[Granulocyte-apheresis in ocular Behçet's disease resistant to medical treatment]. / Granulocito-aferesis en Behçet ocular refractario al tratamiento médico.

OBJECTIVE: To assess the feasibility of granulocyte apheresis (GCAP) in patients with Ocular Behçet's Disease (BD) resistant to immunosuppressive therapy (prednisone, cyclosporin, azathyoprine or mycophenolate mofetil). METHODS: Prospective observational study of five cases, carried out in a university centre. Four patients were resistant to medical treatment and one refused immunosuppressive drugs. The intervention procedure consisted of an extracorporeal GCAP using a column filled with cellulose acetate beads (Adacolumn, JIMRO, Takasaki, Japan). All patients received underwent a schedule of therapy of five sessions, once a week for five consecutive weeks. Visual acuity (Snellen lines), the degree of intraocular inflammation and doses of immunosuppressive therapy were measured and observed every week. RESULTS: Visual acuity improved in the five cases. Intraocular inflammation was measured and observed in every case, relapses were avoided, and treatment with prednisone was reduced by more than half of the initial dose (average reduction 52.7%, SD 14). CONCLUSIONS: GCAP has been shown to be safe and effective as a new therapy in five cases of Ocular Behçet's Disease refractory to medical treatment. Further research is needed in order to confirm the promising results of these initial investigations.

[Behcet's disease therapy review]. / Tratamiento de la enfermedad de Behçet.

Behçet's disease is an inflammatory process of unknown origin, which usually presents with recurrent oral ulcers, genital aphthae, uveitis and cutaneous lesions. However, a wide variety of clinical manifestations have been reported, and virtually any organ system may be affected, showing central nervous system, joints, blood vessels or gastrointestinal tract involvement. Therapeutic approach remains complex, and varies in basis of the affected organs. Complex aphthosis may respond to topical therapy, colchicine and dapsone. If this therapy does not result in adequate disease control, thalidomide, oral prednisone and methotrexate may be useful. When severe ocular lesions or systemic manifestations are present, therapies tend to be more aggressive, usually combining corticosteroids with immunosuppressive agents as cyclosporin, azathioprine, cyclophosphamide, interferon-alfa-2a, and chlorambucil.

[Acute cerebrovascular accident in the primary antiphospholipid syndrome]. / Accidente cerebrovascular agudo en el síndrome antifosfolipídico primario.

OBJECTIVE: To report the prevalence of acute cerebrovascular accidents (ACVA) and risk factors for thrombosis among patients diagnosed of primary antiphospholipid syndrome (PAPLS) and to compare this group with that of patients with PAPLS but not ACVA. PATIENTS AND METHODS: Retrospective data analysis of 30 patients consecutively diagnosed of PAPLS. Episodes of ACVA were quantitated and other cardiovascular risk factors were determined. RESULTS: Thirty percent of patients (9/30) had one or more ACVA. No significant differences were found when the presence of other cardiovascular risk factors in both groups was compared. CONCLUSIONS: Antiphospholipid antibodies in young patients with ACVA should be determined, although some other cardiovascular risk factors may coexist.