Behçet’s disease

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Disease that causes recurrent thrush, associated or not with genital ulcers, skin lesions, joint pain, inflammation in the eye, neurological changes, inflammation and thrombosis in veins, among other symptoms.

Behçet’s disease is quite common in countries that are part of the old silk route, which extends from Asia to the Mediterranean, affecting mainly Greeks, Turks, Arabs and Israelis, as well as Koreans, Chinese and Japanese. It gets its name because it was described in 1937 by the Turkish dermatologist Hulusi Behçet. The onset of symptoms usually occurs between 20 and 40 years of age, men and women are affected in a similar way, but young men of Asian origin have more severe manifestations of the disease. Different genes increase the risk of developing Behçet’s disease and it is believed that environmental factors such as infections can help trigger the disease.

The manifestations of Behçet’s disease occur recurrently, that is, in crises that improve with treatment and return after a period without symptoms. The most important complaint is the presence of recurrent thrush that may or may not be associated with genital ulcers, skin lesions, joint pain, inflammation in the eye, neurological, intestinal changes, inflammation and thrombosis in veins, in addition to the formation of aneurysms in different arteries . Complaints of Behçet’s disease usually start with very painful thrush, many years before diagnosis. Canker sores affect any part of the oral cavity and vary in number and size. Canker sores usually last more than a week and usually leave no scar. Genital ulcers are more painful than canker sores, but they occur less frequently than canker sores. They can be found on the vulva (outside the vagina) in women and on the testicle or penis in men. However, in both sexes, ulcers can be found in the groin, perineum and perianal region. The most common skin lesions in Behçet’s disease include erythema nodosum which are painful, reddened lumps in the legs, pimple-like lesions and papulopustular lesions which are small red lumps and small pus blisters.

Different parts of the eye can be inflamed in patients with Behçet’s disease and the medical terms for this inflammation are known as uveitis, vasculitis in the retina and vitreitis. When the eye is inflamed, there may be only difficulties in vision, without pain or redness in the eyes. Therefore, it is important for the patient to have regular follow-up with an ophthalmologist and seek medical attention whenever they experience any eye problems. The inflammation in the eye seen in Behçet’s disease can lead to irreversible blindness in those who do not treat it properly. Neurological complaints are very serious, they can occur in the form of a severe headache that does not improve with pain relievers and with symptoms similar to those of a stroke. In this situation, emergency care is mandatory in the emergency room to perform examinations, harvest CSF (spine fluid) and have MRI of the skull. In other cases, Behçet’s disease can cause memory and reasoning difficulties, which get worse over time. It is important to note these symptoms and speak to your doctor.

When the intestine is affected by Behçet’s disease, the patient complains of colic-type belly pain, diarrhea and blood in the stool, when this happens, it is necessary to perform tests such as colonoscopy and differentiate from intestinal parasitosis. Inflammation in the intestine is most commonly found in patients with Behçet’s disease of Japanese origin.

Inflammation in blood vessels can lead to thrombosis in the veins of any part of the body, whether in the legs, abdomen or inside the skull. Aneurysms can also be found and are caused by inflammation of the artery wall. They mainly in the arteries that carry blood to the lungs and legs. Fortunately, aneurysms are rare in patients with Behçet’s disease.

The diagnosis of Behçet’s disease is based on the manifestations presented by the patients and analyzed by the doctor. There is no laboratory test to determine the diagnosis. Often, the rheumatologist needs the help of the ophthalmologist to find out if there is inflammation in the eye and which structure is inflamed. After diagnosis, the patient needs to follow up with a rheumatologist regularly to assess whether Behçet’s disease is active and what type of treatment should be prescribed.

The treatment of Behçet’s disease depends on the patient’s complaints and the affected organs. Canker sores can be treated with topical anesthetics and corticosteroids, in addition to oral antiseptics such as chlorhexedine gluconate. Other drugs with local effect may also be prescribed by the doctor to relieve symptoms. Less severe manifestations such as thrush, joint pain, skin lesions and genital ulcers can be treated with medications such as oral corticosteroids, colchicine, pentoxifylline, penicillin, dapsone, thalidomide, among others. Immunosuppressive agents such as azathioprine, cyclophosphamide, cyclosporine and methotrexate are reserved for serious manifestations such as inflammation of the eye, neurological or vascular manifestations (veins or arteries).