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. 2021 Feb 1;23(1):49.
doi: 10.1186/s13075-020-02406-6.

Changes in the proportion of clinical clusters contribute to the phenotypic evolution of Behçet's disease in Japan

Yutaro Soejima  1 , Yohei Kirino  2 , Mitsuhiro Takeno  3 , Michiko Kurosawa  4 , Masaki Takeuchi  5 , Ryusuke Yoshimi  1 , Yumiko Sugiyama  6 , Shigeru Ohno  6 , Yukiko Asami  7 , Akiko Sekiguchi  8 , Toshihisa Igarashi  9 , Shohei Nagaoka  10 , Yoshiaki Ishigatsubo  11 , Hideaki Nakajima  1 , Nobuhisa Mizuki  5
Affiliations

Changes in the proportion of clinical clusters contribute to the phenotypic evolution of Behçet's disease in Japan

Yutaro Soejima et al. Arthritis Res Ther. .

Abstract

Background: We hypothesized that Behçet's disease (BD) consists of several clinical subtypes with different severity, resulting in heterogeneity of the disease. Here, we conducted a study to identify clinical clusters of BD.

Methods: A total of 657 patients registered in the Yokohama City University (YCU) regional BD registry between 1990 and 2018, as well as 6754 patients who were initially registered in the Japanese Ministry of Health, Labour and Welfare (MHLW) database between 2003 and 2014, were investigated. The YCU registry data regarding the clinical manifestations of BD, human leukocyte antigen (HLA) status, treatments, and hospitalizations were analyzed first, followed by similar analyses of the MHLW for validation. A hierarchical cluster analysis was independently performed in both patient groups.

Results: A hierarchical cluster analysis determined five independent clinical clusters in the YCU cohort. Individual counterparts of the YCU clusters were confirmed in the MHLW registry. Recent phenotypical evolutions of BD in Japan, such as increased gastrointestinal (GI) involvement, reduced complete type according to the Japan Criteria, and reduced HLA-B51 positivity were associated with chronologically changing proportions of the clinical clusters.

Conclusions: In this study, we identified independent clinical clusters among BD patients in Japan and found that the proportion of each cluster varied over time. We propose five independent clusters namely "mucocutaneous", "mucocutaneous with arthritis", "neuro", "GI", and "eye."

Keywords: Behçet’s disease; Cluster analysis; Intestinal manifestation.

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Conflict of interest statement

Y. Kirino: Amgen (speaking and consultation fees); M. Takeno: Amgen (advisor for the clinical trial of Apremilast); and S. Nagaoka: Chugai, Bristol-Myers Squibb, Gilead (consultation fees).

Figures

Fig. 1
Fig. 1
Evolution of clusters in the Yokohama City University registry. The Y-axis represents the percentage of each cluster to the total number of specified periods
Fig. 2
Fig. 2
Proposing Behçet’s disease clusters based on the present and previous studies
See this image and copyright information in PMC

Comment in

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