From the Guidelines
The initial treatment for Behçet's disease should focus on promptly suppressing inflammatory exacerbations and recurrences to prevent irreversible organ damage, with a multidisciplinary approach and individualized treatment according to age, gender, type, and severity of organ involvement and patient preferences 1. When considering the management of Behçet's disease, it's crucial to differentiate between mucocutaneous involvement and more severe organ involvement. For mucocutaneous manifestations,
- topical measures such as steroids should be used for the treatment of oral and genital ulcers
- colchicine should be tried first for the prevention of recurrent mucocutaneous lesions, especially when the dominant lesion is erythema nodosum or genital ulcer 1. In cases of more severe disease or organ involvement,
- systemic therapy is necessary, typically starting with corticosteroids and often combined with immunosuppressants
- the goal is to rapidly suppress inflammation and prevent relapses to prevent loss of function 1. Given the potential for serious damage and even death with untreated eye, vascular, nervous system, and gastrointestinal system involvement,
- aggressive treatment is crucial for these cases, usually with systemic corticosteroids plus immunosuppressants
- TNF-alpha inhibitors like infliximab or adalimumab may be considered for severe or refractory cases 1. The treatment regimen should be adjusted based on clinical response and potential side effects, with the aim of controlling inflammation, preventing tissue damage, and minimizing disease flares. Long-term management typically requires maintenance therapy with the lowest effective dose to prevent recurrences.
From the Research
Initial Treatment for Behçet's Disease
The initial treatment for Behçet's disease typically involves a combination of medications to manage symptoms and prevent complications. Some of the commonly used treatments include:
- Colchicine, which has been shown to be effective in reducing the frequency and severity of mucocutaneous lesions, arthritis, and other symptoms 2, 3
- Benzathine penicillin, which may be used in combination with colchicine to treat Behçet's disease 2, 4
- Interferon alfa-2b, which has been shown to be effective in preventing eye involvement and extraocular manifestations, and preserving visual acuity 4
- Corticosteroids and immunosuppressive agents, which may be used to treat ocular lesions and other severe manifestations of the disease 5
Treatment Options for Specific Symptoms
For specific symptoms, the following treatments may be used:
- Oral ulcers: topical steroids, local anesthetics, oral colchicine, and in severe cases, steroids and immunosuppressive medications such as azathioprine, methotrexate, and thalidomide 6
- Genital ulcers: similar treatments to those used for oral ulcers
- Skin lesions: colchicine, benzathine penicillin, and other medications to manage symptoms
- Ocular lesions: corticosteroids and immunosuppressive agents to suppress acute inflammation and reduce recurrence frequency 5
Combination Therapies
Combination therapies, such as the use of colchicine and benzathine penicillin together, may be more effective than using a single medication alone 2. The addition of interferon alfa-2b to colchicine and benzathine penicillin may also be beneficial in preventing eye involvement and extraocular manifestations 4.