Evaluating nerve dysfunction in Behçet's disease: a study using corneal confocal microscopy and electromyography

Area of Science:

• Neurology
• Ophthalmology
• Immunology

Background:

• Behçet's disease (BD) is a multisystem inflammatory disorder.
• Peripheral nerve involvement can occur in BD, but its evaluation is complex.
• Understanding nerve damage in BD is crucial for effective management.

Purpose of the Study:

• To assess peripheral nerve function in Behçet's disease patients.
• Utilize in vivo corneal confocal microscopy (IVCCM) to examine corneal nerves.
• Employ electromyography (EMG) to measure sympathetic skin response (SSR) and cutaneous silent period (CSP).

Main Methods:

• Cross-sectional study with 90 participants: 60 BD patients (30 with uveitis, 30 without) and 30 healthy controls.
• IVCCM analyzed subbasal nerve plexus (SNP) and dendritic cell (DC) densities.
• EMG assessed nerve conduction, CSP, and SSR.
• Subgroup analysis of patients based on systemic medication.

Main Results:

• No significant differences in SNP or DC densities were found between groups.
• Patients on conventional azathioprine treatment showed lower DC densities compared to those on colchicine or biologics.
• BD patients without uveitis exhibited reduced SSR lower extremity amplitude versus controls.
• No significant differences in CSP durations or SSR latencies were observed.

Conclusions:

• SSR amplitudes suggest small fiber neuropathy and autonomic nervous system involvement in BD.
• Preserved CSP and SSR latencies may indicate successful nerve regeneration due to controlled inflammation.
• Lower DC densities in patients on conventional therapy may reflect azathioprine's in vivo mechanism.