Year-end sale on the Essential Guide to Behcet's Disease

I'm dropping the price of "Essential Guide to Behcet's Disease" from $30 to $20 until the end of this month. Anyone reading this post who'd like to take advantage of the sale, please go to my online bookstore at www.bdbooks.info for more information.

I can ship internationally if necessary. All proceeds from book sales pay for reprints of my books when my inventory runs out.

Happy Holidays!

Kleptomania in patients with neuro-Behcet's

Looking for a little light reading this weekend? How about this article, available online for free:  

Shugaiv E, Kıyat-Atamer A, Tüzün E, Kürtüncü M, Baral-Kulaksızoğlu I, Akman Demir G. Kleptomania in Patients with Neuro-Behçet's Disease. Med Princ Pract. 2013;22:550-4. doi: 10.1159/000351798. Epub 2013 Jul 30. PubMed PMID: 23920112.

Here's the actual link, if the one above doesn't connect:
http://www.karger.com/Article/Pdf/351798

Behcet's at the 2013 Rheumatology Congress

The rheumatology world meets every year at the ACR/ARHP conference (American College of Rheumatology and the Association of Reproductive Health Professionals). This year it's in San Diego, from October 25-30.

The ACR has posted a supplement on its website that includes all of the abstracts (summaries) of the research presented at this meeting. Keep in mind that research that's presented at conferences (and hasn't yet been published) may not be complete! It may have some incorrect statistics, wrong conclusions, or other inconsistencies. In other words, don't take the information you read in conference abstracts as gospel truth — but at least it gives us a snapshot of what the researchers are looking at.

Approximately 20 of this year's presentations offer new insights into Behcet's.You can look at all of the abstracts through this link: http://www.rheumatology.org/Publications/MeetingPublications/2013_ACR_ARHP_Annual_Meeting_Abstract_Supplement/#toolbar=1

If you want to specifically look at the Behcet's-related research, do a search of the abstracts (CTRL and F together). I've included a list below of the research that's the most easy to understand — you can read each listing by searching on the abstract numbers on the left. You'll notice that the majority of the numbers fall within a specific range, so you can read most of the Behcet's-related info by starting at 2617. 

BTW, the term "refractory" means stubborn and hard to treat. I've shortened or re-worded some of the study titles to simplify them.

761     Apremilast for the treatment of Behcet's (Phase II study results, Celgene)
1450   Safety of using TNF-blockers after development of tuberculosis
1750   Biologic therapy in refractory Behcet's uveitis
2617   Clinical features of Behcet's in Japan
2618   Bipolar disorders may represent a primary feature of Behcet's
2619   Suicidal thoughts in Behcet's patients
2620   Development of major organ involvement in Behcet's follow-up
2621   Venous claudication in Behcet's (pain and/or cramping in the lower leg due to inadequate blood flow to the muscles) 

2623   CT evaluation of heart/lung lesions in Behcet's pts without lung symptoms 
2624   Using ultrasound to evaluate asymptomatic venous disease in Behcet's
2625   Biologic therapy in treating refractory Behcet's uveitis
2626   Infliximab for sight-threatening and refractory Behcet's uveitis 
2627   Prognosis of visual function in treatment of Behcet's uveitis with infliximab
2628   Shortening the interval between infliximab infusions in Behcet's uveitis
2629   Is complete remission a realistic target with current treatments in Behcet's?
2630   Low medication adherence (taking meds as prescribed) in Behcet's
2631   Fertility in Behcet's
2632   Long-term outcome of neuro-Behcet's

A new study on the impact of influenza vaccinations on Behcet's patients

The results of a new study on how BD patients react to flu vaccinations will be presented in San Diego at the ACR/ARHP (American College of Rheumatology/Association of Reproductive Health Professionals) Congress at the end of October 2013.

Keep in mind that results presented at conferences aren't always final, haven't been published yet and may contain errors! If you have questions about anything you read here — especially whether your current health or meds may cause issues if you get a flu shot — please speak with your doctor(s).


THE BASICS:
 
85 BD patients and 85 healthy people received unadjuvanted [defined at the bottom] flu shots and were monitored for 21 days afterwards.

1. BD patients developed antibodies from the shot significantly LESS often than healthy people (69% vs 83%).
   
2. The BD patients who developed fewer antibodies had more active BD symptoms at the time of the shot (73% vs 39%).
   
3. It didn't make any difference to the outcome if the BD patients were taking corticosteroids, immunosuppressants or TNF-blockers at the time they got the shot. It also didn't matter if they'd just developed BD recently or had had it for decades.
   
4. BD patients had significantly more mild/fleeting side effects from the shot than healthy people: fever (7% vs 0%), headache (27% vs 12%), joint pain (24% vs 0.2%) and muscle pain (25% vs. 9%). None of the BD patients reported moderate or severe side effects.

The researchers concluded that flu shots aren't as effective for some BDers if they're having a high number of active BD symptoms at the time of the shot, but they still recommend getting the shot anyway. They still need to determine if BD patients would get any benefit from a second flu shot, in an attempt to develop more antibodies.

NOTE: This study used "unadjuvanted" vaccine (a vaccine that wasn't live, and didn't include an adjuvant -- "a substance that is added during production to increase the body's immune response to a vaccine" [http://www.phac-aspc.gc.ca/im/pdf/ichp-cips-glos-eng.pdf]).

The abstract for this study can be seen here:
https://ww2.rheumatology.org/apps/MyAnnualMeeting/Abstract/36846

Low-dose naltrexone

Someone just asked in one of the Behcet's support groups if I know anything about the use of low-dose naltrexone (LDN) in the treatment of Behcet's.

There hasn't been any specific research done on its use in BD, but a handful of studies have tried it for MS, Crohn's and fibromyalgia symptoms. 

It's always good to have credible background information on treatments before making any decisions to try them. The US Department of Veterans Affairs/MS Centers of Excellence has put together a "Spotlight" page on naltrexone. You can see it here:
http://www.va.gov/MS/articles/Spotlight_on_Low_Dose_Naltrexone_LDN.asp

And here are some links to LDN studies:

1) Low-dose naltrexone for the treatment of fibromyalgia: findings of a small, randomized, double-blind, placebo-controlled, counterbalanced, crossover trial assessing daily pain levels.
http://www.ncbi.nlm.nih.gov/pubmed/23359310

2) Pilot trial of low-dose naltrexone and quality of life in multiple sclerosis
http://www.ncbi.nlm.nih.gov/pubmed/20695007

3) The effect of low-dose naltrexone on quality of life of patients with multiple sclerosis: a randomized placebo-controlled trial.
http://www.ncbi.nlm.nih.gov/pubmed/20534644

4) A pilot trial of low-dose naltrexone in primary progressive multiple sclerosis.
http://www.ncbi.nlm.nih.gov/pubmed/18728058

5) Low-dose naltrexone therapy improves active Crohn's disease.
http://www.ncbi.nlm.nih.gov/pubmed/17222320

6) Low-dose naltrexone for disease prevention and quality of life.
http://www.ncbi.nlm.nih.gov/pubmed/19041189

Also, PatientsLikeMe.com carries great self-reported patient information on the effectiveness of different medications. Low-dose naltrexone is one of the meds listed on the site. You can see the information here:
http://www.patientslikeme.com/treatments/show/4918-naltrexone-side-effects-and-efficacy#overview 

As always, be careful of websites that seem to go overboard about the off-label use of any medications, including LDN. The presence of exclamation points (!!!) is a dead giveaway that the site is biased and (probably) not credible. And please -- don't buy prescription meds over the Internet. There's no guarantee that you're getting a real version of the medication you've paid for.

If you'd like more information about trying LDN, please speak with your doctor(s).

I came across this abstract this morning and thought I'd share it for educational use.

TITLE:
The prevalence of fibromyalgia in patients with Behcets disease and its relation with disease activity
Rheumatology International, 04/23/2013  Clinical Article

Melikoglu M et al. – The authors' aims were to investigate the prevalence of FM in patients with BD and to evaluate the possible relation of FM presence with BD disease activity. FM is a common and important clinical problem that may represent an additional factor that worsens pain and physical limitations in patients with BD. The higher prevalence of FM in patients with BD seems to be affected by BD itself, rather than its severity.

METHODS

• A total of 104 Behcet patients were included in this study.
• Age, sex, disease durations and the BD Current Activity Form (BDCAF) scores as disease activity evaluation were recorded.
• Presence of FM and the Fibromyalgia Impact Questionnaire (FIQ) scores was investigated.
• Also, ESR and CRP concentrations were determined in all patients.
• Mann–Whitney U test and Pearson’s correlation tests were used for the statistical analysis.
• There were 60 female and 40 male patients with an age range of 19–51 years.

RESULTS

• Eighteen of 100 BD patients were diagnosed as FM.
• Although ages, disease duration and laboratory parameters did not differ between BD patients with and without FM, BD patients with FM were more frequently female (p < 0.000).
• The presence of FM did not differ significantly between patients with and without systemic manifestations.
• Also, oral–genital ulcers, erythema nodosum, thrombophlebitis, pustular lesions and doctor’s impression of disease activity scores were not found to be different in BD patients with or without FM.
• However, there were significant differences in fatigue, headache, arthralgia and patient impression of disease activity (today and last 28 days) between these groups (p < 0.000; p < 0.01; p < 0.01; p = 0.021 and p = 0.027, respectively).
• Also, there were significant correlations between BDCAF and FIQ items that refer pain and fatigue (p < 0.01).

I just heard about this presentation by Dr. Y Yazici, Director of the Behcet's Syndrome Center in NYC:
"Behcet's Syndrome: What it is and what it is not"
(Powerpoint in PDF form)

There's no date on the presentation, but it was done after the publication of his latest book on Behcet's in 2010.

http://www.google.com/url?sa=X&q=http://www.rheumatology.org/Education/Profmeetingcourses/Members/Sota/1015_behcet_Yazici/&ct=ga&cad=CAcQAhgAIAEoBDAAOABAhNmziwVIAVgAYgJlbg&cd=TW1ZLx1a1wU&usg=AFQjCNGqpofHNNDvNzo8uJVJ5x7ZqmopaQ