title: Characteristics of patients with intestinal Behçet's disease requiring treatment with immunosuppressants or anti-TNFα antibody.
abstract: OBJECTIVE
  To identify the specific characteristics of patients with refractory intestinal Behçet's disease (BD) who required more than glucocorticoid (GC) and/or 5-aminosalicylic acid (5-ASA) treatment.
  
  
  METHODS
  A retrospective review of the patient records in a university hospital identified 34 patients with intestinal BD. The patients treated only with glucocorticoid and/or 5-ASA (n = 8) were compared with refractory cases which required additional immunosuppressants, anti-TNFα antibodies, or surgery (n = 12).
  
  
  RESULTS
  In the refractory group, ulcers were found outside the ileocecal region more often, and more active intestinal bleeding or melena was observed, than in the GC/5ASA-controlled group (75% vs 0%, p = 0.001), (58% vs 0%, p = 0.015). The refractory group also showed higher positivity for HLA-B51 (45% vs 0%, p = 0.044), higher blood C-reactive protein (CRP) levels (14.7 ± 8.74 vs 3.93 ± 6.33 mg/dL, p = 0.046), and a higher white blood cell or WBC count (14750 ± 6760 vs 7210 ± 1830/μl, p = 0.025) at onset. The existence of either HLA-B51, melena, or elevated CRP of more than 4 mg/dL predicted the refractory form of BD with 100% sensitivity and 85.7% specificity.
  
  
  CONCLUSIONS
  Refractory intestinal BD was distinguished from the non-refractory form by distinct clinical and laboratory findings. These findings will be useful in identifying patients who require intensive therapy (e.g., anti-TNFα antibodies) in addition to GC/5ASA.
authors.affiliation: a Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan.|b Department of Allergy and Rheumatology , Graduate School of Medicine, The University of Tokyo , Tokyo , Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kimura
authors.affiliation: a Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan.
authors.forename: Kurumi
authors.initials: K
authors.lastname: Asako
authors.affiliation: a Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kikuchi
authors.affiliation: a Department of Internal Medicine , Teikyo University School of Medicine , Tokyo , Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Kono
mesh_terms: D000328:Adult; D000368:Aged; D001528:Behcet Syndrome / Q000188:drug therapy* / Q000276:immunology; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use*; D007410:Intestinal Diseases / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D005765:Gastrointestinal Agents; D007166:Immunosuppressive Agents; D000069285:Infliximab
keywords: Anti-TNFα antibody; HLA-B51; Ileocecal lesion; Immunosuppressive drug; Intestinal Behçet's disease