Verification of subclinical atherosclerosis by carotid doppler ultrasonography in behcet disease patients

ABSTRACT

Behcets disease [BD], is a unique systemic vasculitis, which affects almost all types and sizes of blood vessels. Although the exact pathogenesis of BD remains unclear, small vessel vasculitis accounts for a considerable portion of the pathogenic processes in BD. In addition, large venous or arterial lesions can occur in BD patients and vascular involvement may be seen in 25%. Vasculitis makes the prognosis of BD severe. Doppler ultrasonography may show carotid intima-media thickness [IMT] associated with atherosclerosis in BD which is an endothelial cell dysfunction [ECD] parameter and may partially explain the observed cardiovascular morbidity and mortality. The aim of the present work is to study the use of Doppler ultrasonography in the assessment of the carotid artery involvement regarding the IMT and plaque formation in patients with BD. Correlation with disease activity, clinical manifestations and laboratory investigations were considered. Assessment of the lipid profile of the patients and correlation with the findings of the Doppler ultrasonography was considered. Twenty patients, 15 males and 5 females, suffering from BD satisfying the new set of diagnostic criteria published by the International Study Group for Behcet's Disease in 1990, were included in the present study. They were recruited from the Rheumatology and Rehabilitation department as well as the outpatient clinic, Cairo University hospitals. Patients were taken consecutively, with a mean age of 36.75 +/- 8.57 years [ranged from 22 to 54 years] and mean disease duration of 9.23 +/- 5.83 years [range 1.5 to 20 years]. Twenty age and sex matched healthy volunteers served as controls with a mean age of 34.5 +/- 4.24 years were also included in the present study. Subjects with diabetes mellitus, hypertension or evidence of myocardial infarction were excluded from the study. Full history taking and clinical examination of all patients and investigations including lipid profile were performed for the control and the patients. Medications received by the patients were considered and patients receiving corticosteroids for management of their disease were not excluded. Disease activity was assessed using the Behcets disease current activity form [BDCAF] score. Carotid artery ultrasound scan for the right and left common carotid arteries, carotid bulb and the first 1.5 cm of the internal and external carotid arteries was carried out in the radiodiagnosis department, Cairo University. The IMT of the carotid artery was measured in both patients and control by ultrasonography. The age at disease onset was 27.53 +/- 6.46 years. Six of the patients were smokers. There was no significant correlation between the dose of corticosteroids or colchicine used by the BD patients and the IMT of the carotid artery. However, the dose of steroids significantly positively correlated with the level of low density lipoprotein [LDL] [p = 0.013]. The mean IMT of both right and left carotid arteries in the BD patients was 0.64 +/- 0.32 mm [0.68 +/- 0.38 mm and 0.6 +/- 0.24mm for the right and left IMT respectively]. The IMT of BD patients was significantly different from that in the control subjects [0.42 +/- 0.13 mm] [p = 0.003]. There was no significant difference between smoker and non smoker patients [p = 0.1]. Furthermore, there was no significant correlation between the IMT with the disease duration or BMI [p = 0.46 and 0.3 respectively].The IMT of the carotid artery showed a significant positive correlation with the urea level [p = 0.009] and creatinine [p = 0.013]. There was a tendancy towards a positive correlation between the IMT and the cholesterol level and a negative one with the HDL, however, there was a significant positive correlation with the serum triglycerides [p = 0.03]. There were positive sonographic findings in 3 out of 20 BD patients [15%] compared to the control [0%]. The three patients were two males who had autoimmune hepatitis and one female with HCV positive hepatomegaly. Atherosclerotic plaque was present in two. There was a significant positive correlation between the IMT of the carotid artery and the BDCAF score in BD patients [r = 0.481, p = 0.016]. The score significantly negatively correlated with the platelet count [p = 0.002] while there was no correlation with the cholesterol, triglycerides, low or high density lipoprotein. On comparing the IMT in BD patients according to the presence and absence of arthritis, CNS or eye involvement, there was no significant difference. One can conclude that there is a morphologic evidence of subclinical atherosclerosis in patients with BD. IMT was associated with triglycerides as well as urea and creatinine levels denoting that the renal function forms a possible risk of CVD in BD. The BDCAF is an easy tool that may significantly reflect the cardiovascular involvement in BD patients and may be important for clinical management