Accrual of organ damage in Behçet's syndrome: trajectory, associated factors, and impact on patients' quality of life over a 2-year prospective follow-up study

• Published in: Arthritis research & therapy Vol. 24; no. 1; pp. 253 - 8
• Main Authors: Floris, Alberto, Piga, Matteo, Laconi, Riccardo, Espinosa, Gerard, Lopalco, Giuseppe, Serpa Pinto, Luisa, Kougkas, Nikolaos, Sota, Jurgen, Lo Monaco, Andrea, Govoni, Marcello, Cantarini, Luca, Bertsias, George, Correia, João, Iannone, Florenzo, Cervera, Ricard, Vasconcelos, Carlos, Mathieu, Alessandro, Cauli, Alberto
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.11.2022; BioMed Central; BMC
• Subjects: Arthritis; Behcet Syndrome - epidemiology; Diabetes; Disease Progression; Female; Fibromyalgia; Follow-Up Studies; Humans; Immunosuppressive agents; Immunosuppressive Agents - therapeutic use; Medical prognosis; Mental health; Prospective Studies; Quality of Life; Questionnaires; Risk factors; Severity of Illness Index; Vein & artery diseases; Portugal
• ISSN: 1478-6362; 1478-6354; 1478-6362
• DOI: 10.1186/s13075-022-02947-y

This study aimed to investigate the trajectory of damage accrual, associated factors, and impact on health-related quality of life (HR-QoL) in a multicenter cohort of patients with Behçet's syndrome (BS) over 2 years of follow-up. Patients recruited in the BS Overall Damage Index (BODI) validation study were prospectively monitored for 2 years and assessed for damage accrual, defined as an increase ≥1 in the BODI score, and HR-QoL was evaluated by the SF-36 questionnaire. Logistic and multiple linear regression models were built to determine factors associated with damage accrual and impairment in the different SF-36 domains. During follow-up, 36 out of 189 (19.0%) patients had an increase ≥1 in the BODI score with a mean (SD) difference of 1.7 (0.8) (p <0.001). The incidence rate of damage accrual was stable over time, regardless of the disease duration. Out of 61 new BODI items, 25 (41.0%) were considered related to glucocorticoid (GC) use. In multivariate analysis, duration of GC therapy (OR per 1-year 1.15, 95% CI 1.07-1.23; p <0.001) and occurrence of ≥1 disease relapse (OR 3.15, 95% CI 1.09-9.12; p 0.038) were identified as predictors of damage accrual, whereas the use of immunosuppressants showed a protective effect (OR 0.20, 95% CI 0.08-0.54, p<0.001). Damage accrual was independently associated with the impairment of different physical domains and, to a greater extent, in emotional domains of the SF-36 questionnaire. Female sex, higher disease activity, and fibromyalgia were also significantly associated with impairment in HR-QoL. In BS, organ damage accrues over time, also in long-standing disease, resulting in an impairment of the perceived physical and mental health. Adequate immunosuppressive treatment, preventing disease flares and minimizing exposure to GCs have a crucial role in lowering the risk of damage accrual.