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Mediators of Inflammation
Volume 2014, Article ID 107421, 14 pages
http://dx.doi.org/10.1155/2014/107421
Review Article

Biological Treatments in Behçet’s Disease: Beyond Anti-TNF Therapy

1Interdepartmental Research Center of Systemic Autoimmune and Autoinflammatory Diseases, Rheumatology Unit, Policlinico Le Scotte, University of Siena, Viale Bracci 1, 53100 Siena, Italy
2Rheumatology Unit, Department of Medicine DIMED, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
3Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Via S. Pansini 5, 80131 Naples, Italy
4Institute of Pediatrics, Cattolica Sacro Cuore University, Largo Agostino Gemelli 8, 00168 Rome, Italy
5La Sapienza University, Viale del Policlinico 155, 00161 Rome, Italy
6Department of Pediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital and University of Florence, Viale Pieraccini 24, 50139 Florence, Italy
7Rheumatology Service, Hospital Regional Universitario Carlos Haya, University of Màlaga, Avenida Carlos Haya s/n, 29010 Màlaga, Spain

Received 16 January 2014; Revised 17 April 2014; Accepted 1 May 2014; Published 30 June 2014

Academic Editor: Chiara De Luca

Copyright © 2014 Francesco Caso et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Linked References

  1. D. Rigante, “The fresco of autoinflammatory diseases from the pediatric perspective,” Autoimmunity Reviews, vol. 11, no. 5, pp. 348–356, 2012. View at Publisher · View at Google Scholar · View at Scopus
  2. International Study Group for Behcet's disease, “Criteria for diagnosis of Behçet's disease,” The Lancet, vol. 335, pp. 1078–1080, 1990. View at Google Scholar
  3. D. Saadoun and B. Wechsler, “Behçet's disease,” Orphanet Journal of Rare Diseases, vol. 7, no. 1, article 20, 2012. View at Publisher · View at Google Scholar · View at Scopus
  4. H. Direskeneli, “Behçet's disease: infectious aetiology, new autoantigens, and HLA-B51,” Annals of the Rheumatic Diseases, vol. 60, no. 11, pp. 996–1002, 2001. View at Publisher · View at Google Scholar · View at Scopus
  5. E. F. Remmers, F. Cosan, Y. Kirino et al., “Genome-wide association study identifies variants in the MHC class I, IL10, and IL23R-IL12RB2 regions associated with Behçet's disease,” Nature Genetics, vol. 42, no. 8, pp. 698–702, 2010. View at Publisher · View at Google Scholar · View at Scopus
  6. Y. Kirino, G. Bertsias, Y. Ishigatsubo et al., “Genome-wide association analysis identifies new susceptibility loci for Behçet's disease and epistasis between HLA-B*51 and ERAP1,” Nature Genetics, vol. 45, no. 2, pp. 202–207, 2013. View at Publisher · View at Google Scholar · View at Scopus
  7. C. Maldini, M. P. Lavalley, M. Cheminant, M. de menthon, and A. Mahr, “Relationships of HLA-B51 or B5 genotype with Behçet's disease clinical characteristics: systematic review and meta-analyses of observational studies,” Rheumatology, vol. 51, no. 5, pp. 887–900, 2012. View at Publisher · View at Google Scholar · View at Scopus
  8. M. Piga and A. Mathieu, “Genetic susceptibility to Behçet's disease: role of genes belonging to the MHC region,” Rheumatology, vol. 50, no. 2, Article ID keq331, pp. 299–310, 2011. View at Publisher · View at Google Scholar · View at Scopus
  9. M. De Menthon, M. P. LaValley, C. Maldini, L. Guillevin, and A. Mahr, “HLA-B51/B5 and the risk of Behçet's disease: a systematic review and meta-analysis of case-control genetic association studies,” Arthritis Care and Research, vol. 61, no. 10, pp. 1287–1296, 2009. View at Publisher · View at Google Scholar · View at Scopus
  10. M. Pineton de Chambrun, B. Wechsler, G. Geri, P. Cacoub, and D. Saadoun, “New insights into the pathogenesis of Behçet's disease,” Autoimmunity Reviews, vol. 11, no. 10, pp. 687–698, 2012. View at Publisher · View at Google Scholar · View at Scopus
  11. G. Hatemi, A. Silman, D. Bang et al., “Management of Behçet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for the management of Behçet disease,” Annals of the Rheumatic Diseases, vol. 68, no. 10, pp. 1528–1534, 2009. View at Publisher · View at Google Scholar · View at Scopus
  12. L. Cantarini, A. Vitale, P. Scalini, C. A. Dinarello, D. Rigante, R. Franceschini et al., “Anakinra treatment in drug-resistant Behçet’s disease: a case series,” Clinical Rheumatology, 2013. View at Publisher · View at Google Scholar
  13. G. Hatemi, A. Silman, D. Bang et al., “EULAR recommendations for the management of Behçet disease,” Annals of the Rheumatic Diseases, vol. 67, no. 12, pp. 1656–1662, 2008. View at Publisher · View at Google Scholar · View at Scopus
  14. S. R. Dalvi, R. Yildirim, and Y. Yazici, “Behcets syndrome,” Drugs, vol. 72, no. 17, pp. 2223–2241, 2012. View at Publisher · View at Google Scholar · View at Scopus
  15. E. Aktulga, M. Altaç, A. Müftüoglu, Y. Ozyazgan, H. Pazarli, Y. Tüzün et al., “A double blind study of colchicine in Behçet's disease,” Haematologica, vol. 65, pp. 399–402, 1980. View at Google Scholar
  16. S. Yurdakul, C. Mat, Y. Tüzün, Y. Ozyazgan, V. Hamuryudan, O. Uysal et al., “A double-blind trial of colchicine in Behçet's syndrome,” Arthritis & Rheumatology, vol. 44, pp. 2686–2692, 2001. View at Google Scholar
  17. F. Davatchi, B. Sadeghi Abdollahi, A. Tehrani Banihashemi et al., “Colchicine versus placebo in Behçet's disease: randomized, double-blind, controlled crossover trial,” Modern Rheumatology, vol. 19, no. 5, pp. 542–549, 2009. View at Publisher · View at Google Scholar · View at Scopus
  18. V. Hamuryudan, Y. Ozyazgan, N. Hizli, C. Mat, S. Yurdakul, Y. Tüzün et al., “Azathioprine in Behçet’s syndrome: effects on long-term prognosis,” Arthritis & Rheumatology, vol. 40, pp. 769–774, 1997. View at Google Scholar
  19. H. Yazici, H. Pazarli, C. G. Barnes, Y. Tüzün, Y. Ozyazgan, A. Silman et al., “A controlled trial of azathioprine in Behçet’s syndrome,” The New England Journal of Medicine, vol. 322, pp. 281–285, 1990. View at Google Scholar
  20. Y. Ozyazgan, S. Yurdakul, H. Yazici, B. Tüzün, A. Işçimen, Y. Tüzün et al., “Low dose cyclosporine A versus pulsed cyclophosphamide in Behçet’s syndrome: a single masked trial,” British Journal of Ophthalmology, vol. 76, pp. 241–243, 1992. View at Google Scholar
  21. K. Masuda, A. Nakajima, A. Urayama, K. Nakae, M. Kogure, and G. Inaba, “Double-masked trial of cyclosporin versus colchicine and long-term open study of cyclosporin in Behcet's disease,” The Lancet, vol. 1, no. 8647, pp. 1093–1096, 1989. View at Google Scholar · View at Scopus
  22. V. Hamuryudan, C. Mat, S. Saip et al., “Thalidomide in the treatment of the mucocutaneous lesions of the Behcet syndrome: a randomized, double-blind, placebo-controlled trial,” Annals of Internal Medicine, vol. 128, no. 6, pp. 443–450, 1998. View at Google Scholar · View at Scopus
  23. F. Davatchi, H. Shams, F. Shahram et al., “Methotrexate in ocular manifestations of Behcet's disease: a longitudinal study up to 15 years,” International Journal of Rheumatic Diseases, vol. 16, no. 5, pp. 568–577, 2013. View at Publisher · View at Google Scholar · View at Scopus
  24. F. Davatchi, B. Sadeghi Abdollahi, H. Shams, F. Shahram, A. Nadji, C. Chams-Davatchi et al., “Combination of pulse cyclophosphamide and azathioprine in ocular manifestations of Behçet's disease: longitudinal study of up to 10 years,” International Journal of the Rheumatic Diseases, 2013. View at Publisher · View at Google Scholar
  25. F. Davatchi, F. Shahram, H. Chams et al., “High dose methotrexate for ocular lesions of Behçet's disease. Preliminary short-term results,” Advances in Experimental Medicine and Biology, vol. 528, pp. 579–584, 2003. View at Google Scholar · View at Scopus
  26. V. Hamuryudan, S. Yurdakul, F. Moral, F. Numan, H. Tüzün, N. Tüzüner et al., “Pulmonary arterial aneurysms in Behçet’s syndrome: a report of 24 cases,” British Journal of Rheumatology, vol. 33, pp. 48–51, 1994. View at Google Scholar
  27. V. Hamuryudan, T. Er, E. Seyahi, C. Akman, H. Tüzün, I. Fresko et al., “Pulmonary artery aneurysms in Behçet syndrome,” The American Journal of Medicine, vol. 117, pp. 867–870, 2004. View at Google Scholar
  28. E. Kural-Seyahi, I. Fresko, N. Seyahi et al., “The long-term mortality and morbidity of Behçet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center,” Medicine, vol. 82, no. 1, pp. 60–76, 2003. View at Publisher · View at Google Scholar · View at Scopus
  29. K. T. Calamia, M. Schirmer, and M. Melikoglu, “Major vessel involvement in Behçet's disease: an update,” Current Opinion in Rheumatology, vol. 23, no. 1, pp. 24–31, 2011. View at Publisher · View at Google Scholar · View at Scopus
  30. A. Al-Araji and D. P. Kidd, “Neuro-Behçet's disease: epidemiology, clinical characteristics, and management,” The Lancet Neurology, vol. 8, no. 2, pp. 192–204, 2009. View at Publisher · View at Google Scholar · View at Scopus
  31. I. Kötter, M. Zierhut, A. K. Eckstein et al., “Human recombinant interferon alfa-2a for the treatment of Behçet's disease with sight threatening posterior or panuveitis,” British Journal of Ophthalmology, vol. 87, no. 4, pp. 423–431, 2003. View at Publisher · View at Google Scholar · View at Scopus
  32. N. Seider, I. Beiran, J. Scharf, and B. Miller, “Intravenous immunoglobulin therapy for resistant ocular behçet's disease,” British Journal of Ophthalmology, vol. 85, no. 11, pp. 1287–1288, 2001. View at Publisher · View at Google Scholar · View at Scopus
  33. E. Alpsoy, C. Durusoy, E. Yilmaz et al., “Interferon alfa-2a in the treatment of Behçet disease: a randomized placebo-controlled and double-blind study,” Archives of Dermatology, vol. 138, no. 4, pp. 467–471, 2002. View at Google Scholar · View at Scopus
  34. Z. Y. Zhou, S. L. Chen, N. Shen, and Y. Lu, “Cytokines and Behcet's Disease,” Autoimmunity Reviews, vol. 11, no. 10, pp. 699–704, 2012. View at Publisher · View at Google Scholar · View at Scopus
  35. M. Melikoglu, I. Fresko, C. Mat et al., “Short-term trial of etanercept in Behçet's disease: a double blind, placebo controlled study,” Journal of Rheumatology, vol. 32, no. 1, pp. 98–105, 2005. View at Google Scholar · View at Scopus
  36. D. Perra, M. A. Alba, J. L. Callejas, M. Mesquida, R. Ríos-Fernández, A. Adán et al., “Adalimumab for the treatment of Behçet's disease: experience in 19 patients,” Rheumatology (Oxford), vol. 51, pp. 1825–1831, 2012. View at Google Scholar
  37. P. P. Sfikakis, P. H. Kaklamanis, A. Elezoglou et al., “Infliximab for recurrent, sight-threatening ocular inflammation in adamantiades-Behçet disease,” Annals of Internal Medicine, vol. 140, no. 5, pp. 404–406, 2004. View at Google Scholar · View at Scopus
  38. M. Mesquida, M. Victoria Hernández, V. Llorenç, L. Pelegrín, G. Espinosa, A. D. Dick et al., “Behçet disease-associated uveitis successfully treated with golimumab,” Ocular Immunology and Inflammation, vol. 21, pp. 160–162, 2013. View at Google Scholar
  39. F. Cantini, L. Niccoli, C. Nannini et al., “Efficacy of infliximab in refractory Behçet's disease-associated and idiopathic posterior segment uveitis: a prospective, follow-up study of 50 patients,” Biologics: Targets and Therapy, vol. 6, pp. 5–12, 2012. View at Google Scholar · View at Scopus
  40. S. Iwata, K. Saito, K. Yamaoka et al., “Efficacy of combination therapy of anti-TNF-α antibody infliximab and methotrexate in refractory entero-Behçet's disease,” Modern Rheumatology, vol. 21, no. 2, pp. 184–191, 2011. View at Publisher · View at Google Scholar · View at Scopus
  41. N. Pipitone, I. Olivieri, A. Padula et al., “Infliximab for the treatment of neuro-Behçet's disease: a case series and review of the literature,” Arthritis Care and Research, vol. 59, no. 2, pp. 285–290, 2008. View at Publisher · View at Google Scholar · View at Scopus
  42. A. Borhani Haghighi, A. Safari, M. A. Nazarinia, Z. Habibagahi, and S. Shenavandeh, “Infliximab for patients with neuro-Behcet's disease: case series and literature review,” Clinical Rheumatology, vol. 30, no. 7, pp. 1007–1012, 2011. View at Publisher · View at Google Scholar · View at Scopus
  43. C. Botsios, P. Sfriso, A. Furlan, L. Punzi, and C. A. Dinarello, “Resistant Behçet disease responsive to anakinra,” Annals of Internal Medicine, vol. 149, no. 4, pp. 284–286, 2008. View at Google Scholar · View at Scopus
  44. Y. Bilginer, N. A. Ayaz, and S. Ozen, “Anti-IL-1 treatment for secondary amyloidosis in an adolescent with FMF and Behçet's disease,” Clinical Rheumatology, vol. 29, no. 2, pp. 209–210, 2010. View at Publisher · View at Google Scholar · View at Scopus
  45. A. Gül, I. Tugal-Tutkun, C. A. Dinarello et al., “Interleukin-1β-regulating antibody XOMA 052 (gevokizumab) in the treatment of acute exacerbations of resistant uveitis of Behçet's disease: an open-label pilot study,” Annals of the Rheumatic Diseases, vol. 71, no. 4, pp. 563–566, 2012. View at Publisher · View at Google Scholar · View at Scopus
  46. S. Ugurlu, D. Ucar, E. Seyahi, G. Hatemi, and S. Yurdakul, “Canakinumab in a patient with juvenile Behcet's syndrome with refractory eye disease,” Annals of the Rheumatic Diseases, vol. 71, no. 9, pp. 1589–1591, 2012. View at Google Scholar · View at Scopus
  47. G. Emmi, E. Silvestri, A. M. Cameli, D. Bacherini, L. Vannozzi, D. Squatrito et al., “Anakinra for resistant Behçet uveitis: why not?” Clinical and Experimental Rheumatology, vol. 31, pp. 152–153, 2013. View at Google Scholar
  48. F. Caso, D. Rigante, A. Vitale, O. M. Lucherini, and L. Cantarini, “Efficacy of anakinra in refractory Behçet’s disease sacroiliitis,” Clinical and Experimental Rheumatology. In press.
  49. L. Cantarini, A. Vitale, M. Borri, M. Galeazzi, and R. Franceschini, “Successful use of canakinumab in a patient with resistant Behçet's disease,” Clinical and Experimental Rheumatology, vol. 30, no. 72, article S115, 2012. View at Google Scholar · View at Scopus
  50. A. Vitale, D. Rigante, F. Caso, M. G. Brizi, M. Galeazzi, L. Costa et al., “Inhibition of interleukin-1 by canakinumab as a successful mono-drug strategy for the treatment of Behçet’s disease patients,” Dermatology, vol. 228, no. 3, 2014. View at Publisher · View at Google Scholar
  51. T. Hirano, N. Ohguro, S. Hohki et al., “A case of Behçet's disease treated with a humanized anti-interleukin-6 receptor antibody, tocilizumab,” Modern Rheumatology, vol. 22, no. 2, pp. 298–302, 2012. View at Publisher · View at Google Scholar · View at Scopus
  52. L. S. Shapiro, J. Farrell, and A. Borhani Haghighi, “Tocilizumab treatment for neuro-Behcet's disease, the first report,” Clinical Neurology and Neurosurgery, vol. 114, no. 3, pp. 297–298, 2012. View at Publisher · View at Google Scholar · View at Scopus
  53. P. Urbaniak, P. Hasler, and S. Kretzschmar, “Refractory neuro-Behçet treated by tocilizumab: a case report,” Clinical and Experimental Rheumatology, vol. 30, supplement 72, pp. S73–S75, 2012. View at Google Scholar · View at Scopus
  54. F. Caso, L. Iaccarino, S. Bettio et al., “Refractory pemphigus foliaceus and Behçet's disease successfully treated with tocilizumab,” Immunologic Research, vol. 56, no. 2-3, pp. 390–397, 2013. View at Publisher · View at Google Scholar · View at Scopus
  55. M. D. Redondo-Pachón, R. Enríquez, A. E. Sirvent, E. Andrada, R. Noguera-Pons, I. Millán et al., “Tocilizumab treatment for nephrotic syndrome due to amyloidosis in Behçet's disease,” Renal Failure, vol. 35, pp. 547–550, 2013. View at Google Scholar
  56. A. P. Diamantopoulos and G. Hatemi, “Lack of efficacy of tocilizumab in mucocutaneous Behçet's syndrome: report of two cases,” Rheumatology (Oxford), vol. 52, pp. 1923–1924, 2013. View at Google Scholar
  57. E. M. Baerveldt, J. H. Kappen, H. B. Thio, J. A. M. Van Laar, P. Martin Van Hagen, and E. P. Prens, “Successful long-term triple disease control by ustekinumab in a patient with Behçet's disease, psoriasis and hidradenitis suppurativa,” Annals of the Rheumatic Diseases, vol. 72, no. 4, pp. 626–627, 2013. View at Publisher · View at Google Scholar · View at Scopus
  58. S. Sadreddini, H. Noshad, M. Molaeefard, and R. Noshad, “Treatment of retinal vasculitis in Behçt's disease with rituximab,” Modern Rheumatology, vol. 18, no. 3, pp. 306–308, 2008. View at Publisher · View at Google Scholar · View at Scopus
  59. F. Davatchi, H. Shams, M. Rezaipoor et al., “Rituximab in intractable ocular lesions of Behcet's disease; randomized single-blind control study (pilot study),” International Journal of Rheumatic Diseases, vol. 13, no. 3, pp. 246–252, 2010. View at Publisher · View at Google Scholar · View at Scopus
  60. B. H. Zhao and A. E. Oswald, “Improved clinical control of a challenging case of Behçet's disease with rituximab therapy,” Clinical Rheumatology, vol. 33, pp. 149–150, 2014. View at Google Scholar
  61. C. A. Dinarello and J. W. van der Meer, “Treating inflammation by blocking interleukin-1 in humans,” Seminars in Immunology, vol. 25, no. 6, pp. 469–484, 2013. View at Publisher · View at Google Scholar
  62. F. Caso, D. Rigante, A. Vitale, O. M. Lucherini, L. Costa, M. Atteno et al., “Monogenic autoinflammatory syndromes: state of the art on genetic, clinical, and therapeutic issues,” International Journal of Rheumatology, vol. 2013, Article ID 513782, 15 pages, 2013. View at Publisher · View at Google Scholar
  63. M. Moll and J. B. Kuemmerle-Deschner, “Inflammasome and cytokine blocking strategies in autoinflammatory disorders,” Clinical Immunology, vol. 147, no. 3, pp. 242–275, 2013. View at Publisher · View at Google Scholar · View at Scopus
  64. K. Hamzaoui, M. Hamaz, and K. Ayed, “Production of TNF-alpha and IL-1 in active Behçet's disease,” The Journal of Rheumatology, vol. 17, pp. 1428–1429, 1990. View at Google Scholar
  65. S. Pay, H. Erdem, A. Pekel et al., “Synovial proinflammatory cytokines and their correlation with matrix metalloproteinase-3 expression in Behçet's disease. Does interleukin-1β play a major role in Behçet's synovitis?” Rheumatology International, vol. 26, no. 7, pp. 608–613, 2006. View at Publisher · View at Google Scholar · View at Scopus
  66. J. E. Fonseca, M. J. Santos, H. Canhão, and E. Choy, “Interleukin-6 as a key player in systemic inflammation and joint destruction,” Autoimmunity Reviews, vol. 8, no. 7, pp. 538–542, 2009. View at Publisher · View at Google Scholar · View at Scopus
  67. G. Akman-Demir, E. Tüzün, S. Içöz, N. Yeşilot, S. P. Yentür, M. Kürtüncü et al., “Interleukin-6 in neuro-Behçet’s disease: association with disease subsets and long-term outcome,” Cytokine, vol. 44, pp. 373–366, 2008. View at Google Scholar
  68. P. M. Vaitla, P. M. Radford, P. J. Tighe et al., “Role of interleukin-6 in a patient with tumor necrosis factor receptor-associated periodic syndrome,” Arthritis and Rheumatism, vol. 63, no. 4, pp. 1151–1155, 2011. View at Publisher · View at Google Scholar · View at Scopus
  69. R. S. Woodrick and E. M. Ruderman, “IL-6 inhibition for the treatment of rheumatoid arthritis and other conditions,” Bulletin of the NYU Hospital for Joint Diseases, vol. 70, no. 3, pp. 195–199, 2012. View at Google Scholar · View at Scopus
  70. W. Chi, X. Zhu, P. Yang, X. Liu, X. Lin, H. Zhou et al., “Upregulated IL-23 and IL-17 in Behçet patients with active uveitis,” Investigative Ophthalmology & Visual Science, vol. 49, pp. 3058–3064, 2008. View at Google Scholar
  71. K. Hamzaoui, A. Hamzaoui, F. Guemira, M. Bessioud, M. Hamza, and K. Ayed, “Cytokine profile in Behçet's disease patients: relationship with disease activity,” Scandinavian Journal of Rheumatology, vol. 31, no. 4, pp. 205–210, 2002. View at Publisher · View at Google Scholar · View at Scopus
  72. J. M. Xavier, F. Shahram, F. Davatchi et al., “Association study of IL10 and IL23R-IL12RB2 in Iranian patients with Behçet's disease,” Arthritis & Rheumatology, vol. 64, pp. 2761–2772, 2012. View at Google Scholar
  73. N. Mizuki, A. Meguro, M. Ota et al., “Genome-wide association studies identify IL23R-IL12RB2 and IL10 as Behçet's disease susceptibility loci,” Nature Genetics, vol. 42, no. 8, pp. 703–706, 2010. View at Publisher · View at Google Scholar · View at Scopus
  74. C. Parham, M. Chirica, J. Timans et al., “A receptor for the heterodimeric cytokine IL-23 is composed of IL-12Rβ1 and a novel cytokine receptor subunit, IL-23R,” Journal of Immunology, vol. 168, no. 11, pp. 5699–5708, 2002. View at Google Scholar · View at Scopus
  75. A. Gottlieb, A. Menter, and A. Mendelsohn, “Ustekinumab, a human interleukin 12/23 monoclonal antibody, for psoriatic arthritis: randomised, double-blind, placebo-controlled, crossover trial,” The Lancet, vol. 373, pp. 633–640, 2009. View at Google Scholar · View at Scopus
  76. E. Ekşioǧlu-Demiralp, A. Kibaroǧlu, H. Direskeneli et al., “Phenotypic characteristics of B cells in Behcet's disease: increased activity in B cell subsets,” Journal of Rheumatology, vol. 26, no. 4, pp. 826–832, 1999. View at Google Scholar · View at Scopus
  77. C. H. Suh, Y. B. Park, J. Song, C. H. Lee, and S. K. Lee, “Oligoclonal B lymphocyte expansion in the synovium of a patient with Behçet's disease,” Arthritis & Rheumatology, vol. 44, pp. 1707–1712, 2001. View at Google Scholar
  78. A. Hamzaoui, H. Chelbi, F. H. Sassi, and K. Hamzaoui, “Release of B cell-activating factor of the TNF family in bronchoalveolar lavage from Behçet's disease with pulmonary involvement,” Oxidative Medicine and Cellular Longevity, vol. 3, no. 2, pp. 122–128, 2010. View at Publisher · View at Google Scholar · View at Scopus
  79. S. Hirohata and H. Kikuchi, “Histopathology of the ruptured pulmonary artery aneurysm in a patient with Behçet's disease,” Clinical and Experimental Rheumatology, vol. 27, pp. S91–S95, 2009. View at Google Scholar
  80. G. A. Leget and M. S. Czuczman, “Use of rituximab, the new FDA-approved antibody,” Current Opinion in Oncology, vol. 10, no. 6, pp. 548–551, 1998. View at Google Scholar · View at Scopus
  81. J. C. W. Edwards, L. Szczepański, J. Szechiński et al., “Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis,” The New England Journal of Medicine, vol. 350, no. 25, pp. 2572–2581, 2004. View at Publisher · View at Google Scholar · View at Scopus
  82. L. Andrade-Ortega, F. Irazoque-Palazuelos, S. Muñóz-López, and V. M. Rosales-Don Pablo, “Efficacy and tolerability of rituximab in patients with rhupus,” Reumatologia Clinica, vol. 9, no. 4, pp. 201–205, 2013. View at Publisher · View at Google Scholar · View at Scopus
  83. F. Caso, U. Fiocco, L. Costa, P. Sfriso, L. Punzi, and A. Doria, “Successful use of rituximab in a young patient with immunoglobulin G4-related disease and refractory scleritis,” Joint Bone Spine, vol. 81, no. 2, pp. 190–192, 2014. View at Publisher · View at Google Scholar · View at Scopus
  84. J. I. Shin and M. Eisenhut, “A beneficial effect of rituximab on autoimmune thrombotic thrombocytopenic purpura: just a B-cell depletion?” Journal of Allergy and Clinical Immunology, vol. 133, no. 2, article 600, 2014. View at Publisher · View at Google Scholar
  85. I. Kötter, V. Hamuryudan, Z. E. Oztürk, and H. Yazici, “Interferon therapy in rheumatic diseases: state-of-the-art 2010,” Current Opinion in Rheumatology, vol. 22, pp. 278–283, 2010. View at Google Scholar
  86. H. Direskeneli, “Autoimmunity vs autoinflammation in Behcet's disease: do we oversimplify a complex disorder?” Rheumatology, vol. 45, no. 12, pp. 1461–1465, 2006. View at Publisher · View at Google Scholar · View at Scopus
  87. A. Vitale, D. Rigante, O. M. Lucherini et al., “Biological treatments: new weapons in the management of monogenic autoinflammatory disorders,” Mediators of Inflammation, vol. 2013, Article ID 939847, 16 pages, 2013. View at Publisher · View at Google Scholar · View at Scopus