Behcet's Disease Flashcards
Gene that Behcets is linked to
HLA B51
what is Behcets - brief description?
- This is a complex inflammatory condition which characteristically presents with oral and genital ulcers.
differentials to consider for mouth ulcers in Behcets ?
1) Simple aphthous ulcers
2) SCC
3) HSV
4) Hand, foot and mouth disease (coxsackie A virus)
5) IBD Chron’s Disease
6) RA
7) Folate deficiency
how do mouth ulcers present in Behcets?
- At least 3 episodes of mouth ulcers per year
- Painful, sharply circumcised erosions with a red halo
- Occur at oral mucosa and heal over 2-4 weeks.
how to genital ulcers present in Behcets?
- Similar in appearance to oral ulcers.
- ‘kissing ulcers’ is where they occur on two opposing surfaces so that they are facing each other.
what skin signs might you see in behcets? (3)
- Easily inflamed in Behcet’s so you may see: erythema nodosum, papules and pustules (similar to acne) and vasculitic type rashes.
what eye conditions might you see in behcets?
- Anterior or posterior uveitis
- Retinal vasculitis
- Retinal haemorrhage.
what sx might you see in behcets of the MSK system?
- Morning stiffness
- Arthralgia
- Oligoarthritis often affecting the knee/ ankle causing swelling but with no joint destruction.
which part of the GI tract is commonly affected in behcets?
- Inflammation and ulceration can occur in GI tract affecting commonly the ileum, caecum and ascending colon.
what CNS sx might you see in Behcets?
- Memory impairment
- Headaches and migraines
- Aseptic meningitis
- Meningoencephalitis
what could happen to veins in behcets?
- Veins can become inflamed leading to vein thrombosis.
- These stay in place and don’t embolise as they are related to inflammation in the vessel wall.
- Budd Chiari
- DVT
- Thrombus in pulmonary veins
- Cerebral venous sinus thrombosis
what pulmonary manifestation may occur in behcets?
- Pulmonary artery aneurysms can occur and if rupture fatal.
What is the pathergy test?
- Use a sterile needle to create a subcutaneous abrasion on the forearm.
- Reviewed 24-48 hours after to look for weal >5mm
- This tests for non-specific hypersensitivity in the skin
- This is positive in Behcet’s, Sweet’s syndrome and pyoderma gangrenosum.
how would you manage behcets?
1) Topical steroids for mouth ulcers (soluble betamethasone tablets)
2) Systemic steroids
3) Colchicine (as an anti-inflammatory)
4) Topical anaesthetics for genital ulcers
5) Immunosuppressants such as azathioprine
6) Biologic therapy – infliximab
what is the prognosis like for behcets?
- This is a relapsing/remitting disease
- Have a normal life expectancy and condition can go into complete remission
- Increased mortality with haemoptysis, neurological involvement and other major complications
