Are Exacerbations of Behçet’s Disease (BD) Related to The Menstrual Cycle?: The Relationship Between Menstruation and Disease Flare In A Northern European BD Cohort
W L Ng, F Adeeb, A Sebastian, A Anjum, M Brady, M Gillespie, S Morrissey, F Irwin, B McCarthy, J P Doran, J Devlin, A Fraser
Department of Rheumatology, University Hospital Limerick
Behçet’s disease (BD) is most commonly diagnosed during the reproductive years. Studies have shown that progesterone and oestrogen tend to exhibit anti-inflammatory activity. The precipitous decline of progestogen at the onset of menstruation and after delivery with evidence of disease flare during this period among BD patients in a Korean study has led to the belief that exacerbation may be likely related to the abrupt progesterone withdrawal. The epidemiological characteristics reflect a possible association of BD and female sex hormones.
We aim to determine the relationship of Behçet’s disease flare-ups and menstrual cycle.
A total of 16 female patients fulfilling the International Study Group for Behçet’s Disease (ISGBD) criteria were recruited from a regional rheumatology centre. Telephone interviews were performed to evaluate relationship between the occurrence of BD flare-ups and the menstrual cycle.
The median age was 39 years with interquartile range (IQR) of 14.75 and the median age of menarche was 13 years with IQR of 2. 4(25%) women were menopausal.
7(43.75%) of the patients experienced exacerbation of BD related to menstruation. The types of disease flare were oral aphthosis (85.71%), arthralgia (57.14%), genital ulcerations (42.86%), lethargy (42.86%), skin manifestations (14.29%) and headache (14.29%).7 patients (43.75%) were on contraception, 6 of which contained progesterone.
Of the 9 patients who did not experienced exacerbation during menstruation, 4 were on progesterone containing contraceptives. 9(56.25%) had previous pregnancies; 2 patients had an episode of miscarriage and 1 had a stillbirth.
This study demonstrates that the female sex hormones play a major role in the disease activity of BD. Detailed studies in a larger cohort should be performed to further confirm the relationship.