Clinical features of Behcet’s disease in Mongolia: a multicenter study

Clinical Rheumatology volume 39, pages2697–2706(2020)Cite this article

Abstract

Objective

The aim of the present study is to investigate the clinical features of patients with Behcet’s disease (BD) in Mongolia.

Methods

Patients were identified and examined from six medical institutions in Mongolia from January 2015 to January 2019. BD was diagnosed according to the diagnostic criteria for BD established by the International Study Group.

Results

There were sixty-five patients (22 males and 43 females) recoded, the ratio of 1:1.95, with a marked female predominance. The age of disease onset was 22.2 ± 10.0 (mean ± SD), ranging from 11 to 66 years old. Oral aphthous ulcers, ocular lesions, skin lesions, genital ulcers, pathergy test positivity, articular lesions, superficial vasculitis, deep vein thrombosis, and epididymitis (male only) were observed in 100.0%, 63.1%, 81.5%, 89.2%, 7.7%, 86.2%, 32.3%, 4.6%, and 13.6% of the patients, respectively. The incidence of poor visual prognosis, ≤ 20/200, was significantly higher in males than in females (31.8 vs. 9.3%, incidence rate ratio 4.55 (95% CI 1.16–17.82), p < 0.05). The pathergy test was positive only in 7.7% of cases and only in female subjects. Nasal mucous ulcers were frequently seen in 55.4% of patients that may also be attributed to the environmental conditions of Mongolia. Headache was observed 76.9% of patients in this study.

Conclusions

Clinical manifestations of BD in Mongolia are presented for the first time. The visual prognosis was significantly worse in males. Nasal mucous membrane ulcers and recurrent headaches were frequent among Mongolian patients with BD.

Key Points
• First results of the examination of the clinical features of Behcet’s disease patients in Mongolia.
• Nasal ulcerations and recurrent headaches are frequent symptoms in Mongolia Behcet’s disease patients, potentially attributed to climate.
• Male Behcet’s disease patients in Mongolia have a significantly worse prognosis for eye-related complications and vision.

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Fig. 1
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Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

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Acknowledgments

The authors wish to acknowledge the contribution of Nancy Terry (National Institutes of Health Library, Bethesda, USA) for the manuscript editing and language corrections; Amy Zhang (Immunoregulation Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA) for statistical assistance; Uranchimeg Davaatseren, Uen Bold, Munktsetseg Tserendash, Narantsetseg Vandandorj, Amgalan Tseesed, Ganzorigt Sodnomdarjaa, Lkhagvadolgor Davaajav, Kuliza Aldanish, Munkhzaya Tsengenbayar, Munkhsaikhan Munkhhuyag, Enkhmaa Purev, and Erdenetuya Gongorjav for the assistance with patient data collection. The authors would also like to acknowledge the technical assistance of Bolor Melmii Eye Hospital (Ulaanbaatar, Mongolia) and UB Songdo Hospital (Mongolia, Ulaanbaatar).

Funding

This study was supported by Japan Society for the Promotion of Science (JSPS) KAKENHI; Grant Numbers 16K11297, 19K09975, and Glaucoma Clinic of Zalaa Khukh Tolgoi LLC.

Author information

Affiliations

  1. Department of Ophthalmology, School of Medicine, Mongolian National University of Medical Sciences (MNUMS), Ulaanbaatar, Mongolia

    Javzandulam Balt & Baasankhuu Jamyanjav

  2. Glaucoma Clinic, Zalaa Khukh Tolgoi LLC, Ulaanbaatar, Mongolia

    Javzandulam Balt

  3. Department of Molecular Biology and Genetics, School of Bio-Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia

    Sarantuya Jav & Chimedlkhamsuren Ganbold

  4. Department of Rheumatology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia

    Zulgerel Dandii

  5. Immunoregulation Section, Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA

    Yukihiro Horie

  6. Department of Ophthalmology, Health Sciences University of Hokkaido Hospital, Ainosato 2-5, Kita-ku, Sapporo, 002-8072, Japan

    Yukihiro Horie, Shigeaki Ohno & Nobuyoshi Kitaichi

  7. Department of Ophthalmology, University of Missouri, Columbia, MO, USA

    Anton Lennikov

  8. Department of Oral Growth and Development, Division of Disease Control and Molecular Epidemiology, School of Dentistry, Health Sciences University of Hokkaido, Tobetsu, Japan

    Osamu Uehara

  9. Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan

    Shigeaki Ohno & Nobuyoshi Kitaichi

Authors
  1. Javzandulam Balt
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  2. Baasankhuu Jamyanjav
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  3. Sarantuya Jav
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  4. Zulgerel Dandii
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  5. Chimedlkhamsuren Ganbold
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  6. Yukihiro Horie
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  7. Anton Lennikov
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  8. Osamu Uehara
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  9. Shigeaki Ohno
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  10. Nobuyoshi Kitaichi
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Contributions

The study was conceived and designed, and patients’ data were collected and analyzed, by Javzandulam Balt, Baasankhuu Jamyanjav, Sarantuya Jav, and Zulgerel Dandii. Nobuyoshi Kitaichi and Shigeaki Ohno supervised this work. The manuscript was written, and statistical analyses were performed, by Javzandulam Balt, Chimedlkhamsuren Ganbold, Yukihiro Horie, and Anton Lennikov and critically revised by Yukihiro Horie, Anton Lennikov, and Osamu Uehara. All authors reviewed and accepted the final version of the manuscript.

Corresponding author

Correspondence to Nobuyoshi Kitaichi.

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Ethics approval and consent to participate

Informed consent was obtained from all the patients, and data collection was conducted in accordance with the Declaration of Helsinki and approved by the ethical commissions of the Mongolian National University of Medical Sciences (MNUMS) with decision number 16/3/2016-16. Written permission was obtained from the subjects of the representative photographs demonstrating pathergy test, ulcers of nasal and lip area, and DVT with skin necrosis.

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Balt, J., Jamyanjav, B., Jav, S. et al. Clinical features of Behcet’s disease in Mongolia: a multicenter study. Clin Rheumatol 39, 2697–2706 (2020). https://doi.org/10.1007/s10067-020-05019-1

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Keywords

  • Behcet’s disease
  • Mongolia
  • Multicenter study
  • Nasal mucous ulcers
  • Ocular symptoms
  • Silk Road disease