From the Guidelines
The initial treatment for Behcet's disease typically involves corticosteroids and immunosuppressive medications tailored to the specific symptoms and severity. For mild mucocutaneous manifestations, topical corticosteroids like triamcinolone 0.1% paste applied 3-4 times daily to oral ulcers or betamethasone valerate 0.1% cream for genital ulcers are first-line treatments, as suggested by the 2018 update of the EULAR recommendations for the management of Behçet's syndrome 1. Colchicine (0.5-1.2 mg daily) is often added to prevent recurrent oral and genital ulcers, considering its safety and good tolerability, as agreed upon by the group 1.
Key Considerations
- For patients with acute arthritis, colchicine should be the initial treatment, with azathioprine, interferon-alpha, or TNF-alpha inhibitors considered in recurrent and chronic cases 1.
- In patients with an initial or recurrent episode of acute sight-threatening uveitis, high-dose glucocorticoids, infliximab, or interferon-alpha are recommended 1.
- The choice of immunomodulatory or immunosuppressive drug depends on individual patient characteristics, safety, cost, availability, and patient preferences 1.
Treatment Approach
- Systemic corticosteroids such as prednisone (0.5-1 mg/kg/day) are used for more severe disease or involvement of vital organs, often combined with immunosuppressants like azathioprine (2-3 mg/kg/day), cyclosporine (3-5 mg/kg/day), or TNF-alpha inhibitors like infliximab (5 mg/kg at weeks 0,2,6, then every 8 weeks) 1.
- Treatment aims to suppress the underlying inflammatory process, as Behcet's disease is characterized by vasculitis and dysregulated immune response.
- The therapy must be individualized based on organ involvement, with ocular, neurological, or vascular manifestations requiring more aggressive immunosuppression to prevent permanent damage and disability.
From the Research
Initial Treatment for Behcet's Disease
The initial treatment for Behcet's disease typically involves a combination of medications to manage symptoms and prevent complications. Some of the key treatment options include:
- Corticosteroids and immunosuppressive agents to suppress acute inflammation and reduce the frequency of recurrence 2
- Colchicine, which has been shown to be effective in controlling erythema nodosum and arthralgias, as well as reducing the occurrence of genital ulcers, erythema nodosum, and arthritis 3, 4, 5
- Topical steroids, local anesthetics, and oral colchicine for mild to moderate symptoms 6
- Immunosuppressive medications such as azathioprine, methotrexate, and thalidomide for more severe cases 6
- Anti-TNF agents, such as infliximab, which have been used to treat recalcitrant orogenital ulceration in Behcet's disease 6
Treatment Goals
The primary goal of treatment is to manage symptoms, prevent complications, and improve quality of life. Treatment should be individualized based on the severity of symptoms, organ involvement, and patient response to therapy.
Key Considerations
When treating Behcet's disease, it is essential to consider the following:
- The disease can affect multiple organ systems, and treatment should be tailored to address specific symptoms and complications
- Treatment should be aimed at reducing inflammation, preventing recurrence, and promoting healing
- Patients should be closely monitored for response to treatment and potential side effects of medications 2, 3, 4, 6, 5