktif protein (CRP) (mg/L) değerleri kayıt edildi. Hastalık semptomlarının başlangıç yaşı <40 olanlar klasik başlangıçlı, ≥40 olanlar geç başlangıçlı BH olarak kabul edildi. Hastalık aktivitesi için Krause Behçet Hastalığı Klinik Aktivite Skoru kullanıldı. Bulgular: Yüz on Behçet hastasının 36’sında (%32.7) PT’nin pozitif olduğu görüldü. PT pozitif hastaların 31’inde (%86.1) genital ülser, 9’unda (%25.0) artrit, 7’sinde (%19.4) üveit, 10’unda (%27.8) derin ven trombozu, 10’unda (%27.8) papulo-püstüler lezyon, 6’sında (%16.7) eritema nodozum, 1’inde (%2.8) nöroparankimal 1’inde de (%2.8) nörovasküler tutulum mevcuttu. PT negatif olan hastalarda bu sıklıklar sırası ile 66(%89.2), 19(%25.7), 22(%29.7), 19(%25.7), 12(%16.2), 7(%9.5), 2(%2.7), 1(%1.4) idi. PT’nin pozitiflik durumu ile klinik bulguların görülme sıklıkları istatistiksel açıdan farklı değildi (p>0.05). PT pozitif hastalarda sedimentasyon (mm/sa) ortanca değeri 16(2-98) iken CRP (mg/L) ortanca değeri 3.78(0-126) idi. PT negatif olanlarda bu değerler sırası ile 17.5(1-108) ve 4.5(0-121) idi. PT’nin pozitiflik durumu ile sedimentasyon (mm/sa) ve CRP (mg/L) ortanca değerleri karşılaştırıldığında anlamlı farklılık görülemedi (p>0.05). PT pozitif hastalarda, hastalık aktivitesi toplam skoru ortanca değeri 3 (1-6) iken PT negatif olanlarda bu ortanca değer 3 (1-7) idi. PT pozitif ve negatif olan hastalar hastalık aktivitesi toplam skorları açısından karşılaştırıldığında anlamlı farklılık yoktu (p=0.494). Klasik yaş başlangıçlı hastalar içerisinde PT’si pozitif olan 34(%33.3) hasta var iken geç yaş başlangıçlı olanlar içerisinde PT’si pozitif olan 2(%25.0) hasta vardı. Klasik ve geç başlangıçlı hastalar, PT pozitiflik sıklıkları açısından karşılaştırıldığında anlamlı farklılık bulunamadı (p=1.000). Sonuç: PT pozitifliğinin hastalığın klinik şiddetini tahmin etmede ve BH için tedaviyi düzenlemede yararı halen tartışmalıdır ve daha fazla araştırma gerekmektedir. Belki de PT’nin duyarlılığını artıracak yeni, standardize test yöntemleri bu belirsizliği çözecek ve klinisyenler için testi daha değerli hale getirecektir.

Anahtar Kelimeler:

Behçet hastalığı, Hastalık Aktivitesi, Paterji Testi

Pathergy Test in Behçet's Disease

Background: The primary aim of the study is to investigate the frequency of pathergy positivity in active BD patients at the time of the first diagnosis. Its secondary aim is to compare the status of pathergy with sociodemographic, clinical and laboratory characteristics.Materials and Methods: In this study, 110 BHs were analyzed retrospectively. Sociodemographic characteristics (age, gender), clinical findings, PT status, sedimentation (mm/hr) and C-reactive protein (CRP) (mg/L) values of the patients at the time of initial diagnosis were recorded. Age of onset of disease symptoms <40 were accepted as classical onset, patients ≥40 as late-onset BD. Krause Behçet's Disease Clinical Activity Score was used for disease activity.Results: S PT was found to be positive in 36 (32.7%) of 110 patients with Behçet's disease. In PT positive patients; there was genital ulcer in 31 (86.1%), arthritis in 9(25.0%), uveitis in 7 (19.4%), deep vein thrombosis in 10 (27.8%), papulopustular lesion in 10 (27.8%), erythema nodosum in 6 (16.7%), neuropenchymal involvement in 1 (2.8%) and neurovascular involvement in 1 (2.8%). In PT negative patients, these frequencies were 66 (89.2%), 19 (25.7%), 22 (29.7%), 19 (25.7%), 12 (16.2%), 7 (9.5%), 2 (2.7%) and 1 (1.4%), respectively. The positivity of PT and the frequency of clinical findings were not statistically different (p>0.05). Median value of sedimentation (mm/h) was 16 (2-98), while the median value of CRP (mg/L) was 3.78 (0-126) in PT positive Behçet patients. In PT negative patients, these values were 17.5 (1-108) and 4.5 (0-121), respectively. When the positivity of PT and the median values of sedimentation (mm/hr) and CRP (mg/L) were compared, no significant difference was found (p>0.05). Median value of disease activity total score was 3 (1-6) in PT positive patients, while this median value was 3 (1-7) in PT negative patients. When PT positive and negative patients were compared in terms of disease activity total scores, there was no significant difference (p=0.494). While there were 34 (33.3%) patients with positive PT among classical age-onset patients, there were 2 (25.0%) among those with late onset. When classical and late-onset patients were compared in terms of PT positivity, no significant difference was found (p=1.000).Conclusions: The benefit of PT positivity in predicting the clinical severity of the disease and regulating treatment for BD is still controversial and requires further research. Perhaps new, standardized test methods that will increase the sensitivity of PT will resolve this uncertainty and make the test more valuable for clinicians.

Keywords:

Behçet's disease, Disease Activity, Pathergy Test,

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