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Clinical Sciences |

Human Leukocyte Antigen B27 and B51 Double-Positive Behçet Uveitis FREE

Jae Kyoun Ahn, MD; Yeoung Geol Park, MD
[+] Author Affiliations

Author Affiliations: Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea.


Arch Ophthalmol. 2007;125(10):1375-1380. doi:10.1001/archopht.125.10.1375.
Text Size: A A A
Published online

Objectives  To describe the clinical characteristics of human leukocyte antigen (HLA) B27 and B51 double-positive Behçet uveitis and to determine whether the coexistence of HLA-B27 can affect Behçet uveitis.

Methods  We retrospectively reviewed the medical records of patients with Behçet uveitis and patients with HLA-B27–associated non-Behçet uveitis who underwent HLA-B27 and HLA-B51 typing and were followed up for more than 3 years. We divided the patients into 3 groups according to HLA-B27/B51 status and compared the clinical outcomes. Main outcome measures were demographic features, uveitis characteristics, complications, treatments, and visual prognosis.

Results  Fourteen patients with HLA-B27(+)B51(+) Behçet uveitis, 43 patients with HLA-B27(−)B51(+) Behçet uveitis, and 41 patients with HLA-B27(+)B51(−) non-Behçet uveitis were identified. HLA-B27(+)B51(+) Behçet uveitis showed the demographic features similar to HLA-B27(−) counterparts. However, HLA-B27(+)B51(+) Behçet uveitis showed less involvement of posterior segments, a less chronic course, fewer complications in posterior segments, and less use of systemic medication or surgical intervention for inflammatory control, similar to HLA-B27(+)B51(−) non-Behçet uveitis. The long-term vision prognosis of HLA-B27(+)B51(+) Behçet uveitis was more favorable than that of HLA-B27(−)B51(+) Behçet uveitis.

Conclusions  Our results indicate that HLA-B27(+)B51(+) Behçet uveitis is a benign subgroup of Behçet uveitis. The positivity of HLA-B27 may be a good prognostic factor in Behçet uveitis.

Class I human leukocyte antigen (HLA) is closely associated with disease susceptibility in patients with uveitis. HLA-B51 is the primary gene involved in the pathogenesis of Behçet disease that can aid the diagnosis.13 Behçet uveitis usually shows a chronic course of relapsing uveitis affecting posterior segments during follow-up. However, about 10% of patients with Behçet uveitis develop intraocular inflammation limited to anterior segments.4 Classifying uveitis according to anatomical location and clinical course are important because of therapeutic strategy and vision prognosis.

HLA-B27 is the representative gene related to acute anterior uveitis with or without systemic diseases. HLA-B27–associated uveitis and Behçet uveitis are the most common causes of hypopyon uveitis from noninfectious origins.5 However, the overall clinical course and long-term vision prognosis are much different between Behçet uveitis and HLA-B27–associated uveitis. Although male sex and clinical severity of uveitis have been reported to be associated with the poor vision prognosis of Behçet uveitis,4,6 there is little evidence regarding the clinical significance of HLA-B27 positivity in Behçet uveitis.

In this study, we retrospectively analyzed the demographic features, uveitis characteristics, ocular complications, treatments, and long-term vision prognosis of HLA-B27 and HLA-B51 double-positive Behçet uveitis and compared the outcomes with other 2 groups, such as HLA-B27(−)B51(+) Behçet uveitis and HLA-B27(+)B51(−) non-Behçet uveitis.

We retrospectively reviewed the medical records of patients with Behçet uveitis and patients with HLA-B27–associated non-Behçet uveitis who were seen at the uveitis clinic at Chonnam National University Hospital (Gwangju, Korea) between 2000 and 2004. Informed consent was obtained for each patient who was tested for HLA typing of B27 and B51. Data collection was approved by our institutional review board. The patients with Behçet uveitis fulfilled the criteria of Behçet disease according to international classifications.7 The diagnoses of ankylosing spondylitis and Reiter syndrome were made according to previous reports.8,9 We excluded patients with follow-up times of less than 3 years.

At the initial visit, a comprehensive medical and ophthalmologic history, including an extensive systemic review, was obtained from each patient. Complete ocular examinations were performed at each visit, including best-corrected Snellen visual acuity, slitlamp biomicroscopy, tonometry, and indirect ophthalmoscopy. Initial laboratory investigations were performed on all patients, including a complete blood cell count, urinalysis, VDRL test, angiotensin-converting enzyme test, chest x-ray, and HLA-B27 and HLA-B51 typing. Systemic disease association was documented in our rheumatology department. Ocular laboratory investigations, including anterior segment and fundus photography, fluorescein angiography, and ultrasonography, were performed when indicated.

For the descriptive and statistical analyses, patients were divided into 3 major groups. The first group consisted of patients with HLA-B27(−)B51(+) Behçet uveitis. The second group comprised patients with HLA-B27(+)B51(+) Behçet uveitis, and the third group had HLA-B27(+)B51(−) non-Behçet uveitis. Demographic data, including age at onset of uveitis and sex, were noted, and uveitis characteristics, including anatomical location of uveitis, clinical course, bilaterality, and associated ocular findings (hypopyon, papillitis, retinal hemorrhage, retinal vasculitis, vitritis), according to the criteria of the Standardization of Uveitis Nomenclature (SUN) Working Group grading scheme,10 were recorded at the initial visit or during follow-up. We reviewed ocular complications, including significant cataract and secondary glaucoma, extensive (≥180°) posterior synechiae, clinically significant macular edema, optic atrophy, retinal vein occlusion, formation of retinal new vessels, and retinal detachment. All patients were treated according to anatomical location of the uveitis, degree of intraocular inflammation, and etiology of the uveitis. Most patients initially were treated with topical steroids, and periocular steroids were used for severe recurrent attacks with involvement of posterior segments. Systemic steroids were given if the inflammation could not be controlled with previous therapy, and systemic immunosuppressive agents were used for patients in whom previous therapeutic strategies had failed. Because the nature of Behçet uveitis was usually chronic and severely recurrent, we tried to treat Behçet uveitis with posterior segment involvement by immunosuppressive agents (azathioprine and cyclosporin A) combined with prednisone at the initial visit or early during follow-up. Colchicine treatment was administered by the patients' rheumatologists. The appropriate surgical interventions were performed for patients with visually significant cataract and medically intractable glaucoma. Pars plana vitrectomy was performed in cases of nonclearing vitreous opacity, epiretinal membranes, persistent intraocular inflammation irrespective of the use of immunosuppressive agents, and retinal detachment. Initial visual acuity was defined as acuity obtained at the initial visit. Because visual acuity is usually severely affected during inflammatory episodes, we defined the final visual acuity as the visual acuity during remission at the last follow-up. The distribution of counts was analyzed using a Fisher exact test, correcting for multiple comparisons by requiring a P value less than .05 on individual tests for a net confidence greater than 95%. Parametric data were compared using a Mann-Whitney U test.

A total of 57 patients with HLA-B51–positive Behçet uveitis and 41 patients with HLA-B27–associated non-Behçet uveitis were recruited in this study. All patients were Korean. Fourteen of 57 patients with HLA-B51–positive Behçet uveitis concomitantly were HLA-B27 positive. Recurrent oral ulcerations and skin involvements were confirmed by our rheumatologist in all the patients with HLA-B51–positive Behçet uveitis, which manifested as recurrent genital ulcerations in 46 patients (81%) and positive pathergy test results in 23 patients (40%). There were no differences regarding systemic manifestations according to the presence of HLA-B27. In 5 patients who were HLA-B51 positive, uveitis was the crucial criterion for diagnosing Behçet disease. Two of 14 patients with HLA-B27(+)B51(+) Behçet uveitis concomitantly had ankylosing spondylitis diagnosed by pelvis x-ray, but the systemic manifestations of 2 patients were closer to Behçet disease than to ankylosing spondylitis. No patients with HLA-B27(+)B51(+) Behçet uveitis showed systemic features related to Reiter syndrome, inflammatory bowel disease, or psoriasis. All patients associated with HLA-B27 uveitis were HLA-B51 negative. Of 41 patients with HLA-B27–associated uveitis, 15 were diagnosed with ankylosing spondylitis, 4 patients had Reiter syndrome, and the others showed no definite systemic associations.

The male-female ratio of HLA-B27(+)B51(+) Behçet uveitis was 2.5:1. This ratio was similar to that of HLA-B27(−)B51(+) Behçet uveitis (2.9:1) but was lower than that of HLA-B27(+)B51(−) non-Behçet uveitis (1.2:1). The mean age at uveitis onset was similar between HLA-B27(+)B51(+) Behçet uveitis and HLA-B27(−)B51(+) Behçet uveitis (31.7 vs 31.2 years), but the mean age of Behçet uveitis was significantly younger than that of HLA-B27(+)B51(−) non-Behçet uveitis (39.6 years, P = .04). The demographic features are described in Table 1.

Table 2 outlines the uveitis characteristics of HLA-B27(+)B51(+) Behçet uveitis compared with those of HLA-B27(−)B51(+) Behçet uveitis and HLA-B27(+)B51(−) non-Behçet uveitis at the initial visit or during follow-up. There were significant differences between HLA-B27(+)B51(+) Behçet uveitis and HLA-B27(−)B51(+) Behçet uveitis with respect to anatomical locations, clinical course, and ocular findings. Compared with HLA-B27(−)B51(+) Behçet uveitis, more involvement with anterior segments (P < .01), a more acute course (P = .02), and fewer sight-threatening conditions (P < .01) were observed in HLA-B27(+)B51(+) Behçet uveitis. These uveitis characteristics of HLA-B27(+)B51(+) Behçet uveitis were similar to those of HLA-B27(+)B51(−) non-Behçet uveitis. There were no differences between the groups regarding bilaterality and occurrence rates of hypopyon and papillitis. Two patients who concomitantly had Behçet disease and ankylosing spondylitis did not show the same uveitis characteristics. Bilateral panuveitis with retinal vasculitis was observed in a 23-year-old man, and unilateral recurrent anterior uveitis developed in a 36-year-old man.

Table Graphic Jump LocationTable 2. Uveitis Characteristics at Initial Visit or During Follow-up

Table 3 lists the ocular complications of anterior and posterior segments at the initial visit or during follow-up. There were no statistically significant differences between groups in ocular complication rates. However, frequencies of visually significant cataract were lower in HLA-B27(+)B51(+) Behçet uveitis than in HLA-B27(−)B51(+) Behçet uveitis irrespective of the similar frequencies of glaucoma and posterior synechiae. Also, occurrences of macular edema, optic atrophy, and retinal new vessels were lower in HLA-B27(+)B51(+) Behçet uveitis than in HLA-B27(−)B51(+) Behçet uveitis. The nature of ocular complications of HLA-B27(+)B51(+) Behçet uveitis was comparable with that of HLA-B27(+)B51(−) non-Behçet uveitis. Accordingly, the numbers of patients who had received periocular steroids, systemic steroids, or immunosuppressive agents were significantly higher in HLA-B27(−)B51(+) Behçet uveitis than in HLA-B27(+)B51(+) Behçet uveitis (P < .01) (Table 4). The rates of surgical management by pars plana vitrectomy were significantly more frequent in HLA-B27(−)B51(+) Behçet uveitis than in HLA-B27(+)B51(+) Behçet uveitis (P = .03).

Table Graphic Jump LocationTable 3. Ocular Complications at Initial Visit or During Follow-up
Table Graphic Jump LocationTable 4. Medical and Surgical Management of Patients

Table 5 lists the long-term vision prognosis in this study. As expected from the results described earlier, more patients with HLA-B27(+)B51(+) Behçet uveitis had an initial visual acuity of more than 20/40 or 20/200 than did patients with HLA-B27(−)B51(+) Behçet uveitis (P < .01). The risk of decrease in visual acuity to less than 20/40 (driving vision) during follow-up was significantly lower in HLA-B27(+)B51(+) Behçet uveitis than in HLA-B27(−)B51(+) Behçet uveitis (21.6% vs 95.3%, P < .01). The risk of decrease in visual acuity to less than 20/200 (legal blindness) was also lower in HLA-B27(+)B51(+) Behçet uveitis than in HLA-B27(−)B51(+) Behçet uveitis (7.2% vs 25.6%), although this difference was not statistically significant (P = .26). Vision outcomes of HLA-B27(+)B51(+) Behçet uveitis were comparable with those of HLA-B27(+)B51(−) non-Behçet uveitis.

Our study demonstrates that HLA-B27(+)B51(+) Behçet uveitis, a subgroup of Behçet uveitis, is a specific disease entity characterized by a benign clinical course and favorable vision outcomes in comparison with HLA-B27(−)B51(+) Behçet uveitis and that clinical features of the HLA-B27(+)B51(+) Behçet uveitis are similar to those of HLA-B27(+)B51(−) non-Behçet uveitis. We found that demographic features of HLA-B27(+)B51(+) Behçet uveitis were closer to those of HLA-B27(−)B51(+) Behçet uveitis. In contrast, uveitis characteristics, ocular complications, treatment choices, and long-term vision outcomes of HLA-B27(+)B51(+) Behçet uveitis were closer to those of HLA-B27(+)B51(−) non-Behçet uveitis. Our study suggests that the presence of HLA-B27 in HLA-B51–positive Behçet uveitis may be a good prognostic factor.

Both HLA-B27 and HLA-B51 are known to be representative genes related to the specific syndrome of uveitis. There was laboratory evidence regarding the immunopathogenic roles of 2 genes in disease induction.11,12 Because the positivity of HLA-B51 showed a lot of the geographic variation, the status of HLA-B51 is not currently included in the diagnostic criteria for Behçet disease according to international criteria.13 However, many genetic studies indicated that a gene near HLA-B51 may play a role in the immunopathogenesis of Behçet disease.1,13,14 Furthermore, the diagnostic specificity of HLA-B51 positivity in Korean Behçet disease was 83% superior to that of recurrent oral ulceration and skin involvement even though the diagnostic sensitivity of HLA-B51 positivity was low (50%).15 Therefore, the positivity of HLA-B51 may be a separate finding that helps diagnose or classify Behçet disease. However, recent clinical studies indicated that HLA-B51 status of Behçet uveitis was not correlated with the disease severity.6,16 Our results imply that HLA-B27 status in HLA-B51–positive Behçet uveitis may be correlated with disease severity at the initial visit or during follow-up. Currently, we do not know the function of HLA-B27 on the disease progression or posterior-segment involvement of Behçet uveitis. However, a possible explanation is that HLA-B27 may act as the dominant gene against HLA-B51 in Behçet uveitis.

Male sex and early age at uveitis onset have been reported to be poor prognostic factors in Behçet uveitis.4,17 Our data regarding these demographic factors of all the patients included were consistent with previous reports.4,18 Because the male-female ratio and mean age at uveitis onset were similar between HLA-B27(+)B51(+) Behçet uveitis and HLA-B27(−)B51(+) Behçet uveitis, the demographic factors do not affect our results. In addition, in accordance with previous reports,4,18 we found that the male predominance and younger age at uveitis onset were noted in Behçet uveitis compared with HLA-B27–associated non-Behçet uveitis.

The uveitis characteristics of HLA-B27(−)B51(+) Behçet uveitis in our study are similar to other studies in different ethnic populations.4,6,16,17,19,20 In contrast, HLA-B27–associated uveitis shows less involvement of posterior segments and a more benign clinical course, similar to our patients.18,21,22 These differences in clinical findings may be attributed to the different immune effectors and cytokine environments.23,24 Interestingly, we observed that the clinical characteristics of HLA-B27(+)B51(+) Behçet uveitis included acute or recurrent anterior uveitis with less posterior-segment involvement. Furthermore, in some samples from our previous reports, we found that the ocular infiltrating immune cells and intraocular cytokines were similar between HLA-B27(+)B51(+) Behçet uveitis and HLA-B27(+)B51(−) non-Behçet uveitis (data not shown).23,24 Therefore, the clinical features of HLA-B27(+)B51(+) Behçet uveitis are close to those of HLA-B27(+)B51(−) non-Behçet uveitis.

All ocular complications were observed less frequently in HLA-B27(+)B51(+) Behçet uveitis compared with HLA-B27(−)B51(+) Behçet uveitis. These findings were more prominent in the posterior segments that did directly affect vision outcomes. Because the uveitis characteristics and ocular complications of HLA-B27(+)B51(+) Behçet uveitis were the same as those of HLA-B27(+)B51(−) non-Behçet uveitis, there was much less frequent use of systemic steroids or immunosuppressive agents for control of intraocular inflammation. Our previous report suggested that vitrectomy in persistent Behçet uveitis, despite aggressive treatment with medication, might be helpful in controlling inflammation.25 However, in this study, no patients with HLA-B27(+)B51(+) Behçet uveitis needed to receive vitrectomy for control of intraocular inflammation. These differences indicate, with aggressive medical or surgical treatments as proxy measures of severity, that patients with HLA-B27(−)B51(+) Behçet uveitis clearly suffer more severe treatment-resistant uveitis than do patients with HLA-B27(+)B51(+) Behçet uveitis.

Overall vision outcomes in this study are in agreement with previous studies.4,6,18 Our patients with HLA-B27(+)B51(+) Behçet uveitis appear to have favorable long-term vision prognosis. The risks of a decrease in visual acuity over 3 years to less than 20/200, or to less than 20/40 in particular, are much lower in HLA-B27(+)B51(+) Behçet uveitis than in HLA-B27(−)B51(+) Behçet uveitis. These findings support the idea that HLA-B27(+)B51(+) Behçet uveitis is a mild form of Behçet uveitis.

One may argue that patients with HLA-B27(+)B51(+) Behçet uveitis could be classified into HLA-B27–associated uveitis rather than Behçet uveitis according to the uveitis characteristics of our results. However, it is reasonable to classify HLA-B27(+)B51(+) Behçet uveitis as a subgroup of Behçet uveitis. First, the systemic manifestations of HLA-B27(+)B51(+) Behçet uveitis are not attributed to HLA-B27–associated systemic diseases but to Behçet disease. Second, the positivity of HLA-B51 may be a genetic marker for Behçet disease. Third, only 2 patients with HLA-B27(+)B51(+) Behçet uveitis concurrently had ankylosing spondylitis, and the uveitis characteristics of 1 patient are closer to Behçet uveitis than to HLA-B27–associated uveitis.

In conclusion, HLA-B27(+)B51(+) Behçet uveitis is a benign subgroup of Behçet uveitis, and the clinical characteristics resemble HLA-B27–associated non-Behçet uveitis. Therefore, the presence of HLA-B27 in Behçet uveitis may be a good prognostic factor.

Correspondence: Jae Kyoun Ahn, MD, Department of Ophthalmology, Chonnam National University Medical School, 8 Hakdong, Donggu, Gwangju 501-757, Korea (jkahn@jnu.ac.kr).

Submitted for Publication: March 3, 2007; final revision received May 7, 2007; accepted May 8, 2007.

Financial Disclosure: None reported.

Ohno  SOhguchi  MHirose  S  et al.  Close association of HLA-Bw51 with Behçet's disease. Arch Ophthalmol 1982;100 (9) 1455- 1458
PubMed Link to Article
Yazici  HTuzun  YPazarli  H  et al.  The combined use of HLA-B5 and the pathergy test as diagnostic markers of Behçet's disease in Turkey. J Rheumatol 1980;7 (2) 206- 210
PubMed
Verity  DHWallace  GRVaughan  RWStandford  MR Behçet's disease: from Hippocrates to the third millennium. Br J Ophthalmol 2003;87 (9) 1175- 1183
PubMed Link to Article
Tugal-Tutkun  IOnal  SAltan-Yaycioglu  RAltunbas  HHUrgancioglu  M Uveitis in Behçet's disease: an analysis of 880 patients. Am J Ophthalmol 2004;138 (3) 373- 380
PubMed Link to Article
Ramsay  ALightman  S Hypopyon uveitis. Surv Ophthalmol 2001;46 (1) 1- 18
PubMed Link to Article
Takeuchi  MHokama  HTsukahara  R  et al.  Risk and prognostic factors of poor visual outcome in Behcet's disease with ocular involvement. Graefes Arch Clin Exp Ophthalmol 2005;2431147- 1152(11)
PubMed Link to Article
International Study Group for Behçet's Disease, Criteria for diagnosis of Behçet's disease. Lancet 1990;335 (8697) 1078- 1080
PubMed
Dougados  Mvan der Linden  SJEFJuhlin  R  et al.  The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 1991;34 (10) 1218- 1227
PubMed Link to Article
Lee  DABarker  SMDaniel Su  WP  et al.  The clinical diagnosis of Reiter's syndrome: ophthalmic and nonophthalmic aspects. Ophthalmology 1986;93 (3) 350- 356
PubMed Link to Article
Jabs  DANussenblatt  RBRosenbaum  JTStandardization of Uveitis Nomenclature (SUN) Working Group, Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop. Am J Ophthalmol 2005;140 (3) 509- 516
PubMed Link to Article
Frauendorf  EvonGoessel  HMay  EMarker-Hermann  E HLA-B27-restricted T cells from patients with ankylosing spondylitis recognize peptides from B*2705 that are similar to bacteria-derived peptides. Clin Exp Immunol 2003;134 (2) 351- 359
PubMed Link to Article
Yasuoka  HOkazaki  YKawakami  Y  et al.  Autoreactive CD8+ cytotoxic T lymphocytes to major histocompatibility complex class I chain-related gene A in patients with Behçet's disease. Arthritis Rheum 2004;50 (11) 3658- 3662
PubMed Link to Article
Verity  DHMarr  JEOhno  SWallace  GRStanford  MR Behçet's disease, the silk road and HLA-B51: historical and geographical perspectives. Tissue Antigens 1999;54 (3) 213- 220
PubMed Link to Article
Mizuki  NOta  MYabuki  K  et al.  Localization of the pathogenic gene of Behçet's disease by microsatellite analysis of three different populations. Invest Ophthalmol Vis Sci 2000;41 (12) 3702- 3708
PubMed
Chang  HKKim  SY Survey and validation of the criteria for Behçet's disease recently used in Korea: a suggestion for modification of the International Study Group Criteria. J Korean Med Sci 2003;18 (1) 88- 92
PubMed
Gul  AYyar  AInanc  M  et al.  Lack of association of HLA-B51 with a severe disease course in Behçet's disease. Rheumatology (Oxford) 2001;40 (6) 668- 672
PubMed Link to Article
Demiroglu  HBarista  IDundar  S Risk factor assessment and prognosis of eye involvement in Behçet's disease in Turkey. Ophthalmology 1997;104 (4) 701- 705
PubMed Link to Article
Power  WJPedroza-Seres  MFoster  CS Outcomes in anterior uveitis associated with the HLA-B27 haplotype. Ophthalmology 1998;105 (9) 1646- 1651
PubMed Link to Article
Ambresin  ATao Tran  VSpertini  FHerbort  CP Behçet's disease in western Switzerland: epidemiology and analysis of ocular involvement. Ocul Immunol Inflamm 2002;10 (1) 53- 63
PubMed Link to Article
Muhaya  MLightman  SIkeda  E  et al.  Behçet's disease in Japan and in Great Britain: a comparative study. Ocul Immunol Inflamm 2000;8 (3) 141- 148
PubMed Link to Article
Linssen  AMeenken  C Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol 1995;120 (3) 351- 361
PubMed
Wakefield  DMontanaro  AMcCluskey  P Acute anterior uveitis and HLA-B27. Surv Ophthalmol 1991;36 (3) 223- 232
PubMed Link to Article
Ahn  JKChung  HLee  DSYu  YSYu  HG CD8brightCD56+ T cells are cytotoxic effectors in patients with active Behçet's uveitis. J Immunol 2005;175 (9) 6133- 6142
PubMed Link to Article
Ahn  JKYu  HGChung  HPark  YG Intraocular cytokine environment in active Behçet uveitis. Am J Ophthalmol 2006;142 (3) 429- 434
PubMed Link to Article
Ahn  JKChung  HYu  HG Vitrectomy for persistent panuveitis in Behçet's disease. Ocul Immunol Inflamm 2005;13 (6) 447- 453
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 2. Uveitis Characteristics at Initial Visit or During Follow-up
Table Graphic Jump LocationTable 3. Ocular Complications at Initial Visit or During Follow-up
Table Graphic Jump LocationTable 4. Medical and Surgical Management of Patients

References

Ohno  SOhguchi  MHirose  S  et al.  Close association of HLA-Bw51 with Behçet's disease. Arch Ophthalmol 1982;100 (9) 1455- 1458
PubMed Link to Article
Yazici  HTuzun  YPazarli  H  et al.  The combined use of HLA-B5 and the pathergy test as diagnostic markers of Behçet's disease in Turkey. J Rheumatol 1980;7 (2) 206- 210
PubMed
Verity  DHWallace  GRVaughan  RWStandford  MR Behçet's disease: from Hippocrates to the third millennium. Br J Ophthalmol 2003;87 (9) 1175- 1183
PubMed Link to Article
Tugal-Tutkun  IOnal  SAltan-Yaycioglu  RAltunbas  HHUrgancioglu  M Uveitis in Behçet's disease: an analysis of 880 patients. Am J Ophthalmol 2004;138 (3) 373- 380
PubMed Link to Article
Ramsay  ALightman  S Hypopyon uveitis. Surv Ophthalmol 2001;46 (1) 1- 18
PubMed Link to Article
Takeuchi  MHokama  HTsukahara  R  et al.  Risk and prognostic factors of poor visual outcome in Behcet's disease with ocular involvement. Graefes Arch Clin Exp Ophthalmol 2005;2431147- 1152(11)
PubMed Link to Article
International Study Group for Behçet's Disease, Criteria for diagnosis of Behçet's disease. Lancet 1990;335 (8697) 1078- 1080
PubMed
Dougados  Mvan der Linden  SJEFJuhlin  R  et al.  The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum 1991;34 (10) 1218- 1227
PubMed Link to Article
Lee  DABarker  SMDaniel Su  WP  et al.  The clinical diagnosis of Reiter's syndrome: ophthalmic and nonophthalmic aspects. Ophthalmology 1986;93 (3) 350- 356
PubMed Link to Article
Jabs  DANussenblatt  RBRosenbaum  JTStandardization of Uveitis Nomenclature (SUN) Working Group, Standardization of uveitis nomenclature for reporting clinical data: results of the First International Workshop. Am J Ophthalmol 2005;140 (3) 509- 516
PubMed Link to Article
Frauendorf  EvonGoessel  HMay  EMarker-Hermann  E HLA-B27-restricted T cells from patients with ankylosing spondylitis recognize peptides from B*2705 that are similar to bacteria-derived peptides. Clin Exp Immunol 2003;134 (2) 351- 359
PubMed Link to Article
Yasuoka  HOkazaki  YKawakami  Y  et al.  Autoreactive CD8+ cytotoxic T lymphocytes to major histocompatibility complex class I chain-related gene A in patients with Behçet's disease. Arthritis Rheum 2004;50 (11) 3658- 3662
PubMed Link to Article
Verity  DHMarr  JEOhno  SWallace  GRStanford  MR Behçet's disease, the silk road and HLA-B51: historical and geographical perspectives. Tissue Antigens 1999;54 (3) 213- 220
PubMed Link to Article
Mizuki  NOta  MYabuki  K  et al.  Localization of the pathogenic gene of Behçet's disease by microsatellite analysis of three different populations. Invest Ophthalmol Vis Sci 2000;41 (12) 3702- 3708
PubMed
Chang  HKKim  SY Survey and validation of the criteria for Behçet's disease recently used in Korea: a suggestion for modification of the International Study Group Criteria. J Korean Med Sci 2003;18 (1) 88- 92
PubMed
Gul  AYyar  AInanc  M  et al.  Lack of association of HLA-B51 with a severe disease course in Behçet's disease. Rheumatology (Oxford) 2001;40 (6) 668- 672
PubMed Link to Article
Demiroglu  HBarista  IDundar  S Risk factor assessment and prognosis of eye involvement in Behçet's disease in Turkey. Ophthalmology 1997;104 (4) 701- 705
PubMed Link to Article
Power  WJPedroza-Seres  MFoster  CS Outcomes in anterior uveitis associated with the HLA-B27 haplotype. Ophthalmology 1998;105 (9) 1646- 1651
PubMed Link to Article
Ambresin  ATao Tran  VSpertini  FHerbort  CP Behçet's disease in western Switzerland: epidemiology and analysis of ocular involvement. Ocul Immunol Inflamm 2002;10 (1) 53- 63
PubMed Link to Article
Muhaya  MLightman  SIkeda  E  et al.  Behçet's disease in Japan and in Great Britain: a comparative study. Ocul Immunol Inflamm 2000;8 (3) 141- 148
PubMed Link to Article
Linssen  AMeenken  C Outcomes of HLA-B27-positive and HLA-B27-negative acute anterior uveitis. Am J Ophthalmol 1995;120 (3) 351- 361
PubMed
Wakefield  DMontanaro  AMcCluskey  P Acute anterior uveitis and HLA-B27. Surv Ophthalmol 1991;36 (3) 223- 232
PubMed Link to Article
Ahn  JKChung  HLee  DSYu  YSYu  HG CD8brightCD56+ T cells are cytotoxic effectors in patients with active Behçet's uveitis. J Immunol 2005;175 (9) 6133- 6142
PubMed Link to Article
Ahn  JKYu  HGChung  HPark  YG Intraocular cytokine environment in active Behçet uveitis. Am J Ophthalmol 2006;142 (3) 429- 434
PubMed Link to Article
Ahn  JKChung  HYu  HG Vitrectomy for persistent panuveitis in Behçet's disease. Ocul Immunol Inflamm 2005;13 (6) 447- 453
PubMed Link to Article

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