Diseases & Conditions

Behcet's disease

Behcet's (beh-CHETS) disease, also called Behcet's syndrome, is a rare disorder that causes chronic inflammation in blood vessels throughout your body. The inflammation of Behcet's disease leads to a variety of symptoms that may initially seem unrelated.

The signs and symptoms of Behcet's disease — which may include mouth sores, skin rashes and lesions, and genital sores — vary from person to person and may come and go on their own. Treatment aims to reduce the signs and symptoms of Behcet's disease and to prevent serious complications, such as blindness.

Behcet's disease symptoms vary from person to person. Behcet's disease may disappear and recur on its own. The signs and symptoms that you may experience depend on which parts of your body are affected by the inflammation of Behcet's disease. Body areas most commonly affected by Behcet's disease include:

• Mouth. Painful mouth sores, identical to canker sores, are the most common sign of Behcet's disease. Sores begin as raised, round lesions in the mouth that quickly turn into painful ulcers. The sores heal usually in seven to 21 days, though they do recur.
• Skin. Skin lesions may occur in people with Behcet's disease. Skin problems can vary. Some people may develop acne-like sores on their bodies. Others may develop red, raised and tender nodules on their skin, especially on the lower legs.
• Genitals. People with Behcet's disease may develop sores on their genitals. The sores most commonly occur on the scrotum or the vulva. Sores appear as round, red and ulcerated lesions. The genital sores are usually painful and may leave scars.
• Eyes. Behcet's disease may cause inflammation in the eye — a condition called uveitis (u-ve-I-tis). In people with Behcet's disease, uveitis causes redness, pain and blurred vision in one or both eyes and may come and go. Inflammation that occurs in the blood vessels of the retina is a serious complication of the disorder.
• Joints. Joint swelling and pain most commonly affect the knee in people with Behcet's disease. The ankle, elbow or wrist also may be involved. Signs and symptoms may last one to three weeks and go away on their own.
• Vascular system. Inflammation in veins and large arteries may occur in Behcet's disease, causing redness, pain and swelling in the arms or legs when a blood clot results. In fact, many of the signs and symptoms of Behcet's are believed to be caused by inflammation of the blood vessels (vasculitis). These signs and symptoms may come and go, and they may move from one limb to another. Inflammation in the large arteries can lead to complications such as aneurysms and narrowing or blockage of the vessel.
• Digestive system. Behcet's disease may cause a variety of signs and symptoms that affect the digestive system, including abdominal pain, diarrhea or bleeding.
• Brain. Behcet's disease may cause inflammation in the brain and nervous system that leads to headache, fever, disorientation, poor balance or stroke.

When to see a doctor
Make an appointment with your doctor if you notice any unusual signs and symptoms that might indicate Behcet's disease. If you've been diagnosed with Behcet's disease, see your doctor if you notice any new signs and symptoms.

Doctors don't know what causes Behcet's disease. Many believe Behcet's disease is an autoimmune disorder in which your body's defense system — your immune system — turns on itself. Rather than attack foreign invaders, such as bacteria and viruses, your immune system attacks healthy cells in your body.

Behcet's disease is likely caused by a combination of genetic and environmental factors. Some researchers believe a virus or bacterium may trigger Behcet's disease in people who have a certain genetic background. Other possible triggers that could set off the immune system could include chemicals or heavy metals.

Behcet's disease typically comes and goes in unpredictable cycles. There's some indication that symptoms of the disease become less severe after about 20 years.

Though treatment can't cure Behcet's disease, it often can control signs and symptoms and reduce the risk of complications. For instance, untreated uveitis can lead to blindness. People with signs and symptoms of Behcet's disease in their eyes should be carefully monitored by an eye doctor. Other complications of Behcet's disease depend on the specific set of signs and symptoms you're experiencing.

No cure exists for Behcet's disease. If your signs and symptoms of Behcet's disease are mild, your doctor may offer medications to control temporary flares in pain and inflammation. You may not need to take medication between flares. But if your signs and symptoms are more severe, your doctor may advise systemic medications to control the signs and symptoms of Behcet's disease throughout your body, in addition to medications for the temporary flares.

Treatments for individual signs and symptoms of Behcet's disease
Behcet's disease may come and go on its own in fits of flares and remissions. Your doctor works to control any signs and symptoms you experience during flares with medications such as:

• Skin creams, gels and ointments. Topical medicines are applied directly to skin and genital sores in order to reduce inflammation and pain. These types of medications usually contain a corticosteroid drug that reduces inflammation or an anesthetic to relieve pain.
• Mouth rinses. Special mouthwashes that contain corticosteroids and other agents to reduce the pain of mouth sores may ease your discomfort.
• Eyedrops. Eyedrops containing corticosteroids or other anti-inflammatory medicines can relieve pain and redness in your eyes if inflammation is mild.

Systemic treatments for Behcet's disease
Severe cases of Behcet's disease require treatments to control damage from the disease between flares. If you have moderate to severe Behcet's disease, your doctor may prescribe:

• Corticosteroids to control inflammation. Corticosteroids, such as prednisone, in combination with other medications may reduce the inflammation caused by Behcet's disease. The signs and symptoms of Behcet's disease tend to recur when corticosteroids are used alone, so doctors often prescribe them with another medication to suppress the activity of your immune system (immunosuppressives). Side effects of corticosteroids include weight gain, persistent heartburn, high blood pressure and bone thinning (osteoporosis).
• Medications that suppress your immune system. Immunosuppressive drugs suppress your immune system, which overreacts in Behcet's disease. By stopping your immune system from attacking normal, healthy tissues in your body, immunosuppressive drugs reduce the inflammation that your immune system causes. Immunosuppressive drugs that may play a role in controlling Behcet's disease include azathioprine (Imuran, Azasan), cyclosporine (Sandimmune) and cyclophosphamide (Cytoxan). Since these medications suppress the actions of your immune system, they may increase your risk of infection. Other possible side effects include liver and kidney problems, low blood counts and high blood pressure.
• Medication that regulates your immune system. Interferon alfa (Intron A) regulates the activity of your immune system to control inflammation. It may help control skin sores, joint pain and eye inflammation in people with Behcet's disease. Side effects include flu-like signs and symptoms, such as muscle pain and fatigue. Interferon alfa may be combined with other medications. More recently, small studies have suggested that mediations that block a substance called tumor necrosis factor (TNF), such as infliximab (Remicade) and etanercept (Enbrel), may be effective in treating some of the manifestations of Behcet's.

Other drugs that have been used to treat Behcet's disease include colchicine and methotrexate.