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Q J Med 1999; 92: 727-740
© 1999 Association of Physicians

Behçet's syndrome: a multidisciplinary approach to clinical care

A.J. Whallett, G. Thurairajan, J. Hamburger, R.G. Palmer and P.I. Murray

From the Heartlands and Solihull NHS Trust, 1 Birmingham and Midland Eye Centre, and 2 Birmingham Dental Hospital, Birmingham, UK

Received 22 April 1999 and in revised form 16 September 1999

Dr A.J. Whallett, Department of Rheumatology, Solihull Hospital, Heartlands and Solihull NHS Trust, Lode Lane, Solihull, West Midlands B91 2JL

Behçet's syndrome is a multisystem disorder characterized by recurrent orogenital ulceration and an occlusive vasculitis. Histologically, there is a combination of a perivascular lymphocytic infiltration with endothelial cell damage coupled with a pro-thrombotic tendency. We present a multidisciplinary approach to the management of Behçet's syndrome, and compare our findings with other published studies. Over a nine-year period, 50 patients with Behçet's syndrome were followed in a multidisciplinary combined clinic. Patients were assessed by an ophthalmologist, a rheumatologist and a specialist in oral medicine. Data on disease activity and damage were collected using a standardized proforma for each speciality. Mean age of onset was 30 years; 56% were male. Recurrent oral ulceration was the commonest manifestation and the presenting feature in 76%. The commonest second systems involved were genital mucosae and eyes. We found a larger proportion of patients with ophthalmic (80%) and central nervous system (14%) manifestations compared with many other studies. There was an association between central nervous system and thrombotic events (p<0.001). Our multidisciplinary approach allowed us to keep each system involved in Behçet's syndrome under careful review. The development of recurrent sight-threatening eye disease was unpredictable and occurred despite aggressive immunosuppression.


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