behcet’s disease azami ahad.md. definition: behcet disease is a chronic disease with multisystem...
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BEHCET’s DISEASE
Azami Ahad.MD.
Definition:
Behcet disease is a chronic disease with
multisystem involvment characterized clinically by oral& ophthalmologic,neurologic, or GI manifest (or some combination of these)
Behcet’s DiseaseEpidemiology
Is seen worldwide Highest prevalence in eastern
mediterranean, middle East, East Asia (Silk Road Disease)
Mean ages: 25-30 M/F=1/1
Behcet’s disease(Epidemiology in Iran)
• Incidence: 345 / year
• Prevalence: 1.67/10000 or 1 in 6000
Shahram et al, Behcet’s disease (Hamza ed) 1997Shahram et al, Behcet’s disease (Hamza ed) 1997
Behcet' DiseasePathogenesis
Genetic: o HLAB51 o MICA gene (major histocompatibility complex
class I chain-related gene A)o Neg-associtation with HLA-DR1 ,HLA-DQW1
Immunologic: increased activated natural killer cell, molecular mimicry ,HSPs
Enviromental: herpes simplex(HSV) streptococcal Ag, mycobacterial ,staph aur.
Behcet’s DiseasePathogenesis
CLINICAL SYMPTOMS
MAJOR
Mucous Membrane
Oral
Genital
Skin
Eyes
MINOR
Joints
CNS
GI
Vessels
Others
Clinical features:
Oral aphthae Often denote the onset of behcet’s
disease and constitute a requisite diagnostic features
3-10 lesions 2-12 mm, discrete, painful, shallow, round
or oval red-rimmed 1-3 wk
Behcet’s DiseaseOral Aphtous
Behcet’s Disease
Genital ulcer:Like to oral aphtae vaginal, vulvar, scrotum, penis,
perianal very painful and disabling
Behcet’s DiseaseGenital Aphtous
Behcet DiseaseArticular Manifestations
40-60% Intermittent Asymmetric or symmetric Oligoarthritis knee, wrist ,ankle, elbow Nonerosive arthropathy Sacroiliitis(%10?)
Behcet DiseaseSkin manifestations
Erythema nodosum Pseudofolliculitis Papulopustular Acneiform nodules Sweet’s syndrome like Pyoderma gangrenosum Pathergy test
Behcet’s DiseaseAcneiform nodules
Behcet’s DiseasePathergy Test (pustule Formation)
Behcet Disease Ocular Manifestation
%83 to %95 of men %67 to %73 of women Anterior uveitis Posterior uveitis Panuveitis Hypopyon Retinal vasculitis Secondary glaucoma and cataract
Behcet’s DiseaseHypopyon
Behcet DiseaseVascular Manifestation
Large vessel(arterial and venous) DVT most common complication
Arterial pulmonary aneurysm
Coronary involvement,pericarditis
Behcet’s DiseaseVascular aneurysm
Behcet’s DiseaseVascular Aneurysm
Behcet’s DiseaseVenous Thrombosis
Behcet DiseaseCNS Manifestations
30% of western patients Stroke Aseptic meningitis MS like Peripheral neuropathy(rare)
Behcet’s DiseaseStroke
Behcet Disease GI and Kidney manifestations
Melena Abdominal pain Ulceration Crohne like disease GN Epididymitis MAGIC syndrome (mouth, genital ulceration, inflamed cartilage)
Behcet DiseaseLaboratory Feature
Acute phase reactant (ESR, CRP) RF negative Complement normal HLAB51 positive CSF analysis (oligoclonal band, IgG index) Synovial fluid (inflammatory or non
inflammatoy Imaging: CT, MRI (brain)
Behcet DiseaseDiagnostic Criteria
1-Recurrent oral ulceration (at least three times in one of 12-month period)
Plus two of 2-Recurrent genital ulceration3-Eye lesions4-Skin lesions5-Positive pathergy tes
Yields a sensitivity of 91% and a specificity of 96%
New Simple Way to Use Classification Tree for the Diagnosis of Behcet’s Disease F. Davatchi, S. Chitsaz, A.R. Jamshidi, A. Nadji, C. Chams, H. Chams, F. Shahram,
M. Akbarian, F. Gharibdoost. Point System
Ocular Lesions 5 Point Oral Aphthosis 4 “ Genital Aphthosis 3 “ Pathergy Phenomenon 2 “ Skin Manifestations 1 “
Behcet’s Disease 7 “
D.D
prognosis
Behcet DiseaseTreatment-Aphtous Lesions
Topical or interalesional steroid Oral corticosteroid Colchicine Dapsone Thalidomide MTX Cyclosporine-A Interferon-A
Behcet DiseaseTreatment-ocular Manifestation
Corticosteroid Cyclosporine-A Azathioprine Cyclophosphamide Chlorambucil Methotrexate Surgery
Behcet DiseaseTreatment- Vascular Manifestation
Aspirin Warfarin? Corticosteroid Azathioprine Cyclosporine-A Surgery: arterial aneurysm